Card Set Information
What is the full name of LA Care's MediCare plan?
LA Care Health Plan Medicare Advantage HMO SNP.
What are the membership requirements for LA Care's MediCare plan?
Live in LA county
65 and older
Under age 65 with certain disabilities
Dually eligible or MEDI/MEDI
Must have MediCare both Part A and Part B
Must have Fully Scope Medi-Cal
Cannot have Medi-Cal Share of Cost
Cannot have ESRD at time of enrollment
Cannot be in Long Term Care at time of enrollment
What is the premium in MedCare Part A for someone who worked 40 quarters or 10 years?
What is the premium for MediCare Part B?
Extra Help of LIS (Low Income Subsidy)
What should LA Care SNP members' co pay level be?
2 or 3
What is the name of LA Care's Dental plan?
How many non transportation trips can a MediCare member have in one benefit year 2013 ____ one way
What is the premium for medicare Part B?
What is the medicatino therapy management program called?
Medication Therapy Management Program "Outcomes Pharmacist"
What is it called when the plan gives their initial decision on whether they will cover a Part A or Part B benefit?
How many days does the plan have to resolve a Part C grievance?
A standard Coverage Determination should be resolved within ____.
72 hours or 3 days.
"Transition" is a part of what part of medicare?
What is transition?
A time when the plan provides non-formulary drugs to new members until the doctor can change the prescription or submit supporting documentation on why the member must stay on the medication.
What is the name of LA Care's pharmacy vendor?
What is the dollar amount for eye glasses in LA Care MA-PD plan?
How many routine podiatry visits can a medicare member have during one benefit year?
Unlimited if medically necessary
Name one BAE document a medicare member may show to confirm their co-pay level.
What must our SNP member do when they want to disenroll out of the plan?
Enroll into another plan
Give the plan a written notice
submit a request via the internet