Match the following:

Question

A) copayment
B) participating provider
C) capitation
D) contracted services
E) payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person

1) An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan
2) An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons
3) A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals
4) Covered services provided by a physician that are consistent with the physician's training, licensure, and scope of practice
5) The determination of which health plan will pay for covered services as primary or secondary payer
6) The amount a covered person is required to pay at the time of service
7) Contract issued by a payer under which a covered person may be entitled to covered services
8) Healthcare services provided to covered persons under the terms of the benefit plan
9) A provider who is not under contract with a managed care plan
10) A compensation arrangement in which a provider is paid a per-member-per-month fee

Answer 1

1) J) covered person
2) E) payer
3) B) participating provider
4) D) contracted services
5) G) coordination of benefits
6) A) copayment
7) F) benefit plan
8) H) covered services
9) I) nonparticipating provider
10) C) capitation