Health Insurance

Results: 26

• CHIP Programs (1)
  NL-5000.1500

  CHIP Programs

  NL-5000.1500
  
  Organizations that help families obtain health insurance for their children under the State Children's Health Insurance Program (SCHIP), a program that is jointly financed by the federal and state governments and administered by the states. In some states, CHIP is an expansion of the Medicaid program and allows children of parents with higher incomes than were allowable in the past to participate and receive health insurance through Medicaid. In other states, CHIP is a separate program from Medicaid and covers children whose parents have incomes that are higher than the state's Medicaid eligibility levels. Within broad Federal guidelines, each state determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. The insurance pays for doctor visits, immunizations, hospitalizations and emergency room visits, but additional services may be available depending on the benefits defined by the state. Depending on the family's income, insurance premiums and co-pays may apply.
• Dental Insurance (1)
  LH-3000.1700

  Dental Insurance

  LH-3000.1700
  
  Organizations that issue insurance policies which reimburse policy holders for all or a portion of the costs associated with diagnostic and preventive dental care, restorative work, oral surgery, crowns, inlays, dentures and other dental work.
• Disability Benefits (1)
  NS-1800

  Disability Benefits

  NS-1800
  
  Public social insurance programs that replace income lost because of a physical or mental impairment severe enough to prevent a previously employed person from working. Monthly cash benefits are paid to the eligible individual with a disability and his or her eligible dependents throughout the period of disability.
• General Health Insurance Information/Counseling (1)
  LH-3500.2500

  General Health Insurance Information/Counseling

  LH-3500.2500
  
  Programs that help people in need of health insurance evaluate the full range of alternatives available to them and select the coverage that best meets their needs.
• Health Insurance Information/Counseling (1)
  LH-3500

  Health Insurance Information/Counseling

  LH-3500
  
  Programs that offer information and guidance for people who need assistance in selecting appropriate health insurance coverage and which may also answer questions about health insurance benefits and help people complete insurance forms.
• Health Insurance/Dental Coverage (9)
  LH-3000

  Health Insurance/Dental Coverage

  LH-3000
  
  Organizations that issue insurance policies which reimburse policy holders for all or a portion of the cost of hospital, medical or dental care or lost income arising from an illness or injury.
• Home/Community Based Care Waiver Programs (5)
  NL-5000.5000-800.30

  Home/Community Based Care Waiver Programs

  NL-5000.5000-800.30
  
  State Medicaid programs operating under a waiver that permits them to utilize Medicaid funds, normally available only to pay for care in a skilled nursing, intermediate care or other long-term care facility, to provide case management and home care services for eligible individuals as a means of avoiding premature institutionalization. Individuals must be Medicaid eligible, must be certified or certifiable for long-term care, and must meet other criteria as specified in the state waiver, e.g., age and disability requirements. States are allowed to make waiver services available to people at risk of institutionalization, without being required to make waiver services available to the Medicaid population at large. States use this authority to target services to particular groups, such as elderly individuals, technology-dependent children, seriously emotionally disturbed children, or persons with intellectual disabilities or developmental disabilities; or on the basis of disease or condition, such as AIDS. Covered services depend on the population(s) covered in the waiver. Those for older adults and adults with disabilities, for example, include but are not limited to case/care management, homemaker services, home health aides, personal care, adult day health care, habilitation and respite care. Services for children may also include wraparound facilitation/community support, independent living/skill building services and parent support and training. Every state has its own set of waiver programs that are unique.
• Insurance Complaints (1)
  DD-1500.4800

  Insurance Complaints

  DD-1500.4800
  
  Programs that accept and, where possible, attempt to resolve complaints regarding the licensing, services, unethical or improper conduct of personnel or other inappropriate business practices of companies that sell insurance or settle insurance claims.
• Insurance Issues (1)
  YZ-3450

  Insurance Issues

  YZ-3450
  
  Programs that provide information and/or services that deal with the topic of insurance.
• Insurance Sales Agents (1)
  YO-7900.3300

