Glossary

Used when no comparable, existing test is available. Carrier specific amounts are used to establish a national limitation amount for the following year.

The costs or services that are not covered under the Original Medicare Plan.

In a managed care plan, this is another name for the primary care doctor. This doctor gives you basic medical services and coordinates proper medical care and referrals.

The General Enrollment Period is January 1 through March 31 of each year. If you enroll in Premium Part A or Part B during the General Enrollment Period, your coverage starts on July 1.

Funds held by the Treasury of the United States, other than revenue collected for a specific trust fund (such as SMI) and maintained in a separate account for that purpose. The majority of this fund is derived from individual and business income taxes.

Income to the SMI trust fund from the general fund of the Treasury. Only a very small percentage of total SMI trust fund income each year is attributable to general revenue.

A prescription drug that has the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Assets or liabilities that arise from transactions between a federal entity and a nonfederal entity.

The Balanced Budget and Emergency Deficit Control Act of 1985.

A complaint about the way your Medicare health plan is giving care. For example, you may file a grievance if you have a problem calling the plan or if you are unhappy with the way a staff person at the plan has behaved toward you. A grievance is not the way to deal with a complaint about a treatment decision or a service that is not covered (see Appeal).

Information about grievances and complaints submitted to the health plan.

The total dollar value of all goods and services produced in a year in the United States, regardless of who supplies the labor or property.

A health plan that provides health coverage to employees, former employees, and their families, and is supported by an employer or employee organization.

A health plan that contracts with group practices of doctors to give services in one or more places.

Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can't deny you insurance coverage or place conditions on a policy, must cover you for all pre-existing conditions, and can't charge you more for a policy because of past or present health problems.

A right you have that requires your insurance company to automatically renew or continue your Medigap policy, unless you make untrue statements to the insurance company, commit fraud or don?t pay your premiums.

Guidelines are systematically developed by appropriate groups to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances.