A
HCO stands for this.
What is "Health Care Options"?
This A federal health insurance program for persons: * 65 years of age or older * People under age 65 with certain disabilities * People of all ages with End-Stage Renal This is a nationwide program administered by the CMS.
What is "Medicare"?
T/F - Healthnet determines eligibility.
What is "False"?
State/county __________ _______________ determines eligibility.
Who is " eligibility case worker"?
This is the name of California Medicaid program.
What is "Medi-Cal"?
Medi-Cal is a __________ plan.
What is "HMO"?
This is a group of physicians, organized as a legal entity with an active agreement with Health Net to furnish medical care to Health Net Members.
What is "Medical Group" or "Preferred Provider Group (PPG)"?
Question that we ask on EVERY call.
What is "Do you have any other health insurance"? - Coordination of Benefits
The______________________ pays Health Net a monthly premium to provide these benefits to its members and their eligible dependents.
What is " Department of Health Care Services (DHCS)"?
T/F - We can verify a member by asking the caller for their SSN.
What is "False" ~ NEVER ask for this!!
True /False. When under a capitation arrangement, the member is not permitted to obtain services outside of their assigned PPG.
What is "True"?
A __________ arrangement involves HN and the medical group (PPG). Health Net pays a set amount to the PPG, per member per month ___________ to the contracted medical group to cover services indicated per the Division of Financial Responsibility (DOFR).
What is capitation?
Daily DOUBLE: If our member has other insurance besides us- _________ typically pays, and is considered to be their ___________________ insurance.
Who is "the other insurance?" and "Primary"
This arrangement meant the State paid each provider directly for each service rendered to the beneficiary.
What is "Fee for Service?" A.K.A - pay as you go?
An California individual must first qualify for the ___________ program before enrolling in a managed care plan.
What is "Medi-Cal"?
When assisting a member with changing their doctor, this is the maximum mileage allowed for their in area status.
What is "30 Miles"?
Once the beneficiary is enrolled with Health Net, the beneficiary is now referred to as a “member.” HN assigns the _________ to the member.
What is "the state’s issued Client ID Number or CIN number?"
Effective July 1, 2022, Medi-Cal monthly premium amounts for the Healthy Families Program have been reduced to _______ .
What is $0.00?
They cover: professional/facility services, durable medical equipment, outpatient services, outpatient mental health (through HN), LTC for all counties.
*Fee for Service, Healthnet, or Carve Outs
Who is " Healthnet?"
When a caller has inquiries about Healthy Family Program, refer them to this number.
What is "(800) 880-5305?"
Health Net will send out to a New Member within 7 calendar days a _____________________ and __________, which is sent separately.
What is a "New Member Kit" and "ID Card"?
For mandatory beneficiaries, HCO sends an enrollment packet with the information needed to select a health plan available in the county of residence. Beneficiaries will have _____ days from the date HCO sends out the enrollment packet.
True or False: This packet will include a Health Exemption Form.
What is "30 Days"? and "True"?
To apply for Medi-Cal, the individual can visit their local __________________________ or apply through Covered CA.
What is "Department of Social Services (DSS) office"?
*You can refer to the following links for information:
http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
__________ must report to their eligibility worker or social services office and to their health plan if they gain or terminate other health insurance.
Who is "Medi-Cal beneficiaries"
A newborn baby is covered from ____________ until ____________________
What is "Date of Birth" and "the end of the following month"?