  Insurance Sales Agents

  YO-7900.3300
  
  Individuals who help other individuals, families, and businesses select insurance policies that provide the best protection for their lives, health and property. Insurance agents may work for a single insurance company or may represent several companies and place insurance policies for their clients with the company that offers the best rate and coverage. In either case, insurance sales agents prepare reports, maintain records, seek out new clients and, in the event of a loss, help policyholders settle their insurance claims. Some agents also offer their clients financial analysis or advice on ways the clients can minimize risk.
• Long Term Care Insurance (3)
  LH-3000.4500

  Long Term Care Insurance

  LH-3000.4500
  
  Private insurance companies, government programs and public/private partnership programs that issue individual and group insurance plans or policies which pay for nursing facility care, home health care, adult day health care, respite care, hospice care and/or home modifications to eliminate barriers for people who are chronically ill. Long-term care policies cover all levels of care including skilled, intermediate and custodial. Benefits may be triggered when an individual's doctor orders care, when s/he has some cognitive impairment or if s/he is unable to perform certain activities of daily living independently such as bathing, dressing, eating and toileting. A limited number of states participate in public/private partnerships which have provisions to protect participants from becoming impoverished in order to become eligible for Medicaid long-term care benefits.
• Medicaid (5)
  NL-5000.5000

  Medicaid

  NL-5000.5000
  
  A combined federal and state program administered by the state that provides medical benefits for individuals and families with limited incomes who fit into an eligibility group that is recognized by federal and state law. Each state sets its own guidelines regarding eligibility and services within parameters established at the federal level. Many people are covered by Medicaid, though within these groups, certain additional requirements must be met. Eligibility factors include people's age, whether they are pregnant, have a disability, are blind, or aged; their income and resources (like bank accounts, real property or other items that can be sold for cash); and whether they are U.S. citizens or lawfully admitted immigrants. Families who are receiving benefits through TANF and individuals who receive SSI as aged, blind and disabled are categorically eligible groups. The rules for counting a person's income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes, for people served under the Medicaid Waiver program, for people served by Program of All-Inclusive Care for the Elderly (PACE) programs and for children with disabilities living at home. Medicaid makes payments directly to a person's health care provider; and some recipients may be asked to pay a small part of the cost (co-payment) for some medical services. Most states have additional "state-only" programs to provide medical assistance for specified low-income persons who do not qualify for the Medicaid program.
• Medicaid Fraud Reporting (2)
  FN-1700.9500-500

  Medicaid Fraud Reporting

  FN-1700.9500-500
  
  Programs that provide a hotline, website or other mechanisms that Medicaid recipients and the public at large can use to report recipients or health care providers that make false statements or representations which result in an unauthorized payment by the Medicaid program to themselves or another. Examples of fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies or equipment not furnished; misrepresentation of the dates and descriptions of services furnished, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items.
• Medicaid Information/Counseling (1)
  LH-3500.4900

  Medicaid Information/Counseling

  LH-3500.4900
  
  Programs that offer information and guidance for people who may qualify for Medicaid with the objective of empowering them to make informed choices. Included may be information about the eligibility requirements for Medicaid and how to apply; Medicaid Managed Care options, benefits covered (and not covered) by the program including long-term care and home and community-based services; the payment process for co-payments; Medicaid "spend-down" (the process of reducing income and/or assets an individual possesses in order to qualify for Medicaid); and information about Medicare and the linkages between the two programs. The program may also answer questions about Medicaid services available to individuals with disabilities; and some programs may help people who qualify with enrollment and provide referrals to providers who accept State Medicaid health insurance.
• Medicare Advantage Plan Enrollment (1)
  NS-8000.5000-480

