Insurance Terms

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Across
  1. 4. A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law.
  2. 5. The list of prescription drugs covered by a Medicare Part D or Medicare Advantage prescription drug plan. This list does not remain constant and is subject to change each year, although mid-year changes are limited and a beneficiary will be notified.
  3. 8. Maximum amount on which payment is based for covered health care services.
  4. 9. The amount payable by the insurance company to a plan member for medical costs.
  5. 10. The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
  6. 11. One of the ways you share in your medical costs. You pay a flat fee for certain medical expenses (e.g., $10 for every visit to the doctor), while your insurance company pays the rest.
  7. 12. Insurance plans can place different drugs on different formulary _____, where the _____ represent the varying levels of cost sharing. The lowest _____ may require no or a small copay. The highest _____ may require higher cost sharing such as coinsurance. Insurers use ____ to steer patients toward lower cost medications.
  8. 13. A stage in Part D prescription drug coverage that may temporarily limit what your Medicare prescription drug plan will cover. During this stage of coverage, you may start paying more for covered prescription drugs than what you paid earlier in the year.
  9. 14. A complaint that you communicate to your health insurer or plan
Down
  1. 1. Some plans, especially HMOs, require beneficiaries to receive a written note from their primary care physician before seeing a specialist.
  2. 2. The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay.
  3. 3. The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.
  4. 4. A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.
  5. 6. A cap on the amount of money you have to pay for covered health care services in a plan year
  6. 7. Your share of the costs of a covered health care service, calculated as a percent For example, if the insurance company pays 80% of the claim, you pay 20%.