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TRICARE
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WHY DOES TRICARE EXIST?
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Insurance Chapter 14

Chapter 14 Insurance

QuestionAnswer
TRICARE USED TO BE CHAMPUS; STARTED IN 1967
WHY DOES TRICARE EXIST? TO HELP OUT MILITARY PERSONNEL AND THEIR FAMILIES
HOW MANY REGIONS ARE THERE? 4: 3 IN US NORTH, SOUTH, WEST; 1 OVERSEAS
WHO OVERSEES TRICARE? DEPARTMENT OF DEFENSE
HOW MANY BRANCHES OF MILITARY? 7; ARMY, NAVY, MARINE CORPS, AIRFORCE, COAST GUARD, NAT'L OCEANIC AND ATMOSPHERIC ADMINISTRATION, PUBLIC HEALTH SERVICE.
ELIGIBILITY ACTIVE DUTY/RESERVES ACTIVE FOR 30+ DAYS AND FMAILIES. SPOUSES UNMARRIED CHILDREN/STEPKIDS, RETIREES AND FAMILIES, WIDOW/ERS, UNMARRIED CHILDREN OF DEAD, MEDAL OF HONOR FAMILY, EX SPOUSES NOT REMARRIED.
TSC TRICARE SERVICE CENTER
TRICARE SERVICE CENTERS BENEFICIARY SERVICE REP- FIND HEALTHCARE HEALTH CARE FINDER- RN OR DR FIND REFFERALS NURSE ADVISORS-ASK A NURSE 24/7
BSR BENEFICIARY SERVICE REP
MTF MILITARY TREATMENT FACILITIES
DEERS DEFENSE ELIGIBILITY ENROLLMENT SYSTEM. KEEP TRACK OF WHO'S WHERE AND ELIGIBILITY
MILITARY TREATMENT FACILITIES ON/NEAR BASE. THEY PERFER YOU GET TREATMENT THERE.
CASE MANAGER GUIDES PATIENTS
CRITICAL PATHWAY GUIDES YOU THROUGH ALL THE SERVICES YOU NEED IN THE MOST COST EFFECTIVE WAY
PI PROGRAM INTEGRITY OFFICE. MONITORS FRAUD AND ABUSE.
CHAMPVA CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERAN AFFAIRS
CHAMPVA ELIGIBILITY -SPOUSE/CHILD OF VET DISABLED WHILE ON ACTIVE DUTY -SURVIVING SPOUSE OF MILITARY DEATH -SURVIVING SPOUSE/CHILDREN OF DEAD DISABLED -FAMILY OF ONE WHO DIED IN LINE OF DUTY
WHICH IS THE CLOSEST TO CIVILIAN HMO? PRIME IN TERMS OF PCP AND REFFERAL
TRICARE PRIME LOWEST COST; NO DEDUCTIBLES; NO ENROLLMENT FEE BUT MUST ENROLL EVERY YEAR.
TRICARE STANDARD POTENTIALLY MOST EXPENSIVE; NO ANNUAL ENROLLMENT. HAS HMO, POS, OR CIVILIAN DR, SO MOST FLEXIBILITY.
TRICARE EXTRA LIKE CIVILIAN POINT OF SERVICE PLAN. MIDDLE GROUND OF COST. NO ANNUAL ENROLLMENT.
CATASTROPHIC CAP BENEFIT SAYS THE MAX OUT OF POCKET PAY FOR ACTIVE DUTY SPONSORS & FAMILIES IS 1000/YR AND FOR RETIRED 3000/YR
DUAL ELEGIBILITY TRICARE PRIMARY IF ONLY INSURANCE IF 2, IT DEPENDS ON WHO'S BEING SEEN. CHILDREN, BIRTHDAY RULE IF AGE: MEDICARE PRIMARY IF DISABILITY: TRICARE PRIMARY
SUPPLEMENT PLAN TAKES CARE OF SOME OUT OF POCKET COST
TRICARE CONTRACT UNDERWRITTEN IN AURORA, CO. USE CMS-1500
FILING DEADLINE ONE YEAR AFTER DATE OF SERVICE
DEDUCTIBLES PRIME-NONE, BUT WHEN RETIRED REENROLLMENT FEE EXTRA/STANDARD- $150 IND./$300 FAMILY FOR E5 AND ABOVE.
GOVERNMENT FISCAL YEAR 10/01-09/31
CONFIRMING ELIGIBILITY DEERS
11 DR.'S OFFICE
12 HOME
20 URGENT CARE
21 INPATIENT HOSPITAL
22 OUTPATIENT HOSPITAL
23 EMERGENCY ROOM
CHAMPUS, the acronym for Civilian Health an Medical Program of the Uniformed Services, is now called ____________ and was organized to control escalating medical costs and to standardize benefits for active duty families and military retirees. TRICARE
An active duty service member is known as a __________; once retired this former member is called a ____________________ Sponsor; service retiree or military retiree
an individual who qualifies for TRICARE is known as beneficiary
a system for verifying an individuals TRICARE eligibility is called Defense Enrollment Eligibility Reporting system (DEERS)
Mrs. Hancock, a TRICARE beneficiary, lives 2 miles from a Uniformed Service Medical Treatment Facility but needs to be hospitalized for mental health care services at Orlando Medical Center, a civilian hospital. What type of authorization does she require Nonavailbility statement
