How well do you know accums?

1.

1 point

The member will pay 100% until their DED is met (assume normal setup)

True

False

2.

1 point

The member will pay $0 after their OOP is met (assume normal setup)

True

False

3.

1 point

The CLIENT will pay $0 after a CAP is met (assume normal setup).

True

False

4.

1 point

Use the following info to answer the question:

Deductible:
Individual: $500
Family: $1,500

Assume the deductible is EMBEDDED. What is the MINIMUM number of family members we would need in order to meet the Family limit?

1

2

3

4

5.

1 point

Use the following info to answer the question:

Deductible:
Individual: $500
Family: $1,500

Assume the deductible is NON-EMBEDDED. What is the MINIMUM number of family members we would need to meet the Family limit?

1

2

3

4

6.

1 point

Use the following info to answer the question:

OOP:
Individual: $2000
Family: $4000

Assume the OOP is EMBEDDED. What is the minimum number of family members we would need to meet the Family limit?

1

2

3

4

7.

1 point

Scenario: Ron goes to the pharmacy for the first time this year and pays $56.78 towards his deductible. Assuming his deductible and OOP are setup to cross-apply, what amount will apply to his OOP?

Whatever his copay is

$56.78

$0

None of the above

8.

1 point

Scenario: Leslie fills 4 claims and pays the following amounts towards her deductible during 2015:

January - $37.89
April - $68.93
August - $33.33
December - $89.96

If her deductible is setup with 4th quarter rollover, how much will she have accumulated in her deductible bucket as of January 1st, 2016 when her plan rolls over?

$0

$123.29

$89.96

$500

9.

1 point

You are testing a deductible with an effective date of 9/01/2015. The intent states that the bucket should start over based on CONTRACT year. Based on this, what DOS should be used for your ‘New Year’ test claim to test the bucket restarting?

09/01/2015

01/01/2016

01/02/2016

09/01/2016

10.

1 point

Which of the following types of accumulators will result in the MEMBER paying 100% AFTER the limit is met?

Deductible

OOP

CAP

TrOOP

11.

2 points

Which of the following types of accumulators should always be filled in prior to testing copays and/or pricing?

Deductible

OOP

CAP

None of the above

12.

4 points

Refer to the excel workbook attached to the quiz e-mail for this question.
Note: This question is worth 4 points. No pressure.

Which set of claim output shows an embedded OOP with all claims passing?

Choice A

Choice B

Choice C

Choice D