Check Your Knowledge - Summary of Benefits & Coverage
Quiz by PHRS Training Team
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Match the service with the copay29
linking://Preventive Care|0: Telemedicine|10: Primary Care - non preventative|35: Specialist - non Value-Choice|65
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Match the service with the copay
linking://Preventive Care|0: Telemedicine|10: Primary Care - non preventative|35: Specialist - non Value-Choice|6560s
Who is responsible to ensure a provider is in-network?
Paychex H&B Rep
You, the HRP60s
What is the estimated total cost to the patient to have a baby (assume there are no limits or exclusions)?
How much can a patient save on their copay if they do a telemedicine visit as opposed to a non Value-Choice primary care visit?
What is the out-of-pocket maximum that a family of 3 may pay in a year?
Acupuncture counts towards the out-of-pocket maximum.
What is the copay to see a mental health or substance abuse counselor?
With this plan, is it cheaper to get maintenance drugs (such as daily blood pressure medicine) from a retail pharmacy or by mail?
How may spinal manipulation/chiropractor visits per year are allowed?
One or two? One or two? It’s back to school time, and the entire family needs an eye exam, who is covered?
Just the adults
Just the kids
The entire family60s
Client question: I’m going to a wedding in Colorado, what happens if I get sick?
Rub some dirt on it and walk it off
There is no no coverage, wait until you get home
multiplem://If it’s not an emergency, you can use the telemedicine option:Out of state urgent care and emergency room visits are covered at the listed copay60s
Florida Blue 62 is an example of what kind of plan?
Client question: How can I save money when visiting a specialist?
Use a Value-Choice specialist
There is no cheaper option when visiting a specialist
Go out of network
Get a referral60s
Another client question Part 1: I’m having surgery on my foot, the doctor is in-network, so I’m good to go, right?
You should be, but you won’t know for sure until you get the bill.
Yes, as long as the doctor in charge is in-network, so are all the other services and providers.
Never assume anything, you need to check with your provider to ensure things like lab work are done using an in-network provider.60s
Part 2: This service can help a client understand their coverage and benefits for an upcoming procedure, like foot surgery.
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