Day 2 Week 3

1.What is a copay?

• is the amount you pay each year for most eligible medical services or medicines before your health plan begins to share in the cost of covered services.

• Is a flat fee that you pay on the spot each time you go to your doctor, emergency room, urgent care, medical facility or fill a prescription.

• is a portion of the medical cost you pay after your deductible has been met.

2. Following the Disclosure of Information Grid Article, section "Adult customer or Emancipated minor(calling about themselves or dependent children)", can we provide the DOB?

• No-Confirm Only

• yes, and confirm

3. What is a deductible?

• is the amount you pay each year for most eligible medical services or medicines before your health plan begins to share in the cost of covered services.

• Is a flat fee that you pay on the spot each time you go to your doctor, emergency room, urgent care, medical facility or fill a prescription.

• is a portion of the medical cost you pay after your deductible has been met.

4. Following the Disclosure of Information Grid Article, section "Terminated customer on the policy (ex-spouse, adult dependent), Limit information to the terminated customer only", can we provide Diagnosis/ Procedure Code/CDT Prescription name ?

• yes

• no

5. What is HIPAA?

• Health Insurance Portability and Accountability Act of 1996

• Health Insurance Portability and Accountability Act of 1995

• Health Insurance Portability and Accountability Act of 1997

6. What is coinsurance?

• Is a flat fee that you pay on the spot each time you go to your doctor, emergency room, urgent care, medical facility or fill a prescription.

• is the amount you pay each year for most eligible medical services or medicines before your health plan begins to share in the cost of covered services.

• is a portion of the medical cost you pay after your deductible has been met.

7. If member has a deductible plan only, and has a In network deductible of $500.00, and she/ he expend $200.00, does that means she/he..?

• Still need to reach $300.00 to get coinsurance

• no need to reach $300.00 Cigna will paid ( even is deductible has not met)

8. If Doctor is out of network with Cigna ( meaning no contracted) and he charge $750.00 for a doctor office, but Medicare allow only $350.00 for the service, how much will be the allow amount with Cigna?

•  $350.00

• $450.00

• $750.00

9. If doctor is in network with Cigna, and charge the amount of $100.00 , but based on the contract with cigna the allow amount is $50.00 and member has a Copay of $25.00, how much is the patient responsibility?

• $25.00

• $50.00

• $100.00

10. If doctor is in network with Cigna, and charge the amount of $100.00 , but based on contract with Cigna the allow amount is $50.00 and member has a copay of $25.00, how much will Cigna cover/paid?

• $50.00

• $25.00

• $100.00