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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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