Rewards
The difference in the total amount of rewards an individual could earn in 2024 vs. 2025
What is $200?
Are allowed to make a premium payment on the member's account.
What is anyone who is able to fully authenticate the member and paying with a card/acct in their own name
Plans that have no out of country coverage
What is BlueCare, SimplyBlue, & MyBlue
Specialties that have a referral exception for MyBlue plan members
What is Chiropractor, Podiatrist, Dermatologist (for first 5 visits), OBGYN, & Pediatric vision or dental services
This member's claims/benefits run on a ___ period.
What is Benefit period
Calls get connected to this area when member is having technical issues redeeming a pre-paid card.
What is Rewards Tier 2; ext 89773
We only handle claims and benefits inquiries for this line of business/plan
What is Pre-Aca
For HICS cases, Issue Level 1 must be resolved in ___ and Issue Level 2 must be resolved in ____
What is 72 hours and 15 days
The full benefit info for a bone density screening (at IDTC if specifics needed)
Osteoporosis Screening may be covered under Preventive Services if specific criteria are met; otherwise cost share will be applied based on place of service for diagnostic testing; Referral will be required for specialist visit
As of 12/31/24, the individual INN deductible amount met is ____, and the individual INN OOP max met is ____.
What is $0.00 and $130.33
Calls get connected to this area if a member wants to check the balance of their pre-paid card/transaction history
What is WEX 833-509-1545
Payments CANNOT be taken for reinstatement and a task will need to be sent to CEMB first when a policy is in this status
What is Incomplete
Once the ___ is met, Florida Blue will begin to pay toward health care costs; Once the ___ is met, Florida Blue will pay for covered services at 100%
What is Deductible & Out-of-Pocket Maximum
Benefits for an injection (xolair) in an allergy specialist office
What is $60 copay for drug; $90 copay for specialist
The reason this claim did not apply to the OON deductible and only coinsurance was applied.
What is per BNV Preventive benefits OON is only 50% coinsurance
This happens to a member's unapplied rewards when the plan terminates for any reason.
What is rewards are forfeited
This happens to the covered dependents on a policy when the subscriber requests to terminate their coverage
What is Everyone on the policy will be terminated and any dependents will need to apply for new coverage
The difference between Calendar Year vs. Benefit Period Accumulations?
What is calendar year is from 01/01 - 12/31 vs benefit period starts and ends on an offset date (04/01/25 - 03/31/26)
The Tier 1 and Tier 2 Medical Pharmacy monthly OOP max for this plan
What is $120.00 and $240.00
The reason this claim processed with a member responsibility that did not apply to the accumulators. (The member advises she had a routine labs done for this claim)
What is "Line item 1 denied for Service not covered due to experimental/investigational exclusion; non covered services do not apply to accumulators"
These are 3 things a pre-paid card can be used toward.
What is Contract Number, Requested Name change, Signature, & A legible copy of the legal document indicating new name
The overage dependent rule for this group K9466001
What is covered to the end of the calendar year of the 26th birthday
Alternative options that can be provided when a member has exhausted their therapy benefit maximums for the year
What is (options listed in PROD 35203)
The reason this claim processed with a member responsibility. (The member advises she had a routine mammogram done for this claim)
What is any procedure billed along with mammogram will be subject to applicable cost share (cost share applied for the line item for ultrasound; everything else paid 100%)