  Medicare Advantage Plan Enrollment

  NS-8000.5000-480
  
  Sponsors of Medicare Advantage (MA) health care plans approved by Medicare that accept applications for enrollment in one of the Medicare Advantage options that offer Part A (hospital) and Part B (medical) coverage. Prescription drug coverage may also be included. Many MA Plans offer extra benefits (e.g., vision coverage, dental coverage, hearing care, wellness services and nurse line support) and may offer lower co-payments than Original Medicare. However, MA plans may require participants to use physicians, hospitals and other providers that are part of the plan's provider network. Medicare Advantage Plans include: Medicare Health Maintenance Organization (HMO) Plans; Preferred Provider Organization (PPO) Plans; Private Fee-for-Service (PFFS) Plans; Medicare Special Needs Plans (SNP); and Medicare Savings Account Plans (MSA Plans). To join a MA Plan, an individual must be enrolled in Medicare Part A and Part B. In addition to paying the monthly Part B premium required by Medicare, MA Plans may require a monthly premium for the extra benefits provided by the Plan. Information about Medicare Advantage plans is available in the "Welcome to Medicare" handbook people receive when they enroll, by calling 1-800-MEDICARE or by using the Plan Finder on the Medicare website.
• Medicare Appeals/Complaints (2)
  NS-8000.5000-520

  Medicare Appeals/Complaints

  NS-8000.5000-520
  
  Entities that are responsible for hearing appeals and resolving grievances that have been filed by people who have applied for or are receiving benefits through the Medicare program (including the Part D Prescription Drug Benefit and the subsidies that are available to low income beneficiaries enrolled in the Part D Benefit) and believe that an adverse action has been wrongly taken, including coverage denials, discrimination, violation of rights and/or failure to take an appropriate action.
• Medicare Beneficiaries (1)
  YC-5100

  Medicare Beneficiaries

  YC-5100
  
  Individuals, age 65 and older or younger than age 65 with a disability, who have hospital, medical and prescription drug insurance through the federally-funded Medicare program.
• Medicare Fraud Reporting (1)
  FN-1700.3350-550

  Medicare Fraud Reporting

  FN-1700.3350-550
  
  Programs that provide a hotline, website or other mechanisms that persons with Medicare and the public at large can use to report health care providers or beneficiaries who make false statements or representations which result in an unauthorized payment by the Medicare program to themselves or another. Also included are organizations that accept and investigate reports about fraudulent entities that misrepresent themselves as approved Medicare Part D Prescription Drug Plans; approved plans that use aggressive marketing tactics, discriminate against a beneficiary (e.g., prevent them from signing up for a plan based on their age, health status, race or income), entice beneficiaries to enroll in a more costly plan than they require, or erroneously charge beneficiaries for medication provided under the plan they have selected; or pharmacies that provide a different drug than the one prescribed by the physician. Examples of Medicare fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies, equipment or medications not provided; misrepresentation of the dates and descriptions of services or medications provided, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items. Also included are programs that provide consumer education, counseling and assistance with the objective of helping people identify instances of fraud.
• Medicare Information/Counseling (3)
  LH-3500.5000

  Medicare Information/Counseling

  LH-3500.5000
  
  Programs that offer information and guidance for older adults and people with disabilities regarding their health insurance options with the objective of empowering them to make informed choices. Included is information about benefits covered (and not covered); the payment process; the rights of beneficiaries; the process for eligibility determinations, coverage denials and appeals; consumer safeguards; and options for filling the gap in Medicare coverage (Medigap supplement insurance). Also available is information relating to an individual's eligibility for benefits and assistance with evaluating their options and enrolling in a Medicare plan (A, B, C, and/or D) that will best meet their needs. These programs also address coordination of benefits when beneficiaries have other types of health insurance in addition to Medicare (e.g. Medicaid, employer coverage or retiree insurance) and provide counseling and assistance regarding the subsidies that are available to low income beneficiaries enrolled in the Part D Prescription Drug Benefit (which help pay for Part D premiums and reduce the cost of prescriptions at the pharmacy) and the Medicare Savings Programs which help pay for Medicare out-of-pocket costs. They may also provide information about Medicaid and the linkages between the two programs, referrals to appropriate state and local agencies involved in the Medicaid program, information about other Medicare-related entities (such as peer review organizations, Medicare-approved prescription drug plans, Medicare administrative contractors), and assistance in completing related Medicare insurance forms.
• Medicare Insurance Supplements (11)
  LH-3000.5000

  Medicare Insurance Supplements

  LH-3000.5000
  
  Organizations that offer insurance policies which pay for some health care costs that are not covered by Medicare. These generally include Medicare deductibles and co-payments, but not long-term care.
• Medicare Part D Prescription Drug Plan Enrollment (1)
  NS-8000.5000-660

