Gain access to 24/7 benefits information and compliance tools.
January 20-22, 2020
Rancho Mirage, California
November 24-27, 2019
San Francisco, California
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The Certificate in Health Plan Navigation is earned after completing eight one-hour e-learning courses. Each course is available 24/7 for anytime/anywhere self-paced access. The interactive courses are easy to navigate and contain helpful interactive features to support your learning, including quick quiz questions, engaging video clips and a complete glossary of terms.
Click the courses below to view more information.
Health insurance is a product that helps to minimize the financial impact of a consumer's medical costs by transferring some of the risk to the insurance provider. Yet, despite the importance of this product, many consumers still have anxiety when trying to select a health insurance plan and use the coverage. This course is designed to help consumers to understand the basic concepts and terminology that they need to know.
Explains why health insurance coverage is so important and the main sources of health coverage in the United States, including employer sponsored health plans and government programs.
Identifies communication tools used to explain coverage, such as the ACA required summary of benefits and coverage (SBC) or a summary plan description (SPD), as well as the definitions of basic health coverage terms, including who and what is covered under a plan. Legislative and legal considerations are also discussed.
Describes the goal of managed care and how to differentiate between various plan approaches, including a preferred provider organization (PPO), health maintenance organization (HMO) and point-of-service (POS) plan. Also explains how consumer-driven health plans (CDHPs), health reimbursement arrangements (HRAs) and health savings accounts (HSAs) work.
Outlines other types of ancillary benefits including carved-in and carved-out prescription drug plans, dental plans, vision plans, behavioral health plans and alternative health care.
Current research suggests that only 12% of adults have proficient health literacy, while the remaining 88% of consumers often find themselves unsure of the best options for managing their health care—leading to increased health care costs due to misunderstanding and misuse of resources. This course defines health literacy and its importance and will provide you with a comprehensive overview of how to assist consumers with low health literacy in any setting.
Differentiates the various levels of health literacy and shows how low health literacy can negatively impact consumer health and well-being.
Explains how to recognize signs of low health literacy via verbal and nonverbal cues and how different consumer groups are impacted by low health literacy.
Illustrates how consumers are limited by low health literacy when it comes to accessing health care and understanding difficult insurance plans and concepts.
Provides advice for anyone who counsels consumers through difficult health care decisions on how to eliminate fear, create a welcoming atmosphere and facilitate understanding. Additional topics addressed include overcoming language barriers and jargon.
The Patient Protection and Affordable Care Act (ACA) was passed in 2010 with the intent of making health care affordable and accessible for all consumers. This course offers an introductory look at the main components of ACA, as well as how the law has changed over time. For anyone who counsels health care consumers, this course will provide guidance on how to objectively advise them about their choices.
Identifies the sources of health coverage in the United States and why the concept of risk pooling is important to ACA and other health insurance plans. The purpose and primary components of ACA are also reviewed.
Defines the benefit mandates that apply to all health insurance plans and dives into the details of grandfathered vs. nongrandfathered plans.
Explains the different types of exchanges, including state-based and federally facilitated exchanges, SHOP exchanges and private exchanges, as well as what types of coverage can be purchased through each.
Provides a thorough look at how the individual and employer shared responsibility penalties and the Cadillac Tax were designed to help fund ACA, as well as the current status of each tax.
Discusses the different ways to advise consumers through the unique steps of choosing and enrolling in a health plan.
In an effort to expand health coverage to all consumers, the Patient Protection and Affordable Care Act (ACA) created a new online Marketplace, also called public exchanges, where individual consumers, families and small businesses can go to purchase health plans. In addition to these exchanges, private exchanges are also available to sell health insurance to individuals and groups. This course defines and differentiates the three main types of exchanges and the health coverage and financial assistance available through each.
Compares state-based vs. federally facilitated exchanges, as well as the functions and operations of each. Also covers qualified health plans, eligibility, health premium tax credits and cost-sharing reductions.
Explains the purpose of SHOP, the eligibility requirements for coverage, financial advantages for small employers, and how and why a consumer should enroll.
Describes the various types of private exchanges, as well as the common features of all private exchanges. Enrollment rates for private exchanges are also covered.
Identifies important questions and concerns for consumers as they compare types of exchanges and the coverage available within each and outlines strategies for advising consumers.
For most consumers, taking medication is a part of daily life and understanding his or her prescription drug coverage is incredibly important for obtaining and using drugs correctly and managing costs. But navigating through many sources of coverage, the different types of drugs that exist, various plan costs and features and the claims process can be difficult. This course will provide guidance on how prescription drug plan sponsors can support their participants.
Describes how prescription drugs are made available to consumers through the different types of health care coverage available in the United States, as well as how pharmacy benefit managers (PBMs) support employer-sponsored prescription drug plans.
Reviews the various categories of drugs available to consumers, how they are developed and how they differ based on market availability and chemical makeup.
Explains the different charges that a consumer may incur when purchasing prescription drugs, as well as how a formulary is used to provide plan structure.
Outlines the purchasing process including the types of pharmacies available, point-of-service claims, drug utilization review and other factors that affect prescription drug use.
In order for consumers to use their health care coverage wisely and effectively, it is necessary for them to understand the various costs associated with the coverage as well as to set expectations for quality. This course identifies the most important points that consumers should understand so they can make confident and value-based health care decisions.
Identifies many of the different costs that a consumer may pay for health coverage and elements that will affect the price and value of the consumer's health plan. Topics include cost sharing, premiums, essential health benefits, insurance networks, balance billing, claims and plan affordability.
Describes the different reasons health care costs rise, including medical inflation, the consumer price index, utilization, new technology and drugs, cost shifting, benefit mandates and lifestyle choices. Also compares how costs may vary based on consumer choice.
Discusses the resources for and barriers to predicting actual health care costs, and identifies programs designed to manage health and reduce costs including tools available to consumers, such as the summary of benefits and coverage (SBC).
Defines quality in health care, as well as barriers to quality and different approaches for measuring quality care. Also describes how consumers can use information about care and quality to select a health plan, doctor, hospital or type of treatment.
Identifies important resources consumers can use to find information about quality care.
Health care delivery models are continually evolving as a result of industry trends, economic pressures and legislative mandates. As a result, it is difficult for consumers to stay informed of current options to make the best decisions for their health care. This course reviews the evolution of health care plan types, demonstrating how the different plans utilize various models for delivering care to consumers.
Details the evolution of managed care and the different plan types that are common today, as well as how these plan types are funded and the different tools used for managing plan costs.
Identifies two major plan features, tiered networks and telemedicine, which may be used to deliver specialty care to consumers and discusses the advantages and challenges associated with each feature.
Describes three models of care—patient-centered medical homes (PCMH), centers of excellence and accountable care organizations (ACO)— that plans may approve for consumers to use.
Explains how to advise consumers on choosing between different plan types and how plan features and delivery models can affect plan choices. Also reviews how the Patient Protection and Affordable Care Act (ACA) has affected the delivery of health care.
Each day millions of consumers are out of work due to a disabling condition, making disability insurance an important and valuable type of coverage. Learn more about the various types of private and government-sponsored disability insurance plans as well as how to guide disabled consumers and their families through the decision-making process.
Compares and contrasts group and individual short-term disability (STD) and long-term disability (LTD) plans as well as private and government disability programs.
Explains the basic provisions of a disability plan, including eligibility requirements and waiting periods, and reviews the various definitions of disability based on plan type.
Reviews the qualifications for Social Security Disability Insurance (SSDI) as well as benefits received through this federal program. Also identifies work requirements and restrictions that disabled consumers must follow to maintain eligibility for SSDI.
Outlines how LTD plans are designed, including plan duration, exclusions and other underwriting factors, so consumers can effectively coordinate and maximize benefits.
Outlines how outside income may offset a consumer’s disability payments and how to help consumers coordinate those benefits.
Course content accurately reflects the current Affordable Care Act law. As ACA evolves under the new administration, courses will be updated to reflect any changes.
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