Basic Insurance Terms Crossword Puzzle

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ALLOWED AMOUNT : The max monies a health care plan will reimburse a doctor or hospital for a given service.
PROVIDER : A licensed health care facility, program, agency, doctor or health professional that delivers health care services.
MEMBER : The person to whom health care coverage has been extended by the policyholder (generally their employer) or any of their covered family members. Sometimes referred to as the insured or insured person.
NETWORK : The group of doctors, hospitals and other health care professionals that a managed care plan has contracted with to deliver medical services to its members.
DEPENDENT : An eligible person, other than the member (generally a spouse or child), who has health care benefits under the member's policy
EXCLUSIONS : Specific medical conditions or circumstances that are not covered under a health care plan.
GROUP : A collection of  people covered under the same health care plan and identified by their relation to the same employer or organization.
COPAY : A fixed dollar amount you are required to pay for covered services at the time you receive care
OUT OF POCKET MAX : the most you have to pay for covered expenses under your insurance plan during the year
COINSURANCE : A percentage of a covered service that you are responsible for paying or the percentage paid by your plan. Normally after the deductible is met.
EOB : created after a claim payment has been processed by your health care plan. It explains the actions taken on a claim such as the amount that will be paid, the benefit available, discounts, reasons for denying payment and the claims appeal process.
OUT OF NETWORK : Services provided by doctors and hospitals who have not contracted with your health plan
CLAIM : An itemized bill for services filed by member or provider.
DEDUCTIBLE : The amount you are required to pay annually before reimbursement by your health care benefits plan begins.
HIPAA : A federal law that outlines the rules and requirements employer-sponsored group insurance plans, insurance companies and managed care organizations must follow to provide health care insurance coverage for individuals and groups.

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QUESTIONS LIST:

allowed amount : the max monies a health care plan will reimburse a doctor or hospital for a given service.
provider : a licensed health care facility, program, agency, doctor or health professional that delivers health care services.
member : the person to whom health care coverage has been extended by the policyholder (generally their employer) or any of their covered family members. sometimes referred to as the insured or insured person.
network : the group of doctors, hospitals and other health care professionals that a managed care plan has contracted with to deliver medical services to its members.
dependent : an eligible person, other than the member (generally a spouse or child), who has health care benefits under the member's policy
exclusions : specific medical conditions or circumstances that are not covered under a health care plan.
group : a collection of people covered under the same health care plan and identified by their relation to the same employer or organization.
copay : a fixed dollar amount you are required to pay for covered services at the time you receive care
out of pocket max : the most you have to pay for covered expenses under your insurance plan during the year
coinsurance : a percentage of a covered service that you are responsible for paying or the percentage paid by your plan. normally after the deductible is met.
eob : created after a claim payment has been processed by your health care plan. it explains the actions taken on a claim such as the amount that will be paid, the benefit available, discounts, reasons for denying payment and the claims appeal process.
out of network : services provided by doctors and hospitals who have not contracted with your health plan
claim : an itemized bill for services filed by member or provider.
deductible : the amount you are required to pay annually before reimbursement by your health care benefits plan begins.
hipaa : a federal law that outlines the rules and requirements employer-sponsored group insurance plans, insurance companies and managed care organizations must follow to provide health care insurance coverage for individuals and groups.