Medicare
Includes Part A and Part B
What is Traditional Medicare
Plan that covers services and care that is necessary to treat and an emergency medical condition.
Plan that requires you to have a PCP aka a gatekeeper?
What is an HMO plan?
Tricare Prime has a Primary Care Manager and requires you to have a ________________ on file for visit to see a specialist.
What is a referral?
Person who is financially responsible for the patient account.
What is a guarantor?
Plan for Prescription coverage
What is Medicare Part D?
Plan that is provided to children 18 or under when they don't qualify for Medicaid.
What is CHIP?
Plan that works as a hybrid plan, combines HMO and PPO.
What is a POS plan?
Health plan for Families of Veterans which provide care and shares the cost of covered healthcare services to eligible beneficiaries.
What is ChampVA?
5 Step Communication Tool used to perform excellent customer service.
What is AIDET?
Age 65, Disability, ESRD, ALS
What are the ways to qualify for Medicare?
Type of plan that includes Supeior, Molina, Community First, Aetna, Etc.
What is Managed Medicaid Plan?
A financial assistance program that is not health insurance for Bexar County Residents.
What is Carelink?
Plan that provides Health Care and Prescription services on military installations only and on a space availability basis.
What is Tricare Direct Care?
Person who enrolls in an insurance plan
What is the subscriber?
Plan that covers the gaps that Medicare doesnt cover.
What is a Medicare Supplemental aka Medigap plan?
Plan that helps children 20 and younger who have special health care needs and people with cystic fibrosis of any age improve their health, well-being and quality of life.
What is Children with Special Health Care Needs? (CSHCN)
This is the place that you will look to see if an insurance is in network with UH.
What is the Payer Network Participation Grid?
Plan that requires you to have a voucher
What is VA/Triwest?
The max amount of money customers pay per year.
What is Out of Pocket Maximum?
Traditional Medicare Part A + Part B + Part D=
What is Medicare Part C aka Medicare Advantage Plan?
A cost assistance program designed to help low income of disabled beneficiaries who are eligible with both Medicare and Medicaid that help cover the cost of the premiums.
What is Medicaid QMB?
Plan which is not an insurance, but a cooperative in which members agree to cover a portion of one another's medical cost. You will load as self pay.
What is a Healthshare
What is Tricare for Life?
Rule that determines which insurance will be primary when a dependent child is covered under multiple insurance plans.
What is the birthday rule?