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The Tricare plan that provides benefits under a fee-for-service or cost sharig type of option is known as:
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TRICARE Standard
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The Tricare plan that provides benefits under a fee-for-service or cost sharig type of option is known as:
TRICARE Standard
The TRICARE plan that provides benefits under a preferred provider organization (PPO) type of option is known as:
The TRICARE plan that provides benefits under a health maintenance organization (HMO) type of plan is known as:
THe plan that provides benefits for vetrans with 100% service related disabilities and their families is known as:
An individual who qualifies for TRICARE is known as:
An individual who is in the uniformed services and brings TRICARE coverage to the family is called a:
To be eligible for TRICARE, all sponsors and family members must be enrolled in DEERS, which stands for:
Defense Enrollment Eligibility Reporting System
The TRICARE fiscal year begins on:
October 1
The TRICARE fiscal year ends on:
September 30
If a TRICARE beneficiary receives services from a nonauthorized provider, the physician can bill:
any amount for the service
Authorized TRICARE providers include all of the following:
psychologists, doctor of optometry, & doctor of dental medicine
Authorized nonphysician providers of TRICARE include all of the following:
audiologits, speech therapists, & clinical social workers
Under TRICARE Standard, the category of beneficiaries that pays 25% cost share for outpatient services include all of the following:
former spouses of active duty service members, families of deceased personnel, & retirees from the military
Under TRICARE Standard, the catagory of beneficiaries that pays 20% cost share for outpatient services include:
families of active duty personnel
The annual catastrophic cap for active duty famlies under TRICARE Standard is:
$1000.00 per family
The annual catastrophic cap for retirees under TRICARE Standard is:
$7500.00 per family
Services covered under TRICARE Standard include all of the following :
dental care, durable medical equipment(DME) purchases, & Mental Health care
Noncovered services under TRICARE Standard include all of the following:
chiropractic care, cosmetic surgery, & routine foot care.
When a TRICARE beneficiary cannot receive services from a military treatment facality(MTF), the:
beneficiary must receive a nonavailability statemant(NAS) to receive services from a civilian provider.
Under TRICARE, what does NAS stand for?
Nonavailiability statement
Under TRICARE what does MTF stand for
Military Treatment Facality
The TRICARE plan with the lowest out-of-pocket cost for beneficiaries is:
Uner TRICARE Prime, a PCM is a:
primary care manager
The enrollment for TRICARE Prime is:
$0 for active duty members and $230.00 for retired services members
The TRICARE plan that offers a point-of-services option for care received outside the network is:
The copay for visits to civilian providers under TRICARE Prime is based on:
military rank of the sponsor
Under the point-of-service option of TRICARE Prime, charges for visits to providers outside of the TRICARE Prime network are:
paid 50% by TRICARE & 50% by the beneficiary
Access standards of care for TRICARE Prime enrollees include a drive time of within:
30 minutes of home
Under the access standards of care fro TRICARE Prime enrollees, appointment wait time for routine care should not exceed :
7 days
Under the access standards of care for TRICARE Prime enrollees, the wait time for urgent care should not exceed:
24 hours
Under the access care standards of care for TRICARE Prime enrollees, appointment wait-time for wellness/preventive care should not exceed:
4 weeks
Under TRICARE Prime, the primary care manager provides all of the following services:
referrals to specialists, preventive care, & care for routine illnesses.
Active duty services members are not eligible to enroll in:
Prioty access to medical treatment facilities is given to beneficiaries of:
The cost share for beneficiaries in TRICARE Extra is:
$150.00 deductible & 0% of outpatient charges
Enrollment is not required for:
TRICARE Standard
Specialty care referrals for TRICARE Prime Remote are handled by the:
Healthcare finder
TRICARE beneficiaries older than 65 are eligible for TRICARE for Life if they have:
Medicare Part A & Part B coverage
Fro inpatient care at a civilian network facility, TRICARE Senior Prime members pay:
$11.00 per day
If a beneficiary has both TRICARE for Life & Medicare:
Medicare is primary
For inpatient care at a military facility, TRICARE Senior Prime members pay:
The CHAMPVA program is administered by the:
Health Care Administration
If the Vetrans Administration facility cannot provide necessary medical care, an authorization for services will specify all of the following:
length of the period of treatment, medical services that the VA approves, & amount the VA will pay
The claims processor for all TRICARE for Life claims is:
the Wisconsin Physicians Service
Paper calims for CHAMPVA are submitted to:
the Vetrans Administration Health Administration Center
The TRICARE claims payer for the northern region of the united states is:
Health Net Federal Services
TRICARE claims must be submitted no later than:
1 year from the date of service
Form locator 1a, insured's ID number, should include the:
sponsor's ss#
The Palmetto Government Benefits Administrator provides information to parents of minors about the following:
Emergency surgery
The Palmetto Government Benefits Administration does not provide information to parents of minors for:
The only state that allows private employers to choose wheather or not to provide workers compensation is:
OSHA stands for the:
Occupational Safety & Health Administration
Employers that are regulated by OSHA include:
If an employss feels that his work environment is unsafe, he may file a complaint to the:
Occupational Safety & Health for Private Employers Act (OSHA)
The programs administered by the Office of Workers Compensation Programs include all of the following:
District of Columbia Workers Compensation Act, Division of Energy Employees Occupational Illness Compinsation Program Act, & Federal Employees Compensation Act
The act that covers maritime workers injured or killed on navigable waters of the United States is known as:
Longshore & Harbor Workers Compensation Act
All states provide workers' compensation coverage for:
medical expenses and lost wages
Employers can obtain Workers' compensation insurance policies through all of the following:
private insurance carriers, self insured plans, & state workers compensation funds
Examples of compensable injures include all of the following:
stress injuries caused by work conditions, falls in the company parking lot, & injuries that occur in the company restroom.
