Term | Definition |
If patients are covered by two insurance plans, the health insurance professional may have to submit a primary claim and a _____ claim. | secondary |
The prescription plan under CHAMPVA is considered “_____________,” and beneficiaries typically do not have to sign up for a Medicare Part D plan. | credible coverage |
If treatment is unavailable at an MTF and it becomes necessary for an individual to seek treatment in a civilian hospital, he or she sometimes must obtain a | nonavailability statement |
The acronym for the computerized data bank that lists all active and retired military service members is | DEERS |
Most state laws exclude coverage for injuries sustained while an employee is commuting to and from work. This is referred to as the _____ rule. | coming-and-going |
The worldwide healthcare system for the military is currently called | TRICARE |
TRICARE’s preferred provider option (PPO) is | TRICARE Extra |
The facility that handles TRICARE claims is called a | claims processor |
Which act provides workers’ compensation to employees of private maritime employers? | Longshore and Harbor Workers’ Compensation Act |
An individual responsible for investigating and resolving workers’ complaints against the employer is called a/an | ombudsman |
If there are no problems with the claim, the contractor should send a written notice, known as an __________, in about 1 month. | EOB |
An alternative to the suspension file is to record claims information on a columnar form called a/an | insurance claims register |
A maximum benefit amount paid for short-term disability policies is called a _____ cap. | benefit |
An explanation of benefits is often referred to as a/an | remittance advice |
Workers’ compensation insurance is considered to be “no-fault insurance,” which means | benefits are paid regardless of who is to blame for the injury |
An employee who is not entitled to paid holiday or sick leave and has no expectation of ongoing employment | Casual employee |
The service member, whether in active duty, retired or deceased | Sponsor |
Annual upper limit a family will have to pay for TRICARE Standard-covered services in any fiscal year | Catastrophic cap |
The goal is to return the injured worker to some sort of suitable, gainful employment that he or she can reasonable achieve | Vocational rehabilitation |
Provides workers’ compensation for nonmilitary federal employees | Federal Employment Compensation Act |
Serves as evidence of prior healthcare coverage under TRICARE | Certificate of credible coverage |
A series of files set up chronologically and labeled according to the number of days since the claim was submitted | Suspension files |
A treatment that focuses on helping individuals achieve independence in all areas of their lives. | Occupational therapy |
Income from employment | Earned income |
Organization that has agreed to provide services under the Ticket to Work program guidelines. | Employment network |