§ 422.100 General requirements
§ 422.101 Requirements relating to basic benefits
§ 422.102 Supplemental benefits
§ 422.103 Benefits under an MA MSA plan
§ 422.104 Special rules on supplemental benefits for MA MSA plans
§ 422.105 Special rules for self-referral and point of service option
§ 422.106 Coordination of benefits with employer or union group health plans and Medicaid
§ 422.107 Requirements for dual eligible special needs plans
§ 422.108 Medicare secondary payer (MSP) procedures
§ 422.109 Effect of national coverage determinations (NCDs) and legislative changes in benefits; coverage of clinical trials and A and B device trials
§ 422.110 Discrimination against beneficiaries prohibited
§ 422.111 Disclosure requirements
§ 422.112 Access to services
§ 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance and post-stabilization care services
§ 422.114 Access to services under an MA private fee-for-service plan
§ 422.116 Network adequacy
§ 422.118 Confidentiality and accuracy of enrollee records
§ 422.119 Access to and exchange of health data and plan information
§ 422.120 Access to published provider directory information
§ 422.128 Information on advance directives
§ 422.132 Protection against liability and loss of benefits
§ 422.133 Return to home skilled nursing facility
§ 422.134 Reward and incentive programs
§ 422.135 Additional telehealth benefits
§ 422.136 Medicare Advantage (MA) and step therapy for Part B drugs
§ 422.137 Medicare Advantage Utilization Management Committee
§ 422.138 Prior authorization

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 422 > Subpart C - Benefits and Beneficiary Protections

  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Dependent: A person dependent for support upon another.
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fraud: Intentional deception resulting in injury to another.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Statute: A law passed by a legislature.
  • Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • Trustee: A person or institution holding and administering property in trust.