Altrua HealthShare test question and answers.docx, Exams of Biology

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Altrua HealthShare test question and answers HCSM - answer Health Care Sharing Ministry (under ACA) Altrua members - answer exempt from federal penalty imposed on those who don't have health insurance Altrua members - answer nationwide faith-based membership, uphold Statement of Standards, share in each other's medical needs Altrua is NOT health insurance - answer alternative to rising healthcare costs ACA enrollment is limited - answer failure can result in being locked out of the ACA Statement of Standards - answer not tied to one specific faith, open to all walks of faith, faith based, Biblical standards Solicitors need to be comfortable and willing to embrace same set of standards (Statement of Standards) - answer to professionally, ethically and honorably represent Altrua Faith-based alternative solution - answer problem of rising health care costs, expensive policies no longer only option of - answer reduced coverage, higher deducibles sharing ministries have been available for - answer thirty years; Altrua since 1999; Randall Sluder 2005; operated by Crown HealthShare Administrators, Inc. What happens to eligible medical needs the membership is unable to share? - answer They will remain the financial responsibility of the member should the program cease to operate. What is the Altrua opportunity? - answer like minded members to care for one another in a time of need Altrua is not a legally binding agreement to reimburse any member for medical needs?? - answer not insurance When are medical needs shared? - answer Medical needs will be reimbursed from the escrow from all member contributions. "How it works" for the member. The member shares (pays monthly premium in Insurance terms, but this is not Insurance): - answer 1. The member receives contribution request (a bill or premium invoice in insurance terms) 2. AHS receives contribution (premium) 3. The members may submit additional contributions 4. AHS deposits contributions into AHS escrow 5. AHS transfers monthly operating expenses from escrow to operating account 6. AHS process needs according to guidelines 7. AHS issues check to provider from escrow EOB: Explanation of Benefits equals - answer EOS: Explanation of Sharing Member medical needs are processed according to - answer Member Guidelines and the membership type selected by member "How it works" for the member who is in need of medical help: - answer member has medical need and selects provider or facility, member presents AHS ID card, provider calls AHS for pre- authorization on any non-emergency testing, procedure or surgery, member notifies AHS of any ER visit or hospital admit, provider sends claim to AHS, member receives not an EOB but an EOS, AHS issues check to provider "you just want healthy people, don't want to pay claims" - answer Wrong! We want to negotiate the price. 1st and 2nd MRA (deductible in Insurance world) - answer Member Responsibility Account (deductible) Affiliated provider - answer PHCS network www. multiplan.com Non-affiliated provider - answer not in PHCS network, office visit is 50% of office visit How many office visits per year is the member allowed? - answer six per calendar year Gold and Silver Office visits - answer included up to $300 per visit with $35 MRA (deducible) for PHCS affiliated network; Bronze NA A membership limitation can be removed when? - answer with appropriate medical evidence... Have you ever heard of that happening with traditional health insurance? Fraud results in - answer Cancellation... just like in traditional insurance Membership Qualifications. Financial Participation. - answer Application fee $100, Annual membership contribution: $100?? Altrua donation $25 currently?? Monthly membership contribution Membership Qualifications - What happens if there is a missed contribution? - answer results in that month's eligible needs not being shared Membership Qualifications - What is the consequences of an inactive membership? - answer can be reinstated when past due contributions are made within 90 days - same as ACA plans. What are eligible needs? - answer only needs incurred on or after the membership effective date. Where are the needs filed? - answer Needs must be filed on appropriate appropriate forms. Medical records may also be required from providers; needs forms are on website What about needs arising from a defined and disclosed listing? - answer not eligible Appeals and grievance process - answer Established process. Affiliated provider - answer PHCS network Contributor - answer person named as head of household Escrow instructions - answer Contained on the membership application on page 6. It outlines the order in which contributions may be shared by AHS. Full-time service volunteer?? - answer person eligible as a dependent covered household member. Who, without receiving a salary, contributes services for a religious organization? Guidelines - answer an outline for eligible needs in which contributions are shared in accordance with the membership escrow instructions Member - answer person or persons who qualify to receive voluntary sharing of contributions for eligible medical needs according to the membership escrow instructions, guidelines and membership type Altrua HealthShare - answer 501c3 non profit. Bronze office visits - answer NA Bronze maternity - answer NA Health and Wellness Program Yearly Healthy Lifestyle Credit How is the weight verified? - answer clinic? Applicants whose weight exceeds the $45 increase limit - answer Not eligible for membership What if applicant loses weight? - answer Must maintain weight within guidelines for 90 days. AHS offers a program to help - answer prospective applicants with meeting and maintaining the required height/ weight guidelines. AHS Application process. - answer 1. Fill Membership application and Medical Questionnaires. 