Check Your Knowledge - Summary of Benefits & Coverage
Quiz by PHRS Training Team
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- Q1
Match the service with the copay
linking://Preventive Care|0: Telemedicine|10: Primary Care - non preventative|35: Specialist - non Value-Choice|65
60sEditDelete - Q2
Who is responsible to ensure a provider is in-network?
Patient
Paychex H&B Rep
Doctor
You, the HRP
60sEditDelete - Q3
What is the estimated total cost to the patient to have a baby (assume there are no limits or exclusions)?
13,200
6,665
6,600
65
60sEditDelete - Q4
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?
20
25
10
35
60sEditDelete - Q5
What is the out-of-pocket maximum that a family of 3 may pay in a year?
13,200
6,600
19,800
60sEditDelete - Q6
Acupuncture counts towards the out-of-pocket maximum.
boolean://false
60sEditDelete - Q7
What is the copay to see a mental health or substance abuse counselor?
20
65
10
0
60sEditDelete - Q8
With this plan, is it cheaper to get maintenance drugs (such as daily blood pressure medicine) from a retail pharmacy or by mail?
By mail
Retail pharmacy
60sEditDelete - Q9
How may spinal manipulation/chiropractor visits per year are allowed?
freetextm://30:thirty
60sEditDelete - Q10
One or two? One or two? It’s back to school time, and the entire family needs an eye exam, who is covered?
No one
Just the adults
Just the kids
The entire family
60sEditDelete - Q11
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 copay
60sEditDelete - Q12
Florida Blue 62 is an example of what kind of plan?
POS
HMO
MCP
PPO
60sEditDelete - Q13
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 referral
60sEditDelete - Q14
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.
60sEditDelete - Q15
Part 2: This service can help a client understand their coverage and benefits for an upcoming procedure, like foot surgery.
scrambled://BalanceCare
60sEditDelete - Q16
The following is an example of what? A patient sees their dermatologist for an annual skin check. The dermatologist is in the insurance company's network. While at the appointment, the patient also receives Botox injections to reduce the look of some wrinkles. As a cosmetic treatment that isn't medically necessary the injections aren't covered by the plan. The patient soon receives a bill for the Botox injections.
An inconvenience, but it’s OK because the charge will count towards the out-of-pocket maximum.
An error by the provider, everything should be covered.
A legitimate charge known as balance billing.
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