Website Glossary
Beneficiary - A person who receives Medicaid.
Cause - Also known as "For Cause" or "Good Cause", these are State approved reasons to change health plans during the lock-in period.
Choice Counselor - Choice Counseling is a free service to help Medicaid beneficiaries pick the health plan that is best for them. Picking a plan can be hard. For someone with special health care needs or circumstances, the choice can be even more difficult. A Choice Counselor is the person that helps beneficiaries understand their health plan choices and enrolls them into a Medicaid health plan.
Co-payment (Co-pay) - A Co-payment is an amount paid by the beneficiary for each visit or treatment. Not all visits or treatments require a co-pay. Children and pregnant women are not subject to co-pays for services that are medically necessary.
Enhanced Benefit Reward$ Program - A program that rewards you for taking part in activities that can improve your health. You can earn credits for these activities, known as healthy behaviors (see below), that you can later use to buy health-related items at any pharmacy that accepts Medicaid Complete List of Over-the-Counter Products [1.06MB PDF], Complete List of Over-the-Counter Products [6.77MB Microsoft Excel]. You do not have to do anything to enroll in this program. You are automatically enrolled when you enroll with any Reform Health Plan.
Healthy Behaviors - Healthy Behaviors are behaviors that will improve your health and can earn credits that are put into your Enhanced Benefit Reward$ account. Examples of health behaviors are:
- Childhood exams
- Mammogram / pap smear
- Colorectal screening
- Adult exams
- Disease management participation
- Alcohol / drug treatment program participation
- Smoking cessation program participation
- Weight loss program participation
- Exercise program participation
Health Maintenance Organization (HMO) - HMOs are corporations, licensed under Chapter 627 F.S., that contract with a network of health care providers, such as physicians, hospitals, and laboratories to provide health care services.
Lock-In - Lock-in is the period of time that beneficiaries can not change health plans, except for cause.
Open Enrollment - Open Enrollment is the 60 day period when beneficiaries can change health plans without a State approved cause (see definition). Open Enrollment occurs yearly on the beneficiaries’ anniversary of their first enrollment into a plan.
Opt-Out and Employer Sponsored Insurance (ESI) - Opt-Out is a new program under Medicaid Reform that will allow beneficiaries to use Medicaid dollars to purchase insurance (ESI) offered through their job.
Primary Care Provider (PCP) - A PCP is usually a doctor that monitors your health, treats minor health problems, coordinates your health care, and refers you to a specialist, if needed.
Provider Service Networks (PSNs) - PSNs are health care delivery systems owned and operated by hospitals or physician groups. PSNs have a network of providers and facilities, which provide health care to enrolled beneficiaries.
90 Calendar Day Change Period - After being enrolled in a health plan, beneficiaries who (1) are newly eligible for Medicaid or (2) have regained eligibility after being off Medicaid more than 6 months or (3) change plans during Open Enrollment will have 90 calendar days to "try out" their plan and change to a new plan, if they wish.
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