CPB (Certified Professional Biller) Certification Practice Exam

What protects TRICARE beneficiaries from financial loss due to serious illness or long-term treatment?

1. Case Manager

2. Case Mix

3. Catastrophic Cap Benefit

4. Catchment Area

The correct answer is: Catastrophic Cap Benefit

The Catastrophic Cap Benefit is a critical feature of TRICARE that safeguards beneficiaries from significant financial burdens resulting from serious illnesses or extensive medical treatments. This benefit effectively limits the total amount that a beneficiary must pay out-of-pocket for covered healthcare services within a year. Once a beneficiary reaches this cap, TRICARE covers 100% of their remaining medical expenses for the rest of that year, providing peace of mind and ensuring that individuals and families are not financially devastated by high medical costs. The other options, while relevant in different contexts, do not specifically address the protection against financial loss due to severe health issues. A case manager, for instance, helps coordinate care but does not directly provide financial protection. Case mix refers to the varying types of patients treated within a healthcare facility and their associated costs, but it is not a benefit provided to beneficiaries. A catchment area indicates a geographical region served by a healthcare provider, but it does not pertain to the financial aspects of healthcare coverage.