Pharmacy
Diamond
Plans
Benefits
Misc
100
What is the initial out of pocket limit for Part D?
$2840
100
What screen do you find Provider contracts in?
PROVC
100
What are the Individual Med Supp Plans?
Core and Supp 1
100
How much can a member receive for a Fitness benefit?
$150
100
How long can an HMO member be out of area before being disenrolled?
6 Months
200
If a member reaches the Coverage Gap how much do they pay for Brand drugs?
50%
200
How do you bridge from CREDL to PROVF?
You don't. Can only bridge from PROVF to CREDL or PROVC.
200
What is the OOP maximum for the Individual HMO plans?
$3400
200
What is the name of the company that THPMP outsources the Eye benefit to?
EyeMed
200
What do LIS subsidies 1-4 have in common?
The all receive 100% subsidy towards their part d premium.
300
How much does an HMO No Rx member pay for a Part B Drug?
0
300
How do you access the benefit accumulator?
F6 B from the MEMBR screen.
300
Which HMO plan covers routine dental care?
None
300
What is the hearing aid benefit for a GIC member?
$1700 per 2 years.
300
How do you enter a new member in PBLGR without homing out?
F2
400
What type of drugs do not accumulate towards Part D?
Barbituates
400
How do you check the member's ID card history?
F6 - I.
400
When a member has the HMO and Med Supp plan which one would be considered primary?
Cannot have both at same time.
400
What coverage do HMO members have when they are in Europe?
ER Care
400
What do you put in the contact field in Macess when a son is calling for the member?
The Member Name.
500
What are the catastropic copays for an Rx and Rx Plus member
$2.50 6.30 or 5%
500
What field will tell you if a member has a disability?
MCareSt
500
Name a county that has a $20 premium for the HMO Basic Plan?
Worcester, Essex, Suffolk
500
What is the exact chiropractic benefit
Manual manipulation of the spine to correct subluxation.
500
What Learning Lab did we start in?
4
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