  Medicare Part D Prescription Drug Plan Enrollment

  NS-8000.5000-660
  
  Private Prescription Drug Plans that are approved by the Centers for Medicare & Medicaid Services (CMS) to offer prescription drug coverage for Medicare beneficiaries and accept applications for enrollment. Beneficiaries may also select a plan using the online enrollment application available on the CMS website. The application provides a tool for comparing different plans which vary in costs and specific drugs covered.
• Medicare Savings Programs (2)
  NL-5000.5000-700

  Medicare Savings Programs

  NL-5000.5000-700
  
  Programs that cover all or a portion of Medicare costs for low income Medicare beneficiaries with limited resources/assets. Medicare Savings Programs (MSPs) are administered by Medicaid medical assistance offices, pay all or a portion of Medicare premiums and may pay Medicare deductibles and co-insurance. Included are the Qualified Medicare Beneficiary (QMB) program that pays Medicare premiums, deductibles and co-payments for people with combined incomes that do not exceed 100 percent of the federal poverty level; the Specified Low-Income Beneficiary (SLMB) program that pays Medicare Part B premiums for people with combined incomes between 100 and 120 percent of the federal poverty level; the Qualifying Individuals (QI) program that pays Medicare Part B premiums for people with combined incomes 120 and 135 percent of the federal poverty level; and the Qualified Disabled and Working Individuals (QDWI) program that helps pay the Part A premium for individuals under age 65 who have a disability and are working, have lost their premium-free Part A when they returned to work, are not receiving medical assistance from their state and meet income and resource limits required by their state. The QI program is a limited program (block grant to states), and is available on a first come, first serve basis. Asset/resource limits for these programs are adjusted each year and may vary by state.
• Railroad Workers Disability Insurance (1)
  NS-1800.6500

  Railroad Workers Disability Insurance

  NS-1800.6500
  
  A program administered by the Railroad Retirement Board that provides disability benefits for people who have at least 10 years of railroad employment and become totally disabled, and for individuals who have at least 20 years of service and become partially disabled.
• State/Local Health Insurance Programs (2)
  NL-5000.8000

  State/Local Health Insurance Programs

  NL-5000.8000
  
  Programs that provide health insurance for people who do not qualify for Medicaid, do not have access to insurance provided by an employer or cannot afford privately purchased health insurance. Services covered by these programs vary by state but generally include hospitalization, physician services, emergency room visits, family planning, immunizations, laboratory and x-ray services, outpatient surgery, chiropractic care, prescriptions, eye exams, eye glasses and dental care. Other services may include alcohol and drug treatment, mental health services, medical and equipment and supplies and rehabilitative therapy. Eligibility requirements also vary. Included are state and/or local government health insurance programs which may be administered by the state or at the local level, and public/private partnerships between state and/or local government entities and health insurance companies or other private organizations. Health care is generally provided through participating managed care plans in the area.
• TRICARE Standard (1)
  NS-8000.9000-850

  TRICARE Standard

  NS-8000.9000-850
  
  TRICARE Standard, formerly known as CHAMPUS, provides heath care benefits for active duty members of the uniformed services including the Coast Guard, NOAA and the Public Health Service; qualified family members; retirees and their family members; and the spouses and children of deceased active duty and retired personnel. The program is one of three TRICARE options and helps to pay the costs of inpatient, outpatient and emergency medical services obtained from civilian sources. Beneficiaries pay an annual deductible and a share of the costs and may select the authorized civilian health care provider of their choice. There is no enrollment required for families. TRICARE is a regional managed care program administered by the Department of Defense (DoD) Health Affairs Office in collaboration with civilian contractors.
• Veteran/Military Health Insurance (2)
  NS-8000.9000

  Veteran/Military Health Insurance

  NS-8000.9000
  
  Programs administered by the Department of Defense (DoD) Health Affairs Office or the U.S. Department of Veterans Affairs that provide health benefits coverage for eligible military personnel, eligible veterans and eligible dependents.