Benefits
Employee
Forms
Billing
Systems
100
Grand-mothered/KYP - What is the copay for the Kaiser HMO 30 plan for a regular doctor visit?
$30
100
What makes an employee eligible to enroll on the group's benefits?
Must be a permanent employee, met the group's waiting period, & be working the eligibility hours
100
What form would an employee complete if they are enrolling for the first time?
An Enrollment Application form
100
What are the due dates for payments?
Payments are due by the 20th of the month prior, grace period to the 12th of the current/billed month, and by the last business day of the current/billed month to avoid cancellation. Time due, before 3:00pm. * If due dates fall on the weekend/holiday, then due date is automatically the business day before
100
Where can you locate the group's master application form?
Invision
200
Effective 10/1/14, what is the network name for the UnitedHealthcare HMO-B Platinum?
Advantage Network
200
- When would an employee be eligible if his/her DOH was 6/14/15 and the group has a 30-day waiting period? - What is the latest CC will accept the application form with no issues?
- 8/1/15 - No later than 8/31/15
200
What form would a member complete if they are enrolling their newborn child?
A Change Request form
200
- What is the billing queue extension? - What if a billing representative is not available?
- Ext. 2502 - Take a message on the pink slip, check off "billing", put it in your outbox for pick up
200
- What system do you log into for calls? - What time do our phones go on?
- Zeacom/Desktop - 8:00am
300
What is the difference between "tier-1" and "tier-2" (not copays)?
Tier-1 is preferred and tier-2 is non-preferred
300
- What form would an employee complete to enroll her newborn child? - When will the child be effective if the child was born on 3/14/15?
-Employee change request form. -Child would be eligible effective 3/1/15
300
Provide 3 examples of what the ER CRF is used for?
- Update authorize contacts - COA - Suppress contribution - Change tiers - Change contribution - Add Dental 100
300
- If a group terminates due to non-payment, what do they need to submit to review for reinstatement? - What is the review time? - What inbox do you forward the request?
Authorized group contact would need to submit a LOR, on company letterhead, signed by the authorized contact. Include the group# and request that the group be reinstated. Turn-around time is 24-48 hours. Forward to GPC Issues Inbox
300
Where can you locate a document that was faxed in an hour ago?
RightFax
400
- What are the tiers that CC offers? - What dual tiers can a group offer?
- Platinum, Gold, Silver, and Bronze - Platinum/Gold, Gold/Silver, and Silver/Bronze
400
- Which form would an employee submit to voluntary cancel his/her coverage? - When will termination be effective?
- Employee change request form. - Coverage will terminate at the end of the month in which we receive the form
400
- If a member has a dependent child enrolled who is over the age of 26, what form must they have completed each year? - Who fills out the form? - When is the form sent out?
- The Disabled Dependent Certification form - The Employee and physician - 90 days prior to the child's birthdate
400
- If a client wants to see the breakdown of cost for their employees to date, what can you offer to send? - What are the delivery options?
- Sample/dummy invoice - Should offer to fax & if they don't have a fax, then we can offer to email it
400
What is the login/password for: - CalChoice website - Invision - Pegasus - Share Point
- Choice1 92868 - CAL3 CAL3 - Your user name and password - There is no login/password
500
- ACA, effective 3/1/15: Health Net PPO-B, what is the cost for in-network, in-patient hospital? - Is Health Net PPO available to all members?
- 20%, up to OOP Max - No. Employee must reside in California to have it available, then benefits are available in CA and OOS
500
- What is the dependent age limit? - What if the child is disabled? - What is the dependent age limit for the Pediatric Dental/Vision which is embedded in the ACA Medical plan?
- 26 - If the child is disabled, the child is eligible to remain on the policy as long as the PCP completed the Disabled dependent certification form (this has to be completed each year prior to the child birthday) - 19
500
- What form does a member need to submit to add their Domestic Partner? - Per CaliforniaChoice guidelines, what defines a Domestic Partner?
- Affidavit of Domestic Partnership - Refer to list
500
- Can a group request to waive their late fee? - What do we need to receive to review waiving their late fee? - What is the difference between a level-1 and level-2 late fee waiver request?
- Yes, group can request to waive their late fee, by submitting a LOR, on company letterhead, signed by an auth group contact. Must include reason payment was late, amount, & understanding if waived, it will be done as a one-time courtesy - Level-1 is $400 or less & group has never had a late fee waived. Level-2 over $400 and if less than $400, then group has had a late fee waived already
500
What system allows you to confirm if a group is set-up for auto-pay and/or if a payment was just received?
Infosend
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