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Health Reform Quiz

Health Reform Quiz

Out-of-Pocket Maximum

Which types of health plans are exempt from having to accumulate member cost-sharing to the out-of-pocket maximum?

 Self-insured health plans
 Grandfathered health plans
 Fully insured health plans

Correct.

Sorry, The answer is "grandfathered health plans."

Grandfathered health plans, either insured or self-funded, are exempt from the out-of-pocket maximum limits.

What is the out-of-pocket maximum limit for single coverage in 2014?

 $6,350
 $12,700
 $2,500

You are right.

Sorry, that is incorrect.

The out-of-pocket maximum for single coverage in 2014 is $6,350.

Which of the following payments do not accumulate to a single, combined out-of-pocket maximum?

 Copayments
 Per occurrence deductibles
 Premiums

Yes, correct.

Sorry, the answer is "premiums."

Premiums paid by members do not accumulate to the out-of-pocket maximum.

Flexible Spending Account (FSA)

What is the maximum dollar amount groups can choose to carry over?

 $100
 $300
 $500
 All of the above

Correct.

Sorry, The answer is $500.

According to the IRS guidance, a customer can elect up to the $500 carryover or they can elect not to provide a carryover at all.

Summary of Benefits and Coverage (SBC)

What changes have been made to the second year of applicability SBC template and sample completed SBC?

 a. No changes have been made
 b. Adding whether the plan or coverage provides Minimum Essential Coverage
 c. Adding whether the plan or coverage meets minimum value
 d. Adding whether the plan or coverage provides Essential Health Benefits

Yes, the correct answers are B and C.

The correct answers are B and C.

The only change to the SBC template and sample completed SBC is the addition of statements of whether the plan or coverage provides Minimum Essential Coverage (MEC) and whether the plan or coverage meets the minimum value (MV) requirements (60 percent of costs of benefits for a population). There are no changes to the Uniform Glossary, the Instructions for Completing the SBC, ?Why This Matters? language for the SBC, or to the coverage examples.

True or false: The departments of Health and Human Services (HHS), Labor (DOL) and Treasury provided an extension to the current enforcement relief related to the requirement to provide an SBC and a uniform glossary for the first year of applicability.

 True
 False

True.

The answer is "true."

Current enforcement relief extended through 2014, includes:

  • Extension for use of The Health and Human Services (HHS) coverage calculator for the coverage examples
  • Enforcement relief for plans and issuers that are working diligently and in good faith to come into compliance
  • Employers who have carve out benefits can continue to use a second SBC
  • No additional coverage examples

True or false: Enforcement relief is available for plans and issuers to provide the new required information for the SBC without changing the first year of applicability SBC template.

 True
 False

Yes, this is true.

Sorry, the answer is "true."

If a plan or issuer is unable to modify the SBC template for disclosures required to be provided for the second year of applicability, the departments will not take any enforcement action against a plan or issuer for using the template authorized for the first year of applicability, provided that the SBC is furnished with a cover letter or similar disclosure stating whether the plan or coverage does or does not provide MEC and whether the plan's coverage's share of the total allowed costs of benefits provided under the plan or coverage does or does not meet the MV requirement under the Affordable Care Act.

Women's Preventive Services

A member can obtain a breast pump under the following condition:

 As soon as she finds out she is pregnant
 Within 30 days of the baby?s estimated delivery date
 The member does not need to be pregnant to obtain a breast pump
 All of the above

Correct. Within 30 days of the baby?s estimated delivery date.

The correct answer is within 30 days of the baby's estimated delivery date.

To purchase a breast pump, members will simply need to contact a network doctor or durable medical equipment (DME) supplier to request a breast pump. For a list of breast pump suppliers, members may call the number on their health plan ID card.

Members may purchase a breast pump and submit the receipt for reimbursement.

 True
 False

Yes, the correct answer is FALSE.

Sorry, the correct answer is FALSE.

Members will not be reimbursed for breast pumps they purchase. A member can only obtain a breast pump without cost-share by contacting a network doctor or network DME supplier. For a list of breast pump suppliers, members may call the number on the back of their health plan ID card. The doctor or breast pump supplier will bill UnitedHealthcare directly for reimbursement.

Members need a prescription before ordering a breast pump.

 True
 False

Yes, the correct answer is FALSE.

Sorry, the correct answer is FALSE.

Members do not need a prescription but they must order their breast pump through a network doctor or durable medical equipment supplier. Members may be asked for their doctor's contact information, the date the baby was delivered or their due date. The breast pump supplier may verify this and other information with the member's doctor before the breast pump is issued.

Services provided by a lactation consultant are covered under the expanded women's preventive benefit.

 True
 False

Yes, the correct answer is FALSE.

Sorry, the correct answer is FALSE.

Under the health reform law, lactation support and counseling are covered without cost-share when received through network providers. Lactation consultants or trainers are not licensed under state law to provide medical services nor are they considered part of our provider network. Lactation support and counseling is covered without cost-share when performed by a network physician or health care professional and billed according to our Preventive Care Services Coverage Determination Guideline (PDF). The health reform law does not require services outside of our network to be covered without cost-share, or coverage for lactation consultants who, unlike nurses and doctors, are not licensed under state law to provide medical services.