Private Payers/ACA Plans Crossword

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Across
  1. 3. Document that modifies an insurance contract.
  2. 4. Participating provider’s local BlueCross BlueShield plan.
  3. 6. New health plans created by the ACA named after different types of metals according to the services they cover.
  4. 7. Type of consumer-driven health funding plan option that has employer and employee contributions; funds left over revert to the employer.
  5. 9. Periodic verification that a provider or facility meets the professional standards of a certifying organization
  6. 11. Generally, preauthorization for hospital admission or outpatient procedure; see preauthorization
  7. 13. BlueCross BlueShield plan in the community where the subscriber has contracted for coverage.
  8. 16. A BlueCross BlueShield program that provides benefits for plan subscribers who are away from their local areas.
  9. 17. 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.
  10. 18. Arrangement under which a capitated provider prepays an ancillary provider for specified medical services for plan members.
  11. 19. Category of enrollment in a commercial health plan that may have different eligibility requirements.
  12. 20. A list of a health plan’s selected drugs and their proper dosages; often a plan pays only for the drugs it lists.
  13. 21. Equal in value
Down
  1. 1. The amount of time that must pass before an employee or dependent may enroll in a health plan.
  2. 2. 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
  3. 4. 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.
  4. 5. Vendor that sets up fee schedules and discounts, and processes out-of-network claims for payers.
  5. 8. A national healthcare licensing association of more than forty payers
  6. 10. 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.
  7. 12. Fixed amount that must be met periodically by each individual of an insured/dependent group before benefits from a payer begin
  8. 14. Required benefits that must be offered by metal plans as well as some other insurance plans.
  9. 15. Span of time during which a policyholder selects from an employer’s offered benefits