Across
- 5. Any provider the insured chooses.
- 6. Pays only a specified amount regardless of the actual charge.
- 10. Covers only specific services.
- 13. Individuals pay the HMO a specified amount, and in return the HMO would agree to provide whatever care the individual needed during the year.
- 14. Deductible + Insured's coinsurance multiplied by the stop loss limit.
Down
- 1. A cost-sharing feature;The insured pays a certain percentage of medical expenses after the deductible has been satisfied. Most commonly being 80-20, the insurer pays 80% & the insured pays 20%.
- 2. The insured is no longer required to pay coinsurance when medical expenses exceed this amount.
- 3. Limited to contracted providers.
- 4. Covers broad range of services.
- 7. Only pay providers who are members. The insured could use a provider who is not a member, but they must pay for those visits.
- 8. Pays full charge if reasonable & customary in the same geographical area.
- 9. Each time a physician and hospital provide a service, they are paid a fee in return.
- 11. Has a panel of physicians & hospitals under contract to provide health care services & generally cover 80%-100%, of the cost. Individuals who choose to use other providers are covered for a smaller percentage.
- 12. Set amount that the insured must pay each calendar year, before the policy will pay benefits.