Deck 11: Tricare and Champva

Question 1

The government health program serving dependents of active-duty service members, military retirees and their families, some former spouses, and survivors of deceased military members is called _____.

A) TRICARE
B) BlueCross
C) BlueShield
D) Aetna

Answer 1

TRICARE

Question 2

______ is a regionally managed health care program that brings the resources of military hospitals together with a network of civilian facilities and providers to offer increased access to health care services.

A) BlueCross
B) BlueShield
C) Aetna
D) TRICARE

Answer 2

TRICARE

Question 3

TRICARE, which includes managed care options, replaced the program known as ____.

A) BlueShield
B) CHAMPUS
C) Travelers
D) BlueCross

Answer 3

CHAMPUS

Question 4

What is the uniformed service member in a family qualified for TRICARE or CHAMPVA called?

A) member
B) sponsor
C) benefactor
D) provider

Question 5

_____ is a worldwide database of TRICARE and CHAMPVA beneficiaries.

A) Defense Enrollment Eligibility Reporting System
B) Armed Forces Enrollment Eligibility Reporting System
C) Department of Enrollment Eligibility Recording System
D) Military Enrollment Eligibility Recording System

Question 6

Who is the only one that may contact DEERS to verify eligibility because the information is protected by the Privacy Act?

A) sponsors
B) member of armed forces
C) providers
D) government employee

Question 7

DEERS is the abbreviation for ______.

A) Department of Enrollment Eligibility Recording System
B) Defense Enrollment Eligibility Reporting System
C) Department Entitlement Eligibility Recording System
D) Defense Entitlement Eligibility Reporting System

Question 8

Authorized providers are certified by _______ regional contractors to have met specific educational, licensing, and other requirements.

A) BlueCross
B) TRICARE
C) CHAMPUS
D) CDC

Question 9

TRICARE pays only for services rendered by _____.

A) armed forces health care providers
B) benefactor provider
C) authorized providers
D) patron provider

Question 10

_____ is the TRICARE term for the coinsurance that is the amount that is the responsibility of the patient.

A) write off
B) apportion
C) cost-share
D) allocation share

Question 11

Coinsurance for a TRICARE or CHAMPVA beneficiary is called _____.

A) cost-share
B) allocation share
C) apportion share
D) segment share

Question 12

When a nonPAR provider submits a claim, TRICARE pays its portion of the allowable charges andthe payment is mailed to the _________ who is responsible for paying the provider.

A) Federal Assistant Program
B) benefactor
C) underwriter
D) patient

Question 13

For a service to be eligible for payment, it must be medically necessary, delivered at the appropriate level for the condition, and _______.

A) performed on a military base
B) meet professional medical standards
C) performed by primary care physician
D) performed within 25 miles of where the patient lives

Question 14

TRICARE's fiscal year is from _______.

A) January 1 through December 31
B) October 1 through September 30
C) April 1 through March 31
D) August 1 through July 31

Question 15

_________ is a fee-for-service program that replaces the CHAMPUS program.

A) TRICARE Standard
B) Military Coverage Standard
C) Armed Forces Standard
D) Armed Service Standard

Question 16

_____ provides medical services for members and dependents of the uniformed services.

A) Equipped Treatment Facility
B) Military Treatment Facility
C) Fortified Treatment Facility
D) Furnished Treatment Facility

Question 17

When receiving service at an MTF, who is given first priority?

A) children under the age of 12
B) service members on active duty
C) children under the age of 6
D) retired military members

Question 18

The maximum annual amount a TRICARE beneficiary must pay for deductible and cost share is called _____.

A) disastrous cap
B) devastating cap
C) catastrophic cap
D) cataclysmic cap

Question 19

When service is not available at a MTF and the individual seeks treatment from a civilian provider what benefits go into effect?

A) TRICARE Standard
B) Medicaid
C) Medicare
D) BlueCross Blue Shield

Question 20

Under TRICARE Standard, medical expenses are shared between TRICARE and ____.

A) the government
B) the military
C) insurance company
D) the beneficiary

Question 21

A (n) ______ is geographic area served by a hospital, clinic, or dental clinic.

A) environmental area
B) military area
C) catchment area
D) topographical area

Question 22

A (n) ________ is an electronic document stating that the required service is not available at the nearby military treatment facility.

A) NAS
B) SAN
C) SSA
D) NNA

Question 23

NAS is the abbreviation for ________.

