Fill in the blank
A center that provides immediate walk-in treatment for illnesses and injuries is called___
What is an Urgent Care
Give an example of when a member may have to pay a copay.
An example:
"You go to your Primary Care Physician for a sick visit and your benefit is a copay."
High deductible health plans all come with an FSA.
FALSE!
What is a federal law that guarantees certain employees up to 12 weeks of unpaid leave each year without the threat of job loss.
A. Short term disability
B. Long term disability
C. FMLA
D. I have no idea but good luck!
C. FMLA
An insurance that replaces a percentage of your income for a short time in the event of a disability is called __
What is Short term disability
Wheelchairs, oxygen tanks, and walkers OH MY
My doctor said they have a contract with my health plan and they have agreed on a set allowed amount to be reimbursed for services. They must be in network.
TRUE!
A health spending account owned by an employer that only the employer can contribute to.
A. HSA
B. HRA
C. FSA
D. My paycheck
B. HRA
DME stands for...
Durable Medical Equipment
An employee Assistance program is a workplace program designed to assist employees in resolving personal problems. Can you give an example of some of the services they may offer?
-Therapy
-Legal services
-Childcare resources
-Anger management
The deductible is a percentage of the bill for services that the member must pay - the cost-share.
False! This is co-insurance
Which of the following does NOT apply towards accumulators?
A. Copay
B. Deductible
C. Co-insurance
D. Premiums
D. Premiums
Your doctors office doesn't contract with your insurance plan. This means they are___
OON- Out of network
Give your member an example of what services typically require pre-certification/ prior authorization.
Typically high cost services like MRI, CT scan, Bariatric surgery, etc.
Everyone gets balance billed no matter what. We just need to prep our members for that.
False! We can help our members avoid or prepare for balance billing if we notice they are getting a service or seeing a provider who is out of network.
The amount insurance companies consider to be an appropriate fee for a given service is called...
A. Balance Billing
B. An Allowed amount
C. Out of pocket Maximum
D. Co-insurance
B. An Allowed Amount
MRI's and Inpatient states typically require that the physician obtains approval from the health plan. This requirement is called___
What is a prior authorization/ pre-certification
Give an example of how co-insurance works.
Example: Lets say you got an MRI and your benefit is that you have a $400 deductible and then you're covered at 90% coinsurance.
Once your deductible is met you would be responsible for 10% of the cost of the MRI and your insurance would cover 90%
Once I meet my out of pocket maximum my insurance is going to cover me at 100 percent for all my services, for the rest of the year! I just need to make sure those services are covered and in network.
True!!
Be careful here! If the members accumulators don't combine,
- and the OOPM is met INN
-then the member goes out of network OR
-gets services like massage therapy or other non-covered services...
The member will have to pay out of pocket fully or have to meet a whole new deductible, coinsurance, OOPmax for OON.
Which is a healthcare plan where members select a PCP that serves as a 'gatekeeper' for all other services.
A. HMO
B. PPO
C. HDHP
D. All of the above.
A. HMO