Today is crunch day! For Saturday and Sunday, I will be spending the entire day writing these chapters and studying like mad for the test. My future depends on me passing the test because it's expensive and if I don't pass the first time, I can't attend a training session for my new job until November 30th. I have snacks and hopefully I can talk someone into coming over to help out and quiz me at some point. But expect rapid updates!

Types of Plans

Stage is set as usual.

ERICK: That chapter was amazing.

ADDIE: Right? Thank you for giving me that book.

ERICK: In a modern AU, would that be the season DVDs of Doctor Who?

ADDIE: Probably.

FINN: Is anyone going to talk about the prodigal son scene?

HICCUP: Or about why I'm being written like an old man now?

ASTRID: How so?

HICCUP: Falling asleep on the couch? Really? Talk about stereotypes.

OVERLORD KATIE: My dad used to fall asleep while reading to me.

HICCUP: So that's where you get the idea then.

OVERLORD KATIE: Not so much. Em wrote that.

CLIFF: How come I wasn't in the chapter?

ADDIE: Time constraints.

HIRO: Are we going to get back to insurance?

GOGO: Why are you asking?

HIRO: Because that's probably more interesting than this conversation.

BAYMAX: Our next section is Types of Plans. A Preferred Provider Organization (PPO) is an organization of hospitals and physicians that provide services on a fee for service basis to insurance company's clients. These providers are listed as preferred and the patient may select from any number of hospitals and physicians without having a limitation.

HICCUP: So it's not like HMOs because they can choose anyone. And it's just a fee for service.

BAYMAX: Right. The PPO cover 100% with a minimal copayment for each office visit or hospital stay.

HICCUPL Makes sense. I guess they wouldn't pay the full amount If they use a non PPO doctor.

BAYMAX: Correct. This is Overlord Katie's insurance plan right now.

OVERLORD KATIE: Those copayments are tricky.

BAYMAX: PPOs do not provide care on a prepaid basis but instead physicians are paid a fee for each service.

ADDIE: So not like a cellphone.

BAYMAX: Exactly. Subscribers are not required to use physicians or facilities that have contracts with the PPO. A PPO is a service provider, not an insurance plan. The goal of a PPO is to provide insureds with providers that have agreed to discount their charges.

OVERLORD KATIE: Interesting. I should remember to thank my doctor for that then.

FINN: And your therapist.

OVERLORD KATIE: Oh hush, you.

BAYMAX: In an Open Panel Arrangement, the physicians are not considered to be employees of the PPO.

ASTRID: So they're just... physicians that aren't employed to them.

BAYMAX: Yes. In a Closed Panel Arrangement, the physicians are only allowed to treat patients assigned to them and are considered employees of the PPO.

HICCUP: Sounds like there's no free will to see whatever doctor you want.

ASTRID: Probably not.'

BAYMAX: A Point of Service (POS) plan allows an insured to receive services from nonparticipating or participating providers.

ASTRID: That sounds freer.

BAYMAX: The doctors are paid a set fee per person, regardless of the service they perform.

CLIFF: Sounds like prepaid.

BAYMAX: Somewhat. It's a combination of an HMO and a PPO but there is no gatekeeper. POS and PPO offer a greater selection of providers as compared to an HMO.

HICCUP: Not bad.

BAYMAX: A Point-of-Service plan allows members to join the HMO. If, for any reason, they want to use a physician who is not employed by the HMO, they may do so. Remember: POS allows people to join HMOs but also to use physicians not employed by them.

HICCUP: Okay so... now I'm confused.

OVERLORD KATIE: We all are.

BAYMAX: In a POS plan, an insured does not have to pick a Primary Care Physician (PCP) and may choose Medical providers not found on the preferred list and still retain coverage.

ASTRID: So they can pick anyone.

BAYMAX: Right. If a non-member physician provides service under a POS plan, then the service provider will be paid a fee for their services. The member will be required to pay a higher co-insurance amount or percentage for the privilege of using a non-member physician.

WASABI: So they get the fee anyway but members pay more for using a non-member physician.

BAYMAX: Correct. In a Hospital Indemnity Plan, an elimination period refers to the number of days that an insured must wait before becoming eligible to receive benefits for each hospital stay.

HIRO: So that means the elimination period is basically how many days an insured has to wait before they can get benefits for each stay in the hospital.

BAYMAX: Correct. Major Medical policies were designed to provide an insured with protection against catastrophic loss. These policies require deductibles and co-payments which makes coverage affordable.

TADASHI: So they protect against the catastrophic loss through deductibles and co-payements so the coverage will be affordable.

BAYMAX: Yes. A Supplemental Major Medical policy is designed to provide coverage for services after a basic policy's expenses are satisfied by reaching its limit.

TADASHI: That means they help by covering expenses that basic policies don't cover.

BAYMAX: That is correct. After the Basic policy's funds are reached, an insured must pay a corridor deductible before a Major Medical policy will pay any benefits. It is considered a corridor amount because it is required between the Basic and Major Medical coverage.

WASABI: Okay so... after the funds of a Basic plan runs out, the insured has to pay a deductible before the Major Medical policy will pay benefits. The corridor amount is kind of between the basic and major coverage.

BAYMAX: Correct. A Comprehensive Major Medical is a combination policy of Basic and Major Medical coverage. Almost all Medical expenses are covered generally using one deductible per individual or family in a coinsurance amount.

HIRO: So it's one deductible for everything instead of just getting 2 plans.

BAYMAX: Essentially. Primary characteristics of Major Medical Insurance Plans are high maximum levels, coinsurance, deductible, and blanket coverage.

TADASHI: Earlier vocabulary words.

BAYMAX: Yes. Major Medical Insurance Plans that cover Medical expenses in and out of Medical facilities and contain high maximum benefits are called Eligible Plans.

TADASHI: That means... actually I'm not sure. High maximum benefits, does that mean a lot of benefits?

OVERLORD KATIE: Don't ask me.

BAYMAX: As you know, injuries caused by war, self-inflicted injuries, cosmetic surgery, custodial care, and coverage provided by Worker's Compensation are common exclusions from coverage.

FINN: Of course.

BAYMAX: You know what? I'm tired of this.

GOGO: Wait what?

BAYMAX: I want to go over to Overlord-Overlord Becky to study in person.

OVERLORD KATIE: You're talking weird.

BAYMAX: This is boring and annoying and you remember things easily when you talk through them. I think Overlord-Overlord Becky would help.

OVERLORD KATIE: But that's...

HICCUP: Gasps. She's not.

ASTRID: Say it isn't so!

OVERLORD KATIE: I'm afraid it is. Overlord-Overlord Becky is... my mother.

I'm sick of this.

~KateMarie999