insurance terminology

3. a medical plan in which coverage is provided to participants through a network of selected health care providers
6. minimum amount the enrollee must pay out of his or her own pocket before the payer's percentage begins
8. is a set of benefits that the insurance company offers to a group of its members
9. is an example of a payor
10. the individual enrolled through his/her employer or the primary policy holder on the insurance
12. traditional plan that requires a PCP and a referral to specialist
14. an example of a insurance we are out of network with
16. maximum amount the enrollee must pay before the payer pays at 100%
17. is an insurance company

1. a health care provider who does not have a contract with your health insurance plan
2. the enrollee's percentage of covered charges for services
4. when a patient does not have insurance
5. a federal health insurance program which covers senior citizens and disabled person
7. is an example of a plan
11. a health care provider that has a contract with your health plan to provide health care services to its plan members at a pre-negotiated rate
13. stands for Medicare Secondary Payer Questionnaire
15. a set amount enrollee pays of office visit