Health Insurance Terms 3

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Across
  1. 3. A written order from a primary care doctor for a patient to see a specialist or receive certain medical services. In many Health Maintenance Organizations (HMOs), patients need this from their Primary Care Physician (PCP) before they can receive medical care from anyone except their PCP. If they do not get a this first, the plan may not pay for the services.
  2. 5. The "Part" of Medicare that covers costs if one is admitted to a hospital, a skilled nursing facility, or hospice. It also covers some home health services(2 words).
  3. 7. Approval from a health plan that may be required before a member receives a service or fill a prescription in order for the service or prescription to be covered by a health plan.
  4. 8. Medicare coverage that pays for prescription drugs (2 words).
  5. 9. An individual, agency, or employer that has contracted for services under a health plan.
  6. 10. Checking to insure the patient has health insurance coverage at that time.
  7. 11. Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms, and that meet accepted standards of medicine (2 words).
  8. 12. Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered (2 words).
  9. 13. A person who pays a debt or who is obliged to pay a debt by some written instrument.
  10. 14. The patient, caregiver, or entity responsible for payment of the health care bill.
Down
  1. 1. Health services that cover a range of prevention, wellness, and treatment for common illnesses (2 words).
  2. 2. Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care (2 words).
  3. 4. An easy-to-read summary that allows consumers to make apples-to-apples comparisons of costs and coverage between health plans. They can compare options based on price, benefits, and other features that may be important to them. Consumers will receive this when shopping for coverage on their own or through their job, renew or change coverage, or request it from the health insurance company. This is sometimes referred to as an “Explanation of Coverage" (3 words).
  4. 5. A Medicare health plan offered by a private insurance company that contracts with Medicare (2 words).
  5. 6. Evaluation of an emergency medical condition and treatment to keep the condition from getting worse (2 words).
  6. 7. Optional Medicare plan that covers outpatient care (2 words).