Nov 5, 2012 19:00
11 yrs ago
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English term

cross apply

English to Spanish Medical Insurance
La frase aparece dos veces en un documento de seguros médicos.

All network deductibles *cross apply*.
Deductibe carryover does not apply.
The out-of-pocket maximums *cross apply*.

Alguien me puede ayudar con el significado? Gracias!!

Proposed translations

2 hrs

cómputo combinado

Solo es una sugerencia. A ver si te ayuda a dar con el término adecuado. Abajo te pongo una explicación detallada.

***The out-of-pockets maximums "cross apply"***
=
Cómputo combinado para los límites de reembolso de gastos.
Computación combinada para los límites de reembolso de gastos.

No logro dar con el término exacto pero aquí abajo te pongo la explicación de lo que es. Quizá te ayude. Se suele hablar de ello en las pólizas de salud (seguros médicos) de reembolso. El asegurado paga los gastos en primer lugar (si utiliza servicios ajenos a su cuadro médico) y luego la compañía se hace cargo de una parte (suele ser el 80% o 90%) según se establece en la póliza. La póliza establece unos importes máximos tanto para los médicos/centros dentro del cuadro médico como fuera de él. Con el "cross apply" significa que se aplicarán los gastos dentro del cuadro médico a los límites de fuera del cuadro si se utilizan servicios fuera del cuadro médico. Y al revés, se aplicarán los gastos por servicios fuera del cuadro médico a los límites de los servicios dentro del cuadro médico si el asegurado utiliza servicios dentro del cuadro médico. Un tanto confuso, ¿verdad?

Out-of-Pocket Maximums – How They Work
If you enroll in a PPO option or the OOA option, your out-of-pocket expenses will be
limited by an annual out-of-pocket maximum. Once a person meets the individual limit,
the Plan will pay 100% of that person’s covered expenses for the rest of the year.
If you have family coverage, your family can meet the family out-of-pocket maximum
without each person meeting his or her individual out-of-pocket maximum.
For example, the 90/50 PPO in-network out-of-pocket maximum is $1,200 for
individuals and $2,400 for families. When Kate’s out-of-pocket expenses reach $1,200
the Plan begins to pay 100% of her in-network expenses. If her husband then has $1,000
and one of her children has $200 in out-of-pocket expenses, combined they have met the
$2,400 family out-of-pocket maximum. The Plan will now pay 100% of covered innetwork charges for all four members of the family for the rest of the year.
Deductibles and coinsurance amounts are applied to the out-of-pocket maximum.
Copayments do not apply toward the out-of-pocket maximum.
What Does “Cross Apply” Mean?
In the PPO options, the deductibles and annual out-of-pocket maximums “cross-apply”
for in-network and out-of-network services. This means that in-network expenses apply January 2010 Medical  4
toward your out-of-network limits if you decide to use out-of-network services.
Likewise, out-of-network expenses apply toward your in-network limits if you decide to
use in-network services.

In-Network
Office visits to your PCP are covered at 100% after you pay a $15 copayment. Office
visits to a specialist are covered at 100% after you pay a $35 copayment. Most other
services are covered at 90% after you meet a deductible. The annual deductible is $200
per person, or $400 per family. There are no claim forms to file, and your network
provider will generally arrange for any required notifications.
Out-of-Network
When you use an out-of-network provider, you must pay a deductible each calendar year
before the plan begins to pay benefits. The annual deductible is $400 per person, or $800
per family. In- and out-of-network deductibles cross-apply.
After you pay the deductible, the Plan generally pays 50% of covered expenses up to an
annual maximum benefit of $75,000. Benefits are based on the reasonable and customary
charge for the service. You are responsible for paying the 50% of reasonable and
customary charge not paid by the Plan plus any charge in excess of the reasonable and
customary charge. You generally need to file a claim form to receive out-of-network
benefits, and you are responsible for any required notifications.

Out-of-Pocket Maximums
An annual out-of-pocket maximum limits the amount you will have to pay for covered
services in a calendar year. In-network, the annual out-of-pocket maximum is $1,200 per
person, or $2,400 per family. Out-of-network, the annual out-of-pocket maximum is
$4,800 per person, or $9,600 per family. In-and out-of-network expenses cross-apply
toward out-of-pocket maximums.
Certain expenses do not count toward the out-of-pocket maximum. The out-of-pocket
maximum does not include copayments; charges greater than covered expense amounts;
the amount you pay for emergency room services if used for non-emergency purposes;
penalties you pay for not making notification calls when required; and out-of-network
charges that exceed the “reasonable and customary” allowance.
Example sentence:

Servicios concertados (cuadro médico): La compañía paga directamente al facultativo o centro asistencial, no siendo necesario que abones cantidad alguna. Estos gastos no computan a efectos de límites de reembolso.

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294 days

aplicación cruzada

The term "cross applies" means that in-network payments count toward your out-of-network payment limits if you decide to use out-of-network services. Likewise, out-of-network payments count toward your in-network payment limits if you decide to use in-network services.

What Does “Cross Apply” Mean?
In the PPO options, the deductibles and annual out-of-pocket maximums “cross-apply” for in-network and out-of-network services. This means that in-network expenses apply toward your out-of-network limits if you decide to use out-of-network services. Likewise, out-of-network expenses apply toward your in-network limits if you decide to
use in-network services.

En las anteriores definiciones se establece que los pagos dentro de la red se contabilizan en forma cruzada contra los límites de pago de fuera de la red si se decide utilizar esta última.

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Note added at 294 días (2013-08-27 00:58:29 GMT)
--------------------------------------------------

La traducción sería:
Todos los deducibles de la red aplican en forma cruzada.
Los máximos para gastos varios/menores se aplican en forma cruzada.
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