A special kind of complaint if you disagree with a decision of denial
What is Appeal
100
During AEP, when would someone not be GI for MAPD
What is ESRD
100
There are no required conditions - always GI leaving group coverage
What is FL, AR, MO, KS
100
ALIC
What is Aetna Life Insurance Company
100
Live in CA; have an active medigap plan; switch to plan with same or similar benefits; cannot go from a Plan G to Plan F
What is California Birthday Rule
200
The name for a person who has health care insurance through medicare or medicaid program
What is Beneficiary
200
Can an MAPD plan reimburse the Part B premium?
What is Yes
200
Name two states if employer plan is primary and medicare is secondary you are GI
What is AK, CO, MT, PA, VT, ID, IL, IN, LA, ME, NJ, OH, or TX
200
MOO
What is Mutual of Omaha
200
Live in OR; have an active medigap plan; switch to plan with same or similar benefits; cannot go from a Plan G to Plan F
What is Oregon Birthday Rule
300
Any drug or medication market under a proprietary trademark-protected name
What is Brand Name
300
Aging in or just getting Part B
What is Open Enrollment
300
Election Periods - Medi-Gap
What is OE, GI, SEP
300
UOO
What is United of Omaha
300
Live in WA; have an active medigap plan; switch to plan with same or similar benefits; cannot go from a Plan G to Plan F; must start 30 days from anniversary date
What is Washington Anniversary Rule
400
A fixed percentage paid by the beneficiary for the services
What is Coinsurance
400
Just lost group coverage involuntarily; moved out of service are
What is SEP
400
Part B enrollment month + the following five months
What is Open Enrollment
400
ARLIC
What is Cigna
400
Live in MO; have an active medigap plan; switch to plan with same or similar benefits; cannot go from a Plan G to Plan F; must start 30 days from anniversary date
What is Missouri Anniversary Rule
500
A fixed dollar amount paid by the beneficiary for the services
What is Copayment
500
What type of plan covers the Part B decuctible?
What is Medi-Gap
500
Client has ___ days before and ___ days after to recieve certain Medigap plans under most GI situations
What is 60 & 63
500
AHLIC
What is Aetna Health and Life Insurance Company
500
What state? Aetna only-No GI (carrier overrides state rule) there are no required conditions - always GI when leaving group coverage