TRICARE standard and CHAMPVA beneficiaries identification cards are issued to _________ and ___________. Information must be obtained from ___ and _____ of the card on the health insurance claim form dependent 10 years or more; retirees; front; back
Programs that allow TRICARE standards beneficiaries to recieve treatment, services, or supplies from civilian providers are called cooperative care and partnership
for patients whose sponsors is a rank of E4 and below th TIRCARE standards deductible for outpatient care is how much per patient $50 per family: $100
For patients whose sponsor is a rank of E5 and above, the TRICARE standard deductible for outpatient care is how much per patient $150 Per family:$300
For TRICARE standard dependents of active duty members pay what percentage for outpatient services after the deductible has been met? what percent does TRICARE pay? 20%; 80%
For retired members or their dependents on TRICARE standards, what is thier deductible responsibility for outpatient services? Per Person? Per Family? $150; $300
For TRICARE standard retired members or their dependents pay what percent for outpatient services after the deductible has been met? What percent does TRICARE pay? 25%; 75%
A voluntary TRICARE health maintence organization type of option is known as TRICARE Prime
CHAMPVA is the acronym for ___________________, now known as ___________________ Civilian health and medical program of the veterans administration; Dept of Veteran affairs
Those individuals who serve in the US Armed Forces, finish their service, and are honorably discharged are known as veterans
CHAMPVA is not an insurance program but is considered as a Service benefit program
Which individuals are entitles to CHAMPVA medical benefits Husbands, wifes, and unmarried children of a veteran with a total disability, who died because service-connection disability, and who died in the line of duty on active service
the public law establishing a persons right to review and contest inaccuracies in personal medical records is known as the Privacy Act of 1974
An organization that contracts with the government to process TRICARE and CHAMPVA health insurance claims is known as Fiscal intermediary
the time limit for submitting a TRICARE standards or CHAMPVA claim for outpatient service is _____________________________ for inpatient service it is ___________________________ within 1 year from date of service is provided; 1 year from patients discharge from hospital
The TRICARE Fiscal year Begins October 1 and ends September 30
A Health care professional who helps a patient who is under the TRICARE standard program obtain preauthorization for care is called a health care finder (HCF)
TRICARE standard beneficiaries pay a certain amount each year for the cost share and annual deductible, which is known as catastrophic cap
To qualify for TRICARE for Life (TFL) a beneficiary must be a TRICARE beneficiary, eligible for Medicare Part A, enrolled in Medicare Part B
The time for filing a TRICARE standard claim is within 1 year from the date a service is provided
Medically necessary treatment needed for immediate illness or injury that would not result in further disability or death if not treated immediately is known as urgent care True
TRICARE beneficiaries who use nonauthorized providers and recieve medical services may be responsible for their entire bill True
When an individual on TRICARE prime shows you their identification card, it guarantees TRICARE eligibility False
TRICARE Prime Remote (TPR) is a program designed for military retirees and their families False
Beneficiaries of the CHAMPVA program have complete freedom of choice in selecting their civilian health care providers True
Created by: Lea99
 

 



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