MM
Do you have to meet your deductible in order for preventive care to be covered 100%?
NO
How many “classes” are in each dental policy AND what are their names?
3
Class 1- Preventative
Class 2- Basic Restorative
Class 3- Major Restorative
What does APTC stand for?
Advanced
Premium
Tax
Credit
What are the 3 metallic tiers?
- Bronze
-Silver
-Gold
Give 3 examples of what type of income in NOT included to estimate APTC?
Alimony
Child support
Mil. Disability
what are the differences between a deductible & M.O.O.P.?
Deductible is the amount that would need to be reached in order to obtain co-insurance.
M.O.O.P.- once the Maximum Out Of Pocket is met, the individual/family would be covered 100% for the remaining year.
Are there waiting periods for certain classes? If so, which ones for how long?
Class1- NONE
Class 2- 6 months
Class 3- 12 months
What are the crucial “parts” to how an APTC is estimated??
-Zip Code & County
-Household Size vs who is applying for coverage
-Income
-Age
What type of plans are CSR eligible?
SILVER!!!!!
If someone is not claiming their kids on taxes- can the children still be eligible for APTC/coverage?
NO!!! All dependents have to be claimed by the Primary in order to be eligible for on market coverage, but are still apart of the household size
List 3 Preventative Care Services…
-Pediatric vision
- pre natal
-mammogram
-screening colonoscopy
- some scripts
- annuals
-etc.,
What does EPO stand for?
Exclusive
Provider
Organization
What does CSR stand for?
Cost
Sharing
Reduction
Are bronze “Catastrophic” plans tax credit eligible?
NO- they are not tax credit eligible
How many essential benefits are covered by on every MM?
10
What is Co-Insurance?
The % that either the insured and insurer cover based on the plan structure
Due to QLE of loss coverage with BCBSM/BCN, will waiting periods start over?
As long as the previous dental coverage was with BCBSM, then no.
- Can a customer get a tax credit IF they have group coverage being offered?
NO!!!!!!!!
What would be the best type of plan for someone who goes to the doctors more than 6 -8 times a year?
GOLD
What contributes to the deductibles AND M.O.O.P.’s?
Services rendered
What are the required benefits that must be read to the consumer?
-Name of the plan
-Deductibles/MOOPs
-Co-insurance (if it applies)
-Preventative Care co-pay
-O.pt Mental Health co-pay
-specialists co- pay
-ER & Urgent care
-Lab/pathology testing
-all 5 tiers of scripts
Can someone with Medicare/Medicaid enroll into our dental policies?
Medicare- Yes
Medicaid- NO!!!!!!!!!!!!!!!!
Can you “coach” a customer into what they should put as their est. income for the current year?
NO
What are the metallic tiers co-insurances?
Bronze- 40%/60%
Silver- 30%/70%
Gold- 20%/80%
What does S.M.A.R.T stand for?
Specific
Measurable
Achievable
Relevant
Timeline