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Health Medical Plans (AZ-AHS)

Take this Course
Medical Plan Concepts
  • Fee-for-Service vs. Prepaid
  • Specified Coverage vs. Comprehensive Coverage
  • Minimum Essential Coverage
  • Benefit Schedule vs. Usual
  • In-Network vs. Out-of-Network Benefits
  • Provider Network — Broad vs. Narrow
  • On-Marketplace Plans vs. Off-Marketplace Plans
  • Grandfathered Plan vs. Transition Plan
  • Insureds vs. Subscribers/Participants
  • Dependent Coverage
  • Healthcare Appeal Rights
Health Care Services Organizations (HCSOs)
  • General Characteristics
  • Basic Health Care Services
  • Preventive Care Services
  • PCP vs. Referral (Specialty) Physician
  • Emergency Care
  • Hospital Services
  • Network Exception
  • Cost-Share
  • Maximum Out-of-Pocket (MOOP)
Preferred Provider Organizations (PPOs)
  • General Characteristics
  • Essential Health Benefits
  • Maximum Out-of-Pocket (MOOP)
  • Type of Parties to the Provider Contract
Point-of-Service (POS) Plans
  • Nature and Purpose
  • Gatekeeper
  • Indemnity Plan Features
Cost Containment
  • Cost-Saving Services
  • Open Enrollment Period
  • Preventive Care
  • Hospital Outpatient Benefits
  • Preauthorization
  • Second Opinion
  • Utilization Management
Arizona Requirements
  • Dependent Child Age Limit
  • Coverage for Newborn and Adopted Children
  • Child Coverage
  • Handicapped Dependent Coverage
  • Rating Criteria
Marketing Considerations
  • Advertising
  • Disclosure Form
  • Summary of Benefits & Coverage

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CONTACT US

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(801) 518-1956

Text Us (anytime)

(801) 518-5016

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