National Medical Support Notice (NMSN)

Standardized form developed by the federal government that addresses court-ordered health insurance coverage for children.

network benefits

Benefit level of HealthSelect that requires a participant to choose and use a primary care physician (PCP) from the HealthSelect network of providers, and usually has lower out-of-pocket costs than non-network benefits.

network provider

Provider of medical or dental services that is in a plan’s network of providers. Network providers apply to:

• HealthSelect network benefits
• HMOs
• HumanaDental DHMO
• State of Texas Dental Choice Plan

newly acquired dependent

Dependent that you did not have prior to a qualifying life event (QLE). For example, a member newly acquires a spouse through the QLE of marriage.

newly eligible dependent

A dependent who:

• was not eligible for GBP benefits, but
• becomes eligible for GBP benefits due to a qualifying life event (QLE).

Example: Sarah is a dependent child covered under the GBP. She marries at age 21, which makes her ineligible for participation in the GBP. She divorces at age 23, making her eligible once again for the GBP.

Sarah existed as a dependent while she was married, but was not eligible for the GBP. Once she divorces, she is newly eligible for the GBP.

non-participating retail pharmacy

Local pharmacy that does not participate in a health plan’s Prescription Drug Program. At a non-participating retail pharmacy, HMO participants cannot access benefits. HealthSelect participants may fill a prescription at a non-participating pharmacy, but they will pay a higher price than if they used a retail pharmacy that is part of the HealthSelect network.

nonpayment

Situation where a participant does not pay his or her full premium for health or dental coverage. This may lead to cancellation of the coverage.

non-preferred brand-name drug

Brand-name drug designated as non-preferred in the health plan’s formulary. These drugs are covered at a higher copayment than a preferred brand-name drug or generic drug.