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