Private Payers/ACA Plans Crossword

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Across
  1. 2. Required benefits that must be offered by metal plans as well as some other insurance plans.
  2. 4. A part of a standard health plan that is changed under a negotiated employer-sponsored plan; also refers to subcontracting of coverage by a health plan.
  3. 9. Fixed amount that must be met periodically by each individual of an insured/dependent group before benefits from a payer begin
  4. 10. Arrangement under which a capitated provider prepays an ancillary provider for specified medical services for plan members.
  5. 11. Equal in value
  6. 12. Category of enrollment in a commercial health plan that may have different eligibility requirements.
  7. 14. Type of consumer-driven health plan funding option under which employers, employees, both employers and employees, or individuals set aside funds that can be used to pay for certain types of healthcare costs.
  8. 17. Under HIPAA, a plan (including a self-insured plan) of an employer or employee organization to provide healthcare to the employees, former employees, or their families
  9. 18. Vendor that sets up fee schedules and discounts, and processes out-of-network claims for payers.
Down
  1. 1. Generally, preauthorization for hospital admission or outpatient procedure; see preauthorization
  2. 3. Periodic verification that a provider or facility meets the professional standards of a certifying organization
  3. 5. A list of a health plan’s selected drugs and their proper dosages; often a plan pays only for the drugs it lists.
  4. 6. Document that modifies an insurance contract.
  5. 7. A national healthcare licensing association of more than forty payers
  6. 8. New health plans created by the ACA named after different types of metals according to the services they cover.
  7. 13. The amount of time that must pass before an employee or dependent may enroll in a health plan.
  8. 14. Type of consumer-driven health plan funding option under which an employer sets aside an annual amount an employee can use to pay for certain types of healthcare costs.
  9. 15. Type of consumer-driven health funding plan option that has employer and employee contributions; funds left over revert to the employer.
  10. 16. Span of time during which a policyholder selects from an employer’s offered benefits