Benefits
True or False: Your job at Bswift is to learn as much as you can to educate callers on the various health and welfare offerings that they are eligible for.
True!
Define active enrollment
employees must review or confirm their benefit choices for the upcoming year
Think of eligibility as a question, what question is being asked?
Is the employee eligible for the employer benefits?
Define a "Full Time" employee
Employers usually define fulltime as employees who work 30 hours per week or more.
What does "in-network" mean?
When a doctor, hospital or other provider accepts your health insurance plan we say they're in network.
True or false: It is mandatory for an employer to offer benefits
False!
Define passive enrollment
employees are automatically renewed with their current benefit choices from the previous year if no action is taken.
True or false: There is a law requiring employers to offer benefits to ALL employees?
False; There isn’t a “law” requiring that employers offer benefits to all employee.
Define a "salaried" employee
Paid a set amount per pay period; typically found in "managerial" or "professional" level jobs that have discretion over their schedule.
Is it likely that an HMO plan will cover an Out of network visit?
HMO providers will usually NOT cover any of the bill for out-of-network doctors.
"Benefits” can include?
What else/at what other time would allow an employee to allowed to enroll into benefits? (aside from annual enrollment)
after experiencing a certain qualifying event.
Who set's the requirements for benefits eligibility?
The employer will always determine if their employees meet the guidelines to receive benefits. If they do meet the requirements, they will have the option to either enroll or waive coverage.
Define an "active" employee
Anyone who is actively at work is called "active", this is in comparison to "terminated" status for someone who separated from the company, this includes retirees as well.
TRUE or False: If a member goes to an In-Network provider, they will have lower costs. If the member seeks care out of the network, then the costs will be higher if they are covered at all.
True! Costs are always lower with an in-network provider.
During what time can you sign up or make changes to your benefits?
Annual enrollment/ Open season
The name for when a selected benefits plan actually starts/goes into effect?
This is called Plan Year. When an employee goes through Open Enrollment for their benefits, they may be choosing for next year's benefits.
True or false: It is mandatory to enroll in benefits if an employee is eligible
False! If they do meet the requirements, they will have the option to either enroll or waive coverage.
Define a "union" employee
Employee is part of a "bargaining unit".
True or False: If your health insurance is an HMO or a POS plan, your insurer will likely require you to have a PCP.
True, These plans typically require you to select a specific physician, whom would facilitate and approve the majority of your care.
Define benefits
According to the dictionary, a benefit is a service (such as health insurance) or a payment, or gift made by an employer in addition to wages or salary.
True or false: One of the first things you will do when a call comes in is check the job status and benefit class in the bswift system so you will see these terms a lot.
True! We do not want to ask someone “so, are you actively at work?” People know we have that information available and get annoyed when we ask them questions like that.
True or false: All employee types are eligible for benefits
False, This would depend on the employers requirements for benefits
Define a "cobra" employee
If terminated employee meets the requirements, they could continue their company benefits on their own for a period of time.
Can a cardiologist be listed as a PCP?