5: Email, 6: Other (specify) If Applicant had Percent. Multi, 20 Exchange N/A OK. Checkboxes. words. business in 2017: N/A OK. Percentage of 1: Telehealth via web unique Exchange (video), enrollees with a 2: Telehealth web/telehealth via phone, consultation in 3: Combination 2017 of web (video) and phone, 4: Instant messaging, 5: Email, 6: Other (specify) Applicant Single, Multi, 20 reimburses for Radio Checkboxes. web/telehealth group. N/A OK. consultations 1: Yes, 1: Telehealth 2: No via web (video), 2: Telehealth via phone, 3: Combination of web (video) and phone, 4: Instant messaging, 5: Email, 6: Other (specify) Among members Multi, 20 in plans with Checkboxes. Checkboxes. words. available 1: No cost N/A OK. share, web/telehealth 1: Telehealth 2: Same cost via web consultation, as a primary (video), what is the care visit, 2: Telehealth member cost 3: Same cost via phone, as a specialist share? 3: visit, Combination 4: Telehealth of web (video) visit cost share and phone, (please 4: Instant explain):, messaging, 5: Other 5: Email, (explain): 6: Other (specify)
5: Email, 6: Other (specify) If Applicant had Exchange business in 2017: Percentage of unique Exchange enrollees with a web/telehealth consultation in 2017 Percent. N/A OK. Multi, Checkboxes. N/A OK. 1: Telehealth via web (video), 2: Telehealth via phone, 3: Combination of web (video) and phone, 4: Instant messaging, 5: Email, 6: Other (specify) 20 words. Applicant reimburses for web/telehealth consultations Single, Radio group. 1: Yes, 2: No Multi, Checkboxes. N/A OK. 1: Telehealth via web (video), 2: Telehealth via phone, 3: Combination of web (video) and phone, 4: Instant messaging, 5: Email, 6: Other (specify) 20 Among members in plans with available web/telehealth consultation, what is the member cost share? Multi, Checkboxes. 1: No cost share, 2: Same cost as a primary care visit, 3: Same cost as a specialist visit, 4: Telehealth visit cost share (please explain):, 5: Other (explain): Checkboxes. N/A OK. 1: Telehealth via web (video), 2: Telehealth via phone, 3: Combination of web (video) and phone, 4: Instant messaging, 5: Email, 6: Other (specify) 20 words.
CCSB%20QHP%20Certification%20Application%20Plan%20Year%202019%20Quarterly%20Application_Final.docx