Insurance Basics
What is Health Insurance?
A contract that requires a health insurer to pay some or all of your health care costs in exchange for a premium
What does PRE stand for?
Pre-Renewal Escalation
Name 3 rating strucures
age-banded, composite, tier-rated, community-rated
What is your source of truth?
The Renewal Packet!
How many alt packages should an ER see if they submitted a survey?
3
What is a deductible?
The amount of money you have to pay toward your health care before your health plan begins to pay its share
Name 2 common PREs
Address mismatch, missing SIC code, 0 enrollees, termination, BoR, recert
What age-banded rate displays in Hippo?
21 year old rate
Where do you access a plan's SBC?
Plan details section of Hippo
How do you remove a ghost (0 enrollee) plan from the default offering?
by setting to no successor
What's the difference between an EPO plan and a PPO plan?
It does not provide out-of-network coverage
What 2 fields in SFDC need to be completed to send a group to the OB PRE queue?
OB PRE + OB PRE Details
How are composite rates determined?
The average premium of all eligible employees and dependents
If a RP has both age-banded and composite rates, how do you decipher which structure the group has in place?
Whichever structure is noted first in the packet
What are 2 requirements when building alternate packages?
there must be 3 unless the group doesn't qualify, the group must qualify for each package shown, one package should be a new carrier, must build to align/address the ER's survey
If a plan has a 20% co-insurance, what does this mean?
This means the enrollee is responsible for paying 20% of qualified medical expenses after they've met their deductible
What piece of information do we not include for default only groups?
phone number/contact info TE, alternate packages
What is the correct quoting scheme for an AZ group with BCBS?
Chester Cheetah
What does a SBC outline?
what the plan covers & what the enrollee pays for covered services
If an ER answers "yes" to this survey question, they are happy with their current carrier.
"No- we like our carrier?"
If I am able-bodied, visit the doctor frequently, and need pricier medications, what metal tier plan would suit me best?
Silver Tier
Name 3 ways to identify owners of a company
SOS information, owner/shareholder labels in Hippo, job titles in-app, compensation info in-app, DangerZone owner info, GDrive tax docs/AoI
What is the correct quoting scheme for a renewing group new plan group with Guardian LTD?
Australian Shepherd
Using the RP sent in slack, what would Claudio's premium be if they enrolled in the renewing version of their current plan?
$849.88
How many steps are there for a class-based contribution (CBC) group & what are they?
2
1. notes in the default section calling out the CBC & which portion of the CBC shows in their account
2. linking the CBC to each policy after the ER Confirms plans