Insurance and Pharmacy 101 Terms

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Terms from the Insurance and Pharmacy 101 eLearn. For Insulet employees only.

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Jen

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Insurance and Pharmacy 101 TermsVersión en línea Terms from the Insurance and Pharmacy 101 eLearn. For Insulet employees only. por Jen A B C C D D F G H M N O O P P P P R S T Starts with A A request an individual makes for a health plan to reconsider a PA denial of coverage or rejection of a claim Starts with B Health plan coverage aspect that describes the services and categories included under the plan. Starts with C Percentage of the bill that a patient must pay out-of-pocket for medical services or prescription Starts with C Fixed amount that a patient must pay out-of-pocket for medical services or prescription Starts with D Fixed amount paid out of pocket before the plan begins to cover costs. Starts with D Medical equipment prescribed for long-term use Starts with F A list of drugs covered by a health plan. Starts with G A lower-cost substitute for a prescribed brand-name drug when available. Starts with H Support services that allow pharmaceutical manufacturers to help providers and individuals navigate the process of obtaining a specific prescription medication or device Starts with M Pharmacy that prepares and dispenses prescription medications and delivers them through the mail Starts with N A drug not listed on the formulary, often excluded when generics or more effective options exist. Starts with O Amount of money a person must pay for each type of covered benefit Starts with O The highest amount a person will pay for covered services in a year; once the person hits this annual cap, the insurance pays 100% for the rest of the year Starts with P Health plan coverage category that cover prescription medications included in a plan’s formulary or covered medical supplies at a pharmacy or through a preferred mail-order pharmacy Starts with P A company that a payor contracts with to develop and administer a prescription drug benefit. May be a subsidiary of a health insurance company or program or a separate company Starts with P An order for a medication, therapy, or medical device that a properly authorized person (e.g., an HCP) writes and/or sends to an authorized person (e.g., a pharmacy) who can dispense the order Starts with P Process in which a health plan asks for additional information from the with HCP or pharmacy before it agrees to pay for a medication or service Starts with R Where a pharmacist prepares and dispenses prescription medications for the local community Starts with S A path used to find the most effective drug by starting with treatments that are evidence-based, well-established, safe, affordable, and have fewer side effects before progressing to more costly alternatives Starts with T System that groups drugs into levels; higher levels increase copays or coinsurance.

Insurance and Pharmacy 101 TermsVersión en línea

Terms from the Insurance and Pharmacy 101 eLearn. For Insulet employees only.

por Jen

Starts with A

A request an individual makes for a health plan to reconsider a PA denial of coverage or rejection of a claim

Starts with B

Health plan coverage aspect that describes the services and categories included under the plan.

Starts with C

Percentage of the bill that a patient must pay out-of-pocket for medical services or prescription

Starts with C

Fixed amount that a patient must pay out-of-pocket for medical services or prescription

Starts with D

Fixed amount paid out of pocket before the plan begins to cover costs.

Starts with D

Medical equipment prescribed for long-term use

Starts with F

A list of drugs covered by a health plan.

Starts with G

A lower-cost substitute for a prescribed brand-name drug when available.

Starts with H

Support services that allow pharmaceutical manufacturers to help providers and individuals navigate the process of obtaining a specific prescription medication or device

Starts with M

Pharmacy that prepares and dispenses prescription medications and delivers them through the mail

Starts with N

A drug not listed on the formulary, often excluded when generics or more effective options exist.

Starts with O

Amount of money a person must pay for each type of covered benefit

Starts with O

The highest amount a person will pay for covered services in a year; once the person hits this annual cap, the insurance pays 100% for the rest of the year

Starts with P

Health plan coverage category that cover prescription medications included in a plan’s formulary or covered medical supplies at a pharmacy or through a preferred mail-order pharmacy

Starts with P

A company that a payor contracts with to develop and administer a prescription drug benefit. May be a subsidiary of a health insurance company or program or a separate company

Starts with P

An order for a medication, therapy, or medical device that a properly authorized person (e.g., an HCP) writes and/or sends to an authorized person (e.g., a pharmacy) who can dispense the order

Starts with P

Process in which a health plan asks for additional information from the with HCP or pharmacy before it agrees to pay for a medication or service

Starts with R

Where a pharmacist prepares and dispenses prescription medications for the local community

Starts with S

A path used to find the most effective drug by starting with treatments that are evidence-based, well-established, safe, affordable, and have fewer side effects before progressing to more costly alternatives

Starts with T

System that groups drugs into levels; higher levels increase copays or coinsurance.

Insurance and Pharmacy 101 Terms

Ruleta de Palabras

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Insurance and Pharmacy 101 TermsVersión en línea

por Jen

Starts with A

A request an individual makes for a health plan to reconsider a PA denial of coverage or rejection of a claim

Starts with B

Health plan coverage aspect that describes the services and categories included under the plan.

Starts with C

Percentage of the bill that a patient must pay out-of-pocket for medical services or prescription

Starts with C

Fixed amount that a patient must pay out-of-pocket for medical services or prescription

Starts with D

Fixed amount paid out of pocket before the plan begins to cover costs.

Starts with D

Medical equipment prescribed for long-term use

Starts with F

A list of drugs covered by a health plan.

Starts with G

A lower-cost substitute for a prescribed brand-name drug when available.

Starts with H

Support services that allow pharmaceutical manufacturers to help providers and individuals navigate the process of obtaining a specific prescription medication or device

Starts with M

Pharmacy that prepares and dispenses prescription medications and delivers them through the mail

Starts with N

A drug not listed on the formulary, often excluded when generics or more effective options exist.

Starts with O

Amount of money a person must pay for each type of covered benefit

Starts with O

The highest amount a person will pay for covered services in a year; once the person hits this annual cap, the insurance pays 100% for the rest of the year

Starts with P

Health plan coverage category that cover prescription medications included in a plan’s formulary or covered medical supplies at a pharmacy or through a preferred mail-order pharmacy

Starts with P

A company that a payor contracts with to develop and administer a prescription drug benefit. May be a subsidiary of a health insurance company or program or a separate company

Starts with P

An order for a medication, therapy, or medical device that a properly authorized person (e.g., an HCP) writes and/or sends to an authorized person (e.g., a pharmacy) who can dispense the order

Starts with P

Process in which a health plan asks for additional information from the with HCP or pharmacy before it agrees to pay for a medication or service

Starts with R

Where a pharmacist prepares and dispenses prescription medications for the local community

Starts with S

A path used to find the most effective drug by starting with treatments that are evidence-based, well-established, safe, affordable, and have fewer side effects before progressing to more costly alternatives

Starts with T

System that groups drugs into levels; higher levels increase copays or coinsurance.