Private Payer Insurance Basics
What is a premium?
The amount paid regularly to maintiain health coverage.
What is a deductable?
The amount patients pay before insurance starts paying.
Which covers more people in the US? Private insurance or Medicare/Medicaid?
Private Insurance
What card do CHAMPVA beneficiaries have?
CHAMPVA ID card
What claim form is used by TRICARE patients when filing themselves?
DD From 2642
What does "network" mean?
A group of approved providers and facilites.
What is coinsurance?
A percentage of the cost the patient pays after the deductible.
Is TRICARE private or government insurance?
Government.
Who administers TRICARE?
The Department of Defense.
What agency oversees TRICARE fraud and abuse?
Program Integrity Office
Which type of plan ususllly requires referrals? Is it HMOs or PPOs?
HMO
What is a copayment?
A fixed fee for services like office visits or prescriptions.
What does CHAMPVA stand for?
Civilian Health and Medical Program of the Department of Veterans Affairs.
What agency runs the CHAMPVA claims processing center?
VA Health Administration Center.
What law protects patient health information?
HIPAA
What is an out-of-pocket maximum?
The most a patient pays in a year before insurance cover 100%.
What is cost-sharing designed to do?
Share costs between insurer and patient to reduce unnecessary use.
Which program is for active duty military and their families?
TRICARE
What is required for CHAMPVA for life eligibilty?
Enrollment in Medicare parts A & B
Where is the MHS's Notice of Privacy Practices posted?
On the TRICARE website
What law requires most people to have health insurance or pay a penalty (before 20190
Affordable Care Act (ACA)
What is the catastrophic cap in CHAMPVA?
$3000 per calender year.
Which act reformed VA healthcare enrollment in 1996?
Veterans Health Care Eligibility Reform Act of 1996.
Who is responsible for preauthorization in CHAMPVA?
The patient.
What must be attached to DD Form 2642 when filing a TRICARE claim?
An itemized bill from the provider.