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100

This refers to a document that a plan must provide to a member to show evidence of insurance coverage and provide basic information about that coverage.

ANSWER: Certificate of Coverage

100
  • A care provided by trained registered nurses in a medical setting under a doctor’s supervision.

ANSWER: Skilled Nursing

100
  • What does OTC stand for?

ANSWER: Over the Counter

100
  • What is an RX Plan?

Answer: Are Medicare prescription Drug Plans offered by different health insurance companies to cover the prescription drug costs for the covered medications.

200
  • It’s the amount of money an individual or business pays for an insurance policy. It’s typically paid on a regular basis, such as monthly or annually, to maintain coverage.

ANSWER: Premium

200
  • A care provided to the elderlies at the facility in which they will only leave when they pass away. Sometimes referred to as “Home for the aged.”

ANSWER: Long Term Care

200
  • Medication’s dosage measurements are distinguished into three categories. What are those?

ANSWER: Weight, Volume, Length

200
  • Enumerate the four (4) top call drivers.
  • Answer:
  • Eligibility and Benefits
  • Provider Locate
  • Authorization and Referral
  • Communications
300
  • Refers to the amount of money that an individual must pay out of pocket for covered medical services before their health insurance plan begins to cover the costs.

ANSWER: DEDUCTIBLE

300
  • Sometimes referred to as “Sleep Study”, is a test used to diagnose any sleeping disorders.

Answer: Polysomnography

300
  • Use and distribution are tightly controlled because of their abuse potential risk.

ANSWER: Controlled Drugs.

300
  • These are developed and marketed by a pharmaceutical company. These are usually the “innovator”, or the first drugs available of its kind.

ANSWER: Brand Name Drugs

400
  • Conditions or services that are covered by the insurance carrier but have limits regarding the extent benefits are provided.

ANSWER: Limitations

400

This is typically referring to a list of medications that are approved for use within a healthcare system, such as a hospital, clinic, or insurance plan.

ANSWER: Formulary

400
  • These are high-cost medications that treat rare, complex, and chronic health conditions.

ANSWER: Specialty Drugs

400
  • These are drugs that can be put into the body using a needle and syringe.

ANSWER: Injectable Drugs

500
  • This is the charges for services rendered or supplies furnished by a health care provider, which qualify as covered expenses, and are negotiated amount for a participating provider.

ANSWER: Allowed amount

500
  • Provide at least 4 methods on how medicine can be introduced to the body
  • ANSWER:
  • orally via pill
  • Tablet
  • Capsule
  • Inhalant
  • Nasal Spray
  • Mist
  • Patch
  • Lotion
  • Cream applied to Skin
  • Liquid Eye Drops
  • Suppositories
  • Injected Via Syringe And needle.

500
  • Liquid medicine or treatment delivered through a vein, delivered to a patient in their home.

ANSWER: Home Infusion Drugs.

500
  • An injection that helps stop the development of bone-removing cells before they can reach and damage the bone.

ANSWER: Prolia shot