Plan Components
The amount an employee pays for health insurance every month or pay period.
What is a Premium?
A type of health insurance that contracts with a network of doctors or medical organizations to provide care at predetermined (and frequently discounted) prices.
What is an HMO?
The first thing you say to the caller when the call comes in.
What is a Greeting?
The total amount that an employer pays an employee prior to any deductions.
What is Gross Pay?
Money to help provide for an employee’s family after they pass away.
What is Life Insurance?
The amount you pay for health care services before your health insurance begins to pay.
What is a Deductible?
Members in this plan are free to use any provider's services in their network, don't need a referral to see a specialist and assigning a primary care physician is advised but not needed. Although members can go outside of their network for coverage, the fee is frequently higher.
What is a PPO?
The color of an authenticated call.
What is Green?
The money that is left over after all deductions have been removed from the check.
What is Net Pay?
This insurance pays benefits in the case a person’s accidental death, or the loss-or loss of use- of body parts and functions.
What is Accidental Death and Dismemberment or AD&D?
The percentage of their medical expenses a member must pay after they reached their deductible.
What is Coinsurance?
A health insurance plan that often has cheaper monthly premiums but a higher yearly deductible (sometimes in the four figures) than a normal health plan.
What is an HDHP?
The 2 things documentation notes should be.
What are Clear and Concise.
An employment benefit (such as a pension or a paid holiday) granted by an employer that has a monetary value but does not affect basic wages?
What is a Fringe Benefit?
Provides free or discounted rates on document preparation services (Living will, etc.), phone consultations and discounts on other services of the like.
What are Legal Services?
A fixed amount paid for a health care service, usually when the member receives the service.
What is a Copayment or Copay?
A type of managed-care health insurance plan that offers various benefits based on whether the policyholder visits in-network or out-of-network medical professionals.
What is a POS?
The very last thing that should be done on a call.
What is Transfer to the After Call Survey?
The value of any fringe benefits given to employees. Because fringe benefits are a source of payment, they may be subject to taxation. The taxable portion is added to gross pay so that taxes can be withheld but does not affect the net pay.
What is Imputed Income?
A health insurance program that allow eligible employees and their dependents the continued benefits of health insurance coverage when an employee loses their job or experience a reduction of work hours.
What is COBRA?
The most the member typically pay annually for covered healthcare services.
What is an Out-Of-Pocket Maximum or OOP?
A plan that controls costs by limiting care to hospitals, physicians, and other healthcare providers in the plan network; usually regional. Except in emergencies, they are accountable for the full cost if the employee use an out-of-network provider.
What is an EPO?
This makes you sound friendly and pleasant.
What is Smile as you Speak?
They determine which Fringe Benefits are included in the gross pay amount and taxed.
Who are the IRS?
The maximum amount of time that COBRA benefits can last depending on qualifying event.
What is 36 months?