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Medical Coverage Learner Reflection

Which of the following count towards the Member's Maximum Out of Pocket (MOOP)?
A. Plan Premium, Deductible, Coinsurance/Copays
B. Prescription Deductible and Coinsurance/Copays
C. Deductible, Coinsurance/Copays
D. Medical and Prescription Coinsurance/Copays
How can a member file a standard appeal?
A. In writing
B. Online
C. Verbally
D. All of the above
E. Both A & B
In what systems can you view Preauthorization?
A. Market Prominence and HRP
B. SCP and Member Website
C. MedCompass and Evicore/CareCore
D. EPDB and SFE
Providers with a primary specialty in Family Practice, Internal Medicine, General Practitioner, and some Nurse Practitioners and Physicians Assistants are considered types of ______.
A. Specialists
B. Facilities
C. Primary Care Providers
D. None of the above
Routine Preventative benefits have a __ copayment so long as the benefit has not yet been used. You can check ______ to verify if the Benefit has been used.
A. $5, Market Prominence
B. $0, SCP
C. $5, SFE
D. $0, Accumulators
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