BASIC
BENEFITS OFFERED
RATES
PLANS
LOC/COMM
100
Address Type for Basic node is coded as________.
Head Office
100
What is our standard funding arrangement?
Insured
100
Compensation Change for No Coverage - Not Rated is _______.
No.
100
TRUE or FALSE: HSNCoverageCd should not be coded. Leave default.
False. HSN is standardly covered in Alpha groups. This should be coded as YES.
100
When do we code Prov Dist Tab?
When group is S.A
200
TRUE or FALSE: Renewal notice period and Grace period can be found in the Master App.
False. This is standard coding. 60 Days and 31 days respectively.
200
Give two benefits where Person Link Type is coded as "Spouse".
OSL and OSA
200
What date should be coded when we are coding the "Revision Date"?
Effective date of the group.
200
When do we code Benefit Card Type and ESI GSAS Type?
When EHC - DRUGS - PDD
200
What is the Billing Status for NBD?
Not Bill
300
Name the tabs under the Basic node which we are not updating.
- Calc
- Custom
- Status
- Contract
300
Name the folder/s under the Benefits Offered which have Presentation Sequence and Display Order.
- Benefit
- Coverage Option
300
What is the Rate Units for the following benefits?
ELI
LTD
STD
ELI - 1000
LTD - 100
STD - 10
300
EHC - Mandatory - S.A
What is the coding for Mandatory Benefit?
Claims Submit / Claims Submit
300
What is the rule for coding the BOSS fields?
BOSS MLI = H.O
BOSS Client Billing = SA/TPA
400
When do we code DRUG CARD under Finance Tab?
When EHC - DRUG - is PDD
400
When do we code No Coverage for DLI, EHC and DEN?
DLI - if it's H.O
EHC/DEN - if it's Not Mandatory
400
What kind of rates is as shown below?
Age Banded Rates
400
What should be your next step if PT hours is not indicated in the Master App?
Copy FT hours. They should be the same.
400
How do we code the Renewal Premium Start Date?
1 year from the effective date of the client.
500
How do we code Bill Sort List?
- Make sure the first line is correct (Account Interface only checked)
- Add BGSG
- Click edit. Make sure Sort by class & Member detail are checked; Accounting Interface not checked
- Move Location to the right box.
500
Create the Presentation Sequence for the ff benefits:
ELI
STD
EHC
DLI
OEL
OSL
ADD
DEN
ELI - 10
STD - 70
EHC - 60
DLI - 30
OEL - 20
OSL - 40
ADD - 50
500
How do we name the rates for the following:
Plan A - ELI - 0.25
Plan B - ELI - 0.85
ELI - Plan A
ELI - Plan B
500
What should you do if you incorrectly link the rate to the plan?
- Click the benefit
- Click PBO
- Click Change links
- In Rate Group field, click Change link and link the correct rate.
500
When do we code the following?
- AUTO
- MAN
- NET OF COMMISSIONS
- AUTO = Insured, % or Scale (001, 002)
- MAN = ASO BAR/BAD
- NET = Dummy Advisor or non-commissionable benefits