Intent
Intent in quoting pharmacy benefits
Review RX benefits
A drug sold without a prescription from a health professional
Over the counter
The document that describes any changes to the Member benefits, coverage, costs, premiums and/or service area that will be effective in the new plan contract year.
Annual Notice of Change (ANOC)
A federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
HIPAA
A document that provides information about deductibles, copayments and kinds of services or products that the plan covers.
EOC
Intent in quoting medical benefits
Review Medical Benefits
Coverage Gap is also known as _______
Donut Hole
Medications that are not covered by insurance
Excluded drugs
Name of the list of items covered under member's OTC
catalog
It is the degree to which an employee's actual activities align with their scheduled tasks.
adherence
Intent in looking for a specialist
Search and Assign Provider
A copy of a brand name, usually costs less
generic drug
amount to be paid before an insurance starts to pay
deductible
Department for placing of OTC orders
Healthy Benefits Plus
iBAAG is used for what claim system?
COSMOS
Intent in checking medications if covered by insurance
Formulary Lookup
A term for the way plans share health care costs with the member
Cost share
Fixed amount to pay for medical services
Copay
True or False: A new email address cannot be added without the member’s verbal consent.
True (Ref KM1007997)
Intent used if member is requesting a comprehensive formulary list
Member materials
Intent in adding a rider
Managing a rider
A meal benefit offered to a member following an inpatient stay
Mom's meal
Period after a member met the TROOP
Catastrophic
Vendor that administers U-Card
Solutran
Medicare part that focuses on outpatient coverage
Part B