Carrier Networks
What network does Angle Health use?
What is the Cigna PPO Network
What type of plan can require individual health questionaries?
Self-funded
What is the federally required minimum employers are required to contribute to employee medical plans? (groups under 50)
50% of the lowest cost employee only rate
What is the difference between an EPO and PPO?
EPO has OON included. PPO has OON excluded.
What is the name of the only agency that you are to only send quotes directly to Kyle?
What is Lewis and Palmer
Which Aetna network includes out of network benefits?
What is CPOSII or Choice Point of Service II
Fully Insured rates are filed with the state based on a person's gender, age and physical location. What is this rating method called?
Community Rated
What set of laws governs level-funded plans?
ERISA (the Employee Retirement Income Security Act of 1974
This language in an Aetna plan denotes that labs and x-ray are covered at 100%.
What is $0LXR
What is required to quote STD and LTD for a group?
What is a census with employee wages and job titles.
What dental and vison networks does Humana use for employer groups?
What is Traditional PPO Network for dental.
What is Insight Network for vision.
What are the three parts of a level-funded policy and how do they relate to the monthly premium?
Claims Account, Stop-Loss Premium and Admin feeds. The sum of the 3 equals the total monthly premium.
This law allows employees to continue their group health coverage for a limited time after job loss or reduction in hours, usually at their own expense.
What is COBRA (Consolidated Omnibus Budget Reconciliation Act)
Please explain difference between TRAD and HDHP plans on an Angle Health quote.
TRAD - non HSA Compatible.
HDHP - compatible with HSA
Name the 2 small things on an Angle Health census that can have a large impact on final rates?
What are employee nicknames (not full legal name on census) and incorrect ZIP codes.
Name all of the networks Nationwide uses.
What are :
Aetna - Signature Administrators (ASA) and CPOSII
Cigna - Local Plus, OAP (Open Access Plus) and PPO (Cigna PPO)
PHCS
Some level funded plans (UHC, Aetna, Nationwide, Cigna) have the potential for a refund at the end of the year. Where does this refund come from?
The claims account surplus (when the amount of claims incurred is less than what is in the claims account)
This 1996 law protects the privacy of individuals' medical records and also helps workers keep health coverage when changing jobs.
What is HIPAA
In regards to UHC level-funded plans, what terms will appear in the plan name to denote the same benefits you'd see in an Aetna $0 LXR plan?
What is "LX" for $0 Lab and X-Ray.
What vision network does Principal use?
What is VSP
What FL Blue network(s) is best for groups with out-of-state employees?
What is the Blue Options or the Blue Care with OON rider.
Please explain what a specific deductible/limit and aggregate deductible/limit are in a level funded dplan?
Specific limit - the amount one singular member/employee can incur to the claims account before stop-loss pays claims.
Aggregate - the total amount of claims that can be incurred by the group before stop-loss pays claims
This is the age that employers are required to provide coverage to dependents to under the ACA.
What is age 26.
Based on the following benefits, what language cab you expect to find in this Aetna plan name.
PCP- No Charge
Urgent Care - No Charge
Generic drugs - no charge
All other rx - integrated into the deductible.
What is IntRx
What is the name of the PBM that Angle Health uses?
What is the the Angle Cerpass PBM