It is a medical supplement insurance policy sold by private company?
What is Medigap?
It is a law passed by the U.S. Congress on a reconciliation basis that among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.
What is COBRA?
IDs used to search for a member in ESAWS
What are
CIN Number (for Medicaid members)
New Member ID (NMI)
Social Security Number
HIX Number
Does not cover IVF, GIFT, ZIFT, FET or more complex infertility treatments.
What is Infertility Mandate?
A medical condition in which the heart is enlarged. It is more commonly referred to as an enlarged heart
What is Cardiomegaly?
It is the healthcare program that the Defense Department of U.S. created for military servants.
What is TRICARE/CHAMPUS?
1. In-patient hospital services
2.Skilled Nursing Facility
What are the two service covered by hospital plan?
When clicked a screen will pull up where the rider list for that contract as well access a summary document highlighting benefits can be viewed
What is CAT#? or What is spyglass beside CAT#?
Prohibit insurers and HMOs from limiting a woman’s direct access to primary or preventative services or pregnancy related care from a qualified network provider of her choice to less than two examinations per year for most insured groups. Likewise, insurers and HMOs may not limit direct access to follow-up care or treatment that becomes necessary as a result of such examinations or as a result of an acute gynecological condition. |
What is Women’s Preventive Services (WPS) Mandate or Well Woman Mandate?
A medical practitioner qualified to diagnose and treat tumors
What is an Oncologist?
October 15- December 7
When is the open enrollment period for OEP?
At least 10 years of being a tax payer
What is the primary requirement for Hospital insurance plan?
This detailed information can be displayed as form view or list view which displays as a single line of data. Provides a snapshot of the Member including full name & address, DOB, PCP, etc.
Buttons at the top of the grid are for Request and Reference Options
The spyglasses, when clicked, will provide additional information (if applicable)
Alerts may appear, providing additional information
What is Member Demographics?
Requires HMO’s and indemnity carriers to provide a minimum of 30 inpatient mental health days and 20 outpatient mental health visits and mandates unlimited inpatient, partial hospitalization and outpatient mental health coverage for large group policyholders for treatment of specific Mental Health biologically based diagnoses and Children with Serious Emotional Disturbances (SED). |
What is Timothy's Law? or What is Mental Health Parity Law?
An enhanced form of x-ray technology that is used to measure bone loss.
What is a DEXA Scan? or What is a dual energy X-ray absorptiometry scan?
It is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs.
What is Medicare Part D?
It is a joint between federal and state program that helps the medical cost for some people have limited income.
What is Medicare?
October 15-December 7
When is the open enrollment period or OEP?
Establishes regulations around a dispute resolution process that holds the members harmless for costs associated with non-emergency services, unexpected bills from non-par providers or "surprise bills"
What is Out of Network (OON) Bill?
The administration of antigenic material to stimulate an individual's immune system to develop adaptive immunity to a pathogen.
What is Vaccination?
A qualifier for an individual to get Medicare even if he/she is not yet 65.
What is ESRD?
any age
What is the age requirement to be eligible in Medicaid?
Allows the advocate to document inquiries without having to click on the Create SR button and choose a Category and Subcategory. It also allows the advocate to select the Primary and Linked Entities.
What is a Wizard SR?
Covers newborn care, under the mother’s maternity benefit, for the first 48 hours after vaginal delivery and the first 96 hours after cesarean delivery. Allows the member up to 30 days from the baby’s date of birth to enroll the newborn.
What is a Newborn Mandate?
Designed to provide support to the patient and their loved ones during the final phase of life. Focuses on comfort and provides a better quality of life, with the goal to enable patient to have an alert, pain-free life and live each day as fully as possible.
What is Hospice Care?