Health Talk

2. It is a corporation that provides comprehensive maintenance and acute medical care to patients. It provides preventive medicine, while employing primary care physicians as referrals for more substantial treatment
6. The minimum amount which has to be paid by the member to the insurance company before he can claim for benefits
9. The process of classifying, evaluating, rating, and assuming risks
12. An organization that promotes data interchange and processing standards to the pharmacy service sector of the healthcare industry
13. It is the actual pharmacy or drugstore where the prescription is being filled or delivered to the member
15. A drug product that does not require a prescription under federal or state law
16. A system that is designed to provide drugs in the United States with a specific 11-digit number that identifies the labeler, product, and trade package size
17. One of a group of pharmacies under the same management or ownership
18. Here the provider bills for a procedure that pays more than the procedure actually performed by the provider
20. It is the process used to determine if an individual can receive Healthcare benefits under the plan of coverage

1. The process of assigning premium levels to groups
3. A federal government program to provide hospital expense and medical expense insurance to elderly and disabled persons
4. Instances where a member has benefits from more than one insurance plan
5. Entity which underwrites or administers a variety of health and benefit programs. It could be an insurer or a managed care plan
7. A specific percentage of the cost of treatment the member has to pay for all covered medical expenses remaining after the deductible has been met
8. Price of a prescription drug as identified by drug pricing services, or other sources nationally recognized in the retail prescription drug industry, selected by the Pharmacy Benefit Manager
10. A fill fee is an amount that is determined by the plan that is paid to the pharmacy in addition to the calculated price of the drug
11. A federally mandated method of identifying all healthcare providers in the United States, including, but not limited to, pharmacies, prescribes, nurses and pharmacists
14. The limit on the total coinsurance and deductible you will pay in any calendar year
19. When a drug or dispensing limitation does not meet the guidelines of the health plan but the plan wishes to override those guidelines for a specific member, a _______ is issued