Across
- 5. Provider contracted with the network
- 10. Statement indicating that proposed dental treatment will be covered under the terms of the benefit contract
- 13. Statement sent to a member or provider to explain the insurance benefits of a claim
- 14. Amount member pays to belong to a health plan
- 15. Form of cost sharing that requires insured person to pay a stated percentage of expenses after deductible
- 17. Predetermined amount a member will pay up front for specific services such as office visits
- 21. Benefits reset on a specific date (other than January 1) and run for 365 days
- 23. More than one insurance carried and coverage is divided between the different carriers
- 26. Set time of year when participants can enroll in health insurance or change from one plan to another without a qualifying event
- 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
- 30. How often specific medical services may be provided
Down
- 1. Entity hired to handle claims processing, pay providers, and manage other functions related to the operation of health insurance
- 2. Group of physicians, hospitals, and other providers who participate in a particular managed care plan
- 3. Total amount insurance company will pay per time period (i.e. $1000 total per year)
- 4. Accounts offered for employees to set aside money from each paycheck to cover insurance premiums or medical expenses
- 6. What a provider pays for materials
- 7. Amount paid by member after insurance has covered the maximum amount for a service
- 8. Health plans offered to a specific group of individuals by an employer, association, union , or other entity
- 9. Provider who is not contracted with an administrating network
- 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)
- 12. Health plan purchased independently directly from an insurance company
- 15. Benefits reset on January 1st every year
- 16. Statement showing the payments attached to checks sent to providers
- 18. Amount paid by a member each year before a plan begins to pay for services
- 19. Statement indicating that proposed vision treatment will be covered under the terms of the benefit contract
- 20. Provision of an insurance policy that is purchased separately from the basic policy and provides additional benefits at an additional cost
- 22. Amount charged by provider after mark-up on goods
- 24. Maximum amount a member is allowed per service type (i.e. $200 patient can use toward frames and lenses)
- 25. Negotiated rate provider agrees to charge for services
- 27. Financial professional that evaluates the risks of insuring a particular person or asset and uses that information to set premium pricing
- 28. Highest dollar amount a participating provider can charge for services or materials