A list that describes all the medications covered under a specific insurance plan

Trade, brand, or proprietary drug name

Name of drug when first patented and marketed by owner or manufacturer

HMO( Health Maintenance Organization )

Primary care physician (PCP): Customer is required to choose this person to address medical needs

PPO ( Preferred Provider Organization )

Patient pays more out-of-pocket expenses Chooses physician from list of contracted providers or any wanted No requirements for PPO Examples: Aetna, Anthem Blue Cross Blue Shield, State Farm, United Healthcare Copay higher, deductible

Hospital stays, skilled nursing facilities, hospices, various therapies

Medicare Part BInformation on Prescription Cards

Doctor visits, lab diagnostics, outpatient mental health, physical therapy, medical equipment

Obtain additional insurance through private HMOs

Coverage of medicine; diabetic insulin and syringes

Optional insurance plans purchased through privately owned insurance companies Fills the gap in coverage of Medicare Cannot be used with Medicare Part C There are 12 policy options

For low-income residents, uninsured pregnant women, persons with disabilities Can be used in conjunction with Medicare

for military personnel and their families Covered by Defense Health Agency Eligibility tracked through Defense Enrollment Eligibility Recruiting System (DEERS)

Paid by employers to cover injuries of employee on the job Eligible coverage if work-related injury Patient does not pay for anything

Information on Prescription Cards

Pharmacy benefit international identification number (RxBIN) Pharmacy benefit processor control number (PCN) Prescription group number Identification number Person code DOB Sex code

Basic Information for Patient Profiles

Patient’s name DOB Address Phone number Gender Allergies Insurance provider’s information OTC medications Diagnoses or disease states

All claims processed over a computerized system If rejected, pharmacy must troubleshoot or have patient pay full price Coverage depends on: Average wholesale price (AWP) Copay fee

Help

Options

focusNode

Didn't know it?
click below

Knew it?
click below

Don't Know

Remaining cards (0)

Know

retry

shuffle

restart

0:00

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Insurance and Invent

Chapter 13 Part 1

Question	Answer
Drug Formularies	A list that describes all the medications covered under a specific insurance plan
Non Formulary Drugs
Generic Name or Non - proprietary name
Trade, brand, or proprietary drug name	Name of drug when first patented and marketed by owner or manufacturer
HMO( Health Maintenance Organization )	Primary care physician (PCP): Customer is required to choose this person to address medical needs
PPO ( Preferred Provider Organization )	Patient pays more out-of-pocket expenses Chooses physician from list of contracted providers or any wanted No requirements for PPO Examples: Aetna, Anthem Blue Cross Blue Shield, State Farm, United Healthcare Copay higher, deductible
Medicare	Patient pays more out-of-pocket expenses Chooses physician from list of contracted providers or any wanted No requirements for PPO Examples: Aetna, Anthem Blue Cross Blue Shield, State Farm, United Healthcare Copay higher, deductible
Medicare Part A	Hospital stays, skilled nursing facilities, hospices, various therapies
Medicare Part BInformation on Prescription Cards	Doctor visits, lab diagnostics, outpatient mental health, physical therapy, medical equipment
Medicare Part C	Obtain additional insurance through private HMOs
Medicare Part D	Coverage of medicine; diabetic insulin and syringes
Medigap	Optional insurance plans purchased through privately owned insurance companies Fills the gap in coverage of Medicare Cannot be used with Medicare Part C There are 12 policy options
Medicaid	For low-income residents, uninsured pregnant women, persons with disabilities Can be used in conjunction with Medicare
TRICARE	for military personnel and their families Covered by Defense Health Agency Eligibility tracked through Defense Enrollment Eligibility Recruiting System (DEERS)
Workers Compensation	Paid by employers to cover injuries of employee on the job Eligible coverage if work-related injury Patient does not pay for anything
Information on Prescription Cards	Pharmacy benefit international identification number (RxBIN) Pharmacy benefit processor control number (PCN) Prescription group number Identification number Person code DOB Sex code
Basic Information for Patient Profiles	Patient’s name DOB Address Phone number Gender Allergies Insurance provider’s information OTC medications Diagnoses or disease states
Adjudication	All claims processed over a computerized system If rejected, pharmacy must troubleshoot or have patient pay full price Coverage depends on: Average wholesale price (AWP) Copay fee

Created by: mparcasio

"Know" box contains:
Time elapsed:
Retries: