diff --git a/README.md b/README.md index 08cc88fd77..8ab90485b8 100644 --- a/README.md +++ b/README.md @@ -51,7 +51,7 @@ This template, the application code and configuration it contains, has been buil [馃摵 Watch a video overview of the app.](https://youtu.be/3acB0OWmLvM) -This sample demonstrates a few approaches for creating ChatGPT-like experiences over your own data using the Retrieval Augmented Generation pattern. It uses Azure OpenAI Service to access a GPT model (gpt-4o-mini), and Azure AI Search for data indexing and retrieval. +This sample demonstrates a few approaches for creating ChatGPT-like experiences over your own data using the Retrieval Augmented Generation pattern. It uses Azure OpenAI Service to access a GPT model (gpt-4.1-mini), and Azure AI Search for data indexing and retrieval. The repo includes sample data so it's ready to try end to end. In this sample application we use a fictitious company called Contoso Electronics, and the experience allows its employees to ask questions about the benefits, internal policies, as well as job descriptions and roles. diff --git a/docs/agentic_retrieval.md b/docs/agentic_retrieval.md index 70eee2403a..0f8f8e69a9 100644 --- a/docs/agentic_retrieval.md +++ b/docs/agentic_retrieval.md @@ -10,7 +10,7 @@ See the agentic retrieval documentation. ### Prerequisites -* A deployment of any of the supported agentic retrieval models in the [supported regions](https://learn.microsoft.com/azure/ai-services/openai/concepts/models#standard-deployment-model-availability). If you're not sure, try to create a gpt-4o-mini deployment from your Azure OpenAI deployments page. +* A deployment of any of the supported agentic retrieval models in the [supported regions](https://learn.microsoft.com/azure/ai-services/openai/concepts/models#standard-deployment-model-availability). If you're not sure, try to create a gpt-4.1-mini deployment from your Azure OpenAI deployments page. ### Deployment @@ -24,14 +24,14 @@ See the agentic retrieval documentation. 2. **(Optional) Set the agentic retrieval model** - You can configure which model agentic retrieval uses. By default, gpt-4o-mini is used + You can configure which model agentic retrieval uses. By default, gpt-4.1-mini is used. - For gpt-4o: + To change the model, set the following environment variables appropriately: ```shell azd env set AZURE_OPENAI_SEARCHAGENT_DEPLOYMENT searchagent - azd env set AZURE_OPENAI_SEARCHAGENT_MODEL gpt-4o - azd env set AZURE_OPENAI_SEARCHAGENT_MODEL_VERSION 2024-11-20 + azd env set AZURE_OPENAI_SEARCHAGENT_MODEL gpt-4.1-mini + azd env set AZURE_OPENAI_SEARCHAGENT_MODEL_VERSION 2025-04-14 ``` 3. **Update the infrastructure and application:** diff --git a/docs/deploy_existing.md b/docs/deploy_existing.md index 667bf767d4..3b0972f805 100644 --- a/docs/deploy_existing.md +++ b/docs/deploy_existing.md @@ -26,8 +26,8 @@ You should set these values before running `azd up`. Once you've set them, retur 1. Run `azd env set AZURE_OPENAI_SERVICE {Name of existing OpenAI service}` 1. Run `azd env set AZURE_OPENAI_RESOURCE_GROUP {Name of existing resource group that OpenAI service is provisioned to}` 1. Run `azd env set AZURE_OPENAI_LOCATION {Location of existing OpenAI service}` -1. Run `azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT {Name of existing chat deployment}`. Only needed if your chat deployment name is not the default 'gpt-4o-mini'. -1. Run `azd env set AZURE_OPENAI_CHATGPT_MODEL {Model name of existing chat deployment}`. Only needed if your chat model is not the default 'gpt-4o-mini'. +1. Run `azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT {Name of existing chat deployment}`. Only needed if your chat deployment name is not the default 'gpt-4.1-mini'. +1. Run `azd env set AZURE_OPENAI_CHATGPT_MODEL {Model name of existing chat deployment}`. Only needed if your chat model is not the default 'gpt-4.1-mini'. 1. Run `azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_VERSION {Version string for existing chat deployment}`. Only needed if your chat deployment model version is not the default '2024-07-18'. You definitely need to change this if you changed the model. 1. Run `azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_SKU {Name of SKU for existing chat deployment}`. Only needed if your chat deployment SKU is not the default 'Standard', like if it is 'GlobalStandard' instead. 1. Run `azd env set AZURE_OPENAI_EMB_DEPLOYMENT {Name of existing embedding deployment}`. Only needed if your embeddings deployment is not the default 'embedding'. diff --git a/docs/deploy_features.md b/docs/deploy_features.md index c60a42a66f..89d79ca4b0 100644 --- a/docs/deploy_features.md +++ b/docs/deploy_features.md @@ -24,7 +24,7 @@ You should typically enable these features before running `azd up`. Once you've ## Using different chat completion models -As of late March 2025, the default chat completion model is `gpt-4o-mini`. If you deployed this sample before that date, the default model is `gpt-3.5-turbo`. You can change the chat completion model to any Azure OpenAI chat model that's available in your Azure OpenAI resource region by following these steps: +As of early June 2025, the default chat completion model is `gpt-4.1-mini`. If you deployed this sample before that date, the default model is `gpt-3.5-turbo` or `gpt-4o-mini`. You can change the chat completion model to any Azure OpenAI chat model that's available in your Azure OpenAI resource region by following these steps: 1. To set the name of the deployment, run this command with a unique name in your Azure OpenAI account. You can use any deployment name, as long as it's unique in your Azure OpenAI account. For convenience, many developers use the same deployment name as the model name, but this is not required. @@ -40,24 +40,30 @@ As of late March 2025, the default chat completion model is `gpt-4o-mini`. If yo 1. To set the GPT model to a different [available model](https://learn.microsoft.com/azure/ai-services/openai/concepts/models), run this command with the appropriate model name. - For GPT-4: + For gpt-4.1-mini: ```bash - azd env set AZURE_OPENAI_CHATGPT_MODEL gpt-4 + azd env set AZURE_OPENAI_CHATGPT_MODEL gpt-4.1-mini ``` - For GPT-4o: + For gpt-4o: ```bash azd env set AZURE_OPENAI_CHATGPT_MODEL gpt-4o ``` - For GPT-4o mini: + For gpt-4o mini: ```bash azd env set AZURE_OPENAI_CHATGPT_MODEL gpt-4o-mini ``` + For gpt-4: + + ```bash + azd env set AZURE_OPENAI_CHATGPT_MODEL gpt-4 + ``` + For gpt-3.5-turbo: ```bash @@ -66,24 +72,30 @@ As of late March 2025, the default chat completion model is `gpt-4o-mini`. If yo 1. To set the Azure OpenAI model version from the [available versions](https://learn.microsoft.com/azure/ai-services/openai/concepts/models), run this command with the appropriate version string. - For GPT-4: + For gpt-4.1-mini: ```bash - azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_VERSION turbo-2024-04-09 + azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_VERSION 2025-04-14 ``` - For GPT-4o: + For gpt-4o: ```bash azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_VERSION 2024-05-13 ``` - For GPT-4o mini: + For gpt-4o mini: ```bash azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_VERSION 2024-07-18 ``` + For gpt-4: + + ```bash + azd env set AZURE_OPENAI_CHATGPT_DEPLOYMENT_VERSION turbo-2024-04-09 + ``` + For gpt-3.5-turbo: ```bash diff --git a/docs/gpt4v.md b/docs/gpt4v.md index 7bb4890a17..ba010a1270 100644 --- a/docs/gpt4v.md +++ b/docs/gpt4v.md @@ -23,7 +23,7 @@ For more details on how this feature works, read [this blog post](https://techco * The ability to deploy a gpt-4o model in the [supported regions](https://learn.microsoft.com/azure/ai-services/openai/concepts/models#standard-deployment-model-availability). If you're not sure, try to create a gpt-4o deployment from your Azure OpenAI deployments page. * Ensure that you can deploy the Azure OpenAI resource group in [a region and deployment SKU where all required components are available](https://learn.microsoft.com/azure/cognitive-services/openai/concepts/models#model-summary-table-and-region-availability): * Azure OpenAI models - * gpt-4o-mini + * gpt-4.1-mini * text-embedding-3-large * gpt-4o (for vision/evaluation features) * [Azure AI Vision](https://learn.microsoft.com/azure/ai-services/computer-vision/) diff --git a/evals/results/baseline/README.md b/evals/results/baseline/README.md deleted file mode 100644 index e1f23fede6..0000000000 --- a/evals/results/baseline/README.md +++ /dev/null @@ -1,8 +0,0 @@ -# Baseline Evaluation - -This evaluation was done with the application using the following models: - -* Chat completion: gpt-4o-mini -* Embedding: text-embedding-3-large (with binary quantization, 1024 dimension reducation, and oversampling) - -These are the default models and settings as of May 8, 2025. diff --git a/evals/results/baseline/eval_results.jsonl b/evals/results/baseline/eval_results.jsonl index e3b6f8fe26..e3f17a36e4 100644 --- a/evals/results/baseline/eval_results.jsonl +++ b/evals/results/baseline/eval_results.jsonl @@ -1,50 +1,50 @@ -{"question": "What protection does Contoso offer against balance billing?", "truth": "Contoso offers a balance billing protection through the Northwind Standard plan, which protects employees from unexpected costs when visiting in-network providers. [Northwind_Standard_Benefits_Details.pdf#page=7]", "answer": "Contoso offers balance billing protection through the Northwind Standard plan when visiting in-network providers. This means you are protected from unexpected costs that arise from balance billing, which occurs when a provider bills you for the difference between their charges and what your insurance pays. However, this protection does not apply to emergency services, mental health and substance abuse coverage, out-of-network providers, or any non-covered services [Northwind_Standard_Benefits_Details.pdf#page=7][Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Exceptions to the balance billing protection: 路 Balance billing protection does not apply to emergency services. 路 Balance billing protection does not apply to mental health and substance abuse coverage. 路 Balance billing protection does not apply to out-of-network providers. 路 Balance billing protection is not applicable to any non-covered services. At Contoso, we want to make sure our employees are provided with the best coverage options. That's why we've partnered with Northwind Health to offer the Northwind Standard plan, which provides balance billing protection when visiting in-network providers. We encourage our employees to use the tips provided to help reduce the risk of unexpected costs when visiting a provider. Benefits For Out-Of-Network Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers.\n\nNorthwind_Standard_Benefits_Details.pdf#page=7: Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to offer our employees the Northwind Standard plan. This plan provides a balance billing protection, meaning that you are protected from unexpected costs when visiting in-network providers. What is balance billing? Balance billing is when a provider bills you for the difference between what they charge and what your insurance company is willing to pay. This difference can be hundreds of dollars and is often unexpected. With the Northwind Standard plan, you are protected from balance billing when visiting in-network providers. What is an in-network provider? In-network providers are healthcare providers, such as doctors, hospitals, and labs, that have agreed to accept the Northwind Standard plan's payment terms. Visiting an in-network provider means that you are protected from balance billing. You can find a list of in-network providers on the Northwind Health website. What if I visit an out-of-network provider?\n\nNorthwind_Standard_Benefits_Details.pdf#page=6: If you are unsure, you can contact the customer service department of your health plan to verify.It is also important to ask your provider about their policy on balance billing. Be sure to find out if the provider requires you to pay the balance billing amount up front, or if they will bill you after the health plan pays them. When selecting a provider, also remember to consider the cost of services. Participating providers are often more cost effective than non-participating providers. Additionally, some providers offer discounts to patients who pay out of pocket for services. Finally, if you need to use a non-participating provider for certain services, be sure to check with your health plan first. There may be an exception that will cover the cost of the service. Additionally, if you need to use a non-participating provider and you are concerned about the cost, you can always negotiate with your provider to find a more affordable rate. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to ", "latency": 2.793312, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the information provided in the CONTEXT and directly addressing the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the limitations of the protection, which enhances understanding.", "answer_length": 566, "citations_matched": 1.0, "any_citation": true} -{"question": "what is in-network mean for Northwind Health?", "truth": "In-network providers for Northwind Health are those who have agreed to accept the payment offered by Northwind Health, meaning that the policyholder only pays the portion of the cost not covered by the insurance plan. These providers may also offer additional services or discounts not available from out-of-network providers. [Northwind_Standard_Benefits_Details.pdf#page=8]", "answer": "In-network providers for Northwind Health are healthcare providers that have contracted with Northwind Health to provide services at a discounted rate. They have agreed to accept the payment amount offered by Northwind Health, meaning you only pay the portion of the cost not covered by the insurance plan. In-network providers may also offer additional services or discounts not available to out-of-network providers [Northwind_Standard_Benefits_Details.pdf#page=8][Northwind_Standard_Benefits_Details.pdf#page=103].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan. In-network providers may also offer additional services or discounts that are not available to out-of-network providers.Out-of-Network: Out-of-network providers are those who have not contracted with Northwind Health. As a result, they are not required to accept the amount of payment offered by Northwind Health, meaning that you may be responsible for a greater portion of the cost. Additionally, out-of-network providers may not offer additional services or discounts that are available to in-network providers. When choosing a provider, it is important to make sure that the provider is in-network. While it is possible to receive care from out-of-network providers, it is important to understand that you will be responsible for a greater portion of the costs. To make sure that you are getting the best value for your health care expenses, it is recommended that you choose an in-network provider whenever possible.\n\nNorthwind_Standard_Benefits_Details.pdf#page=103: Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health. This includes primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Provider: An out-of-network provider is a healthcare provider that is not included in the Northwind Health network and is not eligible to receive payments from Northwind Health. Out-of-network providers are not covered by Northwind Standard. Preventive Care Services: Preventive care services are services that are designed to help prevent illness and promote health. These services may include immunizations, physical exams, screenings, and other preventive care services. Emergency Services: Emergency services are services that are provided in the case of an emergency. These services may include emergency surgery, emergency room visits, or other emergency services. Northwind Standard does not provide coverage for emergency services. Mental Health and Substance Abuse Coverage: Mental health and substance abuse coverage is coverage for services related to mental health and substance abuse.", "latency": 3.197911, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY with all relevant details provided.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about extra services or discounts offered by in-network providers, which enhances understanding.", "answer_length": 517, "citations_matched": 1.0, "any_citation": true} -{"question": "What are the financial implications of choosing an out-of-network provider under the Northwind Standard Benefits Details?", "truth": "Choosing an out-of-network provider under the Northwind Standard Benefits Details can be significantly more expensive than in-network providers. You may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. [Northwind_Standard_Benefits_Details.pdf#page=10]", "answer": "Choosing an out-of-network provider under the Northwind Standard plan can have significant financial implications:\n\n1. You may be responsible for a greater portion of the costs compared to using an in-network provider. In some cases, you might have to pay the entire cost of services or a far greater portion than you would with an in-network provider [Northwind_Standard_Benefits_Details.pdf#page=8].\n\n2. Out-of-network providers are not required to accept the same reimbursement rates as contracted providers, leading to potentially much higher costs for care [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n3. Services received from an out-of-network provider may not count towards your deductible or out-of-pocket maximum, meaning you could be responsible for paying the full cost of services, minus any applicable discounts [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n4. You may also face balance billing, where the provider bills you for the difference between their billed charges and the amount paid by Northwind Health [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n5. While some out-of-network services may be covered, you will likely still pay more than you would for in-network services [Northwind_Standard_Benefits_Details.pdf#page=10].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 6.694597, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides a correct answer to the QUERY but includes information from a different context (Northwind Health Plus Benefits), which is not relevant to the QUERY about Northwind Standard Benefits. This makes the RESPONSE partially correct but not fully grounded in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the financial implications, such as balance billing and deductible issues, enhancing understanding.", "answer_length": 1272, "citations_matched": 1.0, "any_citation": true} -{"question": "What are the coverage limitations of the Northwind Standard plan regarding clinical trials?", "truth": "The Northwind Standard plan does not cover travel expenses associated with attending clinical trials, nor does it cover any experimental treatments or services that are not part of the clinical trial. [Northwind_Standard_Benefits_Details.pdf#page=24]", "answer": "The Northwind Standard plan has the following coverage limitations regarding clinical trials:\n\n1. It does not cover travel expenses associated with attending clinical trials [Northwind_Standard_Benefits_Details.pdf#page=24].\n2. Experimental treatments or services that are not part of the clinical trial are not covered [Northwind_Standard_Benefits_Details.pdf#page=24].\n3. Coverage for clinical trial services is limited to certain services, including diagnostic testing, treatment of the condition being studied, medications, lab services, and imaging services. Other services may be eligible for coverage on a case-by-case basis [Northwind_Standard_Benefits_Details.pdf#page=23].\n\nMembers should consult with their doctor before participating in a clinical trial to understand the risks and benefits [Northwind_Standard_Benefits_Details.pdf#page=24].", "context": "Northwind_Standard_Benefits_Details.pdf#page=24: It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials. Additionally, any experimental treatments or services that are not part of the clinical trial are not covered. When considering participation in a clinical trial, members should always consult with their doctor first to make sure it's the right choice for them. Clinical trials are not for everyone, and it's important to fully understand the risks and benefits before making a decision. Members should also be aware that not all clinical trials are free. Some require a fee, and it's important to find out what the cost will be before participating. Finally, members should keep in mind that clinical trials are often available in limited locations, so they may have to travel to participate in a trial. Northwind Health can provide information about nearby clinical trials and may be able to help with the cost of travel. At Northwind Health, we are committed to providing access to the most innovative treatments and therapies available.\n\nNorthwind_Standard_Benefits_Details.pdf#page=23: Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, and can give members access to treatments and therapies not yet available. Northwind Standard offers coverage for certain clinical trial services, including those related to common diseases and conditions. The Northwind Standard plan covers the cost of certain clinical trial services, and some of the most common include: 路 Diagnostic testing and procedures to confirm or diagnose a condition or disease 路 Treatment of the condition or disease being studied 路 Medications 路 Lab services 路 Imaging services Any other clinical trial services that are not explicitly covered by the Northwind Standard plan may be eligible for coverage on a case-by-case basis. To determine if a clinical trial service is covered, members should contact the Northwind Health customer service department for more information.It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=23: Northwind Health Plus covers certain clinical trials that are approved by the Food and Drug Administration (FDA) and that are considered medically necessary. These clinical trials must also be recommended by your doctor or health care provider. The plan covers FDA- approved drugs, medical treatments, and medical devices that are used in the clinical trial. What Are Some Exceptions? Northwind Health Plus does not cover any experimental treatments that are not approved by the FDA or that are not considered medically necessary. Additionally, the plan does not cover any treatments that are used in the clinical trial that are not considered medically necessary. Clinical trials must be recommended by your doctor or health care provider and must be approved by the FDA in order for the plan to cover them.Tips for Employees If you are considering participating in a clinical trial, there are a few things to keep in mind: . Make sure the clinical trial has been approved by the FDA. . Talk to your doctor or health care provider about the trial and ask any questions you may have. 路 Ask about the potential risks and benefits of participating in the trial.", "latency": 3.682579, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately listing the coverage limitations of the Northwind Standard plan regarding clinical trials as described in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the coverage limitations of the Northwind Standard plan regarding clinical trials.", "answer_length": 853, "citations_matched": 1.0, "any_citation": true} -{"question": "Does Contoso cover gendr affirming care?", "truth": "Yes, Contoso offers coverage through Northwind Standard for gender affirming care services, which include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. [Northwind_Standard_Benefits_Details.pdf#page=29]", "answer": "Yes, Contoso covers gender affirming care. This includes hormone therapy, gender affirming surgery, and mental health services related to gender transition through Northwind Health Plus. The coverage encompasses hormone replacement therapy, pre- and post-operative care, as well as counseling and therapy visits related to gender transition [Northwind_Health_Plus_Benefits_Details.pdf#page=29][Northwind_Standard_Benefits_Details.pdf#page=29].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=29: Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus. This coverage includes hormone therapy, gender affirming surgery, and mental health services related to gender transition. Hormone Therapy: Northwind Health Plus covers hormone therapy for individuals undergoing gender transition. This includes gender-affirming hormone replacement therapy such as testosterone or estrogen. The coverage also includes many medications and treatments related to hormone therapy, such as monitoring blood work, doctor visits, and lab tests. Gender Affirming Surgery: Northwind Health Plus covers gender affirming surgery for individuals undergoing gender transition. Northwind Health Plus also covers pre- and post-operative care related to gender affirming surgery. Mental Health Services:Northwind Health Plus covers mental health services related to gender transition. This includes counseling and therapy visits, as well as medications related to mental health treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=29: Affirming Care COVERED SERVICES - Gender Affirming Care At Contoso, we understand that gender identity is an important part of who we are and that it should be respected and supported. We are proud to offer coverage through Northwind Standard for gender affirming care services. Gender affirming care services can include a variety of treatments and services related to gender transition. These services may include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. Hormone Therapy Hormone therapy is a type of gender affirming treatment that can be used to help an individual align their physical characteristics with their gender identity. This type of therapy involves taking hormones that are typically associated with a certain gender to help the individual's body better reflect their gender identity. Gender Affirming Surgery Gender affirming surgery is a type of treatment that involves surgical procedures to help an individual transition to the gender they identify with. Mental Health Care Mental health care related to gender transition can include counseling and therapy services to help an individual through their transition process.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=28: by a physician Exceptions Our plan does not cover: 路 Routine foot care, such as trimming toenails, callus removal, and shoe inserts路 Foot care products, such as arch supports, shoe inserts, and foot orthotics 路 Services that are not medically necessary Tips for Employees 路 Take preventive steps to minimize foot problems, such as wearing comfortable shoes that fit properly and provide adequate support. 路 If you have diabetes, check your feet daily for sores or other problems. . If you have any foot problems, don't delay seeking medical care. Early diagnosis and treatment can often prevent more serious problems from developing. 路 If you need custom orthotics, be sure to get them from a qualified provider who is knowledgeable in their use. 路 If you're prescribed orthotics, be sure to follow the instructions for use and wear them as directed. 路 If you're prescribed medication, be sure to take it as directed. . If you have any questions about your foot care coverage, please contact Northwind Health Plus. Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus.", "latency": 2.843525, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely addresses the query by confirming the coverage and detailing the services included, all of which are supported by the context.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it includes additional relevant insights about the specific services covered and the health plan involved.", "answer_length": 443, "citations_matched": 1.0, "any_citation": true} -{"question": "What typs of hearin care servises are covered by the Northwind Standard plan?", "truth": "The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone-anchored hearing aids. It also covers routine hearing aid maintenance and repair, counseling, hearing aid evaluations, and up to $500 per ear for hearing aid accessories such as ear molds, batteries, and tubing. [Northwind_Standard_Benefits_Details.pdf#page=30]", "answer": "The Northwind Standard plan covers the following hearing care services:\n\n1. Hearing tests\n2. Hearing aids and hearing aid accessories\n3. Cochlear implants\n4. Bone-anchored hearing aids\n5. Up to two hearing aids or implants per ear every three years\n6. Routine hearing aid maintenance and repair\n7. Counseling and hearing aid evaluations\n8. Up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing\n\nThere is no deductible for these services, and no pre-authorization is required. However, services provided by out-of-network providers are not covered, and you would be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount [Northwind_Standard_Benefits_Details.pdf#page=30].", "context": "Northwind_Standard_Benefits_Details.pdf#page=30: We are proud to offer coverage for these services for our employees, and we are committed to providing a safe and supportive environment for all of our employees. Hearing Care Hearing Care At Contoso, we understand the importance of taking care of your hearing health. That's why we provide comprehensive coverage for hearing care with Northwind Standard. You can receive hearing care services from any in-network provider and enjoy comprehensive coverage for all hearing care services. The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone- anchored hearing aids. If a hearing aid or cochlear implant is needed, the plan covers up to two hearing aids or implants per ear every three years. The plan also covers routine hearing aid maintenance and repair, as well as counseling and hearing aid evaluations. In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing.\n\nNorthwind_Standard_Benefits_Details.pdf#page=30: In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing. There is no deductible for hearing care services and no pre-authorization is required. However, the Northwind Standard plan does not cover hearing care services provided by out-of-network providers. If you choose to see an out-of-network provider for hearing care, you will be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount. When it comes to choosing a hearing care provider, it's important to find one who is qualified and experienced. Make sure to ask questions about the provider's qualifications, experience, and specialties. You should also ask about the provider's policies on returns, warranties, and repairs. It's also important to understand the technology behind hearing aids. Ask your provider to explain the differences between digital and analog technology, and be sure to ask about the various features that are available. If you have any questions about the Northwind Standard plan's coverage for hearing care, please \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=30: Be sure to check with your provider and Northwind Health Plus about any pre- authorization requirements. . If you have any questions about your coverage, call Northwind Health Plus customer service. Hearing Care COVERED SERVICES: Hearing Care At Contoso, we understand how important it is for our employees to stay on top of their overall health. That is why we are proud to offer comprehensive hearing care coverage through Northwind Health Plus. This coverage can be used for a variety of hearing care services, including but not limited to hearing tests and evaluations, hearing aids and other associated services, as well as hearing aid fittings and adjustments. In order to take advantage of this coverage, employees must receive care from an in- network provider. Northwind Health Plus has a wide selection of providers in its network, making it easy to find a provider who is right for you. Additionally, the plan covers hearing aid fittings, adjustments, repairs, and replacements, as well as batteries, when necessary. When it comes to hearing aid coverage, Northwind Health Plus covers up to $1,500 every 3 years for all hearing aid services, including the hearing aid itself.", "latency": 3.153796, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information directly from the CONTEXT, without adding unrelated or incorrect details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional relevant insights about financial aspects and network provider conditions, which enhance understanding.", "answer_length": 757, "citations_matched": 1.0, "any_citation": true} -{"question": "Does Northwind Helth cover full costs?", "truth": "Northwind Health may not cover the full cost of a specialist or other non-emergency services. [Northwind_Standard_Benefits_Details.pdf#page=34]", "answer": "Northwind Health may not cover the full cost of specialist or non-emergency services, and you could be responsible for additional costs such as co-pays, coinsurance, or charges for services not covered by your plan [Northwind_Standard_Benefits_Details.pdf#page=34]. If you use an out-of-network provider, you may be responsible for paying the full cost of the services received [Northwind_Health_Plus_Benefits_Details.pdf#page=3]. Additionally, some services may not be covered at all, and you may need to check with Northwind Health prior to receiving services to determine your financial responsibility [Northwind_Health_Plus_Benefits_Details.pdf#page=16].", "context": "Northwind_Standard_Benefits_Details.pdf#page=34: For example, Northwind Health may not cover the full cost of a specialist or other non-emergency services. It is important to be aware of these exceptions when selecting a hospital. When selecting a hospital, you should also consider other services that the hospital offers. For example, some hospitals may offer additional services such as physical therapy, nutrition counseling, or other wellness services. Additionally, some hospitals may offer special programs for specific conditions or diseases. Finally, you should consider the cost of care at the hospital you are considering. Northwind Health may cover some or all of the costs of your care, but you should be aware of any additional costs that you may be responsible for. This includes any co-pays or coinsurance, as well as any additional charges for services not covered by your plan. By taking the time to consider your options, you can select the best hospital for your healthcare needs. Northwind Standard offers coverage for a variety of in-network hospitals, giving you the opportunity to select the hospital that best meets your needs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.", "latency": 3.172102, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely addresses the query using relevant information from the context, explaining the limitations of coverage and potential additional costs, which aligns with a fully correct and complete response.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query by explaining the circumstances under which Northwind Health may not cover full costs, including additional costs and the impact of using out-of-network providers. It provides a comprehensive understanding of the coverage situation.", "answer_length": 658, "citations_matched": 1.0, "any_citation": true} -{"question": "what is Northwind Standard Benefits Details?", "truth": "The Northwind Standard Benefits Details include information on managing prescriptions online or via phone, using a mobile app, and potential discounts on generic medications at preferred pharmacies. It also notes that the plan does not cover certain medications like those for weight loss or fertility treatments, compounded medications, or non-FDA-approved drugs. Over-the-counter medications are also not covered unless prescribed by a doctor. [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "The Northwind Standard plan is a comprehensive health plan that covers medical, vision, and dental services, including preventive care and prescription drug coverage. It provides access to a variety of in-network providers, such as primary care physicians, specialists, hospitals, and pharmacies. \n\nKey covered services include:\n- Preventive care services (physicals, immunizations, screenings)\n- Diagnostic tests and treatments\n- Medical consultations\n- Physical therapy\n- Mental health services\n- Prescription drugs\n- Inpatient hospital services\n- Emergency services\n\nHowever, it does not cover certain services, including cosmetic services, experimental treatments, and most dental services, nor does it cover services from out-of-network providers. It is important to check with Northwind Health for in-network providers to avoid unexpected costs. Northwind Health also offers tools like a cost estimator and a provider directory, along with 24/7 customer service for assistance with coverage questions [Northwind_Standard_Benefits_Details.pdf#page=98][Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 3.688985, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with detailed information about the Northwind Standard Benefits, including covered services, exclusions, and additional tools, along with references to specific pages in a document, enhancing understanding.", "answer_length": 1155, "citations_matched": 0.0, "any_citation": true} -{"question": "What types of rehabilitation therapy does Northwind Standard cover?", "truth": "Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. Coverage includes medically necessary services related to an injury or illness, along with the use of equipment and specialized supplies. [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "Northwind Standard covers the following types of rehabilitation therapy services:\n\n1. **Physical Therapy**: Coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies.\n2. **Occupational Therapy**: Coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies.\n3. **Speech Therapy**: Coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies.\n\nExceptions include services related to cosmetic or reconstructive surgery, treatment of obesity or weight control, and treatment of sleep disorders, which are not covered by the plan [Northwind_Standard_Benefits_Details.pdf#page=48].", "context": "Northwind_Standard_Benefits_Details.pdf#page=48: Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. For physical therapy, coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies. For occupational therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. For speech therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. Exceptions Unfortunately, Northwind Standard does not cover any services related to cosmetic or reconstructive surgery, or any services related to the treatment of obesity or weight control. This plan also does not cover services related to the treatment of sleep disorders. Tips When looking for a rehabilitation therapy provider, make sure that they are in-network and covered by your plan. Also, keep in mind that you may need a referral from a primary care physician for some services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=47: Additionally, the plan does not cover any costs associated with psychological or neuropsychological testing that is done for non-medical reasons such as pre-employment screening or for legal purposes. In order to ensure that your psychological or neuropsychological testing services are covered under the Northwind Standard plan, it is important to review your plan's Summary of Benefits and Coverage (SBC) document. This document will provide you with a full list of covered services, as well as any exceptions that may apply. Overall, the Northwind Standard plan provides coverage for psychological and neuropsychological testing services when they are prescribed or ordered by a health care professional and when they are provided by an in-network provider. It is important to be aware of any exceptions that may apply, as well as to select a highly qualified in-network provider for your tests in order to ensure that your services are covered in full.Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy.\n\nNorthwind_Standard_Benefits_Details.pdf#page=50: In addition, Northwind Standard provides coverage for certain services that are not typically covered by other health plans, such as detoxification services, residential treatment services, and recovery support services. While Northwind Standard does provide coverage for substance use disorder treatment services, there are some exceptions to this coverage. For example, Northwind Standard does not cover services that are provided in a hospital emergency room or a hospital inpatient setting unless they are medically necessary and pre-authorized by Northwind Health. We understand that substance use disorder can have a devastating impact, and we want to make sure that our employees have access to the care they need. If you have any questionsabout Northwind Standard's coverage for substance use disorder services, please contact Northwind Health and speak to one of our customer service representatives. Here are some tips that could be helpful to our employees who may be struggling with substance use disorder: . Seek help as soon as possible. Early intervention and treatment can make a significant difference in achieving successful recovery.", "latency": 7.779022, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, providing all relevant details from the CONTEXT to answer the QUERY accurately.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query by listing the types of rehabilitation therapy covered and provides additional insights about exceptions, making it comprehensive.", "answer_length": 804, "citations_matched": 1.0, "any_citation": true} -{"question": "What shuold I do if I need healthcare services outside Washington with Northwind Health?", "truth": "If you need healthcare services outside Washington, you should contact Northwind Health to get an estimate of the cost of care for services you may need. It is also important to find in-network providers in the state where you are living to receive coverage, and keep your Northwind Standard plan active while you are out of state to remain eligible for coverage. [Northwind_Standard_Benefits_Details.pdf#page=59]", "answer": "If you need healthcare services outside Washington with Northwind Health, you should:\n\n1. Ensure that the provider you plan to visit is part of Northwind Health Plus' nationwide network [Northwind_Health_Plus_Benefits_Details.pdf#page=62].\n2. For Northwind Standard, know that it covers out-of-area emergency services but not non-emergency services or care received outside of Washington for more than 12 consecutive months [Northwind_Standard_Benefits_Details.pdf#page=60].\n3. You must be outside of Washington for no more than 12 consecutive months, more than 100 miles away from your primary care provider, and your plan must have been in effect for at least 6 months to be eligible for out-of-area services [Northwind_Standard_Benefits_Details.pdf#page=59].\n4. Obtain prior authorization from Northwind Health before receiving care to ensure coverage [Northwind_Standard_Benefits_Details.pdf#page=60][Northwind_Standard_Benefits_Details.pdf#page=59].\n\nIf you do not meet these criteria or do not obtain prior authorization, you may be responsible for the full cost of care.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=62: If you are outside Washington, you may still be eligible for coverage through Northwind Health Plus. Northwind Health Plus offers a network of providers that are located throughout the United States. These providers are part of Northwind Health Plus' nationwide network, which is designed to ensure that you are able to receive care, no matter where you are. Out-of-area care is coverage that extends outside of Washington. This means that if you travel outside of the state, you can still receive care from a Northwind Health Plus provider. However, there are some exceptions to this coverage. For example, you may be limited to a certain number of visits or treatments that are covered outside of Washington. Additionally, certain services may not be covered, such as home health care services that are provided outside of the state. If you travel outside of Washington, it is important to keep a few tips in mind. First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=59: It is important to know that Northwind Standard does not provide coverage for non- emergency services outside of Washington. That means you may be responsible for the full cost of care if you seek out care for a condition that could have been treated in Washington. In order to receive coverage for out-of-area care, you must meet the following criteria: . You must be outside of Washington for no more than 12 consecutive months . You must be more than 100 miles away from your primary care provider 路 Your plan must have been in effect for at least 6 months before you receive out-of-area care If you meet the criteria listed above, you may be eligible for coverage of out-of-area services. In order to receive coverage, you must contact Northwind Health in advance of receiving care. You must also obtain prior authorization for any care you wish to receive. If prior authorization is not obtained, you may be responsible for the full cost of care. If you are outside of Washington for more than 12 consecutive months, you may not be eligible for coverage of out-of-area services.", "latency": 4.865753, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is complete and accurate, addressing all aspects of the QUERY using information from the CONTEXT. It provides a thorough and precise answer without adding extraneous details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, covering all necessary details about obtaining healthcare services outside Washington with Northwind Health. It does not add extraneous information and provides a clear and comprehensive guide.", "answer_length": 1077, "citations_matched": 1.0, "any_citation": true} -{"question": "What is prior-authorization in Northwind Standard?", "truth": "Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. Without prior-authorization, the employee may be responsible for the full cost of any services or treatments received without approval. [Northwind_Standard_Benefits_Details.pdf#page=63]", "answer": "Prior-authorization in Northwind Standard is a process where employees must obtain approval from Northwind Health before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of the services. The process involves the employee's physician submitting a request to Northwind Health, which will review it to determine if the service is medically necessary and covered under the plan. Some services that may require prior-authorization include hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs [Northwind_Standard_Benefits_Details.pdf#page=63].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 3.001221, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely describes prior-authorization as outlined in the CONTEXT, addressing all relevant aspects of the process and its implications.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it includes additional insights that enhance understanding, such as the consequences of not obtaining prior-authorization and examples of services that require it.", "answer_length": 736, "citations_matched": 1.0, "any_citation": true} -{"question": "What need for pre-authorization in Northwind Standard Benefits?", "truth": "Some medical services under the Northwind Standard Benefits require pre-authorization before they can be approved to ensure that medically necessary treatments are provided in a timely and cost-effective manner. [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "Prior-authorization is required by Northwind Health for certain services or treatments to ensure they are necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of the services. Services that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, certain prescription drugs, laboratory tests, imaging services, and physical therapy. The employee's physician must submit a request for prior-authorization, which will be reviewed by Northwind Health. Approval or denial will be communicated within three business days. If approved, the service can be received without additional pre-authorization; if denied, an appeal can be submitted. Some services may not be covered even if prior authorization is granted, and it is important to keep a copy of the authorization for coverage verification [Northwind_Standard_Benefits_Details.pdf#page=63][Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 3.567509, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY with all necessary details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing all essential details required for a comprehensive understanding. It also includes additional insights about the implications and process, enhancing the understanding of the pre-authorization requirement.", "answer_length": 1042, "citations_matched": 0.0, "any_citation": true} -{"question": "How does the Northwind Standard handle situations where other plans like Medicare or Medicaid are involved?", "truth": "Northwind Standard may pay first in situations where other plans like Medicare, Medicaid, or a veterans' health plan are involved, even if these other plans are usually the primary payer. [Northwind_Standard_Benefits_Details.pdf#page=75]", "answer": "The Northwind Standard handles situations involving other plans like Medicare or Medicaid as follows:\n\n1. If you have coverage through Medicare or Medicaid, that plan pays first, followed by the Northwind Standard plan as the secondary payer [Northwind_Standard_Benefits_Details.pdf#page=73].\n\n2. You must notify Northwind Health of any changes in your coverage status or any changes in your other coverage. Failure to do so may result in you being responsible for charges that Northwind Health would have paid if notified [Northwind_Standard_Benefits_Details.pdf#page=95].\n\n3. In certain circumstances, you may be able to keep your other coverage and still be eligible for the Northwind Standard plan, but if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=95].\n\n4. Northwind Standard may pay first in some cases, even if Medicare, Medicaid, or a veterans' health plan is usually the primary payer [Northwind_Standard_Benefits_Details.pdf#page=75].\n\n5. When submitting a claim to Northwind Standard, you need to include information about your other coverage to ensure proper billing and avoid delays or denials [Northwind_Standard_Benefits_Details.pdf#page=73].", "context": "Northwind_Standard_Benefits_Details.pdf#page=95: This could include coverage from your spouse's or a parent's employer, or from a government-sponsored program such as Medicare or Medicaid. If you and your spouse have coverage under different plans, you must determine which plan is the primary plan and which is secondary. This is important, as the primary plan will pay first; the secondary plan will pay what the primary plan does not. If you have other coverage, you must notify Northwind Health of any changes in your coverage status or any changes in any of your other coverage. If you fail to do so, you may be responsible for any charges that Northwind Health would have paid if you had notified them of the other coverage. In certain circumstances, you may be able to keep your other coverage and still be eligible for coverage under the Northwind Standard plan. However, if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan. It is also important to note that if you have coverage through a government-sponsored program such as Medicare or Medicaid, you may be subject to certain restrictions.\n\nNorthwind_Standard_Benefits_Details.pdf#page=75: Coordination of Benefits Exceptions There are a few exceptions to COB rules that may apply to you. If you are covered by Medicare, Medicaid, or a veterans' health plan, Northwind Standard may pay first, even if the other plan is usually the primary payer. Additionally, if you are enrolled in a plan that is required by law to coordinate benefits, such as an employer-sponsored plan, Northwind Standard may pay first. Understanding How COB Affects Your Benefits When COB applies, the primary and secondary payers will each pay a portion of the eligible expenses and combined payments cannot exceed the total cost. Depending on the type of service, the primary payer may pay all of the eligible expenses. When this happens, the secondary payer may pay nothing.For example, if you receive a medical bill for $1,000 and the primary payer pays $800, the secondary payer will pay the remaining balance of $200. However, if the primary payer pays the full $1,000, the secondary payer will not pay anything.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan ", "latency": 4.003444, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the QUERY with relevant details from the provided information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not add extraneous information but provides relevant insights into the handling of other plans.", "answer_length": 1288, "citations_matched": 1.0, "any_citation": true} -{"question": "What is the process for submitting claims for services like MRI/CT scans or physical therapy according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, for services such as MRI/CT scans and physical therapy, your provider may need to submit a request prior to the service being performed. It's important to contact Northwind Health if you are unsure whether pre-approval is required. Additionally, when filing a claim, you should include all necessary documentation like itemized bills, a completed claim form, and any other requested documentation to avoid delays or denials. [Northwind_Standard_Benefits_Details.pdf#page=78]", "answer": "To submit claims for services like MRI/CT scans or physical therapy, follow these steps:\n\n1. **Pre-Approval**: Your provider may need to submit a request for pre-approval to Northwind Health before the service is performed. This is necessary for services such as MRI/CT scans and physical therapy [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n2. **Timely Filing**: All claims must be filed within twelve months of the date of service. Claims submitted after this period may be reviewed for consideration, but there is no guarantee of acceptance [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n3. **Documentation**: Include all necessary documentation when filing a claim. This includes itemized bills, a completed claim form, and any other requested documentation. Missing items may delay or deny your claim [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n4. **Filing Method**: If you are a Northwind Standard member, you may file a claim directly through the Northwind website or app. Ensure you have authorization if filing on behalf of a family member [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n5. **Exceptions**: There are exceptions to the twelve-month filing limit for claims related to newborns, deceased members, and services provided out-of-country, which can be submitted up to 24 months after the date of service [Northwind_Standard_Benefits_Details.pdf#page=78].", "context": "Northwind_Standard_Benefits_Details.pdf#page=78: from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services. If you are unsure whether your provider requires pre-approval for a service, you should contact Northwind Health prior to the service being performed. There are a few exceptions to the twelve month timely filing limit. These include claims submitted for newborns, claims submitted for a deceased member, and claims submitted forservices that were provided out-of-country. In these situations, claims may be submitted up to 24 months after the date of service. It's also important to remember that when filing a claim, you should make sure to include all necessary documentation. This includes itemized bills, a completed claim form, and any other documentation that is requested by Northwind Health. If any of these items are missing, your claim may be delayed or denied. To ensure timely filing, it's important to keep track of the dates of service for all services you receive. You should also keep copies of all documentation related to your services, and if you're unsure of the filing \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=64: This means that your doctor or health care provider will need to get prior authorization from Northwind Health before providing the care. Prior authorization is also known as pre-certification, pre-notification, pre-service review, or pre-authorization. It is important for you to understand that prior authorization does not guarantee that the service will be covered by your Northwind Health Plus plan. When Prior Authorization is Required Prior authorization is required for certain services and treatments such as: 路 Hospital admissions 路 Inpatient surgery 路 Outpatient surgery 路 Magnetic Resonance Imaging (MRI) 路 Computed Tomography (CT) 路 Radiation Therapy 路 Durable Medical Equipment 路 Physical, Occupational, and Speech Therapy 路 Home Health Care 路 Infusion Therapy 路 Prosthetics and Orthotics 路 Specialty DrugsIn certain cases, Northwind Health may require prior authorization even if the service is not listed above. Your doctor or health care provider should contact Northwind Health to determine if prior authorization is required prior to providing care.", "latency": 4.708408, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing all essential details required for a comprehensive understanding of the claims submission process.", "answer_length": 1397, "citations_matched": 1.0, "any_citation": true} -{"question": "What is the role of the Independent Review Organization in the appeals process for Northwind Standard plan members?", "truth": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. The decision made by the IRO is considered final and binding, although there are some exceptions that could apply to specific cases. [Northwind_Standard_Benefits_Details.pdf#page=83]", "answer": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. It is a third-party organization that reviews appeals and complaints regarding healthcare services that have been denied coverage. If the IRO upholds the original decision, members may have other options available, such as an external review or an appeal to the state insurance commission. The decision made by the IRO is considered final and binding, though some exceptions may apply to individual cases [Northwind_Standard_Benefits_Details.pdf#page=83][Northwind_Standard_Benefits_Details.pdf#page=82].", "context": "Northwind_Standard_Benefits_Details.pdf#page=83: 路 Ensure that all relevant information is included in the appeal. 路 Submit the appeal within the timeframe specified in the plan. . Keep a copy of your appeal and all supporting documentation. 路 Contact Northwind Health or the IRO if you have any questions or need additional help. . If the IRO upholds the original decision, you may have other options available to you, such as an external review or an appeal to the state insurance commission. Conclusion The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. While the decision made by the IRO is considered final and binding, there are some exceptions that could apply to your case. Familiarizing yourself with the plan provisions and the process for filing an appeal, gathering all relevantinformation, and submitting the appeal within the timeframe specified in the plan are all important steps in the appeals process. Additional Information About Your Coverage COMPLAINTS AND APPEALS If you feel that you have not received the health care services or benefits that you are entitled to, or you are not \n\nNorthwind_Standard_Benefits_Details.pdf#page=82: If you need an expedited appeal due to an urgent medical condition, your plan must respond within 24 hours. Tips . Make sure to include all of the necessary information in your appeal. . Keep a copy of your appeal for your records. . Don't hesitate to contact your plan if you need assistance with the appeal process. 路 Follow up with your plan if you don't receive a response to your appeal within a reasonable amount of time. . Consider hiring a lawyer if you need help with your appeal. Once The IRO Decides Once The IRO DecidesThe Independent Review Organization (IRO) is a third-party organization that reviews appeals and complaints about healthcare services that have been denied coverage under the Northwind Standard plan. If an employee is not satisfied with the decision made by Northwind Health, they can submit a written complaint or request an appeal by filing a formal grievance. What Happens After The IRO Decides? Once the IRO has completed its review, it will issue a formal decision either upholding the original decision or reversing it.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=85: We have a multi-level process in place to ensure that any grievances are addressed and resolved quickly and fairly. Level 1: Initial Review This is the first step in the appeals process. If you have a problem with a service or product received, contact the plan's Customer Service team. The team will review your complaint to determine if a solution can be reached or if the complaint should be escalated to the next level. Level 2: Formal Complaint If a satisfactory resolution is not reached at Level 1, you may submit a formal written complaint to Northwind Health Plus. This should include details of the issue, the date and time of the incident, and the names of any involved personnel. It should also include any relevant documentation or other evidence that supports your claim. Level 3: External ReviewIf the issue is not resolved at Level 2, you may request an external review to be conducted. This review will be conducted by an independent organization that is not affiliated with Northwind Health Plus. The external review will consider all facts and evidence that have been submitted in the appeal and ", "latency": 4.870191, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the role of the IRO as described in the CONTEXT and directly addressing the QUERY without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the IRO's role and includes additional insights about further options available to members, enhancing understanding.", "answer_length": 624, "citations_matched": 1.0, "any_citation": true} -{"question": "Can you explain the eligibility criteria for the Northwind Standard plan offered to Contoso employees?", "truth": "The Northwind Standard plan is a group plan offered to all eligible employees of Contoso and their spouses or dependents. It is important to note that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. [Northwind_Standard_Benefits_Details.pdf#page=88]", "answer": "The eligibility criteria for the Northwind Standard plan offered to Contoso employees include the following:\n\n1. Employees may need to meet specific criteria to be approved for certain services or treatments, which may include medical tests, lifestyle changes, or other requirements [Northwind_Standard_Benefits_Details.pdf#page=63].\n2. Prior-authorization is required for certain services or treatments, and employees must obtain this approval before receiving care to avoid being responsible for the full cost [Northwind_Standard_Benefits_Details.pdf#page=63].\n3. The employee's physician must submit a request for prior-authorization to Northwind Health, which will review it to determine if the service or treatment is medically necessary and a covered benefit [Northwind_Standard_Benefits_Details.pdf#page=63].\n4. Preventive care services and emergency services are not subject to prior-authorization [Northwind_Standard_Benefits_Details.pdf#page=63].\n5. Mental health and substance abuse coverage are also not subject to prior-authorization [Northwind_Standard_Benefits_Details.pdf#page=63].\n6. Out-of-network services require prior-authorization and may incur additional costs to the employee [Northwind_Standard_Benefits_Details.pdf#page=63].\n\nIf you have more specific questions about eligibility or services, please let me know!", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment. These criteria may include specific medical tests or treatments, lifestyle changes, or other requirements. If the employee is unable to meet the criteria, prior-authorization may not be granted. There are some exceptions to the prior-authorization process. For example, preventive care services and emergency services are not subject to prior-authorization. In addition, mental health and substance abuse coverage is not subject to prior-authorization. However, out-of- network services are subject to prior-authorization and may require additional cost to the employee. Here are some tips for Contoso's employees to help them navigate the prior-authorization process: 路 Contact your physician's office to determine if prior-authorization is required before receiving a service or treatment. . Contact Northwind Health to determine if a service or treatment is a covered benefit under Northwind Standard.\n\nNorthwind_Standard_Benefits_Details.pdf#page=102: Depending on the state, employees may have the right to receive legal representation or to appeal denied claims. In some states, employees may have the right to choose their own physician or to receive benefits for permanent disabilities. At Contoso, we are committed to providing our employees with a safe and productive work environment, and we take the necessary steps to ensure that our Workers' Compensation Insurance coverage meets all state and federal requirements. Should you have any questions about this coverage, please contact the Human Resources Department. DEFINITIONS DEFINITIONS When it comes to understanding the Northwind Standard insurance plan, it is important to understand the various terms and definitions associated with this plan. Here is abreakdown of some of the key terms and definitions associated with the Northwind Standard insurance plan. In-Network Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.", "latency": 4.203247, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The RESPONSE is related to the topic of the CONTEXT but does not directly answer the QUERY about eligibility criteria for the plan itself, focusing instead on criteria for services and treatments.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides information related to accessing services under the plan but does not fully address the eligibility criteria for the plan itself, which is what the QUERY specifically asks for.", "answer_length": 1338, "citations_matched": 0.0, "any_citation": true} -{"question": "what wrong things Northwind Health say about what they cover?", "truth": "Northwind Health makes intentionally false or misleading statements about their plans, including claiming to cover emergency services, mental health and substance abuse coverage, and out-of-network services, which they do not actually cover. [Northwind_Standard_Benefits_Details.pdf#page=90]", "answer": "Northwind Health states that their plans do not cover services that are not medically necessary, including cosmetic procedures and elective treatments. Additionally, services provided by healthcare providers who are not contracted with Northwind Health are not covered. The Northwind Standard plan also does not cover any services received outside of the network of in-network providers [Northwind_Standard_Benefits_Details.pdf#page=56][Northwind_Standard_Benefits_Details.pdf#page=89]. \n\nFor the Northwind Health Plus plan, it is noted that certain types of services, such as cosmetic procedures, may not be covered, and there may be limits on the number of visits to a provider that are covered [Northwind_Health_Plus_Benefits_Details.pdf#page=17].", "context": "Northwind_Standard_Benefits_Details.pdf#page=56: Finally, Northwind Health's Northwind Standard plan does not cover services that are not medically necessary. Examples of services that are not covered include cosmetic proceduresand elective treatments. Additionally, the plan does not cover services that are not related to the diagnosis or treatment of an illness or injury. At Northwind Health, we are committed to helping you get the care you need when you need it. We understand that medical issues can arise suddenly and can be unpredictable. That is why we offer coverage for urgent care services through our Northwind Standard plan. If you have any questions about your coverage, please contact our customer service team. Virtual Care COVERED SERVICES: VIRTUAL CARE At Northwind Health, we understand that our members may have difficulty accessing in- person care. That is why we offer virtual care, allowing members to access care from the comfort of their own home. With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice.\n\nNorthwind_Standard_Benefits_Details.pdf#page=89: It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. Exceptions There are a few exceptions to the group coverage provided by the Northwind Standard plan. For example, the plan does not cover services provided by any health care provider who is not contracted with Northwind Health. In addition, the plan does not cover services that are not medically necessary, such as cosmetic surgery. Tips for Employees When you enroll in Northwind Standard, it is important to familiarize yourself with the plan and its coverage options. You should also make sure that you understand any restrictions that may apply to the services you receive. Be sure to check with your provider to make sure that they accept the Northwind Standard plan. Also, it is a good idea to familiarize yourself with the cost of the services you receive, so that you know what you may be responsible for paying out of pocket. Finally, keep in mind that the Northwind Standard plan does not cover any services received outside of the network of in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=17: For instance, some plans may not cover certain types of services, such as cosmetic procedures, or they may have limits on the number of visits to a provider that are covered. It is important to read through your plan to understand what is and isn't covered. When you are using your Northwind Health Plus plan, there are a few tips to keep in mind. First, remember to bring your Northwind Health Plus ID card with you when you go to the doctor or pharmacy. This will help the provider verify your coverage and process your claims. Second, if you are prescribed a medication, check to make sure it is covered by your plan. You may be able to save money by using a generic version of the drug or by using a mail-order pharmacy. Finally, if you are seeing an out-of-network provider, remember that you may be responsible for paying more out-of-pocket costs than you would for an in-network provider. Make sure to check with the provider to get an estimate of what your costs will be. By understanding the plan and its exceptions and limitations, and by following these tips, you can make sure you are getting the most out of your Northwind Health Plus plan.", "latency": 3.733921, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The RESPONSE provides information related to the exclusions in the Northwind Health plans but does not address the specific aspect of the QUERY about \"wrong things\" Northwind Health says about what they cover.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides information about exclusions and limitations in Northwind Health's coverage but does not address the QUERY's focus on incorrect statements made by Northwind Health. It lacks direct relevance to the aspect of \"wrong things\" mentioned in the QUERY.", "answer_length": 750, "citations_matched": 0.0, "any_citation": true} -{"question": "what is northwind standard benefits details?", "truth": "The Northwind Standard Benefits Details include information to help inform and empower members about their responsibilities and the coverage provided by the plan. This includes being aware of the plan's benefits and limitations, as well as obligations under the plan such as co-payments or co-insurance amounts for medical and vision expenses. [Northwind_Standard_Benefits_Details.pdf#page=92]", "answer": "The Northwind Standard plan is a comprehensive health plan that covers medical, vision, and dental services, including preventive care and prescription drug coverage. It provides access to a variety of in-network providers, such as primary care physicians, specialists, hospitals, and pharmacies. \n\nKey covered services include:\n- Preventive care services (physicals, immunizations, screenings)\n- Diagnostic tests and treatments\n- Medical consultations\n- Physical therapy\n- Mental health services\n- Prescription drugs\n- Inpatient hospital services\n- Emergency services\n\nCertain services are not covered, including cosmetic services, experimental treatments, and most dental services. Additionally, services provided by out-of-network providers are not covered. It is important to check with Northwind Health for in-network providers to avoid unexpected costs. The plan also offers tools and resources like a cost estimator and a provider directory, along with 24/7 customer service for assistance [Northwind_Standard_Benefits_Details.pdf#page=98][Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 3.762004, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information about the Northwind Standard benefits, including additional insights about in-network providers and available resources, making it a comprehensive response.", "answer_length": 1145, "citations_matched": 0.0, "any_citation": true} -{"question": "what does Notice of Pre-Existing Condition Exclusions mean?", "truth": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It explains when these exclusions may apply and how they could affect your coverage. [Northwind_Standard_Benefits_Details.pdf#page=96]", "answer": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to understand when these exclusions may apply and how they could affect your coverage [Northwind_Standard_Benefits_Details.pdf#page=96].", "context": "Northwind_Standard_Benefits_Details.pdf#page=96: Notice of Benefit and Payment Parameters: This notice provides important information about the plan and its benefits, including what kind of coverage is provided, what types of services are covered, and what out-of-pocket costs you may be responsible for. Notice of Pre-Existing Condition Exclusions: This notice provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to make sure you understand when pre-existing condition exclusions may apply and how they could affect your coverage. Notice of Continuation Coverage Rights: This notice provides information about your rights to continue coverage if you lose your job or if you experience a qualifying event. It is important to read this notice carefully to make sure you understand your rights to continue coverage. Notice of Availability of Plan Documents: This notice provides information about where you can find the plan documents for Northwind Standard. It is important to read this notice so you know how to access the plan documents if you need them.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods. You should review your plan documents carefully to make sure you understand exactly what is covered and what is excluded. It is also important to understand that the plan is not a substitute for health insurance. You should still maintain health insurance coverage through an employer, a private plan, or a government-sponsored plan. The Northwind Health Plus plan is intended to supplement the coverage you have from other sources. Tips for Making the Most of Your Plan . Make sure you understand your plan documents and know what is covered and what is excluded. 路 Take advantage of preventive care services, such as check-ups and screenings, as these will help you stay healthy and avoid more costly treatments down the road. 路 Consider signing up for the Northwind Health Plus online portal, which allows you to view your health plan information, make payments, and access other resources. 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=93: The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and YouThe Northwind Health Plus plan is a group health plan that is sponsored by Contoso and administered by Northwind Health. As a participant in this group plan, you will have access to a wide range of health benefits and services. Your employer, Contoso, pays a portion of the premium for the plan, and you are responsible for paying the remaining portion. This will be deducted directly from your paycheck each month. In addition to the premium, you may be responsible for certain costs when you receive health care services. Your contributions to the plan are based on the type of coverage you choose. For example, if you choose a single plan, you will pay a lower premium than if you choose a family plan. The premium and other costs you may incur when you receive health care services may change from year to year. It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods.", "latency": 3.146982, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY without introducing extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, explaining the purpose and importance of the notice without adding unnecessary details.", "answer_length": 328, "citations_matched": 1.0, "any_citation": true} -{"question": "What services does Northwind Health cover?", "truth": "Northwind Health is responsible for paying claims for eligible services based on the terms of the plan, but it does not cover emergency services, mental health and substance abuse services, or out-of-network services. [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "Northwind Health covers a variety of services under its plans:\n\n1. **Northwind Standard Plan**:\n - Preventive care services (physicals, immunizations, screenings)\n - Diagnostic tests and treatments\n - Medical consultations\n - Physical therapy\n - Mental health services\n - Prescription drugs\n - Inpatient hospital services\n - Emergency services\n - Coverage is limited to in-network providers, and it does not cover cosmetic services, experimental treatments, and most dental services [Northwind_Standard_Benefits_Details.pdf#page=46].\n\n2. **Northwind Health Plus Plan**:\n - A wide range of mental health services, including counseling, psychiatric visits, therapy, and group therapy\n - Coverage for both inpatient and outpatient visits\n - Services can be provided by in-network and out-of-network providers, though out-of-pocket costs are typically higher for out-of-network care [Northwind_Health_Plus_Benefits_Details.pdf#page=42].\n\nIt's important to check with Northwind Health for specific coverage details and costs associated with services.", "context": "Northwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=42: Northwind Health Plus covers a wide range of mental health services, including counseling, psychiatric visits, therapy, and group therapy. Services are provided in-network and out-of- network, with coverage for both inpatient and outpatient visits. In-Network Services When receiving mental health care, it is important to make sure you are using an in- network provider. When you use an in-network provider, your out-of-pocket costs are generally lower and your coverage is more comprehensive. Northwind Health Plus offers a network of providers that are in-network, including primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Services In some cases, it may be necessary to receive mental health care from an out-of-network provider. Northwind Health Plus will still cover a portion of the cost of services received from an out-of-network provider. However, it is important to note that out-of-pocket costs are typically higher when receiving care from an out-of-network provider. Exceptions Northwind Health Plus does not cover some services related to mental health care, including long-term treatment ", "latency": 3.951751, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE thoroughly and accurately addresses the QUERY by listing the services covered under both the Northwind Standard and Northwind Health Plus plans, as described in the CONTEXT. It includes all relevant details and distinctions between the plans, demonstrating complete understanding.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the services covered by Northwind Health, making it a complete response.", "answer_length": 1069, "citations_matched": 0.0, "any_citation": true} -{"question": "How does choosing an in-network provider with Northwind Health Plus affect my healthcare costs?", "truth": "Choosing an in-network provider with Northwind Health Plus is crucial for lowering healthcare costs because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus provides an extensive network of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, allowing for a selection that best suits your needs. [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "Choosing an in-network provider with Northwind Health Plus affects your healthcare costs by lowering your out-of-pocket expenses compared to using out-of-network providers. Northwind Health has negotiated discounted rates with in-network providers, which means you will pay less for services. Additionally, in-network providers charge lower rates than out-of-network providers, making them the most cost-effective option for your healthcare needs [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=4].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. SUMMARY OF YOUR COSTS SUMMARY OF YOUR COSTS At Northwind Health, we understand that health care costs can be a burden. That's why we offer a comprehensive plan that covers the cost of medical, vision, and dental services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. Your cost for Northwind Health Plus will depend on your plan type, the services you use, and the providers you visit. You can find more information about cost-sharing arrangements on the Northwind Health website. In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=4: HOW PROVIDERS AFFECT YOUR COSTS In-Network Providers HOW PROVIDERS AFFECT YOUR COSTS Choosing the right provider is an important part of getting the most value out of your health insurance plan. With Northwind Health Plus, you have access to an extensive network of in- network providers. Working with these providers is an essential part of getting the most value out of your plan. In-Network Providers When choosing an in-network provider for your health care needs, make sure to check with Northwind Health Plus to ensure that the provider is in-network. This is important because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus offers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This lets you choose a provider that is most convenient for you and your family. It is important to note that in-network providers may not always be available in every area. The Northwind Health Plus website offers a searchable directory of all in-network providers in your area. This directory is regularly updated, so you can be sure that you are choosing from in-network providers that are \n\nNorthwind_Standard_Benefits_Details.pdf#page=9: When choosing a provider, it is important to consider the cost sharing associated with each provider and to ask about any additional fees before receiving care. HOW PROVIDERS AFFECT YOUR COSTS When it comes to health insurance, many people are unaware of the different factors that impact the costs they pay. One of the most significant components that affects your costs is the provider you choose. Northwind Standard provides coverage for a variety of in-networkproviders, and the costs associated with each provider can vary significantly. To ensure you're getting the best value for your health care services, it's important to understand how providers can affect your costs. In-Network Providers Choosing in-network providers is the most cost-effective option when it comes to your Northwind Standard plan. In-network providers have agreed to accept a discounted rate on services, which means they are often less expensive than out-of-network providers. When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or ", "latency": 2.541102, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY without introducing any extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, explaining the cost benefits of choosing an in-network provider with Northwind Health Plus. It includes all essential details required for a comprehensive understanding without adding extraneous information.", "answer_length": 550, "citations_matched": 1.0, "any_citation": true} -{"question": "how does Northwind Health Plus help me save money on healthcare costs?", "truth": "Northwind Health Plus assists in saving money on healthcare costs by providing balance billing protection, ensuring that you are not billed more than the allowed amount by your provider. [Northwind_Health_Plus_Benefits_Details.pdf#page=7]", "answer": "Northwind Health Plus helps you save money on healthcare costs in several ways:\n\n1. Understanding the difference between in-network and non-participating providers can lead to cost savings. Using in-network providers typically results in lower out-of-pocket expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n2. Northwind Health Plus offers balance billing protection, ensuring you will not be billed for the difference between the allowed amount and the billed amount by your provider [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n3. You can use the online provider directory to find in-network providers, which can save you time and money [Northwind_Health_Plus_Benefits_Details.pdf#page=5].\n\n4. It's advisable to check with Northwind Health Plus before visiting a provider to confirm they are in-network and to review your Explanation of Benefits (EOB) after your visit to avoid unexpected charges [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\nBy following these tips and utilizing the resources provided by Northwind Health Plus, you can maximize your healthcare savings.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=7: By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs. Northwind Health Plus is here to help you make the most of your coverage. If you have any additional questions about in-network and non-participating providers, please contact the Northwind Health Plus customer service line. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS: Balance Billing Protection Balance billing is a practice where a provider bills you for the difference between the allowed amount and billed amount. The allowed amount is the amount that your insurance company determines is a reasonable fee for a service. The amount you are billed for is the amount that the provider charges you for the services. With Northwind Health Plus, you are protected from balance billing. This means that you can rest assured that you will not be billed more than the allowed amount by your provider. Balance billing protection is an important part of Northwind Health Plus. This protection ensures that you will not be responsible for the difference between the allowed amount and the \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=7: Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus first. Before your visit, contact the customer service line to find out if the provider is in-network and if there are any exceptions that could apply to your situation. Additionally, it is important to review your Explanation of Benefits (EOB) after your visit to ensure that you are not being charged for any services that were not covered by your insurance. If you are charged for a service that was not covered, contact Northwind Health Plus right away. If you are considering a new provider, it is important to ask if they are in-network with Northwind Health Plus. This can save you time and money in the long run. Additionally, you can use Northwind Health Plus's online provider directory to search for a provider that is in-network and view their ratings. By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=5: Tips for Choosing an In-Network Provider When choosing an in-network provider, there are a few tips to keep in mind: 路 Check with Northwind Health Plus to make sure that the provider you are considering is in-network. 路 Use the searchable directory on the Northwind Health Plus website to find in-network providers in your area. 路 Ask your current provider if they are part of the Northwind Health Plus network. . Consider the cost savings associated with in-network providers when making your decision. 路 Consider the quality of care when choosing a provider. 路 Make sure the provider is familiar with your health insurance plan and its coverage. 路 Make sure the provider is available and can accommodate your schedule. Conclusion Choosing the right provider is an important part of getting the most value out of your health insurance plan. Northwind Health Plus offers an extensive network of in-network providers that can help you save money on health care services. By following the tips outlined above, you can make sure that you are choosing an in-network provider that is most convenient and cost-effective for you and your family.", "latency": 15.129978, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately and completely addressing the query with relevant details from the context.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights on how to maximize savings, which enhances understanding.", "answer_length": 1103, "citations_matched": 1.0, "any_citation": true} -{"question": "what is copay for Northwind Health Plus?", "truth": "When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The copayment (copay) for Northwind Health Plus varies based on the type of service and provider. Here are the typical copay amounts:\n\n- Primary care visits: around $20 (in-network) or $35 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Specialist visits: around $50 (in-network) or $60 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Mental health visits: $45 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Preventive care services: copayment is typically waived if received from an in-network provider [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- Out-of-network services: typically around $60 copayment [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nEmergency room and urgent care visits are not subject to the split copay and will have the full copay amount that applies to the type of provider visited [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an in-network provider. Tips: It is important to remember that copayments are subject to change and may vary depending on the type of service received. It is also important to note that copayments are not waived for out-of-network services, and you may be responsible for the remaining balance after Northwind Health Plus has paid its portion. Finally, it is important to make sure that the provider you are seeing is in-network. This can be easily done by checking the provider directory on the Northwind Health Plus website. It is also important to remember that if you receive a service from an out-of-network provider, you may be responsible for a higher copayment.By understanding and following these tips, you can be sure to get the most out of your Northwind Health Plus coverage and avoid unnecessary copayments. Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=12: Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more affordable for its members. This means that you will pay a lower copay for office visits than you would for other services. The split copay is applied to office visits with primary care physicians, specialists, and mental health providers. Office visits with primary care physicians are subject to a $35 copay. Office visits with specialists are subject to a $60 copay. Mental health visits with a psychiatrist or another mental health provider are subject to a $45 copay. There are a few exceptions to this split copay. Emergency room visits and urgent care visits are not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. Office visits with an anesthesiologist are also not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. When visiting your doctor, it is important to understand which type of provider you are visiting.", "latency": 5.696335, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using the information provided in the CONTEXT, demonstrating a thorough understanding of the copay structure for Northwind Health Plus.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing copay amounts for different services under Northwind Health Plus.", "answer_length": 1049, "citations_matched": 1.0, "any_citation": true} -{"question": "What are the deductible amounts for in-network services under the Northwind Health Plus Benefits Details?", "truth": "The calendar year deductible for in-network services under the Northwind Health Plus Benefits Details is $1,500 for individuals and $3,000 for families. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "The calendar year deductible for in-network services under the Northwind Health Plus plan is $1,500 for individuals and $3,000 for families [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=12: Other services, such as lab tests, X-rays, and imaging tests, are subject to different copay amounts, which are listed on your insurance card. It is also important to remember that the split copay only applies to in-network providers. If you visit an out-of-network provider, you will be subject to a higher copay amount, which is also listed on your insurance card. At Northwind Health Plus, we are committed to helping our members get the care they need at a price they can afford. With the split copay for office visits, we hope to make healthcare more affordable for you and your family.Calendar Year Deductible IMPORTANT PLAN INFORMATION: Calendar Year Deductible The Northwind Health Plus plan has a calendar year deductible that applies to some services. The amount you must pay out-of-pocket before the plan begins to pay for covered services is called the calendar year deductible. The calendar year deductible is the same for all members of the plan and is reset each year on the plan's renewal date. For In-Network Services: The calendar year deductible for in-network services is $1,500 for individuals and $3,000 for families.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.465542, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the information provided in the CONTEXT and directly addressing the QUERY.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing the deductible amounts for both individuals and families without adding any unnecessary details.", "answer_length": 193, "citations_matched": 0.0, "any_citation": true} -{"question": "What is the role of coinsurance in Northwind Health Plus?", "truth": "Coinsurance is a cost-sharing requirement under Northwind Health Plus, where after meeting the deductible, the policyholder is responsible for a certain percentage of the costs for covered services. This percentage is usually a portion of the allowed amount for a service, which the policyholder must pay. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "Coinsurance in Northwind Health Plus is a cost-sharing requirement that applies after you have met your deductible. You will be responsible for a certain percentage of the costs for covered services. Specifically, the coinsurance rate is 20%. For example, if the allowed amount for a service is $100, you would pay $20 (20% of $100), and the insurance company would pay the remaining $80. Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services [Northwind_Health_Plus_Benefits_Details.pdf#page=13][Northwind_Health_Plus_Benefits_Details.pdf#page=107].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=13: Tips: 路 Be sure to check with your provider to find out if a service is subject to the calendar year deductible before receiving the service. 路 Make sure you understand the cost sharing that applies to out-of-network services. 路 Be aware that the calendar year deductible is reset each year on the plan's renewal date. 路 Remember that preventive care services and emergency services are exempt from the calendar year deductible. Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a cost-sharing requirement under Northwind Health Plus. This means that after you have met your deductible, you will be responsible for a certain percentage of the costs for covered services. The coinsurance rate is usually a percentage of the allowed amount for a service, and it is your responsibility to pay this amount. For example, if the allowed amount for a service is $100 and your coinsurance is 20%, you are responsible for paying $20 (20% of $100). The insurance company will pay the remaining amount of $80.Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=107: If an employee has any questions or concerns about their coverage, they should contact their employer or the Workers' Compensation Insurance provider for more information. DEFINITIONS Definitions It is important for employees to understand the definitions of certain terms when it comes to their health insurance plan. The following definitions will help employees obtain a better understanding of Northwind Health Plus. Copayment: A copayment, also known as a copay, is the fixed amount that an employee pays for a covered service. This amount is usually a flat fee and is due at the time of service.Deductible: A deductible is the amount of money that an employee must pay out-of-pocket before the plan begins paying for covered services. Northwind Health Plus has a deductible of $2,000 per year. Coinsurance: Coinsurance is the percentage of the cost of a covered service that an employee must pay after the deductible is met. Northwind Health Plus has a coinsurance of 20%. Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year.\n\nNorthwind_Standard_Benefits_Details.pdf#page=13: Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a type of cost sharing that you are responsible for after meeting your deductible. Coinsurance is often a percentage of the cost of the service you receive. Forexample, if the coinsurance is 10%, you will be responsible for paying 10% of the cost of the service you received, while the insurance company pays the other 90%. Under Northwind Standard, coinsurance is set at 20% for in-network services, with some exceptions. For in-network hospital stays, coinsurance is set at 25%. Additionally, coinsurance for out-of-network services is set at 40%. It's important to note that coinsurance does not apply to the services that are covered by the plan's copayment amounts. Copayment is a fixed amount that you are responsible for paying for certain services and is typically much less than coinsurance. Additionally, Northwind Standard does not require coinsurance for preventive care services. When you receive services, it's important to ask about the cost of the service and make sure you are aware of any coinsurance costs.", "latency": 3.379906, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, including additional insights into how coinsurance works and the types of services it applies to, which enhances understanding.", "answer_length": 653, "citations_matched": 1.0, "any_citation": true} -{"question": "How does the Northwind Health Plus Benefits Details.pdf explain the impact of choosing in-network versus non-participating providers on your healthcare costs, and what are the exceptions to prior authorization that do not require prior approval?", "truth": "The Northwind Health Plus Benefits Details.pdf explains that by understanding the difference between in-network and non-participating providers, you can save money on your healthcare costs. In-network providers are likely part of a negotiated agreement with Northwind Health Plus, which can result in lower costs for the insured. Additionally, there are exceptions to prior authorization that do not require prior approval, including routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. These services are exempt from prior authorization, potentially simplifying and reducing the cost of accessing these types of healthcare. [Northwind_Health_Plus_Benefits_Details.pdf#page=7] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "Choosing in-network providers with Northwind Health Plus can significantly reduce your healthcare costs. If you opt for non-participating providers, you will be responsible for the entire cost of care out-of-pocket, as they are not in-network. However, there are exceptions where you may receive some coverage when using non-participating providers: \n\n1. If you are traveling outside of the United States and cannot find an in-network provider, Northwind Health Plus may cover a portion of the cost.\n2. In a life-threatening situation where you need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received [Northwind_Health_Plus_Benefits_Details.pdf#page=6].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=6: 路 Ask your provider if they offer continuity of care. . If you are switching to a new provider, make sure they are familiar with your medical history. 路 If you are switching from an in-network provider to an out-of-network provider, make sure you understand what that means for your coverage. 路 Make sure you keep all of your medical records up to date. Continuity of care is an important factor to consider when selecting a provider. Northwind Health Plus offers coverage for continuity of care, so you may be able to continue seeing the same provider without having to switch to a different provider in the network. However, there are some exceptions to the continuity of care rule, so it's important to understand what those are. By following these tips, you can ensure you have the best possible coverage and ensure continuity of care. Non-Participating HOW PROVIDERS AFFECT YOUR COSTS When it comes to health care, the provider you choose can have a major impact on your costs. With Northwind Health Plus, you have the option to choose from a variety of in- network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=7: By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs. Northwind Health Plus is here to help you make the most of your coverage. If you have any additional questions about in-network and non-participating providers, please contact the Northwind Health Plus customer service line. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS: Balance Billing Protection Balance billing is a practice where a provider bills you for the difference between the allowed amount and billed amount. The allowed amount is the amount that your insurance company determines is a reasonable fee for a service. The amount you are billed for is the amount that the provider charges you for the services. With Northwind Health Plus, you are protected from balance billing. This means that you can rest assured that you will not be billed more than the allowed amount by your provider. Balance billing protection is an important part of Northwind Health Plus. This protection ensures that you will not be responsible for the difference between the allowed amount and the ", "latency": 5.636184, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE accurately addresses part of the QUERY regarding the impact of provider choice on costs and exceptions for non-participating providers but fails to address the exceptions to prior authorization, making it incomplete.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses the impact of choosing in-network versus non-participating providers but fails to address the exceptions to prior authorization, making it incomplete.", "answer_length": 698, "citations_matched": 0.0, "any_citation": true} -{"question": "How does the prior authorization process outlined in the Northwind Health Plus Benefits Details affect the coinsurance responsibilities for services that require prior authorization?", "truth": "The prior authorization process requires contacting Northwind Health Plus before receiving services or medications that need prior authorization to determine if it is necessary. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. This impacts the coinsurance responsibilities as failing to obtain prior authorization could lead to the policyholder paying the full cost, rather than just the coinsurance amount. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "The prior authorization process for services under the Northwind Health Plus plan requires members to obtain approval before receiving certain services. If prior authorization is not obtained, you may be responsible for the full cost of the services [Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Additionally, the Allowed Amount does not include any applicable copays, coinsurance, or deductibles that may be due [Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Therefore, it is crucial to check with your provider and Northwind Health Plus to understand your financial responsibilities and ensure that services are covered [Northwind_Health_Plus_Benefits_Details.pdf#page=16][Northwind_Health_Plus_Benefits_Details.pdf#page=66].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services. It is important to understand that the Allowed Amount does not include any applicable copays, coinsurance, or deductibles that may be due. It is also important to understand that the Allowed Amount may vary depending on the type of care received and the type of provider that is providing the care. Therefore, it is important to check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. Finally, it is important to keep track of your out-of-pocket expenses. This includes any copays, coinsurance, or deductibles that you may be required to pay. It is important to understand what your financial responsibility is when receiving care under Northwind Health Plus, so that you can plan accordingly and make sure that you are meeting your financial obligations. IMPORTANT PLAN INFORMATIONNorthwind Health Plus is a comprehensive health plan that offers coverage for medical, vision, and dental services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=66: By understanding the prior authorization process and following the tips outlined above, you can help ensure that you receive the care you need in a timely and efficient manner. Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage The Northwind Health Plus plan includes a care management system that requires prior- authorization for certain services to ensure that the plan is covering only medically necessary care. Prior-authorization is a process used by the insurance company to review a request for a specific service to ensure that it is medically necessary and meets the criteria set by the plan. This process helps to ensure that members are receiving the best care possible and that their benefits are used in the most cost-effective manner. In order to receive prior-authorization, members must provide their Northwind Health Plus provider with the necessary clinical information regarding their diagnosis and treatment plan. The provider then submits this information to Northwind Health Plus for review. Northwind Health Plus will then contact the provider with the decision on the prior- authorization request.", "latency": 3.364066, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is related to the topic of prior authorization and financial responsibilities but does not directly address how coinsurance responsibilities are affected by the prior authorization process, making it incomplete.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The response addresses the query by discussing the need for prior authorization and its potential financial implications, but it does not fully explain how coinsurance responsibilities are specifically affected by the prior authorization process.", "answer_length": 742, "citations_matched": 0.0, "any_citation": true} -{"question": "How does the Northwind Standard Benefits Details document explain the financial responsibilities for in-network and out-of-network providers, and what are some specific services covered under the plan as mentioned in the document?", "truth": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, individuals are typically responsible for only a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". However, for out-of-network providers, the costs can be significantly higher, and individuals may be responsible for the entire cost of services or a much larger portion than with an in-network provider. Specific services covered under the plan include the cost of blood or blood products during a hospital stay or procedure, the collection, storage, and transfusion of platelets and plasma, along with necessary laboratory tests to assess compatibility. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=21]", "answer": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance.\" Different types of services may require different co-pays or co-insurance, so it's advisable to contact your provider for specific costs. For out-of-network providers, while Northwind Standard offers coverage, the costs can be significantly higher, and you may be responsible for the entire cost of services or a greater portion than with in-network providers. Some services may also fall outside of the Northwind Standard plan coverage, requiring out-of-pocket payments for those services [Northwind_Standard_Benefits_Details.pdf#page=10][Northwind_Standard_Benefits_Details.pdf#page=8].\n\nSpecific services covered under the plan include mental health and substance abuse services, which generally have the same coverage as medical and surgical services, as well as preventive care services such as immunizations and screenings [Northwind_Health_Plus_Benefits_Details.pdf#page=3].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.", "latency": 3.180017, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE correctly addresses the financial responsibilities for in-network and out-of-network providers but includes incorrect information about the specific services covered under the Northwind Standard plan, which impacts its accuracy and completeness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about financial responsibilities and specific services covered under the plan, as mentioned in the document.", "answer_length": 1103, "citations_matched": 0.5, "any_citation": true} -{"question": "How can a claim for medically necessary rehabilitation therapy services be processed quickly under the Northwind Standard plan?", "truth": "To ensure quick processing of a claim for medically necessary rehabilitation therapy services under the Northwind Standard plan, one should ask the healthcare provider for a detailed explanation of the services and treatments, ensure all documentation including required forms, test results, and physician's notes are complete, send the documentation to Northwind Health promptly, and follow up with them to confirm receipt and processing of the claim. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "To process a claim for medically necessary rehabilitation therapy services quickly under the Northwind Standard plan, you should follow these steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments you are receiving, including the medical necessity for them.\n2. Ensure that all documentation is complete, including all required forms, test results, and physician's notes.\n3. Send the documentation to Northwind Health as soon as possible.\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed.\n\nAdditionally, if the rehabilitation services require prior authorization, make sure that this is obtained before the services are rendered, as Northwind Health will review the request and notify you of the decision within three business days [Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=68: Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require outpatient services, please contact Northwind Health Plus to ensure that the hospital you are visiting is an in-network provider. Ambulatory Surgery Center Services: Ambulatory surgery center services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the ambulatory surgery center you are visiting is an in-network provider. Outpatient Rehabilitative Services: Outpatient rehabilitative services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the outpatient rehabilitative provider you are visiting is an in-network provider. Long-Term Care Services: Long-term care services are covered without prior authorization if it is determined that the services are medically necessary.", "latency": 3.630792, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details about processing claims and prior authorization.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about prior authorization and decision timeframes, enhancing the understanding of the process.", "answer_length": 927, "citations_matched": 0.5, "any_citation": true} -{"question": "What steps can be taken to ensure quick and accurate processing of claims under the Northwind Standard Benefits Details?", "truth": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits Details, one should ask their healthcare provider for a detailed explanation of the services and treatments, including the medical necessity for them. It is also important to ensure that all documentation is complete, including all required forms, test results, and physician's notes. Additionally, sending the documentation to Northwind Health as soon as possible and following up with them to ensure the claim has been received and is being processed are crucial steps. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits, you can take the following steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments you are receiving, including the medical necessity for them [Northwind_Standard_Benefits_Details.pdf#page=88].\n2. Ensure that all documentation is complete, including all required forms, test results, and physician's notes [Northwind_Standard_Benefits_Details.pdf#page=88].\n3. Send the documentation to Northwind Health as soon as possible [Northwind_Standard_Benefits_Details.pdf#page=88].\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed [Northwind_Standard_Benefits_Details.pdf#page=88].\n5. Keep copies of all documentation related to your services [Northwind_Standard_Benefits_Details.pdf#page=79].\n6. If you are unsure of the filing requirements, contact Northwind Health for clarification [Northwind_Standard_Benefits_Details.pdf#page=79].\n7. Provide required notices in a timely manner [Northwind_Health_Plus_Benefits_Details.pdf#page=101].\n\nBy following these steps, you can help ensure that your claims are processed quickly and accurately.", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=79: You should also keep copies of all documentation related to your services, and if you're unsure of the filing requirements, you should contact Northwind Health for clarification. Overall, timely filing is an important part of the claim filing process. By following the guidelines for timely filing and including all necessary documentation with your claims, you can help ensure that your claims are processed quickly and accurately. COMPLAINTS AND APPEALS What You Can Appeal COMPLAINTS AND APPEALS What You Can Appeal When you have Northwind Standard coverage, you have the right to appeal any denial of services or payment of benefits. This includes if you disagree with the amount of the payment or if you feel that your claim was denied incorrectly. You also have the right to appeal if you feel that an authorization was not provided for a service, or if you believe that a service should be covered by your plan but was not. If you believe that your claim was wrongly denied or that you have a dispute over a service that is covered or not covered, you have the right to file a formal appeal.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.", "latency": 4.099918, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is mostly correct and complete, addressing the QUERY with relevant steps from the CONTEXT. However, it includes one step that is not applicable to the Northwind Standard Benefits, slightly reducing its groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, providing all essential steps needed for a comprehensive understanding of how to ensure quick and accurate processing of claims. It does not include additional insights or elaboration, which would have elevated it to a higher score.", "answer_length": 1217, "citations_matched": 0.5, "any_citation": true} -{"question": "What are some services exempt from prior authorization according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, services exempt from prior authorization include routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "According to the Northwind Health Plus Benefits Details, the following services are exempt from prior authorization:\n\n1. **Emergency Care**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n2. **Inpatient Hospital Services**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n3. **Outpatient Hospital Services**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n4. **Certain Preventive Services**: Such as annual physicals and routine check-ups do not require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=63].\n5. **Emergency Services by Out-of-Network Providers**: No prior authorization required if the service is medically necessary and the out-of-network provider is the closest available [Northwind_Health_Plus_Benefits_Details.pdf#page=70].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=67: That is why we provide exceptions to prior authorization for certain medical services, procedures and treatments that may require additional review and approval. The exceptions to prior authorization are based onnational and state medical regulations, as well as medical necessity and appropriateness criteria. The exceptions to prior authorization provided by Northwind Health Plus include: Emergency Care: Emergency care is covered without prior authorization if it is determined to be medically necessary. If you believe that you need emergency care, please contact Northwind Health Plus for approval. Inpatient Hospital Services: Inpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require hospital services, please contact Northwind Health Plus to ensure that the hospital you are admitted to is an in-network provider. Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=70: Remember, if you have any questions about the prior authorization process or coverage for an out-of-network provider, contact Northwind Health directly. Northwind Health is available to answer any questions you may have and provide more information about the prior authorization process. Exceptions to Prior-Authorization For Out-Of-Network Providers CARE MANAGEMENT - Exceptions to Prior-Authorization For Out-Of-Network Providers Northwind Health Plus provides coverage for certain services that may require prior authorization when provided by an out-of-network provider. Prior authorization is required to ensure that the service is medically necessary and to ensure that the service is being provided in accordance with the plan's specific rules and guidelines. Northwind Health Plus makes exceptions to the prior authorization requirement for the following services when provided by an out-of-network provider: 路 Emergency Services: For services that are medically necessary and when the out-of- network provider is the closest provider available, prior authorization is not required.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=63: For services and medications that require prior authorization, you must contact Northwind Health Plus before receiving the service or medication to determine if prior authorization is required. If so, you will need to obtain prior authorization through the Northwind Health Plus prior authorization process. Exceptions There are some exceptions to the prior authorization requirement. Certain preventive services, such as annual physicals and routine check-ups do not require prior authorization. In some cases, Northwind Health Plus may also waive the prior authorization requirement for certain services and medications. Tips for Employees If you think you may need a service or medication that requires prior authorization, it is important to plan ahead and contact Northwind Health Plus before receiving the service or medication. This will help ensure that your service or medication is covered by Northwind Health Plus. If you receive a service or medication without prior authorization, you may be responsible for the entire cost of the service or medication. You can also be billed for any services or medications that are determined to be not medically necessary.", "latency": 5.099652, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely lists the services exempt from prior authorization as described in the CONTEXT, without introducing any unrelated or incorrect information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding.", "answer_length": 1011, "citations_matched": 0.0, "any_citation": true} -{"question": "How does the prior authorization process detailed in the Northwind_Health_Plus_Benefits_Details.pdf impact the out-of-pocket costs for services and medications, and what are the copayment expectations for in-network services as outlined in the same document?", "truth": "The prior authorization process as detailed in the Northwind Health Plus Benefits Details requires contacting Northwind Health Plus before receiving certain services or medications to determine if prior authorization is needed. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. Additionally, for in-network services, the copayment expectations are generally lower, with a typical copayment of around $20 for primary care visits and around $50 for specialist visits. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The prior authorization process can impact out-of-pocket costs for services and medications by potentially requiring approval before certain services or medications are covered, which may affect whether you incur higher costs if the authorization is not obtained. However, specific details about how prior authorization directly affects out-of-pocket costs are not provided in the document.\n\nFor copayment expectations for in-network services, the copayment for primary care visits is typically around $20, specialist visits have a copayment of around $50, and in-network emergency services typically have a copayment of around $100. Preventive care services are covered at 100% with no copayment [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an ", "latency": 3.487467, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE accurately addresses the copayment expectations for in-network services but introduces information about prior authorization that is not supported by the CONTEXT. This makes the RESPONSE partially correct but not fully grounded in the CONTEXT.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses both parts of the QUERY but lacks specific details about how prior authorization impacts out-of-pocket costs, making it incomplete. The copayment information is complete and accurate.", "answer_length": 750, "citations_matched": 0.0, "any_citation": true} -{"question": "How does using in-network providers affect the coinsurance responsibilities for services under the Northwind Health Plus Benefits, and what are the implications of using out-of-network providers?", "truth": "Using in-network providers under the Northwind Health Plus Benefits can result in lower coinsurance rates, meaning the policyholder will pay less for the same service. However, if out-of-network providers are used, the policyholder will be responsible for a larger portion of the cost, and in some cases, may be responsible for the entire cost. This highlights the importance of checking if a provider is in-network before selecting a plan to manage out-of-pocket costs effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=14] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers under the Northwind Health Plus Benefits results in lower out-of-pocket costs because Northwind Health has negotiated discounted rates with these providers. In contrast, using out-of-network providers may lead to higher out-of-pocket costs, including potentially paying the full cost of services, higher deductibles, and higher coinsurance responsibilities [Northwind_Health_Plus_Benefits_Details.pdf#page=3].\n\nFor emergency services, both in-network and out-of-network providers are covered, but using out-of-network providers may incur higher out-of-pocket costs, including copayments and coinsurance, and you may have to pay the difference between the billed amount and what the plan pays [Northwind_Health_Plus_Benefits_Details.pdf#page=27].\n\nOverall, in-network providers generally result in your insurance covering a greater portion of your expenses, while out-of-network providers require you to pay a greater portion of the costs [Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you have questions about the dialysis coverage offered by Northwind Health Plus, please contact your provider or Northwind Health directly. We are committed to providing our employees with comprehensive coverage and support. Emergency Room COVERED SERVICES - EMERGENCY SERVICES At Contoso, we understand that unplanned medical emergencies can arise, and so our insurance partner, Northwind Health, provides coverage for emergency services. This coverage applies to both in-network and out-of-network providers. In-Network Providers If you seek emergency care from an in-network provider, your plan will cover the cost of treatment, including any necessary hospitalization and follow-up care. Depending on the type of plan you have, you may also be responsible for paying a copayment and/or coinsurance. Out-of-Network Providers Emergency services received from out-of-network providers will also be covered, but you may be responsible for higher out-of-pocket costs such as copayments and coinsurance. If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.", "latency": 6.865712, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the QUERY with relevant details about coinsurance responsibilities and implications of using in-network versus out-of-network providers under the Northwind Health Plus Benefits.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about emergency services and general insurance coverage impacts, which enhance understanding.", "answer_length": 1014, "citations_matched": 0.0, "any_citation": true} -{"question": "What are the differences in copayment amounts for primary care and specialist visits under the Northwind Health Plus plan?", "truth": "Under the Northwind Health Plus plan, the copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10] [Northwind_Health_Plus_Benefits_Details.pdf#page=9]", "answer": "Under the Northwind Health Plus plan, the copayment amounts are as follows:\n\n- For in-network primary care visits: approximately $20 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- For in-network specialist visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nFor out-of-network services, the copayment amounts are higher:\n\n- For out-of-network primary care visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- For out-of-network specialist visits: approximately $75 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 4.611795, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, as it accurately provides the copayment amounts for primary care and specialist visits under the Northwind Health Plus plan, distinguishing between in-network and out-of-network services, as detailed in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing the copayment amounts for both primary care and specialist visits, in-network and out-of-network, under the Northwind Health Plus plan.", "answer_length": 585, "citations_matched": 0.0, "any_citation": true} -{"question": "What are the limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details?", "truth": "The limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details include that it only applies to services covered under the plan and not to services that are not covered or are subject to limitations or exclusions. Additionally, it only applies to claims filed within six months of the date of service. There is also no guarantee that the insurance company will be able to recover all or part of the money already paid by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The limitations of the Right of Recovery provision in the Northwind Health Plus plan include:\n\n1. The provision only applies to services that are covered under the plan. If the service is not covered, the employee will not be eligible for recovery [Northwind_Health_Plus_Benefits_Details.pdf#page=101][Northwind_Standard_Benefits_Details.pdf#page=98].\n\n2. The request for the right of recovery must be made within two years of the service being provided. Claims submitted after this period will not be considered [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n3. Certain services are not eligible for the right of recovery, including those related to mental health and substance abuse, emergency services, inpatient services, and any services not covered under the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n4. The right of recovery is only applicable to services paid for by the insured, not by any third party, including family members, friends, employers, or other insurance plans [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n5. The right of recovery is subject to the terms and conditions of the Northwind Standard plan, so it is important to read the plan documents for additional exclusions [Northwind_Standard_Benefits_Details.pdf#page=98].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=98: Additionally, the service must be one that is covered under the plan. If the service is not covered, then the employee will not be eligible for the right of recovery. It is important for employees to keep in mind that the right of recovery must be requested within two years of the service being provided in order for the employee to be eligible for reimbursement. Any claims submitted after this period will not be considered. In addition, there are some services that are not eligible for the right of recovery. These include services related to mental health and substance abuse, emergency services, inpatient services, and any services that are not covered under the Northwind Standard plan. It is also important to note that the right of recovery is only applicable to services that were paid for by the insured, and not by any other third party. This includes family members, friends, employers, or other insurance plans. Employees should keep in mind that the right of recovery is subject to the terms and conditions of the Northwind Standard plan. Therefore, it is important to read the plan documents in detail to understand any additional exclusions or ", "latency": 7.046571, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE attempts to address the QUERY but includes incorrect information from a different plan, which is not supported by the CONTEXT provided.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the limitations of the Right of Recovery provision, without adding any extraneous information.", "answer_length": 1292, "citations_matched": 0.0, "any_citation": true} -{"question": "What are the benefits of the Chronic Condition Management Program offered by the Northwind Health Plus plan?", "truth": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides members with access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. This team offers personalized care and support to help members manage their chronic conditions and live healthier, happier lives. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=73]", "answer": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides several benefits, including:\n\n- Access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Comprehensive care assessments and care plans [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Regular follow-up visits [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Personalized health education [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Assistance with medication management [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Coordination of services with other providers [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Referrals to community resources [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n\nThe program is designed to help members better manage their chronic conditions, reduce the risk of complications, and improve their quality of life [Northwind_Health_Plus_Benefits_Details.pdf#page=74]. It is available to members with specific chronic conditions such as diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and hypertension [Northwind_Health_Plus_Benefits_Details.pdf#page=74].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=74: 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help manage your condition and reduce the risk of complications. . Stay organized: Keeping track of your medications, appointments, and lab results can help you stay on top of your condition and make informed decisions about your care. . Ask for help: Don't be afraid to ask for help from family, friends, and healthcare professionals. . Take advantage of resources: Northwind Health Plus offers a variety of resources and programs to help members manage their chronic conditions.路 Be proactive: Talk to your doctor if you have any questions or concerns about your condition or care plan. At Northwind Health, we understand that managing chronic conditions can be challenging. That's why we're committed to helping our members get the care and support they need to stay healthy and active. Through our Chronic Condition Management Program, we provide members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=74: The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. The CCMP is designed to help members better manage their chronic conditions, reduce the risk of complications, and improve their quality of life. Through the program, members receive: 路 Comprehensive care assessments and care plans 路 Regular follow-up visits 路 Personalized health education 路 Assistance with medication management 路 Coordination of services with other providers 路 Referrals to community resources Exceptions: The CCMP is only available to Northwind Health Plus members who have one or more of the following chronic conditions: diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and hypertension. Tips to Help Employees Manage Chronic Conditions: . Talk to your doctor: It's important to have open and honest conversations with your doctor about your condition and any concerns you may have. 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=73: Talk to your doctor or other health care provider about your health and any treatments that may be available. .Take an active role in your health care. Ask questions and be informed about your health and any treatments that may be available. . Make sure to follow your doctor's instructions and stay up to date on your health care. . If you have any questions or concerns about your health, contact Northwind Health Plus for assistance.Chronic Condition Management CARE MANAGEMENT: Chronic Condition Management At Northwind Health, we understand that managing chronic conditions can be overwhelming and expensive. We are committed to helping our members manage their chronic conditions and live healthier, happier lives. That's why we offer a Chronic Condition Management Program (CCMP) as part of our Northwind Health Plus plan. This program provides members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support. The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists.", "latency": 4.045416, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately listing all the benefits of the Chronic Condition Management Program as provided in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the program's purpose and the specific conditions it covers, which enhances understanding.", "answer_length": 1380, "citations_matched": 0.0, "any_citation": true} -{"question": "What happens if you use out-of-network providers according to Northwind Health Plus?", "truth": "If you use out-of-network providers according to Northwind Health Plus, you will be responsible for a larger portion of the cost. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=75]", "answer": "If you use out-of-network providers under Northwind Health Plus, you must obtain prior authorization before receiving care. This means that Northwind Health will review your request for coverage and decide whether it will cover the care you are seeking. The criteria for approval may vary depending on the type of care requested, and your provider typically submits the request for you. \n\nAdditionally, while Northwind Health Plus offers coverage for out-of-network providers, it may not cover all services, and out-of-network providers may charge more than in-network ones. There may also be limitations or conditions on the coverage granted, such as limits on the number of visits for specific procedures [Northwind_Health_Plus_Benefits_Details.pdf#page=69][Northwind_Health_Plus_Benefits_Details.pdf#page=71].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=62: If you are outside Washington, you may still be eligible for coverage through Northwind Health Plus. Northwind Health Plus offers a network of providers that are located throughout the United States. These providers are part of Northwind Health Plus' nationwide network, which is designed to ensure that you are able to receive care, no matter where you are. Out-of-area care is coverage that extends outside of Washington. This means that if you travel outside of the state, you can still receive care from a Northwind Health Plus provider. However, there are some exceptions to this coverage. For example, you may be limited to a certain number of visits or treatments that are covered outside of Washington. Additionally, certain services may not be covered, such as home health care services that are provided outside of the state. If you travel outside of Washington, it is important to keep a few tips in mind. First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=69: Northwind Health Plus offers coverage for out-of-network providers, but the plan requires prior authorization. This means that you must obtain approval from Northwind Health before seeing an out-of-network provider. Prior authorization is a process in which Northwind Health reviews your request for coverage and decides whether or not it will cover the care that you have requested. To be approved for prior authorization, you must meet certain criteria and provide certain information. This criteria and information may vary depending on the type of care you are requesting. Prior authorization requests must be submitted to Northwind Health by your provider. In most cases, your provider will submit the request for you. Northwind Health will then review the request and make a decision about whether or not it will cover the care.In some cases, Northwind Health may approve the request for coverage, but with certain limitations or conditions. For example, Northwind Health may limit the number of visits for a specific procedure or limit the amount of coverage for a specific procedure.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=71: In conclusion, Northwind Health Plus makes exceptions to the prior authorization requirement for certain services when they are provided by an out-of-network provider. However, it is important to remember that Northwind Health Plus may not cover all of the services provided by an out-of-network provider, that out-of-network providers may charge more than those in-network, and that prior authorization is still required for some services even if they are provided by an out-of-network provider. By being aware of theseexceptions and tips, employees can ensure that they are making responsible and informed decisions about their healthcare needs. Clinical Review CARE MANAGEMENT - Clinical Review Northwind Health Plus offers several care management services to ensure that members are receiving the best possible care. One of the primary care management services is Clinical Review. Clinical Review is an important process that helps to ensure that members are receiving the most appropriate care and that their care is in line with established clinical guidelines. Clinical Review involves a team of healthcare professionals who review services, treatments, and ", "latency": 3.044576, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY by incorporating all relevant details from the CONTEXT about using out-of-network providers, including prior authorization, potential limitations, and cost differences.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the implications and conditions of using out-of-network providers under Northwind Health Plus.", "answer_length": 812, "citations_matched": 0.0, "any_citation": true} -{"question": "What are the specific conditions and exceptions mentioned in the Northwind Health Plus Benefits Details.pdf for coordinating benefits with other employer plans and the Right of Recovery provision?", "truth": "The Northwind Health Plus Benefits Details.pdf specifies that to coordinate benefits with another employer plan, one must use an in-network provider within the Northwind Health Plus network and provide the other employer plan's information. Exceptions include not being able to coordinate benefits with non-major medical plans or high-deductible plans until the deductible is met. Regarding the Right of Recovery provision, it only applies to services covered under the plan and claims filed within six months of the service date. It does not guarantee recovery of payments made, and in cases where recovery is not possible, partial reimbursement might be offered. Documentation such as receipts is necessary if filing a Right of Recovery claim. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=102]", "answer": "For coordinating benefits with other employer plans under the Northwind Health Plus plan, the following conditions and exceptions apply:\n\n1. You must use an in-network provider within the Northwind Health Plus network.\n2. You need to provide your other employer plan's information to coordinate benefits.\n3. You cannot coordinate benefits with a health plan that is not a major medical plan.\n4. If enrolled in a high-deductible health plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\nRegarding the Right of Recovery provision:\n\n1. It only applies to services that are covered under the plan; it does not apply to services that are not covered or are subject to limitations or exclusions.\n2. Claims must be filed within six months of the date of service.\n3. There is no guarantee that the insurance company will recover the money you have already paid; they may only be able to reimburse a portion of it.\n4. You should keep receipts or other documentation if you have paid a provider for a service covered under the plan, as this documentation is necessary for filing a Right of Recovery claim [Northwind_Health_Plus_Benefits_Details.pdf#page=102].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=77: To coordinate benefits with your other employer plan, you must use an in-network provider within the Northwind Health Plus network. You will need to provide your other employer plan's information in order to coordinate benefits. Exceptions There are a few exceptions to coordinating benefits with other health care plans. For example, you cannot coordinate benefits with a health plan that is not a major medical plan. Also, if you are enrolled in a health plan that is a high-deductible plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible. Tips If you have other health care coverage, here are a few tips to help you coordinate benefits with Northwind Health Plus: . Make sure you have your other health care plan's information handy when you use Northwind Health Plus. 路 Always use an in-network provider within the Northwind Health Plus network to ensure that your benefits are coordinated correctly. 路 Make sure you understand your plan's rules for coordinating benefits. 路 Ask your doctor or other health care provider about the cost of services before you receive them to make \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan. It does not apply to services that are not covered or services that are subject to limitations or exclusions. Second, the Right of Recovery provision only applies to claims that are filed within six months of the date of service. Also, keep in mind that the Right of Recovery provision does not guarantee that the insurance company will be able to recover the money that you have already paid. The insurance company may be unable to recover the money that you have paid, or they may not be able to recover the entire amount. In these cases, the insurance company may offer to reimburse you for some portion of the money that you have already paid. Finally, if you have already paid a provider for a service that is covered under the plan, it is important to keep any receipts or other documentation. This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company.", "latency": 3.624614, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY by providing all relevant conditions and exceptions mentioned in the CONTEXT for both coordinating benefits and the Right of Recovery provision.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, covering all essential details without adding extraneous information.", "answer_length": 1251, "citations_matched": 1.0, "any_citation": true} -{"question": "How can a policyholder of Northwind Health Plus ensure that their benefits are coordinated correctly when using an in-network provider, and what are the typical copayments for primary care and specialist visits?", "truth": "To ensure that benefits are coordinated correctly when using an in-network provider within the Northwind Health Plus network, a policyholder must have their other health care plan's information handy and always use an in-network provider. The typical copayments for primary care visits are around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "To ensure that benefits are coordinated correctly when using an in-network provider, policyholders of Northwind Health Plus should follow the guidelines provided by their plan and consult with their provider for any necessary information. \n\nThe typical copayments for in-network services are as follows:\n- Primary care visits: approximately $20 [Northwind_Health_Plus_Benefits_Details.pdf#page=10].\n- Specialist visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 3.27676, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides correct copayment information but lacks specific details on coordinating benefits, making it partially correct.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including specific copayment amounts and a method for ensuring benefits are coordinated correctly.", "answer_length": 491, "citations_matched": 0.5, "any_citation": true} -{"question": "What are the necessary steps to ensure coverage for transplants according to the Northwind Standard Benefits Details?", "truth": "To ensure coverage for transplants according to the Northwind Standard Benefits Details, it is important to discuss transplant needs with a primary care physician, ensure the transplant is medically necessary, and obtain preauthorization. Additionally, coverage includes pre- and post-transplant care but excludes experimental or investigational procedures. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=55]", "answer": "To ensure coverage for transplants under the Northwind Standard plan, you should follow these necessary steps:\n\n1. **Discuss with Your Doctor**: Talk to your primary care physician about your transplant needs to determine if the procedure is medically necessary and covered under your plan [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n2. **Preauthorization**: Obtain the necessary preauthorization for any transplant procedures before proceeding [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n3. **Understand Coverage Details**: Familiarize yourself with your coverage details, including any applicable copays or coinsurance requirements [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n4. **Inquire About Costs**: Ask your doctor about any potential out-of-pocket costs and alternative treatments that may be available [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n5. **Avoid Experimental Procedures**: Ensure that the transplant procedure is not experimental or investigational, as these are not covered by the plan [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n6. **Pre- and Post-Transplant Care**: Be aware that coverage includes pre- and post-transplant care, such as laboratory and diagnostic tests, as long as they are medically necessary [Northwind_Standard_Benefits_Details.pdf#page=55].", "context": "Northwind_Standard_Benefits_Details.pdf#page=55: There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants. For example, it's important to make sure that you are familiar with all of the details of your coverage, including any applicable copays orcoinsurance requirements. It's also a good idea to ask your doctor about any potential out- of-pocket costs you may need to pay, as well as any potential alternative treatments that may be available. Finally, it's important to note that Northwind Standard does not provide coverage for any experimental or investigational transplant procedures. If you're considering a transplant procedure, it's important to make sure that it is a medically necessary procedure, and that it is covered under your Northwind Standard plan. At Northwind Health, we understand how important it is for our members to have access to the best possible care. That's why we're proud to provide coverage for organ and tissue transplants through our Northwind Standard plan. With this coverage, you can get the care you need, while also enjoying the peace of mind that comes from \n\nNorthwind_Standard_Benefits_Details.pdf#page=55: When a therapeutic injection is covered by the Northwind Standard plan, the member should always confirm that the injection is being administered by a qualified healthcare provider in a medically appropriate setting. If a member has any questions about the therapeutic injection, they should contact the Northwind Health customer service team for more information. By understanding the coverage offered by the Northwind Standard plan, members can make informed decisions about their healthcare and ensure that they are getting the best possible care. Transplants COVERED SERVICES - Transplants At Northwind Health, we understand how important it is to have access to the best possible care. That's why our Northwind Standard plan provides coverage for organ and tissue transplants. If you need a transplant of any kind, Northwind Standard will cover the expenses associated with the procedure, including the cost of the donor organ, hospital stays, recovery costs, and medications. It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician.\n\nNorthwind_Standard_Benefits_Details.pdf#page=55: It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician. In addition to covering the cost of the transplant itself, Northwind Standard will also provide coverage for pre- and post-transplant care, such as laboratory tests, diagnostic tests, and other medically necessary services. It's important to note that there are some exceptions to coverage for transplants. For example, Northwind Standard does not cover experimental or investigational transplant procedures, or any services that are not medically necessary. When it comes to making sure you get the best care possible, we believe that the best approach is to work with your doctor to determine the best course of action. It's important to note that coverage for transplants is subject to preauthorization, so it's important to make sure that you get the necessary authorization for any transplant procedures before you move forward. There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants.", "latency": 4.005527, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with all necessary steps and details, making it a complete response.", "answer_length": 1323, "citations_matched": 0.5, "any_citation": true} -{"question": "What are the benefits of using in-network providers according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, using in-network providers results in lower out-of-pocket costs for the policyholder. This is because the plan covers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, which directly impacts the costs incurred by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers offers several benefits according to the Northwind Health Plus Benefits Details:\n\n1. **Cost Savings**: Using in-network providers helps members save money, as they typically charge lower rates compared to out-of-network providers [Northwind_Health_Plus_Benefits_Details.pdf#page=94].\n\n2. **Higher Level of Care**: In-network providers generally provide a higher level of care than out-of-network providers [Northwind_Health_Plus_Benefits_Details.pdf#page=15].\n\n3. **Maximizing Coverage**: Staying in-network allows members to get the most out of their coverage [Northwind_Health_Plus_Benefits_Details.pdf#page=15].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=1: Contoso Electronics Northwind Health Plus Plan Contoso ElectronicsThis document contains information generated using a language model (Azure OpenAI). The information contained in this document is only for demonstration purposes and does not reflect the opinions or beliefs of Microsoft. Microsoft makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this document. All rights reserved to MicrosoftSummary of Benefits Northwind Health Plus Northwind Health Plus is a comprehensive plan that provides comprehensive coverage for medical, vision, and dental services. This plan also offers prescription drug coverage, mental health and substance abuse coverage, and coverage for preventive care services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and other assistance. . Use your plan's in-network providers whenever possible, as this will help you save money. . Utilize Northwind Health's online pharmacy service, which allows you to easily order and manage your prescriptions without leaving home. 路 When you receive health care services, make sure to check that the provider is in-network and that the services are covered by your plan. . Keep track of your claims and other plan information, as this will help you to better understand your plan and stay on top of your health care expenses.. Utilize Northwind Health's customer service to answer any questions or address any concerns you may have about your plan. Healthcare Providers - Independent Contractors OTHER INFORMATION ABOUT THIS PLAN Healthcare Providers - Independent Contractors The Northwind Health Plus plan includes coverage for healthcare services provided by independent contractors.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.940711, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY by listing the benefits of using in-network providers as per the Northwind Health Plus Benefits Details. It includes all essential details required for a comprehensive understanding, making it a complete response.", "answer_length": 641, "citations_matched": 0.0, "any_citation": true} -{"question": "How does the Northwind Health Plus plan address TMJ symptoms and what are the covered services for TMJ treatment?", "truth": "The Northwind Health Plus plan addresses TMJ symptoms by recommending various non-invasive methods such as avoiding chewing gum, large meals, extreme jaw movements, practicing relaxation techniques, and using heat and cold therapy to reduce pain and muscle tension. Additionally, the plan covers therapeutic injections, which are a type of procedure where drugs or other substances are injected directly into the body to treat medical conditions and provide relief from pain, including TMJ. [Northwind_Health_Plus_Benefits_Details.pdf#page=57] [Northwind_Standard_Benefits_Details.pdf#page=54]", "answer": "The Northwind Health Plus plan addresses TMJ symptoms by covering various treatments for Temporomandibular Joint Disorders (TMJ). The covered services include:\n\n1. **Diagnostic Tests**: Coverage for diagnostic tests such as X-rays, CT scans, MRI scans, and ultrasound when deemed medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n2. **Medications**: Coverage for medications to relieve TMJ symptoms, including anti-inflammatory medications, muscle relaxants, and pain medications. In some cases, injections to relieve pain in the jaw joint may also be covered [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n3. **Physical Therapy**: Coverage for physical therapy, which may include stretching exercises, massage, and ultrasound treatments [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n4. **Splints and Devices**: Coverage for splints and other devices that help reduce jaw pain and improve jaw movement [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\nPlease note that Northwind Health Plus does not cover treatments considered experimental or cosmetic, such as facial surgery, Botox injections, and laser treatments [Northwind_Health_Plus_Benefits_Details.pdf#page=56].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=56: Temporomandibular Joint Disorders (TMJ) Care COVERED SERVICES: Temporomandibular Joint Disorders (TMJ) Care Temporomandibular joint (TMJ) disorders are a group of conditions that affect the jaw joint and the muscles that control the jaw's movement. It can be a debilitating condition that affects an individual's ability to talk, eat, and perform other daily activities. Northwind Health Plus covers treatments for TMJ disorders, including the cost of diagnostic tests, medications, and physical therapy. Diagnostic Tests Northwind Health Plus covers a variety of diagnostic tests that can help determine the cause of an individual's TMJ disorder. These tests may include X-rays, CT scans, MRI scans, and ultrasound. Northwind Health Plus will cover the cost of these tests when they are deemed medically necessary. Medications Northwind Health Plus will cover the cost of medications to help relieve the symptoms of TMJ disorders. These medications may include anti-inflammatory medications, muscle relaxants, and pain medications. In some cases, Northwind Health Plus may also cover the cost of injections to help relieve pain in the \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=56: In some cases, Northwind Health Plus may also cover the cost of injections to help relieve pain in the jaw joint. Physical Therapy Northwind Health Plus will cover the cost of physical therapy to help relieve the symptoms of TMJ disorders. Physical therapy may include stretching exercises, massage, and ultrasound treatments. Northwind Health Plus will also cover the cost of splints and other devices that can help reduce jaw pain and improve jaw movement. Exceptions Northwind Health Plus does not cover the cost of any treatments or procedures that are considered experimental or cosmetic. This includes treatments such as facial surgery, Botox injections, and laser treatments. Tips To help manage the symptoms of TMJ disorders, Northwind Health Plus recommends the following tips:路 Practice good posture and body mechanics: Make sure you maintain good posture when sitting and standing, and avoid clenching your teeth or grinding them. 路 Avoid chewing gum: Chewing gum can cause your jaw muscles to become fatigued, which can worsen TMJ symptoms.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=57: 路 Avoid chewing gum: Chewing gum can cause your jaw muscles to become fatigued, which can worsen TMJ symptoms. . Avoid large meals: Eating large meals can put a strain on your jaw muscles, so try to avoid eating large meals or snacks. 路 Practice relaxation techniques: Relaxation techniques such as deep breathing and progressive muscle relaxation can help reduce jaw tension and relieve TMJ symptoms. 路 Use heat and cold therapy: Applying heat or cold to your jaw can help reduce pain and muscle tension. 路 Avoid extreme jaw movements: Avoid extreme jaw movements, such as widely opening your mouth or clenching your teeth. Therapeutic Injections COVERED SERVICES: Therapeutic Injections At Northwind Health, we understand the importance of having access to therapeutic injections that can help treat medical conditions and provide relief from pain. We are pleased to offer coverage for therapeutic injections as part of the Northwind Health Plus plan. Therapeutic injections are a type of procedure in which drugs or other substances are injected directly into the body to treat medical conditions and ", "latency": 6.133987, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately listing the covered services for TMJ treatment as described in the CONTEXT and addressing the QUERY without introducing unrelated information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not add extraneous information but provides a clear and direct answer to the question.", "answer_length": 1217, "citations_matched": 0.0, "any_citation": true} -{"question": "Considering the Northwind Health Plus Benefits Details, how does the coverage of virtual care services relate to the limitations on services like laboratory tests and mental health services?", "truth": "Northwind Health Plus covers the cost of virtual care services, including telemedicine, e-visits, and other virtual consultations with in-network providers, which can be used for diagnosing and treating minor medical conditions or following up on existing medical issues. However, there are limitations to these virtual care services as some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. Additionally, some services may require prior authorization. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=28]", "answer": "Northwind Health Plus covers virtual care services, allowing members to receive care from home for minor medical conditions and follow-ups. However, there are limitations; services such as laboratory tests, imaging studies, and mental health services may not be available via virtual care and may require in-person visits instead. Additionally, some services may require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=60].\n\nSimilarly, Northwind Standard covers virtual care but excludes services that require a physical exam or in-person care, such as lab work and surgeries [Northwind_Standard_Benefits_Details.pdf#page=57].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization. We encourage you to take advantage of virtual care services when appropriate. To make the most of your virtual care experience, be sure to: 路 Prepare for your visit: Make sure you have the necessary supplies and documents in advance, such as your insurance card, medical history, and any questions you may have.路 Follow up: If you need to follow up with your doctor, be sure to do so. Virtual care services are an excellent way to stay in touch with your provider. . Follow instructions: Make sure you follow any instructions given to you by your doctor during or after your virtual visit. 路 Contact us: If you have any questions or need help scheduling a virtual visit, please contact Northwind Health customer service. At Contoso, we understand that today's busy lifestyles can make it difficult to schedule and attend doctor's appointments. That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=57: With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice. Northwind Standard covers virtual care services in the same way it would cover an in- person visit. This includes a variety of services, such as urgent care, primary care, mental health and substance abuse services, and specialist visits. Members also have access to telehealth post-discharge care and chronic disease management. Exceptions Although Northwind Standard covers most virtual care services, there are a few exceptions. Virtual care is not covered for any services that require a physical exam, such as pediatric well-child visits, physical therapy, and lab work. Additionally, virtual care is not covered for any services that require in-person care, such as surgeries and imaging tests. Tips for Members We want to make sure our members get the most out of their virtual care visits. Here are a few tips to help make your virtual care visits as successful as possible: - Make sure your doctor is in-network.", "latency": 2.785608, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The response accurately addresses the query by explaining the coverage and limitations of virtual care services under Northwind Health Plus, as described in the context. However, it includes extraneous information about Northwind Standard, which is not relevant to the specific query, making the response less focused.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the comparison between different plans, which enhances understanding.", "answer_length": 647, "citations_matched": 0.5, "any_citation": true} -{"question": "How does Northwind Health Plus manage coinsurance for virtual care services according to the Northwind_Health_Plus_Benefits_Details.pdf?", "truth": "Northwind Health Plus covers the cost of virtual care services, which include telemedicine, e-visits, and other virtual consultations with in-network providers, potentially reducing out-of-pocket costs such as coinsurance for these services. However, it is important to note that some services may require prior authorization, and limitations may apply, such as certain services not being available via virtual care. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "Northwind Health Plus covers the cost of virtual care services, including telemedicine and e-visits, with in-network providers. By using these virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. However, there may be limitations on certain services, and some may require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=60].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: Have your insurance card on hand: Bring your insurance card with you to the visit, as you may need to provide it to the facility. . Bring your medical records: If you have any relevant medical records, bring them with you to the facility. This will help the provider make a more informed diagnosis. 路 Know when to go to the emergency room: If you are experiencing a medical emergency, call 911 or go to the nearest emergency room for treatment. We understand that receiving urgent care can be a stressful situation. At Northwind Health Plus, we strive to make the process as easy and stress-free as possible. If you have any questions about your coverage, please reach out to us so we can help. Virtual Care COVERED SERVICES: Virtual Care At Contoso, we understand that taking time off to go to the doctor's office isn't always possible. That's why we've partnered with Northwind Health to provide access to virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=61: That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home. Weight Management WEIGHT MANAGEMENT - COVERED SERVICES Weight management is an important part of overall health and wellness, and Northwind Health Plus recognizes this. As part of your health plan, you have access to a variety of coverage options for weight management. Coverage for Weight Loss Programs Northwind Health Plus offers coverage for medically supervised weight loss programs. These programs are designed to help you reach and maintain a healthy weight. Covered services may include nutrition counseling, medical evaluation and follow-up, and laboratory tests. Your plan may also cover the cost of medications prescribed by your doctor as part of your weight loss program. Coverage for Weight Loss Surgery Northwind Health Plus also offers coverage for weight loss surgery. Weight loss surgery is a serious procedure that can help some people achieve major health benefits.", "latency": 2.557069, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The response is related to the topic of virtual care services but does not directly address the specific query about coinsurance management, making it a related topic but not a direct answer.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE is incomplete because it does not address the specific aspect of coinsurance management for virtual care services, which is the main focus of the QUERY.", "answer_length": 427, "citations_matched": 0.5, "any_citation": true} -{"question": "What are the financial responsibilities of a Northwind Standard plan holder when using out-of-network providers according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, when a Northwind Standard plan holder uses out-of-network providers, they may be responsible for the entire cost of services or a far greater portion of the cost than they would with an in-network provider. Although Northwind Standard may offer coverage for some out-of-network providers, the costs associated with these providers can be significantly more expensive. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "According to the Northwind Standard Benefits Details, when using out-of-network providers, a plan holder may face the following financial responsibilities:\n\n1. Coverage for out-of-network providers is offered, but costs can be significantly higher than for in-network providers. You may be responsible for the entire cost of services or a much larger portion than with in-network providers [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n2. Some services provided by out-of-network providers may not be covered by the Northwind Standard plan, leading to out-of-pocket expenses for those services [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n3. If you receive care from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay [Northwind_Health_Plus_Benefits_Details.pdf#page=27].\n\n4. Out-of-network services may not count towards your deductible or out-of-pocket maximum, meaning you could be responsible for the entire cost of the services, minus any applicable discounts [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n5. You may also be subject to balance billing, where the provider bills you for the difference between their charges and what Northwind pays [Northwind_Health_Plus_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay. ExceptionsNorthwind Health Plus does not cover certain types of emergency services. These include services for certain social and cosmetic procedures, elective surgery, experimental treatments, and services for injuries or illnesses that are not medically necessary. Tips for Employees It is important to keep in mind that if you have an emergency, you should seek care from the nearest hospital or medical facility. Regardless of whether it is in-network or out-of- network, you will be covered. It is also important to remember that if you receive care from an out-of-network provider, you may be responsible for higher out-of-pocket costs. It is also important to be aware of the exceptions to Northwind Health Plus' coverage of emergency services. Certain services, such as those for elective surgery and experimental treatments, are not covered. Lastly, it is important to keep your Northwind Health Plus ID card with you at all times.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 3.670049, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE attempts to address the QUERY but includes incorrect information from a different plan, which is not supported by the CONTEXT.", "relevance": 2.0, "gpt_relevance": 2.0, "relevance_reason": "The RESPONSE attempts to address the QUERY but includes information from a different plan document, leading to incorrect information regarding the specific plan asked about.", "answer_length": 1331, "citations_matched": 0.5, "any_citation": true} -{"question": "How does the clinical review process in the Northwind Standard Benefits Details ensure timely and cost-effective medical service provision, and what are the documentation requirements for filing a claim as outlined in the same document?", "truth": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by requiring pre-authorization for some medical services and by designing the process to ensure that medically necessary treatments are provided efficiently. Members are advised to provide accurate and detailed information about their medical needs, including a complete list of current medications and all relevant medical history, along with any necessary documentation like test results or lab reports. For filing a claim, the necessary documentation includes itemized bills, a completed claim form, and any other documentation requested by Northwind Health. This process helps in ensuring that members receive high-quality, cost-effective care. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by evaluating the medical necessity and appropriateness of proposed treatments. This process is conducted by licensed clinicians using evidence-based guidelines. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, to facilitate a smooth review process [Northwind_Standard_Benefits_Details.pdf#page=68][Northwind_Standard_Benefits_Details.pdf#page=67].\n\nFor filing a claim, all claims must be submitted within twelve months of the date of service to ensure timely processing. Claims submitted after this period may be reviewed for payment consideration but are not guaranteed acceptance. Members can file claims directly through the Northwind website or app, and if filing on behalf of a family member, authorization is required. Additionally, some services may require pre-approval from Northwind Health [Northwind_Standard_Benefits_Details.pdf#page=78].", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed ", "latency": 5.440316, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using relevant details from the CONTEXT, demonstrating a thorough understanding without introducing unrelated information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both aspects of the QUERY with accurate and complete information, making it a complete response.", "answer_length": 1107, "citations_matched": 1.0, "any_citation": true} -{"question": "What is the process for ensuring cost-effective care under the Northwind Standard plan?", "truth": "The process for ensuring cost-effective care under the Northwind Standard plan involves a clinical review process that requires pre-authorization for some medical services. This process is designed to ensure that medically necessary treatments are provided in a timely and cost-effective manner. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, along with any necessary documentation like test results or lab reports. This helps to ensure that the clinical review process runs smoothly and quickly. [Northwind_Standard_Benefits_Details.pdf#page=68] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To ensure cost-effective care under the Northwind Standard plan, members should follow these processes:\n\n1. **Pre-authorization**: Some medical services may require pre-authorization. Members should provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, to facilitate the clinical review process [Northwind_Standard_Benefits_Details.pdf#page=68].\n\n2. **Clinical Review**: The plan includes a clinical review process conducted by licensed clinicians in Northwind Health's Medical Management Department. This process evaluates the medical necessity and appropriateness of proposed treatments using evidence-based guidelines [Northwind_Standard_Benefits_Details.pdf#page=67].\n\n3. **Care Management Services**: Members can utilize various care management services offered by the plan to ensure quality and cost-effective care [Northwind_Standard_Benefits_Details.pdf#page=67].\n\n4. **Cost Management Tips**: Members are encouraged to take advantage of preventive care services (covered 100%), visit in-network providers, consider generic prescription drugs, discuss cost-effective treatment options with their doctors, and carefully review their Explanation of Benefits (EOB) statements [Northwind_Standard_Benefits_Details.pdf#page=4].\n\nBy following these steps, members can help ensure they receive high-quality, cost-effective care under the Northwind Standard plan.", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed \n\nNorthwind_Standard_Benefits_Details.pdf#page=4: Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard. Here are a few tips that you can use to get the most out of your coverage: 路 Make sure to take advantage of preventive care services. These services are covered 100% by the plan and can help you avoid more costly treatments down the line. 路 Always make sure to visit in-network providers. Doing so will ensure that you receive the maximum benefit from your plan. 路 Consider generic prescription drugs when available. These drugs can often be cheaper than brand-name drugs and are just as effective. . Talk to your doctor about ways to save money. Many doctors are willing to work with you to find the most cost-effective treatment options available. 路 Review your Explanation of Benefits (EOB) statements carefully. This document will show you exactly how much you are being charged for each service and what your plan is covering. By following these tips, you can ensure that you are getting the most out of your Northwind Standard health plan.", "latency": 4.161841, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details provided in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing the processes involved in ensuring cost-effective care under the Northwind Standard plan.", "answer_length": 1457, "citations_matched": 0.5, "any_citation": true} -{"question": "Considering the information provided in the Northwind Health Plus Benefits Details, how can a policyholder effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers?", "truth": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, a policyholder should use an in-network provider within the Northwind Health Plus network. This is crucial as in-network providers have agreed to charge lower rates for their services, which can help save money on out-of-pocket costs. Additionally, the policyholder needs to provide the other employer plan's information to coordinate benefits. It is also important to understand the plan's rules for coordinating benefits and to inquire about the cost of services before receiving them to ensure benefits are coordinated correctly and cost-effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers, a policyholder can follow these strategies:\n\n1. Use in-network providers: This will lower out-of-pocket costs since Northwind Health has negotiated discounted rates with in-network providers. In-network services typically have lower coinsurance rates as well [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n2. Understand the out-of-pocket maximum: The Northwind Health Plus plan has an out-of-pocket maximum of $4,000 per year. Once this limit is reached, no further out-of-pocket costs are required for covered services for the remainder of the plan year [Northwind_Health_Plus_Benefits_Details.pdf#page=108].\n\n3. Get cost estimates: Ask your provider for an estimate of the cost of a service before receiving it. This can help you plan and understand your potential out-of-pocket expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n4. Keep track of expenses: Monitor the services received and the amounts paid to better understand how much has been paid towards coinsurance requirements for the year [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n5. Contact the plan administrator: If there are any questions about coinsurance requirements or services subject to coinsurance, reach out to the plan administrator for clarification [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\nBy following these steps, a policyholder can better manage their out-of-pocket costs while coordinating benefits with another employer plan.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=14: Many plans offer lower coinsurance rates for in-network providers, meaning you will pay less for the same service. 3. Ask your provider for an estimate of the cost of a service before you receive it. This will help you determine how much of the cost you will be responsible for. 4. Keep track of the services you receive and the amount you pay. This will help you understand how much you have paid towards your coinsurance requirement for the year. 5. Contact your plan administrator if you have any questions about your coinsurance requirement or what services are subject to coinsurance. Out-Of-Pocket Maximum IMPORTANT PLAN INFORMATION: Out-Of-Pocket Maximum Under the Northwind Health Plus plan, members are responsible for costs associated with their health care. These costs can include deductibles, copays, coinsurance, and other out of pocket expenses. To help members manage health care costs, the Northwind Health Plus plan offers a maximum out-of-pocket (OOP) limit. Once a member has reached the OOP limit, they pay no more out-of-pocket costs for the rest of the plan year.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year. This amount includes the deductible, coinsurance, and copayments. Northwind Health Plus has an out-of-pocket maximum of $4,000 per year. In-Network Provider: An in-network provider is a health care provider or facility that is contracted with the insurance company. Employees who use an in-network provider will have lower copayments and coinsurance amounts than those who use an out-of-network provider. Out-of-Network Provider: An out-of-network provider is a health care provider or facility that is not contracted with the insurance company. Employees who use an out-of-network provider will have higher copayments and coinsurance amounts than those who use an in- network provider. Exceptions Northwind Health Plus does have some exceptions to the rules regarding copayments, deductibles, coinsurance, and out-of-pocket maximums. Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance.", "latency": 12.222494, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is mostly correct and relevant to the CONTEXT, but it is incomplete because it does not address the aspect of coordinating benefits with another employer plan, which is a key part of the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing actionable strategies and additional insights that enhance understanding. It is comprehensive and directly relevant to the question asked.", "answer_length": 1647, "citations_matched": 0.0, "any_citation": true} -{"question": "Considering the Northwind Health Plus benefits, how does choosing an in-network provider affect the out-of-pocket costs for a policyholder, and what are the covered services under hospice care according to the plan?", "truth": "Choosing an in-network provider under the Northwind Health Plus plan significantly affects the out-of-pocket costs for a policyholder by reducing them. When a policyholder uses in-network providers, they pay lower out-of-pocket costs compared to using out-of-network providers, where they would be responsible for a larger portion of the cost. Regarding hospice care, the Northwind Health Plus coverage includes care from a hospice team, medications, medical supplies, equipment for treating the terminal illness, counseling for the member and their family, inpatient and respite care, grief counseling, and bereavement services. However, it does not cover services intended to cure the terminal illness, such as chemotherapy, radiation therapy, and surgery. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=33]", "answer": "Choosing an in-network provider will result in lower out-of-pocket costs for a policyholder, as Northwind Health has negotiated discounted rates with these providers. In contrast, using an out-of-network provider may lead to higher copayments, coinsurance amounts, and potentially the full cost of services being the responsibility of the policyholder [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=6].\n\nRegarding hospice care, the specific covered services under hospice care are not detailed in the provided sources, so I don't know.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=108: Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year. This amount includes the deductible, coinsurance, and copayments. Northwind Health Plus has an out-of-pocket maximum of $4,000 per year. In-Network Provider: An in-network provider is a health care provider or facility that is contracted with the insurance company. Employees who use an in-network provider will have lower copayments and coinsurance amounts than those who use an out-of-network provider. Out-of-Network Provider: An out-of-network provider is a health care provider or facility that is not contracted with the insurance company. Employees who use an out-of-network provider will have higher copayments and coinsurance amounts than those who use an in- network provider. Exceptions Northwind Health Plus does have some exceptions to the rules regarding copayments, deductibles, coinsurance, and out-of-pocket maximums. Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus ", "latency": 3.376917, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE accurately addresses the effect of choosing an in-network provider on out-of-pocket costs, which is grounded in the CONTEXT. However, it does not provide information on hospice care services, as these details are not present in the CONTEXT. The RESPONSE is complete for the first part of the QUERY but incomplete for the second part due to the absence of relevant information in the CONTEXT.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides a complete answer to the first part of the QUERY regarding in-network providers but fails to provide any details for the second part about hospice care services, making it incomplete overall.", "answer_length": 588, "citations_matched": 0.0, "any_citation": true} -{"question": "What is the process for getting a service covered under Northwind Standard Benefits Details?", "truth": "To get a service covered under Northwind Standard Benefits Details, prior authorization must be requested from Northwind Health either by the provider or the member before the service is received. If prior authorization is not obtained, Northwind Health may not cover the service. Certain services such as preventive care, emergency care, outpatient hospital services, urgent care, and services in a skilled nursing facility are exempt from this prior authorization process. [Northwind_Standard_Benefits_Details.pdf#page=60] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To get a service covered under the Northwind Standard Benefits, follow these steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments, including the medical necessity.\n2. Ensure all documentation is complete, including required forms, test results, and physician's notes.\n3. Send the documentation to Northwind Health as soon as possible.\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed.\n\nAdditionally, make sure to understand the details of the plan and associated out-of-pocket costs before receiving a service, select in-network providers to maximize coverage, and submit claims promptly after services are rendered. If you have other coverage, inform your provider to ensure proper billing [Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=73][Northwind_Standard_Benefits_Details.pdf#page=17].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan \n\nNorthwind_Standard_Benefits_Details.pdf#page=17: Make sure to understand the details of the plan and the associated out-of-pocket costs before receiving a service. 路 Select in-network providers to maximize coverage and avoid unexpected costs. 路 Submit claims as soon as possible after a service is rendered. 路 Track claims and follow up with Northwind Health if a claim is not processed in a timely manner. 路 Take advantage of preventive services to stay healthy and reduce future costs. . Ask questions and contact Northwind Health if you need assistance understanding your coverage or filing a claim. By understanding the details of the Northwind Standard plan and following the tips above, employees can ensure that they are taking full advantage of their benefits. Taking the timeto understand the plan and ask questions can help employees to make the most of their coverage and stay healthy. COVERED SERVICES Acupuncture COVERED SERVICES: Acupuncture At Contoso, we are proud to offer employees Northwind Standard, an insurance plan that includes coverage for acupuncture.", "latency": 4.756371, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY by including all relevant steps and additional advice mentioned in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it also includes additional relevant insights, making it comprehensive.", "answer_length": 938, "citations_matched": 0.0, "any_citation": true} +{"question": "What protection does Contoso offer against balance billing?", "truth": "Contoso offers a balance billing protection through the Northwind Standard plan, which protects employees from unexpected costs when visiting in-network providers. [Northwind_Standard_Benefits_Details.pdf#page=7]", "answer": "Contoso offers balance billing protection through the Northwind Standard plan, which protects employees from unexpected costs when visiting in-network providers. This means you will not be billed for the difference between what the provider charges and what the insurance pays when you use in-network providers. However, this protection does not apply to emergency services, mental health and substance abuse coverage, out-of-network providers, or non-covered services [Northwind_Standard_Benefits_Details.pdf#page=7][Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Exceptions to the balance billing protection: 路 Balance billing protection does not apply to emergency services. 路 Balance billing protection does not apply to mental health and substance abuse coverage. 路 Balance billing protection does not apply to out-of-network providers. 路 Balance billing protection is not applicable to any non-covered services. At Contoso, we want to make sure our employees are provided with the best coverage options. That's why we've partnered with Northwind Health to offer the Northwind Standard plan, which provides balance billing protection when visiting in-network providers. We encourage our employees to use the tips provided to help reduce the risk of unexpected costs when visiting a provider. Benefits For Out-Of-Network Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers.\n\nNorthwind_Standard_Benefits_Details.pdf#page=7: Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to offer our employees the Northwind Standard plan. This plan provides a balance billing protection, meaning that you are protected from unexpected costs when visiting in-network providers. What is balance billing? Balance billing is when a provider bills you for the difference between what they charge and what your insurance company is willing to pay. This difference can be hundreds of dollars and is often unexpected. With the Northwind Standard plan, you are protected from balance billing when visiting in-network providers. What is an in-network provider? In-network providers are healthcare providers, such as doctors, hospitals, and labs, that have agreed to accept the Northwind Standard plan's payment terms. Visiting an in-network provider means that you are protected from balance billing. You can find a list of in-network providers on the Northwind Health website. What if I visit an out-of-network provider?\n\nNorthwind_Standard_Benefits_Details.pdf#page=6: If you are unsure, you can contact the customer service department of your health plan to verify.It is also important to ask your provider about their policy on balance billing. Be sure to find out if the provider requires you to pay the balance billing amount up front, or if they will bill you after the health plan pays them. When selecting a provider, also remember to consider the cost of services. Participating providers are often more cost effective than non-participating providers. Additionally, some providers offer discounts to patients who pay out of pocket for services. Finally, if you need to use a non-participating provider for certain services, be sure to check with your health plan first. There may be an exception that will cover the cost of the service. Additionally, if you need to use a non-participating provider and you are concerned about the cost, you can always negotiate with your provider to find a more affordable rate. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to ", "latency": 2.824481, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, addressing the QUERY with precise information from the CONTEXT, including all relevant details and exceptions.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, detailing both the coverage and the exceptions. It provides a comprehensive understanding of the balance billing protection offered by Contoso.", "answer_length": 566, "citations_matched": 1.0, "any_citation": true} +{"question": "what is in-network mean for Northwind Health?", "truth": "In-network providers for Northwind Health are those who have agreed to accept the payment offered by Northwind Health, meaning that the policyholder only pays the portion of the cost not covered by the insurance plan. These providers may also offer additional services or discounts not available from out-of-network providers. [Northwind_Standard_Benefits_Details.pdf#page=8]", "answer": "In-network for Northwind Health means healthcare providers who have a contract with Northwind Health to provide services at a discounted rate. These providers have agreed to accept the payment amount offered by Northwind Health, so you only pay the portion of the cost not covered by the insurance plan. In-network providers may also offer additional services or discounts not available from out-of-network providers. This network includes primary care physicians, specialists, hospitals, and pharmacies. Choosing in-network providers generally results in lower out-of-pocket costs for you [Northwind_Standard_Benefits_Details.pdf#page=8][Northwind_Standard_Benefits_Details.pdf#page=103].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan. In-network providers may also offer additional services or discounts that are not available to out-of-network providers.Out-of-Network: Out-of-network providers are those who have not contracted with Northwind Health. As a result, they are not required to accept the amount of payment offered by Northwind Health, meaning that you may be responsible for a greater portion of the cost. Additionally, out-of-network providers may not offer additional services or discounts that are available to in-network providers. When choosing a provider, it is important to make sure that the provider is in-network. While it is possible to receive care from out-of-network providers, it is important to understand that you will be responsible for a greater portion of the costs. To make sure that you are getting the best value for your health care expenses, it is recommended that you choose an in-network provider whenever possible.\n\nNorthwind_Standard_Benefits_Details.pdf#page=103: Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health. This includes primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Provider: An out-of-network provider is a healthcare provider that is not included in the Northwind Health network and is not eligible to receive payments from Northwind Health. Out-of-network providers are not covered by Northwind Standard. Preventive Care Services: Preventive care services are services that are designed to help prevent illness and promote health. These services may include immunizations, physical exams, screenings, and other preventive care services. Emergency Services: Emergency services are services that are provided in the case of an emergency. These services may include emergency surgery, emergency room visits, or other emergency services. Northwind Standard does not provide coverage for emergency services. Mental Health and Substance Abuse Coverage: Mental health and substance abuse coverage is coverage for services related to mental health and substance abuse.", "latency": 2.587654, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE fully captures the meaning of \"in-network\" as described in the CONTEXT, providing a complete and accurate answer to the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it also provides additional insights about the benefits of using in-network providers, enhancing the understanding of the concept.", "answer_length": 689, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the financial implications of choosing an out-of-network provider under the Northwind Standard Benefits Details?", "truth": "Choosing an out-of-network provider under the Northwind Standard Benefits Details can be significantly more expensive than in-network providers. You may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. [Northwind_Standard_Benefits_Details.pdf#page=10]", "answer": "Under the Northwind Standard Benefits, choosing an out-of-network provider means you will likely pay a greater portion of the costs compared to in-network providers. You may be responsible for the entire cost or a much larger share of the cost of services. Out-of-network providers have not contracted with Northwind Health to provide discounted rates, so you may face higher charges. Additionally, some services from out-of-network providers may not be covered, requiring out-of-pocket payment. It is important to understand these differences to get the best value for your healthcare expenses [Northwind_Standard_Benefits_Details.pdf#page=8][Northwind_Standard_Benefits_Details.pdf#page=10].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 2.743468, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the financial implications of choosing an out-of-network provider under the Northwind Standard Benefits Details. It includes all relevant details without adding extraneous information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the financial implications of choosing an out-of-network provider, including potential costs and coverage issues. It also provides additional insights by mentioning the importance of understanding these differences for better healthcare value.", "answer_length": 693, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the coverage limitations of the Northwind Standard plan regarding clinical trials?", "truth": "The Northwind Standard plan does not cover travel expenses associated with attending clinical trials, nor does it cover any experimental treatments or services that are not part of the clinical trial. [Northwind_Standard_Benefits_Details.pdf#page=24]", "answer": "The Northwind Standard plan covers certain clinical trial services such as diagnostic testing, treatment of the condition being studied, medications, lab services, and imaging services. However, it does not cover travel expenses associated with attending clinical trials. Additionally, any experimental treatments or services not part of the clinical trial are not covered. Coverage for other clinical trial services not explicitly listed may be considered on a case-by-case basis. Members should contact Northwind Health customer service for more details [Northwind_Standard_Benefits_Details.pdf#page=23][Northwind_Standard_Benefits_Details.pdf#page=24].", "context": "Northwind_Standard_Benefits_Details.pdf#page=24: It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials. Additionally, any experimental treatments or services that are not part of the clinical trial are not covered. When considering participation in a clinical trial, members should always consult with their doctor first to make sure it's the right choice for them. Clinical trials are not for everyone, and it's important to fully understand the risks and benefits before making a decision. Members should also be aware that not all clinical trials are free. Some require a fee, and it's important to find out what the cost will be before participating. Finally, members should keep in mind that clinical trials are often available in limited locations, so they may have to travel to participate in a trial. Northwind Health can provide information about nearby clinical trials and may be able to help with the cost of travel. At Northwind Health, we are committed to providing access to the most innovative treatments and therapies available.\n\nNorthwind_Standard_Benefits_Details.pdf#page=23: Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, and can give members access to treatments and therapies not yet available. Northwind Standard offers coverage for certain clinical trial services, including those related to common diseases and conditions. The Northwind Standard plan covers the cost of certain clinical trial services, and some of the most common include: 路 Diagnostic testing and procedures to confirm or diagnose a condition or disease 路 Treatment of the condition or disease being studied 路 Medications 路 Lab services 路 Imaging services Any other clinical trial services that are not explicitly covered by the Northwind Standard plan may be eligible for coverage on a case-by-case basis. To determine if a clinical trial service is covered, members should contact the Northwind Health customer service department for more information.It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=23: Employees should keep in mind that any services that are not specifically listed in the plan document are not covered. Clinical Trials COVERED SERVICES: CLINICAL TRIALS At Northwind Health Plus, we understand that life-saving treatments can come from clinical trials. That is why we cover certain clinical trials as part of your plan. What Are Clinical Trials? Clinical trials are research studies conducted in an effort to identify new treatments, drugs, or procedures that can help improve patient outcomes. A clinical trial typically involves a group of participants who are given a certain type of treatment for a certain period of time. The results of the trial are then evaluated to measure the effectiveness of the treatment. What Does Northwind Health Plus Cover? Northwind Health Plus covers certain clinical trials that are approved by the Food and Drug Administration (FDA) and that are considered medically necessary. These clinical trials must also be recommended by your doctor or health care provider.", "latency": 2.28471, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information from the CONTEXT, without adding unrelated or incorrect information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about contacting customer service for more details, which enhances understanding.", "answer_length": 655, "citations_matched": 1.0, "any_citation": true} +{"question": "Does Contoso cover gendr affirming care?", "truth": "Yes, Contoso offers coverage through Northwind Standard for gender affirming care services, which include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. [Northwind_Standard_Benefits_Details.pdf#page=29]", "answer": "Yes, Contoso covers gender affirming care. This includes hormone therapy, gender affirming surgery, and mental health services related to gender transition. Coverage includes hormone replacement therapy, pre- and post-operative care, counseling, therapy visits, and related medications. This coverage is provided through both Northwind Health Plus and Northwind Standard plans [Northwind_Health_Plus_Benefits_Details.pdf#page=29][Northwind_Standard_Benefits_Details.pdf#page=29].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=29: Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus. This coverage includes hormone therapy, gender affirming surgery, and mental health services related to gender transition. Hormone Therapy: Northwind Health Plus covers hormone therapy for individuals undergoing gender transition. This includes gender-affirming hormone replacement therapy such as testosterone or estrogen. The coverage also includes many medications and treatments related to hormone therapy, such as monitoring blood work, doctor visits, and lab tests. Gender Affirming Surgery: Northwind Health Plus covers gender affirming surgery for individuals undergoing gender transition. Northwind Health Plus also covers pre- and post-operative care related to gender affirming surgery. Mental Health Services:Northwind Health Plus covers mental health services related to gender transition. This includes counseling and therapy visits, as well as medications related to mental health treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=29: Affirming Care COVERED SERVICES - Gender Affirming Care At Contoso, we understand that gender identity is an important part of who we are and that it should be respected and supported. We are proud to offer coverage through Northwind Standard for gender affirming care services. Gender affirming care services can include a variety of treatments and services related to gender transition. These services may include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. Hormone Therapy Hormone therapy is a type of gender affirming treatment that can be used to help an individual align their physical characteristics with their gender identity. This type of therapy involves taking hormones that are typically associated with a certain gender to help the individual's body better reflect their gender identity. Gender Affirming Surgery Gender affirming surgery is a type of treatment that involves surgical procedures to help an individual transition to the gender they identify with. Mental Health Care Mental health care related to gender transition can include counseling and therapy services to help an individual through their transition process.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=28: by a physician Exceptions Our plan does not cover: 路 Routine foot care, such as trimming toenails, callus removal, and shoe inserts路 Foot care products, such as arch supports, shoe inserts, and foot orthotics 路 Services that are not medically necessary Tips for Employees 路 Take preventive steps to minimize foot problems, such as wearing comfortable shoes that fit properly and provide adequate support. 路 If you have diabetes, check your feet daily for sores or other problems. . If you have any foot problems, don't delay seeking medical care. Early diagnosis and treatment can often prevent more serious problems from developing. 路 If you need custom orthotics, be sure to get them from a qualified provider who is knowledgeable in their use. 路 If you're prescribed orthotics, be sure to follow the instructions for use and wear them as directed. 路 If you're prescribed medication, be sure to take it as directed. . If you have any questions about your foot care coverage, please contact Northwind Health Plus. Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus.", "latency": 2.574401, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY with all relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it also provides additional insights by specifying the health plans and including references to documentation. This makes it a comprehensive response with insights.", "answer_length": 479, "citations_matched": 1.0, "any_citation": true} +{"question": "What typs of hearin care servises are covered by the Northwind Standard plan?", "truth": "The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone-anchored hearing aids. It also covers routine hearing aid maintenance and repair, counseling, hearing aid evaluations, and up to $500 per ear for hearing aid accessories such as ear molds, batteries, and tubing. [Northwind_Standard_Benefits_Details.pdf#page=30]", "answer": "The Northwind Standard plan covers the following hearing care services:\n- Hearing tests\n- Hearing aids and hearing aid accessories (such as ear molds, batteries, and tubing)\n- Cochlear implants and bone-anchored hearing aids\n- Up to two hearing aids or implants per ear every three years\n- Routine hearing aid maintenance and repair\n- Counseling and hearing aid evaluations\n- Coverage up to $500 per ear for hearing aid accessories\n- No deductible and no pre-authorization required\n- Coverage only for services from in-network providers; out-of-network services are not covered [Northwind_Standard_Benefits_Details.pdf#page=30].", "context": "Northwind_Standard_Benefits_Details.pdf#page=30: We are proud to offer coverage for these services for our employees, and we are committed to providing a safe and supportive environment for all of our employees. Hearing Care Hearing Care At Contoso, we understand the importance of taking care of your hearing health. That's why we provide comprehensive coverage for hearing care with Northwind Standard. You can receive hearing care services from any in-network provider and enjoy comprehensive coverage for all hearing care services. The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone- anchored hearing aids. If a hearing aid or cochlear implant is needed, the plan covers up to two hearing aids or implants per ear every three years. The plan also covers routine hearing aid maintenance and repair, as well as counseling and hearing aid evaluations. In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing.\n\nNorthwind_Standard_Benefits_Details.pdf#page=30: In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing. There is no deductible for hearing care services and no pre-authorization is required. However, the Northwind Standard plan does not cover hearing care services provided by out-of-network providers. If you choose to see an out-of-network provider for hearing care, you will be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount. When it comes to choosing a hearing care provider, it's important to find one who is qualified and experienced. Make sure to ask questions about the provider's qualifications, experience, and specialties. You should also ask about the provider's policies on returns, warranties, and repairs. It's also important to understand the technology behind hearing aids. Ask your provider to explain the differences between digital and analog technology, and be sure to ask about the various features that are available. If you have any questions about the Northwind Standard plan's coverage for hearing care, please \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=30: Be sure to check with your provider and Northwind Health Plus about any pre- authorization requirements. . If you have any questions about your coverage, call Northwind Health Plus customer service. Hearing Care COVERED SERVICES: Hearing Care At Contoso, we understand how important it is for our employees to stay on top of their overall health. That is why we are proud to offer comprehensive hearing care coverage through Northwind Health Plus. This coverage can be used for a variety of hearing care services, including but not limited to hearing tests and evaluations, hearing aids and other associated services, as well as hearing aid fittings and adjustments. In order to take advantage of this coverage, employees must receive care from an in- network provider. Northwind Health Plus has a wide selection of providers in its network, making it easy to find a provider who is right for you. Additionally, the plan covers hearing aid fittings, adjustments, repairs, and replacements, as well as batteries, when necessary. When it comes to hearing aid coverage, Northwind Health Plus covers up to $1,500 every 3 years for all hearing aid services, including the hearing aid itself.", "latency": 2.322965, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the information provided in the CONTEXT and directly answering the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, including additional relevant insights about coverage conditions and financial details.", "answer_length": 628, "citations_matched": 1.0, "any_citation": true} +{"question": "Does Northwind Helth cover full costs?", "truth": "Northwind Health may not cover the full cost of a specialist or other non-emergency services. [Northwind_Standard_Benefits_Details.pdf#page=34]", "answer": "Northwind Health may not cover the full cost of some services, such as specialists or non-emergency services, and you may have additional costs like co-pays or coinsurance [Northwind_Standard_Benefits_Details.pdf#page=34]. For in-network providers, out-of-pocket costs are lower due to negotiated rates, but for out-of-network providers, you may have to pay the full cost upfront and then seek partial reimbursement [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Some services may require pre-authorization, and if not obtained, you could be responsible for the full cost [Northwind_Health_Plus_Benefits_Details.pdf#page=16].", "context": "Northwind_Standard_Benefits_Details.pdf#page=34: For example, Northwind Health may not cover the full cost of a specialist or other non-emergency services. It is important to be aware of these exceptions when selecting a hospital. When selecting a hospital, you should also consider other services that the hospital offers. For example, some hospitals may offer additional services such as physical therapy, nutrition counseling, or other wellness services. Additionally, some hospitals may offer special programs for specific conditions or diseases. Finally, you should consider the cost of care at the hospital you are considering. Northwind Health may cover some or all of the costs of your care, but you should be aware of any additional costs that you may be responsible for. This includes any co-pays or coinsurance, as well as any additional charges for services not covered by your plan. By taking the time to consider your options, you can select the best hospital for your healthcare needs. Northwind Standard offers coverage for a variety of in-network hospitals, giving you the opportunity to select the hospital that best meets your needs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.", "latency": 2.409772, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely answers the query using relevant information from the context, demonstrating a thorough understanding of the coverage details provided.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query by explaining the conditions under which Northwind Health may not cover full costs, including details about in-network and out-of-network providers, additional costs, and pre-authorization requirements. It provides a comprehensive understanding of the coverage situation.", "answer_length": 683, "citations_matched": 1.0, "any_citation": true} +{"question": "what is Northwind Standard Benefits Details?", "truth": "The Northwind Standard Benefits Details include information on managing prescriptions online or via phone, using a mobile app, and potential discounts on generic medications at preferred pharmacies. It also notes that the plan does not cover certain medications like those for weight loss or fertility treatments, compounded medications, or non-FDA-approved drugs. Over-the-counter medications are also not covered unless prescribed by a doctor. [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "The Northwind Standard Benefits plan is a comprehensive health plan covering medical, vision, and dental services, including preventive care and prescription drugs. It provides access to a variety of in-network providers such as primary care physicians, specialists, hospitals, and pharmacies. Covered services include preventive care (physicals, immunizations, screenings), diagnostic tests and treatments, medical consultations, physical therapy, mental health services, prescription drugs, inpatient hospital services, and emergency services. Some services may require pre-authorization or be subject to deductibles or coinsurance. The plan excludes cosmetic services, experimental treatments, most dental services, and out-of-network provider services. Northwind Health processes and pays claims and offers tools like a cost estimator and provider directory, along with 24/7 customer service [Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46][Northwind_Standard_Benefits_Details.pdf#page=98].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 2.818994, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate summary of the Northwind Standard Benefits plan as requested by the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE is comprehensive and includes relevant insights, making it a complete and insightful answer to the QUERY.", "answer_length": 1044, "citations_matched": 0.0, "any_citation": true} +{"question": "What types of rehabilitation therapy does Northwind Standard cover?", "truth": "Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. Coverage includes medically necessary services related to an injury or illness, along with the use of equipment and specialized supplies. [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "Northwind Standard covers rehabilitation therapy services including physical therapy, occupational therapy, and speech therapy. Coverage is for medically necessary services related to an injury or illness, including the use of equipment and supplies. Note that cosmetic or reconstructive surgery, treatment of obesity or weight control, and treatment of sleep disorders are not covered. Also, ensure providers are in-network and you may need a referral from a primary care physician for some services [Northwind_Standard_Benefits_Details.pdf#page=48][Northwind_Standard_Benefits_Details.pdf#page=47].", "context": "Northwind_Standard_Benefits_Details.pdf#page=48: Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. For physical therapy, coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies. For occupational therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. For speech therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. Exceptions Unfortunately, Northwind Standard does not cover any services related to cosmetic or reconstructive surgery, or any services related to the treatment of obesity or weight control. This plan also does not cover services related to the treatment of sleep disorders. Tips When looking for a rehabilitation therapy provider, make sure that they are in-network and covered by your plan. Also, keep in mind that you may need a referral from a primary care physician for some services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=47: Additionally, the plan does not cover any costs associated with psychological or neuropsychological testing that is done for non-medical reasons such as pre-employment screening or for legal purposes. In order to ensure that your psychological or neuropsychological testing services are covered under the Northwind Standard plan, it is important to review your plan's Summary of Benefits and Coverage (SBC) document. This document will provide you with a full list of covered services, as well as any exceptions that may apply. Overall, the Northwind Standard plan provides coverage for psychological and neuropsychological testing services when they are prescribed or ordered by a health care professional and when they are provided by an in-network provider. It is important to be aware of any exceptions that may apply, as well as to select a highly qualified in-network provider for your tests in order to ensure that your services are covered in full.Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=50: By taking the time to research providers in-network with Northwind Health Plus and keeping track of your medical records and tests, you can make sure you are receiving the care and coverage you need. Rehabilitation Therapy Rehabilitation Therapy Rehabilitation therapy is a valuable service that is often necessary to help individuals recover from injury, surgery, or illness. It can help restore physical functioning and help individuals return to their normal daily activities. Northwind Health Plus covers rehabilitation therapy services, including physical therapy, occupational therapy, and speech-language pathology. Physical Therapy Physical therapy helps restore physical function and mobility. It can help individuals who have difficulty walking, bending, or moving due to an illness or injury. Physical therapy can also help improve balance, coordination, and strength. Northwind Health Plus covers physical therapy services that are medically necessary. Occupational Therapy Occupational therapy helps individuals develop, maintain, or restore skills for daily living and work.", "latency": 2.035299, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY by listing the types of rehabilitation therapy covered by Northwind Standard, as specified in the CONTEXT. It also includes relevant details about coverage conditions and exceptions, demonstrating a thorough understanding of the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE not only fully answers the QUERY by listing the types of rehabilitation therapy covered but also provides additional relevant insights into the coverage policy, exclusions, and requirements, enhancing the understanding of the coverage details.", "answer_length": 600, "citations_matched": 1.0, "any_citation": true} +{"question": "What shuold I do if I need healthcare services outside Washington with Northwind Health?", "truth": "If you need healthcare services outside Washington, you should contact Northwind Health to get an estimate of the cost of care for services you may need. It is also important to find in-network providers in the state where you are living to receive coverage, and keep your Northwind Standard plan active while you are out of state to remain eligible for coverage. [Northwind_Standard_Benefits_Details.pdf#page=59]", "answer": "If you have Northwind Standard and need healthcare services outside Washington, you must meet these criteria for coverage: be outside Washington for no more than 12 consecutive months, be more than 100 miles away from your primary care provider, and have had your plan in effect for at least 6 months before receiving out-of-area care. You must contact Northwind Health in advance and obtain prior authorization for the care; otherwise, you may be responsible for the full cost. Emergency services outside Washington are covered, but non-emergency services are not unless these conditions are met [Northwind_Standard_Benefits_Details.pdf#page=59][Northwind_Standard_Benefits_Details.pdf#page=60].\n\nIf you have Northwind Health Plus, first ensure the provider is in the nationwide network by checking the online directory or calling customer service. Keep receipts and documentation for any out-of-state services, as you may need to submit claims for reimbursement. Contact Northwind Health Plus before receiving services to confirm coverage, as not all services outside Washington are covered [Northwind_Health_Plus_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=59: It is important to know that Northwind Standard does not provide coverage for non- emergency services outside of Washington. That means you may be responsible for the full cost of care if you seek out care for a condition that could have been treated in Washington. In order to receive coverage for out-of-area care, you must meet the following criteria: . You must be outside of Washington for no more than 12 consecutive months . You must be more than 100 miles away from your primary care provider 路 Your plan must have been in effect for at least 6 months before you receive out-of-area care If you meet the criteria listed above, you may be eligible for coverage of out-of-area services. In order to receive coverage, you must contact Northwind Health in advance of receiving care. You must also obtain prior authorization for any care you wish to receive. If prior authorization is not obtained, you may be responsible for the full cost of care. If you are outside of Washington for more than 12 consecutive months, you may not be eligible for coverage of out-of-area services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=62: First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network. You can do this by checking Northwind Health Plus' online directory or calling the Northwind Health Plus customer service line. Additionally, it is important to keep track of any expenses or services that you receive outside of Washington. You may need to provide receipts or other documentation to Northwind Health Plus in order to be reimbursed for these expenses. Finally, it is important to remember that Northwind Health Plus does not cover all services outside of Washington. In some cases, you may be required to pay for a service in full and then submit a claim to Northwind Health Plus for reimbursement. It is important to contact Northwind Health Plus prior to receiving any services to ensure that they are covered by your plan.Northwind Health Plus is committed to providing coverage to its members, no matter where they are located. By following these tips and understanding the coverage limits, you can ensure that you will be able to receive the care you need, even when you are \n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.", "latency": 2.543798, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information from the CONTEXT, covering both Northwind Standard and Northwind Health Plus plans. It provides all necessary steps and conditions for receiving healthcare services outside Washington, demonstrating a thorough understanding of the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the importance of prior authorization and documentation, which enhances understanding.", "answer_length": 1146, "citations_matched": 1.0, "any_citation": true} +{"question": "What is prior-authorization in Northwind Standard?", "truth": "Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. Without prior-authorization, the employee may be responsible for the full cost of any services or treatments received without approval. [Northwind_Standard_Benefits_Details.pdf#page=63]", "answer": "Prior-authorization in Northwind Standard is a process where Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This ensures the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may have to pay the full cost. Services that may require prior-authorization include hospital stays, certain medical procedures, durable medical equipment, and some prescription drugs. The employee's physician must submit a request to Northwind Health, which reviews it to determine medical necessity and coverage under the plan. Sometimes, additional criteria must be met for approval. Even with approval, some services may not be covered. It is important to keep a copy of the authorization to ensure coverage. Prior-authorization helps ensure members receive the right care at the right time and is part of the Care Management services included in Northwind Standard [Northwind_Standard_Benefits_Details.pdf#page=60][Northwind_Standard_Benefits_Details.pdf#page=62][Northwind_Standard_Benefits_Details.pdf#page=63].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 2.673454, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE provides a complete and accurate explanation of prior-authorization in Northwind Standard, incorporating all relevant details from the CONTEXT and directly addressing the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the significance and implications of prior-authorization in Northwind Standard.", "answer_length": 1121, "citations_matched": 1.0, "any_citation": true} +{"question": "What need for pre-authorization in Northwind Standard Benefits?", "truth": "Some medical services under the Northwind Standard Benefits require pre-authorization before they can be approved to ensure that medically necessary treatments are provided in a timely and cost-effective manner. [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "In Northwind Standard Benefits, prior-authorization is required for certain services to ensure the care is necessary and medically appropriate. Services that may require prior-authorization include hospital stays, certain medical procedures, durable medical equipment, certain prescription drugs (especially those not on the Northwind Standard formulary), certain laboratory tests, certain imaging services, and physical therapy. The authorization must be requested and approved before receiving the service, either by the provider or the member. If prior-authorization is not obtained, Northwind Health may not cover the service, and the employee may be responsible for the full cost. Exceptions to prior-authorization include preventive care services (like annual physicals or vaccinations), emergency care, outpatient hospital services, urgent care, and skilled nursing facility services. Northwind Health recommends contacting them at least five business days before the scheduled service to obtain authorization. The decision on authorization is communicated within three business days, and there is an option to appeal if coverage is denied. Northwind Health may also perform retrospective reviews after services are provided [Northwind_Standard_Benefits_Details.pdf#page=60][Northwind_Standard_Benefits_Details.pdf#page=62][Northwind_Standard_Benefits_Details.pdf#page=63].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: Before certain services are approved and covered, an authorization must be requested from Northwind Health. This authorization can be requested by either the provider or the member. If you require a service that requires prior authorization, you must make sure that it is requested and approved before you receive the service. If prior authorization is not obtained, Northwind Health may not cover the service. Exceptions There are certain services that are exempt from the prior authorization process. These include: - Preventive care services, such as annual physicals or vaccinations- Services provided in an emergency care setting - Services provided in an outpatient hospital setting - Services provided in an urgent care setting - Services provided in a skilled nursing facility Tips If you have any questions about the prior authorization process, Northwind Health recommends that you contact them at least five business days before the scheduled service. This will allow you to receive the necessary authorization in a timely manner.", "latency": 3.784994, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY with all relevant details included.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, and it includes additional relevant insights about the process and implications of pre-authorization, making it comprehensive.", "answer_length": 1380, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Standard handle situations where other plans like Medicare or Medicaid are involved?", "truth": "Northwind Standard may pay first in situations where other plans like Medicare, Medicaid, or a veterans' health plan are involved, even if these other plans are usually the primary payer. [Northwind_Standard_Benefits_Details.pdf#page=75]", "answer": "Under the Northwind Standard plan, if Medicare or Medicaid is involved, those plans generally pay first before Northwind Standard, which then acts as the secondary payer [Northwind_Standard_Benefits_Details.pdf#page=73]. However, there are exceptions where Northwind Standard may pay first even if Medicare, Medicaid, or a veterans' health plan is involved, especially if required by law or specific coordination of benefits rules [Northwind_Standard_Benefits_Details.pdf#page=75]. When you have other coverage, including government-sponsored programs like Medicare or Medicaid, you must notify Northwind Health of any changes to avoid being responsible for charges [Northwind_Standard_Benefits_Details.pdf#page=95]. Also, Northwind Standard covers services at a lower cost if you use their network providers, but services from out-of-network providers are not covered [Northwind_Standard_Benefits_Details.pdf#page=73].", "context": "Northwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan \n\nNorthwind_Standard_Benefits_Details.pdf#page=75: Coordination of Benefits Exceptions There are a few exceptions to COB rules that may apply to you. If you are covered by Medicare, Medicaid, or a veterans' health plan, Northwind Standard may pay first, even if the other plan is usually the primary payer. Additionally, if you are enrolled in a plan that is required by law to coordinate benefits, such as an employer-sponsored plan, Northwind Standard may pay first. Understanding How COB Affects Your Benefits When COB applies, the primary and secondary payers will each pay a portion of the eligible expenses and combined payments cannot exceed the total cost. Depending on the type of service, the primary payer may pay all of the eligible expenses. When this happens, the secondary payer may pay nothing.For example, if you receive a medical bill for $1,000 and the primary payer pays $800, the secondary payer will pay the remaining balance of $200. However, if the primary payer pays the full $1,000, the secondary payer will not pay anything.\n\nNorthwind_Standard_Benefits_Details.pdf#page=95: This could include coverage from your spouse's or a parent's employer, or from a government-sponsored program such as Medicare or Medicaid. If you and your spouse have coverage under different plans, you must determine which plan is the primary plan and which is secondary. This is important, as the primary plan will pay first; the secondary plan will pay what the primary plan does not. If you have other coverage, you must notify Northwind Health of any changes in your coverage status or any changes in any of your other coverage. If you fail to do so, you may be responsible for any charges that Northwind Health would have paid if you had notified them of the other coverage. In certain circumstances, you may be able to keep your other coverage and still be eligible for coverage under the Northwind Standard plan. However, if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan. It is also important to note that if you have coverage through a government-sponsored program such as Medicare or Medicaid, you may be subject to certain restrictions.", "latency": 3.942346, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately addresses the QUERY by explaining how Medicare or Medicaid generally pays first and mentions exceptions where Northwind Standard may pay first, which is supported by the CONTEXT. It also includes relevant details about notifying Northwind Health of changes in coverage. The mention of network providers is additional but does not detract from the groundedness of the RESPONSE.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about exceptions and network provider usage, which enhances understanding.", "answer_length": 919, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the process for submitting claims for services like MRI/CT scans or physical therapy according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, for services such as MRI/CT scans and physical therapy, your provider may need to submit a request prior to the service being performed. It's important to contact Northwind Health if you are unsure whether pre-approval is required. Additionally, when filing a claim, you should include all necessary documentation like itemized bills, a completed claim form, and any other requested documentation to avoid delays or denials. [Northwind_Standard_Benefits_Details.pdf#page=78]", "answer": "For services like MRI/CT scans or physical therapy, your provider may need to submit a request for prior authorization to Northwind Health before the service is performed. This is also called pre-approval or pre-certification. If you are unsure whether pre-approval is required, you should contact Northwind Health before the service is done. When filing a claim, make sure to include all necessary documentation such as itemized bills and a completed claim form. Claims must be filed within twelve months of the service date to avoid denial, with some exceptions allowing up to 24 months. You may file claims directly through the Northwind website or app if you are a Northwind Standard member [Northwind_Standard_Benefits_Details.pdf#page=78][Northwind_Health_Plus_Benefits_Details.pdf#page=64].", "context": "Northwind_Standard_Benefits_Details.pdf#page=78: from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services. If you are unsure whether your provider requires pre-approval for a service, you should contact Northwind Health prior to the service being performed. There are a few exceptions to the twelve month timely filing limit. These include claims submitted for newborns, claims submitted for a deceased member, and claims submitted forservices that were provided out-of-country. In these situations, claims may be submitted up to 24 months after the date of service. It's also important to remember that when filing a claim, you should make sure to include all necessary documentation. This includes itemized bills, a completed claim form, and any other documentation that is requested by Northwind Health. If any of these items are missing, your claim may be delayed or denied. To ensure timely filing, it's important to keep track of the dates of service for all services you receive. You should also keep copies of all documentation related to your services, and if you're unsure of the filing \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=64: This means that your doctor or health care provider will need to get prior authorization from Northwind Health before providing the care. Prior authorization is also known as pre-certification, pre-notification, pre-service review, or pre-authorization. It is important for you to understand that prior authorization does not guarantee that the service will be covered by your Northwind Health Plus plan. When Prior Authorization is Required Prior authorization is required for certain services and treatments such as: 路 Hospital admissions 路 Inpatient surgery 路 Outpatient surgery 路 Magnetic Resonance Imaging (MRI) 路 Computed Tomography (CT) 路 Radiation Therapy 路 Durable Medical Equipment 路 Physical, Occupational, and Speech Therapy 路 Home Health Care 路 Infusion Therapy 路 Prosthetics and Orthotics 路 Specialty DrugsIn certain cases, Northwind Health may require prior authorization even if the service is not listed above. Your doctor or health care provider should contact Northwind Health to determine if prior authorization is required prior to providing care.", "latency": 3.092681, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information from the CONTEXT, including the need for prior authorization, timely filing requirements, and necessary documentation.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding of the claim submission process.", "answer_length": 797, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the role of the Independent Review Organization in the appeals process for Northwind Standard plan members?", "truth": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. The decision made by the IRO is considered final and binding, although there are some exceptions that could apply to specific cases. [Northwind_Standard_Benefits_Details.pdf#page=83]", "answer": "The role of the Independent Review Organization (IRO) in the appeals process for Northwind Standard plan members is to serve as the final step in the appeals process. The IRO is a third-party organization that reviews appeals and complaints about healthcare services that have been denied coverage under the plan. After reviewing the appeal, the IRO issues a formal decision either upholding the original decision or reversing it. This decision is considered final and binding, though some exceptions may apply. If the IRO upholds the original decision, members may have other options such as an external review or an appeal to the state insurance commission [Northwind_Standard_Benefits_Details.pdf#page=82][Northwind_Standard_Benefits_Details.pdf#page=83].", "context": "Northwind_Standard_Benefits_Details.pdf#page=83: 路 Ensure that all relevant information is included in the appeal. 路 Submit the appeal within the timeframe specified in the plan. . Keep a copy of your appeal and all supporting documentation. 路 Contact Northwind Health or the IRO if you have any questions or need additional help. . If the IRO upholds the original decision, you may have other options available to you, such as an external review or an appeal to the state insurance commission. Conclusion The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. While the decision made by the IRO is considered final and binding, there are some exceptions that could apply to your case. Familiarizing yourself with the plan provisions and the process for filing an appeal, gathering all relevantinformation, and submitting the appeal within the timeframe specified in the plan are all important steps in the appeals process. Additional Information About Your Coverage COMPLAINTS AND APPEALS If you feel that you have not received the health care services or benefits that you are entitled to, or you are not \n\nNorthwind_Standard_Benefits_Details.pdf#page=82: If you need an expedited appeal due to an urgent medical condition, your plan must respond within 24 hours. Tips . Make sure to include all of the necessary information in your appeal. . Keep a copy of your appeal for your records. . Don't hesitate to contact your plan if you need assistance with the appeal process. 路 Follow up with your plan if you don't receive a response to your appeal within a reasonable amount of time. . Consider hiring a lawyer if you need help with your appeal. Once The IRO Decides Once The IRO DecidesThe Independent Review Organization (IRO) is a third-party organization that reviews appeals and complaints about healthcare services that have been denied coverage under the Northwind Standard plan. If an employee is not satisfied with the decision made by Northwind Health, they can submit a written complaint or request an appeal by filing a formal grievance. What Happens After The IRO Decides? Once the IRO has completed its review, it will issue a formal decision either upholding the original decision or reversing it.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=85: We have a multi-level process in place to ensure that any grievances are addressed and resolved quickly and fairly. Level 1: Initial Review This is the first step in the appeals process. If you have a problem with a service or product received, contact the plan's Customer Service team. The team will review your complaint to determine if a solution can be reached or if the complaint should be escalated to the next level. Level 2: Formal Complaint If a satisfactory resolution is not reached at Level 1, you may submit a formal written complaint to Northwind Health Plus. This should include details of the issue, the date and time of the incident, and the names of any involved personnel. It should also include any relevant documentation or other evidence that supports your claim. Level 3: External ReviewIf the issue is not resolved at Level 2, you may request an external review to be conducted. This review will be conducted by an independent organization that is not affiliated with Northwind Health Plus. The external review will consider all facts and evidence that have been submitted in the appeal and ", "latency": 2.705678, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the implications and next steps, which enhances understanding.", "answer_length": 758, "citations_matched": 1.0, "any_citation": true} +{"question": "Can you explain the eligibility criteria for the Northwind Standard plan offered to Contoso employees?", "truth": "The Northwind Standard plan is a group plan offered to all eligible employees of Contoso and their spouses or dependents. It is important to note that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. [Northwind_Standard_Benefits_Details.pdf#page=88]", "answer": "The eligibility criteria for the Northwind Standard plan for Contoso employees are not explicitly detailed in the provided sources. However, it is mentioned that prior-authorization may be required for certain services or treatments, which involves approval from Northwind Health based on medical necessity and coverage under the plan. Employees must have their physician submit a request for prior-authorization, and in some cases, meet specific criteria such as medical tests, treatments, or lifestyle changes to be approved. Preventive care, emergency services, mental health, and substance abuse coverage do not require prior-authorization. Out-of-network services do require prior-authorization and may incur additional costs [Northwind_Standard_Benefits_Details.pdf#page=63][Northwind_Standard_Benefits_Details.pdf#page=102]. \n\nIf you need information on basic eligibility (such as employment status or tenure), that is not provided in these sources.", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment. These criteria may include specific medical tests or treatments, lifestyle changes, or other requirements. If the employee is unable to meet the criteria, prior-authorization may not be granted. There are some exceptions to the prior-authorization process. For example, preventive care services and emergency services are not subject to prior-authorization. In addition, mental health and substance abuse coverage is not subject to prior-authorization. However, out-of- network services are subject to prior-authorization and may require additional cost to the employee. Here are some tips for Contoso's employees to help them navigate the prior-authorization process: 路 Contact your physician's office to determine if prior-authorization is required before receiving a service or treatment. . Contact Northwind Health to determine if a service or treatment is a covered benefit under Northwind Standard.\n\nNorthwind_Standard_Benefits_Details.pdf#page=102: Depending on the state, employees may have the right to receive legal representation or to appeal denied claims. In some states, employees may have the right to choose their own physician or to receive benefits for permanent disabilities. At Contoso, we are committed to providing our employees with a safe and productive work environment, and we take the necessary steps to ensure that our Workers' Compensation Insurance coverage meets all state and federal requirements. Should you have any questions about this coverage, please contact the Human Resources Department. DEFINITIONS DEFINITIONS When it comes to understanding the Northwind Standard insurance plan, it is important to understand the various terms and definitions associated with this plan. Here is abreakdown of some of the key terms and definitions associated with the Northwind Standard insurance plan. In-Network Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.", "latency": 3.953056, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The RESPONSE is related to the topic of the Northwind Standard plan and prior-authorization but does not directly answer the specific query about eligibility criteria for the plan.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides some relevant information but does not fully address the eligibility criteria for the Northwind Standard plan, making it incomplete.", "answer_length": 956, "citations_matched": 0.0, "any_citation": true} +{"question": "what wrong things Northwind Health say about what they cover?", "truth": "Northwind Health makes intentionally false or misleading statements about their plans, including claiming to cover emergency services, mental health and substance abuse coverage, and out-of-network services, which they do not actually cover. [Northwind_Standard_Benefits_Details.pdf#page=90]", "answer": "The sources do not provide information about what Northwind Health says incorrectly about what they cover. They focus on the complaints and appeals process, including how to submit appeals and the levels of grievance resolution [Northwind_Health_Plus_Benefits_Details.pdf#page=85][Northwind_Health_Plus_Benefits_Details.pdf#page=86][Northwind_Health_Plus_Benefits_Details.pdf#page=88]. Therefore, I don't know what wrong things Northwind Health says about what they cover.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=88: Employees should also be sure to provide any and all supporting documentation when filing a complaint or appeal.Finally, employees should be sure to follow up on their complaint or appeal. Employees should contact the insurance company if they have not received a response within 30 days. Employees should also contact the IRO if they have any questions or concerns about the decision. By understanding the exceptions and tips for making sure the IRO decision is accurate, employees can ensure that their complaint or appeal is heard and that the decision is made in their favor. Additional Information About Your Coverage COMPLAINTS AND APPEALS Northwind Health Plus offers a variety of ways for members to submit complaints and appeals. These procedures are designed to ensure that all members have the opportunity to have their issues addressed in a timely manner. If you have a complaint or grievance about your coverage or care, you can contact Northwind Health Plus directly. You can submit a complaint or appeal by phone, mail, or online. You can also contact your insurance provider directly or the state insurance commissioner in your state.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=85: We have a multi-level process in place to ensure that any grievances are addressed and resolved quickly and fairly. Level 1: Initial Review This is the first step in the appeals process. If you have a problem with a service or product received, contact the plan's Customer Service team. The team will review your complaint to determine if a solution can be reached or if the complaint should be escalated to the next level. Level 2: Formal Complaint If a satisfactory resolution is not reached at Level 1, you may submit a formal written complaint to Northwind Health Plus. This should include details of the issue, the date and time of the incident, and the names of any involved personnel. It should also include any relevant documentation or other evidence that supports your claim. Level 3: External ReviewIf the issue is not resolved at Level 2, you may request an external review to be conducted. This review will be conducted by an independent organization that is not affiliated with Northwind Health Plus. The external review will consider all facts and evidence that have been submitted in the appeal and \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=86: How To Submit An Appeal COMPLAINTS AND APPEALS: How To Submit An Appeal At Northwind Health Plus, we understand that sometimes the coverage you receive is not what you expected or hoped for. If you believe that Northwind Health Plus has not properly applied a coverage determination or payment to your claim, you may submit an appeal. What Is an Appeal? An appeal is a formal request to reconsider a decision or action taken by Northwind Health Plus. This includes decisions on coverage and payment of services, supplies, or drugs. You or your healthcare provider can submit an appeal to Northwind Health Plus. In order to submit an appeal, you must provide information that supports your appeal. How to Submit an Appeal If you disagree with a coverage determination or payment made by Northwind Health Plus, you can appeal the decision. Here are the steps you need to take to submit an appeal: Step 1: Gather InformationThe first step in submitting an appeal is to gather the information you need. This includes any documents that support your appeal, such as receipts, doctors' notes, and lab test results.", "latency": 2.21743, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately identifies that the CONTEXT does not contain information about incorrect statements made by Northwind Health regarding their coverage, which directly addresses the QUERY.", "relevance": 1.0, "gpt_relevance": 1.0, "relevance_reason": "The RESPONSE does not provide any relevant information about the incorrect statements made by Northwind Health regarding their coverage, as requested in the QUERY. It instead discusses unrelated topics, such as the complaints and appeals process.", "answer_length": 472, "citations_matched": 0.0, "any_citation": true} +{"question": "what is northwind standard benefits details?", "truth": "The Northwind Standard Benefits Details include information to help inform and empower members about their responsibilities and the coverage provided by the plan. This includes being aware of the plan's benefits and limitations, as well as obligations under the plan such as co-payments or co-insurance amounts for medical and vision expenses. [Northwind_Standard_Benefits_Details.pdf#page=92]", "answer": "The Northwind Standard benefits include comprehensive coverage for medical, vision, and dental services, as well as preventive care and prescription drugs. Covered services include professional visits to primary care physicians and specialists, preventive care like physicals and immunizations, diagnostic tests, medical consultations, physical therapy, mental health services, inpatient hospital services, and emergency services. Some services may require pre-authorization and could be subject to deductibles or coinsurance. The plan covers only in-network providers and excludes cosmetic services, experimental treatments, and most dental services. Northwind Health provides tools like a cost estimator and a provider directory, along with 24/7 customer service for assistance [Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46][Northwind_Standard_Benefits_Details.pdf#page=98].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 2.600404, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY about Northwind Standard benefits details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the Northwind Standard benefits, including coverage details, exclusions, and additional tools, making it a complete response.", "answer_length": 928, "citations_matched": 0.0, "any_citation": true} +{"question": "what does Notice of Pre-Existing Condition Exclusions mean?", "truth": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It explains when these exclusions may apply and how they could affect your coverage. [Northwind_Standard_Benefits_Details.pdf#page=96]", "answer": "The Notice of Pre-Existing Condition Exclusions provides information about any exclusions related to pre-existing conditions that may apply to your coverage. It is important to read this notice carefully to understand when these exclusions may apply and how they could affect your coverage [Northwind_Standard_Benefits_Details.pdf#page=96]. Additionally, the Northwind Health Plus plan may have certain exclusions or limitations on coverage, including pre-existing condition exclusions and/or waiting periods, so reviewing your plan documents carefully is important to know what is covered and excluded [Northwind_Health_Plus_Benefits_Details.pdf#page=93][Northwind_Health_Plus_Benefits_Details.pdf#page=94].", "context": "Northwind_Standard_Benefits_Details.pdf#page=96: Notice of Benefit and Payment Parameters: This notice provides important information about the plan and its benefits, including what kind of coverage is provided, what types of services are covered, and what out-of-pocket costs you may be responsible for. Notice of Pre-Existing Condition Exclusions: This notice provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to make sure you understand when pre-existing condition exclusions may apply and how they could affect your coverage. Notice of Continuation Coverage Rights: This notice provides information about your rights to continue coverage if you lose your job or if you experience a qualifying event. It is important to read this notice carefully to make sure you understand your rights to continue coverage. Notice of Availability of Plan Documents: This notice provides information about where you can find the plan documents for Northwind Standard. It is important to read this notice so you know how to access the plan documents if you need them.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods. You should review your plan documents carefully to make sure you understand exactly what is covered and what is excluded. It is also important to understand that the plan is not a substitute for health insurance. You should still maintain health insurance coverage through an employer, a private plan, or a government-sponsored plan. The Northwind Health Plus plan is intended to supplement the coverage you have from other sources. Tips for Making the Most of Your Plan . Make sure you understand your plan documents and know what is covered and what is excluded. 路 Take advantage of preventive care services, such as check-ups and screenings, as these will help you stay healthy and avoid more costly treatments down the road. 路 Consider signing up for the Northwind Health Plus online portal, which allows you to view your health plan information, make payments, and access other resources. 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=93: The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and YouThe Northwind Health Plus plan is a group health plan that is sponsored by Contoso and administered by Northwind Health. As a participant in this group plan, you will have access to a wide range of health benefits and services. Your employer, Contoso, pays a portion of the premium for the plan, and you are responsible for paying the remaining portion. This will be deducted directly from your paycheck each month. In addition to the premium, you may be responsible for certain costs when you receive health care services. Your contributions to the plan are based on the type of coverage you choose. For example, if you choose a single plan, you will pay a lower premium than if you choose a family plan. The premium and other costs you may incur when you receive health care services may change from year to year. It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods.", "latency": 2.983964, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information from the CONTEXT, without introducing unrelated or incorrect information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate information and provides additional insights about the importance of reviewing plan documents, enhancing understanding.", "answer_length": 708, "citations_matched": 1.0, "any_citation": true} +{"question": "What services does Northwind Health cover?", "truth": "Northwind Health is responsible for paying claims for eligible services based on the terms of the plan, but it does not cover emergency services, mental health and substance abuse services, or out-of-network services. [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "Northwind Health covers the following services under the Northwind Standard plan: preventive care services (physicals, immunizations, screenings), diagnostic tests and treatments, medical consultations, physical therapy, mental health services, prescription drugs, inpatient hospital services, and emergency services. It excludes cosmetic services, experimental treatments, most dental services, and out-of-network provider services [Northwind_Standard_Benefits_Details.pdf#page=46][Northwind_Standard_Benefits_Details.pdf#page=45].\n\nUnder the Northwind Health Plus plan, a wide range of mental health services are covered, including counseling, psychiatric visits, therapy, and group therapy for both inpatient and outpatient visits. Coverage is available for both in-network and out-of-network providers, though out-of-pocket costs are higher for out-of-network care. Some long-term mental health treatments are not covered [Northwind_Health_Plus_Benefits_Details.pdf#page=42].", "context": "Northwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=42: Northwind Health Plus covers a wide range of mental health services, including counseling, psychiatric visits, therapy, and group therapy. Services are provided in-network and out-of- network, with coverage for both inpatient and outpatient visits. In-Network Services When receiving mental health care, it is important to make sure you are using an in- network provider. When you use an in-network provider, your out-of-pocket costs are generally lower and your coverage is more comprehensive. Northwind Health Plus offers a network of providers that are in-network, including primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Services In some cases, it may be necessary to receive mental health care from an out-of-network provider. Northwind Health Plus will still cover a portion of the cost of services received from an out-of-network provider. However, it is important to note that out-of-pocket costs are typically higher when receiving care from an out-of-network provider. Exceptions Northwind Health Plus does not cover some services related to mental health care, including long-term treatment \n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic ", "latency": 3.004087, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the services covered by Northwind Health as described in the CONTEXT. It addresses the QUERY directly and includes all relevant details from the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, detailing the services covered under different plans and mentioning exclusions, which enhances understanding.", "answer_length": 979, "citations_matched": 0.0, "any_citation": true} +{"question": "How does choosing an in-network provider with Northwind Health Plus affect my healthcare costs?", "truth": "Choosing an in-network provider with Northwind Health Plus is crucial for lowering healthcare costs because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus provides an extensive network of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, allowing for a selection that best suits your needs. [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "Choosing an in-network provider with Northwind Health Plus lowers your out-of-pocket costs because these providers have agreed to discounted rates with Northwind Health. This means your cost-sharing amounts, such as co-pays, will generally be lower compared to using out-of-network providers. Additionally, Northwind Health Plus offers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, giving you convenient options while saving on costs. You can check the Northwind Health Plus website for a regularly updated directory of in-network providers in your area to ensure you select one that is in-network [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=4].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. SUMMARY OF YOUR COSTS SUMMARY OF YOUR COSTS At Northwind Health, we understand that health care costs can be a burden. That's why we offer a comprehensive plan that covers the cost of medical, vision, and dental services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. Your cost for Northwind Health Plus will depend on your plan type, the services you use, and the providers you visit. You can find more information about cost-sharing arrangements on the Northwind Health website. In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=4: HOW PROVIDERS AFFECT YOUR COSTS In-Network Providers HOW PROVIDERS AFFECT YOUR COSTS Choosing the right provider is an important part of getting the most value out of your health insurance plan. With Northwind Health Plus, you have access to an extensive network of in- network providers. Working with these providers is an essential part of getting the most value out of your plan. In-Network Providers When choosing an in-network provider for your health care needs, make sure to check with Northwind Health Plus to ensure that the provider is in-network. This is important because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus offers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This lets you choose a provider that is most convenient for you and your family. It is important to note that in-network providers may not always be available in every area. The Northwind Health Plus website offers a searchable directory of all in-network providers in your area. This directory is regularly updated, so you can be sure that you are choosing from in-network providers that are \n\nNorthwind_Standard_Benefits_Details.pdf#page=9: When choosing a provider, it is important to consider the cost sharing associated with each provider and to ask about any additional fees before receiving care. HOW PROVIDERS AFFECT YOUR COSTS When it comes to health insurance, many people are unaware of the different factors that impact the costs they pay. One of the most significant components that affects your costs is the provider you choose. Northwind Standard provides coverage for a variety of in-networkproviders, and the costs associated with each provider can vary significantly. To ensure you're getting the best value for your health care services, it's important to understand how providers can affect your costs. In-Network Providers Choosing in-network providers is the most cost-effective option when it comes to your Northwind Standard plan. In-network providers have agreed to accept a discounted rate on services, which means they are often less expensive than out-of-network providers. When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or ", "latency": 2.920576, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately and completely addressing the query with relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate information and includes additional insights about the convenience and options available with in-network providers, enhancing understanding.", "answer_length": 768, "citations_matched": 1.0, "any_citation": true} +{"question": "how does Northwind Health Plus help me save money on healthcare costs?", "truth": "Northwind Health Plus assists in saving money on healthcare costs by providing balance billing protection, ensuring that you are not billed more than the allowed amount by your provider. [Northwind_Health_Plus_Benefits_Details.pdf#page=7]", "answer": "Northwind Health Plus helps you save money on healthcare costs by covering virtual care services such as telemedicine and e-visits, which can avoid office visit fees and other out-of-pocket costs [Northwind_Health_Plus_Benefits_Details.pdf#page=60]. It also offers discounted rates at retail pharmacies when you present your insurance card, and savings through mail order pharmacy for up to a 90-day supply of medications if you have a chronic condition [Northwind_Health_Plus_Benefits_Details.pdf#page=47]. Additionally, using in-network providers, the 24/7 nurse hotline, and the online pharmacy service can further help reduce expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=94]. Routine physicals are covered with no cost-sharing, supporting preventive care to help avoid costly health issues later [Northwind_Health_Plus_Benefits_Details.pdf#page=47].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=47: 路 When you fill a prescription at a retail pharmacy, make sure to present your Northwind Health Plus insurance card so that you can receive the discounted rate. 路 If you have a chronic condition, consider using a mail order pharmacy to get up to a 90- day supply of medications. This can help you save money. . If you have any questions about your benefits, contact your employer's human resources department. They can provide you with more information about your coverage. Preventive Care COVERED SERVICES: Preventive Care Northwind Health Plus provides coverage for preventive care services. Preventive care is an important part of staying healthy and managing existing health conditions, and Northwind Health Plus covers many different types of preventive care services. Routine Physicals: Northwind Health Plus covers routine physicals with no cost-sharing. Routine physicals can help detect health issues early and can help keep you healthy. During a routine physical, your doctor will review your medical history, check your vital signs, and perform any other tests that are necessary.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and other assistance. . Use your plan's in-network providers whenever possible, as this will help you save money. . Utilize Northwind Health's online pharmacy service, which allows you to easily order and manage your prescriptions without leaving home. 路 When you receive health care services, make sure to check that the provider is in-network and that the services are covered by your plan. . Keep track of your claims and other plan information, as this will help you to better understand your plan and stay on top of your health care expenses.. Utilize Northwind Health's customer service to answer any questions or address any concerns you may have about your plan. Healthcare Providers - Independent Contractors OTHER INFORMATION ABOUT THIS PLAN Healthcare Providers - Independent Contractors The Northwind Health Plus plan includes coverage for healthcare services provided by independent contractors.", "latency": 5.183753, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately addressing the query with all relevant details provided in the context. It does not introduce any unrelated or incorrect information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into how these services help save money, which enhances understanding.", "answer_length": 866, "citations_matched": 0.0, "any_citation": true} +{"question": "what is copay for Northwind Health Plus?", "truth": "When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The copay for Northwind Health Plus varies by service type:\n\n- Primary care visits: typically around $20 (in-network) [Northwind_Health_Plus_Benefits_Details.pdf#page=10].\n- Specialist visits: typically around $50 (in-network) [Northwind_Health_Plus_Benefits_Details.pdf#page=10].\n- Office visits with primary care physicians: $35 copay [Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Office visits with specialists: $60 copay [Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Mental health visits with a psychiatrist or mental health provider: $45 copay [Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Out-of-network services: typically around $60 copay [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- Preventive care services copay is typically waived if received from an in-network provider [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nNote that emergency room, urgent care, and anesthesiologist visits are not subject to the split copay and will have the full copay amount based on the provider type [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an in-network provider. Tips: It is important to remember that copayments are subject to change and may vary depending on the type of service received. It is also important to note that copayments are not waived for out-of-network services, and you may be responsible for the remaining balance after Northwind Health Plus has paid its portion. Finally, it is important to make sure that the provider you are seeing is in-network. This can be easily done by checking the provider directory on the Northwind Health Plus website. It is also important to remember that if you receive a service from an out-of-network provider, you may be responsible for a higher copayment.By understanding and following these tips, you can be sure to get the most out of your Northwind Health Plus coverage and avoid unnecessary copayments. Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=12: Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more affordable for its members. This means that you will pay a lower copay for office visits than you would for other services. The split copay is applied to office visits with primary care physicians, specialists, and mental health providers. Office visits with primary care physicians are subject to a $35 copay. Office visits with specialists are subject to a $60 copay. Mental health visits with a psychiatrist or another mental health provider are subject to a $45 copay. There are a few exceptions to this split copay. Emergency room visits and urgent care visits are not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. Office visits with an anesthesiologist are also not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. When visiting your doctor, it is important to understand which type of provider you are visiting.", "latency": 4.592411, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY with all relevant details included.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about copay exceptions, making it comprehensive.", "answer_length": 1097, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the deductible amounts for in-network services under the Northwind Health Plus Benefits Details?", "truth": "The calendar year deductible for in-network services under the Northwind Health Plus Benefits Details is $1,500 for individuals and $3,000 for families. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "The calendar year deductible for in-network services under the Northwind Health Plus plan is $1,500 for individuals and $3,000 for families. This deductible amount must be paid out-of-pocket before the plan begins to pay for covered services and resets each year on the plan's renewal date [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=12: Other services, such as lab tests, X-rays, and imaging tests, are subject to different copay amounts, which are listed on your insurance card. It is also important to remember that the split copay only applies to in-network providers. If you visit an out-of-network provider, you will be subject to a higher copay amount, which is also listed on your insurance card. At Northwind Health Plus, we are committed to helping our members get the care they need at a price they can afford. With the split copay for office visits, we hope to make healthcare more affordable for you and your family.Calendar Year Deductible IMPORTANT PLAN INFORMATION: Calendar Year Deductible The Northwind Health Plus plan has a calendar year deductible that applies to some services. The amount you must pay out-of-pocket before the plan begins to pay for covered services is called the calendar year deductible. The calendar year deductible is the same for all members of the plan and is reset each year on the plan's renewal date. For In-Network Services: The calendar year deductible for in-network services is $1,500 for individuals and $3,000 for families.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.757245, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding.", "answer_length": 343, "citations_matched": 0.0, "any_citation": true} +{"question": "What is the role of coinsurance in Northwind Health Plus?", "truth": "Coinsurance is a cost-sharing requirement under Northwind Health Plus, where after meeting the deductible, the policyholder is responsible for a certain percentage of the costs for covered services. This percentage is usually a portion of the allowed amount for a service, which the policyholder must pay. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "Coinsurance in Northwind Health Plus is a cost-sharing requirement where, after you have met your deductible, you pay a percentage of the costs for covered services. The coinsurance rate is 20%, meaning you pay 20% of the allowed amount for a service, and the insurance company pays the remaining 80%. Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services [Northwind_Health_Plus_Benefits_Details.pdf#page=13][Northwind_Health_Plus_Benefits_Details.pdf#page=107].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=13: Tips: 路 Be sure to check with your provider to find out if a service is subject to the calendar year deductible before receiving the service. 路 Make sure you understand the cost sharing that applies to out-of-network services. 路 Be aware that the calendar year deductible is reset each year on the plan's renewal date. 路 Remember that preventive care services and emergency services are exempt from the calendar year deductible. Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a cost-sharing requirement under Northwind Health Plus. This means that after you have met your deductible, you will be responsible for a certain percentage of the costs for covered services. The coinsurance rate is usually a percentage of the allowed amount for a service, and it is your responsibility to pay this amount. For example, if the allowed amount for a service is $100 and your coinsurance is 20%, you are responsible for paying $20 (20% of $100). The insurance company will pay the remaining amount of $80.Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=107: If an employee has any questions or concerns about their coverage, they should contact their employer or the Workers' Compensation Insurance provider for more information. DEFINITIONS Definitions It is important for employees to understand the definitions of certain terms when it comes to their health insurance plan. The following definitions will help employees obtain a better understanding of Northwind Health Plus. Copayment: A copayment, also known as a copay, is the fixed amount that an employee pays for a covered service. This amount is usually a flat fee and is due at the time of service.Deductible: A deductible is the amount of money that an employee must pay out-of-pocket before the plan begins paying for covered services. Northwind Health Plus has a deductible of $2,000 per year. Coinsurance: Coinsurance is the percentage of the cost of a covered service that an employee must pay after the deductible is met. Northwind Health Plus has a coinsurance of 20%. Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year.\n\nNorthwind_Standard_Benefits_Details.pdf#page=13: Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a type of cost sharing that you are responsible for after meeting your deductible. Coinsurance is often a percentage of the cost of the service you receive. Forexample, if the coinsurance is 10%, you will be responsible for paying 10% of the cost of the service you received, while the insurance company pays the other 90%. Under Northwind Standard, coinsurance is set at 20% for in-network services, with some exceptions. For in-network hospital stays, coinsurance is set at 25%. Additionally, coinsurance for out-of-network services is set at 40%. It's important to note that coinsurance does not apply to the services that are covered by the plan's copayment amounts. Copayment is a fixed amount that you are responsible for paying for certain services and is typically much less than coinsurance. Additionally, Northwind Standard does not require coinsurance for preventive care services. When you receive services, it's important to ask about the cost of the service and make sure you are aware of any coinsurance costs.", "latency": 2.398893, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY with all relevant details provided.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional relevant insights about the services affected by coinsurance, which enhances understanding.", "answer_length": 566, "citations_matched": 1.0, "any_citation": true} +{"question": "How does the Northwind Health Plus Benefits Details.pdf explain the impact of choosing in-network versus non-participating providers on your healthcare costs, and what are the exceptions to prior authorization that do not require prior approval?", "truth": "The Northwind Health Plus Benefits Details.pdf explains that by understanding the difference between in-network and non-participating providers, you can save money on your healthcare costs. In-network providers are likely part of a negotiated agreement with Northwind Health Plus, which can result in lower costs for the insured. Additionally, there are exceptions to prior authorization that do not require prior approval, including routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. These services are exempt from prior authorization, potentially simplifying and reducing the cost of accessing these types of healthcare. [Northwind_Health_Plus_Benefits_Details.pdf#page=7] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "Choosing in-network providers with Northwind Health Plus helps avoid additional costs, as non-participating providers require you to pay the entire cost of care out-of-pocket. Exceptions include situations when you are traveling outside the U.S. without access to in-network providers or in life-threatening emergencies, where Northwind Health Plus may cover part or all of the costs even if the provider is out-of-network [Northwind_Health_Plus_Benefits_Details.pdf#page=6].\n\nExceptions to prior authorization that do not require prior approval include emergency care, inpatient hospital services, and outpatient hospital services, provided these are medically necessary. However, it is advised to contact Northwind Health Plus to confirm coverage and ensure the hospital is in-network when applicable [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n\nAdditionally, some services provided by out-of-network providers may be exceptions to prior authorization, but coverage may be limited and prior authorization might still be required for certain services [Northwind_Health_Plus_Benefits_Details.pdf#page=71].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=67: That is why we provide exceptions to prior authorization for certain medical services, procedures and treatments that may require additional review and approval. The exceptions to prior authorization are based onnational and state medical regulations, as well as medical necessity and appropriateness criteria. The exceptions to prior authorization provided by Northwind Health Plus include: Emergency Care: Emergency care is covered without prior authorization if it is determined to be medically necessary. If you believe that you need emergency care, please contact Northwind Health Plus for approval. Inpatient Hospital Services: Inpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require hospital services, please contact Northwind Health Plus to ensure that the hospital you are admitted to is an in-network provider. Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=71: In conclusion, Northwind Health Plus makes exceptions to the prior authorization requirement for certain services when they are provided by an out-of-network provider. However, it is important to remember that Northwind Health Plus may not cover all of the services provided by an out-of-network provider, that out-of-network providers may charge more than those in-network, and that prior authorization is still required for some services even if they are provided by an out-of-network provider. By being aware of theseexceptions and tips, employees can ensure that they are making responsible and informed decisions about their healthcare needs. Clinical Review CARE MANAGEMENT - Clinical Review Northwind Health Plus offers several care management services to ensure that members are receiving the best possible care. One of the primary care management services is Clinical Review. Clinical Review is an important process that helps to ensure that members are receiving the most appropriate care and that their care is in line with established clinical guidelines. Clinical Review involves a team of healthcare professionals who review services, treatments, and ", "latency": 3.090917, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing both aspects of the QUERY with relevant details from the document.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about contacting Northwind Health Plus for confirmation, which enhances understanding.", "answer_length": 1115, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the prior authorization process outlined in the Northwind Health Plus Benefits Details affect the coinsurance responsibilities for services that require prior authorization?", "truth": "The prior authorization process requires contacting Northwind Health Plus before receiving services or medications that need prior authorization to determine if it is necessary. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. This impacts the coinsurance responsibilities as failing to obtain prior authorization could lead to the policyholder paying the full cost, rather than just the coinsurance amount. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "If you receive a service or medication that requires prior authorization without obtaining it first, you may be responsible for the entire cost of the service or medication. Additionally, you can be billed for services or medications determined to be not medically necessary. Therefore, following the prior authorization process helps ensure that your service or medication is covered and can affect your coinsurance responsibilities by preventing you from having to pay the full cost out-of-pocket [Northwind_Health_Plus_Benefits_Details.pdf#page=63][Northwind_Health_Plus_Benefits_Details.pdf#page=66].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=66: By understanding the prior authorization process and following the tips outlined above, you can help ensure that you receive the care you need in a timely and efficient manner. Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage The Northwind Health Plus plan includes a care management system that requires prior- authorization for certain services to ensure that the plan is covering only medically necessary care. Prior-authorization is a process used by the insurance company to review a request for a specific service to ensure that it is medically necessary and meets the criteria set by the plan. This process helps to ensure that members are receiving the best care possible and that their benefits are used in the most cost-effective manner. In order to receive prior-authorization, members must provide their Northwind Health Plus provider with the necessary clinical information regarding their diagnosis and treatment plan. The provider then submits this information to Northwind Health Plus for review. Northwind Health Plus will then contact the provider with the decision on the prior- authorization request.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=63: For services and medications that require prior authorization, you must contact Northwind Health Plus before receiving the service or medication to determine if prior authorization is required. If so, you will need to obtain prior authorization through the Northwind Health Plus prior authorization process. Exceptions There are some exceptions to the prior authorization requirement. Certain preventive services, such as annual physicals and routine check-ups do not require prior authorization. In some cases, Northwind Health Plus may also waive the prior authorization requirement for certain services and medications. Tips for Employees If you think you may need a service or medication that requires prior authorization, it is important to plan ahead and contact Northwind Health Plus before receiving the service or medication. This will help ensure that your service or medication is covered by Northwind Health Plus. If you receive a service or medication without prior authorization, you may be responsible for the entire cost of the service or medication. You can also be billed for any services or medications that are determined to be not medically necessary.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.", "latency": 2.082441, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE correctly mentions the importance of obtaining prior authorization to avoid paying the full cost, which is relevant to the QUERY. However, it does not directly address how coinsurance responsibilities are affected, making it incomplete.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query by explaining how the prior authorization process affects coinsurance responsibilities, but it does not provide additional insights or elaboration beyond the basic explanation.", "answer_length": 604, "citations_matched": 0.5, "any_citation": true} +{"question": "How does the Northwind Standard Benefits Details document explain the financial responsibilities for in-network and out-of-network providers, and what are some specific services covered under the plan as mentioned in the document?", "truth": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, individuals are typically responsible for only a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". However, for out-of-network providers, the costs can be significantly higher, and individuals may be responsible for the entire cost of services or a much larger portion than with an in-network provider. Specific services covered under the plan include the cost of blood or blood products during a hospital stay or procedure, the collection, storage, and transfusion of platelets and plasma, along with necessary laboratory tests to assess compatibility. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=21]", "answer": "The Northwind Standard Benefits Details document explains that when using in-network providers, you typically pay a portion of the cost, such as a co-pay or co-insurance, with different services possibly having different co-pays or co-insurance amounts. In-network providers have contracted with Northwind Health to provide services at discounted rates, so you pay only the portion not covered by the insurance plan. For out-of-network providers, coverage may be available but costs are significantly higher, and you may be responsible for the full cost or a much larger portion of the cost. Some services may not be covered at all, requiring out-of-pocket payment [Northwind_Standard_Benefits_Details.pdf#page=8][Northwind_Standard_Benefits_Details.pdf#page=10].\n\nSpecific services covered under the plan include preventive care services such as immunizations and screenings, as well as mental health and substance abuse services, which generally have coverage similar to medical and surgical services. Prescription drug costs are also covered, with out-of-pocket costs depending on the medication tier, where brand-name and non-preferred generics generally cost more than preferred generic and generic medications [Northwind_Health_Plus_Benefits_Details.pdf#page=3].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.", "latency": 3.902698, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE accurately addresses the financial responsibilities for in-network and out-of-network providers as per the Northwind Standard Benefits Details document, but it incorrectly includes information about specific services from a different document, making it partially incorrect.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information regarding both financial responsibilities and specific services covered under the plan, without omitting any essential details.", "answer_length": 1268, "citations_matched": 0.5, "any_citation": true} +{"question": "How can a claim for medically necessary rehabilitation therapy services be processed quickly under the Northwind Standard plan?", "truth": "To ensure quick processing of a claim for medically necessary rehabilitation therapy services under the Northwind Standard plan, one should ask the healthcare provider for a detailed explanation of the services and treatments, ensure all documentation including required forms, test results, and physician's notes are complete, send the documentation to Northwind Health promptly, and follow up with them to confirm receipt and processing of the claim. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "To have a claim for medically necessary rehabilitation therapy services processed quickly under the Northwind Standard plan, you should:\n\n- Ask your healthcare provider to provide a detailed explanation of the services and the medical necessity for them.\n- Ensure all documentation is complete, including required forms, test results, and physician's notes.\n- Send the documentation to Northwind Health as soon as possible.\n- Follow up with Northwind Health to confirm receipt and processing of your claim.\n\nThese steps help ensure your claim is processed quickly and accurately [Northwind_Standard_Benefits_Details.pdf#page=88].\n\nAlso, note that physical therapy may require prior authorization. Northwind Health will review the request and notify you and your doctor of the decision within three business days. Approval allows you to receive the service without additional pre-authorization [Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=68: Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require outpatient services, please contact Northwind Health Plus to ensure that the hospital you are visiting is an in-network provider. Ambulatory Surgery Center Services: Ambulatory surgery center services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the ambulatory surgery center you are visiting is an in-network provider. Outpatient Rehabilitative Services: Outpatient rehabilitative services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the outpatient rehabilitative provider you are visiting is an in-network provider. Long-Term Care Services: Long-term care services are covered without prior authorization if it is determined that the services are medically necessary.", "latency": 3.696745, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, providing a complete and accurate answer to the query by incorporating all necessary details from the context.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about prior authorization, which enhances understanding.", "answer_length": 943, "citations_matched": 0.5, "any_citation": true} +{"question": "What steps can be taken to ensure quick and accurate processing of claims under the Northwind Standard Benefits Details?", "truth": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits Details, one should ask their healthcare provider for a detailed explanation of the services and treatments, including the medical necessity for them. It is also important to ensure that all documentation is complete, including all required forms, test results, and physician's notes. Additionally, sending the documentation to Northwind Health as soon as possible and following up with them to ensure the claim has been received and is being processed are crucial steps. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits Details, you should:\n\n- Ask your healthcare provider for a detailed explanation of the services and treatments, including the medical necessity for them.\n- Make sure all documentation is complete, including required forms, test results, and physician's notes.\n- Send the documentation to Northwind Health as soon as possible.\n- Follow up with Northwind Health to confirm receipt and processing of your claim.\n- Keep copies of all documentation related to your services.\n- If unsure about filing requirements, contact Northwind Health for clarification.\n- File claims timely according to the guidelines.\n\nThese steps help ensure that claims requiring evidence of medical necessity are processed quickly and accurately [Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=79].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=79: You should also keep copies of all documentation related to your services, and if you're unsure of the filing requirements, you should contact Northwind Health for clarification. Overall, timely filing is an important part of the claim filing process. By following the guidelines for timely filing and including all necessary documentation with your claims, you can help ensure that your claims are processed quickly and accurately. COMPLAINTS AND APPEALS What You Can Appeal COMPLAINTS AND APPEALS What You Can Appeal When you have Northwind Standard coverage, you have the right to appeal any denial of services or payment of benefits. This includes if you disagree with the amount of the payment or if you feel that your claim was denied incorrectly. You also have the right to appeal if you feel that an authorization was not provided for a service, or if you believe that a service should be covered by your plan but was not. If you believe that your claim was wrongly denied or that you have a dispute over a service that is covered or not covered, you have the right to file a formal appeal.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.", "latency": 2.393548, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using relevant details from the CONTEXT, demonstrating a full understanding of the steps needed for quick and accurate claim processing.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, including additional insights about the importance of evidence of medical necessity, which enhances understanding.", "answer_length": 904, "citations_matched": 0.5, "any_citation": true} +{"question": "What are some services exempt from prior authorization according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, services exempt from prior authorization include routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "According to Northwind Health Plus Benefits Details, the services exempt from prior authorization include:\n\n- Emergency Care: Covered without prior authorization if medically necessary. For out-of-network providers, emergency services do not require prior authorization if the provider is the closest available [Northwind_Health_Plus_Benefits_Details.pdf#page=67][Northwind_Health_Plus_Benefits_Details.pdf#page=70].\n- Inpatient Hospital Services: Covered without prior authorization if medically necessary, but you should confirm the hospital is in-network [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n- Outpatient Hospital Services: Covered without prior authorization if medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n- Certain Preventive Services: Such as annual physicals and routine check-ups do not require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=63].\n\nThese exceptions are based on medical necessity and regulatory criteria [Northwind_Health_Plus_Benefits_Details.pdf#page=67].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=67: That is why we provide exceptions to prior authorization for certain medical services, procedures and treatments that may require additional review and approval. The exceptions to prior authorization are based onnational and state medical regulations, as well as medical necessity and appropriateness criteria. The exceptions to prior authorization provided by Northwind Health Plus include: Emergency Care: Emergency care is covered without prior authorization if it is determined to be medically necessary. If you believe that you need emergency care, please contact Northwind Health Plus for approval. Inpatient Hospital Services: Inpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require hospital services, please contact Northwind Health Plus to ensure that the hospital you are admitted to is an in-network provider. Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=70: Remember, if you have any questions about the prior authorization process or coverage for an out-of-network provider, contact Northwind Health directly. Northwind Health is available to answer any questions you may have and provide more information about the prior authorization process. Exceptions to Prior-Authorization For Out-Of-Network Providers CARE MANAGEMENT - Exceptions to Prior-Authorization For Out-Of-Network Providers Northwind Health Plus provides coverage for certain services that may require prior authorization when provided by an out-of-network provider. Prior authorization is required to ensure that the service is medically necessary and to ensure that the service is being provided in accordance with the plan's specific rules and guidelines. Northwind Health Plus makes exceptions to the prior authorization requirement for the following services when provided by an out-of-network provider: 路 Emergency Services: For services that are medically necessary and when the out-of- network provider is the closest provider available, prior authorization is not required.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=63: For services and medications that require prior authorization, you must contact Northwind Health Plus before receiving the service or medication to determine if prior authorization is required. If so, you will need to obtain prior authorization through the Northwind Health Plus prior authorization process. Exceptions There are some exceptions to the prior authorization requirement. Certain preventive services, such as annual physicals and routine check-ups do not require prior authorization. In some cases, Northwind Health Plus may also waive the prior authorization requirement for certain services and medications. Tips for Employees If you think you may need a service or medication that requires prior authorization, it is important to plan ahead and contact Northwind Health Plus before receiving the service or medication. This will help ensure that your service or medication is covered by Northwind Health Plus. If you receive a service or medication without prior authorization, you may be responsible for the entire cost of the service or medication. You can also be billed for any services or medications that are determined to be not medically necessary.", "latency": 3.16761, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately lists all the services exempt from prior authorization as mentioned in the context, without omitting any relevant details or introducing incorrect information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about medical necessity and regulatory criteria, which enhance understanding.", "answer_length": 1050, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the prior authorization process detailed in the Northwind_Health_Plus_Benefits_Details.pdf impact the out-of-pocket costs for services and medications, and what are the copayment expectations for in-network services as outlined in the same document?", "truth": "The prior authorization process as detailed in the Northwind Health Plus Benefits Details requires contacting Northwind Health Plus before receiving certain services or medications to determine if prior authorization is needed. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. Additionally, for in-network services, the copayment expectations are generally lower, with a typical copayment of around $20 for primary care visits and around $50 for specialist visits. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The prior authorization process requires your insurance company to review and verify the need for a service or procedure, primarily for out-of-network services. If prior authorization is denied, you may be responsible for all costs associated with the care. Exceptions exist when care is not available in-network, where prior authorization may be waived. This process helps ensure appropriate care and coverage by your plan but can impact your out-of-pocket costs if authorization is not obtained or denied [Northwind_Standard_Benefits_Details.pdf#page=66][Northwind_Standard_Benefits_Details.pdf#page=67].\n\nFor in-network services under Northwind Health Plus, copayments are approximately $20 for primary care visits, $50 for specialist visits, and $100 for emergency services. Preventive care services typically have no copayment. Copayments for out-of-network services are higher and you may be responsible for additional costs beyond copayments [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Standard_Benefits_Details.pdf#page=66: However, it's important toremember that Northwind Standard does not cover out-of-network services in foreign countries. In rare cases, prior authorization may also be waived for services that are not available in- network. If the care you need is not available through an in-network provider, you can seek out an out-of-network provider without obtaining prior authorization. However, you should be aware that you may be responsible for any costs associated with out-of-network services. In order to ensure that you are receiving the best care possible, it's important to understand the basics of prior authorization. Prior authorization is a process in which your insurance company reviews the request and verifies the need for the service or procedure. This helps to ensure that you receive the appropriate care and that the costs associated with the care are covered by your plan. If you're considering seeking care from an out-of-network provider, it's important to remember that prior authorization is required for out-of-network services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=67: If you're considering seeking care from an out-of-network provider, it's important to remember that prior authorization is required for out-of-network services. You should call Northwind Health to obtain prior authorization before you receive care from an out-of- network provider. It's also important to know that prior authorization may be denied if the service or procedure is not medically necessary or not covered under your plan. If prior authorization is denied, you may be responsible for any costs associated with the care. At Northwind Health, we understand that there are times when care is not available through an in-network provider. That's why we make exceptions to the prior-authorization requirement for certain services and procedures. However, it's important to remember that prior authorization is still required for most out-of-network services. If you have any questions about prior authorization for out-of-network providers, please contact Northwind Health. We're here to help you get the care you need, and we're here to help you understand the process of prior authorization.", "latency": 3.11626, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides accurate copayment information for in-network services but incorrectly grounds the prior authorization process in the wrong document, leading to a partially correct response.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE effectively addresses both parts of the QUERY with accurate and complete information, including specific copayment amounts and the impact of the prior authorization process on costs. It does not include additional insights, but it fully answers the question.", "answer_length": 1002, "citations_matched": 0.0, "any_citation": true} +{"question": "How does using in-network providers affect the coinsurance responsibilities for services under the Northwind Health Plus Benefits, and what are the implications of using out-of-network providers?", "truth": "Using in-network providers under the Northwind Health Plus Benefits can result in lower coinsurance rates, meaning the policyholder will pay less for the same service. However, if out-of-network providers are used, the policyholder will be responsible for a larger portion of the cost, and in some cases, may be responsible for the entire cost. This highlights the importance of checking if a provider is in-network before selecting a plan to manage out-of-pocket costs effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=14] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers under Northwind Health Plus Benefits results in lower out-of-pocket costs because Northwind Health has negotiated discounted rates with these providers. Your coinsurance responsibility will generally be lower with in-network providers. In contrast, using out-of-network providers may lead to paying the full cost of services, higher deductibles, and higher coinsurance. Additionally, you might have to pay the difference between the provider's billed amount and what the plan pays. Emergency services are covered both in-network and out-of-network, but out-of-network emergency care may also result in higher copayments and coinsurance [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=27].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you have questions about the dialysis coverage offered by Northwind Health Plus, please contact your provider or Northwind Health directly. We are committed to providing our employees with comprehensive coverage and support. Emergency Room COVERED SERVICES - EMERGENCY SERVICES At Contoso, we understand that unplanned medical emergencies can arise, and so our insurance partner, Northwind Health, provides coverage for emergency services. This coverage applies to both in-network and out-of-network providers. In-Network Providers If you seek emergency care from an in-network provider, your plan will cover the cost of treatment, including any necessary hospitalization and follow-up care. Depending on the type of plan you have, you may also be responsible for paying a copayment and/or coinsurance. Out-of-Network Providers Emergency services received from out-of-network providers will also be covered, but you may be responsible for higher out-of-pocket costs such as copayments and coinsurance. If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.", "latency": 2.937459, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using relevant information from the CONTEXT, demonstrating a thorough understanding of the effects of using in-network and out-of-network providers on coinsurance responsibilities.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about emergency services, which enhances understanding. Therefore, it fits the criteria for a comprehensive response with insights.", "answer_length": 767, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the differences in copayment amounts for primary care and specialist visits under the Northwind Health Plus plan?", "truth": "Under the Northwind Health Plus plan, the copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10] [Northwind_Health_Plus_Benefits_Details.pdf#page=9]", "answer": "Under the Northwind Health Plus plan, the copayment for primary care visits is typically around $20, while for specialist visits it is around $50 for in-network services [Northwind_Health_Plus_Benefits_Details.pdf#page=11][Northwind_Health_Plus_Benefits_Details.pdf#page=10].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 2.062976, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE correctly provides copayment amounts for in-network services but does not address the differences between primary care and specialist visits or between in-network and out-of-network services, making it incomplete.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY by providing the specific copayment amounts for both primary care and specialist visits, making it a complete response.", "answer_length": 275, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details?", "truth": "The limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details include that it only applies to services covered under the plan and not to services that are not covered or are subject to limitations or exclusions. Additionally, it only applies to claims filed within six months of the date of service. There is also no guarantee that the insurance company will be able to recover all or part of the money already paid by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The limitations of the Right of Recovery provision in the Northwind Health Plus plan include:\n\n1. It only applies to services that are covered under the plan and does not apply to services that are not covered or are subject to limitations or exclusions.\n2. Claims must be filed within six months of the date of service.\n3. The provision does not guarantee that the insurance company will be able to recover the money already paid; they may recover only part or none of it.\n4. It is important to keep receipts or other documentation if you have already paid a provider, as this will be necessary to file a claim [Northwind_Health_Plus_Benefits_Details.pdf#page=101][Northwind_Health_Plus_Benefits_Details.pdf#page=102].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan. It does not apply to services that are not covered or services that are subject to limitations or exclusions. Second, the Right of Recovery provision only applies to claims that are filed within six months of the date of service. Also, keep in mind that the Right of Recovery provision does not guarantee that the insurance company will be able to recover the money that you have already paid. The insurance company may be unable to recover the money that you have paid, or they may not be able to recover the entire amount. In these cases, the insurance company may offer to reimburse you for some portion of the money that you have already paid. Finally, if you have already paid a provider for a service that is covered under the plan, it is important to keep any receipts or other documentation. This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.", "latency": 4.152529, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details provided.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information about the limitations of the Right of Recovery provision, without adding extraneous information.", "answer_length": 719, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the benefits of the Chronic Condition Management Program offered by the Northwind Health Plus plan?", "truth": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides members with access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. This team offers personalized care and support to help members manage their chronic conditions and live healthier, happier lives. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=73]", "answer": "The Chronic Condition Management Program offered by the Northwind Health Plus plan provides members with access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists, who offer personalized care and support. The program helps members make lifestyle changes, stay organized with their medications and appointments, ask for help when needed, and take advantage of various resources and programs to manage their chronic conditions. The goal is to help members stay healthy and active while managing their conditions effectively [Northwind_Health_Plus_Benefits_Details.pdf#page=73][Northwind_Health_Plus_Benefits_Details.pdf#page=74][Northwind_Health_Plus_Benefits_Details.pdf#page=75].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=74: 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help manage your condition and reduce the risk of complications. . Stay organized: Keeping track of your medications, appointments, and lab results can help you stay on top of your condition and make informed decisions about your care. . Ask for help: Don't be afraid to ask for help from family, friends, and healthcare professionals. . Take advantage of resources: Northwind Health Plus offers a variety of resources and programs to help members manage their chronic conditions.路 Be proactive: Talk to your doctor if you have any questions or concerns about your condition or care plan. At Northwind Health, we understand that managing chronic conditions can be challenging. That's why we're committed to helping our members get the care and support they need to stay healthy and active. Through our Chronic Condition Management Program, we provide members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=75: Through our Chronic Condition Management Program, we provide members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support. We also offer a variety of resources and programs to help members manage their chronic conditions. With Northwind Health Plus, you can rest assured that you'll have the support and resources you need to stay healthy and active. EXCLUSIONS EXCLUSIONS Although Northwind Health Plus provides comprehensive coverage for medical, vision, and dental services, there are certain services and treatments that are excluded from the plan. It is important to understand these exclusions so that you can plan your care accordingly. Services Not Covered: Northwind Health Plus does not cover services that are not medically necessary, such as cosmetic surgery or elective procedures. Additionally, services or treatments that are experimental or investigational are not covered under this plan. Prescriptions Not Covered: The plan does not cover prescriptions that are not medically necessary, certain over-the-counter medications, or prescription medications that are used to enhance performance in athletics.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=73: Talk to your doctor or other health care provider about your health and any treatments that may be available. .Take an active role in your health care. Ask questions and be informed about your health and any treatments that may be available. . Make sure to follow your doctor's instructions and stay up to date on your health care. . If you have any questions or concerns about your health, contact Northwind Health Plus for assistance.Chronic Condition Management CARE MANAGEMENT: Chronic Condition Management At Northwind Health, we understand that managing chronic conditions can be overwhelming and expensive. We are committed to helping our members manage their chronic conditions and live healthier, happier lives. That's why we offer a Chronic Condition Management Program (CCMP) as part of our Northwind Health Plus plan. This program provides members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support. The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists.", "latency": 2.363678, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY by listing the benefits of the Chronic Condition Management Program as described in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the program's goals and the interdisciplinary team involved, which enhances understanding.", "answer_length": 782, "citations_matched": 0.5, "any_citation": true} +{"question": "What happens if you use out-of-network providers according to Northwind Health Plus?", "truth": "If you use out-of-network providers according to Northwind Health Plus, you will be responsible for a larger portion of the cost. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=75]", "answer": "If you use out-of-network providers with Northwind Health Plus, you should first confirm if the services are covered by the plan. Out-of-network providers may charge more than in-network providers, and Northwind Health Plus does not guarantee the amount charged by out-of-network providers. You are responsible for any balance remaining after the plan pays its portion. Prior authorization is still required for some services even if provided out-of-network, although exceptions exist for certain services. Northwind Health Plus will not reimburse you for out-of-network services unless they are medically necessary and not available from an in-network provider. You may need to submit documentation such as itemized bills, proof of payment, and medical records to receive reimbursement. Keeping detailed records of all medical services and payments is important to ensure full reimbursement under the policy [Northwind_Health_Plus_Benefits_Details.pdf#page=71][Northwind_Health_Plus_Benefits_Details.pdf#page=81].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=71: It is important to ask the provider if the services are covered by Northwind Health Plus and to check with Northwind Health Plus to make sure that the services are covered. It is also important to remember that out-of-network providers may charge more than those in-network. Northwind Health Plus does not guarantee the amount charged by an out- of-network provider, and the member is responsible for any balance remaining after the plan has paid its portion. Finally, it is important to remember that prior authorization is still required for some services even if they are provided by an out-of-network provider. Prior authorization is a process in which Northwind Health Plus reviews and evaluates the medical necessity of the requested service. This process helps to ensure that the services being requested are medically necessary and are provided in accordance with the plan's specific rules and guidelines. In conclusion, Northwind Health Plus makes exceptions to the prior authorization requirement for certain services when they are provided by an out-of-network provider.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=81: Additionally, Northwind Health Plus will not reimburse you for any medical services that you received from an out-of-network provider, unless the service was deemed medically necessary and was not available from an in-network provider. Finally, it is important to remember that Northwind Health Plus may require that you submit certain documentation in order to receive reimbursement. This documentation may include itemized bills, proof of payment, and/or medical records. In order to ensure that you are able to take full advantage of Northwind Health Plus's subrogation and reimbursement policy, it is important to keep detailed records of all medical services that you receive. This includes records of payments made by you, other insurance companies, and Northwind Health Plus. Additionally, it is important to keep a record of any documentation you submit to Northwind Health Plus to support yourreimbursement claim. Keeping these records will help to ensure that you receive the full reimbursement that you are entitled to under the Northwind Health Plus policy. Uninsured And Underinsured Motorist/Personal Injury Protection Coverage WHAT IF I HAVE OTHER COVERAGE?\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=71: In conclusion, Northwind Health Plus makes exceptions to the prior authorization requirement for certain services when they are provided by an out-of-network provider. However, it is important to remember that Northwind Health Plus may not cover all of the services provided by an out-of-network provider, that out-of-network providers may charge more than those in-network, and that prior authorization is still required for some services even if they are provided by an out-of-network provider. By being aware of theseexceptions and tips, employees can ensure that they are making responsible and informed decisions about their healthcare needs. Clinical Review CARE MANAGEMENT - Clinical Review Northwind Health Plus offers several care management services to ensure that members are receiving the best possible care. One of the primary care management services is Clinical Review. Clinical Review is an important process that helps to ensure that members are receiving the most appropriate care and that their care is in line with established clinical guidelines. Clinical Review involves a team of healthcare professionals who review services, treatments, and ", "latency": 3.449853, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately and completely addressing the query with all necessary details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, covering all essential details required for a comprehensive understanding.", "answer_length": 1014, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the specific conditions and exceptions mentioned in the Northwind Health Plus Benefits Details.pdf for coordinating benefits with other employer plans and the Right of Recovery provision?", "truth": "The Northwind Health Plus Benefits Details.pdf specifies that to coordinate benefits with another employer plan, one must use an in-network provider within the Northwind Health Plus network and provide the other employer plan's information. Exceptions include not being able to coordinate benefits with non-major medical plans or high-deductible plans until the deductible is met. Regarding the Right of Recovery provision, it only applies to services covered under the plan and claims filed within six months of the service date. It does not guarantee recovery of payments made, and in cases where recovery is not possible, partial reimbursement might be offered. Documentation such as receipts is necessary if filing a Right of Recovery claim. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=102]", "answer": "For coordinating benefits with other employer plans under Northwind Health Plus, you must use an in-network provider within the Northwind Health Plus network and provide your other employer plan's information. Exceptions include not coordinating benefits with a health plan that is not a major medical plan and not coordinating benefits with Northwind Health Plus if you have a high-deductible plan until the deductible is met [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\nRegarding the Right of Recovery provision, it applies only to services covered under the plan and claims filed within six months of the date of service. It does not apply to services not covered or those subject to limitations or exclusions. The insurance company may not always recover the money paid, and partial reimbursement may be offered. Keeping receipts or documentation of payments is important if you decide to file a Right of Recovery claim [Northwind_Health_Plus_Benefits_Details.pdf#page=102].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=77: To coordinate benefits with your other employer plan, you must use an in-network provider within the Northwind Health Plus network. You will need to provide your other employer plan's information in order to coordinate benefits. Exceptions There are a few exceptions to coordinating benefits with other health care plans. For example, you cannot coordinate benefits with a health plan that is not a major medical plan. Also, if you are enrolled in a health plan that is a high-deductible plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible. Tips If you have other health care coverage, here are a few tips to help you coordinate benefits with Northwind Health Plus: . Make sure you have your other health care plan's information handy when you use Northwind Health Plus. 路 Always use an in-network provider within the Northwind Health Plus network to ensure that your benefits are coordinated correctly. 路 Make sure you understand your plan's rules for coordinating benefits. 路 Ask your doctor or other health care provider about the cost of services before you receive them to make \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan. It does not apply to services that are not covered or services that are subject to limitations or exclusions. Second, the Right of Recovery provision only applies to claims that are filed within six months of the date of service. Also, keep in mind that the Right of Recovery provision does not guarantee that the insurance company will be able to recover the money that you have already paid. The insurance company may be unable to recover the money that you have paid, or they may not be able to recover the entire amount. In these cases, the insurance company may offer to reimburse you for some portion of the money that you have already paid. Finally, if you have already paid a provider for a service that is covered under the plan, it is important to keep any receipts or other documentation. This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company.", "latency": 3.016068, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using relevant details from the CONTEXT, demonstrating full understanding and groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including specific conditions and exceptions for coordinating benefits and details about the Right of Recovery provision. It does not add extraneous information and covers all essential details required for a comprehensive understanding.", "answer_length": 988, "citations_matched": 1.0, "any_citation": true} +{"question": "How can a policyholder of Northwind Health Plus ensure that their benefits are coordinated correctly when using an in-network provider, and what are the typical copayments for primary care and specialist visits?", "truth": "To ensure that benefits are coordinated correctly when using an in-network provider within the Northwind Health Plus network, a policyholder must have their other health care plan's information handy and always use an in-network provider. The typical copayments for primary care visits are around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "To ensure benefits are coordinated correctly when using an in-network provider with Northwind Health Plus, policyholders should select from the variety of in-network providers including primary care physicians and specialists, and be aware of the plan's coverage details, cost-sharing requirements, and any exceptions or limitations. They can also visit the Northwind Health website or contact Northwind Health Plus directly for more information and advice on selecting the right provider [Northwind_Health_Plus_Benefits_Details.pdf#page=16][Northwind_Health_Plus_Benefits_Details.pdf#page=10].\n\nTypical copayments for in-network services are around $20 for primary care visits and around $50 for specialist visits [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: IMPORTANT PLAN INFORMATIONNorthwind Health Plus is a comprehensive health plan that offers coverage for medical, vision, and dental services. It also provides coverage for prescription drugs, mental health and substance abuse services, and preventive care. You can choose from a variety of in- network providers, including primary care physicians, specialists, hospitals, and pharmacies. Emergency services are also covered, both in-network and out-of-network. Co-pays, deductibles, and out-of-pocket maximums may apply to your plan. Your plan may also include separate deductibles for different services, such as prescription drugs and hospitalization. It is important to know what your plan covers and what the cost-sharing requirements are. To get more information, please visit the Northwind Health website or contact them directly. It is also important to remember that there may be certain exceptions or limitations in the plan. For instance, some plans may not cover certain types of services, such as cosmetic procedures, or they may have limits on the number of visits to a provider that are covered.", "latency": 2.864643, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information from the CONTEXT, including how to ensure benefits are coordinated and the typical copayments for primary care and specialist visits.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both parts of the QUERY with accurate and complete information, making it a complete response.", "answer_length": 820, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the necessary steps to ensure coverage for transplants according to the Northwind Standard Benefits Details?", "truth": "To ensure coverage for transplants according to the Northwind Standard Benefits Details, it is important to discuss transplant needs with a primary care physician, ensure the transplant is medically necessary, and obtain preauthorization. Additionally, coverage includes pre- and post-transplant care but excludes experimental or investigational procedures. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=55]", "answer": "To ensure coverage for transplants under the Northwind Standard plan, follow these steps:\n\n1. Confirm that the transplant procedure is medically necessary by discussing your needs with your primary care physician.\n2. Verify that the transplant is covered under your plan, noting that experimental or investigational transplant procedures are not covered.\n3. Obtain preauthorization for the transplant procedure before proceeding.\n4. Be aware of any applicable copays or coinsurance requirements.\n5. Ask your doctor about potential out-of-pocket costs and any alternative treatments.\n6. Coverage includes the transplant procedure, donor organ costs, hospital stays, recovery, medications, and pre- and post-transplant care such as lab and diagnostic tests.\n7. Work closely with your healthcare provider to determine the best course of action.\n\nThese steps will help you get the most out of your Northwind Standard transplant coverage [Northwind_Standard_Benefits_Details.pdf#page=55].", "context": "Northwind_Standard_Benefits_Details.pdf#page=55: There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants. For example, it's important to make sure that you are familiar with all of the details of your coverage, including any applicable copays orcoinsurance requirements. It's also a good idea to ask your doctor about any potential out- of-pocket costs you may need to pay, as well as any potential alternative treatments that may be available. Finally, it's important to note that Northwind Standard does not provide coverage for any experimental or investigational transplant procedures. If you're considering a transplant procedure, it's important to make sure that it is a medically necessary procedure, and that it is covered under your Northwind Standard plan. At Northwind Health, we understand how important it is for our members to have access to the best possible care. That's why we're proud to provide coverage for organ and tissue transplants through our Northwind Standard plan. With this coverage, you can get the care you need, while also enjoying the peace of mind that comes from \n\nNorthwind_Standard_Benefits_Details.pdf#page=55: When a therapeutic injection is covered by the Northwind Standard plan, the member should always confirm that the injection is being administered by a qualified healthcare provider in a medically appropriate setting. If a member has any questions about the therapeutic injection, they should contact the Northwind Health customer service team for more information. By understanding the coverage offered by the Northwind Standard plan, members can make informed decisions about their healthcare and ensure that they are getting the best possible care. Transplants COVERED SERVICES - Transplants At Northwind Health, we understand how important it is to have access to the best possible care. That's why our Northwind Standard plan provides coverage for organ and tissue transplants. If you need a transplant of any kind, Northwind Standard will cover the expenses associated with the procedure, including the cost of the donor organ, hospital stays, recovery costs, and medications. It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician.\n\nNorthwind_Standard_Benefits_Details.pdf#page=55: It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician. In addition to covering the cost of the transplant itself, Northwind Standard will also provide coverage for pre- and post-transplant care, such as laboratory tests, diagnostic tests, and other medically necessary services. It's important to note that there are some exceptions to coverage for transplants. For example, Northwind Standard does not cover experimental or investigational transplant procedures, or any services that are not medically necessary. When it comes to making sure you get the best care possible, we believe that the best approach is to work with your doctor to determine the best course of action. It's important to note that coverage for transplants is subject to preauthorization, so it's important to make sure that you get the necessary authorization for any transplant procedures before you move forward. There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants.", "latency": 3.146726, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE thoroughly and accurately addresses the QUERY, including all relevant details from the CONTEXT about ensuring coverage for transplants under the Northwind Standard plan.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights that enhance understanding, such as discussing potential costs and working closely with healthcare providers.", "answer_length": 983, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the benefits of using in-network providers according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, using in-network providers results in lower out-of-pocket costs for the policyholder. This is because the plan covers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, which directly impacts the costs incurred by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "According to the Northwind Health Plus Benefits Details, the benefits of using in-network providers include saving money because in-network providers typically charge lower rates. Additionally, in-network providers often provide a higher level of care compared to out-of-network providers. Staying in-network helps members get the most out of their coverage. It is also important to check that the provider is in-network and that services are covered by the plan to avoid unexpected expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=15][Northwind_Health_Plus_Benefits_Details.pdf#page=94].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=1: Contoso Electronics Northwind Health Plus Plan Contoso ElectronicsThis document contains information generated using a language model (Azure OpenAI). The information contained in this document is only for demonstration purposes and does not reflect the opinions or beliefs of Microsoft. Microsoft makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this document. All rights reserved to MicrosoftSummary of Benefits Northwind Health Plus Northwind Health Plus is a comprehensive plan that provides comprehensive coverage for medical, vision, and dental services. This plan also offers prescription drug coverage, mental health and substance abuse coverage, and coverage for preventive care services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and other assistance. . Use your plan's in-network providers whenever possible, as this will help you save money. . Utilize Northwind Health's online pharmacy service, which allows you to easily order and manage your prescriptions without leaving home. 路 When you receive health care services, make sure to check that the provider is in-network and that the services are covered by your plan. . Keep track of your claims and other plan information, as this will help you to better understand your plan and stay on top of your health care expenses.. Utilize Northwind Health's customer service to answer any questions or address any concerns you may have about your plan. Healthcare Providers - Independent Contractors OTHER INFORMATION ABOUT THIS PLAN Healthcare Providers - Independent Contractors The Northwind Health Plus plan includes coverage for healthcare services provided by independent contractors.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.190845, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, addressing the QUERY with all relevant details from the CONTEXT without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about checking provider status and service coverage to avoid unexpected expenses.", "answer_length": 597, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Health Plus plan address TMJ symptoms and what are the covered services for TMJ treatment?", "truth": "The Northwind Health Plus plan addresses TMJ symptoms by recommending various non-invasive methods such as avoiding chewing gum, large meals, extreme jaw movements, practicing relaxation techniques, and using heat and cold therapy to reduce pain and muscle tension. Additionally, the plan covers therapeutic injections, which are a type of procedure where drugs or other substances are injected directly into the body to treat medical conditions and provide relief from pain, including TMJ. [Northwind_Health_Plus_Benefits_Details.pdf#page=57] [Northwind_Standard_Benefits_Details.pdf#page=54]", "answer": "Response does not adhere to the expected schema. The answer should be accessible via the JMESPath expression 'message.content' and the context should be accessible via the JMESPath expression 'context.data_points.text'. Either adjust the app response or adjust send_question_to_target() in evaluate.py to match the actual schema.\nResponse: {'error': \"The app encountered an error processing your request.\\nIf you are an administrator of the app, view the full error in the logs. See aka.ms/appservice-logs for more information.\\nError type: \\n\"}", "context": "Response does not adhere to the expected schema. The answer should be accessible via the JMESPath expression 'message.content' and the context should be accessible via the JMESPath expression 'context.data_points.text'. Either adjust the app response or adjust send_question_to_target() in evaluate.py to match the actual schema.\nResponse: {'error': \"The app encountered an error processing your request.\\nIf you are an administrator of the app, view the full error in the logs. See aka.ms/appservice-logs for more information.\\nError type: \\n\"}", "latency": -1, "groundedness": 1.0, "gpt_groundedness": 1.0, "groundedness_reason": "The response does not relate to the query or context in any way, as it only repeats an error message without addressing the question about TMJ treatment under the Northwind Health Plus plan.", "relevance": 1.0, "gpt_relevance": 1.0, "relevance_reason": "The RESPONSE is completely unrelated to the QUERY, as it discusses an error message rather than providing information about TMJ treatment under the Northwind Health Plus plan.", "answer_length": 602, "citations_matched": 0.0, "any_citation": false} +{"question": "Considering the Northwind Health Plus Benefits Details, how does the coverage of virtual care services relate to the limitations on services like laboratory tests and mental health services?", "truth": "Northwind Health Plus covers the cost of virtual care services, including telemedicine, e-visits, and other virtual consultations with in-network providers, which can be used for diagnosing and treating minor medical conditions or following up on existing medical issues. However, there are limitations to these virtual care services as some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. Additionally, some services may require prior authorization. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=28]", "answer": "Northwind Health Plus covers virtual care services such as telemedicine and e-visits for diagnosing and treating minor medical conditions and follow-ups. However, some services like laboratory tests, imaging studies, and mental health services may not be available via virtual care and may require in-person visits or prior authorization. Thus, while virtual care offers convenience and cost savings, it has limitations regarding these specific services [Northwind_Health_Plus_Benefits_Details.pdf#page=60].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization. We encourage you to take advantage of virtual care services when appropriate. To make the most of your virtual care experience, be sure to: 路 Prepare for your visit: Make sure you have the necessary supplies and documents in advance, such as your insurance card, medical history, and any questions you may have.路 Follow up: If you need to follow up with your doctor, be sure to do so. Virtual care services are an excellent way to stay in touch with your provider. . Follow instructions: Make sure you follow any instructions given to you by your doctor during or after your virtual visit. 路 Contact us: If you have any questions or need help scheduling a virtual visit, please contact Northwind Health customer service. At Contoso, we understand that today's busy lifestyles can make it difficult to schedule and attend doctor's appointments. That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=57: With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice. Northwind Standard covers virtual care services in the same way it would cover an in- person visit. This includes a variety of services, such as urgent care, primary care, mental health and substance abuse services, and specialist visits. Members also have access to telehealth post-discharge care and chronic disease management. Exceptions Although Northwind Standard covers most virtual care services, there are a few exceptions. Virtual care is not covered for any services that require a physical exam, such as pediatric well-child visits, physical therapy, and lab work. Additionally, virtual care is not covered for any services that require in-person care, such as surgeries and imaging tests. Tips for Members We want to make sure our members get the most out of their virtual care visits. Here are a few tips to help make your virtual care visits as successful as possible: - Make sure your doctor is in-network.", "latency": 3.162411, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY by explaining the relationship between the coverage of virtual care services and the limitations on certain services, as described in the CONTEXT. It includes all relevant details and does not introduce any extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, explaining the relationship between virtual care services and the limitations on other services.", "answer_length": 507, "citations_matched": 0.5, "any_citation": true} +{"question": "How does Northwind Health Plus manage coinsurance for virtual care services according to the Northwind_Health_Plus_Benefits_Details.pdf?", "truth": "Northwind Health Plus covers the cost of virtual care services, which include telemedicine, e-visits, and other virtual consultations with in-network providers, potentially reducing out-of-pocket costs such as coinsurance for these services. However, it is important to note that some services may require prior authorization, and limitations may apply, such as certain services not being available via virtual care. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "The Northwind_Health_Plus_Benefits_Details.pdf does not provide specific information about how coinsurance is managed for virtual care services under Northwind Health Plus. It mentions that virtual care services are covered and can help avoid out-of-pocket costs associated with in-person visits, but it does not detail coinsurance management [Northwind_Health_Plus_Benefits_Details.pdf#page=60].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: Have your insurance card on hand: Bring your insurance card with you to the visit, as you may need to provide it to the facility. . Bring your medical records: If you have any relevant medical records, bring them with you to the facility. This will help the provider make a more informed diagnosis. 路 Know when to go to the emergency room: If you are experiencing a medical emergency, call 911 or go to the nearest emergency room for treatment. We understand that receiving urgent care can be a stressful situation. At Northwind Health Plus, we strive to make the process as easy and stress-free as possible. If you have any questions about your coverage, please reach out to us so we can help. Virtual Care COVERED SERVICES: Virtual Care At Contoso, we understand that taking time off to go to the doctor's office isn't always possible. That's why we've partnered with Northwind Health to provide access to virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=61: That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home. Weight Management WEIGHT MANAGEMENT - COVERED SERVICES Weight management is an important part of overall health and wellness, and Northwind Health Plus recognizes this. As part of your health plan, you have access to a variety of coverage options for weight management. Coverage for Weight Loss Programs Northwind Health Plus offers coverage for medically supervised weight loss programs. These programs are designed to help you reach and maintain a healthy weight. Covered services may include nutrition counseling, medical evaluation and follow-up, and laboratory tests. Your plan may also cover the cost of medications prescribed by your doctor as part of your weight loss program. Coverage for Weight Loss Surgery Northwind Health Plus also offers coverage for weight loss surgery. Weight loss surgery is a serious procedure that can help some people achieve major health benefits.", "latency": 2.243822, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately states that the CONTEXT does not provide specific information about coinsurance management for virtual care services, which is correct. It does not introduce any incorrect information and is grounded in the CONTEXT provided.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE is relevant as it directly addresses the QUERY by stating that the document does not contain specific information about coinsurance management for virtual care services. It provides a complete answer to the question by clarifying the absence of details in the document.", "answer_length": 396, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the financial responsibilities of a Northwind Standard plan holder when using out-of-network providers according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, when a Northwind Standard plan holder uses out-of-network providers, they may be responsible for the entire cost of services or a far greater portion of the cost than they would with an in-network provider. Although Northwind Standard may offer coverage for some out-of-network providers, the costs associated with these providers can be significantly more expensive. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "According to Northwind_Standard_Benefits_Details.pdf, a Northwind Standard plan holder using out-of-network providers may be responsible for the entire cost of services or a much larger portion than with in-network providers. Coverage for out-of-network providers is limited and can be significantly more expensive. Additionally, some services may not be covered at all, requiring out-of-pocket payment [Northwind_Standard_Benefits_Details.pdf#page=10].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay. ExceptionsNorthwind Health Plus does not cover certain types of emergency services. These include services for certain social and cosmetic procedures, elective surgery, experimental treatments, and services for injuries or illnesses that are not medically necessary. Tips for Employees It is important to keep in mind that if you have an emergency, you should seek care from the nearest hospital or medical facility. Regardless of whether it is in-network or out-of- network, you will be covered. It is also important to remember that if you receive care from an out-of-network provider, you may be responsible for higher out-of-pocket costs. It is also important to be aware of the exceptions to Northwind Health Plus' coverage of emergency services. Certain services, such as those for elective surgery and experimental treatments, are not covered. Lastly, it is important to keep your Northwind Health Plus ID card with you at all times.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 2.101646, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information directly from the CONTEXT, without introducing any unrelated or incorrect information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not add extraneous information but provides a clear explanation of the financial responsibilities.", "answer_length": 453, "citations_matched": 0.5, "any_citation": true} +{"question": "How does the clinical review process in the Northwind Standard Benefits Details ensure timely and cost-effective medical service provision, and what are the documentation requirements for filing a claim as outlined in the same document?", "truth": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by requiring pre-authorization for some medical services and by designing the process to ensure that medically necessary treatments are provided efficiently. Members are advised to provide accurate and detailed information about their medical needs, including a complete list of current medications and all relevant medical history, along with any necessary documentation like test results or lab reports. For filing a claim, the necessary documentation includes itemized bills, a completed claim form, and any other documentation requested by Northwind Health. This process helps in ensuring that members receive high-quality, cost-effective care. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by requiring members to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history. Members must also submit necessary documentation such as test results or lab reports. This process is designed to be straightforward and efficient to ensure medically necessary treatments are provided promptly and cost-effectively [Northwind_Standard_Benefits_Details.pdf#page=68].\n\nFor filing a claim, members must file all claims within twelve months of the date of service to ensure timely processing; late claims may be denied or reviewed without guarantee of acceptance. Claims can be filed directly through the Northwind website or app, and if filing on behalf of a family member, authorization is required. Some services require pre-approval, and providers may need to submit requests before services like MRI/CT scans or physical therapy are performed. Members should keep copies of all documentation related to their services and contact Northwind Health if unsure about filing requirements [Northwind_Standard_Benefits_Details.pdf#page=78][Northwind_Standard_Benefits_Details.pdf#page=79].", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=79: You should also keep copies of all documentation related to your services, and if you're unsure of the filing requirements, you should contact Northwind Health for clarification. Overall, timely filing is an important part of the claim filing process. By following the guidelines for timely filing and including all necessary documentation with your claims, you can help ensure that your claims are processed quickly and accurately. COMPLAINTS AND APPEALS What You Can Appeal COMPLAINTS AND APPEALS What You Can Appeal When you have Northwind Standard coverage, you have the right to appeal any denial of services or payment of benefits. This includes if you disagree with the amount of the payment or if you feel that your claim was denied incorrectly. You also have the right to appeal if you feel that an authorization was not provided for a service, or if you believe that a service should be covered by your plan but was not. If you believe that your claim was wrongly denied or that you have a dispute over a service that is covered or not covered, you have the right to file a formal appeal.", "latency": 3.646689, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses both aspects of the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both aspects of the QUERY with accurate and complete information, making it a complete response.", "answer_length": 1302, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the process for ensuring cost-effective care under the Northwind Standard plan?", "truth": "The process for ensuring cost-effective care under the Northwind Standard plan involves a clinical review process that requires pre-authorization for some medical services. This process is designed to ensure that medically necessary treatments are provided in a timely and cost-effective manner. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, along with any necessary documentation like test results or lab reports. This helps to ensure that the clinical review process runs smoothly and quickly. [Northwind_Standard_Benefits_Details.pdf#page=68] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "The process for ensuring cost-effective care under the Northwind Standard plan involves a clinical review conducted by licensed clinicians in Northwind Health's Medical Management Department. This review evaluates the medical necessity and appropriateness of proposed treatments using evidence-based guidelines. The clinical review process has three levels, starting with evaluation by a Registered Nurse or Medical Doctor. Members may need to obtain pre-authorization for some services, providing detailed and accurate medical information, including medications and relevant history, to help the process run smoothly. The process is designed to be straightforward, efficient, and to ensure timely, cost-effective care. Exceptions are available to help members receive necessary care promptly. Additionally, personal health support programs are offered to help members manage chronic illnesses and optimize care through specialized teams and tailored resources [Northwind_Standard_Benefits_Details.pdf#page=67][Northwind_Standard_Benefits_Details.pdf#page=68].", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed \n\nNorthwind_Standard_Benefits_Details.pdf#page=68: The process is designed to be straightforward and efficient, and the exceptions that are available can help to ensure that members receive the care they need in a timely manner. Byunderstanding the clinical review process and the exceptions that are available, members can help to ensure that they receive the care they need in a timely and cost-effective manner. Personal Health Support Programs CARE MANAGEMENT At Northwind Health, we understand that making sure you get the care you need is an essential part of your overall health. That's why we offer a range of personal health support programs that are part of the Northwind Standard plan. Personal Health Support Programs Northwind Health's personal health support programs are designed to help you achieve your health goals and optimize your care. Our programs provide you with access to specialized care teams and tailored resources to help you manage chronic illnesses, injuries, and other health-related issues. Our personal health support programs are designed to help you get the most out of your health benefits.", "latency": 2.346485, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing a comprehensive understanding of the process for ensuring cost-effective care under the Northwind Standard plan. It also includes additional insights into the support programs, making it a comprehensive response with insights.", "answer_length": 1060, "citations_matched": 0.5, "any_citation": true} +{"question": "Considering the information provided in the Northwind Health Plus Benefits Details, how can a policyholder effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers?", "truth": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, a policyholder should use an in-network provider within the Northwind Health Plus network. This is crucial as in-network providers have agreed to charge lower rates for their services, which can help save money on out-of-pocket costs. Additionally, the policyholder needs to provide the other employer plan's information to coordinate benefits. It is also important to understand the plan's rules for coordinating benefits and to inquire about the cost of services before receiving them to ensure benefits are coordinated correctly and cost-effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, a policyholder should:\n\n1. Use an in-network provider within the Northwind Health Plus network, as this ensures lower out-of-pocket costs due to negotiated discounted rates and proper coordination of benefits [Northwind_Health_Plus_Benefits_Details.pdf#page=77][Northwind_Health_Plus_Benefits_Details.pdf#page=3].\n\n2. Provide information about the other employer plan when using Northwind Health Plus to coordinate benefits correctly [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\n3. Understand the plan's rules for coordinating benefits, including exceptions such as not coordinating with non-major medical plans or high-deductible plans until the deductible is met [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\n4. Ask healthcare providers about the cost of services before receiving them to avoid unexpected expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\n5. Keep track of all out-of-pocket expenses and be aware of the plan's annual deductible and coinsurance amounts [Northwind_Health_Plus_Benefits_Details.pdf#page=75].\n\nFollowing these steps will help a policyholder manage costs effectively when coordinating benefits with another employer plan using in-network providers.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=77: To coordinate benefits with your other employer plan, you must use an in-network provider within the Northwind Health Plus network. You will need to provide your other employer plan's information in order to coordinate benefits. Exceptions There are a few exceptions to coordinating benefits with other health care plans. For example, you cannot coordinate benefits with a health plan that is not a major medical plan. Also, if you are enrolled in a health plan that is a high-deductible plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible. Tips If you have other health care coverage, here are a few tips to help you coordinate benefits with Northwind Health Plus: . Make sure you have your other health care plan's information handy when you use Northwind Health Plus. 路 Always use an in-network provider within the Northwind Health Plus network to ensure that your benefits are coordinated correctly. 路 Make sure you understand your plan's rules for coordinating benefits. 路 Ask your doctor or other health care provider about the cost of services before you receive them to make \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=75: If you are considering a medical service or treatment that is not covered under the plan, you should discuss payment options with your doctor or healthcare provider. Additionally, you may need to consider other payment sources, such as private insurance, flexible spending accounts, or state or federal programs.Finally, it is important to understand the plan's coverage limits and to keep track of all out- of-pocket expenses. You should also be aware of your plan's annual deductible and coinsurance amounts. By understanding Northwind Health Plus's exclusions and following the tips outlined above, you can ensure that you are receiving the most comprehensive coverage available under the plan and avoid any unexpected costs. WHAT IF I HAVE OTHER COVERAGE? Coordinating Benefits With Other Health Care Plans WHAT IF I HAVE OTHER COVERAGE? Coordinating Benefits With Other Health Care Plans If you have other health care coverage, such as Medicare or a health plan from another employer, you may be able to coordinate benefits with Northwind Health Plus. Coordinating benefits means that both plans work together to pay for covered services.", "latency": 3.373029, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, directly addressing the QUERY with precise information from the CONTEXT. It demonstrates complete understanding and does not add extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing all necessary steps for managing out-of-pocket costs and coordinating benefits with another employer plan using in-network providers.", "answer_length": 1310, "citations_matched": 0.5, "any_citation": true} +{"question": "Considering the Northwind Health Plus benefits, how does choosing an in-network provider affect the out-of-pocket costs for a policyholder, and what are the covered services under hospice care according to the plan?", "truth": "Choosing an in-network provider under the Northwind Health Plus plan significantly affects the out-of-pocket costs for a policyholder by reducing them. When a policyholder uses in-network providers, they pay lower out-of-pocket costs compared to using out-of-network providers, where they would be responsible for a larger portion of the cost. Regarding hospice care, the Northwind Health Plus coverage includes care from a hospice team, medications, medical supplies, equipment for treating the terminal illness, counseling for the member and their family, inpatient and respite care, grief counseling, and bereavement services. However, it does not cover services intended to cure the terminal illness, such as chemotherapy, radiation therapy, and surgery. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=33]", "answer": "Choosing an in-network provider with Northwind Health Plus generally results in lower out-of-pocket costs for the policyholder. In-network hospital services are covered at 100%, so you won't be responsible for additional costs, although copayments or coinsurance may apply depending on the service type. Out-of-network providers may result in significantly higher costs, and services may not count toward your deductible or out-of-pocket maximum. You may also face balance billing for the difference between provider charges and plan payments. Exceptions exist for emergencies or when traveling outside the U.S. without in-network options [Northwind_Health_Plus_Benefits_Details.pdf#page=6][Northwind_Health_Plus_Benefits_Details.pdf#page=8][Northwind_Health_Plus_Benefits_Details.pdf#page=34].\n\nRegarding hospice care, Northwind Health Plus covers services including palliative care, bereavement services, and support groups, which provide emotional and spiritual support to members and their families during difficult times. It is recommended to discuss with your doctor about additional hospice services that may be available [Northwind_Health_Plus_Benefits_Details.pdf#page=34].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=34: Finally, it is important to talk to your doctor about any other services that may be available to you and your family through hospice care. These services may include palliative care, bereavement services, and support groups. These services can provide emotional and spiritual support to members and their families during this difficult time. Hospital COVERED SERVICES: Hospitals Northwind Health Plus provides coverage for hospital services, both in-network and out-of- network. In-network hospital services are covered at 100%, meaning you won't be responsible for any additional costs. Out-of-network services are covered at a lower rate, meaning you may be responsible for a portion of the costs.When visiting an in-network hospital, you may be required to pay a copayment or coinsurance depending on the type of service you're receiving. Copayments are a fixed dollar amount that you're responsible for paying, while coinsurance is a percentage of the total cost of the services. It's important to note that some services, such as cosmetic procedures, are not covered by Northwind Health Plus.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 3.308462, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses both aspects of the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both parts of the QUERY with accurate and complete information, making it a complete response.", "answer_length": 1182, "citations_matched": 0.0, "any_citation": true} +{"question": "What is the process for getting a service covered under Northwind Standard Benefits Details?", "truth": "To get a service covered under Northwind Standard Benefits Details, prior authorization must be requested from Northwind Health either by the provider or the member before the service is received. If prior authorization is not obtained, Northwind Health may not cover the service. Certain services such as preventive care, emergency care, outpatient hospital services, urgent care, and services in a skilled nursing facility are exempt from this prior authorization process. [Northwind_Standard_Benefits_Details.pdf#page=60] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To get a service covered under Northwind Standard Benefits, follow these steps:\n\n1. Understand your plan details and out-of-pocket costs before receiving the service.\n2. Use in-network providers to maximize coverage and avoid extra costs.\n3. Ask your healthcare provider for a detailed explanation of the service and its medical necessity if required.\n4. Ensure all documentation is complete, including forms, test results, and physician's notes.\n5. Submit your claim and documentation to Northwind Health as soon as possible.\n6. Include information about any other health coverage you have to ensure proper billing.\n7. Track your claim and follow up with Northwind Health if it is not processed timely.\n\nFollowing these steps helps ensure your claim is processed quickly and accurately under the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=17][Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=73].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan \n\nNorthwind_Standard_Benefits_Details.pdf#page=17: Make sure to understand the details of the plan and the associated out-of-pocket costs before receiving a service. 路 Select in-network providers to maximize coverage and avoid unexpected costs. 路 Submit claims as soon as possible after a service is rendered. 路 Track claims and follow up with Northwind Health if a claim is not processed in a timely manner. 路 Take advantage of preventive services to stay healthy and reduce future costs. . Ask questions and contact Northwind Health if you need assistance understanding your coverage or filing a claim. By understanding the details of the Northwind Standard plan and following the tips above, employees can ensure that they are taking full advantage of their benefits. Taking the timeto understand the plan and ask questions can help employees to make the most of their coverage and stay healthy. COVERED SERVICES Acupuncture COVERED SERVICES: Acupuncture At Contoso, we are proud to offer employees Northwind Standard, an insurance plan that includes coverage for acupuncture.", "latency": 3.939397, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely addresses the query by providing a detailed process for getting a service covered, as supported by the context. It includes all relevant steps mentioned in the context, demonstrating a thorough understanding of the process.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, providing a comprehensive understanding of the process. It also includes additional insights by referencing specific document pages, enhancing the response's relevance and usefulness.", "answer_length": 969, "citations_matched": 0.0, "any_citation": true} diff --git a/evals/results/baseline/evaluate_parameters.json b/evals/results/baseline/evaluate_parameters.json index c2caefdb12..609c15563f 100644 --- a/evals/results/baseline/evaluate_parameters.json +++ b/evals/results/baseline/evaluate_parameters.json @@ -1,6 +1,6 @@ { "evaluation_gpt_model": "gpt-4o", - "evaluation_timestamp": 1746818372, + "evaluation_timestamp": 1748932460, "testdata_path": "/Users/pamelafox/azure-search-openai-demo/evals/ground_truth.jsonl", "target_url": "http://localhost:50505/chat", "target_parameters": { diff --git a/evals/results/baseline/summary.json b/evals/results/baseline/summary.json index ed12752813..2056925596 100644 --- a/evals/results/baseline/summary.json +++ b/evals/results/baseline/summary.json @@ -1,31 +1,31 @@ { "gpt_groundedness": { - "pass_count": 43, - "pass_rate": 0.86, - "mean_rating": 4.5 + "pass_count": 47, + "pass_rate": 0.94, + "mean_rating": 4.76 }, "gpt_relevance": { - "pass_count": 42, - "pass_rate": 0.84, - "mean_rating": 4.22 + "pass_count": 47, + "pass_rate": 0.94, + "mean_rating": 4.42 }, "answer_length": { - "mean": 919.26, - "max": 1647, - "min": 193 + "mean": 829.06, + "max": 1380, + "min": 275 }, "latency": { - "mean": 4.46, - "max": 15.129978, - "min": 2.465542 + "mean": 2.89, + "max": 5.183753, + "min": -1.0 }, "citations_matched": { - "total": 24, - "rate": 0.49 + "total": 26, + "rate": 0.52 }, "any_citation": { - "total": 50, - "rate": 1.0 + "total": 49, + "rate": 0.98 }, "num_questions": { "total": 50 diff --git a/evals/results/gpt4omini-emb3l-2/config.json b/evals/results/gpt4omini-emb3l-2/config.json new file mode 100644 index 0000000000..99de8ef295 --- /dev/null +++ b/evals/results/gpt4omini-emb3l-2/config.json @@ -0,0 +1,28 @@ +{ + "testdata_path": "ground_truth.jsonl", + "results_dir": "results/experiment", + "requested_metrics": ["gpt_groundedness", "gpt_relevance", "answer_length", "latency", "citations_matched", "any_citation"], + "target_url": "http://localhost:50505/chat", + "target_parameters": { + "overrides": { + "top": 3, + "temperature": 0.3, + "minimum_reranker_score": 0, + "minimum_search_score": 0, + "retrieval_mode": "hybrid", + "semantic_ranker": true, + "semantic_captions": false, + "suggest_followup_questions": false, + "use_oid_security_filter": false, + "use_groups_security_filter": false, + "vector_fields": [ + "embedding" + ], + "use_gpt4v": false, + "gpt4v_input": "textAndImages", + "seed": 1 + } + }, + "target_response_answer_jmespath": "message.content", + "target_response_context_jmespath": "context.data_points.text" +} diff --git a/evals/results/gpt4omini-emb3l-2/eval_results.jsonl b/evals/results/gpt4omini-emb3l-2/eval_results.jsonl new file mode 100644 index 0000000000..242b24fa0d --- /dev/null +++ b/evals/results/gpt4omini-emb3l-2/eval_results.jsonl @@ -0,0 +1,50 @@ +{"question": "What protection does Contoso offer against balance billing?", "truth": "Contoso offers a balance billing protection through the Northwind Standard plan, which protects employees from unexpected costs when visiting in-network providers. [Northwind_Standard_Benefits_Details.pdf#page=7]", "answer": "Contoso offers balance billing protection through the Northwind Standard plan when visiting in-network providers. This means you are protected from unexpected costs that arise from balance billing, which occurs when a provider bills you for the difference between their charges and what your insurance pays. However, this protection does not apply to emergency services, mental health and substance abuse coverage, out-of-network providers, or any non-covered services [Northwind_Standard_Benefits_Details.pdf#page=7][Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Exceptions to the balance billing protection: 路 Balance billing protection does not apply to emergency services. 路 Balance billing protection does not apply to mental health and substance abuse coverage. 路 Balance billing protection does not apply to out-of-network providers. 路 Balance billing protection is not applicable to any non-covered services. At Contoso, we want to make sure our employees are provided with the best coverage options. That's why we've partnered with Northwind Health to offer the Northwind Standard plan, which provides balance billing protection when visiting in-network providers. We encourage our employees to use the tips provided to help reduce the risk of unexpected costs when visiting a provider. Benefits For Out-Of-Network Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers.\n\nNorthwind_Standard_Benefits_Details.pdf#page=7: Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to offer our employees the Northwind Standard plan. This plan provides a balance billing protection, meaning that you are protected from unexpected costs when visiting in-network providers. What is balance billing? Balance billing is when a provider bills you for the difference between what they charge and what your insurance company is willing to pay. This difference can be hundreds of dollars and is often unexpected. With the Northwind Standard plan, you are protected from balance billing when visiting in-network providers. What is an in-network provider? In-network providers are healthcare providers, such as doctors, hospitals, and labs, that have agreed to accept the Northwind Standard plan's payment terms. Visiting an in-network provider means that you are protected from balance billing. You can find a list of in-network providers on the Northwind Health website. What if I visit an out-of-network provider?\n\nNorthwind_Standard_Benefits_Details.pdf#page=6: If you are unsure, you can contact the customer service department of your health plan to verify.It is also important to ask your provider about their policy on balance billing. Be sure to find out if the provider requires you to pay the balance billing amount up front, or if they will bill you after the health plan pays them. When selecting a provider, also remember to consider the cost of services. Participating providers are often more cost effective than non-participating providers. Additionally, some providers offer discounts to patients who pay out of pocket for services. Finally, if you need to use a non-participating provider for certain services, be sure to check with your health plan first. There may be an exception that will cover the cost of the service. Additionally, if you need to use a non-participating provider and you are concerned about the cost, you can always negotiate with your provider to find a more affordable rate. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to ", "latency": 2.490954, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully correct and complete, accurately reflecting the information provided in the context regarding balance billing protection and its exceptions.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, explaining the protection offered and its limitations. It also provides additional insights by explaining what balance billing is and referencing specific documents for further details.", "answer_length": 566, "citations_matched": 1.0, "any_citation": true} +{"question": "what is in-network mean for Northwind Health?", "truth": "In-network providers for Northwind Health are those who have agreed to accept the payment offered by Northwind Health, meaning that the policyholder only pays the portion of the cost not covered by the insurance plan. These providers may also offer additional services or discounts not available from out-of-network providers. [Northwind_Standard_Benefits_Details.pdf#page=8]", "answer": "In-network providers for Northwind Health are healthcare providers that have contracted with Northwind Health to provide services at a discounted rate. They have agreed to accept the payment amount offered by Northwind Health, meaning you only pay the portion of the cost not covered by the insurance plan. In-network providers may also offer additional services or discounts not available to out-of-network providers [Northwind_Standard_Benefits_Details.pdf#page=8][Northwind_Standard_Benefits_Details.pdf#page=103].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan. In-network providers may also offer additional services or discounts that are not available to out-of-network providers.Out-of-Network: Out-of-network providers are those who have not contracted with Northwind Health. As a result, they are not required to accept the amount of payment offered by Northwind Health, meaning that you may be responsible for a greater portion of the cost. Additionally, out-of-network providers may not offer additional services or discounts that are available to in-network providers. When choosing a provider, it is important to make sure that the provider is in-network. While it is possible to receive care from out-of-network providers, it is important to understand that you will be responsible for a greater portion of the costs. To make sure that you are getting the best value for your health care expenses, it is recommended that you choose an in-network provider whenever possible.\n\nNorthwind_Standard_Benefits_Details.pdf#page=103: Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health. This includes primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Provider: An out-of-network provider is a healthcare provider that is not included in the Northwind Health network and is not eligible to receive payments from Northwind Health. Out-of-network providers are not covered by Northwind Standard. Preventive Care Services: Preventive care services are services that are designed to help prevent illness and promote health. These services may include immunizations, physical exams, screenings, and other preventive care services. Emergency Services: Emergency services are services that are provided in the case of an emergency. These services may include emergency surgery, emergency room visits, or other emergency services. Northwind Standard does not provide coverage for emergency services. Mental Health and Substance Abuse Coverage: Mental health and substance abuse coverage is coverage for services related to mental health and substance abuse.", "latency": 3.311999, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the CONTEXT and directly answering the QUERY about in-network providers for Northwind Health.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, and it includes additional insights about extra services or discounts offered by in-network providers, which enhances understanding.", "answer_length": 517, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the financial implications of choosing an out-of-network provider under the Northwind Standard Benefits Details?", "truth": "Choosing an out-of-network provider under the Northwind Standard Benefits Details can be significantly more expensive than in-network providers. You may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. [Northwind_Standard_Benefits_Details.pdf#page=10]", "answer": "Choosing an out-of-network provider under the Northwind Standard Benefits can have significant financial implications. Here are the key points:\n\n1. Costs for out-of-network providers are generally much higher than for in-network providers. You may be responsible for the entire cost of services or a much larger portion compared to in-network providers [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n2. Services from out-of-network providers may not count towards your deductible or out-of-pocket maximum, meaning you could end up paying the full cost of services minus any applicable discounts [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n3. You may also face balance billing, where the out-of-network provider bills you for the difference between their charges and what Northwind Health pays [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n4. In some cases, if there is no in-network option available, Northwind Health may cover the same amount as if the care was provided by an in-network provider [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n5. Overall, you will likely pay a greater portion of the costs when using out-of-network providers compared to in-network providers [Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.", "latency": 3.363887, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE attempts to answer the QUERY and includes relevant information from the CONTEXT, but it also introduces details from a different benefits plan (Northwind Health Plus) that are not applicable to the Northwind Standard Benefits Details, leading to inaccuracies.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, covering all essential aspects of the financial implications of choosing an out-of-network provider under the Northwind Standard Benefits Details.", "answer_length": 1256, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the coverage limitations of the Northwind Standard plan regarding clinical trials?", "truth": "The Northwind Standard plan does not cover travel expenses associated with attending clinical trials, nor does it cover any experimental treatments or services that are not part of the clinical trial. [Northwind_Standard_Benefits_Details.pdf#page=24]", "answer": "The Northwind Standard plan has the following coverage limitations regarding clinical trials:\n\n1. It does not cover travel expenses associated with attending clinical trials [Northwind_Standard_Benefits_Details.pdf#page=24].\n2. Experimental treatments or services that are not part of the clinical trial are not covered [Northwind_Standard_Benefits_Details.pdf#page=24].\n3. Coverage for clinical trial services is limited to certain services, including diagnostic testing, treatment of the condition being studied, medications, lab services, and imaging services. Other services may be eligible for coverage on a case-by-case basis [Northwind_Standard_Benefits_Details.pdf#page=23].\n\nMembers should consult with their doctor before participating in a clinical trial to understand the risks and benefits [Northwind_Standard_Benefits_Details.pdf#page=24].", "context": "Northwind_Standard_Benefits_Details.pdf#page=24: It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials. Additionally, any experimental treatments or services that are not part of the clinical trial are not covered. When considering participation in a clinical trial, members should always consult with their doctor first to make sure it's the right choice for them. Clinical trials are not for everyone, and it's important to fully understand the risks and benefits before making a decision. Members should also be aware that not all clinical trials are free. Some require a fee, and it's important to find out what the cost will be before participating. Finally, members should keep in mind that clinical trials are often available in limited locations, so they may have to travel to participate in a trial. Northwind Health can provide information about nearby clinical trials and may be able to help with the cost of travel. At Northwind Health, we are committed to providing access to the most innovative treatments and therapies available.\n\nNorthwind_Standard_Benefits_Details.pdf#page=23: Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, and can give members access to treatments and therapies not yet available. Northwind Standard offers coverage for certain clinical trial services, including those related to common diseases and conditions. The Northwind Standard plan covers the cost of certain clinical trial services, and some of the most common include: 路 Diagnostic testing and procedures to confirm or diagnose a condition or disease 路 Treatment of the condition or disease being studied 路 Medications 路 Lab services 路 Imaging services Any other clinical trial services that are not explicitly covered by the Northwind Standard plan may be eligible for coverage on a case-by-case basis. To determine if a clinical trial service is covered, members should contact the Northwind Health customer service department for more information.It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=23: Northwind Health Plus covers certain clinical trials that are approved by the Food and Drug Administration (FDA) and that are considered medically necessary. These clinical trials must also be recommended by your doctor or health care provider. The plan covers FDA- approved drugs, medical treatments, and medical devices that are used in the clinical trial. What Are Some Exceptions? Northwind Health Plus does not cover any experimental treatments that are not approved by the FDA or that are not considered medically necessary. Additionally, the plan does not cover any treatments that are used in the clinical trial that are not considered medically necessary. Clinical trials must be recommended by your doctor or health care provider and must be approved by the FDA in order for the plan to cover them.Tips for Employees If you are considering participating in a clinical trial, there are a few things to keep in mind: . Make sure the clinical trial has been approved by the FDA. . Talk to your doctor or health care provider about the trial and ask any questions you may have. 路 Ask about the potential risks and benefits of participating in the trial.", "latency": 2.782155, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using relevant details from the CONTEXT, demonstrating a thorough understanding of the coverage limitations of the Northwind Standard plan regarding clinical trials.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the coverage limitations of the Northwind Standard plan regarding clinical trials.", "answer_length": 853, "citations_matched": 1.0, "any_citation": true} +{"question": "Does Contoso cover gendr affirming care?", "truth": "Yes, Contoso offers coverage through Northwind Standard for gender affirming care services, which include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. [Northwind_Standard_Benefits_Details.pdf#page=29]", "answer": "Yes, Contoso covers gender affirming care. This includes hormone therapy, gender affirming surgery, and mental health services related to gender transition through both Northwind Health Plus and Northwind Standard. [Northwind_Health_Plus_Benefits_Details.pdf#page=29][Northwind_Standard_Benefits_Details.pdf#page=29].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=29: Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus. This coverage includes hormone therapy, gender affirming surgery, and mental health services related to gender transition. Hormone Therapy: Northwind Health Plus covers hormone therapy for individuals undergoing gender transition. This includes gender-affirming hormone replacement therapy such as testosterone or estrogen. The coverage also includes many medications and treatments related to hormone therapy, such as monitoring blood work, doctor visits, and lab tests. Gender Affirming Surgery: Northwind Health Plus covers gender affirming surgery for individuals undergoing gender transition. Northwind Health Plus also covers pre- and post-operative care related to gender affirming surgery. Mental Health Services:Northwind Health Plus covers mental health services related to gender transition. This includes counseling and therapy visits, as well as medications related to mental health treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=29: Affirming Care COVERED SERVICES - Gender Affirming Care At Contoso, we understand that gender identity is an important part of who we are and that it should be respected and supported. We are proud to offer coverage through Northwind Standard for gender affirming care services. Gender affirming care services can include a variety of treatments and services related to gender transition. These services may include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. Hormone Therapy Hormone therapy is a type of gender affirming treatment that can be used to help an individual align their physical characteristics with their gender identity. This type of therapy involves taking hormones that are typically associated with a certain gender to help the individual's body better reflect their gender identity. Gender Affirming Surgery Gender affirming surgery is a type of treatment that involves surgical procedures to help an individual transition to the gender they identify with. Mental Health Care Mental health care related to gender transition can include counseling and therapy services to help an individual through their transition process.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=28: by a physician Exceptions Our plan does not cover: 路 Routine foot care, such as trimming toenails, callus removal, and shoe inserts路 Foot care products, such as arch supports, shoe inserts, and foot orthotics 路 Services that are not medically necessary Tips for Employees 路 Take preventive steps to minimize foot problems, such as wearing comfortable shoes that fit properly and provide adequate support. 路 If you have diabetes, check your feet daily for sores or other problems. . If you have any foot problems, don't delay seeking medical care. Early diagnosis and treatment can often prevent more serious problems from developing. 路 If you need custom orthotics, be sure to get them from a qualified provider who is knowledgeable in their use. 路 If you're prescribed orthotics, be sure to follow the instructions for use and wear them as directed. 路 If you're prescribed medication, be sure to take it as directed. . If you have any questions about your foot care coverage, please contact Northwind Health Plus. Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus.", "latency": 2.496571, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It also provides additional insights by specifying the types of care covered and the plans through which they are available, making it a comprehensive response.", "answer_length": 317, "citations_matched": 1.0, "any_citation": true} +{"question": "What typs of hearin care servises are covered by the Northwind Standard plan?", "truth": "The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone-anchored hearing aids. It also covers routine hearing aid maintenance and repair, counseling, hearing aid evaluations, and up to $500 per ear for hearing aid accessories such as ear molds, batteries, and tubing. [Northwind_Standard_Benefits_Details.pdf#page=30]", "answer": "The Northwind Standard plan covers the following hearing care services:\n\n- Hearing tests\n- Hearing aids and hearing aid accessories\n- Cochlear implants\n- Bone-anchored hearing aids\n- Up to two hearing aids or implants per ear every three years\n- Routine hearing aid maintenance and repair\n- Counseling and hearing aid evaluations\n- Up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing\n\nThere is no deductible for hearing care services, and no pre-authorization is required. However, services provided by out-of-network providers are not covered, and you would be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount [Northwind_Standard_Benefits_Details.pdf#page=30].", "context": "Northwind_Standard_Benefits_Details.pdf#page=30: We are proud to offer coverage for these services for our employees, and we are committed to providing a safe and supportive environment for all of our employees. Hearing Care Hearing Care At Contoso, we understand the importance of taking care of your hearing health. That's why we provide comprehensive coverage for hearing care with Northwind Standard. You can receive hearing care services from any in-network provider and enjoy comprehensive coverage for all hearing care services. The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone- anchored hearing aids. If a hearing aid or cochlear implant is needed, the plan covers up to two hearing aids or implants per ear every three years. The plan also covers routine hearing aid maintenance and repair, as well as counseling and hearing aid evaluations. In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing.\n\nNorthwind_Standard_Benefits_Details.pdf#page=30: In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing. There is no deductible for hearing care services and no pre-authorization is required. However, the Northwind Standard plan does not cover hearing care services provided by out-of-network providers. If you choose to see an out-of-network provider for hearing care, you will be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount. When it comes to choosing a hearing care provider, it's important to find one who is qualified and experienced. Make sure to ask questions about the provider's qualifications, experience, and specialties. You should also ask about the provider's policies on returns, warranties, and repairs. It's also important to understand the technology behind hearing aids. Ask your provider to explain the differences between digital and analog technology, and be sure to ask about the various features that are available. If you have any questions about the Northwind Standard plan's coverage for hearing care, please \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=30: Be sure to check with your provider and Northwind Health Plus about any pre- authorization requirements. . If you have any questions about your coverage, call Northwind Health Plus customer service. Hearing Care COVERED SERVICES: Hearing Care At Contoso, we understand how important it is for our employees to stay on top of their overall health. That is why we are proud to offer comprehensive hearing care coverage through Northwind Health Plus. This coverage can be used for a variety of hearing care services, including but not limited to hearing tests and evaluations, hearing aids and other associated services, as well as hearing aid fittings and adjustments. In order to take advantage of this coverage, employees must receive care from an in- network provider. Northwind Health Plus has a wide selection of providers in its network, making it easy to find a provider who is right for you. Additionally, the plan covers hearing aid fittings, adjustments, repairs, and replacements, as well as batteries, when necessary. When it comes to hearing aid coverage, Northwind Health Plus covers up to $1,500 every 3 years for all hearing aid services, including the hearing aid itself.", "latency": 2.645105, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information directly from the CONTEXT without introducing any unrelated or incorrect information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about financial aspects and network provider conditions, which enhance understanding.", "answer_length": 756, "citations_matched": 1.0, "any_citation": true} +{"question": "Does Northwind Helth cover full costs?", "truth": "Northwind Health may not cover the full cost of a specialist or other non-emergency services. [Northwind_Standard_Benefits_Details.pdf#page=34]", "answer": "Northwind Health may not cover the full cost of specialist or non-emergency services, and you could be responsible for additional costs such as co-pays, coinsurance, or charges for services not covered by your plan [Northwind_Standard_Benefits_Details.pdf#page=34]. If you use an out-of-network provider, you may be responsible for paying the full cost of the services received [Northwind_Health_Plus_Benefits_Details.pdf#page=3]. Additionally, some services may not be covered at all, and you may need to check with Northwind Health prior to receiving services to determine your financial responsibility [Northwind_Health_Plus_Benefits_Details.pdf#page=16].", "context": "Northwind_Standard_Benefits_Details.pdf#page=34: For example, Northwind Health may not cover the full cost of a specialist or other non-emergency services. It is important to be aware of these exceptions when selecting a hospital. When selecting a hospital, you should also consider other services that the hospital offers. For example, some hospitals may offer additional services such as physical therapy, nutrition counseling, or other wellness services. Additionally, some hospitals may offer special programs for specific conditions or diseases. Finally, you should consider the cost of care at the hospital you are considering. Northwind Health may cover some or all of the costs of your care, but you should be aware of any additional costs that you may be responsible for. This includes any co-pays or coinsurance, as well as any additional charges for services not covered by your plan. By taking the time to consider your options, you can select the best hospital for your healthcare needs. Northwind Standard offers coverage for a variety of in-network hospitals, giving you the opportunity to select the hospital that best meets your needs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.", "latency": 2.684698, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely addresses the query using relevant information from the context, demonstrating a full understanding of the coverage limitations of Northwind Health.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, including additional insights about potential costs and conditions affecting coverage.", "answer_length": 658, "citations_matched": 1.0, "any_citation": true} +{"question": "what is Northwind Standard Benefits Details?", "truth": "The Northwind Standard Benefits Details include information on managing prescriptions online or via phone, using a mobile app, and potential discounts on generic medications at preferred pharmacies. It also notes that the plan does not cover certain medications like those for weight loss or fertility treatments, compounded medications, or non-FDA-approved drugs. Over-the-counter medications are also not covered unless prescribed by a doctor. [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "The Northwind Standard plan is a comprehensive health plan that covers medical, vision, and dental services, including preventive care and prescription drug coverage. It provides access to a variety of in-network providers, such as primary care physicians, specialists, hospitals, and pharmacies. \n\nKey covered services include:\n- Preventive care services (physicals, immunizations, screenings)\n- Diagnostic tests and treatments\n- Medical consultations\n- Physical therapy\n- Mental health services\n- Prescription drugs\n- Inpatient hospital services\n- Emergency services\n\nHowever, it does not cover certain services, including cosmetic services, experimental treatments, and most dental services, nor does it cover services from out-of-network providers. It is important to check with Northwind Health for in-network providers to avoid unexpected costs. Northwind Health also offers tools like a cost estimator and a provider directory, along with 24/7 customer service for assistance with coverage questions [Northwind_Standard_Benefits_Details.pdf#page=98][Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 3.542278, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information about the Northwind Standard Benefits, including additional insights about tools and services offered by Northwind Health, making it a comprehensive response.", "answer_length": 1155, "citations_matched": 0.0, "any_citation": true} +{"question": "What types of rehabilitation therapy does Northwind Standard cover?", "truth": "Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. Coverage includes medically necessary services related to an injury or illness, along with the use of equipment and specialized supplies. [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "Northwind Standard covers the following types of rehabilitation therapy services:\n\n1. **Physical Therapy**: Coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies.\n2. **Occupational Therapy**: Coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies.\n3. **Speech Therapy**: Coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies.\n\nExceptions include services related to cosmetic or reconstructive surgery, treatment of obesity or weight control, and treatment of sleep disorders, which are not covered by the plan [Northwind_Standard_Benefits_Details.pdf#page=48].", "context": "Northwind_Standard_Benefits_Details.pdf#page=48: Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. For physical therapy, coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies. For occupational therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. For speech therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. Exceptions Unfortunately, Northwind Standard does not cover any services related to cosmetic or reconstructive surgery, or any services related to the treatment of obesity or weight control. This plan also does not cover services related to the treatment of sleep disorders. Tips When looking for a rehabilitation therapy provider, make sure that they are in-network and covered by your plan. Also, keep in mind that you may need a referral from a primary care physician for some services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=47: Additionally, the plan does not cover any costs associated with psychological or neuropsychological testing that is done for non-medical reasons such as pre-employment screening or for legal purposes. In order to ensure that your psychological or neuropsychological testing services are covered under the Northwind Standard plan, it is important to review your plan's Summary of Benefits and Coverage (SBC) document. This document will provide you with a full list of covered services, as well as any exceptions that may apply. Overall, the Northwind Standard plan provides coverage for psychological and neuropsychological testing services when they are prescribed or ordered by a health care professional and when they are provided by an in-network provider. It is important to be aware of any exceptions that may apply, as well as to select a highly qualified in-network provider for your tests in order to ensure that your services are covered in full.Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy.\n\nNorthwind_Standard_Benefits_Details.pdf#page=50: In addition, Northwind Standard provides coverage for certain services that are not typically covered by other health plans, such as detoxification services, residential treatment services, and recovery support services. While Northwind Standard does provide coverage for substance use disorder treatment services, there are some exceptions to this coverage. For example, Northwind Standard does not cover services that are provided in a hospital emergency room or a hospital inpatient setting unless they are medically necessary and pre-authorized by Northwind Health. We understand that substance use disorder can have a devastating impact, and we want to make sure that our employees have access to the care they need. If you have any questionsabout Northwind Standard's coverage for substance use disorder services, please contact Northwind Health and speak to one of our customer service representatives. Here are some tips that could be helpful to our employees who may be struggling with substance use disorder: . Seek help as soon as possible. Early intervention and treatment can make a significant difference in achieving successful recovery.", "latency": 2.934328, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately listing the types of rehabilitation therapy covered and including relevant details about exceptions, making it a complete and correct answer.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query by listing the types of rehabilitation therapy covered and includes additional insights about exceptions, making it comprehensive.", "answer_length": 804, "citations_matched": 1.0, "any_citation": true} +{"question": "What shuold I do if I need healthcare services outside Washington with Northwind Health?", "truth": "If you need healthcare services outside Washington, you should contact Northwind Health to get an estimate of the cost of care for services you may need. It is also important to find in-network providers in the state where you are living to receive coverage, and keep your Northwind Standard plan active while you are out of state to remain eligible for coverage. [Northwind_Standard_Benefits_Details.pdf#page=59]", "answer": "If you need healthcare services outside Washington with Northwind Health, you should:\n\n1. Ensure that the provider you plan to visit is part of Northwind Health Plus' nationwide network [Northwind_Health_Plus_Benefits_Details.pdf#page=62].\n2. For Northwind Standard, know that it covers out-of-area emergency services but not non-emergency services or care received outside of Washington for more than 12 consecutive months [Northwind_Standard_Benefits_Details.pdf#page=60].\n3. You must be outside of Washington for no more than 12 consecutive months, more than 100 miles away from your primary care provider, and your plan must have been in effect for at least 6 months before you receive out-of-area care to be eligible for coverage [Northwind_Standard_Benefits_Details.pdf#page=59].\n4. Contact Northwind Health in advance of receiving care and obtain prior authorization for any services you wish to receive [Northwind_Standard_Benefits_Details.pdf#page=59][Northwind_Standard_Benefits_Details.pdf#page=60].\n\nIf you do not meet these criteria or fail to obtain prior authorization, you may be responsible for the full cost of care.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=62: If you are outside Washington, you may still be eligible for coverage through Northwind Health Plus. Northwind Health Plus offers a network of providers that are located throughout the United States. These providers are part of Northwind Health Plus' nationwide network, which is designed to ensure that you are able to receive care, no matter where you are. Out-of-area care is coverage that extends outside of Washington. This means that if you travel outside of the state, you can still receive care from a Northwind Health Plus provider. However, there are some exceptions to this coverage. For example, you may be limited to a certain number of visits or treatments that are covered outside of Washington. Additionally, certain services may not be covered, such as home health care services that are provided outside of the state. If you travel outside of Washington, it is important to keep a few tips in mind. First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=59: It is important to know that Northwind Standard does not provide coverage for non- emergency services outside of Washington. That means you may be responsible for the full cost of care if you seek out care for a condition that could have been treated in Washington. In order to receive coverage for out-of-area care, you must meet the following criteria: . You must be outside of Washington for no more than 12 consecutive months . You must be more than 100 miles away from your primary care provider 路 Your plan must have been in effect for at least 6 months before you receive out-of-area care If you meet the criteria listed above, you may be eligible for coverage of out-of-area services. In order to receive coverage, you must contact Northwind Health in advance of receiving care. You must also obtain prior authorization for any care you wish to receive. If prior authorization is not obtained, you may be responsible for the full cost of care. If you are outside of Washington for more than 12 consecutive months, you may not be eligible for coverage of out-of-area services.", "latency": 7.885499, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY with all necessary details included.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding without adding extraneous information.", "answer_length": 1134, "citations_matched": 1.0, "any_citation": true} +{"question": "What is prior-authorization in Northwind Standard?", "truth": "Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. Without prior-authorization, the employee may be responsible for the full cost of any services or treatments received without approval. [Northwind_Standard_Benefits_Details.pdf#page=63]", "answer": "Prior-authorization in Northwind Standard is a process where employees must obtain approval from Northwind Health before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of the services. The process involves the employee's physician submitting a request to Northwind Health, which will review it to determine if the service is medically necessary and covered under the plan. Some services that may require prior-authorization include hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs [Northwind_Standard_Benefits_Details.pdf#page=63].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 3.152639, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely describes prior-authorization in Northwind Standard, using information directly from the CONTEXT. It addresses the QUERY fully without adding extraneous information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it includes additional relevant insights, making it comprehensive.", "answer_length": 736, "citations_matched": 1.0, "any_citation": true} +{"question": "What need for pre-authorization in Northwind Standard Benefits?", "truth": "Some medical services under the Northwind Standard Benefits require pre-authorization before they can be approved to ensure that medically necessary treatments are provided in a timely and cost-effective manner. [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "Prior-authorization in Northwind Standard Benefits is required for certain services or treatments to ensure they are necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of the services. Services that may require prior-authorization include hospital stays, certain medical procedures, durable medical equipment, certain prescription drugs, laboratory tests, imaging services, and physical therapy. The employee's physician must submit a request to Northwind Health for approval, which will be reviewed to determine if the service is medically necessary and covered under the plan. Northwind Health will notify the employee and the physician of the decision within three business days. If approved, the service can be received without additional pre-authorization; if denied, there is an option to appeal the decision [Northwind_Standard_Benefits_Details.pdf#page=63][Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 3.220565, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY without introducing unrelated or incorrect information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, providing all essential details about the pre-authorization process in Northwind Standard Benefits. It also offers additional insights into the implications and appeal process, enhancing understanding.", "answer_length": 990, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Standard handle situations where other plans like Medicare or Medicaid are involved?", "truth": "Northwind Standard may pay first in situations where other plans like Medicare, Medicaid, or a veterans' health plan are involved, even if these other plans are usually the primary payer. [Northwind_Standard_Benefits_Details.pdf#page=75]", "answer": "The Northwind Standard handles situations involving other plans like Medicare or Medicaid as follows:\n\n1. If you have coverage through Medicare or Medicaid, that plan pays first, followed by the Northwind Standard plan as the secondary payer [Northwind_Standard_Benefits_Details.pdf#page=73].