Answer to Question 1
B
Answer to Question 2
Answer:
Each preceding question that related to previous payments of deductibles, coinsurance amounts, satisfaction of individual or family limits, accident benefits, and other accumulated amounts will change with the processing of each claim. On our payment worksheet, the updated history appears in the upper-left-hand corner of the sheet. If claims are processed by computer, the computer should handle the updating of the history for you.
If accident benefits were paid on this claim, add the payment amount of the accident benefits to any previous accident benefit amounts paid on this individual for this accident. This amount goes on the first line. The amount paid on all accidents in this calendar year should be placed to the right of this amount, along with the current year (in parentheses).
The amount of the benefits paid under Major Medical should be added to all previous Major Medical benefits paid. If the plan has a calendar year maximum, the amount of the benefits paid should be added to all previous benefits paid during that calendar year. (Remember that annual maximums will be prohibited starting in 2014). Check the contract to see whether there is an annual maximum for Basic and Major Medical payment amounts.
The amount of any deductibles calculated on this claim should be added to any previously paid deductible amounts and the result placed in the deductible space with the current year.
If any of the dates of service on this claim fall within the last three months of the calendar year and the contract includes a carryover provision, the amount of deductible paid on these services should be placed on the line labeled carryover deductible, along with the year. If there is more than one date of service and if some are in the last three months and others are not, the deductible amount should be taken from the amount or amounts of the services in the order in which they are received.
