This program promotes understanding of health insurance basics.
It covers simple terminology like HMO, PPO, premiums, copays, and coinsurance; offers an overview of the major health plan types—private/employer, ACA, and government; discusses structures of employer-sponsored health plans that are fully vs. self-insured; examines the differences in health savings accounts like HSA’s and HRA’s; and cautions about recent accumulator adjustor policies related to manufacture copay coupons.
Attendees will come away with a firm understanding of the terms/jargon used by health plans in addition to greater comprehension of health plan types and their coverage differences.
Key Learning Objectives:
Participants will understand key insurance terminology like HMO, PPO, premiums, copays, coinsurance, etc.
Participants will learn the variances between private/employer, ACA, and government plans, as well as the difference between at-risk/self-insured policies vs. fully insured plans and their impact upon employers and plan members.
Participants will gain an understanding of formulary and the philosophy of PBMs and formulary management and how this drives current insurance policy making.
Participants will learn about recent insurance policy changes that have affected access to specialty medication: copay accumulator adjustors, step therapy, and pharmacy mandates for specialty medications. They will understand what these policies achieve, how they can disrupt or undermine access, and how patients can successfully navigate these issues.
Participants will be instructed in the insurance appeals process and will learn best practices for winning an appeal.
The information contained in this video is provided for informational and educational purposes only, and should not be construed as legal or clinical advice on any subject matter.
Please direct any questions related to this webinar by email to: Shelby.Smoak@biomatrixsprx.com
Thank you!
About Shelby Smoak
Advocate & Education Specialist at BioMatrix Specialty Pharmacy
Shelby Smoak is a tireless advocate for patients with chronic health conditions. In the 90s, his experience living with a bleeding disorder and HIV led him to become actively involved in advocacy. He’s been saturated in the ever-changing dynamics of healthcare ever since. Shelby helps others understand complicated health policy and serves as a voice for patients with rare conditions across the nation. He’s been featured on TV and radio, including NPR. Shelby served on the board for the Hemophilia Association of the Capitol Area and currently serves on the Pfizer B2B board. A former literature professor, Shelby is also a writer and a musician. Awarded a Pen/American grant for writers living with HIV, Smoak holds a Ph.D. in Literature and an M.A. in English. His book, “Bleeder: A Memoir” received praise from sources as diverse as The Minneapolis Star Tribune, Library Journal, and Glamour, and has won several awards, including “Best of the Best” by the American Library Association.
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