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WorksheetsDay 1 Review (101 & ESP)
Total questions: 26
Worksheet time: 19mins
Why is the SPD (Summary Plan Document) important?
Contract between Quantum Health and the Employer
Outline of the pharmacy benefits
Federal laws that govern Employer Sponsored health Plans
Constitution of the health plan – outlining who is covered, what is covered and how it is covered
(a) is how we determine whether or not a member has access to benefits at a particular time.
____ is responsible for updating eligibility with a company's Human Resources
Employer
TPA
Quantum
Employee
Select all of the following that can change a member's eligibility with their health plan
Retirement
No longer being able to afford premiums
Marriage or Divorce
Change in Hours Worked
Vacationing Out of State
Fixed dollar amount that is the member's responsibility at the time of service
OOP Maximum
Deductible
Copay
Coinsurance
Procedures that are "experimental and investigational" are almost always _________
Precertified
Plan Exceptions
Plan Limitations
Plan Exclusions
If a plan says it will only cover a member for 25 chiropractor visit per year this is called a ________
Plan Exclusion
Plan Limitation
Plan Exception
Precertification
Select all of the groups who can contribute money to an HSA (Health Savings Account)
Employee
Employer
TPA
State
Network
The (a) is the only one who can contribute money to an FSA (Flexible Savings Account)
Why do plans offer HRAs?
To pay towards a member's 401k
To offset a member's high deductible
To pay for a member's childcare
To pay for things not covered by a member's HSA
This is the ultimate resource that tells us how a plan is designed.
(a)
Money taken out of a member's paycheck for them to access insurance coverage
(a)
Fixed dollar amount the member has to meet before the plan begins to pay for certain services
(a)
Percentage % of costs share my a member and health plan after the deductible has been met
(a)
Medical services that are not covered by the health plan
(a)
A visit "cap" or fixed dollar amount for specific plan benefits
(a)
Type of plan funded by both the employer and the employee in which funds are stored in an employee benefit trust
Employer Sponsored Health Plan
Carrier Health Plan
Partially Insured Health Plan
Medicare Health Plan
In a Carrier Health Plan the ________ assumes all the risk
Employer
Employee
Insurance Carrier
Stop Loss Carrier
This is the only type of plan that Quantum Health provides medical management for
Employer Sponsored Health Plans
Carrier Health Plans
Primary Health Plans
Medicare Health Plans
Select all of the benefits of an Employer Sponsored Plan
Saves Money
Insurance carrier assumes all of the risk
Employer controls the health plan design
Any left over money goes to the insurance carrier
This is the first person/group that an employer hires to help build a self funded plan
TPA
Network
Quatum Health
PBM
Benefit Consultant
(a) provides EXCEPTIONAL customer service and medical management services to members
This group pays claims and administers the plan
TPA
Benefit Consultant
Network
Quantum Health
A group of providers who provide services at a lower contracted rate is called a (a)
This group maintains and communicates member eligibility to Quantum Health
TPA
Network
Quatum Health
PBM
Benefit Consultant
This insurance for the insurance protects a company from terrible losses due to high cost medical cases
Medicare
Stop Loss
Gap Insurance
Secondary Insurance
