| A | B |
|---|
| Medicare (Federal Level) | Provide hospital and medical expense protection to persons age 65 and older, to persons of any age suffering from end stage renal disease and those who are receiving Social Security benefits |
| Medicare (State Level) | Offers protection to financially needy persons and the state Workers Compensation program provide benefits for eligible workers who are victims of occupational injuries or illnesses |
| Medicare Part A | Hospital Insurance protection |
| Medicare Part B | Medical Insurance protection |
| Medicare Part C | Medicare Advantage - Options (like an HMO or PPO) approved by Medicare and offered by private companies. |
| Medicare Part D | Prescription Drug Benefit |
| Multi-Source Drugs | Brand drugs for which generic drugs are also available |
| True Out-of-Pocket (TROOP) | The cost a person pays out of pocket for eligible Medicare prescription drug coverage |
| The PACE (Programs of All-Inclusive Care for the Elderly) | Combines medical, social, and long-term care services for frail people and is only in states that have chosen to offer it under Medicaid |
| Four Principle benefits under Social Security | Retirement, Survivor, Medicare and Disability |
| Disability Insured Status under SSDIB | Earner has 40 quarters of coverage up to the year they become disabled |
| Definition of disability under SSDIB | The disabled worker must have a “physical or mental condition that prevents him or her from doing any substantial gainful work and it is expected to last at least 12 months or result in death. |
| Primary Insurance Amount (PIA) | The benefit SSDIB will pay based on a calculation of how much a worker has contributed to social security. |
| Health Insurance Portability & Accountability Act – HIPAA | Ensures “portability” of group insurance coverage, and includes various mandated benefits that affect small employers, the self-employed, pregnant women, and the mentally ill |
| Mandated Benefits under HIPPAA | Guarantees coverage for a 48-hour hospital stay for new mothers and their babies after a regular delivery (96 hours for a caesarean section birth). Expands coverage for mental illness by requiring similar coverage for treatment of mental and physical conditions. Further, small employers cannot be denied Group Health insurance coverage because one or more employees are in poor health |
| The Omnibus Budget Reconciliation Act of 1989 – OBRA | Extended the minimum COBRA continuation of coverage period from 18 to 29 months for qualified beneficiaries disabled at the time of termination or reduction of hours. |
| The Tax Equity and Fiscal Responsibility Act of 1982 – TEFRA | Applies to employers with 20 or more employees and is intended to prevent Group Term Life Insurance plans from discriminating in favor of “key employees”, and amended the Social Security Act to make Medicare secondary to Group Health plans. |
| The Employee Retirement Income Security Act of 1974 – | Stringent reporting and disclosure requirements intended to accomplish pension equality, and protects Group Insurance plan participants |
| Cafeteria Plans | A plan in which employees select health benefits from a variety of coverage options, based on their individual and family needs |
| Tricare (formerly CHAMPUS) | Provides benefits for military dependents when no military medical facility is available |
| Workers Compensation | Designed to help the person who suffers from loss of income due to injury or |
| Four types of benefits provide under WC | Medical, Income, Death, Rehabilitation |
