Molina Insurance Terms Questions With 100% Correct Answers.

Long-Term Care Insurance - Answer-Health Insurance that provides funds for people who need home health care, extended health care or nursing home care. Medical Information Bureau (MIB) - Answer-A non-profit organization funded by member life and health insurance companies. Prevents fraud or over-insurance. Health Insurance Counseling & Advocacy Program (HICAP) - Answer-A service provided by volunteers that advises the elderly about insurance needs for no fee. Eligibility / Enrollment Period - Answer-Used in life and health group benefits. Period of time a employee can enroll for benefits without proof of insurability. Broker - Answer-A licensed fire and casualty licensee who represents the client for a fee. Pre-existing condition - Answer-A health condition or sickness that occurred prior to the issuing of a health policy. Preferred Provider Organization - Answer-Provides services at a pre-determined fee. Fully Insured - Answer-Used in Social Security where the worker has paid in for 40 quarters or 10 years. Usual, customary & reasonable - Answer-In health insurance, pays a dollar amount based on the geographical location. Medicare - Answer-Provides health insurance benefits to eligible people over 65 years of age and some disabled people prior to age 65. Health Maintenance Organization (HMO) - Answer-Managed care health insurance with an emphasis on preventative care.Lapse - Answer-Happens when the premium for the policy is not paid and grace period has expired. Worker's Compensation Insurance - Answer-Insurance purchased by employers on their employees in case of work related injuries. Employers are responsible regardless of fault. Foreign Insurance Company - Answer-An insurance company that is incorporate outside the state where it is conducting business. Commission - Answer-Money that is paid to an agent for selling an insurance company's policies. Domestic Insurer - Answer-An insurance company that is organized in the state where it is doing business. Medicare Supplement Insurance - Answer-Fills in gaps left out of Medicare Part A and B. Must include the core benefits (Medi-gap) Agent's appointment - Answer-An agent becomes "appointed" or approved to sell insurance for specific insurance companies. Premium - Answer-The fee a member pays for the insurance policy. Provider - Answer-Healthcare term for anyone providing services to a patient. Examples: doctor, nurse, nurse practitioner, physician's assistant, chiropractor. FFS - Answer-Fee For Service. This plan charges the member a percentage of the costs only when the member uses medical services. The provider gets paid a fixed fee for each services. Some services are paid more than others. Refrerrals - Answer-In HMO plans, the member must have a referral from their Primary Care Provider (PCP) for any specialist for example: a dermatologist. This keeps down costs as the PCP must determine if the specialist visit is warranted. The member must get a referral from the insurance company before booking the visit with a specialist.ANOC - Answer-Annual Notice of Changes. This document is sent to members each year to explain the changes in their plan for the coming year. LIS - Answer-CMS refers to Extra Help as LIS when communicating w insurance carriers, partner organizations, and internally. In most communications w Medicare beneficiaries, CMS and SSA refer to the program as "Extra Help" The Extra Help Medicare program helps pay the costs for premiums, annual deductibles, and prescription cost-sharing related to the Medicare prescription drug Plan. LIPS - Answer-This is the financial assistance folks w Extra Help get to pay their Part D premium (25%, 50%, 75%, 100%). LICS - Answer-CMS also determines their LIS level and their Low-Income Cost-Share (LICS) - i.e. the financial assistance they will get to help pay their Part D cost-share for medications (e.g., $1.25 for generics, $3.75 for brand-name drugs)