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How Pharmacy Plans and Deductibles Work

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Date: : 06/03/2016

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How Pharmacy Plans and Deductibles Work


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Screen ID: Summary

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Date: : 06/03/2016

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How Pharmacy Plans and Deductibles Work


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Screen ID: Importance

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Date: : 06/03/2016

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How Pharmacy Plans and Deductibles Work


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Screen ID: Objective

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Date: : 06/03/2016

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Text = Calibri
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in Humana green
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Insurance
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slide 5
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How Pharmacy Plans and Deductibles Work


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Screen ID: Overview

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Date: : 06/03/2016

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Text = Calibri
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in Humana green
Humana video embedded
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slide 6
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to bring up menu
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Today's question: how did deductibles copays coinsurance and maximums work?

Video narration
(transcript
below)
The simple answer is they define the different ways health insurance
companies pay most
of the costs to keep you

Transcript ofhealthy. It's a little complicated at first, but not when you understand how everything works together. Your deductible is the amount of your medical costs that you have to pay before your health
insurance begins to pay. These amounts can vary dramatically between different plans. Here's an example. Gina has a health plan with a fifteen hundred dollar deductible. If she only has a few
audio:
little things go wrong during the year that cost less than fifteen hundred dollars total, she's going to pay the full amount to treat them. However, if Gina has a catastrophic injury or serious illness that

requires a lot of medical care to get better, she'll pay her fifteen hundred dollar deductible, and then her health insurance takes over to pay most, if not all for additional cover costs. Often plans with
higher deductibles have lower monthly premiums. The exception to deductibles is preventive care, like annual physical exams and routine gynecological visits with in network doctors, which are
covered by most plans even before meeting a deductible. Sometimes, even after you've met your deductible, you may still have to pay a copay. A copay is a set price that you pay when you visit the
doctor a small portion of the total bill. Copays very by policy, and can change if you see a specialist instead of a regular doctor or seek treatment out your provider network. Prescription drug
coverage may also have copays, which can be higher for specialty medicines, and lower for generic drugs. Let's say Gina goes to the doctor with a case of mono. Her doctor charges a thirty dollar
copay, and when Gina fills a prescription, she pays a five dollar copay to the pharmacy. Her out-of-pocket costs are $35 dollars, and her insurance company will reimburse the pharmacy and the
doctor for the difference between the copay and the cost of treatment. Some plans have coinsurance, which is the way you and your health insurer share the costs of your care after you've met your
deductible. For example, if Gina is injured and she's met her deductible for the year, her health plan will pay eighty percent of the cost of the rest for covered expenses, leaving Gina responsible for
the remaining 20 percent. Maximum out-of-pocket is the most you could be responsible for paying for during the plan year for cover expenses. So to sum it up, deductibles are the portion you must
pay first before your insurance pays its share. Then, you pay only a small portion of your health care costs, either set copay amount or coinsurance percentage. Maximum out-of-pocket is the most
will pay for covered treatment in one year. So now you know. Until next time, stay smart and stay healthy.

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Where would you


like to start?

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Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Life block buttons
Click hunter green life block
(Plans with a deductible)
to proceed to slide 7
Click plum life block (Plans
without a deductible) to
proceed to slide 18
Click plum (Menu) life block
to bring up menu

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How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Plans with a


deductible

Screen 7 of 28

Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Life block buttons
Click hunter green life block
(Next) to proceed to
slide 8
Click plum (Menu) life block
to bring up menu
Rollover blocks display text
described in the
Rollover text section
below. Text displays in
white space below
blocks

Audio information

Rollover HDHP/EHDHP:
Rollover Text:

Aggregate or Embedded High Deductible Health Plans


(HDHPs/EHDHPs)
- These plans always have a deductible
- The deductible is shared between medical and pharmacy

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Rollover Copay Plans:


Copay Plans (Rx3, Rx4, Rx5)
-Can be sold with or without a drug deductible
-This deductible is not shared with medical

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: How do claims


process with a deductible?

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Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Money graphic - Alt tag =
Cash
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(Next) to proceed to
slide 9
Click plum life block (Menu)
to bring up menu
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slide 7

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How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Example with


deductible 1

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Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 10
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 8

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clicking one of the
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How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Example with


deductible 2

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Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 11
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 9

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How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Split Claims

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Date: : 06/03/2016

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in Humana green
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Calculator
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slide 12
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How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Split claim


example

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Date: : 06/03/2016

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Text = Calibri
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slide 13
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How Pharmacy Plans and Deductibles Work Screen ID: How claims process after
Project name:
the deductible is met

Screen 13 of 28 Date: : 06/03/2016

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Text = Calibri
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in Humana green
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= Piggy bank,
stethoscope & cash
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slide 14
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to bring up menu
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How Pharmacy Plans and Deductibles Work Screen ID: Example after deductible
Project name:
1

Screen 14 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
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(Next) to proceed to
slide 15
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to bring up menu
Click dark grey life block
(Back) to go back to
slide 13

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How Pharmacy Plans and Deductibles Work Screen ID: Example after deductible
Project name:
2

Screen 15 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 16
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 14

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How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Knowledge Check

Screen 16 of 28 Date: : 06/03/2016

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Text = Calibri
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Instructional text = Calibri
(italic)
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in Humana green
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= Payments button
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(Next) to proceed to
slide 17
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 15
Click plum life block
(Submit) to submit
question and display
feedback (Feedback
detailed below)
Audio information
Note: Answer options will be randomized

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clicking one of the
action buttons

Correct answer feedback: (Displays in a pop up when learner selects correct answer, $130) Correct! Nora must pay her $100
deductible, plus her $30 copay. This is known as a split claim.
Incorrect answer feedback: (Displays in a pop up when learner selects one of the incorrect answers) Incorrect. Reviewing the split
claim example scenario may be helpful for you.