A) unavailability statement
B) inaccessibility statement
C) nonavailability statement
D) unobtainability statement

Question 24

______ is a form required when a TRICARE member seeks medical services outside a MTF.

A) inaccessibility statement
B) unobtainability statement
C) nonavailability statement
D) unavailability statement

Question 25

_____ is a basic managed care plan similar to an HMO.

A) TRICARE Prime
B) TRICARE Superior
C) AARP Prime
D) AARP Superlative

Question 26

What is a provider who coordinates and manages the care of TRICARE beneficiaries called?

A) Key Care Manager
B) Chief Care Manager
C) Leading Care Manager
D) Primary Care Manager

Question 27

After enrolling in the plan, individuals are assigned a (n) ______ who coordinates and manages their medical care.

A) PCM
B) PCP
C) GCP
D) MCP

Question 28

Who is automatically enrolled in TRICARE Prime?

A) Children, of active duty members, under eighteen years old
B) Active-duty service members
C) Spouse of retired military members
D) Children of active duty members, under six years old

Question 29

______ provides no-cost health care through civilian providers for service members and their families on remote assignment.

A) TRICARE Prime Remote
B) TRICARE Distant
C) TRICARE Prime Detached
D) TRICARE Separate

Question 30

To qualify for TRICARE Remote, participants must live and work ______.

A) more than 250 miles from the nearest Military Facility
B) more than 100 miles from the nearest Military Treatment Facility
C) more than 50 miles from the nearest Military Treatment Facility
D) more than 100 miles from the nearest Military Facility

Question 31

________ is an alternative managed care plan for individuals who want to receive services primarily from civilian facilities and physicians rather than from military facilities.

A) TRICARE Plus
B) TRICARE Additional
C) TRICARE Superfluous
D) TRICARE Extra

Question 32

Managed care health plan that offers a network of civilian providers is called ____.

A) TRICARE Additional
B) TRICARE Plus
C) TRICARE Extra
D) TRICARE Superfluous

Question 33

________ program is a premium-based health plan available for purchase by certain members of the National Guard and Reserve activated on or after September 11, 2001.

A) TRICARE Standby Select
B) TRICARE Reserve Select
C) TRICARE Emergency Select
D) TRICARE Alternative Select

Question 34

TRS is the abbreviation for _______.

A) TRICARE Reserve Select
B) TRICARE Ready Select
C) TRICARE Replacement Select
D) TRICARE Registration Select

Question 35

If the individual has other health insurance coverage that is primary to TRICARE, which is billed first?

A) TRICARE
B) The insurance carrier
C) the one with the lowest copayment
D) the one the patient selects

Question 36

______ is a program for beneficiaries who are both Medicare and TRICARE eligible.

A) TRICARE for Life
B) TRICARE Retirement Plan
C) TRICARE Seniors Plan
D) TRICARE Silver Plan

Question 37

The Department of Defense program for Medicare-eligible military retirees and Medicare-eligible family members that offers the opportunity to receive health care at a military treatment facility to individuals age sixty-five and over who are eligible for both Medicare and TRICARE is called _______.

A) TRICARE Seniors Plan
B) TRICARE Retirement Plan
C) TRICARE Silver Plan
D) TRICARE for Life

Question 38

______ shares health care costs for families of veterans with 100 percent service-connected disabilities and the surviving spouses and children of veterans who die from service-connected disabilities.

A) CHAMPVA
B) TRICARE Disabilities
C) CHAMPUS
D) TRICARE Limitations

Question 39

CHAMPVA is the abbreviation for ______.

A) Citizen Health and Medicine Program of Department of Veterans Affairs
B) Civilian Health and Medical Program of the Department of Veterans Affairs
C) Community Healthiness and Medical Program of Veterans Affairs
D) Condition Health and Medicine Program of Department of Veterans Affairs

Question 40

Who is responsible for determining eligibility for the CHAMPVA program?

A) Veterans Administration
B) Insurance Company
C) Social Security Administration
D) Federal Bureau of Retirement

Question 41

_______ is a card that each eligible beneficiary of CHAMPVA must possess to be used at the provider's office checks to determine eligibility.

A) Wellbeing Card
B) Healthiness Card
C) Authorization Card
D) Stipulation Card

Question 42

When the individual has other health insurance benefits in addition to CHAMPVA, which is usually primary payer?

A) insurance company
B) CHAMPVA
C) TRICARE SILVER
D) BlueCross

Question 43

The maximum amount CHAMPVA will pay for a procedure is called ____.

A) CHAMPVA Determined Allowable Charge
B) CHAMPVA Concentrated Allowable Charge
C) CHAMPVA Maximum Allowable Charge
D) CHAMPVA Regulated Allowable Charge

Question 44

________ extends CHAMPVA benefits to spouses or dependents that are age sixty-five and over.

A) CHAMPVA for Life
B) CHAMPVA Seniors Plan
C) CHAMPVA Retirement Plan
D) CHAMPVA Silver Plan

Question 45

When a patient uses a TRICARE participating provider, who files the claim following HIPAA regulations?

