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Flashcards in Product Deck (15):

What is the individual penalty for failing to meet federal regulations mandated for 2016?

Maximum of 2.5% of the consumer's yearly household income or, $695 per adult ($350.50 per child under 18);


What is the meaning for each of the following Cost Assistance acronyms: APTC and CSR?

Advance Premium Tax Credit (APTC), Cost Sharing Reductions (CSR)


What are the specific (start-end) dates for the upcoming 3-month open enrollment period?

November 1, 2015 - Jan 31, 2016


How is the effective date of a policy determined?

Applications dated on or before the 15th will be effective on the 1st of the following month; those dated between the 16th and 31st will be effective on the 1st of the second following month.


What is the Binder Payment, and when is it due?

The Binder Payment is the initial premium, due 30 calendar days from the effective date.


What is the duration of the Free Look period, and what document contains the Start Date?

It is a 10-day window that is measured from date on the approval letter in SLX.


Who is the target market for the MyBlue product?

On-Market Bronze and Silver BlueCare Members receiving subsidies.


What FPL range is required for Cost Share Reduction?

100 - 250% Federal Poverty Level


What common services are not covered by the Short Term Insurance Coverage?

Pre-existing conditions, routine examinations and shots (immunization), treatment for mental disorders and/or substance abuse; in general, care that is not medically necessary is not covered.


What are 8 common dental procedures?

Oral Evaluation and Exam, cleaning, Bitewing X-Ray, Filling, Crown, Root Canal, Periodontal scaling and root planing, Non-surgical simple extraction – single tooth


What are 6 common Eye Glasses, Lens Options?

Polycarbonate, UV Treatment, Tint (solid or gradient), Plastic Scratch Coating, Anti-Reflective Coating, Polarized


What are the 4 major product categories offered?

Health, Dental, Vision, Short Term


What are the advantages of choosing in-network doctors?

Negotiated Rates, Higher Insurance Coverage, Lower Premiums


What is PBM and how does it provide oversight?

The Pharmacy Benefits Manager is Express Scripts: it provides oversight for formulary compliance, therapeutic drug selection, claims processing, mail order services, and drug utilization review.


What are the two payment options that should be offered, which is preferred and what are its parameters?

eCheck is the preferred: Account and Routing Number, name and billing address. The second option is "Bill Me".