Medicare, Group Insurance, TRICARE & CHAMPVA
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20 Terms
For Medicare, individuals 65 > do not have to pay a premium for Part A if what?
They or a spouse paid medicare taxes while they were working
How much is Hospice Care for Medicare patients?
0$
With the passing of HIPAA in 1996, congress increased the potential fine from $2k to what??
$10k fine
In January of 2019, BlueCross and BlueShield changed their name to what?
Anthem
What’s the origin of BlueCross?
Began in 1929 when Baylor University Hospital approached teachers with a plan promising 21 days of hospitalization
What’s the origin of BlueShield?
Approved by the AMA in 1938 supporting the concept of voluntary health insurance
List some things that Participating providers(PAR) must do
Submit claims for all BCBS subscribers
Write off difference or balance between the amount changed by provider & approved fee
Bill patients only the deductible & copay/coinsurance based on BCBS allowed fees
Describe Nonparticipating PARs(nonPAR)
Have not signed contracts and expect to be paid the full fee charged for services rendered
What are Riders?
Special clauses that stipulate additional coverage over and above the standard contract
What is Indemnity?
Security or protection against a loss or other financial burden
Outpatient Pretreatment authorization plan(OPAP) is also known as?
Precertification
All Federal Employee Plans(FEP) contain what phrase?
"Government-Wide Service Benefit Plan”
What logo can be seen on Health Care Anywhere PPO ID cards?
Suitcase logo
What is the deadline for filing claims?
1 year
Where are some mental health claims forwarded to?
Third Party Administrator(TPA)
What was the original name of TRICARE when first implemented in 1967?
Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
TRICARE is split up into how many regions?
2 regions, the East & West
TRICARE eligibility is determined by what Uniformed Services?
All Military branches, Public Health Service, and National Oceanic & Atmospheric Administration
Who is eligible for the Civilian Health and Medical Program of Veteran Affairs?(CHAMPVA)
spouse, widow(er), or child
what is the Fiscal year for TRICARE & CHAMPVA ?
October 1st - September 30th