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Health Insurance Today Chapter 10-11
Terms in this set (49)
TRICARE is organized into geographical regions in the United States and "areas" overseas. How many total regions and areas are there?
Military Health System
The name for the global, comprehensive, integrated system that includes combat medical services, health readiness futures, a healthcare delivery system, public health activities, medical education and training, and medical research and development is:
Each TRICARE region is headed by a(n) _________ who works with the DoD to administer the TRICARE benefits in that region.
Military treatment facility (MTF)
A clinic or hospital operated by the DoD, located on a military base, that provides care to military personnel, retirees, and dependents is called a:
Overseeing conduct on military bases
The responsibilities of a TRICARE regional contractor include all except:
Defense Health Agency (DHA)
On October 1, 2013, the Department of Defense (DoD) established (the) ____________________ to take over management f the Military Health System (MHS) activities, replacing the former Tricare Management Activity (TMA), which ceased operations on that same date.
The computerized data bank that lists all active and retired military service members is called:
Similar to Medicaid and Medicare, TRICARE-eligible individuals are commonly referred to as:
Parents and parents-in-law of ASDMs
Which of these categories of people are not covered under TRICARE?
Workers' compensation coverage
The Affordable Care Act (ACA) requires that individuals maintain health insurance or other coverage that meets the definition of minimum essential coverage that include all except:
Which of these is not one of the three main program options available under TRICARE?
TRICARE Overseas Program
_____________________ provides health benefits to beneficiaries living and traveling overseas when they are eligible for TRICARE.
TRICARE pays for only allowed services, supplies, and procedures, which are referred to as TRICARE:
If needed treatment is unavailable at an MTF and it becomes necessary for the individual to seek inpatient treatment in a civilian hospital, he or she sometimes must obtain a:
Other health insurance
If a TRICARE-eligible beneficiary has additional healthcare coverage through an employer or a private insurer, TRICARE considers this:
TRICARE for life
TRICARE's Medicare-wraparound coverage available to Medicare-eligible TRICARE beneficiaries is called:
TRICARE authorized provider
A hospital or institutional provider, physician, or other provider of services or supplies specifically authorized to provide benefits under TRICARE is commonly referred to as a:
By law, TRICARE nonPARs cannot charge more than ______________% higher than the TRICARE maximum allowable charge.
Providers submitting paper claims should use the:
Electronic transfer fund (EFT)
Which of these is not an authorized method for submitting claims to TRICARE electronically?
CHAMPVA is a federal health benefits program administered by the :
-A widow remarrying
-Divorcing the sponsor
CHAMPVA eligibility can be lost if certain demographic changes occur, such as:
CHAMPVA is managed by the VA's Health Administration Center located in:
In general, CHAMPVA covers ________________% of most healthcare services and supplies that are medically and psychologically necessary.
Annual catastrophic (cat) cap
To provide financial protection against a potential financial crisis of a long-term illness or serious injury, CHAMPVA has established a(n):
CHAMPVA pays for covered services and supplies when they are received from an authorized provider and:
-CHAMPVA supplemental insurance
CHAMPVA is the last payer after all other third-party payers have met their obligations except for:
The deadline for filing military claims is:
When competing a claim, the health insurance professional should remember that the active-duty service member is the:
Workers' compensation got its start in the 1800s in:
In workers' compensation insurance, the premiums are paid by:
Federal Employees' compensation Act (FECA)
The federal program that establishes worker's compensation for federal and postal workers is known by the acronym:
Federal Employed liability Act (FELA)
The federal program that establishes workers' compensation for railroad workers' is known by the acronym:
An individual responsible for investigating and resolving workers' complaints against the employer or insurance company that is denying the benefits is called a(n):
Individuals state statutes
The time limit for filing a workers' compensation claim is established by the:
Time limits vary from state to state
An injury or illness that is job related typically must be reported to the employer:
A patient's inability to perform normal job duties at the previous level of expertise as a result of being absent from work is called:
After the initial attending physician report has been filed, periodic updates must be provided to the employer and insurer; these updates are called:
The type of insurance that replaces a portion of earned income when an individual is unable to perform the requirements of his or her job because of non-job-related injury or illness is called:
When determining SSDI eligibility, the government looks at ____________ that are accumulated as the individual works and pays into Social Security through FICA payroll taxes.
Federal benefit rate
The income limit for the SSI program is based on:
After eliminating all items not considered income and applying all appropriate exclusions to the items that are income, what's left is referred to as:
Americans with Disabilities Act (ADA)
The federal act established in 1990 that protects the civil rights of individuals with disabilities is called the:
Social Security Administration
The examining body that determines whether an applicant qualifies for SSDI is the:
Financial means test
The method of determining whether an individual is eligible for SSI benefits is through a(n):
Social Security disability benefits do not cover the first _______________ of the disability.
Ticket to Work Program
The program whose goal is to increase opportunities and choices for Social Security disability beneficiaries to obtain employment and other support services is:
The _______________ initiates an SSI or SSDI claim by going to the nearest Social Security office in person or by telephoning and arranging for a telephone interview to file the claim.
A benefit cap
The maximum amount of benefits that can be received in a specific time period is called:
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