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Team Mack

Across
The amount paid to keep an insurance policy active.
The process of determining the reimbursement applicable to a particular claim.
A process used by a patient to request the health plan reconsider a previous authorization or claim decision.
A subscriber or dependent, whose Enrollment Application or Change Form has been accepted and for whom premium is paid.
A federally defined health benefit design that qualifies someone to open an health savings account (HSA).
The provisions of the group policy or insurance contract that state requirements that applicants must satisfy to become insured with respect to themselves or their dependents.
Contraceptive devices or medications used in the prevention of pregnancy.
Services received when a member is admitted to a hospital or non-hospital facility as a registered bed patient for whom a room and board charge is made.
A group of physicians, hospitals and other health care providers working with a health care plan to offer care at negotiated rates and at other agreed upon terms.
Payments provided for covered services under the terms of the policy.
The fixed-dollar amount which is due and payable by the member at the time a covered service is provided.
Down
An employer or other entity that has entered into a contract for health care and/or administration of benefits for its eligible members.
Services received from a hospital or non-hospital facility while not an inpatient.
A request for payment for benefits received or services rendered.
Vaccines against specific diseases that can be administered either orally or by injection.
A person or organization who is authorized by an insurer to act on its behalf to negotiate, sell, and service managed care contracts.
The date on which coverage for a member begins.
Treatment of malignant disease by chemical or biological antineoplastic agents
A written order or refill notice issued by a licensed medical profession for drugs which are only available through a pharmacy.
Medications are assigned to one of four, five or six categories known as copayment or coinsurance tiers, based on drug usage, cost and clinical effectiveness.