Pharmacy
A list of generic and brand name prescription drugs covered by a health plan?
What is a Formulary
Tab utilized in ISET to determine the plan Funding Arrangements
What is Plan Details Tab
is a tax-advantaged account created for or by individuals covered under high-deductible health plans (HDHPs) to save for qualified medical expenses. Contributions are made into the account by the individual or their employer and are limited to a maximum amount each year.
What is an HSA account?
The amount you pay for covered health care services before your insurance plan starts to pay.
What is a dedcutible?
To view deductible accumulations for pharmacy claims we would look here
What is the pharmacy accumulator tab
View this SPA for Call Redirection, Call Avoidance and Courtesy Skills Hold/Delay/Disconnect
What is Building Trust Through Advocacy
This tab and system allows us to send correspondence to MBRS from ISET.
What is Communications Tab> EZCOMM
A tax advantages account that lets employees use pre tax funds to pay for eligible dependent care services, such as childcare, or adult daycare while they work, look for work, or attend school.
What is a Dependent Care FSA
The OOP maximum is the maximum amount of expenses that are to be paid by the MBR- before the plan pays at 100% for all eligible expenses
True/False
This document provides customer care with the process to handle pharmacy (RX) calls
What is the Pharmacy Advocacy
This document contains process related to benefits and coverage that address benefit questions, concerns, ad dispute options.
What is Benefits and Coverage Advocacy
To view an appeal we would look in these 2 places?
What is the favorites tab or star in ISET or appeals icon at the top of ISET
is an employer-funded plan that reimburses employees for qualified medical expenses and, in some cases, insurance premiums.
What is an HRA?
This is an out of network reimbursement policy used to determine out of network rates (or “allowed amounts”) for claim processing
What is ENRP/MNRP
A program that keeps pharmacy cost down and lets MBRS use other alternative medications when available for the same condition.
What is Step Therapy
When a MBR request a Michigan Coverage Letter. What SPA am I?
What is the Claims Advocacy
To initiate a vacation override we would check this tab
What is the Prior Auth/Overrides Tab
You establish this account through your employer. With this account you contribute via payroll deductions, your employer can also contribute. This money can only be used to pay for certain out-of-pocket health care costs.
What is an FSA ?
a period during which one may freely enroll in or change one's selection of a health insurance plan or other benefit program that is ordinarily subject to restrictions:
What is Open Enrollment
a requirement that your physician obtains approval from your health care provider before prescribing a specific medication for you.
What is Prior Authorization?
Provide processes used by dedicated Premier advocates and the family engagement center (FEC) too assist MBRS with specialized support needs.
What is the Specialized Support Advocacy
when member is requesting a lifetime review/ deductible-oop audit we route to unet gen q
True/False
Supply correct answer
Claim filing limit is located on which screen in CAMS
What is The Spending Account tab in CAMS
Reference CAMS interactive job aid
This is an event that triggers a special enrollment period for an individual or family to purchase health insurance outside of the regular annual ACA open enrollment period.
What is a qualifying life event?