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At least 991 records · Page 55Linked to original sources
PubMed1999

Using choice-based conjoint to determine the relative importance of dental benefit plan attributes.

The purpose of this study was to use conjoint analysis to determine the importance of specific dental benefit plan features for University of Iowa (UI) staff and to build a model to predict enrollment. From a random sample of 2000 UI staff, 40 percent responded (N = 773). The survey instrument was developed using seven attributes (five dental benefit plan features and two facility characteristics) each offered at three levels (e.g., premium = $20, $15, $10/month). Pilot testing was used to find a realistic range of plan options. Twenty-seven hypothetical dental benefit plans were developed using fractional factorial combinations of the three levels for each of the seven attributes. For all of the hypothetical plans, dental care was to be provided in the UI predoctoral dental clinic. Plan profiles were arranged four per page by combining the existing plan with three hypothetical plans, for a total of nine pages. Respondents' task was to select one plan from each set of four. A regression-like statistical model (Multinomial Logit) was used to estimate importance of each attribute and each attribute level. Relative importance (and coefficients) for each of the seven attributes are as follows: maximum annual benefit (.98), orthodontic coverage (.72), routine restorative (.70), major restorative (.67), time to complete treatment (.61), clinic hours of operation (.47), premium (.18). For each attribute, relative importance of each of three levels will also be presented. These coefficients for each level are used to predict enrollment for plans with specific combinations of the dental benefit plan features.

Algorithms↗
PubMed2001

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/TRICARE; partial implementation of Pharmacy Benefits Program; implementation of National Defense Authorization Act Medical Benefits for fiscal year 2001. Office of the Secretary, DoD. Interim final rule.

This interim final rule implements several sections of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001. The rule allows coverage of physical examinations for beneficiaries ages 5 through 11 that are required in connection with school enrollment; provides an additional two-year period for survivors of deceased active-duty members to remain eligible for TRICARE medical and dental benefits at active-duty dependent rates; extends eligibility for medical and dental benefits to Medal of Honor recipients and their immediate dependents in the same manner as if the recipient were entitled to retired pay; partially implements the Pharmacy Benefits Program establishing revised copays and cost-shares for the prescription drug benefit; implements the TRICARE Senior Pharmacy Program by establishing a new eligibility for prescription drug benefits for Medicare-eligible retirees; allows a waiver of copayments, cost-shares, and deductibles for all Uniformed Services TRICARE eligible active duty family members residing with their TRICARE Prime Remote eligible Active Duty Service Member Sponsor within a TRICARE Prime Remote designated area until implementation of the TRICARE Prime Remote for Family Member Program or October 30, 2001, whichever is later; provides for the elimination of TRICARE Prime copayments for active duty family members enrolled in TRICARE Prime; provides for the reimbursement of reasonable travel expenses for TRICARE Prime beneficiaries referred by a primary care provider to a specialty care provider who provides services over 100 miles away; and reduces the maximum amount which retirees, their family members and survivors would be liable from $7,500 to $3,000. The Department is publishing this rule as an interim final rule in order to meet statutorily required effective dates. Public comments, however, are invited and will be considered as to possible revisions to this rule.

Child↗
PubMedDate not supplied

The doctor in DR.

Explore the source record for details and available documents.

American Dental Association↗
PubMed2003

Special issues for younger Medicare beneficiaries with disabilities.

While most people know that older Americans are eligible for Medicare and Social Security retirement benefits at age 65, many do not know that people with disabilities under age 65 can also be covered by Medicare. In this brief we focus on how people with disabilities qualify for Medicare and how their Medicare benefits coordinate with other types of health benefits they may have.

Adult↗
PubMed2003

Coordination of benefits.

Figuring out who is supposed to "pay first" when your client has Medicare and other health benefits can be confusing both for you and your clients. In this brief we discuss how Medicare coordinates payment of claims with other health benefits.

Cost Sharing↗
PubMed2004

Federal employees health benefits children's equity. Final rule.

The Office of Personnel Management (OPM) is issuing final regulations to implement the Federal Employees Health Benefits Children's Equity Act of 2000, which was enacted October 30, 2000. This law mandates the enrollment of a Federal employee for self and family coverage in the Federal Employees Health Benefits (FEHB) Program, if the employee is subject to a court or administrative order requiring him or her to provide health benefits for his or her child or children and the employee does not provide documentation of compliance with the order.

