Glossary

Your decision to join or leave Original Medicare or a Medicare Advantage plan.

Refers to the exchange of routine business transactions from one computer to another in a standard format, using standard communications protocols.

A term used to describe the electronic transfer of monies from one financial institution to another.

Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

A term used to cover all of the partner company activities involved in developing the Retiree Drug Subsidy Program (RDS) and administering its various aspects such as enrollment, payments, appeals, etc. ERISA - Employee Retirement Income Security Act of 1974 (ERISA)

If you are in Original Medicare, this is the difference between a doctor’s or other health care provider’s actual charge (which may be limited by Medicare or the state) and the Medicare-approved payment amount.

A fast decision from the Medicare Advantage plan about whether it will provide a health service. A beneficiary may receive a fast decision within 72 hours when life, health or ability to regain function may be jeopardized.