|» SEP or "Special Election Period"||» state pharmaceutical assistance
|» short-term disability||» step therapy (step edits)|
|» short-term medical||» stop-loss|
|» skilled nursing facility|
|SEP or "Special Election Period"|
|The time period granted to Medicare beneficiaries who are allowed to change plans outside of the normal AEP. Examples of people who are granted a SEP are: Medicaid recipients (dual-eligibles), Victims of Hurricane Katrina, or Medicare beneficiaries who are no longer part of a creditable prescription drug plan (such as when their individual plan no longer exists). When someone involuntarily loses their existing benefits, they have a 60 day SEP during which they are able to enter into another Medicare Part D plan. Also, if someone moves out of the service area of their plan (for instance, moving to another state), they will have a 60 day SEP after the move during which they can re-enroll into a Medicare Part D plan. Related to this word are AEP, IEP, and OEP.
|An injury or illness that keeps a person from working for a short time. The definition of short-term disability (and the time period over which coverage extends) differs among insurance companies and employers. Short-term disability insurance coverage is designed to protect an individual's full or partial wages during a time of injury or illness (that is not work-related) that would prohibit the individual from working.
|Temporary coverage for an individual for a short period of time, usually from 30 to 365 days.
|skilled nursing facility|
|A facility that provides inpatient skilled nursing care, rehabilitation services or other related health services. "Skilled nursing" does not include a convalescent home or custodial care.
|state pharmaceutical assistance programs (SPAP)|
|State pharmaceutical assistance programs help cover the prescription drug costs of elderly people with low incomes or people with disabilities who don't qualify for Medicaid. Currently, 39 states offer some type of program to provide prescription drug coverage or assistance. Most programs use state funds to subsidize a portion of the costs for people who qualify.
|step therapy (step edits)|
|In some cases, you're required to first try certain drugs to treat your medical condition before the plan will cover another drug for that condition. You and your doctor must work with the plan to ensure coverage. These drugs are designated 'ST' in the formulary.
|The dollar amount of claims filed for eligible expenses at which which point you've paid 100 percent of your out-of-pocket and the insurance begins to pay at 100%. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.|