Child↗
PubMed2005

Medicare program; Medicare prescription drug benefit. Final rule.

This final rule implements the provisions of the Social Security Act (the Act) establishing and regulating the Medicare Prescription Drug Benefit. The new voluntary prescription drug benefit program was enacted into law on December 8, 2003 in section 101 of Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Although this final rule specifies most of the requirements for implementing the new prescription drug program, readers should note that we are also issuing a closely related rule that concerns Medicare Advantage organizations, which, if they offer coordinated care plans, must offer at least one plan that combines medical coverage under Parts A and B with prescription drug coverage. Readers should also note that separate CMS guidance on many operational details appears or will soon appear on the CMS website, such as materials on formulary review criteria, risk plan and fallback plan solicitations, bid instructions, solvency standards and pricing tools, plan benefit packages. The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The MMA specifies that the prescription drug benefit program will become available to beneficiaries beginning on January 1, 2006. Generally, coverage for the prescription drug benefit will be provided under private prescription drug plans (PDPs), which will offer only prescription drug coverage, or through Medicare Advantage prescription drug plans (MA PDs), which will offer prescription drug coverage that is integrated with the health care coverage they provide to Medicare beneficiaries under Part C of Medicare. PDPs must offer a basic prescription drug benefit. MA-PDs must offer either a basic benefit or broader coverage for no additional cost. If this required level of coverage is offered, MA-PDs or PDPs, but not fallback PDPs may also offer supplemental benefits through enhanced alternative coverage for an additional premium. All organizations offering drug plans will have flexibility in the design of the prescription drug benefit. Consistent with the MMA, this final rule also provides for subsidy payments to sponsors of qualified retiree prescription drug plans to encourage retention of employer-sponsored benefits. We are implementing the drug benefit in a way that permits and encourages a range of options for Medicare beneficiaries to augment the standard Medicare coverage. These options include facilitating additional coverage through employer plans, MA-PD plans and high-option PDPs, and through charity organizations and State pharmaceutical assistance programs. See sections II.C, II.J, and II.P, and II.R of this preamble for further details on these issues. The proposed rule identified options and alternatives to the provisions we proposed and we strongly encouraged comments and ideas on our approach and on alternatives to help us design the Medicare Prescription Drug Benefit Program to operate as effectively and efficiently as possible in meeting the needs of Medicare beneficiaries.

Aged↗
PubMed2005

Medicare program; Medicare prescription drug benefit; interpretation. Final rule; interpretation.

This final rule modifies or clarifies our interpretations in several areas of the final rule titled "Medicare Prescription Drug Benefit" published in the Federal Register on January 28, 2005. First, it clarifies our interpretation of "entity", to respond to inquiries we received subsequent to the publication of the Prescription Drug Benefit (Part D) final rule on January 28, 2005. We were asked whether a joint enterprise could be considered an "entity" under section 1860D-12(a)(1) of the Social Security Act (the Act), for purposes of offering a prescription drug plan (PDP). Our interpretation is discussed in the Supplementary Information section of this final rule. Second, also subsequent to the publication of the Prescription Drug Benefit (Part D) final rule on January 28, 2005, we received inquiries from parties about our discussion of the actuarial equivalence standard and the manner in which an employee health plan sponsor could apply the aggregate net value test in the regulatory text of the final rule. Our interpretation is discussed in the "Provisions" section of this final rule. In addition, subsequent to publishing the August 3, 2004 proposed rule (69 FR 46684), we received comments on how the late enrollment penalty would be coordinated with the late enrollment penalty for Part B, and whether the one percent penalty would be sufficient to control for adverse selection. We clarify in the Provisions section of this final rule that the example given in the proposed rule, published on August 3, 2004, did not accord with the proposed or final regulatory language because it did not account for the fact that the base beneficiary premium increases on an annual basis. To remedy this error and in response to comments received on the proposed rule, we provide an interpretation that as the base beneficiary premium increases, the late enrollment penalty must also increase, and is in keeping with how the Part B penalty is calculated. Finally, we are providing clarifying language related to transitioning Part D enrollees from their prior drug coverage to their new Part D plan coverage. The Medicare Prescription Drug Benefit final rule will take effect on March 22, 2005. Our interpretations are deemed to be included in that final rule.

Health Benefit Plans, Employee↗