Sample Insurance Company Health Plan

Mamber Name: Abraham Lincoln

Member ID: ABC1234567

TYPE: Employee Only

Group: BGC01

COPAY: PCP $20, SPEC $50, ER $100

Employer: Busy Grocery Corporation

PLAN: PPO

RxBIN: 012345

RxPCN ABC001

The insurance card is needed to process a claim. These cards are all different in appearance, but they contain the same type of information. Complete these questions.

Using the above example of a health insurance card, answer the following questions. Answer with cannot be determined if the information is not available from the card. (All answers are 1 point except where noted) Use complete and correct sentences for your answers.

1. What represents a unique patient identifier for this card?
2. If the cardholder had an appointment with a urologist, what amount would he expect to pay for the office visit?
3. Determine which entity has purchased the insurance policy.
4. What does the PPO stand for in the Plan field and what does it mean?
5. Define managed care (2 points)
6. If a patient requires a referral to see a specialist, what would be the steps necessary to see the specialist and why would a plan what this as part of the managed care system plan? (2 points)