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Consolidated Omnibus Budget Reconciliation Act COBRA ; COBRA is a law requiring employers that have more than 20 employees to offer employees the option of paying for their own insurance premiums after the employee quits, is laid-off, or gets fired. The employee must pay the monthly insurance premiums usually between $200 and $600 each month ; , but there is no change in the coverage. Individuals who accept COBRA can stay on that insurance program for 18 months as long as regular payments are made. If an employee leaves work due to disability, he or she can apply for an extension of 11 additional months on COBRA. Who to call. Your Human Resources contact through work. Washington State Health Insurance Pool WSHIP ; The Washington State Health Insurance Pool WSHIP ; "is designed to provide health insurance to Washington residents who are unable to find adequate health insurance coverage in the private market due to their mental or physical condition" from the WSHIP mission statement ; . Insurance companies can legally reject applications for individual insurance coverage based on a person's medical status. WSHIP is the alternative for people who get rejected. If you are eligible for insurance through employment or you are eligible for Medicaid note that this says Medicaid, the DSHS program, not Medicare, the SSA program ; , you cannot receive WSHIP. Applying for WSHIP involves applying for an individual insurance plan and getting rejected. It may be a good idea to consult with a case manager before starting this process. WSHIP does not have dental or vision coverage. Who to call. For WSHIP information: 1-800-877-5187 Early Intervention Insurance Program EIIP ; The Early Intervention Insurance Program EIIP ; is a state program funded by the Department of Health. The program will pay the monthly insurance premiums for low-income individuals with an HIV + diagnosis, but not an AIDS diagnosis. The Early Intervention Insurance Program will pay for COBRA plans, WSHIP, and some individual insurance plans. EIIP will not pay for dental insurance premiums. Who to call. EIIP: 284-9277 Evergreen Health Insurance Program EHIP ; The Evergreen Health Insurance Program EHIP ; is a state program currently funded by the Department of Social and Health Services. The Evergreen Health Insurance Program will pay the monthly insurance premiums for lowincome individuals with an AIDS diagnosis. The Evergreen Health Insurance program will pay for COBRA plans, WSHIP there is a waitlist for WSHIP coverage ; , other individual insurance plans, and Medicare B premiums. EHIP will not pay for dental insurance premiums. Who to call. EHIP: 323-2834 or 1-800-945-4256 Early Intervention Program EIP ; The Early Intervention Program EIP ; is Washington State's version of the federal AIDS Prescription Drug Program APDP ; or AIDS Drug Assistance Program ADAP ; . All of these names refer to a single pot of money that is given to the states to help low-income HIV + individuals access medications. In Washington, state money is added to this federal money to create the Early Intervention Program EIP ; . Effective April 2004, a monthly costshare for prescriptions has been added based on your income and whether or not you have other insurance coverage. Individuals under 100% Federal Poverty Level are exempt from this cost share, but must apply for Medicaid coverage. Only individuals earning less than 300% of federal poverty level around $2, 000 per month ; are eligible for enrollment in EIP. The Early Intervention Program will do one of three things: Complete Coverage If you do not have insurance, the Early Intervention Program will pay for all doctor visits, labs, and prescriptions that are connected to monitoring and treating HIV. This will not pay for unrelated illnesses or injuries, dental care, vision services, or hospitalization. Prescription Assistance For individuals with primary insurance, the Early Intervention Program will pay for the co-pays on medication related to the treatment of HIV, for example, order vermox.
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Uninterrupted coverage from the date of original enrollment. Contraception The process by which pregnancy is prevented by either barring conception of an embryo or the implantation of it within the uterine wall. Contract A legal agreement between an individual subscriber or an employer group and a health plan that describes the benefits and limitations of the coverage. Contract Holder The individual in whose name a contract is issued or the employee covered under an employer's group health contract. The subscriber can enroll dependents under family coverage. Conversion A change of a customer's contractual status involving the method of payment of subscription charges and possible types of coverage. For example, a member may transfer from a group policy to direct payment coverage upon termination of employment. Coordination of Benefits COB ; The provision which applies when an enrollee is covered by two health plans at the same time. The provision is designed so that the payments of both plans do not exceed 100% of the covered charges. The provision also designates the order in which the multiple health plans are to pay benefits. Under a COB provision, one plan is determined to be primary and its benefits are applied to the claim first. The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. Benefits are thus "coordinated" between the two health plans. Co-payment or co-pay ; The fixed dollar amount that your policy requires you to pay as your share of the cost of certain services each time you receive care. Cost Sharing The provision of a health insurance policy that requires insured individuals to pay some portion of the covered medical expenses. Several forms of cost sharing are deductible, copayment and coinsurance. Covered Services The services for which Empire provides benefits under the terms of your contract. Custodial Care Maintenance care of a patient which is designed to assist the patient in daily living and not primarily provided for the treatment of an illness, disease or condition. Custodial care includes but is not limited to help in walking, bathing and feeding. Customary and Reasonable C&R ; The amount customarily charged for the service by other physicians in the area often defined as a specific percentile of all charges in the community ; , and the reasonable cost of services for a given patient after medical review of the case. Also called "Usual, Customary and Reasonable" UCR ; . Customary Charges The fees most providers charge for a certain procedure. These charges are determined based on charge data collected from providers in a geographical area at a certain time period. Because can soriatane treatment drug night.

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