MEDICARE STUDY GUIDE COMPREHENSIVE
OVERVIEW 2026
◉ Fund/Fund Administrator.
Answer: Is a person that concentrates on providing a set of services
that support the running and managing of a fund. Specific to Unions.
◉ Fund/Fund Administrator prt.2.
Answer: Does all the back-office financial paperwork, supports the
investment team in the administration of the assigned funds, and
ensures efficient day-to-day functions. May be an outsourced third-
party service.
◉ Private Sector.
Answer: Is part of the economy, sometimes referred to as the citizen
sector, which is owned by private individuals or groups, usually as a
means of enterprise for profit, rather than being owned by the State.
◉ Public Sector.
Answer: Is a part of the economy composed of both public services
and public enterprises.
◉ "The Local".
,Answer: A local union is sometimes referred to as "thee local," a
group of workers who are part of a larger union but focus on the
needs of a specific geographic area or industry.
◉ Third Party Administrator (TPA).
Answer: Is an organization that process insurance claims or manage
certain aspects of employee benefit plans on behalf of a separate
entity. It's also a term used to define organizations within the
insurance industry which administer other services like
underwriting and customer service.
◉ Union.
Answer: A trade union is an association of workers forming a legal
unit or legal personhood, usually called a "bargaining unit" , which
acts as a bargaining agent and legal representative for a unit of
employees in all matters of law or right arising from or in the
administration of a collective agreement.
◉ Coinsurance.
Answer: Percentage of costs of a covered service the patient pays
after they've paid their deductible.
◉ Coinsurance Example.
, Answer: If the plan's allowed amount for an office visit is $100 and
the coinsurance is 20%, the patient is responsible for the $20
coinsurance in addition to the deductible.
◉ Copay.
Answer: A fixed amount for a covered service that is paid by the
patient to the insurance company before the patient receives service
from the provider.
◉ Deductible.
Answer: The amount the patient must pay out of pocket to the
provider before the insurance company will pay any expenses. Once
the deductible is met, regular copays and/or coinsurance apply. It
also may not apply to certain services or prescriptions.
◉ Deductible Example - would not apply.
Answer: Annual Wellness Visit or A Bonus and/or Lifestyle
Medication
◉ Deductible Example - would apply.
Answer: If the Medical plan has a $200 deductible on medical
services, the retiree pays 100% of costs until they reach $200.
◉ Employer Group Waiver Plan (EGWP).
OVERVIEW 2026
◉ Fund/Fund Administrator.
Answer: Is a person that concentrates on providing a set of services
that support the running and managing of a fund. Specific to Unions.
◉ Fund/Fund Administrator prt.2.
Answer: Does all the back-office financial paperwork, supports the
investment team in the administration of the assigned funds, and
ensures efficient day-to-day functions. May be an outsourced third-
party service.
◉ Private Sector.
Answer: Is part of the economy, sometimes referred to as the citizen
sector, which is owned by private individuals or groups, usually as a
means of enterprise for profit, rather than being owned by the State.
◉ Public Sector.
Answer: Is a part of the economy composed of both public services
and public enterprises.
◉ "The Local".
,Answer: A local union is sometimes referred to as "thee local," a
group of workers who are part of a larger union but focus on the
needs of a specific geographic area or industry.
◉ Third Party Administrator (TPA).
Answer: Is an organization that process insurance claims or manage
certain aspects of employee benefit plans on behalf of a separate
entity. It's also a term used to define organizations within the
insurance industry which administer other services like
underwriting and customer service.
◉ Union.
Answer: A trade union is an association of workers forming a legal
unit or legal personhood, usually called a "bargaining unit" , which
acts as a bargaining agent and legal representative for a unit of
employees in all matters of law or right arising from or in the
administration of a collective agreement.
◉ Coinsurance.
Answer: Percentage of costs of a covered service the patient pays
after they've paid their deductible.
◉ Coinsurance Example.
, Answer: If the plan's allowed amount for an office visit is $100 and
the coinsurance is 20%, the patient is responsible for the $20
coinsurance in addition to the deductible.
◉ Copay.
Answer: A fixed amount for a covered service that is paid by the
patient to the insurance company before the patient receives service
from the provider.
◉ Deductible.
Answer: The amount the patient must pay out of pocket to the
provider before the insurance company will pay any expenses. Once
the deductible is met, regular copays and/or coinsurance apply. It
also may not apply to certain services or prescriptions.
◉ Deductible Example - would not apply.
Answer: Annual Wellness Visit or A Bonus and/or Lifestyle
Medication
◉ Deductible Example - would apply.
Answer: If the Medical plan has a $200 deductible on medical
services, the retiree pays 100% of costs until they reach $200.
◉ Employer Group Waiver Plan (EGWP).
