Type
Word Search
Description

dental
reinstatements
stop loss
aggregate
application
streamlines
renewal
recission
dependents
fully insured
effective date
networks
ancillary
grievance
deductible
maximum
Pharmacy
coinsurance
alternate
claims

Insurance Terms Crossword

Type
Crossword
Description

Business person who analyzes the probabilities of risk/risk management. Actuary
Person who sells, services, or negotiates insurance policies either with a company or individually. Agent
Physical injury that can include sickness/disease to a person Bodily Injury
A clause in most property insurance policies to encourage policyholders to carry a good amount of insurance. If the insured person doesn’t maintain the amount specified in the clause (usually 80%), the insured person will share a higher proportion of the loss. Coinsurance
The date when an insurance company issues a policy. Date of Issue
Portion of the insured loss paid by the policyholder Deductible
Amount at which an asset can be bought or sold in a transaction between willing parties. Fair Value
The termination of a policy due to failure to pay the required renewal premium. Lapse
It is a state assistance program, to provide hospital and medical expense insurance to people over 65 years of age. Medicare
Money charged for the insurance coverage reflecting expectation of loss. Premium
Uncertainty including the possibility of loss by an unexpected event for which insurance is used for. Risk
homeowners insurance sold to tenants living in the described property. Tenants
The person who identifies and classifies the degree of risk posed by the person trying to be insured. They determine whether or not coverage should be provided and what the rate should be Underwriter
Insurance that will cover an employer’s liability for injuries or death to people in their employment Workers' Compensation
The amount that has to be paid by the insured person during a calendar year before the insurer is responsible for more loss costs Deductible

Healthcare Vocabulary Crossword

Type
Crossword
Description

A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits Health Insurance
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed. Primary Care Provider
A provider who focuses on one area of medicine. Like a cardiologist or neurologist Specialist
A contracted, pre-determined dollar amount insurance company requires a patient to pay for a particular medical service. (It requires patients to pay a small amount upfront to deter people from seeking medical care that may not be necessary.) Copay
The contracted rate a health insurance company will pay toward a specific medical service. Allowable Charges
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket maximum is met). CoInsurance
A pre-determined annual amount patient must pay before insurance begins to cover. Deductible
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible) Out of Pocket
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage. Subscriber
A person entitled to health insurance benefits under the subscriber’s plan. Covered Member
Insurance Company Payor
A specific package of benefits negotiated between the company and the employer. Plan
Dates during which the insurance plan is active. Effective Dates
Explanation of Benefits is a statement from the insurance company that details payments and adjustments made for services. EOBs go to both the provider and the patient. EOB
/Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.) Denial
The order in which the claim is sent to insurance companies. If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges. Filing Order
The pathway a patient takes from one provider to another. Referrals may be required by insurance before a patient can be seen by the other provider. Referral
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.) Authorization

Pharmacy Week Puzzle Crossword

Type
Crossword
Description

Pharmacy Network National
Low cost alternative Generic
Online claim approval Adjudication
Brand Name Zithromax Azithromycin
Medication for Alzheimers Namenda
President of PerformRx Tegenu
Our PBM PerformRx
Pharmacist designation RPH
Pharmacy Contact Callcenter
Class of drugs Specialty
Our Claims Processor Argus
Contracted pharmacies Network
Brand Name Omeprazole Prilosec
Needs Approval Prior Authorization
Where Prescriptions are filled Pharmacy
Handles our newsletter Marketing
Review of Pharmacy claims Audit
Inhaler for Asthma Proair
Agreement to provide services Contract

Insurance Word Search

Type
Word Search
Description

Benefit Cap
Blue Cross Blue Shield
Coinsurance
Commercial Insurance Plan
Copay
Covered
Deductible
Dosage
Formulary Exception
Healthcare Provider
Medical Doctor Office
Medicare Part D Plan
Non Covered
Out of Pocket Max
Patient
Payer
Pharmacy Benefit Manager
Prior Authorization
Provider
Registered Nurse
Specialty Pharmacy
Start Form

Insurance terms Word Search

Type
Word Search
Description

Premium
Unearned premium
Standard policy
Proof of loss
Probability
Peril
Loss
Insurer
Insured
Insurance agent
Grace Period
Face amount
Exclusions
Deductible
Coverage
Claim
Cash Value
Benefits
Beneficiary
Actuary
Actuarial table
Hazard

Insurance terms 101 Crossword

Type
Crossword
Description

Another word for amendment endorsement
Digital breach aka Data
Not just for a rainy day Umbrella
Typically 12 months Term
License update requirement Cecredits
Professional liability Eando
What must have occurred for a loss? Damages
Small business comprehensive coverage tool Bop
Maximum a policy will pay Limits
Maximum policy will pay in a policy term Aggregate
Insurance price tag Quote
You're at fault, you're ______________ Liable
Your clients go-to person (acronym) Csr
Insured info & policy specs page (abbr) Dec
Go backwards on policy effective date Backdate
Cancelation w/full premium returned Flat
Cancellation w/minimum premium earned Short
They bring in new business Producers
Extended discovery period coverage Tail

