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Across
  1. 1. A federal law that outlines the requirements that employer sponsored group insurance plans, insurance companies, and managed care organizations must satisfy in order to provide health insurance coverage in the individual and group healthcare markets.
  2. 4. Enables members to purchase, at discounted prices, certain prescription drugs that are not covered by the regular prescription drug benefit
  3. 5. If a Kentucky member goes to the ER in Tennessee which hospital will be in charge of processing the claim?
  4. 7. A preferred, participating, or member provider may ask you to sign a _____ prior to receiving care
  5. 8. A fixed dollar amount that the member has to pay per visit
  6. 9. A questionnaire designed to assess your overall health and identify potential health risks.
  7. 14. what is one of the main differences between Basic and Standard Option
  8. 16. What type of representative can completed an address change?
  9. 17. A plan's description of benefits, limitations, exclusions, and definitions under the FEHB program
  10. 18. A provider that has agreed to accept a specific negotiated amount as payment in full or covered services is ______.
  11. 20. A building or place that provides a particular service or is used for a particular industry?
  12. 21. Errors in medical care that are clearly identifiable, preventable, and serious in their consequences, are called _____.
Down
  1. 2. An injury caused by external force or element such as a blow or fall and which requires immediate medical attention is known as _____.
  2. 3. A percentage that the member has to pay per service
  3. 6. Used to identify the type and level of Blue Cross and Blue Shield
  4. 8. What is it called if you change to another plan during Open Season?
  5. 10. If you are a participant in an approve ______, this health plan will provide benefits for covered related care
  6. 11. A Blue Cross and/or Blue Shield Plan that serves a specific geographical area.
  7. 12. An application for payment of benefits under a health plan?
  8. 13. If you do not seek damages for your illness or injury, you must permit us to initiate recovery on your behalf (including the right to bring suit in your name). This is called ______.
  9. 15. The amount the member pays after the insurance pays
  10. 19. What is the amount we use to determine our payment and your cost-share for covered services