Across
- 2. Out-of-pocket ___________ The most a member will have to pay for covered services in a plan year. After they have spent this amount on deductibles, copayments, and coinsurance, their health plan will pay 100% of the cost for any additional covered benefits.
- 3. A specified percentage of the cost of treatment the insured is required to pay for all covered medical expenses remaining after the deductible has been met
- 6. Maximum amount on which payment is based for covered health care services is called the _______ amount
- 7. ________ billing is when out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service.
- 8. These are either in-network or out of network (also known as Preferred or Non-Preferred)
- 9. A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.
Down
- 1. _______ billing is an unexpected bill that can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
- 3. A fixed dollar amount a member will pay at the time services are rendered. Typically, these apply to office visits, prescriptions or hospitalizations.
- 4. If you reach your out-of-pocket maximum, your insurer (EMI) will cover 100% if you are in-________
- 5. The portion of health care charges that a member will pay before their insurance starts covering it.