Option introduced in the Medicare prescription drug plan that allows each plan to group different drug types together (i.e., generic, brand, preferred brand). Tiers could be used to describe drug groups that are based on classes of drugs. If the tier option is used, the plan should provide clarification on the drug types covered under the tier in the prescription drug plan notes section.

Same as drug utilization review except it is qualitative. See drug utilization review (DUR) .

Evaluation of prescription drug use and prescribing patterns by physicians to establish the appropriateness of drug treatment. DUR may be done for individual patients, an entire insured group, for current, past, or future usage. Medication costs may be reduced by substituting generic for brand name drugs and use of a drug formulary.

Individual who receives medical and/or disability benefits from both Medicare and Medicaid programs. Formerly called Medicare/Medicaid (Medi-Medi) . Also see Medicare/Medicaid (Medi-Medi) .

Insurance plan that allows an individual the opportunity to choose between joining a managed care plan or a traditional health insurance plan (e.g., indemnity insurance or a managed care organization).

Insurance sales representative who is licensed and registered with more than one broker.

Part of the Health Maintenance Organization (HMO) Act of 1973 in which employers must meet specific specifications to offer health insurance through a federally qualified HMO as an alternative to a traditional health insurance plan. Also referred to as dual choice .