Leave Management
Statutory
Medical
Caller Interactions
Claim Financials
100

What does ADA stand for?

Americans with Disabilities Act

100

What is the 2025 maximum weekly benefit for CA?

$1,681

100

What are two expedited scenarios for pregnancy?

Eclampsia 

Early labor

Twins or triplets

Pregnancy diabetes

100

Where do you find the employee voicemail auth?

Phone messages

100

What does non-taxable 100% mean?

Cannot tax any of the benefit

200

What are the three factors for eligibility for federal leave (FMLA)?

  1. Verify 1250 hours worked in 12 months preceding leave
  2. Verify 12 months of service in past 7 years
  3. Verify covered employer (50 / 75 rule)
200

What is the 2025 maximum weekly benefit for NY PFL?

$1,177.32

200

What are The Hartford Maternity Guidelines?

2/6/6

200

What is the voicemail and timely response standard?

All claim staff shall respond to a message requesting a return call as follows: · If a message arrives prior to 2:00 PM, the call is returned before the end of the day · If a message arrives after 2:00 PM, the call is returned before 12:00 PM the following day

200

What does OIB stand for?

Other income benefits

300

What are the six qualifying leave reasons?

Adoption / Foster Care Placement 

Birth / Care of Newborn

Care of Family Member  

Military Exigency Leave

Military Caregiver Leave  

300

What are the six statutory states?

CA,HI,NJ,NY,PR and RI

300

What does COPD stand for?

Chronic Obstructive Pulmonary Disease

300

How do you call an international number?

  • Review phone numbers on file to determine if code already provided
  • Conduct internet search for country calling code, if not provided
    Example: Search for 'India's country calling code' provides '91' in search results.
300

On which screen can you find the payment method?

Plan Info

400

What does in "loco parentis" mean?

Care of

400

What are the eligibility requirements for NY PFL (full time EE)?

26 weeks of service from date of hire

400

What is MCM?

What is VCM?

What is BHCM?

Medical Case Manager

Vocational Case Manager

Behavioral Health Case Manager

400

How do you verify the caller? (employee)

  1. Verify caller information (all items):

    • Last name
    • First name
    • Insured ID, Employee ID, Claim / Leave ID or Claim Number
  3. Verify 2 of the following, if caller can't provide all items

    • Last four digits of their SSN
    • Date of birth
    • ER / policy name
500

How many years of service can time worked be used towards FMLA eligibility?

7

500

What does CAPFL and CASDI stand for?

CAPFL-California Paid Family Leave

CASDI-California State Disability Income

500

WALK-IN VS REFERRAL

walk in-

  • Review records to determine if sufficient information for referral
  • Confirm interpretation of functional assessment based on medical records appears reasonable
  • Confirm accuracy of system guidelines for a diagnosis and / or surgical procedure
  • Clarify usual treatment for a condition and / or appropriate provider
  • REFERRAL
  • Evaluation of diagnostic test in the context of the claimant's diagnosis
  • Initial review of diagnostic test results with review of additional medical records such as OV note, MRI etc.
  • Determine if records support impairment or restrictions and limitations
  • Determine if APS is sufficient to make a determination regarding restrictions / limitations and / or duration
500

How do you authenticate an authorized individual?

  1. Verify authorization
  2. Verify caller information (all items):

    • Full name and relationship to EE
    • Insured ID Number or last 4 digits of EE SSN
    • EE date of birth
    • EE birth city and state
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