A) TRICARE
B) participating provider
C) the patient
D) the insurance company

Question 46

The worldwide database of TRICARE and CHAMPVA beneficiaries is abbreviated___.

A) DEERS
B) PCM
C) CHAMPUS
D) MTF

Question 47

What may a TRICARE beneficiary who lives within a certain distance of a military hospital be required to file before entering a civilian hospital for inpatient nonemergency care?

A) patient statement
B) nonavailability statement
C) referral
D) nothing is required

Question 48

The uniformed service member in a family qualified for TRICARE is called the ____.

A) sponsor
B) subscriber
C) primary care manager
D) provider

Question 49

The program that provides benefits for veterans with a 100 percent disability, as well as for their dependents or survivors, is called _______.

A) TRICARE
B) DEERS
C) PCM
D) CHAMPVA

Question 50

The provider who coordinates care of TRICARE beneficiaries is called the ____.

A) sponsor
B) subscriber
C) primary care manager
D) agent

Question 51

TRICARE is the Department of Defense's health insurance plan for _____.

A) military personnel and their families
B) federal government employees
C) state government employees
D) CHAMPUS replaced TRICARE

Question 52

TRICARE benefits spouses and children of active-duty service members, who are called _____.

A) beneficiaries
B) subscribers
C) sponsors
D) members

Question 53

TRICARE Standard covers medical services provided by a civilian physician when the individual cannot receive treatment from a _____.

A) physician
B) sponsor
C) primary care physician
D) military treatment facility

Question 54

Under TRICARE Prime, individuals are assigned a Primary Care Manager when they ______.

A) join the military
B) enroll in the plan
C) retire from the military
D) have served in the military for 5 years

Question 55

The enrollment fee to join TRICARE Extra costs ____.

A) $0
B) $10
C) $100
D) $500

Question 56

Due to the large number of military reservists who have been called up for active duty, the Department of Defense implemented _______.

A) TRICARE Extra
B) TRICARE Prime
C) TRICARE Reserve Select
D) TRICARE Standard

Question 57

The program that provides no-cost health care through civilian providers for service members and their families who live and work more than 50 miles from the nearest military treatment facility is _____.

A) TRICARE Extra
B) TRICARE Prime
C) TRICARE Prime Remote
D) TRICARE Standard

Question 58

The government program that helps to pay health care costs for families of veterans who are totally and permanently disabled because of service-related injuries is ____.

A) CHAMPUS
B) TRICARE Prime
C) TRICARE Extra
D) CHAMPVA

Question 59

Which HIPAA rules must TRICARE and CHAMPVA programs follow?

A) Concealment Rule
B) Discretion Rule
C) Electronic Health Care Transaction and Code Sets
D) Preference Rule

Question 60

The plan that offers health care at a military treatment facility to individuals age sixty-five and over who are eligible for both Medicare and TRICARE is _____.

A) TRICARE Extra
B) TRICARE for Life
C) CHAMPVA for Life
D) TRICARE Prime

Question 61

The plan that extends CHAMPVA benefits to spouses or dependents who are age sixty-five and over is _______.

A) TRICARE for Life
B) TRICARE Extra
C) CHAMPVA for Life
D) Medicare

Question 62

TRICARE and CHAMPVA claims must be filed within how long from the date services were provided?

A) 30 days
B) 90 days
C) one year
D) two years

Question 63

The TRICARE catastrophic cap is a (n) ______.

A) annual amount
B) monthly amount
C) biannual amount
D) there is no time limit

Question 64

In the TRICARE and CHAMPVA programs, cost share has the same meaning as ___.

A) copayment
B) coinsurance
C) deductible
D) premium

Question 65

The TRICARE for Life program offers ______.

A) preventive services and prescription drug benefits
B) elective surgery
C) prescription benefits from Canada
D) optional services

Question 66

______ covers medical services provided by a civilian physician when the individual cannot receive treatment from a military treatment facility.

A) CHAMPVA
B) TRICARE Standard
C) Medicare
D) Medicaid

Question 67

After enrolling in TRICARE Prime, each individual is assigned a (n) ____.

A) Primary Care Manager
B) Case Manager
C) Situation Manager
D) Circumstance Manager

Question 68

TRICARE claims are submitted by participating providers to the contractor for the region based on

A) patient's phone number
B) patient's work location
C) patient's cell number

Question 69

The portion of every charge that a TRICARE or CHAMPVA beneficiary must pay is called the _______.

A) copayment
B) coinsurance
C) costshare
D) deductible