health insurance today ch. 10 & 11

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TRICARE's two main objectives are:

accessibility and affordability

TRICARE is administered regionally, serving___ separate regions.


Each region is headed by an individual who is responsible for oversight of all healthcare delivery activities within his or her region and is called a:

Regional director

The name of the total healthcare system of the U.S. uniformed services is:

Military Health System

TRICARE is administered by:

The Department of Defense

The main purpose of the TRICARE Management Activity (TMA) is to:

Enhance the performance of TRICARE worldwide

The computerized data bank that lists all active and retired military service members is called:


Similar to Medicaid and Medicare, TRICARE-eligible individuals are referred to as:


The fee-for-service option offer by TRICARE, which has basically the same benefits as the original CHAMPUS program, is:

TRICARE Standard

The TRICARE option similar to preferred provider organization-type managed care is:


CHAMPVA is managed by:

The VA's HAC

CHAMPVA eligibility can be lost if certain demographic changes occur, such as:

A widow remarrying, Divorcing the sponsor, Becoming eligible for Medicare. (all the above)

CHAMPVA is the last payer after all other third-party payers have met their obligations except for:

Medicaid, CHAMPVA supplemental insurance (d. a and b are correct)

The deadline for filing military claims is:

1 year

The annual catastrophic (cat) cap for CHAMPVA is:



The sponsor's relationship to the beneficiary creates eligibility under TRICARE


Military retirees and their family members are not eligible for TRICARE


TRICARE pays for only their allowed services, supplies, and procedures.


There is no "cost-sharing" under TRICARE regulations


Active duty personnel are not CHAMPUS-eligible and are automatically enrolled in TRICARE Standard


TRICARE Prime is a health maintenance organization-type managed care option in which MTFs are the principal source of healthcare


Under TRICARE Prime's point of service (POS) option, enrollees are allowed to receive healthcare services only from providers within the POS network.


Under TRICARE FOR LIFE,TRICARE pays Medicare deductibles and coinsurance or copayment amounts up to 115% of Medicare-allowable charges


Eligibility for patients claiming TRICARE and CHAMPVA coverage should be verified


TRICARE participating providers (PARS) must accept the TRICARE allowable charge as payment in full for the healthcare services provided and cannot balance bill.


Patients using TRICARE Standard are usually responsible for submitting their own claims.


In the case of nonparticipating providers (nonPARs), TRICARE Standard patients must file their own claims; however, the reimbursement check is sent to the provider


Even though electronic claims submission is preferred by most major carriers, military carriers still prefer paper claims


The deadline for submitting military claims varies from region to region


Workers'compensation got its start in the 1800s in:

The employer

In workers' compensation insurance, the premiums are paid by:


The federal program that establishes workers' compensation for nonmilitary federal government employees is known by the acronym:


The federal program that establishes workers' compensation for railroad workers engaged in interstate commerce 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):

Individual state statutes

The time limit for filing a workers' compensation claim is established by:

Time limits vary from state to state

An injury or illness that is job related typically must be reported to the employer:

Job deconditioning

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:

Progress reports, Supplemental reports (d. a and b)

After the initial attending physician report has been filed, periodic updates must be provided to the employer/insurer, called:

Disability insurance

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:

A benefit cap

The maximum amount of benefits that can be received in a specific time period is called:

Americans with Disabilities Act (ADA)

The federal act established in 1990 that protects the civil rights of individuals with disabilities is called the:

State Disability Determination unit

The examining body that determines if an applicant qualifies for SSDI is the:

Financial means test

The method of determining whether or not an individual is eligible for SSI benefits is through a(n):

Ticket to Work

The program that provides greater choice in selecting the providers and rehabilitation services disabled individuals need to help them keep working or return to work is called:


Employers must purchase workers' compensation policies from the state in which their business operates.


In the United States, any employee who is injured on the job or develops an employment-related illness that prevents the individual from working is likely to be eligible to collect workers' compensation benefits.


If an employee is injured on the job, the employer can be penalized if the cause of injury or illness was due to the employer being conspicuously negligent.


Most state workers' compensation laws include coverage for injuries sustained while an employee is commuting to and from work.


If a workers' compensation claim is denied, the worker may file a claim with his or her health insurance carrier only after all workers' compensation appeals have been exhausted.


The first thing an injured employee must do is call his or her family physician.


Workers' compensation claims must be submitted on the universal CMS-1500 claim form.


As long as a workers' compensation claim is pending, the provider cannot bill the patient.


Workers' compensation patients are not required to sign a release of information form for a claim form to be filed.


An individual may receive benefits from only one federal disability program even if he or she meets all the eligibility requirements for several.


The SSI program provides monthly cash payments to low-income aged, blind, and disabled individuals.


The CDC Disability and Health Team's focus is promoting safe workplace procedures.

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