CareFirst

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Across
  1. 2. Any correspondence submitted by the member, member’s authorized representative or provider that indicates that the claimant is addressing/requesting an appeal, reconsideration, denial or adverse decision.
  2. 4. A legal agreement between an individual subscriber or an employer group and a health plan that describes the benefits and limitations of the coverage.
  3. 6. Someone the policyholder designates as responsible for making medical decisions for the policyholder
  4. 9. An insurance company
  5. 10. Individuals who qualify for the APTC (138 – 400% MD & DC and 100% - 400% VA of FPL) will owe a reduced premium to carriers.
  6. 11. An official order or commission to do something in which an individual, group or organization must comply.
  7. 12. A request submitted by an individual or his/her provider to his/her insurance company for payment for services he/she obtained from a health care professional.
  8. 14. A period of time, other than the annual enrollment, during which individuals are eligible to enroll in with a Private insurance carrier if they experience certain life events.
  9. 16. Members services agents use this application to assist members with their questions and document the calls
  10. 17. An insured person's qualification for coverage under his/her contract at the time health care is rendered.
  11. 18. Application found in associates landing which is used to find applications, notices of changes from members and the Exchange(s).
Down
  1. 1. The first month’s premium payment that prospective members are required to pay in order to effectuate their coverage.
  2. 2. The process used by health plans to determine the amount of payment for a claim.
  3. 3. Required approval for designated medical services and / or hospital admissions.
  4. 4. is often specified by a percentage.
  5. 5. The process by insurance carriers work together to make sure members receive the maximum amount of benefits available without them gaining a financial advantage if they have more than one health insurance policy.
  6. 7. The amount an individual must pay for health care expenses before insurance covers the costs.
  7. 8. healthcare reform legislation passed and signed into law by President Barack Obama in March 2010
  8. 9. A predetermined (flat) fee that an individual pays for health care services
  9. 13. A person who sells health insurance and related products in a state or legal jurisdiction in which they are licensed.
  10. 15. Past due payment of premiums.