Show:
MEMBERS
PROVIDERS
ENROLLMENT
COST SHARING
BENEFITS
100
The name given for the standard period of
time during which members can sign up for an
AMBETTER plan on the Health Insurance Marketplace.
What is Open Enrollment?
100
Be prepared to present THIS any time
you receive healthcare services.
What is Ambetter member ID Card?
100
After enrollment, completing this will help
Ambetter design your plan around your specific
needs AND you can earn $50 on your My Health
Pays™ prepaid Visa® card.
What is Ambetter Welcome Survey?
100
The total co-payment amount a member
needs to pay for prescriptions and/or medical
services during a benefit year.
What is the Out-of-Pocket Maximum (OOP Max)
OR - Maximum Out-of-Pocket (MOOP)
100
THIS is a covered service in Ambetter from Celticare Health
but it is NOT a covered service in Ambetter by NH
Healthy Families. It is defined as "The condition of
a presumably healthy individual who is unable to
conceive or produce conception during a period of one year.
What is Infertility (Treatment or Services)?
200
E.O.B. stands for THIS.
What is Explanation of Benefits?
200
A provider who does not have a contract
with Ambetter or with its subcontractor to provide
healthcare services to Ambetter members.
What is "Non Par" - OR - "Out of Network"?
200
A SPECIAL ENROLLMENT PERIOD begins if a
subscriber/spouse/dependent experiences
ONE OF THESE... such as getting married or divorced,
birth/adoption/placement for adoption
of a child, the death of a spouse or dependent, or
moving out of the health plan’s service area.
What is a "major life change" or a "qualifying event"?
200
The annual dollar amount that must be
paid out of pocket for certain covered services before
Ambetter becomes obligated to pay for covered services.
What is the Deductible
OR - Annual Deductible?
200
The list of drugs included as
part of a health plan’s covered benefits.
What is Formulary - OR - Preferred Drug List (PDL)?
300
The person with whom an insurance company
contracts to provide health benefits for that person
and enrolled dependents.
What is Subscriber?
300
EOP
What is "Evidence of Payment" or "Explanation of Payment"?
300
An AMBETTER subscriber who receives one of
THESE types of subsidies has a longer grace period than a subscriber who does not.
What is an Advanced Premium Tax Credit (APTC)?
300
A form of medical cost-sharing in a health
insurance plan that requires an insured person to pay
a stated percentage of medical expenses after the
deductible amount, if any, was paid.
What is Co-Insurance?
300
Ambetter from CeltiCare Health has THIS
free service to help our members who
don’t feel comfortable speaking English.
What is Interpreter Services?
400
A form of medical cost sharing in a health
insurance plan that requires a member to pay a
fixed dollar amount when a medical service is received.
What is Co-Payment - OR - Co-Pay?
400
The doctor that manages all aspects
of your healthcare and is the "go to"
person to contact for your health
questions and concerns.
What is Primary Care Provider?
400
Open Enrollment began on Nov. 1, 2015
and ends on THIS DATE.
What is Jan. 31, 2016
400
Eligibility for subsidies on the Exchange is defined
according to income as a percentage of THIS.
What is Federal Poverty Level (FPL)?
400
Free clinical help is available right from
your home or anywhere you have telephone access,
24 hours a day, seven (7) days a week,
365 days a year with THIS valuable service.
What is 24/7 Nurse Advice Line - OR - NurseWise?
500
At Ambetter, members' privacy is very important.
Ambetter protects all verbal, written and electronic
forms of THIS across the organization.
What is Protected Health Information?(PHI).
500
A licensed institution providing healthcare
services or a healthcare setting, such as hospitals,
licensed inpatient centers, ambulatory surgical
or treatment centers, skilled nursing centers,
diagnostic, laboratory and imaging centers,
rehabilitation and other therapeutic health settings.
What is a Facility?
500
Once enrolled, members are encouraged to create
THIS online, so they can access their plan benefit and
coverage information, member handbook, Schedule of Benefits
and claims information, all in one place.
What is a Secure Member Account?
500
If you visit a health care provider's office
or clinic for any of these services, there is never a co-pay
or deductible.
What is Preventive care
OR - Screening
OR - Immunization
OR - Essential Health Benefits (EHB)?
500
1) Made primarily to serve a medical purpose
2) Able to stand repeated use
3) Not generally useful in the absence of illness or injury
4) Appropriate for home use
What is Durable Medical Equipment (DME)