A-B-Cs
MA
What is Medicaid/Medical Assistance?
These plans are referred to as duals. [bonus = name both]
What are 1) Connect + Medicare & 2) Minnesota Senior Health Options?
Drugs and products that are available for purchase without a prescription.
What are Over the Counter (OTC) Drugs?
The highest financial amount that Member has pay out-of-pocket during the calendar year.
What is Maximum Out-of-Pocket (MOOP)?
The geographic area where Member must live to be eligible for a Health Plan.
What is Service Area?
SNBC
What is Special Needs BasicCare [aka Connect & Connect + Medicare]?
Most plans are just for me as the Member, yet this plan is for my whole crew.
What is Individual and Family Plans (IFP)?
Certain medical equipment that is ordered by doctor for Member to use at home.
What is Durable Medical Equipment (DME)?
Financial amount as a set amount Member pays each time they receive medical service or supply.
What is Copay?
UCare's extra perks/supplemental regarding education. [bonus = name all 3]
What is Community Education Discount, GEDWorks, and/or Julius Education?
MCO
What is Managed Care Organization (MCO)?
These plans are specifically for the senior / age 65+ group. [name at least 2 types]
What are 1) Minnesota Senior Care Plus (MSC+), 2) Minnesota Senior Health Options (MSHO), & 3) UCare Medicare Plans?
Health services that help Members stay healthy, by finding and preventing health problems.
What are Preventive Services?
Financial amount as a monthly payment Member must pay to Medicare, an insurance company, or a Health Plan for health or prescription drug coverage.
What is Premium?
Health services or certain drug that need approval from the Health Plan in advance before Member can receive/obtain them.
What is Prior Authorization (PA)?
PMAP
What is Prepaid Medical Assistance Program?
These plan types have the widest age ranges. [name at least 2 types]
What are 1) Medicaid (MA), 2) Fee For Service (FFS), 3) Managed Care Organization (MCO), 4) Individual and Family Plans (IFP), 5) Prepaid Medical Assistance Program (PMAP), and 6) Minnesota Care.
Contracted health care providers who are part of the Health Plan as In vs Out.
What is Network?
Financial amount Member must pay for health care or prescriptions before their Health Plan begins to pay.
What is Deductible?
UCare's extra perks/supplemental benefits regarding wellness kits include... [name at least 2 types]
What is 1) Connect to Wellness, 2)Living Well Kids, 3) Strong & Stable, 4) Medication, 5) Dental, 6) Memory, 7) Stress & Anxiety, & 8) Mask & Sanitizer? https://www.ucare.org/health-wellness/fitness-wellness
FFS
What is Fee for Service?
These plan types have NO monthly premiums. [bonus = name both]
What are 1) Prepaid Medical Assistance Program (PMAP) and 2) Minnesota Senior Health Options (MSHO)?
A list of prescription drugs, both brand name and generic drugs, covered by the Health Plan.
What is Formulary (aka Drug List, List of Covered Drugs, Preferred Drug List)?
Financial amount (as a percentage) is what the Member may be required to pay as their share of the cost for services or items.
What is Coinsurance?
Determination for whether services, supplies, or drugs that are appropriate and needed.
What is Medical Necessity?