What is the number of days a analyst has to send the AE the SBC.
100
$350
What is the processing cost of translations.
100
Means ALL benefits must be in keeping with the provisions
of the Affordable Care Act.
What is non-grandfathered
100
Is the percent of , the allowed amount, the member is
responsible to pay.
What is Co-insurance
200
8
What is the number of pages of a SBC.
200
10
What is what is the number of day the AE has to return the SBC to the analyst.
200
1.50
What is is the cost to print and mail a SBC
200
This is a funding arrangement where upon the insurer takes on the financial responsibility for funding of claims and performs administrative tasks.
What is Insured
200
This is used when documenting the benefit differential when members go in or out of network on a PPO based plan.
What is PPO vs. Non-PPO
300
4
What is the number of physical pages of a SBC.
300
1
What is the number of days the analyst has to PDF the versions to the AE.
300
This is a funding arrangement where upon the client takes on the financial responsibility for funding of claims and HCSC performs just the administrative tasks. (payment of claims, calls, etc)
What is ASO
300
The fixed dollar value the member must pay at the time of service. Can
be for services at an MD’s office, ER, or at the in-patient/outpatient admit level
What is Copay
400
90
What is the max number a days that a SBC can be request before the effective date.
400
14
What is the number number of covered and not covered services.
400
$150
What is the cost of revisions for translations services
400
Common means dollars applied to
these buckets for both in and out of network combine. (i.e. out of network feeds
In-network and vice versus.) Separate means they do not feed one another.
What is Common vs. Separate OPX or Deductible:
400
Is a pre-determined dollar value the member must pay before
receiving payment on certain sets of benefits.
What is Deductible
500
7
What is the number of days that the AE has to provide a SBC to a client
500
3
What is the MAX amount of time that you should get your SBC to yur AE.
500
5-7
What is the number of days it takes to recieve print/mail back order.
500
Means not all benefits must be in adherence with the provisions of the Affordable Care Act.
What is grandfathered
500
Is the total amount a member is expected to pay out of pocket for a benefit period. Usually per year. What makes up this amount can vary.