\n\n2. You must notify Northwind Health of any changes in your coverage status or any changes in your other coverage. Failure to do so may result in you being responsible for charges that Northwind Health would have paid if notified [Northwind_Standard_Benefits_Details.pdf#page=95].\n\n3. In certain circumstances, you may be able to keep your other coverage and still be eligible for the Northwind Standard plan, but if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=95].\n\n4. Northwind Standard may pay first in some cases, even if Medicare, Medicaid, or a veterans' health plan is usually the primary payer [Northwind_Standard_Benefits_Details.pdf#page=75].\n\n5. When submitting a claim to Northwind Standard, you need to include information about your other coverage to ensure proper billing and to receive the full benefits offered by each plan [Northwind_Standard_Benefits_Details.pdf#page=73].", "context": "Northwind_Standard_Benefits_Details.pdf#page=95: This could include coverage from your spouse's or a parent's employer, or from a government-sponsored program such as Medicare or Medicaid. If you and your spouse have coverage under different plans, you must determine which plan is the primary plan and which is secondary. This is important, as the primary plan will pay first; the secondary plan will pay what the primary plan does not. If you have other coverage, you must notify Northwind Health of any changes in your coverage status or any changes in any of your other coverage. If you fail to do so, you may be responsible for any charges that Northwind Health would have paid if you had notified them of the other coverage. In certain circumstances, you may be able to keep your other coverage and still be eligible for coverage under the Northwind Standard plan. However, if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan. It is also important to note that if you have coverage through a government-sponsored program such as Medicare or Medicaid, you may be subject to certain restrictions.\n\nNorthwind_Standard_Benefits_Details.pdf#page=75: Coordination of Benefits Exceptions There are a few exceptions to COB rules that may apply to you. If you are covered by Medicare, Medicaid, or a veterans' health plan, Northwind Standard may pay first, even if the other plan is usually the primary payer. Additionally, if you are enrolled in a plan that is required by law to coordinate benefits, such as an employer-sponsored plan, Northwind Standard may pay first. Understanding How COB Affects Your Benefits When COB applies, the primary and secondary payers will each pay a portion of the eligible expenses and combined payments cannot exceed the total cost. Depending on the type of service, the primary payer may pay all of the eligible expenses. When this happens, the secondary payer may pay nothing.For example, if you receive a medical bill for $1,000 and the primary payer pays $800, the secondary payer will pay the remaining balance of $200. However, if the primary payer pays the full $1,000, the secondary payer will not pay anything.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan ", "latency": 3.529067, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT and directly answers the QUERY by explaining how Northwind Standard handles situations involving other plans like Medicare or Medicaid. It includes relevant details from the CONTEXT without introducing unrelated information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, covering all essential details required for a comprehensive understanding of how the Northwind Standard handles situations involving other plans like Medicare or Medicaid.", "answer_length": 1314, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the process for submitting claims for services like MRI/CT scans or physical therapy according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, for services such as MRI/CT scans and physical therapy, your provider may need to submit a request prior to the service being performed. It's important to contact Northwind Health if you are unsure whether pre-approval is required. Additionally, when filing a claim, you should include all necessary documentation like itemized bills, a completed claim form, and any other requested documentation to avoid delays or denials. [Northwind_Standard_Benefits_Details.pdf#page=78]", "answer": "To submit claims for services like MRI/CT scans or physical therapy, follow these steps:\n\n1. **Pre-Approval**: Your provider may need to submit a request for pre-approval to Northwind Health before the service is performed. This is necessary for MRI/CT scans, physical therapy, and other specialty services [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n2. **Timely Filing**: All claims must be filed within twelve months of the date of service. Claims submitted after this period may be reviewed for consideration, but there is no guarantee they will be accepted [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n3. **Documentation**: When filing a claim, include all necessary documentation, such as itemized bills, a completed claim form, and any other requested documentation. Missing items may delay or deny your claim [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n4. **Filing Method**: If you are a Northwind Standard member, you may file a claim directly through the Northwind website or app. If filing on behalf of a family member, ensure you have their authorization [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n5. **Keep Records**: Keep track of the dates of service and maintain copies of all documentation related to your services [Northwind_Standard_Benefits_Details.pdf#page=78].", "context": "Northwind_Standard_Benefits_Details.pdf#page=78: from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services. If you are unsure whether your provider requires pre-approval for a service, you should contact Northwind Health prior to the service being performed. There are a few exceptions to the twelve month timely filing limit. These include claims submitted for newborns, claims submitted for a deceased member, and claims submitted forservices that were provided out-of-country. In these situations, claims may be submitted up to 24 months after the date of service. It's also important to remember that when filing a claim, you should make sure to include all necessary documentation. This includes itemized bills, a completed claim form, and any other documentation that is requested by Northwind Health. If any of these items are missing, your claim may be delayed or denied. To ensure timely filing, it's important to keep track of the dates of service for all services you receive. You should also keep copies of all documentation related to your services, and if you're unsure of the filing \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=64: This means that your doctor or health care provider will need to get prior authorization from Northwind Health before providing the care. Prior authorization is also known as pre-certification, pre-notification, pre-service review, or pre-authorization. It is important for you to understand that prior authorization does not guarantee that the service will be covered by your Northwind Health Plus plan. When Prior Authorization is Required Prior authorization is required for certain services and treatments such as: 路 Hospital admissions 路 Inpatient surgery 路 Outpatient surgery 路 Magnetic Resonance Imaging (MRI) 路 Computed Tomography (CT) 路 Radiation Therapy 路 Durable Medical Equipment 路 Physical, Occupational, and Speech Therapy 路 Home Health Care 路 Infusion Therapy 路 Prosthetics and Orthotics 路 Specialty DrugsIn certain cases, Northwind Health may require prior authorization even if the service is not listed above. Your doctor or health care provider should contact Northwind Health to determine if prior authorization is required prior to providing care.", "latency": 3.493366, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all necessary details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing the process for submitting claims as requested.", "answer_length": 1313, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the role of the Independent Review Organization in the appeals process for Northwind Standard plan members?", "truth": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. The decision made by the IRO is considered final and binding, although there are some exceptions that could apply to specific cases. [Northwind_Standard_Benefits_Details.pdf#page=83]", "answer": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. It is a third-party organization that reviews appeals and complaints regarding healthcare services that have been denied coverage. If the IRO upholds the original decision, members may have other options available, such as an external review or an appeal to the state insurance commission. The decision made by the IRO is considered final and binding, although some exceptions may apply to individual cases [Northwind_Standard_Benefits_Details.pdf#page=83][Northwind_Standard_Benefits_Details.pdf#page=82].", "context": "Northwind_Standard_Benefits_Details.pdf#page=83: 路 Ensure that all relevant information is included in the appeal. 路 Submit the appeal within the timeframe specified in the plan. . Keep a copy of your appeal and all supporting documentation. 路 Contact Northwind Health or the IRO if you have any questions or need additional help. . If the IRO upholds the original decision, you may have other options available to you, such as an external review or an appeal to the state insurance commission. Conclusion The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. While the decision made by the IRO is considered final and binding, there are some exceptions that could apply to your case. Familiarizing yourself with the plan provisions and the process for filing an appeal, gathering all relevantinformation, and submitting the appeal within the timeframe specified in the plan are all important steps in the appeals process. Additional Information About Your Coverage COMPLAINTS AND APPEALS If you feel that you have not received the health care services or benefits that you are entitled to, or you are not \n\nNorthwind_Standard_Benefits_Details.pdf#page=82: If you need an expedited appeal due to an urgent medical condition, your plan must respond within 24 hours. Tips . Make sure to include all of the necessary information in your appeal. . Keep a copy of your appeal for your records. . Don't hesitate to contact your plan if you need assistance with the appeal process. 路 Follow up with your plan if you don't receive a response to your appeal within a reasonable amount of time. . Consider hiring a lawyer if you need help with your appeal. Once The IRO Decides Once The IRO DecidesThe Independent Review Organization (IRO) is a third-party organization that reviews appeals and complaints about healthcare services that have been denied coverage under the Northwind Standard plan. If an employee is not satisfied with the decision made by Northwind Health, they can submit a written complaint or request an appeal by filing a formal grievance. What Happens After The IRO Decides? Once the IRO has completed its review, it will issue a formal decision either upholding the original decision or reversing it.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=85: We have a multi-level process in place to ensure that any grievances are addressed and resolved quickly and fairly. Level 1: Initial Review This is the first step in the appeals process. If you have a problem with a service or product received, contact the plan's Customer Service team. The team will review your complaint to determine if a solution can be reached or if the complaint should be escalated to the next level. Level 2: Formal Complaint If a satisfactory resolution is not reached at Level 1, you may submit a formal written complaint to Northwind Health Plus. This should include details of the issue, the date and time of the incident, and the names of any involved personnel. It should also include any relevant documentation or other evidence that supports your claim. Level 3: External ReviewIf the issue is not resolved at Level 2, you may request an external review to be conducted. This review will be conducted by an independent organization that is not affiliated with Northwind Health Plus. The external review will consider all facts and evidence that have been submitted in the appeal and ", "latency": 3.472806, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the role of the IRO as described in the CONTEXT and directly addressing the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the role of the IRO, and it provides additional insights into the appeals process, making it comprehensive.", "answer_length": 626, "citations_matched": 1.0, "any_citation": true} +{"question": "Can you explain the eligibility criteria for the Northwind Standard plan offered to Contoso employees?", "truth": "The Northwind Standard plan is a group plan offered to all eligible employees of Contoso and their spouses or dependents. It is important to note that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. [Northwind_Standard_Benefits_Details.pdf#page=88]", "answer": "The eligibility criteria for the Northwind Standard plan offered to Contoso employees include the following:\n\n1. Employees may need to meet specific criteria to be approved for certain services or treatments, which may include medical tests, lifestyle changes, or other requirements [Northwind_Standard_Benefits_Details.pdf#page=63].\n2. Prior-authorization is required for certain services or treatments, and if not obtained, the employee may be responsible for the full cost of those services [Northwind_Standard_Benefits_Details.pdf#page=63].\n3. The employee's physician must submit a request for prior-authorization to Northwind Health, which will review it to determine if the service or treatment is medically necessary and a covered benefit [Northwind_Standard_Benefits_Details.pdf#page=63].\n4. Preventive care services and emergency services are not subject to prior-authorization [Northwind_Standard_Benefits_Details.pdf#page=63].\n5. Mental health and substance abuse coverage are also not subject to prior-authorization [Northwind_Standard_Benefits_Details.pdf#page=63].\n6. Out-of-network services are subject to prior-authorization and may incur additional costs for the employee [Northwind_Standard_Benefits_Details.pdf#page=63].\n\nIf you have any specific questions or need further details, feel free to ask!", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment. These criteria may include specific medical tests or treatments, lifestyle changes, or other requirements. If the employee is unable to meet the criteria, prior-authorization may not be granted. There are some exceptions to the prior-authorization process. For example, preventive care services and emergency services are not subject to prior-authorization. In addition, mental health and substance abuse coverage is not subject to prior-authorization. However, out-of- network services are subject to prior-authorization and may require additional cost to the employee. Here are some tips for Contoso's employees to help them navigate the prior-authorization process: 路 Contact your physician's office to determine if prior-authorization is required before receiving a service or treatment. . Contact Northwind Health to determine if a service or treatment is a covered benefit under Northwind Standard.\n\nNorthwind_Standard_Benefits_Details.pdf#page=102: Depending on the state, employees may have the right to receive legal representation or to appeal denied claims. In some states, employees may have the right to choose their own physician or to receive benefits for permanent disabilities. At Contoso, we are committed to providing our employees with a safe and productive work environment, and we take the necessary steps to ensure that our Workers' Compensation Insurance coverage meets all state and federal requirements. Should you have any questions about this coverage, please contact the Human Resources Department. DEFINITIONS DEFINITIONS When it comes to understanding the Northwind Standard insurance plan, it is important to understand the various terms and definitions associated with this plan. Here is abreakdown of some of the key terms and definitions associated with the Northwind Standard insurance plan. In-Network Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.", "latency": 4.160402, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The response is related to the topic of the Northwind Standard plan but does not directly address the query about eligibility criteria for the plan itself. It focuses on the requirements for accessing services, which is not the same as eligibility for the plan.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, covering all necessary aspects of the eligibility criteria for the Northwind Standard plan. It does not add extraneous information and offers further assistance, making it a complete response.", "answer_length": 1319, "citations_matched": 0.0, "any_citation": true} +{"question": "what wrong things Northwind Health say about what they cover?", "truth": "Northwind Health makes intentionally false or misleading statements about their plans, including claiming to cover emergency services, mental health and substance abuse coverage, and out-of-network services, which they do not actually cover. [Northwind_Standard_Benefits_Details.pdf#page=90]", "answer": "Northwind Health states that their plans do not cover services that are not medically necessary, including cosmetic procedures and elective treatments. Additionally, services provided by healthcare providers who are not contracted with Northwind Health are not covered. The Northwind Standard plan also does not cover any services received outside of the network of in-network providers [Northwind_Standard_Benefits_Details.pdf#page=56][Northwind_Standard_Benefits_Details.pdf#page=89]. \n\nFor the Northwind Health Plus plan, similar limitations apply, including potential non-coverage of cosmetic procedures and limits on the number of visits to a provider [Northwind_Health_Plus_Benefits_Details.pdf#page=17].", "context": "Northwind_Standard_Benefits_Details.pdf#page=56: Finally, Northwind Health's Northwind Standard plan does not cover services that are not medically necessary. Examples of services that are not covered include cosmetic proceduresand elective treatments. Additionally, the plan does not cover services that are not related to the diagnosis or treatment of an illness or injury. At Northwind Health, we are committed to helping you get the care you need when you need it. We understand that medical issues can arise suddenly and can be unpredictable. That is why we offer coverage for urgent care services through our Northwind Standard plan. If you have any questions about your coverage, please contact our customer service team. Virtual Care COVERED SERVICES: VIRTUAL CARE At Northwind Health, we understand that our members may have difficulty accessing in- person care. That is why we offer virtual care, allowing members to access care from the comfort of their own home. With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice.\n\nNorthwind_Standard_Benefits_Details.pdf#page=89: It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. Exceptions There are a few exceptions to the group coverage provided by the Northwind Standard plan. For example, the plan does not cover services provided by any health care provider who is not contracted with Northwind Health. In addition, the plan does not cover services that are not medically necessary, such as cosmetic surgery. Tips for Employees When you enroll in Northwind Standard, it is important to familiarize yourself with the plan and its coverage options. You should also make sure that you understand any restrictions that may apply to the services you receive. Be sure to check with your provider to make sure that they accept the Northwind Standard plan. Also, it is a good idea to familiarize yourself with the cost of the services you receive, so that you know what you may be responsible for paying out of pocket. Finally, keep in mind that the Northwind Standard plan does not cover any services received outside of the network of in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=17: For instance, some plans may not cover certain types of services, such as cosmetic procedures, or they may have limits on the number of visits to a provider that are covered. It is important to read through your plan to understand what is and isn't covered. When you are using your Northwind Health Plus plan, there are a few tips to keep in mind. First, remember to bring your Northwind Health Plus ID card with you when you go to the doctor or pharmacy. This will help the provider verify your coverage and process your claims. Second, if you are prescribed a medication, check to make sure it is covered by your plan. You may be able to save money by using a generic version of the drug or by using a mail-order pharmacy. Finally, if you are seeing an out-of-network provider, remember that you may be responsible for paying more out-of-pocket costs than you would for an in-network provider. Make sure to check with the provider to get an estimate of what your costs will be. By understanding the plan and its exceptions and limitations, and by following these tips, you can make sure you are getting the most out of your Northwind Health Plus plan.", "latency": 2.481331, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE accurately reflects the exclusions mentioned in the CONTEXT but does not address the QUERY's specific request for \"wrong things\" or inaccuracies in Northwind Health's statements about coverage. Therefore, it is partially correct but incomplete in addressing the QUERY.", "relevance": 1.0, "gpt_relevance": 1.0, "relevance_reason": "The response does not address the query's focus on incorrect statements made by Northwind Health. It provides information on coverage limitations, which is not what the query is asking for.", "answer_length": 710, "citations_matched": 0.0, "any_citation": true} +{"question": "what is northwind standard benefits details?", "truth": "The Northwind Standard Benefits Details include information to help inform and empower members about their responsibilities and the coverage provided by the plan. This includes being aware of the plan's benefits and limitations, as well as obligations under the plan such as co-payments or co-insurance amounts for medical and vision expenses. [Northwind_Standard_Benefits_Details.pdf#page=92]", "answer": "The Northwind Standard plan is a comprehensive health plan that covers medical, vision, and dental services, including preventive care and prescription drug coverage. It provides access to a variety of in-network providers, such as primary care physicians, specialists, hospitals, and pharmacies. \n\nKey covered services include:\n- Preventive care services (physicals, immunizations, screenings)\n- Diagnostic tests and treatments\n- Medical consultations\n- Physical therapy\n- Mental health services\n- Prescription drugs\n- Inpatient hospital services\n- Emergency services\n\nHowever, it does not cover certain services, including cosmetic services, experimental treatments, and most dental services, nor does it cover services from out-of-network providers. It is important to check with Northwind Health for in-network providers to avoid unexpected costs. Northwind Health also offers tools like a cost estimator and a provider directory, along with 24/7 customer service for assistance with coverage questions [Northwind_Standard_Benefits_Details.pdf#page=98][Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 3.04964, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the Northwind Standard benefits, including additional insights into the plan's features and limitations, which enhances understanding.", "answer_length": 1155, "citations_matched": 0.0, "any_citation": true} +{"question": "what does Notice of Pre-Existing Condition Exclusions mean?", "truth": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It explains when these exclusions may apply and how they could affect your coverage. [Northwind_Standard_Benefits_Details.pdf#page=96]", "answer": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to understand when these exclusions may apply and how they could affect your coverage [Northwind_Standard_Benefits_Details.pdf#page=96]. Additionally, you may be subject to certain exclusions or limitations on your coverage, including pre-existing condition exclusions and/or waiting periods, so reviewing your plan documents is crucial [Northwind_Health_Plus_Benefits_Details.pdf#page=94].", "context": "Northwind_Standard_Benefits_Details.pdf#page=96: Notice of Benefit and Payment Parameters: This notice provides important information about the plan and its benefits, including what kind of coverage is provided, what types of services are covered, and what out-of-pocket costs you may be responsible for. Notice of Pre-Existing Condition Exclusions: This notice provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to make sure you understand when pre-existing condition exclusions may apply and how they could affect your coverage. Notice of Continuation Coverage Rights: This notice provides information about your rights to continue coverage if you lose your job or if you experience a qualifying event. It is important to read this notice carefully to make sure you understand your rights to continue coverage. Notice of Availability of Plan Documents: This notice provides information about where you can find the plan documents for Northwind Standard. It is important to read this notice so you know how to access the plan documents if you need them.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods. You should review your plan documents carefully to make sure you understand exactly what is covered and what is excluded. It is also important to understand that the plan is not a substitute for health insurance. You should still maintain health insurance coverage through an employer, a private plan, or a government-sponsored plan. The Northwind Health Plus plan is intended to supplement the coverage you have from other sources. Tips for Making the Most of Your Plan . Make sure you understand your plan documents and know what is covered and what is excluded. 路 Take advantage of preventive care services, such as check-ups and screenings, as these will help you stay healthy and avoid more costly treatments down the road. 路 Consider signing up for the Northwind Health Plus online portal, which allows you to view your health plan information, make payments, and access other resources. 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=93: The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and YouThe Northwind Health Plus plan is a group health plan that is sponsored by Contoso and administered by Northwind Health. As a participant in this group plan, you will have access to a wide range of health benefits and services. Your employer, Contoso, pays a portion of the premium for the plan, and you are responsible for paying the remaining portion. This will be deducted directly from your paycheck each month. In addition to the premium, you may be responsible for certain costs when you receive health care services. Your contributions to the plan are based on the type of coverage you choose. For example, if you choose a single plan, you will pay a lower premium than if you choose a family plan. The premium and other costs you may incur when you receive health care services may change from year to year. It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods.", "latency": 3.857484, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using relevant information from the CONTEXT, demonstrating full groundedness.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query by explaining the meaning of the term and its implications, and it provides additional insights by advising on the importance of reviewing plan documents. This makes the response comprehensive and insightful.", "answer_length": 582, "citations_matched": 1.0, "any_citation": true} +{"question": "What services does Northwind Health cover?", "truth": "Northwind Health is responsible for paying claims for eligible services based on the terms of the plan, but it does not cover emergency services, mental health and substance abuse services, or out-of-network services. [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "Northwind Health covers a variety of services under its plans:\n\n1. **Northwind Standard Plan**:\n - Preventive care services (physicals, immunizations, screenings)\n - Diagnostic tests and treatments\n - Medical consultations\n - Physical therapy\n - Mental health services\n - Prescription drugs\n - Inpatient hospital services\n - Emergency services\n - Coverage for professional visits to primary care physicians and specialists (medically necessary services provided by in-network providers) [Northwind_Standard_Benefits_Details.pdf#page=46][Northwind_Standard_Benefits_Details.pdf#page=45].\n\n2. **Northwind Health Plus Plan**:\n - A wide range of mental health services (counseling, psychiatric visits, therapy, group therapy)\n - Coverage for both inpatient and outpatient visits\n - Services from in-network and out-of-network providers, though out-of-pocket costs are typically higher for out-of-network services [Northwind_Health_Plus_Benefits_Details.pdf#page=42].\n\nPlease note that certain services, such as cosmetic services, experimental treatments, and most dental services, are not covered by the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=42: Northwind Health Plus covers a wide range of mental health services, including counseling, psychiatric visits, therapy, and group therapy. Services are provided in-network and out-of- network, with coverage for both inpatient and outpatient visits. In-Network Services When receiving mental health care, it is important to make sure you are using an in- network provider. When you use an in-network provider, your out-of-pocket costs are generally lower and your coverage is more comprehensive. Northwind Health Plus offers a network of providers that are in-network, including primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Services In some cases, it may be necessary to receive mental health care from an out-of-network provider. Northwind Health Plus will still cover a portion of the cost of services received from an out-of-network provider. However, it is important to note that out-of-pocket costs are typically higher when receiving care from an out-of-network provider. Exceptions Northwind Health Plus does not cover some services related to mental health care, including long-term treatment ", "latency": 3.334235, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using the information provided in the CONTEXT, covering all relevant details about the services offered by Northwind Health under its plans.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the services covered by Northwind Health, including details about different plans and exclusions.", "answer_length": 1198, "citations_matched": 0.0, "any_citation": true} +{"question": "How does choosing an in-network provider with Northwind Health Plus affect my healthcare costs?", "truth": "Choosing an in-network provider with Northwind Health Plus is crucial for lowering healthcare costs because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus provides an extensive network of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, allowing for a selection that best suits your needs. [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "Choosing an in-network provider with Northwind Health Plus affects your healthcare costs by lowering your out-of-pocket expenses compared to using out-of-network providers. Northwind Health has negotiated discounted rates with in-network providers, which means you will pay less for services. Additionally, in-network providers charge lower rates than out-of-network providers, making them the most cost-effective option for your healthcare needs [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=4].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. SUMMARY OF YOUR COSTS SUMMARY OF YOUR COSTS At Northwind Health, we understand that health care costs can be a burden. That's why we offer a comprehensive plan that covers the cost of medical, vision, and dental services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. Your cost for Northwind Health Plus will depend on your plan type, the services you use, and the providers you visit. You can find more information about cost-sharing arrangements on the Northwind Health website. In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=4: HOW PROVIDERS AFFECT YOUR COSTS In-Network Providers HOW PROVIDERS AFFECT YOUR COSTS Choosing the right provider is an important part of getting the most value out of your health insurance plan. With Northwind Health Plus, you have access to an extensive network of in- network providers. Working with these providers is an essential part of getting the most value out of your plan. In-Network Providers When choosing an in-network provider for your health care needs, make sure to check with Northwind Health Plus to ensure that the provider is in-network. This is important because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus offers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This lets you choose a provider that is most convenient for you and your family. It is important to note that in-network providers may not always be available in every area. The Northwind Health Plus website offers a searchable directory of all in-network providers in your area. This directory is regularly updated, so you can be sure that you are choosing from in-network providers that are \n\nNorthwind_Standard_Benefits_Details.pdf#page=9: When choosing a provider, it is important to consider the cost sharing associated with each provider and to ask about any additional fees before receiving care. HOW PROVIDERS AFFECT YOUR COSTS When it comes to health insurance, many people are unaware of the different factors that impact the costs they pay. One of the most significant components that affects your costs is the provider you choose. Northwind Standard provides coverage for a variety of in-networkproviders, and the costs associated with each provider can vary significantly. To ensure you're getting the best value for your health care services, it's important to understand how providers can affect your costs. In-Network Providers Choosing in-network providers is the most cost-effective option when it comes to your Northwind Standard plan. In-network providers have agreed to accept a discounted rate on services, which means they are often less expensive than out-of-network providers. When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or ", "latency": 2.54252, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY without introducing any extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, explaining the cost benefits of choosing in-network providers with Northwind Health Plus. It includes all essential details required for a comprehensive understanding.", "answer_length": 550, "citations_matched": 1.0, "any_citation": true} +{"question": "how does Northwind Health Plus help me save money on healthcare costs?", "truth": "Northwind Health Plus assists in saving money on healthcare costs by providing balance billing protection, ensuring that you are not billed more than the allowed amount by your provider. [Northwind_Health_Plus_Benefits_Details.pdf#page=7]", "answer": "Northwind Health Plus helps you save money on healthcare costs in several ways:\n\n1. Understanding the difference between in-network and non-participating providers can lead to cost savings. Using in-network providers typically results in lower out-of-pocket expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n2. Northwind Health Plus offers balance billing protection, ensuring that you will not be billed more than the allowed amount for services. This means you won't be responsible for the difference between the allowed amount and what the provider charges [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n3. It is recommended to check with Northwind Health Plus before visiting a provider to confirm if they are in-network and to review your Explanation of Benefits (EOB) after visits to avoid unexpected charges [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n4. Using the online provider directory can help you find in-network providers, which can save you time and money [Northwind_Health_Plus_Benefits_Details.pdf#page=5].\n\n5. Choosing an in-network provider is crucial for maximizing the value of your health insurance plan, as it typically leads to lower costs [Northwind_Health_Plus_Benefits_Details.pdf#page=5].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=7: By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs. Northwind Health Plus is here to help you make the most of your coverage. If you have any additional questions about in-network and non-participating providers, please contact the Northwind Health Plus customer service line. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS: Balance Billing Protection Balance billing is a practice where a provider bills you for the difference between the allowed amount and billed amount. The allowed amount is the amount that your insurance company determines is a reasonable fee for a service. The amount you are billed for is the amount that the provider charges you for the services. With Northwind Health Plus, you are protected from balance billing. This means that you can rest assured that you will not be billed more than the allowed amount by your provider. Balance billing protection is an important part of Northwind Health Plus. This protection ensures that you will not be responsible for the difference between the allowed amount and the \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=7: Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus first. Before your visit, contact the customer service line to find out if the provider is in-network and if there are any exceptions that could apply to your situation. Additionally, it is important to review your Explanation of Benefits (EOB) after your visit to ensure that you are not being charged for any services that were not covered by your insurance. If you are charged for a service that was not covered, contact Northwind Health Plus right away. If you are considering a new provider, it is important to ask if they are in-network with Northwind Health Plus. This can save you time and money in the long run. Additionally, you can use Northwind Health Plus's online provider directory to search for a provider that is in-network and view their ratings. By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=5: Tips for Choosing an In-Network Provider When choosing an in-network provider, there are a few tips to keep in mind: 路 Check with Northwind Health Plus to make sure that the provider you are considering is in-network. 路 Use the searchable directory on the Northwind Health Plus website to find in-network providers in your area. 路 Ask your current provider if they are part of the Northwind Health Plus network. . Consider the cost savings associated with in-network providers when making your decision. 路 Consider the quality of care when choosing a provider. 路 Make sure the provider is familiar with your health insurance plan and its coverage. 路 Make sure the provider is available and can accommodate your schedule. Conclusion Choosing the right provider is an important part of getting the most value out of your health insurance plan. Northwind Health Plus offers an extensive network of in-network providers that can help you save money on health care services. By following the tips outlined above, you can make sure that you are choosing an in-network provider that is most convenient and cost-effective for you and your family.", "latency": 4.262242, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately addressing the query with all relevant details provided in the context.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, providing all essential details required for a comprehensive understanding of how Northwind Health Plus helps save money on healthcare costs.", "answer_length": 1247, "citations_matched": 1.0, "any_citation": true} +{"question": "what is copay for Northwind Health Plus?", "truth": "When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The copayment (copay) for Northwind Health Plus varies based on the type of service and provider network. Here are the typical copay amounts:\n\n- **Primary Care Visits**: Approximately $20 (in-network) or $35 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- **Specialist Visits**: Approximately $50 (in-network) or $60 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- **Mental Health Visits**: Approximately $45 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- **Out-of-Network Services**: Typically around $60 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nPreventive care services copayment is typically waived if received from an in-network provider [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an in-network provider. Tips: It is important to remember that copayments are subject to change and may vary depending on the type of service received. It is also important to note that copayments are not waived for out-of-network services, and you may be responsible for the remaining balance after Northwind Health Plus has paid its portion. Finally, it is important to make sure that the provider you are seeing is in-network. This can be easily done by checking the provider directory on the Northwind Health Plus website. It is also important to remember that if you receive a service from an out-of-network provider, you may be responsible for a higher copayment.By understanding and following these tips, you can be sure to get the most out of your Northwind Health Plus coverage and avoid unnecessary copayments. Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=12: Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more affordable for its members. This means that you will pay a lower copay for office visits than you would for other services. The split copay is applied to office visits with primary care physicians, specialists, and mental health providers. Office visits with primary care physicians are subject to a $35 copay. Office visits with specialists are subject to a $60 copay. Mental health visits with a psychiatrist or another mental health provider are subject to a $45 copay. There are a few exceptions to this split copay. Emergency room visits and urgent care visits are not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. Office visits with an anesthesiologist are also not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. When visiting your doctor, it is important to understand which type of provider you are visiting.", "latency": 4.040166, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY with all necessary details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about copay amounts for different services under Northwind Health Plus, without adding extraneous information.", "answer_length": 880, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the deductible amounts for in-network services under the Northwind Health Plus Benefits Details?", "truth": "The calendar year deductible for in-network services under the Northwind Health Plus Benefits Details is $1,500 for individuals and $3,000 for families. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "The calendar year deductible for in-network services under the Northwind Health Plus plan is $1,500 for individuals and $3,000 for families [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=12: Other services, such as lab tests, X-rays, and imaging tests, are subject to different copay amounts, which are listed on your insurance card. It is also important to remember that the split copay only applies to in-network providers. If you visit an out-of-network provider, you will be subject to a higher copay amount, which is also listed on your insurance card. At Northwind Health Plus, we are committed to helping our members get the care they need at a price they can afford. With the split copay for office visits, we hope to make healthcare more affordable for you and your family.Calendar Year Deductible IMPORTANT PLAN INFORMATION: Calendar Year Deductible The Northwind Health Plus plan has a calendar year deductible that applies to some services. The amount you must pay out-of-pocket before the plan begins to pay for covered services is called the calendar year deductible. The calendar year deductible is the same for all members of the plan and is reset each year on the plan's renewal date. For In-Network Services: The calendar year deductible for in-network services is $1,500 for individuals and $3,000 for families.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.148354, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, directly addressing the QUERY with precise information from the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing the specific deductible amounts for both individuals and families. However, it does not include additional insights or elaboration that would enhance understanding beyond the direct answer.", "answer_length": 193, "citations_matched": 0.0, "any_citation": true} +{"question": "What is the role of coinsurance in Northwind Health Plus?", "truth": "Coinsurance is a cost-sharing requirement under Northwind Health Plus, where after meeting the deductible, the policyholder is responsible for a certain percentage of the costs for covered services. This percentage is usually a portion of the allowed amount for a service, which the policyholder must pay. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "Coinsurance in Northwind Health Plus is a cost-sharing requirement that applies after you have met your deductible. You will be responsible for a certain percentage of the costs for covered services. Specifically, the coinsurance rate is 20%. For example, if the allowed amount for a service is $100, you would pay $20 (20% of $100), and the insurance company would pay the remaining $80. Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services [Northwind_Health_Plus_Benefits_Details.pdf#page=13][Northwind_Health_Plus_Benefits_Details.pdf#page=107].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=13: Tips: 路 Be sure to check with your provider to find out if a service is subject to the calendar year deductible before receiving the service. 路 Make sure you understand the cost sharing that applies to out-of-network services. 路 Be aware that the calendar year deductible is reset each year on the plan's renewal date. 路 Remember that preventive care services and emergency services are exempt from the calendar year deductible. Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a cost-sharing requirement under Northwind Health Plus. This means that after you have met your deductible, you will be responsible for a certain percentage of the costs for covered services. The coinsurance rate is usually a percentage of the allowed amount for a service, and it is your responsibility to pay this amount. For example, if the allowed amount for a service is $100 and your coinsurance is 20%, you are responsible for paying $20 (20% of $100). The insurance company will pay the remaining amount of $80.Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=107: If an employee has any questions or concerns about their coverage, they should contact their employer or the Workers' Compensation Insurance provider for more information. DEFINITIONS Definitions It is important for employees to understand the definitions of certain terms when it comes to their health insurance plan. The following definitions will help employees obtain a better understanding of Northwind Health Plus. Copayment: A copayment, also known as a copay, is the fixed amount that an employee pays for a covered service. This amount is usually a flat fee and is due at the time of service.Deductible: A deductible is the amount of money that an employee must pay out-of-pocket before the plan begins paying for covered services. Northwind Health Plus has a deductible of $2,000 per year. Coinsurance: Coinsurance is the percentage of the cost of a covered service that an employee must pay after the deductible is met. Northwind Health Plus has a coinsurance of 20%. Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year.\n\nNorthwind_Standard_Benefits_Details.pdf#page=13: Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a type of cost sharing that you are responsible for after meeting your deductible. Coinsurance is often a percentage of the cost of the service you receive. Forexample, if the coinsurance is 10%, you will be responsible for paying 10% of the cost of the service you received, while the insurance company pays the other 90%. Under Northwind Standard, coinsurance is set at 20% for in-network services, with some exceptions. For in-network hospital stays, coinsurance is set at 25%. Additionally, coinsurance for out-of-network services is set at 40%. It's important to note that coinsurance does not apply to the services that are covered by the plan's copayment amounts. Copayment is a fixed amount that you are responsible for paying for certain services and is typically much less than coinsurance. Additionally, Northwind Standard does not require coinsurance for preventive care services. When you receive services, it's important to ask about the cost of the service and make sure you are aware of any coinsurance costs.", "latency": 2.868438, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details provided.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, including an example that enhances understanding, making it a comprehensive response with insights.", "answer_length": 653, "citations_matched": 1.0, "any_citation": true} +{"question": "How does the Northwind Health Plus Benefits Details.pdf explain the impact of choosing in-network versus non-participating providers on your healthcare costs, and what are the exceptions to prior authorization that do not require prior approval?", "truth": "The Northwind Health Plus Benefits Details.pdf explains that by understanding the difference between in-network and non-participating providers, you can save money on your healthcare costs. In-network providers are likely part of a negotiated agreement with Northwind Health Plus, which can result in lower costs for the insured. Additionally, there are exceptions to prior authorization that do not require prior approval, including routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. These services are exempt from prior authorization, potentially simplifying and reducing the cost of accessing these types of healthcare. [Northwind_Health_Plus_Benefits_Details.pdf#page=7] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "Choosing in-network providers with Northwind Health Plus helps you avoid additional costs, as non-participating providers require you to pay the entire cost of care out-of-pocket. If you visit a non-participating provider, you will be responsible for all expenses unless exceptions apply. Exceptions include situations where you are traveling outside the United States and cannot find an in-network provider, or if you are in a life-threatening situation and need to go to the nearest hospital, in which case Northwind Health Plus may cover a portion of the cost [Northwind_Health_Plus_Benefits_Details.pdf#page=6].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=6: 路 Ask your provider if they offer continuity of care. . If you are switching to a new provider, make sure they are familiar with your medical history. 路 If you are switching from an in-network provider to an out-of-network provider, make sure you understand what that means for your coverage. 路 Make sure you keep all of your medical records up to date. Continuity of care is an important factor to consider when selecting a provider. Northwind Health Plus offers coverage for continuity of care, so you may be able to continue seeing the same provider without having to switch to a different provider in the network. However, there are some exceptions to the continuity of care rule, so it's important to understand what those are. By following these tips, you can ensure you have the best possible coverage and ensure continuity of care. Non-Participating HOW PROVIDERS AFFECT YOUR COSTS When it comes to health care, the provider you choose can have a major impact on your costs. With Northwind Health Plus, you have the option to choose from a variety of in- network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=7: By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs. Northwind Health Plus is here to help you make the most of your coverage. If you have any additional questions about in-network and non-participating providers, please contact the Northwind Health Plus customer service line. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS: Balance Billing Protection Balance billing is a practice where a provider bills you for the difference between the allowed amount and billed amount. The allowed amount is the amount that your insurance company determines is a reasonable fee for a service. The amount you are billed for is the amount that the provider charges you for the services. With Northwind Health Plus, you are protected from balance billing. This means that you can rest assured that you will not be billed more than the allowed amount by your provider. Balance billing protection is an important part of Northwind Health Plus. This protection ensures that you will not be responsible for the difference between the allowed amount and the ", "latency": 3.785678, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE correctly addresses the impact of choosing in-network versus non-participating providers and mentions exceptions, but it fails to address the part of the QUERY regarding exceptions to prior authorization.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both aspects of the QUERY with accurate and complete information, making it a complete response.", "answer_length": 615, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the prior authorization process outlined in the Northwind Health Plus Benefits Details affect the coinsurance responsibilities for services that require prior authorization?", "truth": "The prior authorization process requires contacting Northwind Health Plus before receiving services or medications that need prior authorization to determine if it is necessary. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. This impacts the coinsurance responsibilities as failing to obtain prior authorization could lead to the policyholder paying the full cost, rather than just the coinsurance amount. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "The prior authorization process for services under the Northwind Health Plus plan requires members to obtain approval before receiving certain services. If prior authorization is not obtained, you may be responsible for the full cost of the services [Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Additionally, the Allowed Amount does not include any applicable copays, coinsurance, or deductibles that may be due [Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Therefore, it is crucial to check with your provider and Northwind Health Plus to understand your financial responsibilities and ensure that services are covered [Northwind_Health_Plus_Benefits_Details.pdf#page=16][Northwind_Health_Plus_Benefits_Details.pdf#page=66].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services. It is important to understand that the Allowed Amount does not include any applicable copays, coinsurance, or deductibles that may be due. It is also important to understand that the Allowed Amount may vary depending on the type of care received and the type of provider that is providing the care. Therefore, it is important to check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. Finally, it is important to keep track of your out-of-pocket expenses. This includes any copays, coinsurance, or deductibles that you may be required to pay. It is important to understand what your financial responsibility is when receiving care under Northwind Health Plus, so that you can plan accordingly and make sure that you are meeting your financial obligations. IMPORTANT PLAN INFORMATIONNorthwind Health Plus is a comprehensive health plan that offers coverage for medical, vision, and dental services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=66: By understanding the prior authorization process and following the tips outlined above, you can help ensure that you receive the care you need in a timely and efficient manner. Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage The Northwind Health Plus plan includes a care management system that requires prior- authorization for certain services to ensure that the plan is covering only medically necessary care. Prior-authorization is a process used by the insurance company to review a request for a specific service to ensure that it is medically necessary and meets the criteria set by the plan. This process helps to ensure that members are receiving the best care possible and that their benefits are used in the most cost-effective manner. In order to receive prior-authorization, members must provide their Northwind Health Plus provider with the necessary clinical information regarding their diagnosis and treatment plan. The provider then submits this information to Northwind Health Plus for review. Northwind Health Plus will then contact the provider with the decision on the prior- authorization request.", "latency": 3.150143, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides relevant information about prior authorization and financial responsibilities but does not fully address the specific aspect of coinsurance responsibilities as asked in the QUERY.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses the QUERY by discussing the financial implications of prior authorization, including the potential full cost responsibility if authorization is not obtained. However, it does not explicitly detail how coinsurance responsibilities are affected, making the response incomplete.", "answer_length": 742, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Standard Benefits Details document explain the financial responsibilities for in-network and out-of-network providers, and what are some specific services covered under the plan as mentioned in the document?", "truth": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, individuals are typically responsible for only a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". However, for out-of-network providers, the costs can be significantly higher, and individuals may be responsible for the entire cost of services or a much larger portion than with an in-network provider. Specific services covered under the plan include the cost of blood or blood products during a hospital stay or procedure, the collection, storage, and transfusion of platelets and plasma, along with necessary laboratory tests to assess compatibility. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=21]", "answer": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance.\" In contrast, if you choose an out-of-network provider, you may be responsible for the entire cost of services or a significantly greater portion of the cost than you would with an in-network provider. Coverage for out-of-network providers may still exist, but it typically comes with higher costs [Northwind_Standard_Benefits_Details.pdf#page=10][Northwind_Standard_Benefits_Details.pdf#page=8].\n\nSpecific services covered under the plan include mental health and substance abuse services, which generally have the same coverage as medical and surgical services. Additionally, preventive care services such as immunizations and screenings are also covered [Northwind_Health_Plus_Benefits_Details.pdf#page=3].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.", "latency": 3.068287, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE accurately addresses the financial responsibilities for in-network and out-of-network providers but incorrectly includes information about specific services that are not mentioned in the Northwind Standard Benefits Details document, leading to a partially correct response with incorrect details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE effectively addresses both parts of the QUERY, providing accurate and complete information about financial responsibilities and specific services covered under the plan. The reference to two documents is a minor issue but does not detract significantly from the completeness of the response.", "answer_length": 930, "citations_matched": 0.5, "any_citation": true} +{"question": "How can a claim for medically necessary rehabilitation therapy services be processed quickly under the Northwind Standard plan?", "truth": "To ensure quick processing of a claim for medically necessary rehabilitation therapy services under the Northwind Standard plan, one should ask the healthcare provider for a detailed explanation of the services and treatments, ensure all documentation including required forms, test results, and physician's notes are complete, send the documentation to Northwind Health promptly, and follow up with them to confirm receipt and processing of the claim. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "To process a claim for medically necessary rehabilitation therapy services quickly under the Northwind Standard plan, you should follow these steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments you are receiving, including the medical necessity for them.\n2. Ensure that all documentation is complete, including all required forms, test results, and physician's notes.\n3. Send the documentation to Northwind Health as soon as possible.\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed.\n\nAdditionally, if the rehabilitation services require prior authorization, make sure that this is obtained before the services are rendered, as Northwind Health will review the request to determine if the service is medically necessary and covered [Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=68: Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require outpatient services, please contact Northwind Health Plus to ensure that the hospital you are visiting is an in-network provider. Ambulatory Surgery Center Services: Ambulatory surgery center services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the ambulatory surgery center you are visiting is an in-network provider. Outpatient Rehabilitative Services: Outpatient rehabilitative services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the outpatient rehabilitative provider you are visiting is an in-network provider. Long-Term Care Services: Long-term care services are covered without prior authorization if it is determined that the services are medically necessary.", "latency": 3.273177, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the QUERY with all relevant details provided in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing all essential steps required for processing a claim quickly under the Northwind Standard plan.", "answer_length": 932, "citations_matched": 0.5, "any_citation": true} +{"question": "What steps can be taken to ensure quick and accurate processing of claims under the Northwind Standard Benefits Details?", "truth": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits Details, one should ask their healthcare provider for a detailed explanation of the services and treatments, including the medical necessity for them. It is also important to ensure that all documentation is complete, including all required forms, test results, and physician's notes. Additionally, sending the documentation to Northwind Health as soon as possible and following up with them to ensure the claim has been received and is being processed are crucial steps. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits, you can take the following steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments you are receiving, including the medical necessity for them [Northwind_Standard_Benefits_Details.pdf#page=88].\n2. Ensure that all documentation is complete, including all required forms, test results, and physician's notes [Northwind_Standard_Benefits_Details.pdf#page=88].\n3. Send the documentation to Northwind Health as soon as possible [Northwind_Standard_Benefits_Details.pdf#page=88].\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed [Northwind_Standard_Benefits_Details.pdf#page=88].\n5. Keep copies of all documentation related to your services [Northwind_Standard_Benefits_Details.pdf#page=79].\n6. If you are unsure of the filing requirements, contact Northwind Health for clarification [Northwind_Standard_Benefits_Details.pdf#page=79].\n7. Provide required notices in a timely manner [Northwind_Health_Plus_Benefits_Details.pdf#page=101].\n\nBy following these steps, you can help ensure that your claims are processed quickly and accurately.", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=79: You should also keep copies of all documentation related to your services, and if you're unsure of the filing requirements, you should contact Northwind Health for clarification. Overall, timely filing is an important part of the claim filing process. By following the guidelines for timely filing and including all necessary documentation with your claims, you can help ensure that your claims are processed quickly and accurately. COMPLAINTS AND APPEALS What You Can Appeal COMPLAINTS AND APPEALS What You Can Appeal When you have Northwind Standard coverage, you have the right to appeal any denial of services or payment of benefits. This includes if you disagree with the amount of the payment or if you feel that your claim was denied incorrectly. You also have the right to appeal if you feel that an authorization was not provided for a service, or if you believe that a service should be covered by your plan but was not. If you believe that your claim was wrongly denied or that you have a dispute over a service that is covered or not covered, you have the right to file a formal appeal.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.", "latency": 4.405582, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is mostly correct and complete, with one minor inclusion from a different plan that does not significantly affect the overall groundedness. Therefore, it deserves a high score.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not add extraneous information but provides specific steps and references to ensure quick and accurate processing of claims.", "answer_length": 1217, "citations_matched": 0.5, "any_citation": true} +{"question": "What are some services exempt from prior authorization according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, services exempt from prior authorization include routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "According to the Northwind Health Plus Benefits Details, the following services are exempt from prior authorization:\n\n1. **Emergency Care**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n2. **Inpatient Hospital Services**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n3. **Outpatient Hospital Services**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n4. **Certain Preventive Services**: Such as annual physicals and routine check-ups do not require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=63].\n5. **Emergency Services by Out-of-Network Providers**: If medically necessary and the out-of-network provider is the closest available, prior authorization is not required [Northwind_Health_Plus_Benefits_Details.pdf#page=70].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=67: That is why we provide exceptions to prior authorization for certain medical services, procedures and treatments that may require additional review and approval. The exceptions to prior authorization are based onnational and state medical regulations, as well as medical necessity and appropriateness criteria. The exceptions to prior authorization provided by Northwind Health Plus include: Emergency Care: Emergency care is covered without prior authorization if it is determined to be medically necessary. If you believe that you need emergency care, please contact Northwind Health Plus for approval. Inpatient Hospital Services: Inpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require hospital services, please contact Northwind Health Plus to ensure that the hospital you are admitted to is an in-network provider. Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=70: Remember, if you have any questions about the prior authorization process or coverage for an out-of-network provider, contact Northwind Health directly. Northwind Health is available to answer any questions you may have and provide more information about the prior authorization process. Exceptions to Prior-Authorization For Out-Of-Network Providers CARE MANAGEMENT - Exceptions to Prior-Authorization For Out-Of-Network Providers Northwind Health Plus provides coverage for certain services that may require prior authorization when provided by an out-of-network provider. Prior authorization is required to ensure that the service is medically necessary and to ensure that the service is being provided in accordance with the plan's specific rules and guidelines. Northwind Health Plus makes exceptions to the prior authorization requirement for the following services when provided by an out-of-network provider: 路 Emergency Services: For services that are medically necessary and when the out-of- network provider is the closest provider available, prior authorization is not required.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=63: For services and medications that require prior authorization, you must contact Northwind Health Plus before receiving the service or medication to determine if prior authorization is required. If so, you will need to obtain prior authorization through the Northwind Health Plus prior authorization process. Exceptions There are some exceptions to the prior authorization requirement. Certain preventive services, such as annual physicals and routine check-ups do not require prior authorization. In some cases, Northwind Health Plus may also waive the prior authorization requirement for certain services and medications. Tips for Employees If you think you may need a service or medication that requires prior authorization, it is important to plan ahead and contact Northwind Health Plus before receiving the service or medication. This will help ensure that your service or medication is covered by Northwind Health Plus. If you receive a service or medication without prior authorization, you may be responsible for the entire cost of the service or medication. You can also be billed for any services or medications that are determined to be not medically necessary.", "latency": 3.721503, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately listing the services exempt from prior authorization as detailed in the CONTEXT. It directly addresses the QUERY with precise information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY by listing all relevant services exempt from prior authorization and includes specific conditions and references, making it a complete and accurate response.", "answer_length": 1001, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the prior authorization process detailed in the Northwind_Health_Plus_Benefits_Details.pdf impact the out-of-pocket costs for services and medications, and what are the copayment expectations for in-network services as outlined in the same document?", "truth": "The prior authorization process as detailed in the Northwind Health Plus Benefits Details requires contacting Northwind Health Plus before receiving certain services or medications to determine if prior authorization is needed. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. Additionally, for in-network services, the copayment expectations are generally lower, with a typical copayment of around $20 for primary care visits and around $50 for specialist visits. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The prior authorization process ensures that a service or medication is medically necessary and covered by your plan. If you do not obtain prior authorization for out-of-network services, you may not be covered for those costs, potentially leading to higher out-of-pocket expenses if the request is denied [Northwind_Standard_Benefits_Details.pdf#page=65].\n\nRegarding copayment expectations for in-network services, your out-of-pocket costs will generally be lower when using in-network providers due to negotiated discounted rates. Copayments for services can vary based on the type of service, and prescription drugs typically have a copayment that varies depending on the drug type, with generic drugs usually having lower copayments than brand-name drugs [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=108].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Standard_Benefits_Details.pdf#page=65: Prior authorization is a process that ensures that the service or medication you receive is medically necessary, and that it is covered by your plan. In order to get coverage for out-of-network services, you must make sure to get prior authorization from Northwind Health. This is done by contacting the Northwind Health Customer Service team, who will review the request and provide you with a decision. If your request is approved, you will be covered for the service or medication. If it is not approved, you will not be covered. When requesting prior authorization for an out-of-network provider, you should make sure to provide Northwind Health with all the necessary information, including: 路 The name, address, and contact information of the out-of-network provider. 路 The date of service. 路 The diagnosis or reason for the service. 路 The type of service or medication requested. . The estimated cost of the service or medication.It is important to note that, in some cases, Northwind Health may require additional information in order to make a decision.", "latency": 3.582625, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides correct information about copayment expectations for in-network services but incorrectly includes details about prior authorization from a different document than specified in the QUERY, making it incomplete.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses the QUERY but lacks specific details from the Northwind_Health_Plus_Benefits_Details.pdf, making it incomplete.", "answer_length": 864, "citations_matched": 0.0, "any_citation": true} +{"question": "How does using in-network providers affect the coinsurance responsibilities for services under the Northwind Health Plus Benefits, and what are the implications of using out-of-network providers?", "truth": "Using in-network providers under the Northwind Health Plus Benefits can result in lower coinsurance rates, meaning the policyholder will pay less for the same service. However, if out-of-network providers are used, the policyholder will be responsible for a larger portion of the cost, and in some cases, may be responsible for the entire cost. This highlights the importance of checking if a provider is in-network before selecting a plan to manage out-of-pocket costs effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=14] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers under the Northwind Health Plus Benefits results in lower out-of-pocket costs because Northwind Health has negotiated discounted rates with these providers. In contrast, using out-of-network providers may lead to higher costs, as you could be responsible for paying the full cost of services, a higher deductible, and higher coinsurance [Northwind_Health_Plus_Benefits_Details.pdf#page=3].\n\nIn emergency situations, both in-network and out-of-network providers are covered, but using out-of-network providers may incur higher out-of-pocket costs, including copayments and coinsurance, and you may need to pay the difference between the billed amount and what the plan pays [Northwind_Health_Plus_Benefits_Details.pdf#page=27].\n\nOverall, in-network providers generally result in your insurance covering a greater portion of your expenses, while out-of-network providers lead to you being responsible for a greater portion of the costs [Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you have questions about the dialysis coverage offered by Northwind Health Plus, please contact your provider or Northwind Health directly. We are committed to providing our employees with comprehensive coverage and support. Emergency Room COVERED SERVICES - EMERGENCY SERVICES At Contoso, we understand that unplanned medical emergencies can arise, and so our insurance partner, Northwind Health, provides coverage for emergency services. This coverage applies to both in-network and out-of-network providers. In-Network Providers If you seek emergency care from an in-network provider, your plan will cover the cost of treatment, including any necessary hospitalization and follow-up care. Depending on the type of plan you have, you may also be responsible for paying a copayment and/or coinsurance. Out-of-Network Providers Emergency services received from out-of-network providers will also be covered, but you may be responsible for higher out-of-pocket costs such as copayments and coinsurance. If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.", "latency": 4.830903, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the QUERY with all relevant details and without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It also provides additional insights regarding emergency situations and the general impact on insurance coverage.", "answer_length": 1010, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the differences in copayment amounts for primary care and specialist visits under the Northwind Health Plus plan?", "truth": "Under the Northwind Health Plus plan, the copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10] [Northwind_Health_Plus_Benefits_Details.pdf#page=9]", "answer": "Under the Northwind Health Plus plan, the copayment amounts are as follows:\n\n- For in-network primary care visits: approximately $20 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- For in-network specialist visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nFor out-of-network services, the copayment amounts are higher:\n\n- For out-of-network primary care visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- For out-of-network specialist visits: approximately $75 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 3.495412, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information from the CONTEXT, without adding any extraneous information. It provides all relevant details about the copayment differences for primary care and specialist visits under the Northwind Health Plus plan.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not include additional insights or elaboration beyond the requested information.", "answer_length": 585, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details?", "truth": "The limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details include that it only applies to services covered under the plan and not to services that are not covered or are subject to limitations or exclusions. Additionally, it only applies to claims filed within six months of the date of service. There is also no guarantee that the insurance company will be able to recover all or part of the money already paid by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The limitations of the Right of Recovery provision in the Northwind Health Plus plan include:\n\n1. The provision only applies to services that are covered under the plan. If the service is not covered, the employee will not be eligible for recovery [Northwind_Health_Plus_Benefits_Details.pdf#page=101][Northwind_Standard_Benefits_Details.pdf#page=98].\n\n2. The request for the right of recovery must be made within two years of the service being provided. Claims submitted after this period will not be considered [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n3. Certain services are not eligible for the right of recovery, including those related to mental health and substance abuse, emergency services, inpatient services, and any services not covered under the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n4. The right of recovery is only applicable to services paid for by the insured, not by any third party, including family members, friends, employers, or other insurance plans [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n5. The right of recovery is subject to the terms and conditions of the Northwind Standard plan, so it is important to read the plan documents for additional exclusions [Northwind_Standard_Benefits_Details.pdf#page=98].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=98: Additionally, the service must be one that is covered under the plan. If the service is not covered, then the employee will not be eligible for the right of recovery. It is important for employees to keep in mind that the right of recovery must be requested within two years of the service being provided in order for the employee to be eligible for reimbursement. Any claims submitted after this period will not be considered. In addition, there are some services that are not eligible for the right of recovery. These include services related to mental health and substance abuse, emergency services, inpatient services, and any services that are not covered under the Northwind Standard plan. It is also important to note that the right of recovery is only applicable to services that were paid for by the insured, and not by any other third party. This includes family members, friends, employers, or other insurance plans. Employees should keep in mind that the right of recovery is subject to the terms and conditions of the Northwind Standard plan. Therefore, it is important to read the plan documents in detail to understand any additional exclusions or ", "latency": 3.637749, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE attempts to address the QUERY but includes incorrect information by referencing limitations from the Northwind Standard plan, which are not applicable to the Northwind Health Plus plan as per the provided CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the limitations of the Right of Recovery provision, making it a complete response.", "answer_length": 1292, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the benefits of the Chronic Condition Management Program offered by the Northwind Health Plus plan?", "truth": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides members with access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. This team offers personalized care and support to help members manage their chronic conditions and live healthier, happier lives. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=73]", "answer": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides several benefits, including:\n\n- Access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Comprehensive care assessments and care plans [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Regular follow-up visits [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Personalized health education [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Assistance with medication management [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Coordination of services with other providers [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Referrals to community resources [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n\nThe program is designed to help members better manage their chronic conditions, reduce the risk of complications, and improve their quality of life [Northwind_Health_Plus_Benefits_Details.pdf#page=74]. It is available to members with specific chronic conditions such as diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and hypertension [Northwind_Health_Plus_Benefits_Details.pdf#page=74].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=74: 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help manage your condition and reduce the risk of complications. . Stay organized: Keeping track of your medications, appointments, and lab results can help you stay on top of your condition and make informed decisions about your care. . Ask for help: Don't be afraid to ask for help from family, friends, and healthcare professionals. . Take advantage of resources: Northwind Health Plus offers a variety of resources and programs to help members manage their chronic conditions.路 Be proactive: Talk to your doctor if you have any questions or concerns about your condition or care plan. At Northwind Health, we understand that managing chronic conditions can be challenging. That's why we're committed to helping our members get the care and support they need to stay healthy and active. Through our Chronic Condition Management Program, we provide members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=74: The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. The CCMP is designed to help members better manage their chronic conditions, reduce the risk of complications, and improve their quality of life. Through the program, members receive: 路 Comprehensive care assessments and care plans 路 Regular follow-up visits 路 Personalized health education 路 Assistance with medication management 路 Coordination of services with other providers 路 Referrals to community resources Exceptions: The CCMP is only available to Northwind Health Plus members who have one or more of the following chronic conditions: diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and hypertension. Tips to Help Employees Manage Chronic Conditions: . Talk to your doctor: It's important to have open and honest conversations with your doctor about your condition and any concerns you may have. 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=73: Talk to your doctor or other health care provider about your health and any treatments that may be available. .Take an active role in your health care. Ask questions and be informed about your health and any treatments that may be available. . Make sure to follow your doctor's instructions and stay up to date on your health care. . If you have any questions or concerns about your health, contact Northwind Health Plus for assistance.Chronic Condition Management CARE MANAGEMENT: Chronic Condition Management At Northwind Health, we understand that managing chronic conditions can be overwhelming and expensive. We are committed to helping our members manage their chronic conditions and live healthier, happier lives. That's why we offer a Chronic Condition Management Program (CCMP) as part of our Northwind Health Plus plan. This program provides members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support. The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists.", "latency": 4.605035, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY by listing all relevant benefits of the CCMP as described in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the program's design and target conditions, which enhances understanding.", "answer_length": 1380, "citations_matched": 0.0, "any_citation": true} +{"question": "What happens if you use out-of-network providers according to Northwind Health Plus?", "truth": "If you use out-of-network providers according to Northwind Health Plus, you will be responsible for a larger portion of the cost. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=75]", "answer": "If you use out-of-network providers under Northwind Health Plus, you must obtain prior authorization before receiving care. This means that Northwind Health will review your request for coverage and decide whether it will cover the care you are seeking. The criteria for approval may vary depending on the type of care requested, and your provider typically submits the request for you. \n\nAdditionally, while Northwind Health Plus offers coverage for out-of-network providers, it may not cover all services, and out-of-network providers may charge more than in-network ones. There may also be limitations or conditions on the coverage granted, such as limits on the number of visits for specific procedures [Northwind_Health_Plus_Benefits_Details.pdf#page=69][Northwind_Health_Plus_Benefits_Details.pdf#page=71].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=62: If you are outside Washington, you may still be eligible for coverage through Northwind Health Plus. Northwind Health Plus offers a network of providers that are located throughout the United States. These providers are part of Northwind Health Plus' nationwide network, which is designed to ensure that you are able to receive care, no matter where you are. Out-of-area care is coverage that extends outside of Washington. This means that if you travel outside of the state, you can still receive care from a Northwind Health Plus provider. However, there are some exceptions to this coverage. For example, you may be limited to a certain number of visits or treatments that are covered outside of Washington. Additionally, certain services may not be covered, such as home health care services that are provided outside of the state. If you travel outside of Washington, it is important to keep a few tips in mind. First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=69: Northwind Health Plus offers coverage for out-of-network providers, but the plan requires prior authorization. This means that you must obtain approval from Northwind Health before seeing an out-of-network provider. Prior authorization is a process in which Northwind Health reviews your request for coverage and decides whether or not it will cover the care that you have requested. To be approved for prior authorization, you must meet certain criteria and provide certain information. This criteria and information may vary depending on the type of care you are requesting. Prior authorization requests must be submitted to Northwind Health by your provider. In most cases, your provider will submit the request for you. Northwind Health will then review the request and make a decision about whether or not it will cover the care.In some cases, Northwind Health may approve the request for coverage, but with certain limitations or conditions. For example, Northwind Health may limit the number of visits for a specific procedure or limit the amount of coverage for a specific procedure.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=71: In conclusion, Northwind Health Plus makes exceptions to the prior authorization requirement for certain services when they are provided by an out-of-network provider. However, it is important to remember that Northwind Health Plus may not cover all of the services provided by an out-of-network provider, that out-of-network providers may charge more than those in-network, and that prior authorization is still required for some services even if they are provided by an out-of-network provider. By being aware of theseexceptions and tips, employees can ensure that they are making responsible and informed decisions about their healthcare needs. Clinical Review CARE MANAGEMENT - Clinical Review Northwind Health Plus offers several care management services to ensure that members are receiving the best possible care. One of the primary care management services is Clinical Review. Clinical Review is an important process that helps to ensure that members are receiving the most appropriate care and that their care is in line with established clinical guidelines. Clinical Review involves a team of healthcare professionals who review services, treatments, and ", "latency": 2.968574, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, providing all essential details required for a comprehensive understanding. It also includes additional insights about the financial implications and coverage limitations, which enhance the understanding of the situation.", "answer_length": 812, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the specific conditions and exceptions mentioned in the Northwind Health Plus Benefits Details.pdf for coordinating benefits with other employer plans and the Right of Recovery provision?", "truth": "The Northwind Health Plus Benefits Details.pdf specifies that to coordinate benefits with another employer plan, one must use an in-network provider within the Northwind Health Plus network and provide the other employer plan's information. Exceptions include not being able to coordinate benefits with non-major medical plans or high-deductible plans until the deductible is met. Regarding the Right of Recovery provision, it only applies to services covered under the plan and claims filed within six months of the service date. It does not guarantee recovery of payments made, and in cases where recovery is not possible, partial reimbursement might be offered. Documentation such as receipts is necessary if filing a Right of Recovery claim. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=102]", "answer": "To coordinate benefits with other employer plans under the Northwind Health Plus plan, you must use an in-network provider within the Northwind Health Plus network and provide your other employer plan's information. Exceptions include not being able to coordinate benefits with a health plan that is not a major medical plan, and if you are enrolled in a high-deductible plan, you cannot coordinate benefits until you have met the deductible [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\nRegarding the Right of Recovery provision, it applies only to services covered under the plan and does not apply to services that are not covered or are subject to limitations or exclusions. Claims must be filed within six months of the date of service. The provision does not guarantee recovery of all paid amounts, and you should keep receipts or documentation if you decide to file a claim [Northwind_Health_Plus_Benefits_Details.pdf#page=102].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=77: To coordinate benefits with your other employer plan, you must use an in-network provider within the Northwind Health Plus network. You will need to provide your other employer plan's information in order to coordinate benefits. Exceptions There are a few exceptions to coordinating benefits with other health care plans. For example, you cannot coordinate benefits with a health plan that is not a major medical plan. Also, if you are enrolled in a health plan that is a high-deductible plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible. Tips If you have other health care coverage, here are a few tips to help you coordinate benefits with Northwind Health Plus: . Make sure you have your other health care plan's information handy when you use Northwind Health Plus. 路 Always use an in-network provider within the Northwind Health Plus network to ensure that your benefits are coordinated correctly. 路 Make sure you understand your plan's rules for coordinating benefits. 路 Ask your doctor or other health care provider about the cost of services before you receive them to make \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan. It does not apply to services that are not covered or services that are subject to limitations or exclusions. Second, the Right of Recovery provision only applies to claims that are filed within six months of the date of service. Also, keep in mind that the Right of Recovery provision does not guarantee that the insurance company will be able to recover the money that you have already paid. The insurance company may be unable to recover the money that you have paid, or they may not be able to recover the entire amount. In these cases, the insurance company may offer to reimburse you for some portion of the money that you have already paid. Finally, if you have already paid a provider for a service that is covered under the plan, it is important to keep any receipts or other documentation. This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company.", "latency": 3.069894, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY by providing the specific conditions and exceptions for both coordinating benefits and the Right of Recovery provision as outlined in the CONTEXT. It does not introduce unrelated or incorrect information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including specific conditions and exceptions for both coordinating benefits and the Right of Recovery provision, without adding extraneous information.", "answer_length": 944, "citations_matched": 1.0, "any_citation": true} +{"question": "How can a policyholder of Northwind Health Plus ensure that their benefits are coordinated correctly when using an in-network provider, and what are the typical copayments for primary care and specialist visits?", "truth": "To ensure that benefits are coordinated correctly when using an in-network provider within the Northwind Health Plus network, a policyholder must have their other health care plan's information handy and always use an in-network provider. The typical copayments for primary care visits are around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "To ensure that benefits are coordinated correctly when using an in-network provider, policyholders of Northwind Health Plus should follow the guidelines provided by their plan and consult with their provider for any necessary information regarding coverage.\n\nThe typical copayments for in-network services are as follows:\n- Primary care visits: approximately $20 [Northwind_Health_Plus_Benefits_Details.pdf#page=10].\n- Specialist visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 4.314512, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides correct copayment information but lacks specific details from the CONTEXT on ensuring benefits coordination, making it partially correct.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both parts of the QUERY with accurate and complete information, without adding extraneous details or insights.", "answer_length": 509, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the necessary steps to ensure coverage for transplants according to the Northwind Standard Benefits Details?", "truth": "To ensure coverage for transplants according to the Northwind Standard Benefits Details, it is important to discuss transplant needs with a primary care physician, ensure the transplant is medically necessary, and obtain preauthorization. Additionally, coverage includes pre- and post-transplant care but excludes experimental or investigational procedures. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=55]", "answer": "To ensure coverage for transplants under the Northwind Standard plan, you should follow these necessary steps:\n\n1. **Discuss with Your Doctor**: Talk to your primary care physician about your transplant needs to determine if the procedure is medically necessary and covered under your plan [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n2. **Preauthorization**: Obtain the necessary preauthorization for any transplant procedures before proceeding [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n3. **Understand Coverage Details**: Familiarize yourself with the details of your coverage, including any applicable copays or coinsurance requirements [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n4. **Inquire About Costs**: Ask your doctor about any potential out-of-pocket costs and alternative treatments that may be available [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n5. **Confirm Medical Necessity**: Ensure that the transplant is not experimental or investigational, as these are not covered by the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n6. **Coverage for Related Services**: Be aware that Northwind Standard covers pre- and post-transplant care, including laboratory tests and other medically necessary services [Northwind_Standard_Benefits_Details.pdf#page=55].", "context": "Northwind_Standard_Benefits_Details.pdf#page=55: There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants. For example, it's important to make sure that you are familiar with all of the details of your coverage, including any applicable copays orcoinsurance requirements. It's also a good idea to ask your doctor about any potential out- of-pocket costs you may need to pay, as well as any potential alternative treatments that may be available. Finally, it's important to note that Northwind Standard does not provide coverage for any experimental or investigational transplant procedures. If you're considering a transplant procedure, it's important to make sure that it is a medically necessary procedure, and that it is covered under your Northwind Standard plan. At Northwind Health, we understand how important it is for our members to have access to the best possible care. That's why we're proud to provide coverage for organ and tissue transplants through our Northwind Standard plan. With this coverage, you can get the care you need, while also enjoying the peace of mind that comes from \n\nNorthwind_Standard_Benefits_Details.pdf#page=55: When a therapeutic injection is covered by the Northwind Standard plan, the member should always confirm that the injection is being administered by a qualified healthcare provider in a medically appropriate setting. If a member has any questions about the therapeutic injection, they should contact the Northwind Health customer service team for more information. By understanding the coverage offered by the Northwind Standard plan, members can make informed decisions about their healthcare and ensure that they are getting the best possible care. Transplants COVERED SERVICES - Transplants At Northwind Health, we understand how important it is to have access to the best possible care. That's why our Northwind Standard plan provides coverage for organ and tissue transplants. If you need a transplant of any kind, Northwind Standard will cover the expenses associated with the procedure, including the cost of the donor organ, hospital stays, recovery costs, and medications. It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician.