Terms Covering Tri-Care, Tech Act and Other Health Insurance Information

Health Insurance Glossary Page 8

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Spina Bifida Orange Benefits Act. A federal law that was passed in 1996 that provides benefits for children and adults with spina bifida whose biological parents were exposed to Agent Orange during the Vietnam conflict.

Tech Act Programs. Programs established under the 1988 federal Technology-Related Assistance for Individuals with Disabilities Act.

Traditional Plan. A health insurance plan that allows a participant to choose any medical provider; following treatment, the participant pays the bill and sends it to the insurer for reimbursement.

Tri-Care Extra. A PPO option within the CHAMPUS program, part of the standard CHAMPUS plan.

Tri-Care Prime. A managed care option within the CHAMPUS program.

Tri-Care Standard. The traditional CHAMPUS program. TTY. A teletype writer; designed to enable the deaf to communicate by telephone.

UCR (Usual and Customary Rate). The maximum amount that an insurer will generally consider for reimbursement; it is usually determined by a statistical analysis of claims for a particular procedure in a specific geographic area.

Yearly Co-payment Maximum. The maximum amount that an individual has to pay each year before the insurer will provide reimbursement for covered major medical claims at the 100% rate.

Yearly Individual Deductible. The amount an individual needs to pay each year before the insurer will generally begin to pay major medical claims.

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