Worksheets2nd day PDP
Total questions: 15
Worksheet time: 10mins
A “premium” is
The amount a member must pay for their health insurance plan
The amount paid to a doctor/facility for services
The amount the insurance company reimburses a member for out-of-pocket expenses
The amount a pharmacy charges for their services
What is a co-payment suitable definition?
The periodic payment required to keep a policy in force
A flat-dollar amount that a member must pay for a prescription
A percentage of a healthcare professional 's charge for which the member is financially responsible under the terms of the policy
None of the above
Marie’s yearly deductible is $1,400. She paid $350 towards that in June when she went to her routine visits. In July, she went to have a surgery. She was again charged $350 for the services. How much does she have left in her deductible?
$350
$400
$0
$700
What amount of a $210 bill would Alexandra be required to pay if her Part D plan stipulates 20% co-insurance and she has already met her deductible?
$34
$42
$66
$40
Emily has a deductible of $100 and has paid $50 toward it. She must have a Tier 3 medication that will cost $150. Her coinsurance is 20 percent. How much does she need to pay?
$60
$50
$65
$70
what do we do when we do not understand the members question
Just assume What the member needs
place them on hold and let them hung up
Ask Probing questions and request for them to repeat again, if its necessary
What intent do we use when the member says that they need to know where they can have some blood tests done?
{select all that apply}
Search and assign provider
Send non marketing materials
Update member preferences
On the UHC web site
in Pictionary mode, Draw your favorite Present Ever Received.
Where do you find the details of coverage for a Medication?
on the Formulary
on Google
on IBAAG
On Bing
How many PDP standalone plans we have in UHC?
4
6
2
there is no such thing as PDP plans
What is that thing that you want to ask but you are too afraid to do it?
Which is the stage where members need to pay full medication amount?
Donut hole
Co-insurance
Benefit period
Deductible
Does a deductible apply in all our UHC plans?
True
False
Ruth has a true out of pocket of $1,000 with her deductibles only contributing to that out of pocket maximum. Ruth has accumulated $995.00 towards that amount. She will go to the pharmacy today and has a co-pay of $25.00 for a vaccine administration. How much will Ruth have to pay?
$5
$15
$25
$10
Melissa needs to get a Tier 5 medication that will cost $100.000. She has a Walgreens plan. Can she jump in to the catastrophic stage just with this claim?
Yes
No
