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3rd Degree
100
This application allows users to manage a variety of data including enrollment offers/options, enrollment waiting periods, billing information, etc.
What is Group Configurator?
100
"End of Birth Month" is an example of what type of rule?
What is a Birthdate Rule?
100
This is the largest source of funding for Medical and Health-related services for people with low income in the United States.
What is Medicaid?
100
If a group's Health plan covers Prescription drugs, these rules would prevent the group from also having a standalone Prescription plan.
What are co-existence rules?
100
Groups are divided into different Market Segments based on this.
What is the number of people in the group (group size)?
200
The process of determining which plans to present to a group for the groups new contract period.
What is Renewal?
200
This is the future place where default values will be set.
What is Base Plan?
200
A standard code used in Claims Adjudication and is tied to specific benefits.
What is a Service Code?
200
The meaning of the acronyms IRC/MRC
What is Individual Relationship Code/What is Member Relationship Code
200
A time period during which eligible employees may opt to sign up for or change coverage under a group health insurance plan.
What is Open Enrollment?
300
A period of time, beginning with your effective date, during which your health insurance plan does not provide coverage for pre-existing conditions.
What is a Waiting Period?
300
An employer who funds their health insurance plan rather being funded through a health insurance company.
What is an ASO (Self Insured) employer?
300
A grouping of plans into which a subscriber may enroll.
What is an Option?
300
Healthcare Exchanges are targeted primarily toward these two types of consumers.
What are Individuals and Small Groups?
300
Medicare Products are mandated and designed by this entity.
What is the Federal Government?
400
Plans versions with this workflow status have and end date and a later effective version exists for the Plan ID.
What is an Archived plan?
400
An Inpatient Hospital Stay maximum of $1,000 per admission is an example of this type of limit.
What is a Dollar Limit?
400
An independent agent who works with many insurance companies to find the best available policies for his or her clients.
What is a Broker?
400
A grouping of employees/subscribers based on criteria.
What is a Category (Subgroup)?
400
The maximum amount an insurance carrier will pay for a service.
What is the Allowed Amount?
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