Insurance Chapter 14 Word Scramble

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Question	Answer
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

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