MOA115 CH 12 questions n answers A+
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Describe TRICARE and indicate who is eligible for TRICARE - correct answer ✔✔Insurance
provider that helps military members and their families receive the medical services they need.
If you are an active duty or retired Uniformed Service member. You are the spouse or child of an
active duty or retired Uniformed Service member. You are a National Guard or Reserve
members
Describe CHAMPVA and indicate who is eligible for CHAMPVA. - correct answer ✔✔Is a
comprehensive health care insurance in which the VA shares the cost of covered health care
services and supplies with eligible beneficiaries. To be eligible for CHAMPVA, you cannot be
eligible for TRICARE/CHAMPUS
Explain what is involved when a provider participates in TRICARE. - correct answer ✔✔Providers
who participate in TRICARE or accept assignment agree to file claims for TRICARE beneficiaries,
accept payment directly from TRICARE and accept the TRICARE-allowable charge as payment in
full for their services. Non-network individual providers may participate on a case-by-case basis.
Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary.
Hospitals that participate in Medicare must, by law, also participate in TRICARE for inpatient
care. For outpatient care, they may or may not participate.
Describe what a PPO is. - correct answer ✔✔PPO is short for Preferred Provider Organization A
preferred provider organization (PPO) is a medical care arrangement in which medical
professionals and facilities provide services to subscribed clients at reduced rates. PPO medical
and healthcare providers are called preferred providers.
Explain how a PPO is different from an HMO. - correct answer ✔✔PPO i allows patients to
choose any physician they wish, either inside or outside of their network.HMO is the coverage
restricts patients to a particular group of physicians called a network
rated
Describe TRICARE and indicate who is eligible for TRICARE - correct answer ✔✔Insurance
provider that helps military members and their families receive the medical services they need.
If you are an active duty or retired Uniformed Service member. You are the spouse or child of an
active duty or retired Uniformed Service member. You are a National Guard or Reserve
members
Describe CHAMPVA and indicate who is eligible for CHAMPVA. - correct answer ✔✔Is a
comprehensive health care insurance in which the VA shares the cost of covered health care
services and supplies with eligible beneficiaries. To be eligible for CHAMPVA, you cannot be
eligible for TRICARE/CHAMPUS
Explain what is involved when a provider participates in TRICARE. - correct answer ✔✔Providers
who participate in TRICARE or accept assignment agree to file claims for TRICARE beneficiaries,
accept payment directly from TRICARE and accept the TRICARE-allowable charge as payment in
full for their services. Non-network individual providers may participate on a case-by-case basis.
Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary.
Hospitals that participate in Medicare must, by law, also participate in TRICARE for inpatient
care. For outpatient care, they may or may not participate.
Describe what a PPO is. - correct answer ✔✔PPO is short for Preferred Provider Organization A
preferred provider organization (PPO) is a medical care arrangement in which medical
professionals and facilities provide services to subscribed clients at reduced rates. PPO medical
and healthcare providers are called preferred providers.
Explain how a PPO is different from an HMO. - correct answer ✔✔PPO i allows patients to
choose any physician they wish, either inside or outside of their network.HMO is the coverage
restricts patients to a particular group of physicians called a network
