Across
- 1. A health insurance plan with lower premiums and higher deductibles, often paired with a Health Savings Account (HSA) to help pay for medical expenses.
- 3. A health insurance plan that offers flexibility to see any doctor, with lower costs for using in-network providers and no referral needed to see specialists.
- 5. Refers to the member’s portion of costs for healthcare services covered by their health insurance plan.
- 7. A U.S. law enacted in 2010 that expanded health insurance coverage, prohibited coverage denial for pre-existing conditions, and introduced subsidies and marketplaces to make insurance more affordable.
- 8. A type of cost-sharing where the member pays a percentage of costs for covered expenses after the deductible has been met (e.g., member pays 20%, insurance pays 80%).
- 10. A federal law that allows employees and their families to continue their employer-sponsored health insurance for a limited time after losing coverage due to job loss or other qualifying events, usually at their own expense.
- 12. A type of cost-sharing where a dollar amount is set and must be met before insurance starts to pay covered expenses.
- 13. A doctor or hospital that has a contractual agreement with an insurance network to provide services at a lower cost.
- 16. A provider not contracted with a plan’s insurance network. Claims from out-of-network providers are generally subject to higher out-of-pocket costs to the member.
- 19. The amount a member pays regularly (monthly or yearly) and is collected by their employer to have health insurance. Employers may use these to cover the cost of the claims themselves or to cover PEPM’s.
- 20. The maximum amount a member can pay in a year for covered services. After the out-of-pocket is met, insurance pays 100% of covered expenses.
- 24. Timely enrollment refers to enrolling in a program or benefits within a specified timeframe, usually after becoming eligible.
- 25. A type of health insurance plan that allows patients to see any doctor or specialist regardless of network status and reimburses them for a portion of the costs, usually after they pay out-of-pocket and submit claims.
- 27. A type of health insurance option where employers pay for their employees' medical claims directly while a third-party administrator (TPA) typically administers the plan by handling the administrative tasks associated with the claims.
Down
- 2. PEPM refers to a payment structure where employers contribute a fixed amount for each employee's insurance coverage every month to the TPA for plan administration.
- 4. A type of cost-sharing where the member pays a fixed amount for a healthcare service (e.g., $20 for a doctor visit).
- 6. A period during which one may freely enroll in or change one's selection of a health insurance plan or other benefit program.
- 9. A U.S. law that protects patients from unexpected medical bills for emergency services and out-of-network care at in-network facilities.
- 11. A health insurance plan that categorizes providers, services, or treatments into different levels (or "tiers"), with lower costs for services from higher-tier (preferred) providers and higher costs for lower-tier providers. Higher-tier provider benefits tend to be better than in-network provider benefits.
- 14. A federal law that requires group health plans and insurers to cover breast reconstruction and related services after a mastectomy.
- 15. Eligibility refers to the criteria an individual must meet to qualify for enrollment in a health insurance plan, such as age, income, employment status, residency, or immigration status.
- 17. A hybrid of HMO and PPO. Members need a referral for specialists but can go out of network for care at a higher cost.
- 18. A health insurance plan that only covers care provided by in-network doctors and hospitals, except in emergencies, without requiring referrals for specialists.
- 21. A health insurance plan where the employer pays a fixed premium to an insurance carrier, which assumes all financial responsibility for employee healthcare claims.
- 22. A health insurance plan that requires members to choose a primary care physician (PCP) and get referrals to see specialists, typically only covering in-network care.
- 23. A U.S. law that protects the privacy and security of individuals' medical information and ensures health insurance coverage continuity when changing or losing jobs.
- 26. A federal law that sets standards for private employer-sponsored benefit plans, including health and retirement plans, to protect employees' rights and ensure fair management of plan funds.