Insurance Terms

1. A member that is covered on someone's plan but they are not the main policy holder
5. A doctor's note that allows members to pick up medicine at the pharmacy
7. Geographic area that the plan providers are available to manage a member's care
8. The main policy holder
11. The maximum the Plan will pay for covered benefits minus any applicable cost sharing
12. An instruction from your PCP that gives you the ability to see another plan provider
13. Acronym for Primary Care Physician
14. A fixed dollar amount you must pay for certain covered benefits

2. The process by which hospitals report member emergent and non-emergent inpatient admissions and surgical day care to HPHC
3. A specific dollar amount that is payable by the insured for covered benefits each calendar or plan year before any benefits are available
4. An insurance determination to pay for a service prior to delivery
6. The area that the member must live in order to be eligible to enroll on a plan
9. A percentage of covered charges that is the responsibility of the insured to pay
10. Acronym for Health Maintenance Organization