HOP Jeopardy

The Basics

100

What is Luminare Health?

Luminare Health is a TPA - we process claims and render the benefits.

200

What is HOP (Health Options Program) in your own words?

HOP is a supplemental insurance to Medicare that is available to members of PSERS and their dependents.

300

What is the relationship between HOP & Luminare Health?

HOP is one of Luminare Health's largest clients.

400

What 4 items need to be verified for HIPAA when speaking with a an EE calling for themselves?

Name, DOB, Address, ID #

500

What are all of the QE? (Qualifying Events)

• You retire or lose health care coverage under your school employer’s health plan. (Coverage under your school employer’s health plan includes any COBRA continuation coverage you may elect under that school employer’s plan).
• You involuntarily lose health care coverage under a non-school employer’s health plan, (including any COBRA continuation coverage you may elect under that non-school employer’s health plan).
• You or your spouse reach age 65 or become eligible for Medicare.
• There is a change in your family status including divorce, the death of a spouse, addition of a dependent through birth, adoption, or marriage, or a dependent loses eligibility.
• You become eligible for Premium Assistance due to a change in legislation.
• A plan approved for Premium Assistance terminates or you move out of a plan’s service area.

Medicare

100

What is Medicare Part D and what happens if a prospective member doesn't enroll in it?

This is the Rx side of the plan, and they will obtain a permanent Late Enrollment Penalty.

200

What is the relationship between HOP and Medicare?

HOP is a supplement to Medicare, meaning they will pick up what MC does not.

300

What is the difference between Medicare A & B?

Part A is for hospital-related services, while Part B covers a wider range of medical services outside of the hospital setting.

400

What are some examples of the plans potential members can enroll into that are considered Medicare Part C?

Highmark Freedom Blue PPO, Capital Blue Cross PPO, Aetna Medicare P01 PPO, UPMC PSERS HOP Custom PPO

500

When does somebody qualify for Medicare?

• 65 and older
• Under 65 with certain disabilities
• ALS
• ESRD

HOP

100

What is premium assistance and how does it work?

PSERS provides Premium Assistance—a special financial incentive—to help eligible retirees pay for health coverage through the Health Options Program or another Commonwealth public school employer or district health plan. Up to $100 is paid to the member's monthly premium by PSERS.

200

Who is eligible to enroll in HOP?

• You retire or lose health care coverage under your school employer’s health plan. Coverage under your school employer’s health plan includes any COBRA continuation coverage you may elect under that school employer’s plan.
• You involuntarily lose health care coverage under a non-school employer’s health plan, including any COBRA continuation coverage you may elect under that non-school employer’s health plan.
• You or your spouse reach age 65 or become eligible for Medicare.
• There is a change in your family status including divorce, the death of a spouse, addition of a dependent through birth, adoption, or marriage, or a dependent loses eligibility.2
• You become eligible for Premium Assistance due to a change in legislation.
• A plan approved for Premium Assistance terminates or you move out of a plan’s service area.

300

True or False: A Split record is when a Retiree and Dependent are enrolling, and are set up in separate accounts in different plan/package numbers.

True

400

When does someone qualify to change or update their plan?

When they experience a Qualifying Event:

• You retire or lose health care coverage under your school employer’s health plan. Coverage under your school employer’s health plan includes any COBRA continuation coverage you may elect under that school employer’s plan.
• You involuntarily lose health care coverage under a non-school employer’s health plan, including any COBRA continuation coverage you may elect under that non-school employer’s health plan.
• You or your spouse reach age 65 or become eligible for Medicare.
• There is a change in your family status including divorce, the death of a spouse, addition of a dependent through birth, adoption, or marriage, or a dependent loses eligibility.2
• You become eligible for Premium Assistance due to a change in legislation.
• A plan approved for Premium Assistance terminates or you move out of a plan’s service area.

500

Explain what the difference is between the Option Selection Period and Open Enrollment Period.

Option Selection Period: When a current member can make changes and updates to their plan.

Open Enrollment Period: When a potential member can enroll without a qualifying event.

MP

100

What did EE, Hope Smiley, last pay for her premium?

$378

200

Where do you click in MP when you've started a script, but need to end it due to it being the wrong member?

"Whoops, wrong member," option in MP

300

When can a Home Address be changed over the phone by a CSR?

• When the Retiree is calling to update the home address and we have them in the system with a shell/M03 account
• When a member is calling to correct an apartment number and we can access the Address Update Letter (AUL) and see that the AUL information matches what the member is saying.

400

Which card(s) are you able to look at to see if a Fee For Service ID card was requested and sent?

Scheduled and or Completed Card

500

True or False: A Split record is when a Retiree and Dependent are enrolling and are set up in separate accounts in different plan/package numbers.

True

MISC.

100

What is the premium for this member? Freya Blum: 16750275

$362.00

200

Does this Rx require step therapy? (Mounjaro)

No

300

Explain what Silver Sneakers is.

Silver Sneakers is a health and fitness program designed for seniors (65 and older). It provides access to: 

• Gym memberships: Silver Sneakers members can join participating gyms at no cost. 
• Fitness classes: A variety of classes are offered, including yoga, Zumba, and strength training. 
• Online fitness: Members can access on-demand workout videos and live classes. 

400

When does someone qualify for premium assistance?

You are eligible for Premium Assistance if you are a retiree who meets one of the following retirement type requirements:

• All classes with at least 24½ eligibility points regardless of age, or
• Class T-C and T-D: You terminate school employment at or after reaching age 62 with at least 15 eligibility points, or
• Class T-E and T-F: You terminate school employment at or after reaching age 65 with at least 15 eligibility points, or
• Class T-G and T-H: You terminate school employment at or after reaching age 67 with at least 15 eligibility points, or
• You are receiving a disability retirement benefit from PSERS.

500

What is the birthday rate?

A discount for the HOP Medical Plan only, beginning if someone enrolls when they're 65. Each year, the discount percentage decreases by 3% until they pay the normal rate when they turn 70.

65 - 15%, 66 - 12%,67 - 9%, 68 - 6%, 69 - 3%