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