Aetna Activity Room 2

RX Terms

100

Coinsurance 

What is - 

• The percentage the beneficiaries pay after for service.

200

Copayment 

What is Fix rate for service- like $35 office copay for PCP

300

Deductible 

What is 

• A set amount for the beneficiaries pay out of pocket before the plan picks up at 100%

400

MOOP

What is 

• Is the most the beneficiaries will pay out of pocket annually

500

Tier

What is 1,2,3,4,5,6- this can also determine the copayments

Rx Terms

100

Transitional Fill 

What is Within the first 90 days when switching plans, you get refills on certain medications until PA is approved with new Plan

200

Formulary Exception

What is 

• When plan does not cover medication but due to certain conditions PCP can request it to be paid. (allergy, current medication is not on the formulary)

300

Step Therapy

What is 

• Taking the cheaper medication that is for condition first before stepping up to the more costly for the same condition.

400

Standard vs Preferred Pharmacy

What is 

• Preferred network and you get your meds a lower cost- Standard are out of network and medication will cost more.

500

Prior Auth 

What is 

• Some medications need proof of medical necessity.

 

Network terms

100

Referral 

What is 

• PCP must submit requests for specialist

200

I can be a PCP

What is 

• Family, General, Internist, NP, PA, Geriatrician

300

I am the difference between HMO and PPO.

What is HMO’s have lower cost and need referrals and you must use network only providers or plan does not pay, PPO no referral needed and could higher copayments. And you can go where you want.

400

Enrollment Period 

What is Time of the year when beneficiaries can enroll in a plan

500

I can enroll in a DSNP plan.

Who is 

• Beneficiaries that have both Medicare and Medicaid.

SHB

100

Dental Vision and Hearing 

What is 

• Addition Supplemental benefits are embedded into beneficiaries’ plans. Covering dental visits, vision, and hearing and copays will apply with an annual benefit allowance.

200

OTC Catalog Benfits

What is 

• Beneficiaries guide to what they can use their other counter allowance.

300

Part B Premium Reduction 

What is 

• Beneficiaries can enroll in plans that have Part B give backs. This money is given to Medicare, and they will see the amount reflected in their month SSI check.

400

Fitness Benefits 

What is 

• Free gym membership or a fitness kit if beneficiaries do not go to the gym.

500

Transportation 

What is 

• Beneficiaries can use this benefit if they need rides to approve medical appointments and other location.

Riddle me this

100

 I have keys but no locks, and space but no rooms. You can enter, but never go outside.

What is a keyboard?

200

What has to be broken before you can use it?

What is an egg?

300

What gets wetter the more it dries?

What is a towel?

400

I am tall when I am young and I am short when I am old. 

What is a candle? 

500

What is always coming but never arrives?

What is tomorrow?