A health problem that results from exposure to a workplace health hazard such as fumes is called a(n):
occupational disease
A worker may not receive benefits for a generally covered injury if any of the following are true:
injury occurred while the worker was intoxicted, worker is also receiving social security benefits, & worker failed to follow safety precations.
An employee who is injured on the job, requires treatment, but is not able to return to work within several days, will receive injury:
with temporary disability
An employee who is injured on the job, requires treatment, is not able to return to work, and is not expected to be able to perform his regular job in the future, will receive injury:
with permanent disablity
An employee who is injured on the job, requires treatment, & is able to return to work after retraining, will receive injury:
requiring vocational rehabilitation
The category of workers' compensation benefits that will pay for medical expenses only is called injury
without disablity
The retraining of an employee so that he can return to work after a workers compensation injury is called
vocational rehabilitation
In all categories of workers' compensationclaims, the injured worker will receive compensation for:
medical expenses
The documentation that describes the degree of permanent damage done to the workers body as a whole as a result of a workers' compensation injury is called the:
impairment rating
The form that is used transmission of information about the employss's limitation in performing his job duties is called the:
work status report
The report that affirms that the worker is fit to return to work & resume his normal job responsibilities is called the:
final report
An impartial doctor who helps resolve workers compensation disputes is called a:
designated doctor
A worker & insurance company that decide that a different designated doctor is desired must make an agreement within:
10 days
All communication with a designated doctor about a worker's injuries must be made directly with the:
worker's compendation office handling the claim
Maximum medical improvement is the earlier of the point in time that an injured worker has improved as as likely or:
104 weeks from the date the worker became eligible to receive income benefits.
The permanent physical damage to a workers body from a work related injury or illness is known as:
Ombudsman can provide all of the following services :
a presentation of facs & evidence at dispute resolution proceeding, information about how to appeal a dispute resolution decision, & information to the injured worker to help make decisions.
An injured worker or insurance company must dispute an impairment rating within:
90 days
The four types of workers' compensation benefits include:
medical, income, death, & and burial
Medical benefits for an injured worker begin:
immediately and have no time limit for ending
All of the following are types of income benefits
lifetime income benefits, temporary income benefits, & supplemental income benefits
In order to receive temporary income benefits, an injured worker must have lost some or all income for more than:
7 days
If an injured worker has an impairment rating of 8%, the worker would receive impairment income benefits for:
24 weeks
Supplemental income benefits are paid for a maximum of:
401 weeks
An injured worker is entitles to lifetime income benefits for all of the following conditions:
a physically traumatic injury to the brain resulting in insanity, thrid degree burns covering the majority of either both hands or one hand & the face, & total & permanent loss of sight in both eyes.
The spouse of a worker killed on the job is eligible for death benefits:
until the spouse remarries plus a lump sum payment of 2 years
Dependent children of a worker killed on the job are eligible fo receive deathe benefits until they:
turn 18, or 25 if enrolled as a full time student in college
If an individual has both an employer-sponsored disability plan and the government program:
the government plan is orimary and the employer plan would be supplemental
An individual who becomes disabled not due to an injury at work is eligible for:
income benefits only
Social Security Disablity Insurance is paid for by:
workers' payroll deductions matched by the employer
To qualify for Social Security Disability Insurance, individuals must be unable to work because of a medical condition that is expected to last at least:
1 year
The prosoective approval of health care based solely on medical necessity is called:
Workers compensation claims must be submitted to the insurance carrier on or before the:
95th day after the date of service
A workers' compensation insurance carrier must pay, reduce, deny, or determine to audit a claim no later than:
45th day after receipt of the claim
If a workers' compensation claim is denied, the provider can request a review by:
an independent review organization
An employer who misrepresents the amount of payroll or classification of employees in order to reduce workers' compensation payments commits:
premium fraud
A worker who works full time at an unreported job but draws workers' compensation benefits commits:
benefit fraud
A managed care provider who does not provide a sufficient level of treatment because of a capitation agreement is referred to as committing:
Fees for workers' compensation services that are not provided by managed care plan are based on:
the medicare fee schedule

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