Across
- 4. Law requiring that a health plan or insurance carrier must offer a particular procedure or type of coverage.
- 5. A group of affiliated contracted healthcare providers (physicians, hospitals, testing centers, rehabilitation centers etc.), such as an HMO, PPO, or Point of Service plan.
- 6. A federal program of medical care benefits created in 1965 designed for those over age 65 or permanently disabled. Medicare consists of two separate programs: A and B. Medicare Part A, which is automatic at age 65, covers hospital costs and is financed largely by employer payroll taxes. Medicare Part B covers outpatient care and is financed through taxes and individual payments toward a premium.
- 9. An insurance program for people with low incomes who are unable to afford healthcare. Although funded by the federal government, Medicaid is administered by each state. Following very broad federal guidelines, states determine specific benefits and amounts of payment for providers.
- 13. A medical condition that starts suddenly and requires immediate care.
- 16. A cost-sharing requirement under some health insurance policies in which the insured person pays some of the costs of covered services.
- 17. amount of money, or value of certain services (such as one physician visit), a patient or family must pay before costs (or percentages of costs) are covered by the health plan or insurance company, usually per year.
- 18. A fixed prepayment, per patient covered, to a healthcare provider to deliver medical services to a particular group of patients. The payment is the same no matter how many services or what type of services each patient actually gets. Under capitation, the provider is financially responsible.
- 19. A person's healthcare costs are paid by their insurance or by the government..
- 20. A list of medications that a managed care company encourages or requires physicians to prescribe as necessary in order to reduce costs.
Down
- 1. A "cap" or limit on the amount of services that may be provided. It may be the maximum cost or number of days that a service or treatment is covered.
- 2. A healthcare procedure that is not an emergency and that the patient and doctor plan in advance.
- 3. A person who is eligible for or receiving benefits under an insurance policy or plan.
- 7. Bills for services. Doctors, hospitals, labs and other providers send billed claims to health insurance plans, and what the plans pay are called paid claims.
- 8. The person enrolled in a health plan.
- 10. Large businesses, small businesses, and individuals who form a group for insurance coverage.
- 11. A private organization, usually an insurance company, that finances healthcare.
- 12. Flat fees or payments (often $5-10) that a patient pays for each doctor visit or prescription.
- 14. The person in a managed care organization, often a primary care provider, who controls a patient's access to healthcare services and whose approval is required for referrals to other services or other specialists.
- 15. The services that members are entitled to receive based on their health plan.