Terminology
Hodge Podge
Health Insurance
Claims, Payments, Legal
Medicare
Total Benefit Solutions Inc
100
A specific amount of money that must be paid yearly before the benefits begin.
What is a Deductible?
100
A state to state health benefits program designed for low income people, and those who are blind, disabled, members of families with dependent children deprived of the support of at least one parent.
What is Medicaid.
100

A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network

What is an EPO

100
A standard designed to protect medical records and all personal health information.
What is the Health Insurance Portability and Accountability Act
100
Offered to all medicare recipients to cover the cost of their prescription drugs.
What is Medicare Part D
100

What is the name of our tech support person at Agency Smart

Who is Anthony Arbolino

215

The percentage of total average costs for covered benefits that a plan will cover.

What is Actuarial value

215

What is Ed MacConnell's middle name

What is Thomas

215

In a PPO you don't need one of these

What is a referral

215

What is Total Benefit Solutions main phone number?

What is 215-355-2121

215

A plan that provides exrtra services to those with a financial need or chronic medical condition

What is a special needs plan ( SNP)

215

What is Total Benefit Solutions Secure Fax Number?

what is (877) 464-0167 

355

A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage in the Health Insurance Marketplace®.

What is the APTC

355

Another term for the Health Insurance Marketplace®, a service available in every state that helps individuals, families, and small businesses shop for and enroll in affordable medical insurance.

What is  Exchange

355
A managed care organization developed to control the expenditure of health care dollars and to manage patient care.
What is a Health Maintenance Organization
355
When an insurer determines whether an insurance claim is correct and able to be paid, and if so makes payment.
What is Claims Adjudication
355
Covers outpatient health care services, services by physicians and durable medical equipment.
What is Medicare Part B
355

Name the program that TBSI uses for sending secure emails

What is Trustifi

427
Conditions like acquired immunodeficiency syndrome, attempted suicide, cancer, losses due to injury on the job, and pregnancy are reasons why a person should not be allowed to deduct expenses
What is a Policy Limitation
427

The law was amended by the Health Care and Education Reconciliation Act on March 30, 2010.

What is the

Patient Protection and Affordable Care Act  ( ACA or Obamacare)

427
A plan in which the members may seek care outside the network, or directly from preferred providers.
What is Point of Service
427
Medicare Part B coverage requires you to use this universal claim form.
What is a CMS 1500
427
Inpatient health care services, services in hospitals, nursing facilities, home health care, and hospice care.
What is Medicare Part A
427

What is the name of the portal TBSI uses for tracking and quoting Medicare plans

What is the Ritter Platform

525

Health care that you get when you're admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.

What is Inpatient care

525

A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event.

What is COBRA

525

A financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims, the company has a medical loss ratio of 80%

What is Medical loss ratio (MLR)

525

The organization of your treatment across several health care providers. Medical homes and Accountable Care Organizations are two common ways to coordinate care.

Care coordination

525

With this health insurance plan, Medicare remains your primary payor of claims

What is a Medicare Supplement or Medigap

525

When does TBSI have a regularly scheduled Team meeting

What is Mondays at 2PM

750

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

What is Coinsurance

750
A preferred provider organization plan for the dependents of the men and women in the military.
What is Tricare Extra
750
These groups sign up health care providers who agree to charge a fixed fee for services.
What is a Managed Care Program
750
In the pharmacy, This person tracks claims, processes and verifies accuracy of payments, and files secondary payer claims.
Who is the Insurance Specialist
750
Medicare is a federal program authorized by Congress and administered by this group.
What is Centers for Medicare & Medicaid Services
750

Who handles the commission processing for TBSI

Who is Samantha

919
The amount you pay each month to belong to a health plan.
What is a Premium?
919

A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events,

What is Special Enrollment Period (SEP)

919
Enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or other health provider designated by their program as a preferred provider.
What is a Preferred Provider Organization
919
The intentional deception or misrepresentation that results in unauthorized benefits to an individual or organization.
What is Health Insurance Fraud
919

Some varieties of this plan may require members to pay a premium similar to the Medicare Part B premium.

What is Medicare Part C

919

What does the title CHRS stand for in Ed MacConnells name

What is certified healthcare reform specialist

1000

Name 3 national insurance carriers

United Healthcare, Aetna, Cigna

1000

The name of the Annual Medicare manual all Medicare beneficiaries get and should have handy

Medicare and You

1000

What is the actuarial value of a bronze plan?

What is 60%

1000

A national provider network that Blue plans participate in

What is Blue Card PPO

1000

A notice your Medicare Advantage or PDP plan sends beneficiaries each year

What is the ANOC

1000

What is Ed's granddaughter's name?

Who is Chloe

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