The percentage of the payment that a member is responsible for.
What is coinsurance.
100
The Urgent Care copay must be greater then Specialist but less than or equal to this copay.
What is Emergency Room
200
SSSG
What is Similarly Sized Subscriber Groups
200
When a QPOS plan requires no referrals, the plan is this.
What is Aetna Choice Point of Service
200
This provides coverage for certain prosethics.
What is DME.
200
This refers to when Referred and Non-referred benefit maximums are tracked together.
What are unstacked benefits.
200
If a coinsurance is elected for ER/UC, it must be the same coinsurance as these 2 primary benefits.
What are IP Hospital and SPU.
300
SMU
What is Standards Management Unit
300
Where a patient goes to have a galbladder removed.
What is Short Procedures Unit (SPU)
300
This coverage includes a $5 copay for diagnostic preventative restorative care and oral surgery.
What is Advantage Dental.
300
When OON services are covered at 100% with no deductible up to $150.
What is Preventative Care Rider.
300
This amount may be applied as follows:
**Applies to all services
**Applies to all services except Preventive Care
**Applies to all except PCP, Specialistm and ER
** Applies to inpatient hospital and outpatient surgey
What is INN Deductible.
400
GEBAR
What is Group Enrollment Billing Accounts Receivable
400
Coverage provided at an IOE contracted Facility only.
What is Transplants
400
Specimens of tissue, fluid, etc are analyzed and tested with this benefit.
What is Diagnostic Outpatient Lab
400
This occurs when another state can write the OON benefits in this location but this state cannot write the OON benefits for another state.
What is Partial Geo-Swapping.
400
When quoting a coinsurance, you must always include this.
What is the Annual Out of Pocket Max (Member Coinsurance Limit)
500
LIU
What is Legislative Investigations Unit
500
Allows amounts accumulated in the last 90 days of prior period to be credited to the current year.
What is Deductible Carryover.
500
The Primary diagnosis must be a neuromusculosketal condition related to mechanical joint and/or Soft Tissue Dysfunction.
What is Spinal Minuplation.
500
OON Care is subject to deductibles, coinsurance, and this requirement.
What is precertification.
500
The OON Deductible must be equal to or greater than this INN copay.