\n\nNorthwind_Standard_Benefits_Details.pdf#page=55: It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician. In addition to covering the cost of the transplant itself, Northwind Standard will also provide coverage for pre- and post-transplant care, such as laboratory tests, diagnostic tests, and other medically necessary services. It's important to note that there are some exceptions to coverage for transplants. For example, Northwind Standard does not cover experimental or investigational transplant procedures, or any services that are not medically necessary. When it comes to making sure you get the best care possible, we believe that the best approach is to work with your doctor to determine the best course of action. It's important to note that coverage for transplants is subject to preauthorization, so it's important to make sure that you get the necessary authorization for any transplant procedures before you move forward. There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants.", "latency": 7.991896, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately addressing the query with all relevant details mentioned in the context. It does not introduce any unrelated or incorrect information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with all necessary steps and details, making it a complete response.", "answer_length": 1328, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the benefits of using in-network providers according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, using in-network providers results in lower out-of-pocket costs for the policyholder. This is because the plan covers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, which directly impacts the costs incurred by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers offers several benefits according to the Northwind Health Plus Benefits Details:\n\n1. **Cost Savings**: Using in-network providers helps members save money, as they typically charge lower rates compared to out-of-network providers [Northwind_Health_Plus_Benefits_Details.pdf#page=94].\n\n2. **Higher Level of Care**: In-network providers generally provide a higher level of care than out-of-network providers [Northwind_Health_Plus_Benefits_Details.pdf#page=15].\n\n3. **Maximizing Coverage**: Staying in-network allows members to get the most out of their coverage [Northwind_Health_Plus_Benefits_Details.pdf#page=15].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=1: Contoso Electronics Northwind Health Plus Plan Contoso ElectronicsThis document contains information generated using a language model (Azure OpenAI). The information contained in this document is only for demonstration purposes and does not reflect the opinions or beliefs of Microsoft. Microsoft makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this document. All rights reserved to MicrosoftSummary of Benefits Northwind Health Plus Northwind Health Plus is a comprehensive plan that provides comprehensive coverage for medical, vision, and dental services. This plan also offers prescription drug coverage, mental health and substance abuse coverage, and coverage for preventive care services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and other assistance. . Use your plan's in-network providers whenever possible, as this will help you save money. . Utilize Northwind Health's online pharmacy service, which allows you to easily order and manage your prescriptions without leaving home. 路 When you receive health care services, make sure to check that the provider is in-network and that the services are covered by your plan. . Keep track of your claims and other plan information, as this will help you to better understand your plan and stay on top of your health care expenses.. Utilize Northwind Health's customer service to answer any questions or address any concerns you may have about your plan. Healthcare Providers - Independent Contractors OTHER INFORMATION ABOUT THIS PLAN Healthcare Providers - Independent Contractors The Northwind Health Plus plan includes coverage for healthcare services provided by independent contractors.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 3.022922, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely answers the query by listing the benefits of using in-network providers as described in the context. It includes all relevant details and is fully grounded in the provided context.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for understanding the benefits of using in-network providers according to the Northwind Health Plus Benefits Details.", "answer_length": 641, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Health Plus plan address TMJ symptoms and what are the covered services for TMJ treatment?", "truth": "The Northwind Health Plus plan addresses TMJ symptoms by recommending various non-invasive methods such as avoiding chewing gum, large meals, extreme jaw movements, practicing relaxation techniques, and using heat and cold therapy to reduce pain and muscle tension. Additionally, the plan covers therapeutic injections, which are a type of procedure where drugs or other substances are injected directly into the body to treat medical conditions and provide relief from pain, including TMJ. [Northwind_Health_Plus_Benefits_Details.pdf#page=57] [Northwind_Standard_Benefits_Details.pdf#page=54]", "answer": "The Northwind Health Plus plan addresses TMJ symptoms by covering various treatments for Temporomandibular Joint Disorders (TMJ). The covered services include:\n\n1. **Diagnostic Tests**: Coverage for diagnostic tests such as X-rays, CT scans, MRI scans, and ultrasound when deemed medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n2. **Medications**: Coverage for medications to relieve TMJ symptoms, including anti-inflammatory medications, muscle relaxants, and pain medications. In some cases, injections to relieve pain in the jaw joint may also be covered [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n3. **Physical Therapy**: Coverage for physical therapy, which may include stretching exercises, massage, and ultrasound treatments. The plan also covers splints and other devices to help reduce jaw pain and improve jaw movement [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\nExceptions include treatments considered experimental or cosmetic, such as facial surgery, Botox injections, and laser treatments, which are not covered [Northwind_Health_Plus_Benefits_Details.pdf#page=56].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=56: Temporomandibular Joint Disorders (TMJ) Care COVERED SERVICES: Temporomandibular Joint Disorders (TMJ) Care Temporomandibular joint (TMJ) disorders are a group of conditions that affect the jaw joint and the muscles that control the jaw's movement. It can be a debilitating condition that affects an individual's ability to talk, eat, and perform other daily activities. Northwind Health Plus covers treatments for TMJ disorders, including the cost of diagnostic tests, medications, and physical therapy. Diagnostic Tests Northwind Health Plus covers a variety of diagnostic tests that can help determine the cause of an individual's TMJ disorder. These tests may include X-rays, CT scans, MRI scans, and ultrasound. Northwind Health Plus will cover the cost of these tests when they are deemed medically necessary. Medications Northwind Health Plus will cover the cost of medications to help relieve the symptoms of TMJ disorders. These medications may include anti-inflammatory medications, muscle relaxants, and pain medications. In some cases, Northwind Health Plus may also cover the cost of injections to help relieve pain in the \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=56: In some cases, Northwind Health Plus may also cover the cost of injections to help relieve pain in the jaw joint. Physical Therapy Northwind Health Plus will cover the cost of physical therapy to help relieve the symptoms of TMJ disorders. Physical therapy may include stretching exercises, massage, and ultrasound treatments. Northwind Health Plus will also cover the cost of splints and other devices that can help reduce jaw pain and improve jaw movement. Exceptions Northwind Health Plus does not cover the cost of any treatments or procedures that are considered experimental or cosmetic. This includes treatments such as facial surgery, Botox injections, and laser treatments. Tips To help manage the symptoms of TMJ disorders, Northwind Health Plus recommends the following tips:路 Practice good posture and body mechanics: Make sure you maintain good posture when sitting and standing, and avoid clenching your teeth or grinding them. 路 Avoid chewing gum: Chewing gum can cause your jaw muscles to become fatigued, which can worsen TMJ symptoms.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=57: 路 Avoid chewing gum: Chewing gum can cause your jaw muscles to become fatigued, which can worsen TMJ symptoms. . Avoid large meals: Eating large meals can put a strain on your jaw muscles, so try to avoid eating large meals or snacks. 路 Practice relaxation techniques: Relaxation techniques such as deep breathing and progressive muscle relaxation can help reduce jaw tension and relieve TMJ symptoms. 路 Use heat and cold therapy: Applying heat or cold to your jaw can help reduce pain and muscle tension. 路 Avoid extreme jaw movements: Avoid extreme jaw movements, such as widely opening your mouth or clenching your teeth. Therapeutic Injections COVERED SERVICES: Therapeutic Injections At Northwind Health, we understand the importance of having access to therapeutic injections that can help treat medical conditions and provide relief from pain. We are pleased to offer coverage for therapeutic injections as part of the Northwind Health Plus plan. Therapeutic injections are a type of procedure in which drugs or other substances are injected directly into the body to treat medical conditions and ", "latency": 3.599419, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding of the TMJ treatment coverage under the Northwind Health Plus plan.", "answer_length": 1129, "citations_matched": 0.0, "any_citation": true} +{"question": "Considering the Northwind Health Plus Benefits Details, how does the coverage of virtual care services relate to the limitations on services like laboratory tests and mental health services?", "truth": "Northwind Health Plus covers the cost of virtual care services, including telemedicine, e-visits, and other virtual consultations with in-network providers, which can be used for diagnosing and treating minor medical conditions or following up on existing medical issues. However, there are limitations to these virtual care services as some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. Additionally, some services may require prior authorization. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=28]", "answer": "Northwind Health Plus covers virtual care services, allowing members to receive care from home for minor medical conditions and follow-ups. However, there are limitations; services such as laboratory tests, imaging studies, and mental health services may not be available via virtual care and may require in-person visits instead. Additionally, some services may require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=60].\n\nSimilarly, Northwind Standard covers virtual care but excludes services that require a physical exam or in-person care, such as lab work and surgeries [Northwind_Standard_Benefits_Details.pdf#page=57].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization. We encourage you to take advantage of virtual care services when appropriate. To make the most of your virtual care experience, be sure to: 路 Prepare for your visit: Make sure you have the necessary supplies and documents in advance, such as your insurance card, medical history, and any questions you may have.路 Follow up: If you need to follow up with your doctor, be sure to do so. Virtual care services are an excellent way to stay in touch with your provider. . Follow instructions: Make sure you follow any instructions given to you by your doctor during or after your virtual visit. 路 Contact us: If you have any questions or need help scheduling a virtual visit, please contact Northwind Health customer service. At Contoso, we understand that today's busy lifestyles can make it difficult to schedule and attend doctor's appointments. That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=57: With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice. Northwind Standard covers virtual care services in the same way it would cover an in- person visit. This includes a variety of services, such as urgent care, primary care, mental health and substance abuse services, and specialist visits. Members also have access to telehealth post-discharge care and chronic disease management. Exceptions Although Northwind Standard covers most virtual care services, there are a few exceptions. Virtual care is not covered for any services that require a physical exam, such as pediatric well-child visits, physical therapy, and lab work. Additionally, virtual care is not covered for any services that require in-person care, such as surgeries and imaging tests. Tips for Members We want to make sure our members get the most out of their virtual care visits. Here are a few tips to help make your virtual care visits as successful as possible: - Make sure your doctor is in-network.", "latency": 2.966381, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The response accurately addresses the query by explaining the relationship between virtual care coverage and service limitations for Northwind Health Plus. However, it includes unnecessary information about Northwind Standard, which is not relevant to the query, making the response less focused.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, explaining the relationship between virtual care coverage and limitations on certain services. It includes all essential details required for a comprehensive understanding without adding extraneous information.", "answer_length": 647, "citations_matched": 0.5, "any_citation": true} +{"question": "How does Northwind Health Plus manage coinsurance for virtual care services according to the Northwind_Health_Plus_Benefits_Details.pdf?", "truth": "Northwind Health Plus covers the cost of virtual care services, which include telemedicine, e-visits, and other virtual consultations with in-network providers, potentially reducing out-of-pocket costs such as coinsurance for these services. However, it is important to note that some services may require prior authorization, and limitations may apply, such as certain services not being available via virtual care. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "Northwind Health Plus covers the cost of virtual care services, including telemedicine and e-visits, with in-network providers. There may be cost savings benefits, as using virtual care services can help avoid out-of-pocket costs associated with in-person visits. However, some services may require prior authorization, and certain services like laboratory tests and imaging studies may not be available via virtual care [Northwind_Health_Plus_Benefits_Details.pdf#page=60].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: Have your insurance card on hand: Bring your insurance card with you to the visit, as you may need to provide it to the facility. . Bring your medical records: If you have any relevant medical records, bring them with you to the facility. This will help the provider make a more informed diagnosis. 路 Know when to go to the emergency room: If you are experiencing a medical emergency, call 911 or go to the nearest emergency room for treatment. We understand that receiving urgent care can be a stressful situation. At Northwind Health Plus, we strive to make the process as easy and stress-free as possible. If you have any questions about your coverage, please reach out to us so we can help. Virtual Care COVERED SERVICES: Virtual Care At Contoso, we understand that taking time off to go to the doctor's office isn't always possible. That's why we've partnered with Northwind Health to provide access to virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=61: That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home. Weight Management WEIGHT MANAGEMENT - COVERED SERVICES Weight management is an important part of overall health and wellness, and Northwind Health Plus recognizes this. As part of your health plan, you have access to a variety of coverage options for weight management. Coverage for Weight Loss Programs Northwind Health Plus offers coverage for medically supervised weight loss programs. These programs are designed to help you reach and maintain a healthy weight. Covered services may include nutrition counseling, medical evaluation and follow-up, and laboratory tests. Your plan may also cover the cost of medications prescribed by your doctor as part of your weight loss program. Coverage for Weight Loss Surgery Northwind Health Plus also offers coverage for weight loss surgery. Weight loss surgery is a serious procedure that can help some people achieve major health benefits.", "latency": 5.836321, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The RESPONSE does not address the specific aspect of coinsurance management for virtual care services as requested in the QUERY. It provides related information about coverage and cost savings but omits the specific details about coinsurance.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses virtual care services but does not specifically address coinsurance management, which is the key aspect of the QUERY. Therefore, it is incomplete.", "answer_length": 474, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the financial responsibilities of a Northwind Standard plan holder when using out-of-network providers according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, when a Northwind Standard plan holder uses out-of-network providers, they may be responsible for the entire cost of services or a far greater portion of the cost than they would with an in-network provider. Although Northwind Standard may offer coverage for some out-of-network providers, the costs associated with these providers can be significantly more expensive. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "According to the Northwind Standard Benefits Details, when using out-of-network providers, a plan holder may face the following financial responsibilities:\n\n1. Coverage for out-of-network providers is offered, but costs can be significantly higher than for in-network providers. You may be responsible for the entire cost of services or a much larger portion than with in-network providers [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n2. Some services provided by out-of-network providers may not be covered by the Northwind Standard plan, leading to out-of-pocket expenses for those services [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n3. If you receive care from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay [Northwind_Health_Plus_Benefits_Details.pdf#page=27].\n\n4. Out-of-network services may not count towards your deductible or out-of-pocket maximum, meaning you could be responsible for the entire cost of the services, minus any applicable discounts [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n5. You may also be subject to balance billing, where the provider bills you for the difference between their charges and what Northwind pays [Northwind_Health_Plus_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay. ExceptionsNorthwind Health Plus does not cover certain types of emergency services. These include services for certain social and cosmetic procedures, elective surgery, experimental treatments, and services for injuries or illnesses that are not medically necessary. Tips for Employees It is important to keep in mind that if you have an emergency, you should seek care from the nearest hospital or medical facility. Regardless of whether it is in-network or out-of- network, you will be covered. It is also important to remember that if you receive care from an out-of-network provider, you may be responsible for higher out-of-pocket costs. It is also important to be aware of the exceptions to Northwind Health Plus' coverage of emergency services. Certain services, such as those for elective surgery and experimental treatments, are not covered. Lastly, it is important to keep your Northwind Health Plus ID card with you at all times.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 3.710588, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE includes correct information from the relevant document but also introduces unrelated information from a different document, which is not asked for in the QUERY. This makes the RESPONSE partially correct but not fully grounded in the specified CONTEXT.", "relevance": 2.0, "gpt_relevance": 2.0, "relevance_reason": "The RESPONSE attempts to address the QUERY but includes incorrect information by referencing details from a different plan document, making it partially incorrect and incomplete.", "answer_length": 1331, "citations_matched": 0.5, "any_citation": true} +{"question": "How does the clinical review process in the Northwind Standard Benefits Details ensure timely and cost-effective medical service provision, and what are the documentation requirements for filing a claim as outlined in the same document?", "truth": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by requiring pre-authorization for some medical services and by designing the process to ensure that medically necessary treatments are provided efficiently. Members are advised to provide accurate and detailed information about their medical needs, including a complete list of current medications and all relevant medical history, along with any necessary documentation like test results or lab reports. For filing a claim, the necessary documentation includes itemized bills, a completed claim form, and any other documentation requested by Northwind Health. This process helps in ensuring that members receive high-quality, cost-effective care. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "The clinical review process in the Northwind Standard Benefits Details is designed to ensure that medically necessary treatments are provided in a timely and cost-effective manner. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, to facilitate a smooth review process. Necessary documentation, such as test results or lab reports, should also be provided [Northwind_Standard_Benefits_Details.pdf#page=68][Northwind_Standard_Benefits_Details.pdf#page=67].\n\nFor filing a claim, it is important to do so within twelve months of the date of service to ensure timely processing. Claims submitted after this period may be considered but are not guaranteed acceptance. Claims can be filed directly through the Northwind website or app, and if filing on behalf of a family member, authorization is required. Additionally, some services may need pre-approval from Northwind Health [Northwind_Standard_Benefits_Details.pdf#page=78].", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed ", "latency": 3.867519, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses both parts of the QUERY using relevant information from the CONTEXT, demonstrating a thorough understanding of the clinical review process and claim filing requirements.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information regarding both the clinical review process and the documentation requirements for filing a claim.", "answer_length": 1047, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the process for ensuring cost-effective care under the Northwind Standard plan?", "truth": "The process for ensuring cost-effective care under the Northwind Standard plan involves a clinical review process that requires pre-authorization for some medical services. This process is designed to ensure that medically necessary treatments are provided in a timely and cost-effective manner. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, along with any necessary documentation like test results or lab reports. This helps to ensure that the clinical review process runs smoothly and quickly. [Northwind_Standard_Benefits_Details.pdf#page=68] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "The process for ensuring cost-effective care under the Northwind Standard plan involves several key components:\n\n1. **Pre-authorization and Clinical Review**: Some medical services may require pre-authorization, and the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost-effective manner. Members should provide accurate and detailed information about their medical needs, including current medications and relevant medical history, to facilitate this process [Northwind_Standard_Benefits_Details.pdf#page=68].\n\n2. **Care Management Services**: The Northwind Standard plan offers care management services, including clinical review conducted by licensed clinicians who evaluate the medical necessity and appropriateness of proposed treatments using evidence-based guidelines [Northwind_Standard_Benefits_Details.pdf#page=67].\n\n3. **Cost Management Tips**: Members are encouraged to take advantage of preventive care services (which are covered 100%), visit in-network providers, consider generic prescription drugs, consult with their doctors about cost-effective treatment options, and carefully review their Explanation of Benefits (EOB) statements to manage costs effectively [Northwind_Standard_Benefits_Details.pdf#page=4].", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed \n\nNorthwind_Standard_Benefits_Details.pdf#page=4: Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard. Here are a few tips that you can use to get the most out of your coverage: 路 Make sure to take advantage of preventive care services. These services are covered 100% by the plan and can help you avoid more costly treatments down the line. 路 Always make sure to visit in-network providers. Doing so will ensure that you receive the maximum benefit from your plan. 路 Consider generic prescription drugs when available. These drugs can often be cheaper than brand-name drugs and are just as effective. . Talk to your doctor about ways to save money. Many doctors are willing to work with you to find the most cost-effective treatment options available. 路 Review your Explanation of Benefits (EOB) statements carefully. This document will show you exactly how much you are being charged for each service and what your plan is covering. By following these tips, you can ensure that you are getting the most out of your Northwind Standard health plan.", "latency": 7.172256, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details from the provided information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights on cost management, making it comprehensive.", "answer_length": 1293, "citations_matched": 0.5, "any_citation": true} +{"question": "Considering the information provided in the Northwind Health Plus Benefits Details, how can a policyholder effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers?", "truth": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, a policyholder should use an in-network provider within the Northwind Health Plus network. This is crucial as in-network providers have agreed to charge lower rates for their services, which can help save money on out-of-pocket costs. Additionally, the policyholder needs to provide the other employer plan's information to coordinate benefits. It is also important to understand the plan's rules for coordinating benefits and to inquire about the cost of services before receiving them to ensure benefits are coordinated correctly and cost-effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers, a policyholder can follow these strategies:\n\n1. Use in-network providers: This will lower out-of-pocket costs since Northwind Health has negotiated discounted rates with in-network providers. In-network services typically have lower coinsurance rates as well [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n2. Understand the out-of-pocket maximum: The Northwind Health Plus plan has an out-of-pocket maximum of $4,000 per year. Once this limit is reached, no further out-of-pocket costs are required for covered services for the remainder of the plan year [Northwind_Health_Plus_Benefits_Details.pdf#page=108].\n\n3. Get cost estimates: Ask your provider for an estimate of the cost of a service before receiving it. This can help you plan and understand your potential out-of-pocket expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n4. Keep track of expenses: Monitor the services received and the amounts paid to better understand how much has been paid towards coinsurance requirements for the year [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n5. Contact the plan administrator: If there are any questions about coinsurance requirements or specific services, reaching out to the plan administrator can provide clarity [Northwind_Health_Plus_Benefits_Details.pdf#page=14]. \n\nBy following these steps, a policyholder can effectively manage their out-of-pocket costs while coordinating benefits with another employer plan.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=14: Many plans offer lower coinsurance rates for in-network providers, meaning you will pay less for the same service. 3. Ask your provider for an estimate of the cost of a service before you receive it. This will help you determine how much of the cost you will be responsible for. 4. Keep track of the services you receive and the amount you pay. This will help you understand how much you have paid towards your coinsurance requirement for the year. 5. Contact your plan administrator if you have any questions about your coinsurance requirement or what services are subject to coinsurance. Out-Of-Pocket Maximum IMPORTANT PLAN INFORMATION: Out-Of-Pocket Maximum Under the Northwind Health Plus plan, members are responsible for costs associated with their health care. These costs can include deductibles, copays, coinsurance, and other out of pocket expenses. To help members manage health care costs, the Northwind Health Plus plan offers a maximum out-of-pocket (OOP) limit. Once a member has reached the OOP limit, they pay no more out-of-pocket costs for the rest of the plan year.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year. This amount includes the deductible, coinsurance, and copayments. Northwind Health Plus has an out-of-pocket maximum of $4,000 per year. In-Network Provider: An in-network provider is a health care provider or facility that is contracted with the insurance company. Employees who use an in-network provider will have lower copayments and coinsurance amounts than those who use an out-of-network provider. Out-of-Network Provider: An out-of-network provider is a health care provider or facility that is not contracted with the insurance company. Employees who use an out-of-network provider will have higher copayments and coinsurance amounts than those who use an in- network provider. Exceptions Northwind Health Plus does have some exceptions to the rules regarding copayments, deductibles, coinsurance, and out-of-pocket maximums. Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance.", "latency": 4.769511, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is well-grounded in the CONTEXT, providing accurate and relevant strategies for managing out-of-pocket costs. However, it does not fully address the aspect of coordinating benefits with another employer plan, which is part of the QUERY. Therefore, it is partially correct but not entirely complete.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing strategies and insights that enhance understanding. It includes all essential details required for a comprehensive understanding and offers additional insights into managing out-of-pocket costs.", "answer_length": 1644, "citations_matched": 0.0, "any_citation": true} +{"question": "Considering the Northwind Health Plus benefits, how does choosing an in-network provider affect the out-of-pocket costs for a policyholder, and what are the covered services under hospice care according to the plan?", "truth": "Choosing an in-network provider under the Northwind Health Plus plan significantly affects the out-of-pocket costs for a policyholder by reducing them. When a policyholder uses in-network providers, they pay lower out-of-pocket costs compared to using out-of-network providers, where they would be responsible for a larger portion of the cost. Regarding hospice care, the Northwind Health Plus coverage includes care from a hospice team, medications, medical supplies, equipment for treating the terminal illness, counseling for the member and their family, inpatient and respite care, grief counseling, and bereavement services. However, it does not cover services intended to cure the terminal illness, such as chemotherapy, radiation therapy, and surgery. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=33]", "answer": "Choosing an in-network provider will lower your out-of-pocket costs compared to using an out-of-network provider. Northwind Health has negotiated discounted rates with in-network providers, resulting in lower copayments and coinsurance amounts for policyholders who use them. In contrast, using an out-of-network provider may lead to higher copayments, coinsurance, and potentially being responsible for the full cost of services received [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=6].\n\nRegarding hospice care, the specific covered services under hospice care are not detailed in the provided sources. Therefore, I don't know the covered services under hospice care according to the plan.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=108: Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year. This amount includes the deductible, coinsurance, and copayments. Northwind Health Plus has an out-of-pocket maximum of $4,000 per year. In-Network Provider: An in-network provider is a health care provider or facility that is contracted with the insurance company. Employees who use an in-network provider will have lower copayments and coinsurance amounts than those who use an out-of-network provider. Out-of-Network Provider: An out-of-network provider is a health care provider or facility that is not contracted with the insurance company. Employees who use an out-of-network provider will have higher copayments and coinsurance amounts than those who use an in- network provider. Exceptions Northwind Health Plus does have some exceptions to the rules regarding copayments, deductibles, coinsurance, and out-of-pocket maximums. Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus ", "latency": 3.337237, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE accurately addresses the first part of the QUERY regarding in-network providers and out-of-pocket costs, but it cannot provide information on hospice care services due to the lack of such details in the CONTEXT. This makes the RESPONSE partially correct and complete.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides complete information for the first part of the QUERY but lacks details for the second part regarding hospice care services, making it an incomplete response overall.", "answer_length": 745, "citations_matched": 0.0, "any_citation": true} +{"question": "What is the process for getting a service covered under Northwind Standard Benefits Details?", "truth": "To get a service covered under Northwind Standard Benefits Details, prior authorization must be requested from Northwind Health either by the provider or the member before the service is received. If prior authorization is not obtained, Northwind Health may not cover the service. Certain services such as preventive care, emergency care, outpatient hospital services, urgent care, and services in a skilled nursing facility are exempt from this prior authorization process. [Northwind_Standard_Benefits_Details.pdf#page=60] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To get a service covered under the Northwind Standard Benefits, follow these steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments, including the medical necessity.\n2. Ensure all documentation is complete, including required forms, test results, and physician's notes.\n3. Send the documentation to Northwind Health as soon as possible.\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed [Northwind_Standard_Benefits_Details.pdf#page=88].\n\nAdditionally, make sure to submit claims as soon as possible after receiving a service, and track your claims to ensure timely processing [Northwind_Standard_Benefits_Details.pdf#page=17].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan \n\nNorthwind_Standard_Benefits_Details.pdf#page=17: Make sure to understand the details of the plan and the associated out-of-pocket costs before receiving a service. 路 Select in-network providers to maximize coverage and avoid unexpected costs. 路 Submit claims as soon as possible after a service is rendered. 路 Track claims and follow up with Northwind Health if a claim is not processed in a timely manner. 路 Take advantage of preventive services to stay healthy and reduce future costs. . Ask questions and contact Northwind Health if you need assistance understanding your coverage or filing a claim. By understanding the details of the Northwind Standard plan and following the tips above, employees can ensure that they are taking full advantage of their benefits. Taking the timeto understand the plan and ask questions can help employees to make the most of their coverage and stay healthy. COVERED SERVICES Acupuncture COVERED SERVICES: Acupuncture At Contoso, we are proud to offer employees Northwind Standard, an insurance plan that includes coverage for acupuncture.", "latency": 3.775241, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details from the provided information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, and it includes additional relevant insights about timely submission and tracking of claims, which enhances understanding.", "answer_length": 723, "citations_matched": 0.0, "any_citation": true} diff --git a/evals/results/gpt4omini-emb3l-2/evaluate_parameters.json b/evals/results/gpt4omini-emb3l-2/evaluate_parameters.json new file mode 100644 index 0000000000..6981f826ba --- /dev/null +++ b/evals/results/gpt4omini-emb3l-2/evaluate_parameters.json @@ -0,0 +1,27 @@ +{ + "evaluation_gpt_model": "gpt-4o", + "evaluation_timestamp": 1748934102, + "testdata_path": "/Users/pamelafox/azure-search-openai-demo/evals/ground_truth.jsonl", + "target_url": "http://localhost:50505/chat", + "target_parameters": { + "overrides": { + "top": 3, + "temperature": 0.3, + "minimum_reranker_score": 0, + "minimum_search_score": 0, + "retrieval_mode": "hybrid", + "semantic_ranker": true, + "semantic_captions": false, + "suggest_followup_questions": false, + "use_oid_security_filter": false, + "use_groups_security_filter": false, + "vector_fields": [ + "embedding" + ], + "use_gpt4v": false, + "gpt4v_input": "textAndImages", + "seed": 1 + } + }, + "num_questions": null +} diff --git a/evals/results/gpt4omini-emb3l-2/summary.json b/evals/results/gpt4omini-emb3l-2/summary.json new file mode 100644 index 0000000000..fe54740648 --- /dev/null +++ b/evals/results/gpt4omini-emb3l-2/summary.json @@ -0,0 +1,33 @@ +{ + "gpt_groundedness": { + "pass_count": 44, + "pass_rate": 0.88, + "mean_rating": 4.54 + }, + "gpt_relevance": { + "pass_count": 44, + "pass_rate": 0.88, + "mean_rating": 4.2 + }, + "answer_length": { + "mean": 906.34, + "max": 1644, + "min": 193 + }, + "latency": { + "mean": 3.71, + "max": 7.991896, + "min": 2.148354 + }, + "citations_matched": { + "total": 24, + "rate": 0.49 + }, + "any_citation": { + "total": 50, + "rate": 1.0 + }, + "num_questions": { + "total": 50 + } +} diff --git a/evals/results/gpt4omini-emb3l/README.md b/evals/results/gpt4omini-emb3l/README.md new file mode 100644 index 0000000000..4b8048311b --- /dev/null +++ b/evals/results/gpt4omini-emb3l/README.md @@ -0,0 +1,10 @@ +# Baseline Evaluation + +This evaluation was done with the application configured to use the following models: + +* Chat completion: **gpt-4.1-mini (2025-04-14 model version)** +* Embedding: **text-embedding-3-large (with binary quantization, 1024 dimension reducation, and oversampling)** + +The model used for evaluation was: **gpt-4o (2024-08-06 version)** + +These are the default models and settings as of June 2025. diff --git a/evals/results/gpt4omini-emb3l/config.json b/evals/results/gpt4omini-emb3l/config.json new file mode 100644 index 0000000000..99de8ef295 --- /dev/null +++ b/evals/results/gpt4omini-emb3l/config.json @@ -0,0 +1,28 @@ +{ + "testdata_path": "ground_truth.jsonl", + "results_dir": "results/experiment", + "requested_metrics": ["gpt_groundedness", "gpt_relevance", "answer_length", "latency", "citations_matched", "any_citation"], + "target_url": "http://localhost:50505/chat", + "target_parameters": { + "overrides": { + "top": 3, + "temperature": 0.3, + "minimum_reranker_score": 0, + "minimum_search_score": 0, + "retrieval_mode": "hybrid", + "semantic_ranker": true, + "semantic_captions": false, + "suggest_followup_questions": false, + "use_oid_security_filter": false, + "use_groups_security_filter": false, + "vector_fields": [ + "embedding" + ], + "use_gpt4v": false, + "gpt4v_input": "textAndImages", + "seed": 1 + } + }, + "target_response_answer_jmespath": "message.content", + "target_response_context_jmespath": "context.data_points.text" +} diff --git a/evals/results/gpt4omini-emb3l/eval_results.jsonl b/evals/results/gpt4omini-emb3l/eval_results.jsonl new file mode 100644 index 0000000000..e3b6f8fe26 --- /dev/null +++ b/evals/results/gpt4omini-emb3l/eval_results.jsonl @@ -0,0 +1,50 @@ +{"question": "What protection does Contoso offer against balance billing?", "truth": "Contoso offers a balance billing protection through the Northwind Standard plan, which protects employees from unexpected costs when visiting in-network providers. [Northwind_Standard_Benefits_Details.pdf#page=7]", "answer": "Contoso offers balance billing protection through the Northwind Standard plan when visiting in-network providers. This means you are protected from unexpected costs that arise from balance billing, which occurs when a provider bills you for the difference between their charges and what your insurance pays. However, this protection does not apply to emergency services, mental health and substance abuse coverage, out-of-network providers, or any non-covered services [Northwind_Standard_Benefits_Details.pdf#page=7][Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Exceptions to the balance billing protection: 路 Balance billing protection does not apply to emergency services. 路 Balance billing protection does not apply to mental health and substance abuse coverage. 路 Balance billing protection does not apply to out-of-network providers. 路 Balance billing protection is not applicable to any non-covered services. At Contoso, we want to make sure our employees are provided with the best coverage options. That's why we've partnered with Northwind Health to offer the Northwind Standard plan, which provides balance billing protection when visiting in-network providers. We encourage our employees to use the tips provided to help reduce the risk of unexpected costs when visiting a provider. Benefits For Out-Of-Network Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers.\n\nNorthwind_Standard_Benefits_Details.pdf#page=7: Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to offer our employees the Northwind Standard plan. This plan provides a balance billing protection, meaning that you are protected from unexpected costs when visiting in-network providers. What is balance billing? Balance billing is when a provider bills you for the difference between what they charge and what your insurance company is willing to pay. This difference can be hundreds of dollars and is often unexpected. With the Northwind Standard plan, you are protected from balance billing when visiting in-network providers. What is an in-network provider? In-network providers are healthcare providers, such as doctors, hospitals, and labs, that have agreed to accept the Northwind Standard plan's payment terms. Visiting an in-network provider means that you are protected from balance billing. You can find a list of in-network providers on the Northwind Health website. What if I visit an out-of-network provider?\n\nNorthwind_Standard_Benefits_Details.pdf#page=6: If you are unsure, you can contact the customer service department of your health plan to verify.It is also important to ask your provider about their policy on balance billing. Be sure to find out if the provider requires you to pay the balance billing amount up front, or if they will bill you after the health plan pays them. When selecting a provider, also remember to consider the cost of services. Participating providers are often more cost effective than non-participating providers. Additionally, some providers offer discounts to patients who pay out of pocket for services. Finally, if you need to use a non-participating provider for certain services, be sure to check with your health plan first. There may be an exception that will cover the cost of the service. Additionally, if you need to use a non-participating provider and you are concerned about the cost, you can always negotiate with your provider to find a more affordable rate. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS - Balance Billing Protection At Contoso, we understand that medical costs can be intimidating and confusing, which is why we've partnered with Northwind Health to ", "latency": 2.793312, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the information provided in the CONTEXT and directly addressing the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the limitations of the protection, which enhances understanding.", "answer_length": 566, "citations_matched": 1.0, "any_citation": true} +{"question": "what is in-network mean for Northwind Health?", "truth": "In-network providers for Northwind Health are those who have agreed to accept the payment offered by Northwind Health, meaning that the policyholder only pays the portion of the cost not covered by the insurance plan. These providers may also offer additional services or discounts not available from out-of-network providers. [Northwind_Standard_Benefits_Details.pdf#page=8]", "answer": "In-network providers for Northwind Health are healthcare providers that have contracted with Northwind Health to provide services at a discounted rate. They have agreed to accept the payment amount offered by Northwind Health, meaning you only pay the portion of the cost not covered by the insurance plan. In-network providers may also offer additional services or discounts not available to out-of-network providers [Northwind_Standard_Benefits_Details.pdf#page=8][Northwind_Standard_Benefits_Details.pdf#page=103].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan. In-network providers may also offer additional services or discounts that are not available to out-of-network providers.Out-of-Network: Out-of-network providers are those who have not contracted with Northwind Health. As a result, they are not required to accept the amount of payment offered by Northwind Health, meaning that you may be responsible for a greater portion of the cost. Additionally, out-of-network providers may not offer additional services or discounts that are available to in-network providers. When choosing a provider, it is important to make sure that the provider is in-network. While it is possible to receive care from out-of-network providers, it is important to understand that you will be responsible for a greater portion of the costs. To make sure that you are getting the best value for your health care expenses, it is recommended that you choose an in-network provider whenever possible.\n\nNorthwind_Standard_Benefits_Details.pdf#page=103: Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health. This includes primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Provider: An out-of-network provider is a healthcare provider that is not included in the Northwind Health network and is not eligible to receive payments from Northwind Health. Out-of-network providers are not covered by Northwind Standard. Preventive Care Services: Preventive care services are services that are designed to help prevent illness and promote health. These services may include immunizations, physical exams, screenings, and other preventive care services. Emergency Services: Emergency services are services that are provided in the case of an emergency. These services may include emergency surgery, emergency room visits, or other emergency services. Northwind Standard does not provide coverage for emergency services. Mental Health and Substance Abuse Coverage: Mental health and substance abuse coverage is coverage for services related to mental health and substance abuse.", "latency": 3.197911, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY with all relevant details provided.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about extra services or discounts offered by in-network providers, which enhances understanding.", "answer_length": 517, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the financial implications of choosing an out-of-network provider under the Northwind Standard Benefits Details?", "truth": "Choosing an out-of-network provider under the Northwind Standard Benefits Details can be significantly more expensive than in-network providers. You may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. [Northwind_Standard_Benefits_Details.pdf#page=10]", "answer": "Choosing an out-of-network provider under the Northwind Standard plan can have significant financial implications:\n\n1. You may be responsible for a greater portion of the costs compared to using an in-network provider. In some cases, you might have to pay the entire cost of services or a far greater portion than you would with an in-network provider [Northwind_Standard_Benefits_Details.pdf#page=8].\n\n2. Out-of-network providers are not required to accept the same reimbursement rates as contracted providers, leading to potentially much higher costs for care [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n3. Services received from an out-of-network provider may not count towards your deductible or out-of-pocket maximum, meaning you could be responsible for paying the full cost of services, minus any applicable discounts [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n4. You may also face balance billing, where the provider bills you for the difference between their billed charges and the amount paid by Northwind Health [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n5. While some out-of-network services may be covered, you will likely still pay more than you would for in-network services [Northwind_Standard_Benefits_Details.pdf#page=10].", "context": "Northwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 6.694597, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides a correct answer to the QUERY but includes information from a different context (Northwind Health Plus Benefits), which is not relevant to the QUERY about Northwind Standard Benefits. This makes the RESPONSE partially correct but not fully grounded in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the financial implications, such as balance billing and deductible issues, enhancing understanding.", "answer_length": 1272, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the coverage limitations of the Northwind Standard plan regarding clinical trials?", "truth": "The Northwind Standard plan does not cover travel expenses associated with attending clinical trials, nor does it cover any experimental treatments or services that are not part of the clinical trial. [Northwind_Standard_Benefits_Details.pdf#page=24]", "answer": "The Northwind Standard plan has the following coverage limitations regarding clinical trials:\n\n1. It does not cover travel expenses associated with attending clinical trials [Northwind_Standard_Benefits_Details.pdf#page=24].\n2. Experimental treatments or services that are not part of the clinical trial are not covered [Northwind_Standard_Benefits_Details.pdf#page=24].\n3. Coverage for clinical trial services is limited to certain services, including diagnostic testing, treatment of the condition being studied, medications, lab services, and imaging services. Other services may be eligible for coverage on a case-by-case basis [Northwind_Standard_Benefits_Details.pdf#page=23].\n\nMembers should consult with their doctor before participating in a clinical trial to understand the risks and benefits [Northwind_Standard_Benefits_Details.pdf#page=24].", "context": "Northwind_Standard_Benefits_Details.pdf#page=24: It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials. Additionally, any experimental treatments or services that are not part of the clinical trial are not covered. When considering participation in a clinical trial, members should always consult with their doctor first to make sure it's the right choice for them. Clinical trials are not for everyone, and it's important to fully understand the risks and benefits before making a decision. Members should also be aware that not all clinical trials are free. Some require a fee, and it's important to find out what the cost will be before participating. Finally, members should keep in mind that clinical trials are often available in limited locations, so they may have to travel to participate in a trial. Northwind Health can provide information about nearby clinical trials and may be able to help with the cost of travel. At Northwind Health, we are committed to providing access to the most innovative treatments and therapies available.\n\nNorthwind_Standard_Benefits_Details.pdf#page=23: Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, and can give members access to treatments and therapies not yet available. Northwind Standard offers coverage for certain clinical trial services, including those related to common diseases and conditions. The Northwind Standard plan covers the cost of certain clinical trial services, and some of the most common include: 路 Diagnostic testing and procedures to confirm or diagnose a condition or disease 路 Treatment of the condition or disease being studied 路 Medications 路 Lab services 路 Imaging services Any other clinical trial services that are not explicitly covered by the Northwind Standard plan may be eligible for coverage on a case-by-case basis. To determine if a clinical trial service is covered, members should contact the Northwind Health customer service department for more information.It's important for members to note that the Northwind Standard plan does not cover travel expenses associated with attending clinical trials.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=23: Northwind Health Plus covers certain clinical trials that are approved by the Food and Drug Administration (FDA) and that are considered medically necessary. These clinical trials must also be recommended by your doctor or health care provider. The plan covers FDA- approved drugs, medical treatments, and medical devices that are used in the clinical trial. What Are Some Exceptions? Northwind Health Plus does not cover any experimental treatments that are not approved by the FDA or that are not considered medically necessary. Additionally, the plan does not cover any treatments that are used in the clinical trial that are not considered medically necessary. Clinical trials must be recommended by your doctor or health care provider and must be approved by the FDA in order for the plan to cover them.Tips for Employees If you are considering participating in a clinical trial, there are a few things to keep in mind: . Make sure the clinical trial has been approved by the FDA. . Talk to your doctor or health care provider about the trial and ask any questions you may have. 路 Ask about the potential risks and benefits of participating in the trial.", "latency": 3.682579, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately listing the coverage limitations of the Northwind Standard plan regarding clinical trials as described in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the coverage limitations of the Northwind Standard plan regarding clinical trials.", "answer_length": 853, "citations_matched": 1.0, "any_citation": true} +{"question": "Does Contoso cover gendr affirming care?", "truth": "Yes, Contoso offers coverage through Northwind Standard for gender affirming care services, which include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. [Northwind_Standard_Benefits_Details.pdf#page=29]", "answer": "Yes, Contoso covers gender affirming care. This includes hormone therapy, gender affirming surgery, and mental health services related to gender transition through Northwind Health Plus. The coverage encompasses hormone replacement therapy, pre- and post-operative care, as well as counseling and therapy visits related to gender transition [Northwind_Health_Plus_Benefits_Details.pdf#page=29][Northwind_Standard_Benefits_Details.pdf#page=29].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=29: Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus. This coverage includes hormone therapy, gender affirming surgery, and mental health services related to gender transition. Hormone Therapy: Northwind Health Plus covers hormone therapy for individuals undergoing gender transition. This includes gender-affirming hormone replacement therapy such as testosterone or estrogen. The coverage also includes many medications and treatments related to hormone therapy, such as monitoring blood work, doctor visits, and lab tests. Gender Affirming Surgery: Northwind Health Plus covers gender affirming surgery for individuals undergoing gender transition. Northwind Health Plus also covers pre- and post-operative care related to gender affirming surgery. Mental Health Services:Northwind Health Plus covers mental health services related to gender transition. This includes counseling and therapy visits, as well as medications related to mental health treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=29: Affirming Care COVERED SERVICES - Gender Affirming Care At Contoso, we understand that gender identity is an important part of who we are and that it should be respected and supported. We are proud to offer coverage through Northwind Standard for gender affirming care services. Gender affirming care services can include a variety of treatments and services related to gender transition. These services may include hormone therapy, gender affirming surgeries, and mental health care related to gender transition. Hormone Therapy Hormone therapy is a type of gender affirming treatment that can be used to help an individual align their physical characteristics with their gender identity. This type of therapy involves taking hormones that are typically associated with a certain gender to help the individual's body better reflect their gender identity. Gender Affirming Surgery Gender affirming surgery is a type of treatment that involves surgical procedures to help an individual transition to the gender they identify with. Mental Health Care Mental health care related to gender transition can include counseling and therapy services to help an individual through their transition process.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=28: by a physician Exceptions Our plan does not cover: 路 Routine foot care, such as trimming toenails, callus removal, and shoe inserts路 Foot care products, such as arch supports, shoe inserts, and foot orthotics 路 Services that are not medically necessary Tips for Employees 路 Take preventive steps to minimize foot problems, such as wearing comfortable shoes that fit properly and provide adequate support. 路 If you have diabetes, check your feet daily for sores or other problems. . If you have any foot problems, don't delay seeking medical care. Early diagnosis and treatment can often prevent more serious problems from developing. 路 If you need custom orthotics, be sure to get them from a qualified provider who is knowledgeable in their use. 路 If you're prescribed orthotics, be sure to follow the instructions for use and wear them as directed. 路 If you're prescribed medication, be sure to take it as directed. . If you have any questions about your foot care coverage, please contact Northwind Health Plus. Gender Affirming Care COVERED SERVICES: Gender Affirming Care Contoso is proud to offer employees comprehensive coverage for gender affirming care through Northwind Health Plus.", "latency": 2.843525, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely addresses the query by confirming the coverage and detailing the services included, all of which are supported by the context.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it includes additional relevant insights about the specific services covered and the health plan involved.", "answer_length": 443, "citations_matched": 1.0, "any_citation": true} +{"question": "What typs of hearin care servises are covered by the Northwind Standard plan?", "truth": "The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone-anchored hearing aids. It also covers routine hearing aid maintenance and repair, counseling, hearing aid evaluations, and up to $500 per ear for hearing aid accessories such as ear molds, batteries, and tubing. [Northwind_Standard_Benefits_Details.pdf#page=30]", "answer": "The Northwind Standard plan covers the following hearing care services:\n\n1. Hearing tests\n2. Hearing aids and hearing aid accessories\n3. Cochlear implants\n4. Bone-anchored hearing aids\n5. Up to two hearing aids or implants per ear every three years\n6. Routine hearing aid maintenance and repair\n7. Counseling and hearing aid evaluations\n8. Up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing\n\nThere is no deductible for these services, and no pre-authorization is required. However, services provided by out-of-network providers are not covered, and you would be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount [Northwind_Standard_Benefits_Details.pdf#page=30].", "context": "Northwind_Standard_Benefits_Details.pdf#page=30: We are proud to offer coverage for these services for our employees, and we are committed to providing a safe and supportive environment for all of our employees. Hearing Care Hearing Care At Contoso, we understand the importance of taking care of your hearing health. That's why we provide comprehensive coverage for hearing care with Northwind Standard. You can receive hearing care services from any in-network provider and enjoy comprehensive coverage for all hearing care services. The Northwind Standard plan covers all types of hearing care services, including hearing tests, hearing aids and hearing aid accessories, as well as cochlear implants and bone- anchored hearing aids. If a hearing aid or cochlear implant is needed, the plan covers up to two hearing aids or implants per ear every three years. The plan also covers routine hearing aid maintenance and repair, as well as counseling and hearing aid evaluations. In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing.\n\nNorthwind_Standard_Benefits_Details.pdf#page=30: In addition, the Northwind Standard plan covers up to $500 per ear for hearing aid accessories, such as ear molds, batteries, and tubing. There is no deductible for hearing care services and no pre-authorization is required. However, the Northwind Standard plan does not cover hearing care services provided by out-of-network providers. If you choose to see an out-of-network provider for hearing care, you will be responsible for the difference between the out-of-network provider's charges and the plan's allowed amount. When it comes to choosing a hearing care provider, it's important to find one who is qualified and experienced. Make sure to ask questions about the provider's qualifications, experience, and specialties. You should also ask about the provider's policies on returns, warranties, and repairs. It's also important to understand the technology behind hearing aids. Ask your provider to explain the differences between digital and analog technology, and be sure to ask about the various features that are available. If you have any questions about the Northwind Standard plan's coverage for hearing care, please \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=30: Be sure to check with your provider and Northwind Health Plus about any pre- authorization requirements. . If you have any questions about your coverage, call Northwind Health Plus customer service. Hearing Care COVERED SERVICES: Hearing Care At Contoso, we understand how important it is for our employees to stay on top of their overall health. That is why we are proud to offer comprehensive hearing care coverage through Northwind Health Plus. This coverage can be used for a variety of hearing care services, including but not limited to hearing tests and evaluations, hearing aids and other associated services, as well as hearing aid fittings and adjustments. In order to take advantage of this coverage, employees must receive care from an in- network provider. Northwind Health Plus has a wide selection of providers in its network, making it easy to find a provider who is right for you. Additionally, the plan covers hearing aid fittings, adjustments, repairs, and replacements, as well as batteries, when necessary. When it comes to hearing aid coverage, Northwind Health Plus covers up to $1,500 every 3 years for all hearing aid services, including the hearing aid itself.", "latency": 3.153796, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely answers the QUERY using information directly from the CONTEXT, without adding unrelated or incorrect details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional relevant insights about financial aspects and network provider conditions, which enhance understanding.", "answer_length": 757, "citations_matched": 1.0, "any_citation": true} +{"question": "Does Northwind Helth cover full costs?", "truth": "Northwind Health may not cover the full cost of a specialist or other non-emergency services. [Northwind_Standard_Benefits_Details.pdf#page=34]", "answer": "Northwind Health may not cover the full cost of specialist or non-emergency services, and you could be responsible for additional costs such as co-pays, coinsurance, or charges for services not covered by your plan [Northwind_Standard_Benefits_Details.pdf#page=34]. If you use an out-of-network provider, you may be responsible for paying the full cost of the services received [Northwind_Health_Plus_Benefits_Details.pdf#page=3]. Additionally, some services may not be covered at all, and you may need to check with Northwind Health prior to receiving services to determine your financial responsibility [Northwind_Health_Plus_Benefits_Details.pdf#page=16].", "context": "Northwind_Standard_Benefits_Details.pdf#page=34: For example, Northwind Health may not cover the full cost of a specialist or other non-emergency services. It is important to be aware of these exceptions when selecting a hospital. When selecting a hospital, you should also consider other services that the hospital offers. For example, some hospitals may offer additional services such as physical therapy, nutrition counseling, or other wellness services. Additionally, some hospitals may offer special programs for specific conditions or diseases. Finally, you should consider the cost of care at the hospital you are considering. Northwind Health may cover some or all of the costs of your care, but you should be aware of any additional costs that you may be responsible for. This includes any co-pays or coinsurance, as well as any additional charges for services not covered by your plan. By taking the time to consider your options, you can select the best hospital for your healthcare needs. Northwind Standard offers coverage for a variety of in-network hospitals, giving you the opportunity to select the hospital that best meets your needs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.", "latency": 3.172102, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response accurately and completely addresses the query using relevant information from the context, explaining the limitations of coverage and potential additional costs, which aligns with a fully correct and complete response.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query by explaining the circumstances under which Northwind Health may not cover full costs, including additional costs and the impact of using out-of-network providers. It provides a comprehensive understanding of the coverage situation.", "answer_length": 658, "citations_matched": 1.0, "any_citation": true} +{"question": "what is Northwind Standard Benefits Details?", "truth": "The Northwind Standard Benefits Details include information on managing prescriptions online or via phone, using a mobile app, and potential discounts on generic medications at preferred pharmacies. It also notes that the plan does not cover certain medications like those for weight loss or fertility treatments, compounded medications, or non-FDA-approved drugs. Over-the-counter medications are also not covered unless prescribed by a doctor. [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "The Northwind Standard plan is a comprehensive health plan that covers medical, vision, and dental services, including preventive care and prescription drug coverage. It provides access to a variety of in-network providers, such as primary care physicians, specialists, hospitals, and pharmacies. \n\nKey covered services include:\n- Preventive care services (physicals, immunizations, screenings)\n- Diagnostic tests and treatments\n- Medical consultations\n- Physical therapy\n- Mental health services\n- Prescription drugs\n- Inpatient hospital services\n- Emergency services\n\nHowever, it does not cover certain services, including cosmetic services, experimental treatments, and most dental services, nor does it cover services from out-of-network providers. It is important to check with Northwind Health for in-network providers to avoid unexpected costs. Northwind Health also offers tools like a cost estimator and a provider directory, along with 24/7 customer service for assistance with coverage questions [Northwind_Standard_Benefits_Details.pdf#page=98][Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 3.688985, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with detailed information about the Northwind Standard Benefits, including covered services, exclusions, and additional tools, along with references to specific pages in a document, enhancing understanding.", "answer_length": 1155, "citations_matched": 0.0, "any_citation": true} +{"question": "What types of rehabilitation therapy does Northwind Standard cover?", "truth": "Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. Coverage includes medically necessary services related to an injury or illness, along with the use of equipment and specialized supplies. [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "Northwind Standard covers the following types of rehabilitation therapy services:\n\n1. **Physical Therapy**: Coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies.\n2. **Occupational Therapy**: Coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies.\n3. **Speech Therapy**: Coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies.\n\nExceptions include services related to cosmetic or reconstructive surgery, treatment of obesity or weight control, and treatment of sleep disorders, which are not covered by the plan [Northwind_Standard_Benefits_Details.pdf#page=48].", "context": "Northwind_Standard_Benefits_Details.pdf#page=48: Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy. For physical therapy, coverage is for medically necessary physical therapy services related to an injury or illness, including the use of equipment and supplies. For occupational therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. For speech therapy, coverage is for medically necessary services related to an injury or illness, including the use of specialized equipment and supplies. Exceptions Unfortunately, Northwind Standard does not cover any services related to cosmetic or reconstructive surgery, or any services related to the treatment of obesity or weight control. This plan also does not cover services related to the treatment of sleep disorders. Tips When looking for a rehabilitation therapy provider, make sure that they are in-network and covered by your plan. Also, keep in mind that you may need a referral from a primary care physician for some services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=47: Additionally, the plan does not cover any costs associated with psychological or neuropsychological testing that is done for non-medical reasons such as pre-employment screening or for legal purposes. In order to ensure that your psychological or neuropsychological testing services are covered under the Northwind Standard plan, it is important to review your plan's Summary of Benefits and Coverage (SBC) document. This document will provide you with a full list of covered services, as well as any exceptions that may apply. Overall, the Northwind Standard plan provides coverage for psychological and neuropsychological testing services when they are prescribed or ordered by a health care professional and when they are provided by an in-network provider. It is important to be aware of any exceptions that may apply, as well as to select a highly qualified in-network provider for your tests in order to ensure that your services are covered in full.Rehabilitation Therapy REHABILITATION THERAPY Northwind Standard covers a range of rehabilitation therapy services, including physical, occupational, and speech therapy.\n\nNorthwind_Standard_Benefits_Details.pdf#page=50: In addition, Northwind Standard provides coverage for certain services that are not typically covered by other health plans, such as detoxification services, residential treatment services, and recovery support services. While Northwind Standard does provide coverage for substance use disorder treatment services, there are some exceptions to this coverage. For example, Northwind Standard does not cover services that are provided in a hospital emergency room or a hospital inpatient setting unless they are medically necessary and pre-authorized by Northwind Health. We understand that substance use disorder can have a devastating impact, and we want to make sure that our employees have access to the care they need. If you have any questionsabout Northwind Standard's coverage for substance use disorder services, please contact Northwind Health and speak to one of our customer service representatives. Here are some tips that could be helpful to our employees who may be struggling with substance use disorder: . Seek help as soon as possible. Early intervention and treatment can make a significant difference in achieving successful recovery.", "latency": 7.779022, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, providing all relevant details from the CONTEXT to answer the QUERY accurately.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query by listing the types of rehabilitation therapy covered and provides additional insights about exceptions, making it comprehensive.", "answer_length": 804, "citations_matched": 1.0, "any_citation": true} +{"question": "What shuold I do if I need healthcare services outside Washington with Northwind Health?", "truth": "If you need healthcare services outside Washington, you should contact Northwind Health to get an estimate of the cost of care for services you may need. It is also important to find in-network providers in the state where you are living to receive coverage, and keep your Northwind Standard plan active while you are out of state to remain eligible for coverage. [Northwind_Standard_Benefits_Details.pdf#page=59]", "answer": "If you need healthcare services outside Washington with Northwind Health, you should:\n\n1. Ensure that the provider you plan to visit is part of Northwind Health Plus' nationwide network [Northwind_Health_Plus_Benefits_Details.pdf#page=62].\n2. For Northwind Standard, know that it covers out-of-area emergency services but not non-emergency services or care received outside of Washington for more than 12 consecutive months [Northwind_Standard_Benefits_Details.pdf#page=60].\n3. You must be outside of Washington for no more than 12 consecutive months, more than 100 miles away from your primary care provider, and your plan must have been in effect for at least 6 months to be eligible for out-of-area services [Northwind_Standard_Benefits_Details.pdf#page=59].\n4. Obtain prior authorization from Northwind Health before receiving care to ensure coverage [Northwind_Standard_Benefits_Details.pdf#page=60][Northwind_Standard_Benefits_Details.pdf#page=59].\n\nIf you do not meet these criteria or do not obtain prior authorization, you may be responsible for the full cost of care.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=62: If you are outside Washington, you may still be eligible for coverage through Northwind Health Plus. Northwind Health Plus offers a network of providers that are located throughout the United States. These providers are part of Northwind Health Plus' nationwide network, which is designed to ensure that you are able to receive care, no matter where you are. Out-of-area care is coverage that extends outside of Washington. This means that if you travel outside of the state, you can still receive care from a Northwind Health Plus provider. However, there are some exceptions to this coverage. For example, you may be limited to a certain number of visits or treatments that are covered outside of Washington. Additionally, certain services may not be covered, such as home health care services that are provided outside of the state. If you travel outside of Washington, it is important to keep a few tips in mind. First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=59: It is important to know that Northwind Standard does not provide coverage for non- emergency services outside of Washington. That means you may be responsible for the full cost of care if you seek out care for a condition that could have been treated in Washington. In order to receive coverage for out-of-area care, you must meet the following criteria: . You must be outside of Washington for no more than 12 consecutive months . You must be more than 100 miles away from your primary care provider 路 Your plan must have been in effect for at least 6 months before you receive out-of-area care If you meet the criteria listed above, you may be eligible for coverage of out-of-area services. In order to receive coverage, you must contact Northwind Health in advance of receiving care. You must also obtain prior authorization for any care you wish to receive. If prior authorization is not obtained, you may be responsible for the full cost of care. If you are outside of Washington for more than 12 consecutive months, you may not be eligible for coverage of out-of-area services.", "latency": 4.865753, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is complete and accurate, addressing all aspects of the QUERY using information from the CONTEXT. It provides a thorough and precise answer without adding extraneous details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, covering all necessary details about obtaining healthcare services outside Washington with Northwind Health. It does not add extraneous information and provides a clear and comprehensive guide.", "answer_length": 1077, "citations_matched": 1.0, "any_citation": true} +{"question": "What is prior-authorization in Northwind Standard?", "truth": "Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. Without prior-authorization, the employee may be responsible for the full cost of any services or treatments received without approval. [Northwind_Standard_Benefits_Details.pdf#page=63]", "answer": "Prior-authorization in Northwind Standard is a process where employees must obtain approval from Northwind Health before receiving certain services or treatments. This ensures that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of the services. The process involves the employee's physician submitting a request to Northwind Health, which will review it to determine if the service is medically necessary and covered under the plan. Some services that may require prior-authorization include hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs [Northwind_Standard_Benefits_Details.pdf#page=63].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=60: By following the tips outlined above, you can ensure that you are prepared if you find yourself needing care outside of Washington. Northwind Standard provides coverage for out-of-area emergency services, but it does not provide coverage for non-emergency services, out-of-network services, or care received outside of Washington for more than 12 consecutive months. Prior authorization must also be obtained in order to receive coverage. Keeping your plan active while out of state will also ensure that you remain eligible for coverage. CARE MANAGEMENT Prior-Authorization CARE MANAGEMENT: Prior Authorization Northwind Standard includes Care Management services, which are designed to provide support, information, and proactive care for members. Specifically, this plan includes a Prior Authorization (PA) process for certain services. Prior Authorization is a process used by Northwind Health to make sure that a covered service is medically necessary and is the most cost-effective way to receive the service. Before certain services are approved and covered, an authorization must be requested from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 3.001221, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely describes prior-authorization as outlined in the CONTEXT, addressing all relevant aspects of the process and its implications.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it includes additional insights that enhance understanding, such as the consequences of not obtaining prior-authorization and examples of services that require it.", "answer_length": 736, "citations_matched": 1.0, "any_citation": true} +{"question": "What need for pre-authorization in Northwind Standard Benefits?", "truth": "Some medical services under the Northwind Standard Benefits require pre-authorization before they can be approved to ensure that medically necessary treatments are provided in a timely and cost-effective manner. [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "Prior-authorization is required by Northwind Health for certain services or treatments to ensure they are necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of the services. Services that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, certain prescription drugs, laboratory tests, imaging services, and physical therapy. The employee's physician must submit a request for prior-authorization, which will be reviewed by Northwind Health. Approval or denial will be communicated within three business days. If approved, the service can be received without additional pre-authorization; if denied, an appeal can be submitted. Some services may not be covered even if prior authorization is granted, and it is important to keep a copy of the authorization for coverage verification [Northwind_Standard_Benefits_Details.pdf#page=63][Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: Some services may not be covered, even if prior authorization is approved. Finally, if the service is approved, make sure to keep a copy of the authorization. This will help ensure that you receive the coverage you are entitled to. Prior authorization can be a complicated process. However, it is important to remember that it is in place to help ensure that members receive the right care at the right time. Northwind Health is committed to helping members make informed decisions about their health care.Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage At Northwind Health, Contoso's employees have access to a variety of healthcare benefits, including coverage for medical, vision, and dental services. With Northwind Standard, employees can also choose from a variety of in-network providers for their care. However, in order to get the most out of their benefit coverage, employees should be aware of the prior-authorization process for certain services and treatments. Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before ", "latency": 3.567509, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY with all necessary details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing all essential details required for a comprehensive understanding. It also includes additional insights about the implications and process, enhancing the understanding of the pre-authorization requirement.", "answer_length": 1042, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Standard handle situations where other plans like Medicare or Medicaid are involved?", "truth": "Northwind Standard may pay first in situations where other plans like Medicare, Medicaid, or a veterans' health plan are involved, even if these other plans are usually the primary payer. [Northwind_Standard_Benefits_Details.pdf#page=75]", "answer": "The Northwind Standard handles situations involving other plans like Medicare or Medicaid as follows:\n\n1. If you have coverage through Medicare or Medicaid, that plan pays first, followed by the Northwind Standard plan as the secondary payer [Northwind_Standard_Benefits_Details.pdf#page=73].\n\n2. You must notify Northwind Health of any changes in your coverage status or any changes in your other coverage. Failure to do so may result in you being responsible for charges that Northwind Health would have paid if notified [Northwind_Standard_Benefits_Details.pdf#page=95].\n\n3. In certain circumstances, you may be able to keep your other coverage and still be eligible for the Northwind Standard plan, but if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=95].\n\n4. Northwind Standard may pay first in some cases, even if Medicare, Medicaid, or a veterans' health plan is usually the primary payer [Northwind_Standard_Benefits_Details.pdf#page=75].\n\n5. When submitting a claim to Northwind Standard, you need to include information about your other coverage to ensure proper billing and avoid delays or denials [Northwind_Standard_Benefits_Details.pdf#page=73].", "context": "Northwind_Standard_Benefits_Details.pdf#page=95: This could include coverage from your spouse's or a parent's employer, or from a government-sponsored program such as Medicare or Medicaid. If you and your spouse have coverage under different plans, you must determine which plan is the primary plan and which is secondary. This is important, as the primary plan will pay first; the secondary plan will pay what the primary plan does not. If you have other coverage, you must notify Northwind Health of any changes in your coverage status or any changes in any of your other coverage. If you fail to do so, you may be responsible for any charges that Northwind Health would have paid if you had notified them of the other coverage. In certain circumstances, you may be able to keep your other coverage and still be eligible for coverage under the Northwind Standard plan. However, if the other coverage is primary, you will be responsible for any charges that would have been paid by the Northwind Standard plan. It is also important to note that if you have coverage through a government-sponsored program such as Medicare or Medicaid, you may be subject to certain restrictions.\n\nNorthwind_Standard_Benefits_Details.pdf#page=75: Coordination of Benefits Exceptions There are a few exceptions to COB rules that may apply to you. If you are covered by Medicare, Medicaid, or a veterans' health plan, Northwind Standard may pay first, even if the other plan is usually the primary payer. Additionally, if you are enrolled in a plan that is required by law to coordinate benefits, such as an employer-sponsored plan, Northwind Standard may pay first. Understanding How COB Affects Your Benefits When COB applies, the primary and secondary payers will each pay a portion of the eligible expenses and combined payments cannot exceed the total cost. Depending on the type of service, the primary payer may pay all of the eligible expenses. When this happens, the secondary payer may pay nothing.For example, if you receive a medical bill for $1,000 and the primary payer pays $800, the secondary payer will pay the remaining balance of $200. However, if the primary payer pays the full $1,000, the secondary payer will not pay anything.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan ", "latency": 4.003444, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the QUERY with relevant details from the provided information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not add extraneous information but provides relevant insights into the handling of other plans.", "answer_length": 1288, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the process for submitting claims for services like MRI/CT scans or physical therapy according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, for services such as MRI/CT scans and physical therapy, your provider may need to submit a request prior to the service being performed. It's important to contact Northwind Health if you are unsure whether pre-approval is required. Additionally, when filing a claim, you should include all necessary documentation like itemized bills, a completed claim form, and any other requested documentation to avoid delays or denials. [Northwind_Standard_Benefits_Details.pdf#page=78]", "answer": "To submit claims for services like MRI/CT scans or physical therapy, follow these steps:\n\n1. **Pre-Approval**: Your provider may need to submit a request for pre-approval to Northwind Health before the service is performed. This is necessary for services such as MRI/CT scans and physical therapy [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n2. **Timely Filing**: All claims must be filed within twelve months of the date of service. Claims submitted after this period may be reviewed for consideration, but there is no guarantee of acceptance [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n3. **Documentation**: Include all necessary documentation when filing a claim. This includes itemized bills, a completed claim form, and any other requested documentation. Missing items may delay or deny your claim [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n4. **Filing Method**: If you are a Northwind Standard member, you may file a claim directly through the Northwind website or app. Ensure you have authorization if filing on behalf of a family member [Northwind_Standard_Benefits_Details.pdf#page=78].\n\n5. **Exceptions**: There are exceptions to the twelve-month filing limit for claims related to newborns, deceased members, and services provided out-of-country, which can be submitted up to 24 months after the date of service [Northwind_Standard_Benefits_Details.pdf#page=78].", "context": "Northwind_Standard_Benefits_Details.pdf#page=78: from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services. If you are unsure whether your provider requires pre-approval for a service, you should contact Northwind Health prior to the service being performed. There are a few exceptions to the twelve month timely filing limit. These include claims submitted for newborns, claims submitted for a deceased member, and claims submitted forservices that were provided out-of-country. In these situations, claims may be submitted up to 24 months after the date of service. It's also important to remember that when filing a claim, you should make sure to include all necessary documentation. This includes itemized bills, a completed claim form, and any other documentation that is requested by Northwind Health. If any of these items are missing, your claim may be delayed or denied. To ensure timely filing, it's important to keep track of the dates of service for all services you receive. You should also keep copies of all documentation related to your services, and if you're unsure of the filing \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=64: This means that your doctor or health care provider will need to get prior authorization from Northwind Health before providing the care. Prior authorization is also known as pre-certification, pre-notification, pre-service review, or pre-authorization. It is important for you to understand that prior authorization does not guarantee that the service will be covered by your Northwind Health Plus plan. When Prior Authorization is Required Prior authorization is required for certain services and treatments such as: 路 Hospital admissions 路 Inpatient surgery 路 Outpatient surgery 路 Magnetic Resonance Imaging (MRI) 路 Computed Tomography (CT) 路 Radiation Therapy 路 Durable Medical Equipment 路 Physical, Occupational, and Speech Therapy 路 Home Health Care 路 Infusion Therapy 路 Prosthetics and Orthotics 路 Specialty DrugsIn certain cases, Northwind Health may require prior authorization even if the service is not listed above. Your doctor or health care provider should contact Northwind Health to determine if prior authorization is required prior to providing care.", "latency": 4.708408, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing all essential details required for a comprehensive understanding of the claims submission process.", "answer_length": 1397, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the role of the Independent Review Organization in the appeals process for Northwind Standard plan members?", "truth": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. The decision made by the IRO is considered final and binding, although there are some exceptions that could apply to specific cases. [Northwind_Standard_Benefits_Details.pdf#page=83]", "answer": "The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. It is a third-party organization that reviews appeals and complaints regarding healthcare services that have been denied coverage. If the IRO upholds the original decision, members may have other options available, such as an external review or an appeal to the state insurance commission. The decision made by the IRO is considered final and binding, though some exceptions may apply to individual cases [Northwind_Standard_Benefits_Details.pdf#page=83][Northwind_Standard_Benefits_Details.pdf#page=82].", "context": "Northwind_Standard_Benefits_Details.pdf#page=83: 路 Ensure that all relevant information is included in the appeal. 路 Submit the appeal within the timeframe specified in the plan. . Keep a copy of your appeal and all supporting documentation. 路 Contact Northwind Health or the IRO if you have any questions or need additional help. . If the IRO upholds the original decision, you may have other options available to you, such as an external review or an appeal to the state insurance commission. Conclusion The Independent Review Organization (IRO) is the final step in the appeals process for Northwind Standard plan members. While the decision made by the IRO is considered final and binding, there are some exceptions that could apply to your case. Familiarizing yourself with the plan provisions and the process for filing an appeal, gathering all relevantinformation, and submitting the appeal within the timeframe specified in the plan are all important steps in the appeals process. Additional Information About Your Coverage COMPLAINTS AND APPEALS If you feel that you have not received the health care services or benefits that you are entitled to, or you are not \n\nNorthwind_Standard_Benefits_Details.pdf#page=82: If you need an expedited appeal due to an urgent medical condition, your plan must respond within 24 hours. Tips . Make sure to include all of the necessary information in your appeal. . Keep a copy of your appeal for your records. . Don't hesitate to contact your plan if you need assistance with the appeal process. 路 Follow up with your plan if you don't receive a response to your appeal within a reasonable amount of time. . Consider hiring a lawyer if you need help with your appeal. Once The IRO Decides Once The IRO DecidesThe Independent Review Organization (IRO) is a third-party organization that reviews appeals and complaints about healthcare services that have been denied coverage under the Northwind Standard plan. If an employee is not satisfied with the decision made by Northwind Health, they can submit a written complaint or request an appeal by filing a formal grievance. What Happens After The IRO Decides? Once the IRO has completed its review, it will issue a formal decision either upholding the original decision or reversing it.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=85: We have a multi-level process in place to ensure that any grievances are addressed and resolved quickly and fairly. Level 1: Initial Review This is the first step in the appeals process. If you have a problem with a service or product received, contact the plan's Customer Service team. The team will review your complaint to determine if a solution can be reached or if the complaint should be escalated to the next level. Level 2: Formal Complaint If a satisfactory resolution is not reached at Level 1, you may submit a formal written complaint to Northwind Health Plus. This should include details of the issue, the date and time of the incident, and the names of any involved personnel. It should also include any relevant documentation or other evidence that supports your claim. Level 3: External ReviewIf the issue is not resolved at Level 2, you may request an external review to be conducted. This review will be conducted by an independent organization that is not affiliated with Northwind Health Plus. The external review will consider all facts and evidence that have been submitted in the appeal and ", "latency": 4.870191, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the role of the IRO as described in the CONTEXT and directly addressing the QUERY without introducing unrelated information.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the IRO's role and includes additional insights about further options available to members, enhancing understanding.", "answer_length": 624, "citations_matched": 1.0, "any_citation": true} +{"question": "Can you explain the eligibility criteria for the Northwind Standard plan offered to Contoso employees?", "truth": "The Northwind Standard plan is a group plan offered to all eligible employees of Contoso and their spouses or dependents. It is important to note that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. [Northwind_Standard_Benefits_Details.pdf#page=88]", "answer": "The eligibility criteria for the Northwind Standard plan offered to Contoso employees include the following:\n\n1. Employees may need to meet specific criteria to be approved for certain services or treatments, which may include medical tests, lifestyle changes, or other requirements [Northwind_Standard_Benefits_Details.pdf#page=63].\n2. Prior-authorization is required for certain services or treatments, and employees must obtain this approval before receiving care to avoid being responsible for the full cost [Northwind_Standard_Benefits_Details.pdf#page=63].\n3. The employee's physician must submit a request for prior-authorization to Northwind Health, which will review it to determine if the service or treatment is medically necessary and a covered benefit [Northwind_Standard_Benefits_Details.pdf#page=63].\n4. Preventive care services and emergency services are not subject to prior-authorization [Northwind_Standard_Benefits_Details.pdf#page=63].\n5. Mental health and substance abuse coverage are also not subject to prior-authorization [Northwind_Standard_Benefits_Details.pdf#page=63].\n6. Out-of-network services require prior-authorization and may incur additional costs to the employee [Northwind_Standard_Benefits_Details.pdf#page=63].\n\nIf you have more specific questions about eligibility or services, please let me know!", "context": "Northwind_Standard_Benefits_Details.pdf#page=63: In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment. These criteria may include specific medical tests or treatments, lifestyle changes, or other requirements. If the employee is unable to meet the criteria, prior-authorization may not be granted. There are some exceptions to the prior-authorization process. For example, preventive care services and emergency services are not subject to prior-authorization. In addition, mental health and substance abuse coverage is not subject to prior-authorization. However, out-of- network services are subject to prior-authorization and may require additional cost to the employee. Here are some tips for Contoso's employees to help them navigate the prior-authorization process: 路 Contact your physician's office to determine if prior-authorization is required before receiving a service or treatment. . Contact Northwind Health to determine if a service or treatment is a covered benefit under Northwind Standard.