Appeal The process by which you may submit a written request for review of a grievance decision. This may include requesting further explanation or to provide additional information for consideration.
Applicant Refers to a person who has submitted a written application to join the Peace Corps Program.
Authorization Form Peace Corps document that authorizes specific health care services.
Balance Due Statement This is an invoice from one of your medical providers stating an amount that is owed to them according to their records. Balance due statements typically DO NOT include information necessary to process claim payment (See definition of “Bill”) Should you receive a balance due statement you may forward that to the Peace Corps Health Benefit administrator for review but often the administrator will need additional information from the health care provider in order to process for additional payment.
Claim An invoice sent from the health care provider to the Peace Corps Health Benefit Administrator detailing charges for medical services provided. A claim includes detailed diagnostic and procedure coding information and follows a prescribed format, i.e. UB92 or HCFA 1500. A detailed claim can be used by the Peace Corps Health Benefit Administrator to make payments directly to the provider and are distinguished from “Balance Due” statements by the inclusion of the required coding. (See Balance Due Statement) A “bill” is another term for a “claim”.
COS Close of service. The end of service as a Peace Corps Volunteer.
Covered Services Services authorized by Peace Corps that will be paid when provided by a health care professional acting within the scope of his/her license.
Crisis Corps The Peace Corps program that mobilizes RPCVs and COS-ing Volunteers to provide short-term aid in several program areas, including recovery from natural disasters, humanitarian crises, and post-conflict development assistance.
Durable Medical Equipment (DME) Medical equipment used in the course of treatment including such items as crutches, knee braces, wheelchairs, hospital beds, prostheses, etc.
Exclusions A summary of the payment made by your health plan to the medical provider.
Explanation of Benefits A summary of the payment made by your health plan to the medical provider.
FECA Federal Employees Compensation Act. Federal program for both employees and Volunteers that provides benefits for service-related injuries or illnesses.
Grievance A “grievance” means any dissatisfaction expressed orally or in writing by or on the member’s behalf.
Hospital An institution whose primary function is to provide Inpatient services for a variety of medical conditions, both surgical and non-surgical. Most hospitals provide some Outpatient services, particularly emergency care.
Identification Card A card issued by Peace Corps that contains the member’s name, identification number, participating medical and dental provider networks, claims mailing address and phone numbers for Customer Service. You should present this card along with your authorization form when going to the doctor or hospital.
In-network Providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount for services./td>
Inpatient A patient confined to the hospital who receives lodging and food as well as treatment.
Medevac Medical evacuation. Relocation of a trainee or Volunteer to a location where appropriate evaluation and treatment are available when the medical problems are beyond the level of care available locally.
Network A group of doctors, hospitals and other health care providers contracted to provide services to health plan members for less than their usual fees.
OMS Office of Medical Services. Peace Corps’ headquarters office that provides medical screening, in-service health care, and post-service support to trainees and Volunteers.
OSS Office of Special Services. Peace Corps’ headquarters office that provides assistance in handling emergencies affecting trainees, Volunteers, or their families.
Outpatient A patient who is not hospitalized overnight but who visits a hospital, clinic, or associated facility for diagnosis or treatment.
Out-of-Network This phrase usually refers to physicians, hospitals or other health care providers who are considered nonparticipants of a specified health plan.
PCV Peace Corps Volunteer. American citizen who has completed pre-service training and has been sworn-in as a Volunteer.
PCMO Peace Corps Medical Officer. Peace Corps staff member who is responsible for assisting Volunteers in maintaining their health while in the country of assignment.
Preferred Provider Provider of service who has agreed to reduced fees and service oversight.
Provider Provider is a term used for health professionals who provide health care services. Sometimes, the term refers only to physicians. Often, however, the term also refers to other health care professionals such as hospitals, nurse practitioners, chiropractors, physical therapists, and others offering specialized health care services.
RPCV Returned Peace Corps Volunteer.
RVS Returned Volunteer Services. Peace Corps’ headquarters office that provides career, education, and related assistance to RPCVs.
Usual, Customary and Reasonable(U & C or UCR) A reduction in the payment of benefits on a claim which is justified by the health plan as “the going rate” to be paid in that geographical area.