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Benefits Quiz Answers With Explanations

1. Colonoscopies are automatically covered as routine at age 50

FALSE:  To be covered colonscopies need to have a procesdure code. 

2. The shingles vaccine is covered

TRUE:  Vaccines are covered. 

3. There is a $100 co-pay for emergency room visits

FALSE: Emergency rooms are covered at 100% of UCR.  The only trouble we sometimes end up with is when a member goes to an emergency room somewhere that balance bills.  This is rare, but has happened.  Also, it is essential that any follow up visits be done an in-network.

4. For dental work that will cost over $200 there needs to be pre-approval

TRUE:  It is also more important to go in-network for dental or you will end up being balance billed.

 5. Your out of pocket expenses are the same if you go to a non-dentemax dentist.

 FALSE:  See #4

6. Hearing tests are covered

FALSE:  Almost never.  Sometimes these are covered when they relate to another condition, but usually not. 

7. Vision exams and lenses have a straight dollar benefit, regardless of your cost.

TRUE:  $55 for Eye exams, $130 for single lenses with frames, $145 for bifocals, $170 for trifocals. 

8. Some UH doctors or labs are in network

TRUE:  Some UH facilities are as well - some are not.  You can check with your doctor or check on the MMO website for a full list of network doctors.

9. If your kid needs a second set of braces your $2700 benefit starts over.

 FALSE:  Unless we get a new carrier the $2700 limit is per mouth.

10. In one calendar year women need to choose to have a physical exam by their  doctor or a gynecological exam by their OBGYN.

FALSE:  Women are covered for both exams annually.

11. If you go out of network you pay the first $100 then 10% of everything else.

 FALSE:  Trick question.  You pay the first $100, but only 10% of the next $2000.  Maximum out of pocket per individual will be $300, $600 for family.  The only other out of pocket could be that when you are out of network you can get balance billed, that is, being charged the difference between what MMO pays and what the provider charges.

12. Doctors can never resubmit bills to Medical Mutual.

FALSE:  We ask doctors offices to resubmit claims all the time to help clarify what has really been done.  Some offices will say it is illegal, which is true if they lie about what they submit.

13. Any prescription you get from your doctor will be covered by Medco.

FALSE:  There are some things that are not covered, but these are the excpetions.

14. Mental health services are not covered.

FALSE:  We have outpatient mental health services up to 31 visits covered.  Out of network there is a copay after the 11 visit of 20%, 50% after visit 21.

15. If you waive medical insurance to get $1000 then you still have access to Vision, Dental, Prescription, and skilled nursing without an employee contribution.

TRUE:  You can waive hospitlization only - which is the part that has co-insurance coming out of our checks.  The vision, dental, prescription, and skilled nursing benefits come as a different package that do not have co-insurance. 

16. The Union has a negotiated benefit that members can access when they are experiencing non-medical issues; like dealing with aging parent, financial problems, workplace stress, etc.

TRUE:  We have an employee assistance program called IMPACT.  Employees, family dependents or members of the employee's household are eligible for up to 2 pre-paid counseling sessions.  Call 1-800-227-6007.

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