CCG & Terminology Trainer Flashcards
MOOP
What is the definition
Maximum out of pocket
The maximum dollar amount an insured can be responsible for and covered products or services in a set time period usually a plan year
OOP
What do the letters stand for
Out-of-pocket
OOP
What is the definition
Out of pocket
If the plan has a deductible, the subscriber pays 100% out of pocket until it is satisfied.
MOOP
What do the letters stand for
Maximum out-of-pocket
Subscribe
The primary cardholder who is enrolled for single or family coverage and whose dependence may also be eligible for benefits
Copayment
A specific flat rate dollar amount that the member must pay each time they get a prescription
Co- insurance
A preset Dollar amount the member pays prior to receiving the full benefit
Benefit or plan year
The 12 month. And then the plan would start over
EOB
What do the letters stand for?
Explanation of benefits
EOB
What is the definition
Exclamation of benefits
Documentation explaining how the benefit was administered for service and products rendered
TPA
What do the letters stand for?
Third-party administrator
TPA
What is the definition?
Third-party billing
Third party administrator managers that administration of the benefit for an employer or health plan Navitus is not a TPA this is only for dental vision and health care.
CPI
What do the letters stand for?
Pharmaceutical care incentive
CPI
What is the definition?
Pharmaceutical care incentive
It is a incentive program that will reimbursed pharmacist for part of the time they spend counseling patients
ACA
What do the letters stand for?
Affordable care act
ACA
What does this mean?
The affordable care act
means it is a requirement to cover some contraceptives at a zero co-pay. There are some exceptions the grandfathered versus the non-grandfathered in relations to the affordable healthcare
Grandfathered versus non-grandfathered in relation to the health care reform what does this mean?
This one is for grandfathered
Grandfathering,
In relation to healthcare reform means that the client chooses to maintain the benefit they held prior to January 1 of 2013 affordable care act changes that require coverage of certain contraceptive products at a zero co-pay.
Grandfathered versus non-grandfathered in the relation to healthcare reform
This one is non-grandfathered
Non-grandfathered means that they will be covered at zero co-pay
