UHC - 1

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Across
  1. 2. when health plans work together to insure providers are paid the payable amount
  2. 5. this period allows for individuals enrolled in a MA plan the opportunity to disenroll.
  3. 7. member neglects to send in a payment and their account becomes...
  4. 12. the member may be required to try one or more of these other drugs before the plan will cover the drug.
  5. 13. Physical, Emotional, Sexual abuse, exploitation, neglect or abandonment of the elderly
  6. 16. Dedicated disenrollment, Enrollment, Cancellation Team
  7. 17. assist high-risk members with an exceptional level of service.
  8. 19. a limit for a certain medication for a member for a certain amount of time
  9. 20. a penalty for not enrolling in part d
  10. 21. an individual the members grants the right to discuss and/or receive personal health information.
  11. 23. Medicare Advantage; original medicare combined
  12. 24. any material that we send to a member or prospect
  13. 25. prescriptions crossover from coverages
  14. 29. skilled nursing care and certain other health care services that members receive in their homes for the treatment of an illness or injury
  15. 32. a payment arrangement for health care providers
  16. 33. period after the deductible has been met
  17. 34. a single point of contact for customer service issues that arise out of normal venues.
  18. 37. when members enroll in a MA plan they may have the opportunity to pay an extra monthly premium for additional benefits called...
  19. 38. services of this rider include the ability to speak directly with an expert registered nurse or access the Health information Library.
  20. 39. Medical Insurance
  21. 41. how a member pays their premium
  22. 44. a request to end coverage when the enrollee makes the request before their proposed effective date
  23. 45. the right of the insurer to pursue a third party that caused an insurance loss to the insured
  24. 47. Prescription Coverage
Down
  1. 1. a special way of caring for people who are terminally ill and providing counseling for their families.
  2. 3. Health Maintenance Organization
  3. 4. a request to end coverage or change plans
  4. 6. during this phase of coverage the member is responsible for 100% of their drug costs.
  5. 8. a non-participating provider would also be known as...
  6. 9. Medicare Advantage plans designed for specific needs
  7. 10. Preferred Provider Organization
  8. 11. Responsible for providing live support to customer service
  9. 14. skilled nursing care and rehab services provided on a continuous, daily basis.
  10. 15. a participating provider would also be known as...
  11. 16. a process that we use to give another entity the authority to perform specific functions on our behalf
  12. 18. Medicare-Medicaid Program
  13. 22. state and county code
  14. 26. fitness rider
  15. 27. request that the plan cover a higher tier medication at the cost of the next, lower-tier
  16. 28. Member Initiated Organization Determination
  17. 30. a request to end coverage while the enrollees application is new, or pending
  18. 31. Period after the member has met TrOOP cost for the benefit year.
  19. 35. Online Document Management System
  20. 36. Period occurs annually between October 15 and December 7.
  21. 39. Hospital Insurance
  22. 40. period between the member meeting the initial coverage limit and prior to meeting TrOOP cost
  23. 42. explanation of benefits
  24. 43. Enterprise Document Storage System
  25. 46. out of area