Across
- 5. Plans that generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan (2 words).
- 6. A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.
- 7. Agreed upon fees paid for coverage of medical benefits for a defined benefit period; can be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsor.
- 10. A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement.
Down
- 1. Acronym for Kaiser Permanente's Medicare Advantage Plan that includes Medi-Cal coverage.
- 2. A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.
- 3. Acronym for a health care system that assumes both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to members, usually in return for a fixed, prepaid fee.
- 4. A Type of coverage where the member can seek care from providers and institutions outside their network, usually at an additional cost (3 words)
- 8. Acronym for the maximum dollar amount a group member is required to pay out of pocket during a year. Until this maximum is met, the plan and group member shares in the cost of covered expenses. After the maximum is reached, the insurance carrier pays all covered expense.
- 9. Acronym for type of plan where the member must pay a certain out of pocket amount for most services prior to only paying copayments or coinsurance.