Avesis Health Insurance Basics

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Across
  1. 5. Provider contracted with the network
  2. 10. Statement indicating that proposed dental treatment will be covered under the terms of the benefit contract
  3. 13. Statement sent to a member or provider to explain the insurance benefits of a claim
  4. 14. Amount member pays to belong to a health plan
  5. 15. Form of cost sharing that requires insured person to pay a stated percentage of expenses after deductible
  6. 17. Predetermined amount a member will pay up front for specific services such as office visits
  7. 21. Benefits reset on a specific date (other than January 1) and run for 365 days
  8. 23. More than one insurance carried and coverage is divided between the different carriers
  9. 26. Set time of year when participants can enroll in health insurance or change from one plan to another without a qualifying event
  10. 29. Amount paid for medical service in a geographic area based on what providers in the area usually charge for the same or similar services
  11. 30. How often specific medical services may be provided
Down
  1. 1. Entity hired to handle claims processing, pay providers, and manage other functions related to the operation of health insurance
  2. 2. Group of physicians, hospitals, and other providers who participate in a particular managed care plan
  3. 3. Total amount insurance company will pay per time period (i.e. $1000 total per year)
  4. 4. Accounts offered for employees to set aside money from each paycheck to cover insurance premiums or medical expenses
  5. 6. What a provider pays for materials
  6. 7. Amount paid by member after insurance has covered the maximum amount for a service
  7. 8. Health plans offered to a specific group of individuals by an employer, association, union , or other entity
  8. 9. Provider who is not contracted with an administrating network
  9. 11. Defines the scope of the coverage afforded (i.e. missing tooth clause – indicates if tooth lost prior to insurance coverage beginning no coverage for services)
  10. 12. Health plan purchased independently directly from an insurance company
  11. 15. Benefits reset on January 1st every year
  12. 16. Statement showing the payments attached to checks sent to providers
  13. 18. Amount paid by a member each year before a plan begins to pay for services
  14. 19. Statement indicating that proposed vision treatment will be covered under the terms of the benefit contract
  15. 20. Provision of an insurance policy that is purchased separately from the basic policy and provides additional benefits at an additional cost
  16. 22. Amount charged by provider after mark-up on goods
  17. 24. Maximum amount a member is allowed per service type (i.e. $200 patient can use toward frames and lenses)
  18. 25. Negotiated rate provider agrees to charge for services
  19. 27. Financial professional that evaluates the risks of insuring a particular person or asset and uses that information to set premium pricing
  20. 28. Highest dollar amount a participating provider can charge for services or materials