2. Applicant submits application along with fees. 3. Once AHS receives application and fees, new applicant will be contacted by phone or email 4. New apps will go through the approval process pending tests. 5. If the new applicant decides to withdraw their app they must contact AHS directly. AHS Application process. - answer 6. If the new applicant has membership limitations that apply, new applicant must sign the membership limitations doc prior to membership being effective. 7. If new applicant accepts terms of membership, new applicant will be contacted by phone or email advising them of their acceptance and effective date. 8. A new member pack will be mailed to the dress of the New Member. 9. Membership ID cards will be mailed separately to New Member once completed. 10. For any questions regarding a new membership call 888-244-3839 Ethics and Compliance - answer 1. Representatives should endeavor to place the public interest above their own. 2. Reps should seek to improve professional knowledge 3. Reps should obey all laws 4. Reps should should be diligent in the performance of their occupational duties and strive to improve functioning of the HCSM 5. Reps should raise ethical standards 6. Reps should maintain honorable relationships with clients Ethics and Compliance - answer 7. Reps should assist in improving public understanding of HCSM 8. Reps should provide considerate and courteous service as well as respect personal privacy and dignity of prospective members. 9. Reps should ensure application process is accurate 10. Reps must submit full payments and never finance contributions 11. Reps must ensure prospective members receive appropriate documentation as defined in guidelines 12. Reps must fully comply with Membership Guidelines to ensure eligibility Representatives will not - answer call the program insurance 400,000 + members How it works when the Member has a Medical need or crisis: - answer 1. Member selects a provider or facility 2. Member presents AHS ID card 3. Provider calls AHS provider department for pre- authorization on non-emergencies 4. Member or provider notifies AHS of any ER visit or hospital admit 5. Provider sends claim to AHS 6. Member receives EOS (EOB) 7. AHS issues check to provider from escrow account CO-OPS VERSUS HEALTH CARE SHARING Health Care Sharing Ministries are nothing like CO- OPS. - answer HCSM are not-for-profit, and they are run by their members, but they do not try to act like insurance companies. They don't have a contract to pay benefits. The members of the Ministry help to share the medical expenses of other members, but each member is ultimately responsible for his or her own expenses. Preventative services are not shared. The Ministry doesn't take out loans, it doesn't use actuaries, it doesn't do underwriting, and it is not subject to insurance regulations. They are, however, subject to the same regulations as all other charities. Dependents Qualifications - answer Children under the age of 20, spouse living under the same roof (no estranged spouses) Dependents Qualifications Newborn - answer Must notify AHS within 30 days of birth Dependents Qualifications - answer Children 20-24 with appropriate documentation proof and 90 days beyond 25th birthday with proof of an ongoing need Dependents Qualifications - answer Full time student -12 hours pre semester and a full-time volunteer (missionary). Dependents Qualifications - answer older dependents due to medical conditions verified by a qualified health professional Dependents doing drugs - answer Violation, off the plan Employer must offer - answer choices to the employee pre-existing conditions - answer LIMITED for the first 12 months of membership Not eligible - answer Surgery in the first 90 days unless..., abortion unless..., infertility testing, maternity from adultery or fornication, hysterectomy without securing tow independent medical opinions and both must agree. not eligible - answer DME, untimely filing of needs - 9 months for active members, psychiatric counseling, metal health, autism, substance abuse, ADD, hyperactivity, sharing limits maternity - answer 10 consecutive months in a combined membership If a member elects to use a mid-wife - answer mid- wife must be tested for group B strep prior to delivery. Complications of pregnancy - answer not subject to maternity sharing limits newborn will be eligible to participate - answer 30 days after delivery once pregnant the member must - answer notify Altrua to determine eligibility criteria have been met. The member will have the choice of 2 reimbursement options. Appeals - answer Most situations can be resolved simply by calling a member services representative refusal of treatment - answer may mean future medical needs will not be eligible for sharing groups less than 49 - answer small group in Texas groups over 50 - answer large group in Texas