Terminology
PPO stands for....
Preferred Provider Organization
What type of market segment has 45 employees & is located in NJ.
Small Employer/Commercial Account
Horizon BCBSNJ has how many members?
Over 3.7 million members
A major account has at minimum "___" employees
500
OLI stands for what?
Online Information
The prefix “Anti-“ means
Against
____________ entity are responsible for the daily administrative activities of the SHBP and the SEHBP.
The Division of Pensions and Benefits
What companies are competitors of Horizon? Name three.
Aetna, Cigna & UHC
There are four Units of Coverage or Contract Types. They are Single, Husband & Wife, Family and __________.
Parent and Child(ren)
the period of time that employees must be employed before becoming eligible for coverage under than employer’s group health plan?
Waiting period
What is the definition of the prefix “Meso-“ ?
Middle
What is the definition of a non-participating healthcare professional or non-participating provider?
A healthcare professional or provider that does not have a contract with Horizon BCBSNJ.
The Blue Cross Blue Shield association consist of "___" plans in "____" States
39 plans in 50 states
Which health care product requires a patient’s care to be coordinated by a PCP?
HMO
What types of doctors can be considered a PCP?
Internist, General Practitioner & pediatrician
Define subscriber liability
what the subscriber must pay out of pocket.
What is the term when Horizon BCBSNJ pays either the member or the healthcare professional directly for each covered medical expense after the service was provided?
Fee-for-Service
Who is the VP of Enterprise Operations?
Vincent Alonge
Which of the following facilities provides a full range of inpatient and outpatient services?
Acute Care Facility
What type of Doctor is a Hematologist?
Blood Doctor/Specialist
UCSW stands for what?
Universal Customer Service workstation
The group number 95503 is used for which SHBP plan?
NJ Direct Zero (Educators Only)
Who is the Executive Vice President Government Programs (GP) and Operations?
Mark Barnard
Group Number 76150 is a _______________?
National Account
Name the New Jersey law that allows children older than the child-dependent age in a parent’s coverage to elect to remain covered until age 31, if certain other eligibility standards are me
DU31