Category 1
What is (HMO) abbreviation means?
Health Maintenance Organization (HMO)
The action allowed for the member to do during OPEN ENROLLMENT PERIOD.
Action Allowed: Switch or Drop
The Open Enrollment Period allows the member to switch from one Medicare Advantage plan to another Medicare Advantage plan OR drop their Medicare Advantage plan and return to Original Medicare.
This refer to the document where member can check on their descriptive benefits and details of the plan.
Evidence of Coverage
It is a Medical Alert System
Lifestation
Onekit
Tools/Resources we use to check member benefits .
GPS, HRP,Star Central Portal, Aetnamedicare.com ,
tool we use to process premium payments of the mm.
PNC
Criteria that the mm's must meet to be eligible in Special Election period
Gaining or losing creditable coverage
A dollar amount the member is responsible for paying, before the plan and member begin to share the cost towards covered services.
Deductible -
Additional Benefit member enroll if following benefits in not imbedded on their plan.
Dental, Vision and/or Hearing
Optional Supplemental Benefits (OSB)
member may choose to elect in addition to the medical benefits covered by Original Medicare and those offered through the member’s benefit plan. Based on plan and offering, this could be dental, vision and/or hearing.
PAPA PAlS/ PAPA PROGRAM
is our internal system for Authorizations and Case Management
Medcompass
Tab on Salesforce where you will able to pull up the mm documents such as EOC, ANOC or Formulary etc.
Health Policy Documents
refers to those processes that happen through partnerships and collaboration to keep the member's experience at the center of everything we do.
Seamless Service
TAT of Post-service Standard Appeal
60 calendar days
Provide the 3 Premium Billing Payment Options .
What is (SPAP) abbreviation means?
State Pharmaceutical Assistance Program
programs that coordinate with Aetna plans to provide help with Medicare Prescription Drug Plan premiums and prescription drug costs. SPAPs provide assistance based on financial need, age or medical condition, a
What is the color of original medicare card?
Red,white and blue card
What is the difference between cancellation and disenrollment request?
Cancellation is a request we process if the plan is not effective yet .
Disenrollment is a request we process if teh policy has been activated already .
What is the provider participation disclaimer?
This information is subject to change at any time. Therefore, please check with the provider before scheduling your appointment or receiving services to confirm he or she is participating in Aetna's network.
Mr.Smith is paying $30 for part c premium and $15 for part d premium, and he is eligible for 75% LIS .
How much is the monthly premium payment of the mm?
$33.75 = total monthly payment for premiums .
part d premium - $15 / 3.75
$15*75% -= 11.25
LIS- 75%
The system we are using to capture the bank account info of the mm in processing their payment , where they have to use their touchpad to enter their credentials.
SMART SIP
What is the name of our SM(Shifht Manager)?
Geraldine JAJI
What does CREST stands for?
Corporate Real Estate Service Team
It's a virtual desktop to log on to your systems
Citrix