HMO
The states making up the HPHC service area for HMO plans.
What are MA, ME, NH, RI, CT, and VT?
The form a member would fill out to authorize an individual to as their healthcare representative.
What is the Designation of Representative form?
A set dollar amount a member pays for a doctor visit or prescription regardless of the amount of the claim.
What is a copay?
The document that lists our call handling guidelines.
What is the Call Quality Guidelines?
This mustachioed mascot's face has appeared on a cylindrical snack package since 1967.
Who is Julius Pringles (Mr. P)?
Provider who coordinates the member's care, referrals to see a specialist must come from this provider.
What is a Primary Care Provider?
Member services and other Workforce members use this document to verify the identity of an individual/entity calling to request PI/PHI and the authority of that individual/entity to have access to the requested information. .
What is the verification grid?
A dollar amount that a member must spend towards their health care before the health insurance company will pay for claims.
What is deductible?
Located in PBDR, it contains additional resources such as the DME Grid and the Mandated Benefits Job Aid.
What is Helpful Links?
This soft drink is the preferred beverage of Chris DeCaro and was released in the US on August 9, 1982.
What is Diet Coke?
This benefit will be covered as listed in the member's SOB regardless of facility's contract status or location in regards to the service area.
What is Emergency Room Care?
Abortion, AIDS/ARC, Alcohol & Substance Abuse, Behavioral Health, Sexually Transmitted Infections, Domestic Violence, Genetic Testing, HIV, Physical Abuse, Reproductive Health.
What are the protected categories?
When members must pay a percentage of a claim.
What is coinsurance?
Our "truth source" for all things cost sharing.
What is the schedule of benefits?
The number of staircases located in Hogwarts.
What is 142?
An enhanced benefit allowing child dependents to recieve in network care for non emergency services outside of the HMO service area.
What is out of area dependent?
A type of authorized caller that is listed after Legal reviews provided legal instrument.
What is Personal Representative
When a family deductible applies for plans with 2+ members with no cap per member.
What is a non-embedded deductible?
Member plan document that includes how members can obtain care, detailed description of benefits and exclusions, as well as a list of self referrable services.
What is the Member Handbook?
The first author to use a "typemachine" or typewriter to write a manuscript.
Who is Mark Twain?
Gynecology services, urgent care services, acupuncture, chiropractic care, routine eye exam.
What are some self referable services?
Type of authorization that is only good for the duration of that call.
What is a verbal authorization?
The maximum amount the Plan will pay for Covered Benefits minus any applicable Member Cost Sharing
What is the allowed amount?
This application houses job aids/processes and procedures to help you answer member inquries.
What is SupportPoint?
Before becoming president, this US president was a licensed bartender.
Who is Abraham Lincoln?