INSURANCE 101 Crossword

A cap on the benefits your insurance company will pay in a year while you're enrolled in a health insurance plan.
The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
A request for your health insurance company or the Health Insurance Marketplace to review a decision that denies a benefit or payment. Authorized Representative: Someone who you choose to act on your behalf, like a family member or other trusted person.
A year of benefits coverage under an individual health insurance plan
The health care items or services covered under a health insurance plan.
The organization of your treatment across several health care providers
A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible
A limit in a range of major life activities. This includes activities like seeing, hearing, walking and tasks like thinking and working.
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole").
The amount you pay for covered health care services before your insurance plan starts to pay.
Health care services that your health insurance or plan doesn’t pay for or cover.
A federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
A program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage. There are two ways to get Medicare prescription drug coverage: through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that includes drug coverage. These plans are offered by insurance companies and other private companies approved by Medicare.
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services
A health plan that contracts with doctors, hospitals, pharmacies, and other health care providers to provide members of the plan with services and supplies at a discounted price
The percentage (for example, 40%) you pay of the allowed amount for covered health care services to providers who don't contract with your health insurance or plan
The yearly period when people can enroll in a health insurance plan
A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
Drugs and medications that, by law, require a prescription
Health insurance or plan that helps pay for prescription drugs and medications.
Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.