How Pharmacy Plans and Deductibles Work Screen ID: Example after deductible
Project name:
2

Screen 17 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional Text = Calibri
(Italic)
Humana life block header
in Humana green
Click hunter green life block
(Yes) to go back to slide
7
Click dark grey life block
(No, Proceed to Next
Lesson) to go to slide 18
Click plum life block (No,
Proceed to End of
Course) to go to slide 24
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 16
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audio:
Description:N/A

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Plans without a


deductible

Screen 18 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional text = Calibri
(Italic)
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 19
Click plum life block (Menu)
to bring up menu
Rollover block displays text
described in the
Rollover text section
below when user moves
mouse over that space.
Text displays in white
space below block.
Audio information

Rollover Text:
Copay Plans (Rx3, Rx4, Rx5)
-Can be sold with or without a drug deductible
-This deductible is not shared with medical

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clicking one of the
action buttons

How Pharmacy Plans and Deductibles Work Screen ID: How claims process when Screen 19 of 28
Project name:
Date: : 06/03/2016
there is no deductible?

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Text = Calibri
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in Humana green
Insurance policy graphicAlt tag = Insurance
policy paperwork
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slide 20
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to bring up menu
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audio:
Description:N/A

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Example without


deductible 1

Screen 20 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 21
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 19

Audio information
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clicking one of the
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Transcript ofN/A
audio:
Description:N/A

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Example without


deductible 2

Screen 21 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 22
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 20

Audio information
Click sound when
clicking one of the
action buttons

Transcript ofN/A
audio:
Description:N/A

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Knowledge Check

Screen 22 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional text = Calibri
(italic)
Humana life block header
in Humana green
Pharmacist graphic - Alt tag
= Pharmacist
Click hunter green life block
(Next) to proceed to
slide 23
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 21
Click plum life block
(Submit) to submit
question and display
feedback (Feedback
detailed below)
Audio information
Note: Answer options will be randomized

Click sound when


clicking one of the
action buttons

Correct answer feedback: (Displays in a pop up when learner selects correct answer, $75) Correct! Sam has no deductible, and
his tier 3 copay is $75.
Incorrect answer feedback: (Displays in a pop up when learner selects one of the incorrect answers) Incorrect. Reviewing the
claim example s without a deductible may be helpful for you.

How Pharmacy Plans and Deductibles Work Screen ID: Would you like to review? Screen 23 of 28
Project name:
Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional Text = Calibri
(Italic)
Humana life block header
in Humana green
Click hunter green life block
(Yes) to go back to slide
18
Click dark grey life block
(No, Proceed to Next
Lesson) to go to slide 7
Click plum life block (No,
Proceed to End of
Course) to go to slide 24
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 22
Audio information
Click sound when
clicking one of the
action buttons
Transcript ofN/A
audio:
Description:N/A

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Summary

Screen 24 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 25
Click plum life block (Menu)
to bring up menu

Audio information
Click sound when
clicking one of the
action buttons

Transcript ofN/A
audio:
Description:N/A

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Assessment question 1

Screen 25 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional text = Calibri
(italic)
Humana life block header
in Humana green
Click hunter green life block
(Next) to proceed to
slide 26
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 24
Click plum life block
(Submit) to submit
question and display
feedback (Feedback
detailed below)

Audio information
Click sound when
clicking one of the
action buttons

Correct answer feedback: (Displays in a pop up when learner drags descriptions to the correct locations) Correct! You correctly
arranged the claim descriptions on the timeline.
Incorrect answer feedback: (Displays in a pop up when learner drags one or more description to the incorrect location) Incorrect.
Review the Plans with a deductible lesson for more practice.

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Assessment question 2

Screen 26 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional text = Calibri
(italic)
Humana life block header
in Humana green
Bottle graphic - Alt tag =
Prescription bottle
Click hunter green life block
(Next) to proceed to
slide 27
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 25
Click plum life block
(Submit) to submit
question and display
feedback (Feedback
detailed below)
Audio information
Note: Answer options will be randomized

Click sound when


clicking one of the
action buttons

Correct answer feedback: (Displays in a pop up when learner selects correct answer, The drugs applicable copay or
coinsurance) Correct! If there is no deductible on the plan, the member will pay their applicable copay or coinsurance based on the
drug tier.
Incorrect answer feedback: (Displays in a pop up when learner selects one of the incorrect answers) Incorrect. Review the Plans
without a deductible section for more practice.

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Assessment question 3

Screen 27 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Instructional text = Calibri
(italic)
Humana life block header
in Humana green
Pharmacy graphic - Alt tag =
Pharmacy consultation

Click hunter green life block


(Next) to proceed to
slide 28
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 26
Click plum life block
(Submit) to submit
question and display
feedback (Feedback
detailed below)
Audio information
Note: Answer options will be randomized

Click sound when


clicking one of the
action buttons

Correct answer feedback: (Displays in a pop up when learner selects correct answer, $80) Correct! This claim is a split claim, and
Nate will owe the rest of his deductible, plus his copay.
Incorrect answer feedback: (Displays in a pop up when learner selects one of the incorrect answers) Incorrect. Review the
information on split claims for more practice.

How Pharmacy Plans and Deductibles Work


Project name:

Screen ID: Assessment Score

Screen 28 of 28 Date: : 06/03/2016

Graphics info
Text = Calibri
Logo text = FS Humana
Humana life block header
in Humana green
Click hunter green life block
(Exit) to end course
Click plum life block (Menu)
to bring up menu
Click dark grey life block
(Back) to go back to
slide 27

Audio information
Click sound when
clicking one of the
action buttons

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