Summary of Benefits for MAPD/PDPs
Yes because headers do not need to be read
Minor because the ADP did not read the benefits verbatim
Yes and the ADP should be coached
Inpatient Hospital Care/Hospital Stays
Primary Care Physician
Ambulatory Surgical Center
Physician Specialist Services
Diagnostic Radiological Services
N/A. If it is a non-required benefit it does not matter.
Yes, the ADP did more than they were supposed to.
Minor, If the ADP/BA reads a non-required benefit, it must be read accurately.
No. The ADP went above and beyond what they had to read and should not be marked down.
Yes. The ADP only has to read four benefits as listed in the definitions
No. As long as long as they read them all accurately.
Home Health Care
Skilled Nursing Facility (SNF)
Long Term Care Pharmacy Drug Tiers
Outpatient rehabilitation services
Yes, they must always be read
No, as long as they are the same as the Initial Coverage tiers
Minor, because the ADP did not read 'Medicare-covered ambulance benefits'
Yes, because benefits do not need to be read verbatim
Minor, because the ADP was required to read both lines
C. Yes, because when there are two different copays or coinsurance listed, the ADP is only expected to read the first benefit
Yes, benefits are not required to be read verbatim
Minor, because the ADP left out 'For Medicare-covered hospital stays:'
Minor, because the ADP said 'Days 11 - and beyond there is no copay' instead of '- Days 11 - 90: $0 copay per day'
Minor because the ADP said 'Days 1 - 10: $150 copay per stay' instead of '- Days 1 - 10: $150 copay per day'
Yes, because benefits are not required to be read verbatim
Minor, because the ADP did not read 'Worldwide Coverage'
Yes, the ADP read the correct copay amount
Minor, because the ADP did not say 'immediately'
Minor, because the ADP did not say 'In-Network'
Here's an interesting quiz for you.