Health Insurance Terms

5. Plans that generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan (2 words).
6. A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.
7. Agreed upon fees paid for coverage of medical benefits for a defined benefit period; can be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsor.
10. A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement.

1. Acronym for Kaiser Permanente's Medicare Advantage Plan that includes Medi-Cal coverage.
2. A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.
3. Acronym for a health care system that assumes both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to members, usually in return for a fixed, prepaid fee.
4. A Type of coverage where the member can seek care from providers and institutions outside their network, usually at an additional cost (3 words)
8. Acronym for the maximum dollar amount a group member is required to pay out of pocket during a year. Until this maximum is met, the plan and group member shares in the cost of covered expenses. After the maximum is reached, the insurance carrier pays all covered expense.
9. Acronym for type of plan where the member must pay a certain out of pocket amount for most services prior to only paying copayments or coinsurance.