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ADP English Benefits Presentation > Presentation > Flashcards

Presentation Flashcards

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Proverbs and Idioms flashcards
1
Q

Urgent care

A

When you need urgent attention and perhaps cannot see your primary care physician

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2
Q

Emergency care

A

When you require emergency attention/resources

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3
Q

Aetna T1A drugs

A

Value drugs

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4
Q

Aetna T1 drugs

A

Generic drugs

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5
Q

Aetna T2 drugs

A

Preferred brand

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6
Q

Aetna T3 drugs

A

Non-preferred brand drug/generic drug

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7
Q

Aetna T4 drugs

A

Specialty drug

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8
Q

Virtual visit

A

Access to care virtually for non-emergency conditions like the cold, flu, allergies

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9
Q

What is an embedded plan?

A

An embedded plan is when members have their own individual deductible or out of pocket maximum that you have to meet

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10
Q

What is a non-embedded plan or a true individual family plan?

A

When more than just the employee is enrolled in a plan and the members have to meet the family deductible and/or out of pocket maximum. There is no individual deductible if more than just the employee is enrolled in the plan

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11
Q

What does COC stand for?

A

Certificate of Coverage

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12
Q

What does SBC stand for?

A

Summary of benefits and coverage

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13
Q

Mail order benefit

A
  • Allows you to receive medications to your home automatically
  • Can save money because you can receive a 90 day subscription while paying for a 60 day co-payment
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14
Q

What is balanced billing?

A

The difference between the in-network contracted rate and out-of-network negotiated rate

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15
Q

Preventative medication for conditions such as

A
  • Hypertension
  • High cholesterol
  • Diabeties
  • Asthma
  • Osteoporosis (condition in which bones become weak and brittle)
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16
Q

With a high deductible plan, everything is subject to a deductible. True or False?

A

True

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17
Q

Describe health advocate

A
  • Health advocate is a program available for employees who enroll into a medical plan. The service is also available to dependents, spouses, parents, and parents-in-law.
  • Can help with scheduling doctors appointments and tests
  • Can help resolve issues with Billings and claims
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18
Q

How does dental rollover work?

A
  • It works like an incentive to stay healthy
  • If your claims do not reach the threshold during the calendar year, you will get the rollover dollars added to the next year
19
Q

How does dental preventative care work?

A

Dental preventative care is covered at 100% meaning you will not have to pay out-of-pocket, but it is being deducted from the dental benefits maximum

20
Q

What does a dental benefits maximum mean?

A

This is the maximum that the dental insurance will cover for that plan year

21
Q

How does dental orthodontic services work?

A

For new orthodontic service

22
Q

How does the dental lifetime maximum work?

A

You have a maximum per person enrolled in the dental plan.

23
Q

Vision plans with ADP run on a calendar year or plan year?

A

Plan year

24
Q

For in-network vision services members must choose one service, either prescription glasses, contact lenses, or laser vision care per calendar year. True or false?

A

True

25
Q

Who is eligible to enroll in a health savings account (HSA)?

A
  • WSE who enroll in a high deductible health plan
26
Q

Does the HSA run on a plan year or calendar year?

A

Calendar year with IRS limits

27
Q

What expenses qualify under a HSA?

A

Medical, dental, vision expenses

28
Q

Do unused HSA funds roll over?

A

Yes, unused HSA funds get rolled over

29
Q

What is considered dental preventative care?

A
  1. Cleanings
  2. Oral exams (looking at teeth, mouth, and throat to identify problems like cavities, swelling, broken teeth)
  3. Fluoride treatments
  4. Sealants
  5. X-rays
  6. Space maintainers
  7. Emergency palliative treatment
30
Q

What are dental oral exams?

A

Oral exams (looking at teeth, mouth, and throat to identify problems like cavities, swelling, broken teeth)

31
Q

What is dental basic care?

A
  1. Diagnostic consultations
  2. Fillings
  3. Periodontal services (gum disease services)
  4. Endodontic services (root canals)
  5. Oral surgery like simple and complex extractions
  6. General anesthesia
  7. Repair & maintenance of crowns, bridges, dentures
32
Q

What is dental major care?

A
  1. Bridges and dentures
  2. Crowns & veneers
  3. Inlays & onlays
33
Q

What are medical advanced imaging examples?

A
  1. CT/PET Scans

2. MRIs

34
Q

What are the medical plan types?

A
  1. Health Maintenance Organization (HMO)
  2. Preferred Provider Organization (PPO)
  3. Point of Service (POS)
  4. Exclusive Provider Organization (EPO)
  5. High Deductible Health Plan (HDHP) or Consumer Driven Health Plan
35
Q

Do HMO’s offer in network or Out of network coverage?

A

In network coverage only

36
Q

Do PPO’s offer in network or Out of network coverage?

A

In and out of network coverage

37
Q

Do POS plans offer in or out of network coverage?

A

In and out of network coverage

38
Q

Do EPO’s offer in network or Out of network coverage?

A

In network coverage only

39
Q

Do HDHP or consumer driven health plans offer in network or Out of network coverage?

A

Can be in or out of network coverage

40
Q

What is a dental passive PPO?

A

Deductible, coinsurance, and/or plan maximum amounts are the same, whether members get care in or out of the network.

41
Q

What is an active dental PPO?

A

Deductible, coinsurance, and/or plan maximum amounts can be different for in-and out-of-network care.

42
Q

What is a dental health maintenance organization?

A
  • Works like an HMO, where the dentist must be in the DHMO network.
  • This type of plan gives you lower cost for coverage
43
Q

What is considered a highly compensated employee for DCFSA?

A

$135,000+ year

ADP English Benefits Presentation (1 decks)

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