Insurance Review Crossword

Type
Crossword
Description

Provides payments for both liability and property insurance on a vehicle automobile-insurance
Receives money if a person dies beneficiary
Out-of-pocket money paid by policyholder before an insurance company deductible
Money paid for health care health-insurance
Financial product purchased to protect one against the risk of loss insurance
The chance of loss from an event that cannot be entirely controlled risk
Someone who relies on someone else for income dependent
Provides payment payment beneficiaries who were named by the insured person life-insurance
When the act of insuring an event increases the likelihood that the event will happen moral-hazard
A person who owns the insurance policy policyholder
The money paid to an insurance company to purchase policy premium
Cash set aside that can be used to cover the costs of unexpected expenses emergency-savings
A formal request to an insurance company asking for a payment when the policyholder has an accident, illness, or injury claim
Requires the insured individual to pay a fixed percentage of the loss after the deductible has been paid co-insurance
Provides payments to replace earnings during times when workers cannot work due to illness or injury disability-insurance
Employers may offer employees benefits in the form of products of services that add extra value for the employee beyond earned wages employee-benefits
The donation of a product or service in place of cash in-kind-income

Basics of Health Insurance Crossword

Type
Crossword
Description

An established schedule of fees set for services performed by providers and paid by the patient fee for service
protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury Health insurance
the sum of money paid at the time of medical service; it is a form of coinsurance copayment
provision frequently is found in medical insurance policies whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio coinsurance
Civilian Health and Medical Program of the Veterans Administration known as CHAMPUS
states that when an individual is covered under two insurance policies, the insurance plan of the policyholder whose birthday comes first in the calendar year (month and day, not year) becomes the primary insurance. birthday rule
A term used in managed care for an approved referral authorization
a payment method used by many managed care organizations in which a fixed amount of money is reimbursed to the provider for patients enrolled during a specific period of time, no matter what services were received or how many visits were made. Capitation
a letter or statement from Medicare that describes what was paid, denied, or reduced in payment. EOMB
Pays expenses involved in the care of the teeth and gums Dental care
Protects a person in the event of a certain type of accident, such as an airplane crash Special risk insurance
Often includes benefits for medical expenses payable to individuals who are injured in the insured person’s home or during an automobile accident Liability insurance
Covers a continuum of maintenance and health services for chronically ill, disabled, or mentally retarded individuals Vision care
Provides payment of a specified amount on the insured’s death Life insurance
Pays the cost of all or part of the insured person’s hospital room and board and specific hospital services Hospitalization
a review of individual cases by a committee to make sure services are medically necessary and to study how providers use medical care resources utilization review
40. An insurance term used when a primary care provider wants to send a patient to a specialist referral
periodic (monthly, quarterly, or annual) payment of a specific sum of money to an insurance company for which the insurer, in return, agrees to provide certain benefits premium
person who pays a premium to an insurance company and in whose name the policy is written in exchange for the insurance protection provided by a policy of insurance policyholder
a general practice or nonspecialist provider or physician responsible for the care of a patient for some health maintenance organizations gatekeeper

Medicare 101 Crossword

Type
Crossword
Description

Groups of drugs that have a different cost for each group. Tier
the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan. Appeal
An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. Assignment
A geographic area where a health insurance plan accepts members if it limits membership based on where people live. Service area
A coverage rule used by some Medicare Prescription Drug Plans that requires you to try one or more similar, lower cost drugs to treat your condition before the plan will cover the prescribed drug. Step therapy
A person who has health care insurance through the Medicare or Medicaid programs. Beneficiary
The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. Benefit period
A written order from your primary care doctor for you to see a specialist or get certain medical services. Referral
A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered. Claim
An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance
An amount added to your monthly premium for Part B or a Medicare drug plan (Part D) if you don't join when you're first eligible. You pay this higher amount as long as you have Medicare. There are some exceptions. Penalty
Approval that you must get from a Medicare drug plan before you fill your prescription in order for the prescription to be covered by your plan. Prior authorization
The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. Deductible
A type of Medicare prescription drug coverage determination, a drug plan's decision to cover a drug that's not on its drug list or to waive a coverage rule Exception
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Formulary
A complaint about the way your Medicare health plan or Medicare drug plan is giving care. Grievance
Health care that you get when you're admitted to a health care facility, like a hospital or skilled nursing facility. Inpatient care
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services. Network

Insurance Terms Crossword

Type
Crossword
Description

A person who sells insurance policies. Sometimes referred to as a producer, planner or advisor Agent
The person, people, or entity designated to receive the death benefits from a life insurance policy or annuity contract. Beneficiary
A policyholder's request for reimbursement from an insurance company under a home insurance policy for a loss to property. Claim
A period of up to two years during which a life insurance company may deny payment of a claim because of suicide or a material misrepresentation on an application. Contestability
When a policy is guaranteed to pay out but there is a limited death benefit within the first two years. This occurs when the second health question is answered yes or left blank Guaranteed Issue
The person or organization covered by an insurance policy. Insured
The termination of an insurance policy because a renewal premium is not paid by the end of the grace period. Lapse
The contract issued by the insurance company to the insured. Policy
Relative incidence of death within a particular group categorized according to age or some other factor such as occupation, sex, or ethnicity. Actuaries use these tables to estimate insurance premiums for products being sold. Mortality
The person or party who owns an individual insurance policy. This person may be the insured, the beneficiary, or another person. This person usually is the one who pays the premium and is the only person who may make changes to a policy. Policy Owner
The process by which a life insurance company puts a policy back in force after it lapsed because of nonpayment of renewal premiums. Reinstatement
The termination of an insurance contract by the insurer when material misrepresentation has occurred. Rescission
A written agreement attached to the policy expanding or limiting the benefits otherwise payable under the policy. Also called an "endorsement." Rider
The person who reviews an application for insurance and decides if the applicant is acceptable and at what premium rate. Underwriter