\n\nNorthwind_Standard_Benefits_Details.pdf#page=102: Depending on the state, employees may have the right to receive legal representation or to appeal denied claims. In some states, employees may have the right to choose their own physician or to receive benefits for permanent disabilities. At Contoso, we are committed to providing our employees with a safe and productive work environment, and we take the necessary steps to ensure that our Workers' Compensation Insurance coverage meets all state and federal requirements. Should you have any questions about this coverage, please contact the Human Resources Department. DEFINITIONS DEFINITIONS When it comes to understanding the Northwind Standard insurance plan, it is important to understand the various terms and definitions associated with this plan. Here is abreakdown of some of the key terms and definitions associated with the Northwind Standard insurance plan. In-Network Provider: An in-network provider is a healthcare provider that has a contract with Northwind Health and is included in the network of providers who are eligible to receive payments from Northwind Health.\n\nNorthwind_Standard_Benefits_Details.pdf#page=63: Prior-authorization is a process in which Northwind Health requires Contoso's employees to get approval from their plan before receiving certain services or treatments. This process helps ensure that the care is necessary and medically appropriate. If prior-authorization is not obtained, the employee may be responsible for the full cost of any services or treatments that are received without approval. Some services or treatments that may require prior-authorization include, but are not limited to, hospital stays, certain medical procedures, durable medical equipment, and certain prescription drugs. In order to obtain prior-authorization, the employee's physician must submit a request to Northwind Health. The request will then be reviewed by Northwind Health to determine if the service or treatment is medically necessary and if it is a covered benefit under the Northwind Standard plan. In some cases, Northwind Health may also require that the employee meet certain criteria in order to be approved for a service or treatment.", "latency": 4.203247, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The RESPONSE is related to the topic of the CONTEXT but does not directly answer the QUERY about eligibility criteria for the plan itself, focusing instead on criteria for services and treatments.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides information related to accessing services under the plan but does not fully address the eligibility criteria for the plan itself, which is what the QUERY specifically asks for.", "answer_length": 1338, "citations_matched": 0.0, "any_citation": true} +{"question": "what wrong things Northwind Health say about what they cover?", "truth": "Northwind Health makes intentionally false or misleading statements about their plans, including claiming to cover emergency services, mental health and substance abuse coverage, and out-of-network services, which they do not actually cover. [Northwind_Standard_Benefits_Details.pdf#page=90]", "answer": "Northwind Health states that their plans do not cover services that are not medically necessary, including cosmetic procedures and elective treatments. Additionally, services provided by healthcare providers who are not contracted with Northwind Health are not covered. The Northwind Standard plan also does not cover any services received outside of the network of in-network providers [Northwind_Standard_Benefits_Details.pdf#page=56][Northwind_Standard_Benefits_Details.pdf#page=89]. \n\nFor the Northwind Health Plus plan, it is noted that certain types of services, such as cosmetic procedures, may not be covered, and there may be limits on the number of visits to a provider that are covered [Northwind_Health_Plus_Benefits_Details.pdf#page=17].", "context": "Northwind_Standard_Benefits_Details.pdf#page=56: Finally, Northwind Health's Northwind Standard plan does not cover services that are not medically necessary. Examples of services that are not covered include cosmetic proceduresand elective treatments. Additionally, the plan does not cover services that are not related to the diagnosis or treatment of an illness or injury. At Northwind Health, we are committed to helping you get the care you need when you need it. We understand that medical issues can arise suddenly and can be unpredictable. That is why we offer coverage for urgent care services through our Northwind Standard plan. If you have any questions about your coverage, please contact our customer service team. Virtual Care COVERED SERVICES: VIRTUAL CARE At Northwind Health, we understand that our members may have difficulty accessing in- person care. That is why we offer virtual care, allowing members to access care from the comfort of their own home. With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice.\n\nNorthwind_Standard_Benefits_Details.pdf#page=89: It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group. Exceptions There are a few exceptions to the group coverage provided by the Northwind Standard plan. For example, the plan does not cover services provided by any health care provider who is not contracted with Northwind Health. In addition, the plan does not cover services that are not medically necessary, such as cosmetic surgery. Tips for Employees When you enroll in Northwind Standard, it is important to familiarize yourself with the plan and its coverage options. You should also make sure that you understand any restrictions that may apply to the services you receive. Be sure to check with your provider to make sure that they accept the Northwind Standard plan. Also, it is a good idea to familiarize yourself with the cost of the services you receive, so that you know what you may be responsible for paying out of pocket. Finally, keep in mind that the Northwind Standard plan does not cover any services received outside of the network of in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=17: For instance, some plans may not cover certain types of services, such as cosmetic procedures, or they may have limits on the number of visits to a provider that are covered. It is important to read through your plan to understand what is and isn't covered. When you are using your Northwind Health Plus plan, there are a few tips to keep in mind. First, remember to bring your Northwind Health Plus ID card with you when you go to the doctor or pharmacy. This will help the provider verify your coverage and process your claims. Second, if you are prescribed a medication, check to make sure it is covered by your plan. You may be able to save money by using a generic version of the drug or by using a mail-order pharmacy. Finally, if you are seeing an out-of-network provider, remember that you may be responsible for paying more out-of-pocket costs than you would for an in-network provider. Make sure to check with the provider to get an estimate of what your costs will be. By understanding the plan and its exceptions and limitations, and by following these tips, you can make sure you are getting the most out of your Northwind Health Plus plan.", "latency": 3.733921, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The RESPONSE provides information related to the exclusions in the Northwind Health plans but does not address the specific aspect of the QUERY about \"wrong things\" Northwind Health says about what they cover.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides information about exclusions and limitations in Northwind Health's coverage but does not address the QUERY's focus on incorrect statements made by Northwind Health. It lacks direct relevance to the aspect of \"wrong things\" mentioned in the QUERY.", "answer_length": 750, "citations_matched": 0.0, "any_citation": true} +{"question": "what is northwind standard benefits details?", "truth": "The Northwind Standard Benefits Details include information to help inform and empower members about their responsibilities and the coverage provided by the plan. This includes being aware of the plan's benefits and limitations, as well as obligations under the plan such as co-payments or co-insurance amounts for medical and vision expenses. [Northwind_Standard_Benefits_Details.pdf#page=92]", "answer": "The Northwind Standard plan is a comprehensive health plan that covers medical, vision, and dental services, including preventive care and prescription drug coverage. It provides access to a variety of in-network providers, such as primary care physicians, specialists, hospitals, and pharmacies. \n\nKey covered services include:\n- Preventive care services (physicals, immunizations, screenings)\n- Diagnostic tests and treatments\n- Medical consultations\n- Physical therapy\n- Mental health services\n- Prescription drugs\n- Inpatient hospital services\n- Emergency services\n\nCertain services are not covered, including cosmetic services, experimental treatments, and most dental services. Additionally, services provided by out-of-network providers are not covered. It is important to check with Northwind Health for in-network providers to avoid unexpected costs. The plan also offers tools and resources like a cost estimator and a provider directory, along with 24/7 customer service for assistance [Northwind_Standard_Benefits_Details.pdf#page=98][Northwind_Standard_Benefits_Details.pdf#page=45][Northwind_Standard_Benefits_Details.pdf#page=46].", "context": "Northwind_Standard_Benefits_Details.pdf#page=98: Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits The Northwind Standard plan is a comprehensive health plan that provides coverage for medical, vision, and dental services. It also includes preventive care services and prescription drug coverage. Northwind Standard offers a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies.Under this plan, Northwind Health will cover the cost of eligible services you receive, as long as you follow certain rules. Some services may require pre-authorization or be subject to an annual deductible or coinsurance. Northwind Health is also responsible for processing and paying claims correctly. Right to Benefits You have the right to receive the benefits available under the Northwind Standard plan. This includes the right to receive services from any in-network provider, subject to certain rules and regulations. You also have the right to be informed about the types of services that are covered and the costs associated with them. Payment of Benefits Northwind Health is responsible for paying claims correctly.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.", "latency": 3.762004, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information about the Northwind Standard benefits, including additional insights about in-network providers and available resources, making it a comprehensive response.", "answer_length": 1145, "citations_matched": 0.0, "any_citation": true} +{"question": "what does Notice of Pre-Existing Condition Exclusions mean?", "truth": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It explains when these exclusions may apply and how they could affect your coverage. [Northwind_Standard_Benefits_Details.pdf#page=96]", "answer": "The Notice of Pre-Existing Condition Exclusions provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to understand when these exclusions may apply and how they could affect your coverage [Northwind_Standard_Benefits_Details.pdf#page=96].", "context": "Northwind_Standard_Benefits_Details.pdf#page=96: Notice of Benefit and Payment Parameters: This notice provides important information about the plan and its benefits, including what kind of coverage is provided, what types of services are covered, and what out-of-pocket costs you may be responsible for. Notice of Pre-Existing Condition Exclusions: This notice provides information about any pre-existing condition exclusions that may apply to your coverage. It is important to read this notice carefully to make sure you understand when pre-existing condition exclusions may apply and how they could affect your coverage. Notice of Continuation Coverage Rights: This notice provides information about your rights to continue coverage if you lose your job or if you experience a qualifying event. It is important to read this notice carefully to make sure you understand your rights to continue coverage. Notice of Availability of Plan Documents: This notice provides information about where you can find the plan documents for Northwind Standard. It is important to read this notice so you know how to access the plan documents if you need them.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods. You should review your plan documents carefully to make sure you understand exactly what is covered and what is excluded. It is also important to understand that the plan is not a substitute for health insurance. You should still maintain health insurance coverage through an employer, a private plan, or a government-sponsored plan. The Northwind Health Plus plan is intended to supplement the coverage you have from other sources. Tips for Making the Most of Your Plan . Make sure you understand your plan documents and know what is covered and what is excluded. 路 Take advantage of preventive care services, such as check-ups and screenings, as these will help you stay healthy and avoid more costly treatments down the road. 路 Consider signing up for the Northwind Health Plus online portal, which allows you to view your health plan information, make payments, and access other resources. 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=93: The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and YouThe Northwind Health Plus plan is a group health plan that is sponsored by Contoso and administered by Northwind Health. As a participant in this group plan, you will have access to a wide range of health benefits and services. Your employer, Contoso, pays a portion of the premium for the plan, and you are responsible for paying the remaining portion. This will be deducted directly from your paycheck each month. In addition to the premium, you may be responsible for certain costs when you receive health care services. Your contributions to the plan are based on the type of coverage you choose. For example, if you choose a single plan, you will pay a lower premium than if you choose a family plan. The premium and other costs you may incur when you receive health care services may change from year to year. It is important to note that you may be subject to certain exclusions or limitations on your coverage, such as pre-existing condition exclusions and/or waiting periods.", "latency": 3.146982, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY without introducing extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, explaining the purpose and importance of the notice without adding unnecessary details.", "answer_length": 328, "citations_matched": 1.0, "any_citation": true} +{"question": "What services does Northwind Health cover?", "truth": "Northwind Health is responsible for paying claims for eligible services based on the terms of the plan, but it does not cover emergency services, mental health and substance abuse services, or out-of-network services. [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "Northwind Health covers a variety of services under its plans:\n\n1. **Northwind Standard Plan**:\n - Preventive care services (physicals, immunizations, screenings)\n - Diagnostic tests and treatments\n - Medical consultations\n - Physical therapy\n - Mental health services\n - Prescription drugs\n - Inpatient hospital services\n - Emergency services\n - Coverage is limited to in-network providers, and it does not cover cosmetic services, experimental treatments, and most dental services [Northwind_Standard_Benefits_Details.pdf#page=46].\n\n2. **Northwind Health Plus Plan**:\n - A wide range of mental health services, including counseling, psychiatric visits, therapy, and group therapy\n - Coverage for both inpatient and outpatient visits\n - Services can be provided by in-network and out-of-network providers, though out-of-pocket costs are typically higher for out-of-network care [Northwind_Health_Plus_Benefits_Details.pdf#page=42].\n\nIt's important to check with Northwind Health for specific coverage details and costs associated with services.", "context": "Northwind_Standard_Benefits_Details.pdf#page=46: The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic tests and treatments - Medical consultations - Physical therapy - Mental health services - Prescription drugs - Inpatient hospital services - Emergency services Northwind Standard does not cover certain types of services, including cosmetic services, experimental treatments, and most dental services. It also does not cover services provided by out-of-network providers. When using your Northwind Standard plan, it is important to understand your coverage and any costs that you may be responsible for. Northwind Health offers a variety of tools and resources to help you make the most of your coverage, including a cost estimator tool and a provider directory. Northwind also offers 24/7 customer service to answer any questions you may have about your coverage. Using your Northwind Standard plan can help you get the care you need while saving money. It is important to understand your coverage and any out-of-pocket costs that may beassociated with services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=45: With Northwind Standard, you can take advantage of these important services, which are covered at no additional cost.Remember, preventive care is an important part of your overall health. Northwind Health is dedicated to helping you get the preventive care you need to stay healthy and protect yourself for the future. Professional Visits And Services COVERED SERVICES: Professional Visits and Services Northwind Standard provides coverage for professional visits and services. This includes visits to your primary care physician, specialists, and other health care providers. This coverage is available for services that are medically necessary and are provided by in- network providers. In-network providers will generally provide services at a lower cost than out-of-network providers, so it is important to check with Northwind Health before making an appointment to ensure that the provider is in-network. This can help you save money and avoid unexpected costs. The Northwind Standard plan covers services such as: - Preventive care services, including physicals, immunizations, and screenings - Diagnostic \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=42: Northwind Health Plus covers a wide range of mental health services, including counseling, psychiatric visits, therapy, and group therapy. Services are provided in-network and out-of- network, with coverage for both inpatient and outpatient visits. In-Network Services When receiving mental health care, it is important to make sure you are using an in- network provider. When you use an in-network provider, your out-of-pocket costs are generally lower and your coverage is more comprehensive. Northwind Health Plus offers a network of providers that are in-network, including primary care physicians, specialists, hospitals, and pharmacies. Out-of-Network Services In some cases, it may be necessary to receive mental health care from an out-of-network provider. Northwind Health Plus will still cover a portion of the cost of services received from an out-of-network provider. However, it is important to note that out-of-pocket costs are typically higher when receiving care from an out-of-network provider. Exceptions Northwind Health Plus does not cover some services related to mental health care, including long-term treatment ", "latency": 3.951751, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE thoroughly and accurately addresses the QUERY by listing the services covered under both the Northwind Standard and Northwind Health Plus plans, as described in the CONTEXT. It includes all relevant details and distinctions between the plans, demonstrating complete understanding.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the services covered by Northwind Health, making it a complete response.", "answer_length": 1069, "citations_matched": 0.0, "any_citation": true} +{"question": "How does choosing an in-network provider with Northwind Health Plus affect my healthcare costs?", "truth": "Choosing an in-network provider with Northwind Health Plus is crucial for lowering healthcare costs because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus provides an extensive network of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, allowing for a selection that best suits your needs. [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "Choosing an in-network provider with Northwind Health Plus affects your healthcare costs by lowering your out-of-pocket expenses compared to using out-of-network providers. Northwind Health has negotiated discounted rates with in-network providers, which means you will pay less for services. Additionally, in-network providers charge lower rates than out-of-network providers, making them the most cost-effective option for your healthcare needs [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=4].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. SUMMARY OF YOUR COSTS SUMMARY OF YOUR COSTS At Northwind Health, we understand that health care costs can be a burden. That's why we offer a comprehensive plan that covers the cost of medical, vision, and dental services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network. Your cost for Northwind Health Plus will depend on your plan type, the services you use, and the providers you visit. You can find more information about cost-sharing arrangements on the Northwind Health website. In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=4: HOW PROVIDERS AFFECT YOUR COSTS In-Network Providers HOW PROVIDERS AFFECT YOUR COSTS Choosing the right provider is an important part of getting the most value out of your health insurance plan. With Northwind Health Plus, you have access to an extensive network of in- network providers. Working with these providers is an essential part of getting the most value out of your plan. In-Network Providers When choosing an in-network provider for your health care needs, make sure to check with Northwind Health Plus to ensure that the provider is in-network. This is important because in-network providers charge lower rates than out-of-network providers. Northwind Health Plus offers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This lets you choose a provider that is most convenient for you and your family. It is important to note that in-network providers may not always be available in every area. The Northwind Health Plus website offers a searchable directory of all in-network providers in your area. This directory is regularly updated, so you can be sure that you are choosing from in-network providers that are \n\nNorthwind_Standard_Benefits_Details.pdf#page=9: When choosing a provider, it is important to consider the cost sharing associated with each provider and to ask about any additional fees before receiving care. HOW PROVIDERS AFFECT YOUR COSTS When it comes to health insurance, many people are unaware of the different factors that impact the costs they pay. One of the most significant components that affects your costs is the provider you choose. Northwind Standard provides coverage for a variety of in-networkproviders, and the costs associated with each provider can vary significantly. To ensure you're getting the best value for your health care services, it's important to understand how providers can affect your costs. In-Network Providers Choosing in-network providers is the most cost-effective option when it comes to your Northwind Standard plan. In-network providers have agreed to accept a discounted rate on services, which means they are often less expensive than out-of-network providers. When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or ", "latency": 2.541102, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely answering the QUERY without introducing any extraneous information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, explaining the cost benefits of choosing an in-network provider with Northwind Health Plus. It includes all essential details required for a comprehensive understanding without adding extraneous information.", "answer_length": 550, "citations_matched": 1.0, "any_citation": true} +{"question": "how does Northwind Health Plus help me save money on healthcare costs?", "truth": "Northwind Health Plus assists in saving money on healthcare costs by providing balance billing protection, ensuring that you are not billed more than the allowed amount by your provider. [Northwind_Health_Plus_Benefits_Details.pdf#page=7]", "answer": "Northwind Health Plus helps you save money on healthcare costs in several ways:\n\n1. Understanding the difference between in-network and non-participating providers can lead to cost savings. Using in-network providers typically results in lower out-of-pocket expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n2. Northwind Health Plus offers balance billing protection, ensuring you will not be billed for the difference between the allowed amount and the billed amount by your provider [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\n3. You can use the online provider directory to find in-network providers, which can save you time and money [Northwind_Health_Plus_Benefits_Details.pdf#page=5].\n\n4. It's advisable to check with Northwind Health Plus before visiting a provider to confirm they are in-network and to review your Explanation of Benefits (EOB) after your visit to avoid unexpected charges [Northwind_Health_Plus_Benefits_Details.pdf#page=7].\n\nBy following these tips and utilizing the resources provided by Northwind Health Plus, you can maximize your healthcare savings.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=7: By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs. Northwind Health Plus is here to help you make the most of your coverage. If you have any additional questions about in-network and non-participating providers, please contact the Northwind Health Plus customer service line. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS: Balance Billing Protection Balance billing is a practice where a provider bills you for the difference between the allowed amount and billed amount. The allowed amount is the amount that your insurance company determines is a reasonable fee for a service. The amount you are billed for is the amount that the provider charges you for the services. With Northwind Health Plus, you are protected from balance billing. This means that you can rest assured that you will not be billed more than the allowed amount by your provider. Balance billing protection is an important part of Northwind Health Plus. This protection ensures that you will not be responsible for the difference between the allowed amount and the \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=7: Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus first. Before your visit, contact the customer service line to find out if the provider is in-network and if there are any exceptions that could apply to your situation. Additionally, it is important to review your Explanation of Benefits (EOB) after your visit to ensure that you are not being charged for any services that were not covered by your insurance. If you are charged for a service that was not covered, contact Northwind Health Plus right away. If you are considering a new provider, it is important to ask if they are in-network with Northwind Health Plus. This can save you time and money in the long run. Additionally, you can use Northwind Health Plus's online provider directory to search for a provider that is in-network and view their ratings. By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=5: Tips for Choosing an In-Network Provider When choosing an in-network provider, there are a few tips to keep in mind: 路 Check with Northwind Health Plus to make sure that the provider you are considering is in-network. 路 Use the searchable directory on the Northwind Health Plus website to find in-network providers in your area. 路 Ask your current provider if they are part of the Northwind Health Plus network. . Consider the cost savings associated with in-network providers when making your decision. 路 Consider the quality of care when choosing a provider. 路 Make sure the provider is familiar with your health insurance plan and its coverage. 路 Make sure the provider is available and can accommodate your schedule. Conclusion Choosing the right provider is an important part of getting the most value out of your health insurance plan. Northwind Health Plus offers an extensive network of in-network providers that can help you save money on health care services. By following the tips outlined above, you can make sure that you are choosing an in-network provider that is most convenient and cost-effective for you and your family.", "latency": 15.129978, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The response is fully grounded in the context, accurately and completely addressing the query with relevant details from the context.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights on how to maximize savings, which enhances understanding.", "answer_length": 1103, "citations_matched": 1.0, "any_citation": true} +{"question": "what is copay for Northwind Health Plus?", "truth": "When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The copayment (copay) for Northwind Health Plus varies based on the type of service and provider. Here are the typical copay amounts:\n\n- Primary care visits: around $20 (in-network) or $35 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Specialist visits: around $50 (in-network) or $60 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=10][Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Mental health visits: $45 (split copay) [Northwind_Health_Plus_Benefits_Details.pdf#page=12].\n- Preventive care services: copayment is typically waived if received from an in-network provider [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- Out-of-network services: typically around $60 copayment [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nEmergency room and urgent care visits are not subject to the split copay and will have the full copay amount that applies to the type of provider visited [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an in-network provider. Tips: It is important to remember that copayments are subject to change and may vary depending on the type of service received. It is also important to note that copayments are not waived for out-of-network services, and you may be responsible for the remaining balance after Northwind Health Plus has paid its portion. Finally, it is important to make sure that the provider you are seeing is in-network. This can be easily done by checking the provider directory on the Northwind Health Plus website. It is also important to remember that if you receive a service from an out-of-network provider, you may be responsible for a higher copayment.By understanding and following these tips, you can be sure to get the most out of your Northwind Health Plus coverage and avoid unnecessary copayments. Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=12: Split Copay For Office Visits IMPORTANT PLAN INFORMATION: Split Copay For Office Visits Northwind Health Plus offers a split copay for office visits in order to make healthcare more affordable for its members. This means that you will pay a lower copay for office visits than you would for other services. The split copay is applied to office visits with primary care physicians, specialists, and mental health providers. Office visits with primary care physicians are subject to a $35 copay. Office visits with specialists are subject to a $60 copay. Mental health visits with a psychiatrist or another mental health provider are subject to a $45 copay. There are a few exceptions to this split copay. Emergency room visits and urgent care visits are not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. Office visits with an anesthesiologist are also not subject to the split copay and will be subject to the full copay amount that applies to the type of provider that you visited. When visiting your doctor, it is important to understand which type of provider you are visiting.", "latency": 5.696335, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using the information provided in the CONTEXT, demonstrating a thorough understanding of the copay structure for Northwind Health Plus.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing copay amounts for different services under Northwind Health Plus.", "answer_length": 1049, "citations_matched": 1.0, "any_citation": true} +{"question": "What are the deductible amounts for in-network services under the Northwind Health Plus Benefits Details?", "truth": "The calendar year deductible for in-network services under the Northwind Health Plus Benefits Details is $1,500 for individuals and $3,000 for families. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "The calendar year deductible for in-network services under the Northwind Health Plus plan is $1,500 for individuals and $3,000 for families [Northwind_Health_Plus_Benefits_Details.pdf#page=12].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=12: Other services, such as lab tests, X-rays, and imaging tests, are subject to different copay amounts, which are listed on your insurance card. It is also important to remember that the split copay only applies to in-network providers. If you visit an out-of-network provider, you will be subject to a higher copay amount, which is also listed on your insurance card. At Northwind Health Plus, we are committed to helping our members get the care they need at a price they can afford. With the split copay for office visits, we hope to make healthcare more affordable for you and your family.Calendar Year Deductible IMPORTANT PLAN INFORMATION: Calendar Year Deductible The Northwind Health Plus plan has a calendar year deductible that applies to some services. The amount you must pay out-of-pocket before the plan begins to pay for covered services is called the calendar year deductible. The calendar year deductible is the same for all members of the plan and is reset each year on the plan's renewal date. For In-Network Services: The calendar year deductible for in-network services is $1,500 for individuals and $3,000 for families.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.465542, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately reflecting the information provided in the CONTEXT and directly addressing the QUERY.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing the deductible amounts for both individuals and families without adding any unnecessary details.", "answer_length": 193, "citations_matched": 0.0, "any_citation": true} +{"question": "What is the role of coinsurance in Northwind Health Plus?", "truth": "Coinsurance is a cost-sharing requirement under Northwind Health Plus, where after meeting the deductible, the policyholder is responsible for a certain percentage of the costs for covered services. This percentage is usually a portion of the allowed amount for a service, which the policyholder must pay. [Northwind_Health_Plus_Benefits_Details.pdf#page=13]", "answer": "Coinsurance in Northwind Health Plus is a cost-sharing requirement that applies after you have met your deductible. You will be responsible for a certain percentage of the costs for covered services. Specifically, the coinsurance rate is 20%. For example, if the allowed amount for a service is $100, you would pay $20 (20% of $100), and the insurance company would pay the remaining $80. Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services [Northwind_Health_Plus_Benefits_Details.pdf#page=13][Northwind_Health_Plus_Benefits_Details.pdf#page=107].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=13: Tips: 路 Be sure to check with your provider to find out if a service is subject to the calendar year deductible before receiving the service. 路 Make sure you understand the cost sharing that applies to out-of-network services. 路 Be aware that the calendar year deductible is reset each year on the plan's renewal date. 路 Remember that preventive care services and emergency services are exempt from the calendar year deductible. Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a cost-sharing requirement under Northwind Health Plus. This means that after you have met your deductible, you will be responsible for a certain percentage of the costs for covered services. The coinsurance rate is usually a percentage of the allowed amount for a service, and it is your responsibility to pay this amount. For example, if the allowed amount for a service is $100 and your coinsurance is 20%, you are responsible for paying $20 (20% of $100). The insurance company will pay the remaining amount of $80.Coinsurance may apply to all services, including hospitalization, emergency room visits, preventive care, and some mental health and substance abuse services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=107: If an employee has any questions or concerns about their coverage, they should contact their employer or the Workers' Compensation Insurance provider for more information. DEFINITIONS Definitions It is important for employees to understand the definitions of certain terms when it comes to their health insurance plan. The following definitions will help employees obtain a better understanding of Northwind Health Plus. Copayment: A copayment, also known as a copay, is the fixed amount that an employee pays for a covered service. This amount is usually a flat fee and is due at the time of service.Deductible: A deductible is the amount of money that an employee must pay out-of-pocket before the plan begins paying for covered services. Northwind Health Plus has a deductible of $2,000 per year. Coinsurance: Coinsurance is the percentage of the cost of a covered service that an employee must pay after the deductible is met. Northwind Health Plus has a coinsurance of 20%. Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year.\n\nNorthwind_Standard_Benefits_Details.pdf#page=13: Coinsurance IMPORTANT PLAN INFORMATION: Coinsurance Coinsurance is a type of cost sharing that you are responsible for after meeting your deductible. Coinsurance is often a percentage of the cost of the service you receive. Forexample, if the coinsurance is 10%, you will be responsible for paying 10% of the cost of the service you received, while the insurance company pays the other 90%. Under Northwind Standard, coinsurance is set at 20% for in-network services, with some exceptions. For in-network hospital stays, coinsurance is set at 25%. Additionally, coinsurance for out-of-network services is set at 40%. It's important to note that coinsurance does not apply to the services that are covered by the plan's copayment amounts. Copayment is a fixed amount that you are responsible for paying for certain services and is typically much less than coinsurance. Additionally, Northwind Standard does not require coinsurance for preventive care services. When you receive services, it's important to ask about the cost of the service and make sure you are aware of any coinsurance costs.", "latency": 3.379906, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, including additional insights into how coinsurance works and the types of services it applies to, which enhances understanding.", "answer_length": 653, "citations_matched": 1.0, "any_citation": true} +{"question": "How does the Northwind Health Plus Benefits Details.pdf explain the impact of choosing in-network versus non-participating providers on your healthcare costs, and what are the exceptions to prior authorization that do not require prior approval?", "truth": "The Northwind Health Plus Benefits Details.pdf explains that by understanding the difference between in-network and non-participating providers, you can save money on your healthcare costs. In-network providers are likely part of a negotiated agreement with Northwind Health Plus, which can result in lower costs for the insured. Additionally, there are exceptions to prior authorization that do not require prior approval, including routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. These services are exempt from prior authorization, potentially simplifying and reducing the cost of accessing these types of healthcare. [Northwind_Health_Plus_Benefits_Details.pdf#page=7] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "Choosing in-network providers with Northwind Health Plus can significantly reduce your healthcare costs. If you opt for non-participating providers, you will be responsible for the entire cost of care out-of-pocket, as they are not in-network. However, there are exceptions where you may receive some coverage when using non-participating providers: \n\n1. If you are traveling outside of the United States and cannot find an in-network provider, Northwind Health Plus may cover a portion of the cost.\n2. In a life-threatening situation where you need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received [Northwind_Health_Plus_Benefits_Details.pdf#page=6].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=6: 路 Ask your provider if they offer continuity of care. . If you are switching to a new provider, make sure they are familiar with your medical history. 路 If you are switching from an in-network provider to an out-of-network provider, make sure you understand what that means for your coverage. 路 Make sure you keep all of your medical records up to date. Continuity of care is an important factor to consider when selecting a provider. Northwind Health Plus offers coverage for continuity of care, so you may be able to continue seeing the same provider without having to switch to a different provider in the network. However, there are some exceptions to the continuity of care rule, so it's important to understand what those are. By following these tips, you can ensure you have the best possible coverage and ensure continuity of care. Non-Participating HOW PROVIDERS AFFECT YOUR COSTS When it comes to health care, the provider you choose can have a major impact on your costs. With Northwind Health Plus, you have the option to choose from a variety of in- network providers.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=7: By understanding the difference between in-network and non-participating providers and being aware of any exceptions that may apply to you, you can save money on your health care costs. Northwind Health Plus is here to help you make the most of your coverage. If you have any additional questions about in-network and non-participating providers, please contact the Northwind Health Plus customer service line. Balance Billing Protection HOW PROVIDERS AFFECT YOUR COSTS: Balance Billing Protection Balance billing is a practice where a provider bills you for the difference between the allowed amount and billed amount. The allowed amount is the amount that your insurance company determines is a reasonable fee for a service. The amount you are billed for is the amount that the provider charges you for the services. With Northwind Health Plus, you are protected from balance billing. This means that you can rest assured that you will not be billed more than the allowed amount by your provider. Balance billing protection is an important part of Northwind Health Plus. This protection ensures that you will not be responsible for the difference between the allowed amount and the ", "latency": 5.636184, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE accurately addresses part of the QUERY regarding the impact of provider choice on costs and exceptions for non-participating providers but fails to address the exceptions to prior authorization, making it incomplete.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses the impact of choosing in-network versus non-participating providers but fails to address the exceptions to prior authorization, making it incomplete.", "answer_length": 698, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the prior authorization process outlined in the Northwind Health Plus Benefits Details affect the coinsurance responsibilities for services that require prior authorization?", "truth": "The prior authorization process requires contacting Northwind Health Plus before receiving services or medications that need prior authorization to determine if it is necessary. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. This impacts the coinsurance responsibilities as failing to obtain prior authorization could lead to the policyholder paying the full cost, rather than just the coinsurance amount. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "The prior authorization process for services under the Northwind Health Plus plan requires members to obtain approval before receiving certain services. If prior authorization is not obtained, you may be responsible for the full cost of the services [Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Additionally, the Allowed Amount does not include any applicable copays, coinsurance, or deductibles that may be due [Northwind_Health_Plus_Benefits_Details.pdf#page=16]. Therefore, it is crucial to check with your provider and Northwind Health Plus to understand your financial responsibilities and ensure that services are covered [Northwind_Health_Plus_Benefits_Details.pdf#page=16][Northwind_Health_Plus_Benefits_Details.pdf#page=66].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=16: You should always check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. This way, you will know what your financial responsibility will be and can plan accordingly. When you receive services from an out-of-network provider, you may be required to pay the full Allowed Amount up front. You then can submit a claim to Northwind Health Plus for reimbursement of the Allowed Amount less any applicable copays, coinsurance, or deductibles. In some cases, Northwind Health Plus may not cover services that are considered experimental or investigational. If a service is not covered, you may be responsible for the entire cost of the service. Therefore, it is important to check with Northwind Health Plus prior to receiving services to determine if a service is covered. In addition, some services may be subject to pre-authorization or pre-certification. This means that you must obtain approval from Northwind Health Plus prior to receiving the service. If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=16: If pre-authorization or pre-certification is not obtained, you may be responsible for the full cost of the services. It is important to understand that the Allowed Amount does not include any applicable copays, coinsurance, or deductibles that may be due. It is also important to understand that the Allowed Amount may vary depending on the type of care received and the type of provider that is providing the care. Therefore, it is important to check with the provider prior to receiving services to determine the Allowed Amount that Northwind Health Plus will pay for the services you are receiving. Finally, it is important to keep track of your out-of-pocket expenses. This includes any copays, coinsurance, or deductibles that you may be required to pay. It is important to understand what your financial responsibility is when receiving care under Northwind Health Plus, so that you can plan accordingly and make sure that you are meeting your financial obligations. IMPORTANT PLAN INFORMATIONNorthwind Health Plus is a comprehensive health plan that offers coverage for medical, vision, and dental services.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=66: By understanding the prior authorization process and following the tips outlined above, you can help ensure that you receive the care you need in a timely and efficient manner. Prior-Authorization for Benefit Coverage CARE MANAGEMENT: Prior-Authorization for Benefit Coverage The Northwind Health Plus plan includes a care management system that requires prior- authorization for certain services to ensure that the plan is covering only medically necessary care. Prior-authorization is a process used by the insurance company to review a request for a specific service to ensure that it is medically necessary and meets the criteria set by the plan. This process helps to ensure that members are receiving the best care possible and that their benefits are used in the most cost-effective manner. In order to receive prior-authorization, members must provide their Northwind Health Plus provider with the necessary clinical information regarding their diagnosis and treatment plan. The provider then submits this information to Northwind Health Plus for review. Northwind Health Plus will then contact the provider with the decision on the prior- authorization request.", "latency": 3.364066, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is related to the topic of prior authorization and financial responsibilities but does not directly address how coinsurance responsibilities are affected by the prior authorization process, making it incomplete.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The response addresses the query by discussing the need for prior authorization and its potential financial implications, but it does not fully explain how coinsurance responsibilities are specifically affected by the prior authorization process.", "answer_length": 742, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Standard Benefits Details document explain the financial responsibilities for in-network and out-of-network providers, and what are some specific services covered under the plan as mentioned in the document?", "truth": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, individuals are typically responsible for only a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". However, for out-of-network providers, the costs can be significantly higher, and individuals may be responsible for the entire cost of services or a much larger portion than with an in-network provider. Specific services covered under the plan include the cost of blood or blood products during a hospital stay or procedure, the collection, storage, and transfusion of platelets and plasma, along with necessary laboratory tests to assess compatibility. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=21]", "answer": "The Northwind Standard Benefits Details document explains that when selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance.\" Different types of services may require different co-pays or co-insurance, so it's advisable to contact your provider for specific costs. For out-of-network providers, while Northwind Standard offers coverage, the costs can be significantly higher, and you may be responsible for the entire cost of services or a greater portion than with in-network providers. Some services may also fall outside of the Northwind Standard plan coverage, requiring out-of-pocket payments for those services [Northwind_Standard_Benefits_Details.pdf#page=10][Northwind_Standard_Benefits_Details.pdf#page=8].\n\nSpecific services covered under the plan include mental health and substance abuse services, which generally have the same coverage as medical and surgical services, as well as preventive care services such as immunizations and screenings [Northwind_Health_Plus_Benefits_Details.pdf#page=3].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.", "latency": 3.180017, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE correctly addresses the financial responsibilities for in-network and out-of-network providers but includes incorrect information about the specific services covered under the Northwind Standard plan, which impacts its accuracy and completeness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about financial responsibilities and specific services covered under the plan, as mentioned in the document.", "answer_length": 1103, "citations_matched": 0.5, "any_citation": true} +{"question": "How can a claim for medically necessary rehabilitation therapy services be processed quickly under the Northwind Standard plan?", "truth": "To ensure quick processing of a claim for medically necessary rehabilitation therapy services under the Northwind Standard plan, one should ask the healthcare provider for a detailed explanation of the services and treatments, ensure all documentation including required forms, test results, and physician's notes are complete, send the documentation to Northwind Health promptly, and follow up with them to confirm receipt and processing of the claim. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=48]", "answer": "To process a claim for medically necessary rehabilitation therapy services quickly under the Northwind Standard plan, you should follow these steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments you are receiving, including the medical necessity for them.\n2. Ensure that all documentation is complete, including all required forms, test results, and physician's notes.\n3. Send the documentation to Northwind Health as soon as possible.\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed.\n\nAdditionally, if the rehabilitation services require prior authorization, make sure that this is obtained before the services are rendered, as Northwind Health will review the request and notify you of the decision within three business days [Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=62].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=62: There are certain services that require prior authorization before the service is rendered. These services can include, but are not limited to, hospital stays, certain laboratory tests, certain imaging services, physical therapy, and durable medical equipment. Northwind Health may also require prior authorization for drugs that are not on the Northwind Standard formulary. When you or your doctor request a service that requires prior authorization, Northwind Health will review the request. Northwind Health will then decide if the service is medically necessary and covered under Northwind Standard. Northwind Health will notify you and your doctor of the decision within three business days. If Northwind Health approves the service, you may receive the service without any additional pre-authorization. However, if Northwind Health denies coverage, you may be able to appeal the decision. You can contact Northwind Health by phone or mail to submit an appeal. Northwind Health may also review claims after the services have been provided. This process is called retrospective review and is used to ensure that the services provided were medically necessary and appropriate.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=68: Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require outpatient services, please contact Northwind Health Plus to ensure that the hospital you are visiting is an in-network provider. Ambulatory Surgery Center Services: Ambulatory surgery center services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the ambulatory surgery center you are visiting is an in-network provider. Outpatient Rehabilitative Services: Outpatient rehabilitative services are covered without prior authorization if it is determined that the services are medically necessary. However, please contact Northwind Health Plus to ensure that the outpatient rehabilitative provider you are visiting is an in-network provider. Long-Term Care Services: Long-term care services are covered without prior authorization if it is determined that the services are medically necessary.", "latency": 3.630792, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with relevant details about processing claims and prior authorization.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about prior authorization and decision timeframes, enhancing the understanding of the process.", "answer_length": 927, "citations_matched": 0.5, "any_citation": true} +{"question": "What steps can be taken to ensure quick and accurate processing of claims under the Northwind Standard Benefits Details?", "truth": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits Details, one should ask their healthcare provider for a detailed explanation of the services and treatments, including the medical necessity for them. It is also important to ensure that all documentation is complete, including all required forms, test results, and physician's notes. Additionally, sending the documentation to Northwind Health as soon as possible and following up with them to ensure the claim has been received and is being processed are crucial steps. [Northwind_Standard_Benefits_Details.pdf#page=88] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To ensure quick and accurate processing of claims under the Northwind Standard Benefits, you can take the following steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments you are receiving, including the medical necessity for them [Northwind_Standard_Benefits_Details.pdf#page=88].\n2. Ensure that all documentation is complete, including all required forms, test results, and physician's notes [Northwind_Standard_Benefits_Details.pdf#page=88].\n3. Send the documentation to Northwind Health as soon as possible [Northwind_Standard_Benefits_Details.pdf#page=88].\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed [Northwind_Standard_Benefits_Details.pdf#page=88].\n5. Keep copies of all documentation related to your services [Northwind_Standard_Benefits_Details.pdf#page=79].\n6. If you are unsure of the filing requirements, contact Northwind Health for clarification [Northwind_Standard_Benefits_Details.pdf#page=79].\n7. Provide required notices in a timely manner [Northwind_Health_Plus_Benefits_Details.pdf#page=101].\n\nBy following these steps, you can help ensure that your claims are processed quickly and accurately.", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=79: You should also keep copies of all documentation related to your services, and if you're unsure of the filing requirements, you should contact Northwind Health for clarification. Overall, timely filing is an important part of the claim filing process. By following the guidelines for timely filing and including all necessary documentation with your claims, you can help ensure that your claims are processed quickly and accurately. COMPLAINTS AND APPEALS What You Can Appeal COMPLAINTS AND APPEALS What You Can Appeal When you have Northwind Standard coverage, you have the right to appeal any denial of services or payment of benefits. This includes if you disagree with the amount of the payment or if you feel that your claim was denied incorrectly. You also have the right to appeal if you feel that an authorization was not provided for a service, or if you believe that a service should be covered by your plan but was not. If you believe that your claim was wrongly denied or that you have a dispute over a service that is covered or not covered, you have the right to file a formal appeal.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.", "latency": 4.099918, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is mostly correct and complete, addressing the QUERY with relevant steps from the CONTEXT. However, it includes one step that is not applicable to the Northwind Standard Benefits, slightly reducing its groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, providing all essential steps needed for a comprehensive understanding of how to ensure quick and accurate processing of claims. It does not include additional insights or elaboration, which would have elevated it to a higher score.", "answer_length": 1217, "citations_matched": 0.5, "any_citation": true} +{"question": "What are some services exempt from prior authorization according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, services exempt from prior authorization include routine office visits, immunizations, X-Ray services, emergency services, family planning services, maternity services, services and supplies related to diabetes, preventive care services, mental health and substance abuse services, routine eye exams, and routine dental exams. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=65]", "answer": "According to the Northwind Health Plus Benefits Details, the following services are exempt from prior authorization:\n\n1. **Emergency Care**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n2. **Inpatient Hospital Services**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n3. **Outpatient Hospital Services**: Covered without prior authorization if determined to be medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=67].\n4. **Certain Preventive Services**: Such as annual physicals and routine check-ups do not require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=63].\n5. **Emergency Services by Out-of-Network Providers**: No prior authorization required if the service is medically necessary and the out-of-network provider is the closest available [Northwind_Health_Plus_Benefits_Details.pdf#page=70].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=67: That is why we provide exceptions to prior authorization for certain medical services, procedures and treatments that may require additional review and approval. The exceptions to prior authorization are based onnational and state medical regulations, as well as medical necessity and appropriateness criteria. The exceptions to prior authorization provided by Northwind Health Plus include: Emergency Care: Emergency care is covered without prior authorization if it is determined to be medically necessary. If you believe that you need emergency care, please contact Northwind Health Plus for approval. Inpatient Hospital Services: Inpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary. However, if you require hospital services, please contact Northwind Health Plus to ensure that the hospital you are admitted to is an in-network provider. Outpatient Hospital Services: Outpatient hospital services are covered without prior authorization if it is determined that the services are medically necessary.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=70: Remember, if you have any questions about the prior authorization process or coverage for an out-of-network provider, contact Northwind Health directly. Northwind Health is available to answer any questions you may have and provide more information about the prior authorization process. Exceptions to Prior-Authorization For Out-Of-Network Providers CARE MANAGEMENT - Exceptions to Prior-Authorization For Out-Of-Network Providers Northwind Health Plus provides coverage for certain services that may require prior authorization when provided by an out-of-network provider. Prior authorization is required to ensure that the service is medically necessary and to ensure that the service is being provided in accordance with the plan's specific rules and guidelines. Northwind Health Plus makes exceptions to the prior authorization requirement for the following services when provided by an out-of-network provider: 路 Emergency Services: For services that are medically necessary and when the out-of- network provider is the closest provider available, prior authorization is not required.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=63: For services and medications that require prior authorization, you must contact Northwind Health Plus before receiving the service or medication to determine if prior authorization is required. If so, you will need to obtain prior authorization through the Northwind Health Plus prior authorization process. Exceptions There are some exceptions to the prior authorization requirement. Certain preventive services, such as annual physicals and routine check-ups do not require prior authorization. In some cases, Northwind Health Plus may also waive the prior authorization requirement for certain services and medications. Tips for Employees If you think you may need a service or medication that requires prior authorization, it is important to plan ahead and contact Northwind Health Plus before receiving the service or medication. This will help ensure that your service or medication is covered by Northwind Health Plus. If you receive a service or medication without prior authorization, you may be responsible for the entire cost of the service or medication. You can also be billed for any services or medications that are determined to be not medically necessary.", "latency": 5.099652, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely lists the services exempt from prior authorization as described in the CONTEXT, without introducing any unrelated or incorrect information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding.", "answer_length": 1011, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the prior authorization process detailed in the Northwind_Health_Plus_Benefits_Details.pdf impact the out-of-pocket costs for services and medications, and what are the copayment expectations for in-network services as outlined in the same document?", "truth": "The prior authorization process as detailed in the Northwind Health Plus Benefits Details requires contacting Northwind Health Plus before receiving certain services or medications to determine if prior authorization is needed. If prior authorization is not obtained, the policyholder may be responsible for the entire cost of the service or medication. Additionally, for in-network services, the copayment expectations are generally lower, with a typical copayment of around $20 for primary care visits and around $50 for specialist visits. [Northwind_Health_Plus_Benefits_Details.pdf#page=63] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The prior authorization process can impact out-of-pocket costs for services and medications by potentially requiring approval before certain services or medications are covered, which may affect whether you incur higher costs if the authorization is not obtained. However, specific details about how prior authorization directly affects out-of-pocket costs are not provided in the document.\n\nFor copayment expectations for in-network services, the copayment for primary care visits is typically around $20, specialist visits have a copayment of around $50, and in-network emergency services typically have a copayment of around $100. Preventive care services are covered at 100% with no copayment [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=108: Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance. Prescription Drugs: Prescription drugs are generally subject to a copayment, and the amount varies depending on the type of drug. Generic drugs typically have a lower copayment than brand-name drugs. Mental Health and Substance Abuse Services: These services are subject to a copayment and deductible. The copayment and deductible amounts can vary depending on the type of service. Emergency Services: Emergency services are subject to a copayment and deductible, but the amount can vary depending on whether the services are received in-network or out-of- network. Tips 路 Always check to see if a provider is in-network or out-of-network before receiving services.路 Ask your doctor about generic drugs if you are prescribed a medication. 路 Contact Northwind Health if you have any questions about your coverage or benefits. 路 Keep track of your out-of-pocket expenses to ensure you do not exceed the out-of-pocket maximum.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an ", "latency": 3.487467, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE accurately addresses the copayment expectations for in-network services but introduces information about prior authorization that is not supported by the CONTEXT. This makes the RESPONSE partially correct but not fully grounded in the CONTEXT.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE addresses both parts of the QUERY but lacks specific details about how prior authorization impacts out-of-pocket costs, making it incomplete. The copayment information is complete and accurate.", "answer_length": 750, "citations_matched": 0.0, "any_citation": true} +{"question": "How does using in-network providers affect the coinsurance responsibilities for services under the Northwind Health Plus Benefits, and what are the implications of using out-of-network providers?", "truth": "Using in-network providers under the Northwind Health Plus Benefits can result in lower coinsurance rates, meaning the policyholder will pay less for the same service. However, if out-of-network providers are used, the policyholder will be responsible for a larger portion of the cost, and in some cases, may be responsible for the entire cost. This highlights the importance of checking if a provider is in-network before selecting a plan to manage out-of-pocket costs effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=14] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers under the Northwind Health Plus Benefits results in lower out-of-pocket costs because Northwind Health has negotiated discounted rates with these providers. In contrast, using out-of-network providers may lead to higher out-of-pocket costs, including potentially paying the full cost of services, higher deductibles, and higher coinsurance responsibilities [Northwind_Health_Plus_Benefits_Details.pdf#page=3].\n\nFor emergency services, both in-network and out-of-network providers are covered, but using out-of-network providers may incur higher out-of-pocket costs, including copayments and coinsurance, and you may have to pay the difference between the billed amount and what the plan pays [Northwind_Health_Plus_Benefits_Details.pdf#page=27].\n\nOverall, in-network providers generally result in your insurance covering a greater portion of your expenses, while out-of-network providers require you to pay a greater portion of the costs [Northwind_Standard_Benefits_Details.pdf#page=8].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you have questions about the dialysis coverage offered by Northwind Health Plus, please contact your provider or Northwind Health directly. We are committed to providing our employees with comprehensive coverage and support. Emergency Room COVERED SERVICES - EMERGENCY SERVICES At Contoso, we understand that unplanned medical emergencies can arise, and so our insurance partner, Northwind Health, provides coverage for emergency services. This coverage applies to both in-network and out-of-network providers. In-Network Providers If you seek emergency care from an in-network provider, your plan will cover the cost of treatment, including any necessary hospitalization and follow-up care. Depending on the type of plan you have, you may also be responsible for paying a copayment and/or coinsurance. Out-of-Network Providers Emergency services received from out-of-network providers will also be covered, but you may be responsible for higher out-of-pocket costs such as copayments and coinsurance. If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay.\n\nNorthwind_Standard_Benefits_Details.pdf#page=8: Or Non-Contracted Providers HOW PROVIDERS AFFECT YOUR COSTS: Benefits For Out-Of-Network Or Non-Contracted Providers One of the important considerations when choosing a health insurance plan is understanding the differences between in-network and out-of-network providers. When you receive health care from an in-network provider, your insurance plan will generally cover a greater portion of your expenses. However, when you receive health care from an out-of-network provider, you may be required to pay a greater portion of the costs. Under Northwind Standard, you may receive care from out-of-network providers, but you will be responsible for a greater portion of the costs. To make sure you are getting the best value for your health care expenses, it is important to understand the differences between in-network and out-of-network providers and how they affect your costs. In-Network: In-network providers are those who have contracted with Northwind Health to provide services at a discounted rate. In-network providers have agreed to accept the amount of payment offered by Northwind Health, meaning that you pay the portion of the cost that is not covered by the insurance plan.", "latency": 6.865712, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately addressing the QUERY with relevant details about coinsurance responsibilities and implications of using in-network versus out-of-network providers under the Northwind Health Plus Benefits.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about emergency services and general insurance coverage impacts, which enhance understanding.", "answer_length": 1014, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the differences in copayment amounts for primary care and specialist visits under the Northwind Health Plus plan?", "truth": "Under the Northwind Health Plus plan, the copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=10] [Northwind_Health_Plus_Benefits_Details.pdf#page=9]", "answer": "Under the Northwind Health Plus plan, the copayment amounts are as follows:\n\n- For in-network primary care visits: approximately $20 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- For in-network specialist visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n\nFor out-of-network services, the copayment amounts are higher:\n\n- For out-of-network primary care visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].\n- For out-of-network specialist visits: approximately $75 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 4.611795, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, as it accurately provides the copayment amounts for primary care and specialist visits under the Northwind Health Plus plan, distinguishing between in-network and out-of-network services, as detailed in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing the copayment amounts for both primary care and specialist visits, in-network and out-of-network, under the Northwind Health Plus plan.", "answer_length": 585, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details?", "truth": "The limitations of the Right of Recovery provision in the Northwind Health Plus Benefits Details include that it only applies to services covered under the plan and not to services that are not covered or are subject to limitations or exclusions. Additionally, it only applies to claims filed within six months of the date of service. There is also no guarantee that the insurance company will be able to recover all or part of the money already paid by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "The limitations of the Right of Recovery provision in the Northwind Health Plus plan include:\n\n1. The provision only applies to services that are covered under the plan. If the service is not covered, the employee will not be eligible for recovery [Northwind_Health_Plus_Benefits_Details.pdf#page=101][Northwind_Standard_Benefits_Details.pdf#page=98].\n\n2. The request for the right of recovery must be made within two years of the service being provided. Claims submitted after this period will not be considered [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n3. Certain services are not eligible for the right of recovery, including those related to mental health and substance abuse, emergency services, inpatient services, and any services not covered under the Northwind Standard plan [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n4. The right of recovery is only applicable to services paid for by the insured, not by any third party, including family members, friends, employers, or other insurance plans [Northwind_Standard_Benefits_Details.pdf#page=98].\n\n5. The right of recovery is subject to the terms and conditions of the Northwind Standard plan, so it is important to read the plan documents for additional exclusions [Northwind_Standard_Benefits_Details.pdf#page=98].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=101: In order to ensure that claims are processed correctly and quickly, members should always provide the required notices in a timely manner. Additionally, members should keep copies of all notices for their own records.Right Of Recovery OTHER INFORMATION ABOUT THIS PLAN: Right of Recovery The Right of Recovery provision in Northwind's Health Plus plan allows you to file a claim with the insurance company if you have already paid a bill for a medical service that is covered under the plan. This is important because it can help you recover any expenses that you have already paid out-of-pocket, including co-pays, co-insurance, and deductibles. Under this provision, you must first file a claim with the insurance company, and then the insurance company can attempt to recover the money that you have already paid from the provider who charged you. In some cases, if you have already paid the provider, they may be willing to reimburse you directly. However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan.\n\nNorthwind_Standard_Benefits_Details.pdf#page=98: Additionally, the service must be one that is covered under the plan. If the service is not covered, then the employee will not be eligible for the right of recovery. It is important for employees to keep in mind that the right of recovery must be requested within two years of the service being provided in order for the employee to be eligible for reimbursement. Any claims submitted after this period will not be considered. In addition, there are some services that are not eligible for the right of recovery. These include services related to mental health and substance abuse, emergency services, inpatient services, and any services that are not covered under the Northwind Standard plan. It is also important to note that the right of recovery is only applicable to services that were paid for by the insured, and not by any other third party. This includes family members, friends, employers, or other insurance plans. Employees should keep in mind that the right of recovery is subject to the terms and conditions of the Northwind Standard plan. Therefore, it is important to read the plan documents in detail to understand any additional exclusions or ", "latency": 7.046571, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE attempts to address the QUERY but includes incorrect information from a different plan, which is not supported by the CONTEXT provided.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information about the limitations of the Right of Recovery provision, without adding any extraneous information.", "answer_length": 1292, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the benefits of the Chronic Condition Management Program offered by the Northwind Health Plus plan?", "truth": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides members with access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. This team offers personalized care and support to help members manage their chronic conditions and live healthier, happier lives. [Northwind_Health_Plus_Benefits_Details.pdf#page=102] [Northwind_Health_Plus_Benefits_Details.pdf#page=73]", "answer": "The Chronic Condition Management Program (CCMP) offered by the Northwind Health Plus plan provides several benefits, including:\n\n- Access to an interdisciplinary team of healthcare professionals, including physicians, nurses, social workers, nutritionists, pharmacists, and other specialists [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Comprehensive care assessments and care plans [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Regular follow-up visits [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Personalized health education [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Assistance with medication management [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Coordination of services with other providers [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n- Referrals to community resources [Northwind_Health_Plus_Benefits_Details.pdf#page=74].\n\nThe program is designed to help members better manage their chronic conditions, reduce the risk of complications, and improve their quality of life [Northwind_Health_Plus_Benefits_Details.pdf#page=74]. It is available to members with specific chronic conditions such as diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and hypertension [Northwind_Health_Plus_Benefits_Details.pdf#page=74].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=74: 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help manage your condition and reduce the risk of complications. . Stay organized: Keeping track of your medications, appointments, and lab results can help you stay on top of your condition and make informed decisions about your care. . Ask for help: Don't be afraid to ask for help from family, friends, and healthcare professionals. . Take advantage of resources: Northwind Health Plus offers a variety of resources and programs to help members manage their chronic conditions.路 Be proactive: Talk to your doctor if you have any questions or concerns about your condition or care plan. At Northwind Health, we understand that managing chronic conditions can be challenging. That's why we're committed to helping our members get the care and support they need to stay healthy and active. Through our Chronic Condition Management Program, we provide members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=74: The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists. The CCMP is designed to help members better manage their chronic conditions, reduce the risk of complications, and improve their quality of life. Through the program, members receive: 路 Comprehensive care assessments and care plans 路 Regular follow-up visits 路 Personalized health education 路 Assistance with medication management 路 Coordination of services with other providers 路 Referrals to community resources Exceptions: The CCMP is only available to Northwind Health Plus members who have one or more of the following chronic conditions: diabetes, asthma, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and hypertension. Tips to Help Employees Manage Chronic Conditions: . Talk to your doctor: It's important to have open and honest conversations with your doctor about your condition and any concerns you may have. 路 Make lifestyle changes: Eating a healthy diet, exercising regularly, and quitting smoking can help \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=73: Talk to your doctor or other health care provider about your health and any treatments that may be available. .Take an active role in your health care. Ask questions and be informed about your health and any treatments that may be available. . Make sure to follow your doctor's instructions and stay up to date on your health care. . If you have any questions or concerns about your health, contact Northwind Health Plus for assistance.Chronic Condition Management CARE MANAGEMENT: Chronic Condition Management At Northwind Health, we understand that managing chronic conditions can be overwhelming and expensive. We are committed to helping our members manage their chronic conditions and live healthier, happier lives. That's why we offer a Chronic Condition Management Program (CCMP) as part of our Northwind Health Plus plan. This program provides members with access to an interdisciplinary team of healthcare professionals who can provide personalized care and support. The team includes physicians, nurses, social workers, nutritionists, pharmacists, and other specialists.", "latency": 4.045416, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately listing all the benefits of the Chronic Condition Management Program as provided in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights into the program's purpose and the specific conditions it covers, which enhances understanding.", "answer_length": 1380, "citations_matched": 0.0, "any_citation": true} +{"question": "What happens if you use out-of-network providers according to Northwind Health Plus?", "truth": "If you use out-of-network providers according to Northwind Health Plus, you will be responsible for a larger portion of the cost. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=75]", "answer": "If you use out-of-network providers under Northwind Health Plus, you must obtain prior authorization before receiving care. This means that Northwind Health will review your request for coverage and decide whether it will cover the care you are seeking. The criteria for approval may vary depending on the type of care requested, and your provider typically submits the request for you. \n\nAdditionally, while Northwind Health Plus offers coverage for out-of-network providers, it may not cover all services, and out-of-network providers may charge more than in-network ones. There may also be limitations or conditions on the coverage granted, such as limits on the number of visits for specific procedures [Northwind_Health_Plus_Benefits_Details.pdf#page=69][Northwind_Health_Plus_Benefits_Details.pdf#page=71].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=62: If you are outside Washington, you may still be eligible for coverage through Northwind Health Plus. Northwind Health Plus offers a network of providers that are located throughout the United States. These providers are part of Northwind Health Plus' nationwide network, which is designed to ensure that you are able to receive care, no matter where you are. Out-of-area care is coverage that extends outside of Washington. This means that if you travel outside of the state, you can still receive care from a Northwind Health Plus provider. However, there are some exceptions to this coverage. For example, you may be limited to a certain number of visits or treatments that are covered outside of Washington. Additionally, certain services may not be covered, such as home health care services that are provided outside of the state. If you travel outside of Washington, it is important to keep a few tips in mind. First, you should make sure that any provider you plan to visit is a part of Northwind Health Plus' nationwide network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=69: Northwind Health Plus offers coverage for out-of-network providers, but the plan requires prior authorization. This means that you must obtain approval from Northwind Health before seeing an out-of-network provider. Prior authorization is a process in which Northwind Health reviews your request for coverage and decides whether or not it will cover the care that you have requested. To be approved for prior authorization, you must meet certain criteria and provide certain information. This criteria and information may vary depending on the type of care you are requesting. Prior authorization requests must be submitted to Northwind Health by your provider. In most cases, your provider will submit the request for you. Northwind Health will then review the request and make a decision about whether or not it will cover the care.In some cases, Northwind Health may approve the request for coverage, but with certain limitations or conditions. For example, Northwind Health may limit the number of visits for a specific procedure or limit the amount of coverage for a specific procedure.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=71: In conclusion, Northwind Health Plus makes exceptions to the prior authorization requirement for certain services when they are provided by an out-of-network provider. However, it is important to remember that Northwind Health Plus may not cover all of the services provided by an out-of-network provider, that out-of-network providers may charge more than those in-network, and that prior authorization is still required for some services even if they are provided by an out-of-network provider. By being aware of theseexceptions and tips, employees can ensure that they are making responsible and informed decisions about their healthcare needs. Clinical Review CARE MANAGEMENT - Clinical Review Northwind Health Plus offers several care management services to ensure that members are receiving the best possible care. One of the primary care management services is Clinical Review. Clinical Review is an important process that helps to ensure that members are receiving the most appropriate care and that their care is in line with established clinical guidelines. Clinical Review involves a team of healthcare professionals who review services, treatments, and ", "latency": 3.044576, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY by incorporating all relevant details from the CONTEXT about using out-of-network providers, including prior authorization, potential limitations, and cost differences.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the implications and conditions of using out-of-network providers under Northwind Health Plus.", "answer_length": 812, "citations_matched": 0.0, "any_citation": true} +{"question": "What are the specific conditions and exceptions mentioned in the Northwind Health Plus Benefits Details.pdf for coordinating benefits with other employer plans and the Right of Recovery provision?", "truth": "The Northwind Health Plus Benefits Details.pdf specifies that to coordinate benefits with another employer plan, one must use an in-network provider within the Northwind Health Plus network and provide the other employer plan's information. Exceptions include not being able to coordinate benefits with non-major medical plans or high-deductible plans until the deductible is met. Regarding the Right of Recovery provision, it only applies to services covered under the plan and claims filed within six months of the service date. It does not guarantee recovery of payments made, and in cases where recovery is not possible, partial reimbursement might be offered. Documentation such as receipts is necessary if filing a Right of Recovery claim. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=102]", "answer": "For coordinating benefits with other employer plans under the Northwind Health Plus plan, the following conditions and exceptions apply:\n\n1. You must use an in-network provider within the Northwind Health Plus network.\n2. You need to provide your other employer plan's information to coordinate benefits.\n3. You cannot coordinate benefits with a health plan that is not a major medical plan.\n4. If enrolled in a high-deductible health plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible [Northwind_Health_Plus_Benefits_Details.pdf#page=77].\n\nRegarding the Right of Recovery provision:\n\n1. It only applies to services that are covered under the plan; it does not apply to services that are not covered or are subject to limitations or exclusions.\n2. Claims must be filed within six months of the date of service.\n3. There is no guarantee that the insurance company will recover the money you have already paid; they may only be able to reimburse a portion of it.\n4. You should keep receipts or other documentation if you have paid a provider for a service covered under the plan, as this documentation is necessary for filing a Right of Recovery claim [Northwind_Health_Plus_Benefits_Details.pdf#page=102].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=77: To coordinate benefits with your other employer plan, you must use an in-network provider within the Northwind Health Plus network. You will need to provide your other employer plan's information in order to coordinate benefits. Exceptions There are a few exceptions to coordinating benefits with other health care plans. For example, you cannot coordinate benefits with a health plan that is not a major medical plan. Also, if you are enrolled in a health plan that is a high-deductible plan, you cannot coordinate benefits with Northwind Health Plus until you have met the deductible. Tips If you have other health care coverage, here are a few tips to help you coordinate benefits with Northwind Health Plus: . Make sure you have your other health care plan's information handy when you use Northwind Health Plus. 路 Always use an in-network provider within the Northwind Health Plus network to ensure that your benefits are coordinated correctly. 路 Make sure you understand your plan's rules for coordinating benefits. 路 Ask your doctor or other health care provider about the cost of services before you receive them to make \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company. To sum up, the Right of Recovery provision in Northwind's Health Plus plan is a great way to help you recover any money that you have already paid for medical services that are covered under the plan. However, there are some restrictions and exceptions to this provision, so be sure to review the plan documents carefully before filing a claim. Additionally, if you have already paid a provider for a service that is covered under the plan, be sure to keep any receipts or other documentation, as this may be necessary if you decide to file a claim. Right To And Payment Of Benefits OTHER INFORMATION ABOUT THIS PLAN: Right To And Payment Of Benefits Under the Northwind Health Plus plan, members are entitled to receive the benefits listed in the plan documents. These benefits can be received from any in-network provider, as long as all eligibility requirements are met. The plan pays for covered health care services and supplies, including preventive care services, at the rates specified in \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=102: However, there are some restrictions and exceptions to this provision that you should be aware of. First, the Right of Recovery provision only applies to services that are covered under the plan. It does not apply to services that are not covered or services that are subject to limitations or exclusions. Second, the Right of Recovery provision only applies to claims that are filed within six months of the date of service. Also, keep in mind that the Right of Recovery provision does not guarantee that the insurance company will be able to recover the money that you have already paid. The insurance company may be unable to recover the money that you have paid, or they may not be able to recover the entire amount. In these cases, the insurance company may offer to reimburse you for some portion of the money that you have already paid. Finally, if you have already paid a provider for a service that is covered under the plan, it is important to keep any receipts or other documentation. This documentation will be necessary if you decide to file a Right of Recovery claim with the insurance company.", "latency": 3.624614, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY by providing all relevant conditions and exceptions mentioned in the CONTEXT for both coordinating benefits and the Right of Recovery provision.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, covering all essential details without adding extraneous information.", "answer_length": 1251, "citations_matched": 1.0, "any_citation": true} +{"question": "How can a policyholder of Northwind Health Plus ensure that their benefits are coordinated correctly when using an in-network provider, and what are the typical copayments for primary care and specialist visits?", "truth": "To ensure that benefits are coordinated correctly when using an in-network provider within the Northwind Health Plus network, a policyholder must have their other health care plan's information handy and always use an in-network provider. The typical copayments for primary care visits are around $20, while specialist visits have a copayment of around $50. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "To ensure that benefits are coordinated correctly when using an in-network provider, policyholders of Northwind Health Plus should follow the guidelines provided by their plan and consult with their provider for any necessary information. \n\nThe typical copayments for in-network services are as follows:\n- Primary care visits: approximately $20 [Northwind_Health_Plus_Benefits_Details.pdf#page=10].\n- Specialist visits: approximately $50 [Northwind_Health_Plus_Benefits_Details.pdf#page=11].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=10: They can provide you with helpful information and advice about selecting the right provider for your needs. By following these tips and doing your research, you can make sure you're getting the best care possible at the lowest cost. With Northwind Health Plus, you can rest assured that you're getting quality coverage for all your healthcare needs.IMPORTANT PLAN INFORMATION Copayments (Copays) IMPORTANT PLAN INFORMATION: Copayments (Copays) When using Northwind Health Plus, you may be responsible for a copayment (or copay) for certain services. A copayment is a fixed amount that you are expected to pay for a service. The amount of the copayment varies based on the type of service received, whether the service is rendered by an in-network or out-of-network provider, and other factors. In-Network Copays: For in-network services, copayments are generally lower than for out-of-network services. The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=11: The copayment for primary care visits is typically around $20, while specialist visits have a copayment of around $50. For in-network emergency services, the copayment is typically around $100. In addition, for in-network preventive care services, there is typically no copayment. Out-of-Network Copays: For out-of-network services, copayments are typically higher than for in-network services. The copayment for primary care visits is typically around $50, while specialist visits have a copayment of around $75. For out-of-network emergency services, the copayment is typically around $150. Please note that Northwind Health Plus will only cover a portion of out-of-network services, and you may be responsible for the remaining balance. Exceptions: There are a few exceptions to the copayment amounts listed above. For example, for mental health and substance abuse services, the copayment for in-network services is typically around $30 and the copayment for out-of-network services is typically around $60. In addition, the copayment for preventive care services is typically waived if received from an \n\nNorthwind_Standard_Benefits_Details.pdf#page=3: This means that you will need to pay the first $2,000 of your medical expenses before the plan will begin to cover the remaining amount. Co-payments and Co-insurance Once you have met your deductible, you will be responsible for co-payments and co- insurance. Co-payments are a fixed amount that you will need to pay at the time of service, while co-insurance is a percentage that you will need to pay. For Northwind Standard, the co-payment is $30 for primary care visits and $50 for specialist visits. The co-insurance is 20% of the remaining cost after the deductible has been met. Out-of-Pocket Maximum The out-of-pocket maximum for Northwind Standard is $6,000 per person, per year. This is the maximum amount that you will need to pay for your medical expenses in a given year.Once you have reached this limit, the plan will cover 100% of your expenses for the remainder of the year. Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard.", "latency": 3.27676, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE provides correct copayment information but lacks specific details on coordinating benefits, making it partially correct.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including specific copayment amounts and a method for ensuring benefits are coordinated correctly.", "answer_length": 491, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the necessary steps to ensure coverage for transplants according to the Northwind Standard Benefits Details?", "truth": "To ensure coverage for transplants according to the Northwind Standard Benefits Details, it is important to discuss transplant needs with a primary care physician, ensure the transplant is medically necessary, and obtain preauthorization. Additionally, coverage includes pre- and post-transplant care but excludes experimental or investigational procedures. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=55]", "answer": "To ensure coverage for transplants under the Northwind Standard plan, you should follow these necessary steps:\n\n1. **Discuss with Your Doctor**: Talk to your primary care physician about your transplant needs to determine if the procedure is medically necessary and covered under your plan [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n2. **Preauthorization**: Obtain the necessary preauthorization for any transplant procedures before proceeding [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n3. **Understand Coverage Details**: Familiarize yourself with your coverage details, including any applicable copays or coinsurance requirements [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n4. **Inquire About Costs**: Ask your doctor about any potential out-of-pocket costs and alternative treatments that may be available [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n5. **Avoid Experimental Procedures**: Ensure that the transplant procedure is not experimental or investigational, as these are not covered by the plan [Northwind_Standard_Benefits_Details.pdf#page=55].\n\n6. **Pre- and Post-Transplant Care**: Be aware that coverage includes pre- and post-transplant care, such as laboratory and diagnostic tests, as long as they are medically necessary [Northwind_Standard_Benefits_Details.pdf#page=55].", "context": "Northwind_Standard_Benefits_Details.pdf#page=55: There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants. For example, it's important to make sure that you are familiar with all of the details of your coverage, including any applicable copays orcoinsurance requirements. It's also a good idea to ask your doctor about any potential out- of-pocket costs you may need to pay, as well as any potential alternative treatments that may be available. Finally, it's important to note that Northwind Standard does not provide coverage for any experimental or investigational transplant procedures. If you're considering a transplant procedure, it's important to make sure that it is a medically necessary procedure, and that it is covered under your Northwind Standard plan. At Northwind Health, we understand how important it is for our members to have access to the best possible care. That's why we're proud to provide coverage for organ and tissue transplants through our Northwind Standard plan. With this coverage, you can get the care you need, while also enjoying the peace of mind that comes from \n\nNorthwind_Standard_Benefits_Details.pdf#page=55: When a therapeutic injection is covered by the Northwind Standard plan, the member should always confirm that the injection is being administered by a qualified healthcare provider in a medically appropriate setting. If a member has any questions about the therapeutic injection, they should contact the Northwind Health customer service team for more information. By understanding the coverage offered by the Northwind Standard plan, members can make informed decisions about their healthcare and ensure that they are getting the best possible care. Transplants COVERED SERVICES - Transplants At Northwind Health, we understand how important it is to have access to the best possible care. That's why our Northwind Standard plan provides coverage for organ and tissue transplants. If you need a transplant of any kind, Northwind Standard will cover the expenses associated with the procedure, including the cost of the donor organ, hospital stays, recovery costs, and medications. It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician.\n\nNorthwind_Standard_Benefits_Details.pdf#page=55: It's important to note that transplants are subject to certain criteria, including a determination of medical necessity, so it's important to discuss your transplant needs with your primary care physician. In addition to covering the cost of the transplant itself, Northwind Standard will also provide coverage for pre- and post-transplant care, such as laboratory tests, diagnostic tests, and other medically necessary services. It's important to note that there are some exceptions to coverage for transplants. For example, Northwind Standard does not cover experimental or investigational transplant procedures, or any services that are not medically necessary. When it comes to making sure you get the best care possible, we believe that the best approach is to work with your doctor to determine the best course of action. It's important to note that coverage for transplants is subject to preauthorization, so it's important to make sure that you get the necessary authorization for any transplant procedures before you move forward. There are also a few tips that can help make sure that you get the most out of your Northwind Standard coverage for transplants.", "latency": 4.005527, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with all necessary steps and details, making it a complete response.", "answer_length": 1323, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the benefits of using in-network providers according to the Northwind Health Plus Benefits Details?", "truth": "According to the Northwind Health Plus Benefits Details, using in-network providers results in lower out-of-pocket costs for the policyholder. This is because the plan covers a wide range of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies, which directly impacts the costs incurred by the policyholder. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=10]", "answer": "Using in-network providers offers several benefits according to the Northwind Health Plus Benefits Details:\n\n1. **Cost Savings**: Using in-network providers helps members save money, as they typically charge lower rates compared to out-of-network providers [Northwind_Health_Plus_Benefits_Details.pdf#page=94].\n\n2. **Higher Level of Care**: In-network providers generally provide a higher level of care than out-of-network providers [Northwind_Health_Plus_Benefits_Details.pdf#page=15].\n\n3. **Maximizing Coverage**: Staying in-network allows members to get the most out of their coverage [Northwind_Health_Plus_Benefits_Details.pdf#page=15].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=1: Contoso Electronics Northwind Health Plus Plan Contoso ElectronicsThis document contains information generated using a language model (Azure OpenAI). The information contained in this document is only for demonstration purposes and does not reflect the opinions or beliefs of Microsoft. Microsoft makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this document. All rights reserved to MicrosoftSummary of Benefits Northwind Health Plus Northwind Health Plus is a comprehensive plan that provides comprehensive coverage for medical, vision, and dental services. This plan also offers prescription drug coverage, mental health and substance abuse coverage, and coverage for preventive care services. With Northwind Health Plus, you can choose from a variety of in-network providers, including primary care physicians, specialists, hospitals, and pharmacies. This plan also offers coverage for emergency services, both in-network and out-of-network.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=94: 路 Take advantage of Northwind Health's 24/7 nurse hotline, which can provide you with medical advice and other assistance. . Use your plan's in-network providers whenever possible, as this will help you save money. . Utilize Northwind Health's online pharmacy service, which allows you to easily order and manage your prescriptions without leaving home. 路 When you receive health care services, make sure to check that the provider is in-network and that the services are covered by your plan. . Keep track of your claims and other plan information, as this will help you to better understand your plan and stay on top of your health care expenses.. Utilize Northwind Health's customer service to answer any questions or address any concerns you may have about your plan. Healthcare Providers - Independent Contractors OTHER INFORMATION ABOUT THIS PLAN Healthcare Providers - Independent Contractors The Northwind Health Plus plan includes coverage for healthcare services provided by independent contractors.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=15: Second, it's important to stay in-network as much as possible. Staying in-network helps members get the most out of their coverage and saves them money. In-network providers typically charge lower rates and provide a higher level of care than out-of-network providers. Third, it's important to understand the difference between deductibles, copays, and coinsurance. Deductibles are the amount a member has to pay before the plan starts paying, copays are a set fee for services, and coinsurance is the percentage of the cost a member has to pay. Understanding these three terms can help members make more informed decisions about their care. Finally, it's important to take advantage of preventive care services. Preventive care services are covered at 100% by Northwind Health Plus and can help members stay healthy and avoid costly treatments and services down the road. Reaching the out-of-pocket maximum can be a challenge, but with the right knowledge and tips, members can take advantage of their Northwind Health Plus plan and get the most out of their coverage.", "latency": 2.940711, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using information from the CONTEXT, demonstrating full groundedness.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY by listing the benefits of using in-network providers as per the Northwind Health Plus Benefits Details. It includes all essential details required for a comprehensive understanding, making it a complete response.", "answer_length": 641, "citations_matched": 0.0, "any_citation": true} +{"question": "How does the Northwind Health Plus plan address TMJ symptoms and what are the covered services for TMJ treatment?", "truth": "The Northwind Health Plus plan addresses TMJ symptoms by recommending various non-invasive methods such as avoiding chewing gum, large meals, extreme jaw movements, practicing relaxation techniques, and using heat and cold therapy to reduce pain and muscle tension. Additionally, the plan covers therapeutic injections, which are a type of procedure where drugs or other substances are injected directly into the body to treat medical conditions and provide relief from pain, including TMJ. [Northwind_Health_Plus_Benefits_Details.pdf#page=57] [Northwind_Standard_Benefits_Details.pdf#page=54]", "answer": "The Northwind Health Plus plan addresses TMJ symptoms by covering various treatments for Temporomandibular Joint Disorders (TMJ). The covered services include:\n\n1. **Diagnostic Tests**: Coverage for diagnostic tests such as X-rays, CT scans, MRI scans, and ultrasound when deemed medically necessary [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n2. **Medications**: Coverage for medications to relieve TMJ symptoms, including anti-inflammatory medications, muscle relaxants, and pain medications. In some cases, injections to relieve pain in the jaw joint may also be covered [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n3. **Physical Therapy**: Coverage for physical therapy, which may include stretching exercises, massage, and ultrasound treatments [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\n4. **Splints and Devices**: Coverage for splints and other devices that help reduce jaw pain and improve jaw movement [Northwind_Health_Plus_Benefits_Details.pdf#page=56].\n\nPlease note that Northwind Health Plus does not cover treatments considered experimental or cosmetic, such as facial surgery, Botox injections, and laser treatments [Northwind_Health_Plus_Benefits_Details.pdf#page=56].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=56: Temporomandibular Joint Disorders (TMJ) Care COVERED SERVICES: Temporomandibular Joint Disorders (TMJ) Care Temporomandibular joint (TMJ) disorders are a group of conditions that affect the jaw joint and the muscles that control the jaw's movement. It can be a debilitating condition that affects an individual's ability to talk, eat, and perform other daily activities. Northwind Health Plus covers treatments for TMJ disorders, including the cost of diagnostic tests, medications, and physical therapy. Diagnostic Tests Northwind Health Plus covers a variety of diagnostic tests that can help determine the cause of an individual's TMJ disorder. These tests may include X-rays, CT scans, MRI scans, and ultrasound. Northwind Health Plus will cover the cost of these tests when they are deemed medically necessary. Medications Northwind Health Plus will cover the cost of medications to help relieve the symptoms of TMJ disorders. These medications may include anti-inflammatory medications, muscle relaxants, and pain medications. In some cases, Northwind Health Plus may also cover the cost of injections to help relieve pain in the \n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=56: In some cases, Northwind Health Plus may also cover the cost of injections to help relieve pain in the jaw joint. Physical Therapy Northwind Health Plus will cover the cost of physical therapy to help relieve the symptoms of TMJ disorders. Physical therapy may include stretching exercises, massage, and ultrasound treatments. Northwind Health Plus will also cover the cost of splints and other devices that can help reduce jaw pain and improve jaw movement. Exceptions Northwind Health Plus does not cover the cost of any treatments or procedures that are considered experimental or cosmetic. This includes treatments such as facial surgery, Botox injections, and laser treatments. Tips To help manage the symptoms of TMJ disorders, Northwind Health Plus recommends the following tips:路 Practice good posture and body mechanics: Make sure you maintain good posture when sitting and standing, and avoid clenching your teeth or grinding them. 路 Avoid chewing gum: Chewing gum can cause your jaw muscles to become fatigued, which can worsen TMJ symptoms.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=57: 路 Avoid chewing gum: Chewing gum can cause your jaw muscles to become fatigued, which can worsen TMJ symptoms. . Avoid large meals: Eating large meals can put a strain on your jaw muscles, so try to avoid eating large meals or snacks. 路 Practice relaxation techniques: Relaxation techniques such as deep breathing and progressive muscle relaxation can help reduce jaw tension and relieve TMJ symptoms. 路 Use heat and cold therapy: Applying heat or cold to your jaw can help reduce pain and muscle tension. 路 Avoid extreme jaw movements: Avoid extreme jaw movements, such as widely opening your mouth or clenching your teeth. Therapeutic Injections COVERED SERVICES: Therapeutic Injections At Northwind Health, we understand the importance of having access to therapeutic injections that can help treat medical conditions and provide relief from pain. We are pleased to offer coverage for therapeutic injections as part of the Northwind Health Plus plan. Therapeutic injections are a type of procedure in which drugs or other substances are injected directly into the body to treat medical conditions and ", "latency": 6.133987, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully correct and complete, accurately listing the covered services for TMJ treatment as described in the CONTEXT and addressing the QUERY without introducing unrelated information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including all essential details required for a comprehensive understanding. It does not add extraneous information but provides a clear and direct answer to the question.", "answer_length": 1217, "citations_matched": 0.0, "any_citation": true} +{"question": "Considering the Northwind Health Plus Benefits Details, how does the coverage of virtual care services relate to the limitations on services like laboratory tests and mental health services?", "truth": "Northwind Health Plus covers the cost of virtual care services, including telemedicine, e-visits, and other virtual consultations with in-network providers, which can be used for diagnosing and treating minor medical conditions or following up on existing medical issues. However, there are limitations to these virtual care services as some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. Additionally, some services may require prior authorization. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=28]", "answer": "Northwind Health Plus covers virtual care services, allowing members to receive care from home for minor medical conditions and follow-ups. However, there are limitations; services such as laboratory tests, imaging studies, and mental health services may not be available via virtual care and may require in-person visits instead. Additionally, some services may require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=60].\n\nSimilarly, Northwind Standard covers virtual care but excludes services that require a physical exam or in-person care, such as lab work and surgeries [Northwind_Standard_Benefits_Details.pdf#page=57].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization. We encourage you to take advantage of virtual care services when appropriate. To make the most of your virtual care experience, be sure to: 路 Prepare for your visit: Make sure you have the necessary supplies and documents in advance, such as your insurance card, medical history, and any questions you may have.路 Follow up: If you need to follow up with your doctor, be sure to do so. Virtual care services are an excellent way to stay in touch with your provider. . Follow instructions: Make sure you follow any instructions given to you by your doctor during or after your virtual visit. 路 Contact us: If you have any questions or need help scheduling a virtual visit, please contact Northwind Health customer service. At Contoso, we understand that today's busy lifestyles can make it difficult to schedule and attend doctor's appointments. That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=57: With virtual care, members can talk to a doctor or nurse practitioner by phone or video call, receive a diagnosis and treatment, and get prescriptions sent to their pharmacy of choice. Northwind Standard covers virtual care services in the same way it would cover an in- person visit. This includes a variety of services, such as urgent care, primary care, mental health and substance abuse services, and specialist visits. Members also have access to telehealth post-discharge care and chronic disease management. Exceptions Although Northwind Standard covers most virtual care services, there are a few exceptions. Virtual care is not covered for any services that require a physical exam, such as pediatric well-child visits, physical therapy, and lab work. Additionally, virtual care is not covered for any services that require in-person care, such as surgeries and imaging tests. Tips for Members We want to make sure our members get the most out of their virtual care visits. Here are a few tips to help make your virtual care visits as successful as possible: - Make sure your doctor is in-network.", "latency": 2.785608, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The response accurately addresses the query by explaining the coverage and limitations of virtual care services under Northwind Health Plus, as described in the context. However, it includes extraneous information about Northwind Standard, which is not relevant to the specific query, making the response less focused.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, including additional insights about the comparison between different plans, which enhances understanding.", "answer_length": 647, "citations_matched": 0.5, "any_citation": true} +{"question": "How does Northwind Health Plus manage coinsurance for virtual care services according to the Northwind_Health_Plus_Benefits_Details.pdf?", "truth": "Northwind Health Plus covers the cost of virtual care services, which include telemedicine, e-visits, and other virtual consultations with in-network providers, potentially reducing out-of-pocket costs such as coinsurance for these services. However, it is important to note that some services may require prior authorization, and limitations may apply, such as certain services not being available via virtual care. [Northwind_Health_Plus_Benefits_Details.pdf#page=60] [Northwind_Health_Plus_Benefits_Details.pdf#page=14]", "answer": "Northwind Health Plus covers the cost of virtual care services, including telemedicine and e-visits, with in-network providers. By using these virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. However, there may be limitations on certain services, and some may require prior authorization [Northwind_Health_Plus_Benefits_Details.pdf#page=60].", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=60: With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location. Northwind Health Plus covers the cost of virtual care services, such as telemedicine, e-visits, and other virtual consultations with in-network providers. These services can be used to diagnose and treat minor medical conditions and can also be used to follow up on existing medical issues. If a virtual visit isn't appropriate, Northwind Health Plus covers the cost of an in-person visit. In addition to providing convenient access to care, Northwind Health Plus also offers cost savings benefits. By using virtual care services, you can avoid paying for office visits and other out-of-pocket costs associated with seeing a doctor in person. Before scheduling a virtual visit, it's important to note that there may be some limitations. For instance, some services, such as laboratory tests, imaging studies, and mental health services, may not be available via virtual care. It's also important to note that some services may require prior authorization.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=60: Have your insurance card on hand: Bring your insurance card with you to the visit, as you may need to provide it to the facility. . Bring your medical records: If you have any relevant medical records, bring them with you to the facility. This will help the provider make a more informed diagnosis. 路 Know when to go to the emergency room: If you are experiencing a medical emergency, call 911 or go to the nearest emergency room for treatment. We understand that receiving urgent care can be a stressful situation. At Northwind Health Plus, we strive to make the process as easy and stress-free as possible. If you have any questions about your coverage, please reach out to us so we can help. Virtual Care COVERED SERVICES: Virtual Care At Contoso, we understand that taking time off to go to the doctor's office isn't always possible. That's why we've partnered with Northwind Health to provide access to virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home, office, or other location.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=61: That's why we're proud to offer Northwind Health Plus, which provides access to convenient and cost-saving virtual care services. With Northwind Health Plus, you can get the care you need from the comfort of your own home. Weight Management WEIGHT MANAGEMENT - COVERED SERVICES Weight management is an important part of overall health and wellness, and Northwind Health Plus recognizes this. As part of your health plan, you have access to a variety of coverage options for weight management. Coverage for Weight Loss Programs Northwind Health Plus offers coverage for medically supervised weight loss programs. These programs are designed to help you reach and maintain a healthy weight. Covered services may include nutrition counseling, medical evaluation and follow-up, and laboratory tests. Your plan may also cover the cost of medications prescribed by your doctor as part of your weight loss program. Coverage for Weight Loss Surgery Northwind Health Plus also offers coverage for weight loss surgery. Weight loss surgery is a serious procedure that can help some people achieve major health benefits.", "latency": 2.557069, "groundedness": 2.0, "gpt_groundedness": 2.0, "groundedness_reason": "The response is related to the topic of virtual care services but does not directly address the specific query about coinsurance management, making it a related topic but not a direct answer.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE is incomplete because it does not address the specific aspect of coinsurance management for virtual care services, which is the main focus of the QUERY.", "answer_length": 427, "citations_matched": 0.5, "any_citation": true} +{"question": "What are the financial responsibilities of a Northwind Standard plan holder when using out-of-network providers according to the Northwind_Standard_Benefits_Details.pdf?", "truth": "According to the Northwind_Standard_Benefits_Details.pdf, when a Northwind Standard plan holder uses out-of-network providers, they may be responsible for the entire cost of services or a far greater portion of the cost than they would with an in-network provider. Although Northwind Standard may offer coverage for some out-of-network providers, the costs associated with these providers can be significantly more expensive. [Northwind_Standard_Benefits_Details.pdf#page=10] [Northwind_Standard_Benefits_Details.pdf#page=99]", "answer": "According to the Northwind Standard Benefits Details, when using out-of-network providers, a plan holder may face the following financial responsibilities:\n\n1. Coverage for out-of-network providers is offered, but costs can be significantly higher than for in-network providers. You may be responsible for the entire cost of services or a much larger portion than with in-network providers [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n2. Some services provided by out-of-network providers may not be covered by the Northwind Standard plan, leading to out-of-pocket expenses for those services [Northwind_Standard_Benefits_Details.pdf#page=10].\n\n3. If you receive care from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay [Northwind_Health_Plus_Benefits_Details.pdf#page=27].\n\n4. Out-of-network services may not count towards your deductible or out-of-pocket maximum, meaning you could be responsible for the entire cost of the services, minus any applicable discounts [Northwind_Health_Plus_Benefits_Details.pdf#page=8].\n\n5. You may also be subject to balance billing, where the provider bills you for the difference between their charges and what Northwind pays [Northwind_Health_Plus_Benefits_Details.pdf#page=8].", "context": "Northwind_Standard_Benefits_Details.pdf#page=10: When selecting an in-network provider, you will likely only have to pay a portion of the cost for services, often referred to as a \"co-pay\" or \"co-insurance\". It's important to note that different types of services may require different co-pays or co-insurance, so it's best to contact your provider to understand what the cost will be. Out-of-Network Providers Northwind Standard offers coverage for some out-of-network providers, but the costs associated with these providers can be significantly more expensive than in-network providers. If you choose an out-of-network provider, you may be responsible for the entire cost of services, or a far greater portion of the cost than you would with an in-network provider. In some cases, Northwind Standard may offer coverage for out-of-network providers, but you may still have to pay more than you would for an in-network provider. Exceptions Some providers may offer services that are outside of the Northwind Standard plan coverage. Depending on the services provided, you may have to pay out-of-pocket for services that are not covered.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=27: If you receive services from an out-of-network provider, you may also be responsible for paying the difference between the amount billed by the provider and the amount the plan will pay. ExceptionsNorthwind Health Plus does not cover certain types of emergency services. These include services for certain social and cosmetic procedures, elective surgery, experimental treatments, and services for injuries or illnesses that are not medically necessary. Tips for Employees It is important to keep in mind that if you have an emergency, you should seek care from the nearest hospital or medical facility. Regardless of whether it is in-network or out-of- network, you will be covered. It is also important to remember that if you receive care from an out-of-network provider, you may be responsible for higher out-of-pocket costs. It is also important to be aware of the exceptions to Northwind Health Plus' coverage of emergency services. Certain services, such as those for elective surgery and experimental treatments, are not covered. Lastly, it is important to keep your Northwind Health Plus ID card with you at all times.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=8: Generally, out-of-network providers are not required to accept the same reimbursement rates as contracted providers, so the cost of care could be significantly higher. It is also important to know that services received from an out-of-network provider may not count towards your deductible or be applied to your out-of-pocket maximum. This means that you may be responsible for paying the entire cost of the services, minus any applicable discounts. It is important to keep in mind that you may also be subject to balance billing from an out-of-network provider. Balance billing occurs when the provider bills you for the difference between their billed charges and the amount paid by Northwind Health Plus. In some cases, you may be able to receive care from an out-of-network provider if there is not an in-network option available. In these cases, Northwind Health Plus will cover the same amount as if the care was provided by an in-network provider. When considering care from an out-of-network provider, it is important to understand the potential risks of doing so.", "latency": 3.670049, "groundedness": 3.0, "gpt_groundedness": 3.0, "groundedness_reason": "The RESPONSE attempts to address the QUERY but includes incorrect information from a different plan, which is not supported by the CONTEXT.", "relevance": 2.0, "gpt_relevance": 2.0, "relevance_reason": "The RESPONSE attempts to address the QUERY but includes information from a different plan document, leading to incorrect information regarding the specific plan asked about.", "answer_length": 1331, "citations_matched": 0.5, "any_citation": true} +{"question": "How does the clinical review process in the Northwind Standard Benefits Details ensure timely and cost-effective medical service provision, and what are the documentation requirements for filing a claim as outlined in the same document?", "truth": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by requiring pre-authorization for some medical services and by designing the process to ensure that medically necessary treatments are provided efficiently. Members are advised to provide accurate and detailed information about their medical needs, including a complete list of current medications and all relevant medical history, along with any necessary documentation like test results or lab reports. For filing a claim, the necessary documentation includes itemized bills, a completed claim form, and any other documentation requested by Northwind Health. This process helps in ensuring that members receive high-quality, cost-effective care. [Northwind_Standard_Benefits_Details.pdf#page=78] [Northwind_Standard_Benefits_Details.pdf#page=68]", "answer": "The clinical review process in the Northwind Standard Benefits Details ensures timely and cost-effective medical service provision by evaluating the medical necessity and appropriateness of proposed treatments. This process is conducted by licensed clinicians using evidence-based guidelines. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, to facilitate a smooth review process [Northwind_Standard_Benefits_Details.pdf#page=68][Northwind_Standard_Benefits_Details.pdf#page=67].\n\nFor filing a claim, all claims must be submitted within twelve months of the date of service to ensure timely processing. Claims submitted after this period may be reviewed for payment consideration but are not guaranteed acceptance. Members can file claims directly through the Northwind website or app, and if filing on behalf of a family member, authorization is required. Additionally, some services may require pre-approval from Northwind Health [Northwind_Standard_Benefits_Details.pdf#page=78].", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=78: By taking the time to review your policy and make sure that you have the right coverage, you can be sure that you have the protection you need. HOW DO I FILE A CLAIM? Timely Filing HOW DO I FILE A CLAIM? Timely Filing At Northwind Health, timely filing is important to ensure that your claims are processed correctly and in a timely manner. All claims must be filed within twelve months of the date of service, otherwise the claims may be denied. Claims submitted after the twelve month window may be reviewed for consideration of payment, however, no guarantee is made that the claims will be accepted. If you are a Northwind Standard member, you may be able to file a claim directly through the Northwind website or app. If you're filing a claim on behalf of a family member, make sure that you have their authorization to do so. It's important to also keep in mind that some services are subject to pre-approval from Northwind Health, and your provider may need to submit a request prior to the service being performed. This includes services such as MRI/CT scans, physical therapy, and other specialty services.\n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed ", "latency": 5.440316, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE accurately and completely addresses the QUERY using relevant details from the CONTEXT, demonstrating a thorough understanding without introducing unrelated information.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses both aspects of the QUERY with accurate and complete information, making it a complete response.", "answer_length": 1107, "citations_matched": 1.0, "any_citation": true} +{"question": "What is the process for ensuring cost-effective care under the Northwind Standard plan?", "truth": "The process for ensuring cost-effective care under the Northwind Standard plan involves a clinical review process that requires pre-authorization for some medical services. This process is designed to ensure that medically necessary treatments are provided in a timely and cost-effective manner. Members are encouraged to provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, along with any necessary documentation like test results or lab reports. This helps to ensure that the clinical review process runs smoothly and quickly. [Northwind_Standard_Benefits_Details.pdf#page=68] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To ensure cost-effective care under the Northwind Standard plan, members should follow these processes:\n\n1. **Pre-authorization**: Some medical services may require pre-authorization. Members should provide accurate and detailed information about their medical needs, including a complete list of current medications and relevant medical history, to facilitate the clinical review process [Northwind_Standard_Benefits_Details.pdf#page=68].\n\n2. **Clinical Review**: The plan includes a clinical review process conducted by licensed clinicians in Northwind Health's Medical Management Department. This process evaluates the medical necessity and appropriateness of proposed treatments using evidence-based guidelines [Northwind_Standard_Benefits_Details.pdf#page=67].\n\n3. **Care Management Services**: Members can utilize various care management services offered by the plan to ensure quality and cost-effective care [Northwind_Standard_Benefits_Details.pdf#page=67].\n\n4. **Cost Management Tips**: Members are encouraged to take advantage of preventive care services (covered 100%), visit in-network providers, consider generic prescription drugs, discuss cost-effective treatment options with their doctors, and carefully review their Explanation of Benefits (EOB) statements [Northwind_Standard_Benefits_Details.pdf#page=4].\n\nBy following these steps, members can help ensure they receive high-quality, cost-effective care under the Northwind Standard plan.", "context": "Northwind_Standard_Benefits_Details.pdf#page=68: Members should be aware that some medical services may require pre- authorization before they can be approved, and that the clinical review process may take some time. Additionally, members should keep in mind that the clinical review process is designed to ensure that medically necessary treatments are provided in a timely and cost- effective manner. To help ensure that the clinical review process runs smoothly and quickly, members should provide accurate and detailed information about their medical needs when requesting treatment. This includes a complete list of their current medications, as well as all relevant medical history. Additionally, members should provide any necessary documentation that may be required, such as test results or lab reports. Finally, members should make sure that they understand the process and any exceptions that may apply. Overall, the clinical review process is an important component of the Northwind Standard plan, and it helps to ensure that members receive high-quality, cost-effective care. The process is designed to be straightforward and efficient, and the exceptions that are available \n\nNorthwind_Standard_Benefits_Details.pdf#page=67: We're here to help you get the care you need, and we're here to help you understand the process of prior authorization. Clinical Review CARE MANAGEMENT: Clinical Review The Northwind Standard plan offers a variety of care management services to help ensure that members receive quality, cost-effective care. These services include clinical review, which is a process that evaluates the medical necessity and appropriateness of a proposed course of treatment, as well as any adjustment or changes to existing treatments. Clinical review is conducted by Northwind Health's Medical Management Department, which is staffed by licensed clinicians who are experienced in the various medical conditions and treatments that are covered by the Northwind Standard plan. These clinicians use evidence-based guidelines and other important criteria to evaluate the proposed course of treatment and make sure that it is medically necessary and appropriate.Northwind Health utilizes a three-level clinical review process. The first level of review involves a Registered Nurse (RN) or Medical Doctor (MD) evaluating the proposed \n\nNorthwind_Standard_Benefits_Details.pdf#page=4: Tips for Managing Your Costs There are several steps that you can take to help manage your costs when you are enrolled in Northwind Standard. Here are a few tips that you can use to get the most out of your coverage: 路 Make sure to take advantage of preventive care services. These services are covered 100% by the plan and can help you avoid more costly treatments down the line. 路 Always make sure to visit in-network providers. Doing so will ensure that you receive the maximum benefit from your plan. 路 Consider generic prescription drugs when available. These drugs can often be cheaper than brand-name drugs and are just as effective. . Talk to your doctor about ways to save money. Many doctors are willing to work with you to find the most cost-effective treatment options available. 路 Review your Explanation of Benefits (EOB) statements carefully. This document will show you exactly how much you are being charged for each service and what your plan is covering. By following these tips, you can ensure that you are getting the most out of your Northwind Standard health plan.", "latency": 4.161841, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, accurately and completely addressing the QUERY with all relevant details provided in the CONTEXT.", "relevance": 4.0, "gpt_relevance": 4.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, detailing the processes involved in ensuring cost-effective care under the Northwind Standard plan.", "answer_length": 1457, "citations_matched": 0.5, "any_citation": true} +{"question": "Considering the information provided in the Northwind Health Plus Benefits Details, how can a policyholder effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers?", "truth": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, a policyholder should use an in-network provider within the Northwind Health Plus network. This is crucial as in-network providers have agreed to charge lower rates for their services, which can help save money on out-of-pocket costs. Additionally, the policyholder needs to provide the other employer plan's information to coordinate benefits. It is also important to understand the plan's rules for coordinating benefits and to inquire about the cost of services before receiving them to ensure benefits are coordinated correctly and cost-effectively. [Northwind_Health_Plus_Benefits_Details.pdf#page=77] [Northwind_Health_Plus_Benefits_Details.pdf#page=4]", "answer": "To effectively manage out-of-pocket costs while coordinating benefits with another employer plan, especially when using in-network providers, a policyholder can follow these strategies:\n\n1. Use in-network providers: This will lower out-of-pocket costs since Northwind Health has negotiated discounted rates with in-network providers. In-network services typically have lower coinsurance rates as well [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n2. Understand the out-of-pocket maximum: The Northwind Health Plus plan has an out-of-pocket maximum of $4,000 per year. Once this limit is reached, no further out-of-pocket costs are required for covered services for the remainder of the plan year [Northwind_Health_Plus_Benefits_Details.pdf#page=108].\n\n3. Get cost estimates: Ask your provider for an estimate of the cost of a service before receiving it. This can help you plan and understand your potential out-of-pocket expenses [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n4. Keep track of expenses: Monitor the services received and the amounts paid to better understand how much has been paid towards coinsurance requirements for the year [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\n5. Contact the plan administrator: If there are any questions about coinsurance requirements or services subject to coinsurance, reach out to the plan administrator for clarification [Northwind_Health_Plus_Benefits_Details.pdf#page=14].\n\nBy following these steps, a policyholder can better manage their out-of-pocket costs while coordinating benefits with another employer plan.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=14: Many plans offer lower coinsurance rates for in-network providers, meaning you will pay less for the same service. 3. Ask your provider for an estimate of the cost of a service before you receive it. This will help you determine how much of the cost you will be responsible for. 4. Keep track of the services you receive and the amount you pay. This will help you understand how much you have paid towards your coinsurance requirement for the year. 5. Contact your plan administrator if you have any questions about your coinsurance requirement or what services are subject to coinsurance. Out-Of-Pocket Maximum IMPORTANT PLAN INFORMATION: Out-Of-Pocket Maximum Under the Northwind Health Plus plan, members are responsible for costs associated with their health care. These costs can include deductibles, copays, coinsurance, and other out of pocket expenses. To help members manage health care costs, the Northwind Health Plus plan offers a maximum out-of-pocket (OOP) limit. Once a member has reached the OOP limit, they pay no more out-of-pocket costs for the rest of the plan year.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=108: Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year. This amount includes the deductible, coinsurance, and copayments. Northwind Health Plus has an out-of-pocket maximum of $4,000 per year. In-Network Provider: An in-network provider is a health care provider or facility that is contracted with the insurance company. Employees who use an in-network provider will have lower copayments and coinsurance amounts than those who use an out-of-network provider. Out-of-Network Provider: An out-of-network provider is a health care provider or facility that is not contracted with the insurance company. Employees who use an out-of-network provider will have higher copayments and coinsurance amounts than those who use an in- network provider. Exceptions Northwind Health Plus does have some exceptions to the rules regarding copayments, deductibles, coinsurance, and out-of-pocket maximums. Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance.", "latency": 12.222494, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE is mostly correct and relevant to the CONTEXT, but it is incomplete because it does not address the aspect of coordinating benefits with another employer plan, which is a key part of the QUERY.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The RESPONSE fully addresses the QUERY with accurate and complete information, providing actionable strategies and additional insights that enhance understanding. It is comprehensive and directly relevant to the question asked.", "answer_length": 1647, "citations_matched": 0.0, "any_citation": true} +{"question": "Considering the Northwind Health Plus benefits, how does choosing an in-network provider affect the out-of-pocket costs for a policyholder, and what are the covered services under hospice care according to the plan?", "truth": "Choosing an in-network provider under the Northwind Health Plus plan significantly affects the out-of-pocket costs for a policyholder by reducing them. When a policyholder uses in-network providers, they pay lower out-of-pocket costs compared to using out-of-network providers, where they would be responsible for a larger portion of the cost. Regarding hospice care, the Northwind Health Plus coverage includes care from a hospice team, medications, medical supplies, equipment for treating the terminal illness, counseling for the member and their family, inpatient and respite care, grief counseling, and bereavement services. However, it does not cover services intended to cure the terminal illness, such as chemotherapy, radiation therapy, and surgery. [Northwind_Health_Plus_Benefits_Details.pdf#page=9] [Northwind_Health_Plus_Benefits_Details.pdf#page=33]", "answer": "Choosing an in-network provider will result in lower out-of-pocket costs for a policyholder, as Northwind Health has negotiated discounted rates with these providers. In contrast, using an out-of-network provider may lead to higher copayments, coinsurance amounts, and potentially the full cost of services being the responsibility of the policyholder [Northwind_Health_Plus_Benefits_Details.pdf#page=3][Northwind_Health_Plus_Benefits_Details.pdf#page=6].\n\nRegarding hospice care, the specific covered services under hospice care are not detailed in the provided sources, so I don't know.", "context": "Northwind_Health_Plus_Benefits_Details.pdf#page=108: Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount of money that an employee has to pay for covered services in a plan year. This amount includes the deductible, coinsurance, and copayments. Northwind Health Plus has an out-of-pocket maximum of $4,000 per year. In-Network Provider: An in-network provider is a health care provider or facility that is contracted with the insurance company. Employees who use an in-network provider will have lower copayments and coinsurance amounts than those who use an out-of-network provider. Out-of-Network Provider: An out-of-network provider is a health care provider or facility that is not contracted with the insurance company. Employees who use an out-of-network provider will have higher copayments and coinsurance amounts than those who use an in- network provider. Exceptions Northwind Health Plus does have some exceptions to the rules regarding copayments, deductibles, coinsurance, and out-of-pocket maximums. Preventive Care: Preventive care services such as annual physicals and vaccinations are covered at 100% with no copayment, deductible, or coinsurance.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=3: In-Network Costs: If you use an in-network provider, your out-of-pocket costs will be lower than if you use an out-of-network provider. This is because Northwind Health has negotiated discounted rates with in-network providers. Out-of-Network Costs: If you use an out-of-network provider, you may be responsible for paying the full cost of the services you receive. Additionally, you may have to pay a higher deductible and coinsurance. Prescription Drug Costs: Prescription drug costs are also taken into consideration with Northwind Health Plus. Your out-of-pocket costs will depend on the tier of the medication you are prescribed. Generally, brand-name and non-preferred generic medications will have higher out-of-pocket costs than preferred generic and generic medications. Mental Health and Substance Abuse Coverage: Northwind Health Plus also provides coverage for mental health and substance abuse services. Generally, coverage for mental health and substance abuse services will be the same as coverage for medical and surgical services. Preventive Care Services: Northwind Health Plus also covers preventive care services such as immunizations and screenings.\n\nNorthwind_Health_Plus_Benefits_Details.pdf#page=6: With Northwind Health Plus, you have the option to choose from a variety of in- network providers. However, if you choose to go outside of the network, you may incur additional costs. Non-Participating Providers Non-participating providers are providers that are not in-network with Northwind Health Plus. When you visit a provider that is not in-network, you will be responsible for the entire cost of the care. This means that, if you choose to visit a provider who is not in-network, you will have to pay the entire cost of the service out-of-pocket.Exceptions There are some exceptions to this rule. If you are traveling outside of the United States and you cannot find an in-network provider, you may be able to visit a non-participating provider and Northwind Health Plus may cover a portion of the cost. Additionally, if you are in a life-threatening situation and need to go to the nearest hospital, Northwind Health Plus may provide coverage for the care received. Tips If you are considering visiting a provider that is not in-network, it is important to check with Northwind Health Plus ", "latency": 3.376917, "groundedness": 4.0, "gpt_groundedness": 4.0, "groundedness_reason": "The RESPONSE accurately addresses the effect of choosing an in-network provider on out-of-pocket costs, which is grounded in the CONTEXT. However, it does not provide information on hospice care services, as these details are not present in the CONTEXT. The RESPONSE is complete for the first part of the QUERY but incomplete for the second part due to the absence of relevant information in the CONTEXT.", "relevance": 3.0, "gpt_relevance": 3.0, "relevance_reason": "The RESPONSE provides a complete answer to the first part of the QUERY regarding in-network providers but fails to provide any details for the second part about hospice care services, making it incomplete overall.", "answer_length": 588, "citations_matched": 0.0, "any_citation": true} +{"question": "What is the process for getting a service covered under Northwind Standard Benefits Details?", "truth": "To get a service covered under Northwind Standard Benefits Details, prior authorization must be requested from Northwind Health either by the provider or the member before the service is received. If prior authorization is not obtained, Northwind Health may not cover the service. Certain services such as preventive care, emergency care, outpatient hospital services, urgent care, and services in a skilled nursing facility are exempt from this prior authorization process. [Northwind_Standard_Benefits_Details.pdf#page=60] [Northwind_Standard_Benefits_Details.pdf#page=44]", "answer": "To get a service covered under the Northwind Standard Benefits, follow these steps:\n\n1. Ask your healthcare provider for a detailed explanation of the services and treatments, including the medical necessity.\n2. Ensure all documentation is complete, including required forms, test results, and physician's notes.\n3. Send the documentation to Northwind Health as soon as possible.\n4. Follow up with Northwind Health to confirm that your claim has been received and is being processed.\n\nAdditionally, make sure to understand the details of the plan and associated out-of-pocket costs before receiving a service, select in-network providers to maximize coverage, and submit claims promptly after services are rendered. If you have other coverage, inform your provider to ensure proper billing [Northwind_Standard_Benefits_Details.pdf#page=88][Northwind_Standard_Benefits_Details.pdf#page=73][Northwind_Standard_Benefits_Details.pdf#page=17].", "context": "Northwind_Standard_Benefits_Details.pdf#page=88: that require evidence of medical necessity, there are a few steps you can take to ensure that your claim is processed quickly and accurately:路 Ask your healthcare provider to provide you with a detailed explanation of the services and treatments you are receiving, as well as the medical necessity for them. . Make sure that all documentation is complete, including all required forms, test results, and physician's notes. . Send the documentation to Northwind Health as soon as possible. 路 Follow up with Northwind Health to ensure that your claim has been received and is being processed. By following these steps and providing any necessary evidence of medical necessity, you can help to ensure that your claim is processed quickly and accurately. The Group And You OTHER INFORMATION ABOUT THIS PLAN The Group and You The Northwind Standard plan is a group plan, meaning that it is offered to a group of people and not to individuals. The group includes all eligible employees of Contoso and their spouses or dependents. It is important to understand that the plan may not cover all or part of the cost of services received by those who are not considered eligible members of the group.\n\nNorthwind_Standard_Benefits_Details.pdf#page=73: health plans, the health plan that pays first is determined by the order of benefit determination. Generally, the employee's primary health plan paysfirst, followed by the secondary health plan. However, if one of the health plans is a Medicare or Medicaid plan, that plan pays first. Under the Northwind Standard Plan, if you have other coverage, you may be able to use the network providers and services that are covered by Northwind Standard at a lower cost. However, the cost of services obtained from providers that are not in the Northwind Standard network will not be covered by the plan. When you receive health care services, it's important to identify all of your coverage to the provider to ensure that they bill each health plan appropriately. This helps to ensure that you receive the full benefits offered by each plan. If you do not identify all of your health coverage, it may result in a delay of payment or denial of coverage. When you submit a claim to Northwind Standard, you'll need to include information about the other coverage you have. If the claim is sent to Northwind Standard before any other plan, the claim will be processed based on the Northwind Standard plan \n\nNorthwind_Standard_Benefits_Details.pdf#page=17: Make sure to understand the details of the plan and the associated out-of-pocket costs before receiving a service. 路 Select in-network providers to maximize coverage and avoid unexpected costs. 路 Submit claims as soon as possible after a service is rendered. 路 Track claims and follow up with Northwind Health if a claim is not processed in a timely manner. 路 Take advantage of preventive services to stay healthy and reduce future costs. . Ask questions and contact Northwind Health if you need assistance understanding your coverage or filing a claim. By understanding the details of the Northwind Standard plan and following the tips above, employees can ensure that they are taking full advantage of their benefits. Taking the timeto understand the plan and ask questions can help employees to make the most of their coverage and stay healthy. COVERED SERVICES Acupuncture COVERED SERVICES: Acupuncture At Contoso, we are proud to offer employees Northwind Standard, an insurance plan that includes coverage for acupuncture.", "latency": 4.756371, "groundedness": 5.0, "gpt_groundedness": 5.0, "groundedness_reason": "The RESPONSE is fully grounded in the CONTEXT, providing a complete and accurate answer to the QUERY by including all relevant steps and additional advice mentioned in the CONTEXT.", "relevance": 5.0, "gpt_relevance": 5.0, "relevance_reason": "The response fully addresses the query with accurate and complete information, and it also includes additional relevant insights, making it comprehensive.", "answer_length": 938, "citations_matched": 0.0, "any_citation": true} diff --git a/evals/results/gpt4omini-emb3l/evaluate_parameters.json b/evals/results/gpt4omini-emb3l/evaluate_parameters.json new file mode 100644 index 0000000000..c2caefdb12 --- /dev/null +++ b/evals/results/gpt4omini-emb3l/evaluate_parameters.json @@ -0,0 +1,27 @@ +{ + "evaluation_gpt_model": "gpt-4o", + "evaluation_timestamp": 1746818372, + "testdata_path": "/Users/pamelafox/azure-search-openai-demo/evals/ground_truth.jsonl", + "target_url": "http://localhost:50505/chat", + "target_parameters": { + "overrides": { + "top": 3, + "temperature": 0.3, + "minimum_reranker_score": 0, + "minimum_search_score": 0, + "retrieval_mode": "hybrid", + "semantic_ranker": true, + "semantic_captions": false, + "suggest_followup_questions": false, + "use_oid_security_filter": false, + "use_groups_security_filter": false, + "vector_fields": [ + "embedding" + ], + "use_gpt4v": false, + "gpt4v_input": "textAndImages", + "seed": 1 + } + }, + "num_questions": null +} diff --git a/evals/results/gpt4omini-emb3l/summary.json b/evals/results/gpt4omini-emb3l/summary.json new file mode 100644 index 0000000000..ed12752813 --- /dev/null +++ b/evals/results/gpt4omini-emb3l/summary.json @@ -0,0 +1,33 @@ +{ + "gpt_groundedness": { + "pass_count": 43, + "pass_rate": 0.86, + "mean_rating": 4.5 + }, + "gpt_relevance": { + "pass_count": 42, + "pass_rate": 0.84, + "mean_rating": 4.22 + }, + "answer_length": { + "mean": 919.26, + "max": 1647, + "min": 193 + }, + "latency": { + "mean": 4.46, + "max": 15.129978, + "min": 2.465542 + }, + "citations_matched": { + "total": 24, + "rate": 0.49 + }, + "any_citation": { + "total": 50, + "rate": 1.0 + }, + "num_questions": { + "total": 50 + } +} diff --git a/infra/core/host/container-apps.bicep b/infra/core/host/container-apps.bicep index f48a6b3610..0428571215 100644 --- a/infra/core/host/container-apps.bicep +++ b/infra/core/host/container-apps.bicep @@ -61,9 +61,7 @@ module containerAppsEnvironment 'br/public:avm/res/app/managed-environment:0.8.0 module containerRegistry 'br/public:avm/res/container-registry/registry:0.5.1' = { name: '${name}-container-registry' - scope: !empty(containerRegistryResourceGroupName) - ? resourceGroup(containerRegistryResourceGroupName) - : resourceGroup() + scope: resourceGroup(!empty(containerRegistryResourceGroupName) ? containerRegistryResourceGroupName : resourceGroup().name) params: { name: containerRegistryName location: location diff --git a/infra/main.bicep b/infra/main.bicep index 2d9340e14b..da31b2b385 100644 --- a/infra/main.bicep +++ b/infra/main.bicep @@ -150,10 +150,10 @@ param chatGptDeploymentSkuName string = '' param chatGptDeploymentCapacity int = 0 var chatGpt = { - modelName: !empty(chatGptModelName) ? chatGptModelName : 'gpt-4o-mini' - deploymentName: !empty(chatGptDeploymentName) ? chatGptDeploymentName : 'chat' - deploymentVersion: !empty(chatGptDeploymentVersion) ? chatGptDeploymentVersion : '2024-07-18' - deploymentSkuName: !empty(chatGptDeploymentSkuName) ? chatGptDeploymentSkuName : 'GlobalStandard' // Not backward-compatible + modelName: !empty(chatGptModelName) ? chatGptModelName : 'gpt-4.1-mini' + deploymentName: !empty(chatGptDeploymentName) ? chatGptDeploymentName : 'gpt-4.1-mini' + deploymentVersion: !empty(chatGptDeploymentVersion) ? chatGptDeploymentVersion : '2025-04-14' + deploymentSkuName: !empty(chatGptDeploymentSkuName) ? chatGptDeploymentSkuName : 'GlobalStandard' deploymentCapacity: chatGptDeploymentCapacity != 0 ? chatGptDeploymentCapacity : 30 } @@ -204,9 +204,9 @@ param searchAgentModelVersion string = '' param searchAgentDeploymentSkuName string = '' param searchAgentDeploymentCapacity int = 0 var searchAgent = { - modelName: !empty(searchAgentModelName) ? searchAgentModelName : 'gpt-4o' + modelName: !empty(searchAgentModelName) ? searchAgentModelName : 'gpt-4.1-mini' deploymentName: !empty(searchAgentDeploymentName) ? searchAgentDeploymentName : 'searchagent' - deploymentVersion: !empty(searchAgentModelVersion) ? searchAgentModelVersion : '2024-08-06' + deploymentVersion: !empty(searchAgentModelVersion) ? searchAgentModelVersion : '2025-04-14' deploymentSkuName: !empty(searchAgentDeploymentSkuName) ? searchAgentDeploymentSkuName : 'GlobalStandard' deploymentCapacity: searchAgentDeploymentCapacity != 0 ? searchAgentDeploymentCapacity : 30 } diff --git a/tests/conftest.py b/tests/conftest.py index ebe32b3486..2405dad8e9 100644 --- a/tests/conftest.py +++ b/tests/conftest.py @@ -126,7 +126,7 @@ def mock_openai_chatcompletion(monkeypatch): class AsyncChatCompletionIterator: def __init__(self, answer: str, reasoning: bool, usage: dict[str, Any]): chunk_id = "test-id" - model = "gpt-4o-mini" if not reasoning else "o3-mini" + model = "gpt-4.1-mini" if not reasoning else "o3-mini" self.responses = [ {"object": "chat.completion.chunk", "choices": [], "id": chunk_id, "model": model, "created": 1}, { @@ -373,11 +373,11 @@ def mock_blob_container_client(monkeypatch): { "OPENAI_HOST": "azure", "AZURE_OPENAI_SERVICE": "test-openai-service", - "AZURE_OPENAI_CHATGPT_MODEL": "gpt-4o-mini", - "AZURE_OPENAI_CHATGPT_DEPLOYMENT": "gpt-4o-mini", + "AZURE_OPENAI_CHATGPT_MODEL": "gpt-4.1-mini", + "AZURE_OPENAI_CHATGPT_DEPLOYMENT": "gpt-4.1-mini", "AZURE_OPENAI_EMB_DEPLOYMENT": "test-ada", - "AZURE_OPENAI_SEARCHAGENT_MODEL": "gpt-4o-mini", - "AZURE_OPENAI_SEARCHAGENT_DEPLOYMENT": "gpt-4o-mini", + "AZURE_OPENAI_SEARCHAGENT_MODEL": "gpt-4.1-mini", + "AZURE_OPENAI_SEARCHAGENT_DEPLOYMENT": "gpt-4.1-mini", "USE_AGENTIC_RETRIEVAL": "true", } ] @@ -386,11 +386,11 @@ def mock_blob_container_client(monkeypatch): { "OPENAI_HOST": "azure", "AZURE_OPENAI_SERVICE": "test-openai-service", - "AZURE_OPENAI_CHATGPT_MODEL": "gpt-4o-mini", - "AZURE_OPENAI_CHATGPT_DEPLOYMENT": "gpt-4o-mini", + "AZURE_OPENAI_CHATGPT_MODEL": "gpt-4.1-mini", + "AZURE_OPENAI_CHATGPT_DEPLOYMENT": "gpt-4.1-mini", "AZURE_OPENAI_EMB_DEPLOYMENT": "test-ada", - "AZURE_OPENAI_SEARCHAGENT_MODEL": "gpt-4o-mini", - "AZURE_OPENAI_SEARCHAGENT_DEPLOYMENT": "gpt-4o-mini", + "AZURE_OPENAI_SEARCHAGENT_MODEL": "gpt-4.1-mini", + "AZURE_OPENAI_SEARCHAGENT_DEPLOYMENT": "gpt-4.1-mini", "USE_AGENTIC_RETRIEVAL": "true", "AZURE_USE_AUTHENTICATION": "true", "AZURE_SERVER_APP_ID": "SERVER_APP", @@ -415,7 +415,7 @@ def mock_env(monkeypatch, request): monkeypatch.setenv("AZURE_SEARCH_SERVICE", "test-search-service") monkeypatch.setenv("AZURE_SPEECH_SERVICE_ID", "test-id") monkeypatch.setenv("AZURE_SPEECH_SERVICE_LOCATION", "eastus") - monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4o-mini") + monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4.1-mini") monkeypatch.setenv("ALLOWED_ORIGIN", "https://frontend.com") for key, value in request.param.items(): monkeypatch.setenv(key, value) @@ -618,7 +618,7 @@ async def auth_client( monkeypatch.setenv("AZURE_STORAGE_CONTAINER", "test-storage-container") monkeypatch.setenv("AZURE_SEARCH_INDEX", "test-search-index") monkeypatch.setenv("AZURE_SEARCH_SERVICE", "test-search-service") - monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4o-mini") + monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4.1-mini") monkeypatch.setenv("USE_USER_UPLOAD", "true") monkeypatch.setenv("AZURE_USERSTORAGE_ACCOUNT", "test-userstorage-account") monkeypatch.setenv("AZURE_USERSTORAGE_CONTAINER", "test-userstorage-container") @@ -657,7 +657,7 @@ async def auth_public_documents_client( monkeypatch.setenv("AZURE_STORAGE_CONTAINER", "test-storage-container") monkeypatch.setenv("AZURE_SEARCH_INDEX", "test-search-index") monkeypatch.setenv("AZURE_SEARCH_SERVICE", "test-search-service") - monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4o-mini") + monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4.1-mini") monkeypatch.setenv("USE_USER_UPLOAD", "true") monkeypatch.setenv("AZURE_USERSTORAGE_ACCOUNT", "test-userstorage-account") monkeypatch.setenv("AZURE_USERSTORAGE_CONTAINER", "test-userstorage-container") diff --git a/tests/e2e.py b/tests/e2e.py index 00e30c4375..adb5805e07 100644 --- a/tests/e2e.py +++ b/tests/e2e.py @@ -56,7 +56,7 @@ def run_server(port: int): "AZURE_SPEECH_SERVICE_ID": "test-id", "AZURE_SPEECH_SERVICE_LOCATION": "eastus", "AZURE_OPENAI_SERVICE": "test-openai-service", - "AZURE_OPENAI_CHATGPT_MODEL": "gpt-4o-mini", + "AZURE_OPENAI_CHATGPT_MODEL": "gpt-4.1-mini", "AZURE_OPENAI_EMB_MODEL_NAME": "text-embedding-3-large", "AZURE_OPENAI_EMB_DIMENSIONS": "3072", }, diff --git a/tests/snapshots/test_app/test_ask_prompt_template/client0/result.json b/tests/snapshots/test_app/test_ask_prompt_template/client0/result.json index f83f1d6f9e..f87c699598 100644 --- a/tests/snapshots/test_app/test_ask_prompt_template/client0/result.json +++ b/tests/snapshots/test_app/test_ask_prompt_template/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_prompt_template/client1/result.json b/tests/snapshots/test_app/test_ask_prompt_template/client1/result.json index ac939263bd..2101ea2479 100644 --- a/tests/snapshots/test_app/test_ask_prompt_template/client1/result.json +++ b/tests/snapshots/test_app/test_ask_prompt_template/client1/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_prompt_template_concat/client0/result.json b/tests/snapshots/test_app/test_ask_prompt_template_concat/client0/result.json index f77470bcc3..747854fb5f 100644 --- a/tests/snapshots/test_app/test_ask_prompt_template_concat/client0/result.json +++ b/tests/snapshots/test_app/test_ask_prompt_template_concat/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_prompt_template_concat/client1/result.json b/tests/snapshots/test_app/test_ask_prompt_template_concat/client1/result.json index 5f45fc15f6..f5eaea9742 100644 --- a/tests/snapshots/test_app/test_ask_prompt_template_concat/client1/result.json +++ b/tests/snapshots/test_app/test_ask_prompt_template_concat/client1/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_hybrid/client0/result.json b/tests/snapshots/test_app/test_ask_rtr_hybrid/client0/result.json index 90b1d3ee4a..c5580e560f 100644 --- a/tests/snapshots/test_app/test_ask_rtr_hybrid/client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_hybrid/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_hybrid/client1/result.json b/tests/snapshots/test_app/test_ask_rtr_hybrid/client1/result.json index 6b6a8268de..24a3c895e0 100644 --- a/tests/snapshots/test_app/test_ask_rtr_hybrid/client1/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_hybrid/client1/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text/client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text/client0/result.json index b935f47728..36e8a4d4ea 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text/client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text/client1/result.json b/tests/snapshots/test_app/test_ask_rtr_text/client1/result.json index 171edf3150..d08007ecf8 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text/client1/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text/client1/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_agent/agent_client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text_agent/agent_client0/result.json index ec9bbf3360..86019f5e31 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_agent/agent_client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_agent/agent_client0/result.json @@ -40,8 +40,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "query_plan": [ { "elapsed_ms": 200, @@ -84,8 +84,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_agent_filter/agent_auth_client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text_agent_filter/agent_auth_client0/result.json index 029348cb23..d997437fed 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_agent_filter/agent_auth_client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_agent_filter/agent_auth_client0/result.json @@ -40,8 +40,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "query_plan": [ { "elapsed_ms": 200, @@ -84,8 +84,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_filter/auth_client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text_filter/auth_client0/result.json index 690d363b98..7e36cf601a 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_filter/auth_client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_filter/auth_client0/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_filter_public_documents/auth_public_documents_client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text_filter_public_documents/auth_public_documents_client0/result.json index 391cb4714a..bb68c0c910 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_filter_public_documents/auth_public_documents_client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_filter_public_documents/auth_public_documents_client0/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client0/result.json index e5ea25f3d2..3899663b89 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client1/result.json b/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client1/result.json index d481a2f01e..cc4a73f6ca 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client1/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_semanticcaptions/client1/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client0/result.json b/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client0/result.json index 4723627288..90e819d0b1 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client0/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client1/result.json b/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client1/result.json index 58f164e257..a7961ad07b 100644 --- a/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client1/result.json +++ b/tests/snapshots/test_app/test_ask_rtr_text_semanticranker/client1/result.json @@ -67,7 +67,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_ask_vision/client0/result.json b/tests/snapshots/test_app/test_ask_vision/client0/result.json index a0b3899161..a20d442559 100644 --- a/tests/snapshots/test_app/test_ask_vision/client0/result.json +++ b/tests/snapshots/test_app/test_ask_vision/client0/result.json @@ -66,7 +66,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_followup/client0/result.json b/tests/snapshots/test_app/test_chat_followup/client0/result.json index 2ef9486287..fe60e20a2f 100644 --- a/tests/snapshots/test_app/test_chat_followup/client0/result.json +++ b/tests/snapshots/test_app/test_chat_followup/client0/result.json @@ -38,7 +38,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_followup/client1/result.json b/tests/snapshots/test_app/test_chat_followup/client1/result.json index b2320dfa8b..def88f4948 100644 --- a/tests/snapshots/test_app/test_chat_followup/client1/result.json +++ b/tests/snapshots/test_app/test_chat_followup/client1/result.json @@ -39,7 +39,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -100,7 +100,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_hybrid/client0/result.json b/tests/snapshots/test_app/test_chat_hybrid/client0/result.json index 450afbce97..36b4fc9d62 100644 --- a/tests/snapshots/test_app/test_chat_hybrid/client0/result.json +++ b/tests/snapshots/test_app/test_chat_hybrid/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_hybrid/client1/result.json b/tests/snapshots/test_app/test_chat_hybrid/client1/result.json index d940ea2104..2ac2c398c4 100644 --- a/tests/snapshots/test_app/test_chat_hybrid/client1/result.json +++ b/tests/snapshots/test_app/test_chat_hybrid/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client0/result.json b/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client0/result.json index 0cd9a21ef2..c3ac0d1b04 100644 --- a/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client0/result.json +++ b/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client1/result.json b/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client1/result.json index c8ef1612d1..dd1eefb405 100644 --- a/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client1/result.json +++ b/tests/snapshots/test_app/test_chat_hybrid_semantic_captions/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client0/result.json b/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client0/result.json index 3cd84d9e06..47d8771efb 100644 --- a/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client0/result.json +++ b/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client1/result.json b/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client1/result.json index 3033cdab41..9d789b4c96 100644 --- a/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client1/result.json +++ b/tests/snapshots/test_app/test_chat_hybrid_semantic_ranker/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_prompt_template/client0/result.json b/tests/snapshots/test_app/test_chat_prompt_template/client0/result.json index 8cba036157..8d5813ed6e 100644 --- a/tests/snapshots/test_app/test_chat_prompt_template/client0/result.json +++ b/tests/snapshots/test_app/test_chat_prompt_template/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_prompt_template/client1/result.json b/tests/snapshots/test_app/test_chat_prompt_template/client1/result.json index 56fce921c9..e04281665b 100644 --- a/tests/snapshots/test_app/test_chat_prompt_template/client1/result.json +++ b/tests/snapshots/test_app/test_chat_prompt_template/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_prompt_template_concat/client0/result.json b/tests/snapshots/test_app/test_chat_prompt_template_concat/client0/result.json index 3be296c7a4..a2fcf087c6 100644 --- a/tests/snapshots/test_app/test_chat_prompt_template_concat/client0/result.json +++ b/tests/snapshots/test_app/test_chat_prompt_template_concat/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_prompt_template_concat/client1/result.json b/tests/snapshots/test_app/test_chat_prompt_template_concat/client1/result.json index e5bbd176ba..dc72539ca3 100644 --- a/tests/snapshots/test_app/test_chat_prompt_template_concat/client1/result.json +++ b/tests/snapshots/test_app/test_chat_prompt_template_concat/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_seed/client0/result.json b/tests/snapshots/test_app/test_chat_seed/client0/result.json index 450afbce97..36b4fc9d62 100644 --- a/tests/snapshots/test_app/test_chat_seed/client0/result.json +++ b/tests/snapshots/test_app/test_chat_seed/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_seed/client1/result.json b/tests/snapshots/test_app/test_chat_seed/client1/result.json index d940ea2104..2ac2c398c4 100644 --- a/tests/snapshots/test_app/test_chat_seed/client1/result.json +++ b/tests/snapshots/test_app/test_chat_seed/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_session_state_persists/client0/result.json b/tests/snapshots/test_app/test_chat_session_state_persists/client0/result.json index a58d3390d3..412ba62071 100644 --- a/tests/snapshots/test_app/test_chat_session_state_persists/client0/result.json +++ b/tests/snapshots/test_app/test_chat_session_state_persists/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_session_state_persists/client1/result.json b/tests/snapshots/test_app/test_chat_session_state_persists/client1/result.json index 8c67d2d404..fca318bbb7 100644 --- a/tests/snapshots/test_app/test_chat_session_state_persists/client1/result.json +++ b/tests/snapshots/test_app/test_chat_session_state_persists/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_stream_followup/client0/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_followup/client0/result.jsonlines index 8380ef5141..b2362b3e58 100644 --- a/tests/snapshots/test_app/test_chat_stream_followup/client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_followup/client0/result.jsonlines @@ -1,5 +1,5 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf]. ", "role": "assistant"}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} -{"delta": {"role": "assistant"}, "context": {"context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "followup_questions": ["What is the capital of Spain?"]}} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "followup_questions": ["What is the capital of Spain?"]}} diff --git a/tests/snapshots/test_app/test_chat_stream_followup/client1/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_followup/client1/result.jsonlines index def8c8147b..67e4b109db 100644 --- a/tests/snapshots/test_app/test_chat_stream_followup/client1/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_followup/client1/result.jsonlines @@ -1,5 +1,5 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf]. ", "role": "assistant"}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} -{"delta": {"role": "assistant"}, "context": {"context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "followup_questions": ["What is the capital of Spain?"]}} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\n\n\n\n\nGenerate 3 very brief follow-up questions that the user would likely ask next.\nEnclose the follow-up questions in double angle brackets. Example:\n<>\n<>\n<>\nDo not repeat questions that have already been asked.\nMake sure the last question ends with \">>\"."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "followup_questions": ["What is the capital of Spain?"]}} diff --git a/tests/snapshots/test_app/test_chat_stream_session_state_persists/client0/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_session_state_persists/client0/result.jsonlines index 1feee1e314..4ada156637 100644 --- a/tests/snapshots/test_app/test_chat_stream_session_state_persists/client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_session_state_persists/client0/result.jsonlines @@ -1,4 +1,4 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini"}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini"}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "role": null}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} diff --git a/tests/snapshots/test_app/test_chat_stream_session_state_persists/client1/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_session_state_persists/client1/result.jsonlines index 78a5ba87b1..44ae8aa50c 100644 --- a/tests/snapshots/test_app/test_chat_stream_session_state_persists/client1/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_session_state_persists/client1/result.jsonlines @@ -1,4 +1,4 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "role": null}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": {"conversation_id": 1234}} diff --git a/tests/snapshots/test_app/test_chat_stream_text/client0/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_text/client0/result.jsonlines index 1921ccb193..cc0318ac9e 100644 --- a/tests/snapshots/test_app/test_chat_stream_text/client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_text/client0/result.jsonlines @@ -1,4 +1,4 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "role": null}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} diff --git a/tests/snapshots/test_app/test_chat_stream_text/client1/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_text/client1/result.jsonlines index 2a98d4730b..88ac66828c 100644 --- a/tests/snapshots/test_app/test_chat_stream_text/client1/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_text/client1/result.jsonlines @@ -1,4 +1,4 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "role": null}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} diff --git a/tests/snapshots/test_app/test_chat_stream_text_filter/auth_client0/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_text_filter/auth_client0/result.jsonlines index e632b25868..f01bdecf3e 100644 --- a/tests/snapshots/test_app/test_chat_stream_text_filter/auth_client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_text_filter/auth_client0/result.jsonlines @@ -1,4 +1,4 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": "category ne 'excluded' and (oids/any(g:search.in(g, 'OID_X')) or groups/any(g:search.in(g, 'GROUP_Y, GROUP_Z')))", "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": "category ne 'excluded' and (oids/any(g:search.in(g, 'OID_X')) or groups/any(g:search.in(g, 'GROUP_Y, GROUP_Z')))", "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "role": null}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": "category ne 'excluded' and (oids/any(g:search.in(g, 'OID_X')) or groups/any(g:search.in(g, 'GROUP_Y, GROUP_Z')))", "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: What is the capital of France?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "capital of France", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": "category ne 'excluded' and (oids/any(g:search.in(g, 'OID_X')) or groups/any(g:search.in(g, 'GROUP_Y, GROUP_Z')))", "use_vector_search": false, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}], "score": 0.03279569745063782, "reranker_score": 3.4577205181121826, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "What is the capital of France?\n\nSources:\n\nBenefit_Options-2.pdf: There is a whistleblower policy."}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} diff --git a/tests/snapshots/test_app/test_chat_stream_vision/client0/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_vision/client0/result.jsonlines index 6fcf1b40da..b5b2e05426 100644 --- a/tests/snapshots/test_app/test_chat_stream_vision/client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_vision/client0/result.jsonlines @@ -1,4 +1,4 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Financial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions "], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: Are interest rates high?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "interest rates", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Financial_Market_Analysis_Report_2023_pdf-46696E616E6369616C204D61726B657420416E616C79736973205265706F727420323032332E706466-page-14", "content": "31\nFinancial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors\nImpact of Interest Rates, Inflation, and GDP Growth on Financial Markets\n5\n4\n3\n2\n1\n0\n-1 2018 2019\n-2\n-3\n-4\n-5\n2020\n2021 2022 2023\nMacroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance.\n-Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends\nRelative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100)\n2028\nBased on historical data, current trends, and economic indicators, this section presents predictions ", "category": null, "sourcepage": "Financial Market Analysis Report 2023-6.png", "sourcefile": "Financial Market Analysis Report 2023.pdf", "oids": null, "groups": null, "captions": [], "score": 0.04972677677869797, "reranker_score": 3.1704962253570557, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "Are interest rates high?\n\nSources:\n\nFinancial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions"}], "props": {"model": "gpt-4o-mini"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Financial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions "], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: Are interest rates high?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "interest rates", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Financial_Market_Analysis_Report_2023_pdf-46696E616E6369616C204D61726B657420416E616C79736973205265706F727420323032332E706466-page-14", "content": "31\nFinancial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors\nImpact of Interest Rates, Inflation, and GDP Growth on Financial Markets\n5\n4\n3\n2\n1\n0\n-1 2018 2019\n-2\n-3\n-4\n-5\n2020\n2021 2022 2023\nMacroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance.\n-Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends\nRelative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100)\n2028\nBased on historical data, current trends, and economic indicators, this section presents predictions ", "category": null, "sourcepage": "Financial Market Analysis Report 2023-6.png", "sourcefile": "Financial Market Analysis Report 2023.pdf", "oids": null, "groups": null, "captions": [], "score": 0.04972677677869797, "reranker_score": 3.1704962253570557, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "Are interest rates high?\n\nSources:\n\nFinancial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions"}], "props": {"model": "gpt-4.1-mini"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "role": null}} -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Financial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions "], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: Are interest rates high?"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "interest rates", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Financial_Market_Analysis_Report_2023_pdf-46696E616E6369616C204D61726B657420416E616C79736973205265706F727420323032332E706466-page-14", "content": "31\nFinancial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors\nImpact of Interest Rates, Inflation, and GDP Growth on Financial Markets\n5\n4\n3\n2\n1\n0\n-1 2018 2019\n-2\n-3\n-4\n-5\n2020\n2021 2022 2023\nMacroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance.\n-Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends\nRelative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100)\n2028\nBased on historical data, current trends, and economic indicators, this section presents predictions ", "category": null, "sourcepage": "Financial Market Analysis Report 2023-6.png", "sourcefile": "Financial Market Analysis Report 2023.pdf", "oids": null, "groups": null, "captions": [], "score": 0.04972677677869797, "reranker_score": 3.1704962253570557, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "Are interest rates high?\n\nSources:\n\nFinancial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions"}], "props": {"model": "gpt-4o-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Financial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions "], "images": null}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: Are interest rates high?"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}, {"title": "Search using generated search query", "description": "interest rates", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "use_vector_search": true, "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Financial_Market_Analysis_Report_2023_pdf-46696E616E6369616C204D61726B657420416E616C79736973205265706F727420323032332E706466-page-14", "content": "31\nFinancial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors\nImpact of Interest Rates, Inflation, and GDP Growth on Financial Markets\n5\n4\n3\n2\n1\n0\n-1 2018 2019\n-2\n-3\n-4\n-5\n2020\n2021 2022 2023\nMacroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance.\n-Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends\nRelative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100)\n2028\nBased on historical data, current trends, and economic indicators, this section presents predictions ", "category": null, "sourcepage": "Financial Market Analysis Report 2023-6.png", "sourcefile": "Financial Market Analysis Report 2023.pdf", "oids": null, "groups": null, "captions": [], "score": 0.04972677677869797, "reranker_score": 3.1704962253570557, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\nAnswer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\nIf the question is not in English, answer in the language used in the question.\nEach source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf]."}, {"role": "user", "content": "Are interest rates high?\n\nSources:\n\nFinancial Market Analysis Report 2023.pdf#page=6: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions"}], "props": {"model": "gpt-4.1-mini", "token_usage": {"prompt_tokens": 23, "completion_tokens": 896, "reasoning_tokens": 0, "total_tokens": 919}}}], "followup_questions": null}, "session_state": null} diff --git a/tests/snapshots/test_app/test_chat_stream_vision/client1/result.jsonlines b/tests/snapshots/test_app/test_chat_stream_vision/client1/result.jsonlines index 1ec8a4d2c9..4b28a07f1f 100644 --- a/tests/snapshots/test_app/test_chat_stream_vision/client1/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_stream_vision/client1/result.jsonlines @@ -1,3 +1,3 @@ -{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Financial Market Analysis Report 2023-6.png: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions "], "images": ["data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z/C/HgAGgwJ/lK3Q6wAAAABJRU5ErkJggg=="]}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: Are interest rates high?"}], "props": {"model": "gpt-4o-mini", "deployment": "test-chatgpt"}}, {"title": "Search using generated search query", "description": "interest rates", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "vector_fields": "textAndImageEmbeddings", "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Financial_Market_Analysis_Report_2023_pdf-46696E616E6369616C204D61726B657420416E616C79736973205265706F727420323032332E706466-page-14", "content": "31\nFinancial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors\nImpact of Interest Rates, Inflation, and GDP Growth on Financial Markets\n5\n4\n3\n2\n1\n0\n-1 2018 2019\n-2\n-3\n-4\n-5\n2020\n2021 2022 2023\nMacroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance.\n-Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends\nRelative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100)\n2028\nBased on historical data, current trends, and economic indicators, this section presents predictions ", "category": null, "sourcepage": "Financial Market Analysis Report 2023-6.png", "sourcefile": "Financial Market Analysis Report 2023.pdf", "oids": null, "groups": null, "captions": [], "score": 0.04972677677869797, "reranker_score": 3.1704962253570557, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "You are an intelligent assistant helping analyze the Annual Financial Report of Contoso Ltd., The documents contain text, graphs, tables and images.\nEach image source has the file name in the top left corner of the image with coordinates (10,10) pixels and is in the format SourceFileName:\nEach text source starts in a new line and has the file name followed by colon and the actual information\nAlways include the source name from the image or text for each fact you use in the response in the format: [filename]\nAnswer the following question using only the data provided in the sources below.\nIf asking a clarifying question to the user would help, ask the question.\nBe brief in your answers.\nThe text and image source can be the same file name, don't use the image title when citing the image source, only use the file name as mentioned\nIf you cannot answer using the sources below, say you don't know. Return just the answer without any input texts."}, {"role": "user", "content": [{"type": "text", "text": "Are interest rates high?"}, {"type": "image_url", "image_url": {"url": "data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z/C/HgAGgwJ/lK3Q6wAAAABJRU5ErkJggg=="}}, {"type": "text", "text": "Sources:\n\nFinancial Market Analysis Report 2023-6.png: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions"}]}], "props": {"model": "gpt-4"}}], "followup_questions": null}, "session_state": null} +{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Financial Market Analysis Report 2023-6.png: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions "], "images": ["data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z/C/HgAGgwJ/lK3Q6wAAAABJRU5ErkJggg=="]}, "thoughts": [{"title": "Prompt to generate search query", "description": [{"role": "system", "content": "Below is a history of the conversation so far, and a new question asked by the user that needs to be answered by searching in a knowledge base.\nYou have access to Azure AI Search index with 100's of documents.\nGenerate a search query based on the conversation and the new question.\nDo not include cited source filenames and document names e.g. info.txt or doc.pdf in the search query terms.\nDo not include any text inside [] or <<>> in the search query terms.\nDo not include any special characters like '+'.\nIf the question is not in English, translate the question to English before generating the search query.\nIf you cannot generate a search query, return just the number 0."}, {"role": "user", "content": "How did crypto do last year?"}, {"role": "assistant", "content": "Summarize Cryptocurrency Market Dynamics from last year"}, {"role": "user", "content": "What are my health plans?"}, {"role": "assistant", "content": "Show available health plans"}, {"role": "user", "content": "Generate search query for: Are interest rates high?"}], "props": {"model": "gpt-4.1-mini", "deployment": "test-chatgpt"}}, {"title": "Search using generated search query", "description": "interest rates", "props": {"use_semantic_captions": false, "use_semantic_ranker": false, "use_query_rewriting": false, "top": 3, "filter": null, "vector_fields": "textAndImageEmbeddings", "use_text_search": true}}, {"title": "Search results", "description": [{"id": "file-Financial_Market_Analysis_Report_2023_pdf-46696E616E6369616C204D61726B657420416E616C79736973205265706F727420323032332E706466-page-14", "content": "31\nFinancial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors\nImpact of Interest Rates, Inflation, and GDP Growth on Financial Markets\n5\n4\n3\n2\n1\n0\n-1 2018 2019\n-2\n-3\n-4\n-5\n2020\n2021 2022 2023\nMacroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance.\n-Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends\nRelative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100)\n2028\nBased on historical data, current trends, and economic indicators, this section presents predictions ", "category": null, "sourcepage": "Financial Market Analysis Report 2023-6.png", "sourcefile": "Financial Market Analysis Report 2023.pdf", "oids": null, "groups": null, "captions": [], "score": 0.04972677677869797, "reranker_score": 3.1704962253570557, "search_agent_query": null}], "props": null}, {"title": "Prompt to generate answer", "description": [{"role": "system", "content": "You are an intelligent assistant helping analyze the Annual Financial Report of Contoso Ltd., The documents contain text, graphs, tables and images.\nEach image source has the file name in the top left corner of the image with coordinates (10,10) pixels and is in the format SourceFileName:\nEach text source starts in a new line and has the file name followed by colon and the actual information\nAlways include the source name from the image or text for each fact you use in the response in the format: [filename]\nAnswer the following question using only the data provided in the sources below.\nIf asking a clarifying question to the user would help, ask the question.\nBe brief in your answers.\nThe text and image source can be the same file name, don't use the image title when citing the image source, only use the file name as mentioned\nIf you cannot answer using the sources below, say you don't know. Return just the answer without any input texts."}, {"role": "user", "content": [{"type": "text", "text": "Are interest rates high?"}, {"type": "image_url", "image_url": {"url": "data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mP8z/C/HgAGgwJ/lK3Q6wAAAABJRU5ErkJggg=="}}, {"type": "text", "text": "Sources:\n\nFinancial Market Analysis Report 2023-6.png: 31 Financial markets are interconnected, with movements in one segment often influencing others. This section examines the correlations between stock indices, cryptocurrency prices, and commodity prices, revealing how changes in one market can have ripple effects across the financial ecosystem.Impact of Macroeconomic Factors Impact of Interest Rates, Inflation, and GDP Growth on Financial Markets 5 4 3 2 1 0 -1 2018 2019 -2 -3 -4 -5 2020 2021 2022 2023 Macroeconomic factors such as interest rates, inflation, and GDP growth play a pivotal role in shaping financial markets. This section analyzes how these factors have influenced stock, cryptocurrency, and commodity markets over recent years, providing insights into the complex relationship between the economy and financial market performance. -Interest Rates % -Inflation Data % GDP Growth % :unselected: :unselected:Future Predictions and Trends Relative Growth Trends for S&P 500, Bitcoin, and Oil Prices (2024 Indexed to 100) 2028 Based on historical data, current trends, and economic indicators, this section presents predictions"}]}], "props": {"model": "gpt-4"}}], "followup_questions": null}, "session_state": null} {"delta": {"content": null, "role": "assistant"}} {"delta": {"content": "From the provided sources, the impact of interest rates and GDP growth on financial markets can be observed through the line graph. [Financial Market Analysis Report 2023-7.png]", "role": null}} diff --git a/tests/snapshots/test_app/test_chat_text/client0/result.json b/tests/snapshots/test_app/test_chat_text/client0/result.json index 81d4d5f92a..099a6671d0 100644 --- a/tests/snapshots/test_app/test_chat_text/client0/result.json +++ b/tests/snapshots/test_app/test_chat_text/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text/client1/result.json b/tests/snapshots/test_app/test_chat_text/client1/result.json index d5a1c19294..cbc70d27ec 100644 --- a/tests/snapshots/test_app/test_chat_text/client1/result.json +++ b/tests/snapshots/test_app/test_chat_text/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_agent/agent_client0/result.json b/tests/snapshots/test_app/test_chat_text_agent/agent_client0/result.json index 5f813bd45d..c249658ac0 100644 --- a/tests/snapshots/test_app/test_chat_text_agent/agent_client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_agent/agent_client0/result.json @@ -40,8 +40,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "query_plan": [ { "elapsed_ms": 200, @@ -76,8 +76,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_filter/auth_client0/result.json b/tests/snapshots/test_app/test_chat_text_filter/auth_client0/result.json index 446ddfcecc..6e222b7312 100644 --- a/tests/snapshots/test_app/test_chat_text_filter/auth_client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_filter/auth_client0/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_filter_agent/agent_auth_client0/result.json b/tests/snapshots/test_app/test_chat_text_filter_agent/agent_auth_client0/result.json index 1069d6870e..a14482013a 100644 --- a/tests/snapshots/test_app/test_chat_text_filter_agent/agent_auth_client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_filter_agent/agent_auth_client0/result.json @@ -40,8 +40,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "query_plan": [ { "elapsed_ms": 200, @@ -76,8 +76,8 @@ } ], "props": { - "deployment": "gpt-4o-mini", - "model": "gpt-4o-mini", + "deployment": "gpt-4.1-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_filter_public_documents/auth_public_documents_client0/result.json b/tests/snapshots/test_app/test_chat_text_filter_public_documents/auth_public_documents_client0/result.json index 8bf512a76e..27eba9f32e 100644 --- a/tests/snapshots/test_app/test_chat_text_filter_public_documents/auth_public_documents_client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_filter_public_documents/auth_public_documents_client0/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_semantic_ranker/client0/result.json b/tests/snapshots/test_app/test_chat_text_semantic_ranker/client0/result.json index bd98db5ab5..740f2d75d9 100644 --- a/tests/snapshots/test_app/test_chat_text_semantic_ranker/client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_semantic_ranker/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_semantic_ranker/client1/result.json b/tests/snapshots/test_app/test_chat_text_semantic_ranker/client1/result.json index 833040bf44..eb1a308a75 100644 --- a/tests/snapshots/test_app/test_chat_text_semantic_ranker/client1/result.json +++ b/tests/snapshots/test_app/test_chat_text_semantic_ranker/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_semanticcaptions/client0/result.json b/tests/snapshots/test_app/test_chat_text_semanticcaptions/client0/result.json index c429280aaf..c7df144bfd 100644 --- a/tests/snapshots/test_app/test_chat_text_semanticcaptions/client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_semanticcaptions/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_semanticcaptions/client1/result.json b/tests/snapshots/test_app/test_chat_text_semanticcaptions/client1/result.json index 161c91c4b6..b0abe59bbf 100644 --- a/tests/snapshots/test_app/test_chat_text_semanticcaptions/client1/result.json +++ b/tests/snapshots/test_app/test_chat_text_semanticcaptions/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_semanticranker/client0/result.json b/tests/snapshots/test_app/test_chat_text_semanticranker/client0/result.json index bd98db5ab5..740f2d75d9 100644 --- a/tests/snapshots/test_app/test_chat_text_semanticranker/client0/result.json +++ b/tests/snapshots/test_app/test_chat_text_semanticranker/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_text_semanticranker/client1/result.json b/tests/snapshots/test_app/test_chat_text_semanticranker/client1/result.json index 833040bf44..eb1a308a75 100644 --- a/tests/snapshots/test_app/test_chat_text_semanticranker/client1/result.json +++ b/tests/snapshots/test_app/test_chat_text_semanticranker/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vector/client0/result.json b/tests/snapshots/test_app/test_chat_vector/client0/result.json index d70b6adeaf..8de81cb8fc 100644 --- a/tests/snapshots/test_app/test_chat_vector/client0/result.json +++ b/tests/snapshots/test_app/test_chat_vector/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vector/client1/result.json b/tests/snapshots/test_app/test_chat_vector/client1/result.json index ddf12b26c6..fda2ed18ac 100644 --- a/tests/snapshots/test_app/test_chat_vector/client1/result.json +++ b/tests/snapshots/test_app/test_chat_vector/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client0/result.json b/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client0/result.json index eeec58d14e..e81da1c15c 100644 --- a/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client0/result.json +++ b/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client1/result.json b/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client1/result.json index 6401c93de4..ca719eaea1 100644 --- a/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client1/result.json +++ b/tests/snapshots/test_app/test_chat_vector_semantic_ranker/client1/result.json @@ -37,7 +37,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -98,7 +98,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vision/client0/result.json b/tests/snapshots/test_app/test_chat_vision/client0/result.json index 05330f4c2a..f02a1f5c77 100644 --- a/tests/snapshots/test_app/test_chat_vision/client0/result.json +++ b/tests/snapshots/test_app/test_chat_vision/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -90,7 +90,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vision/client0/result.jsonlines b/tests/snapshots/test_app/test_chat_vision/client0/result.jsonlines index aca468be97..a0cd256acd 100644 --- a/tests/snapshots/test_app/test_chat_vision/client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_vision/client0/result.jsonlines @@ -1,3 +1,3 @@ {"choices": [{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."]}, "thoughts": [{"title": "Original user query", "description": "Are interest rates high?", "props": null}, {"title": "Generated search query", "description": "The capital of France is Paris. [Benefit_Options-2.pdf].", "props": {"semanticCaptions": false, "has_vector": true}}, {"title": "Results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "embedding": null, "imageEmbedding": null, "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}]}], "props": null}, {"title": "Prompt", "description": ["{'role': 'system', 'content': \"Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\\n Answer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\\n For tabular information return it as an html table. Do not return markdown format. If the question is not in English, answer in the language used in the question.\\n Each source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\\n \\n \\n \"}", "{'role': 'user', 'content': 'Are interest rates high?\\n\\nSources:\\nBenefit_Options-2.pdf: There is a whistleblower policy.'}"], "props": null}]}, "session_state": null, "finish_reason": null, "index": 0}], "object": "chat.completion.chunk"} -{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} -{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} diff --git a/tests/snapshots/test_app/test_chat_vision/client1/result.json b/tests/snapshots/test_app/test_chat_vision/client1/result.json index a080480d45..364144b7a0 100644 --- a/tests/snapshots/test_app/test_chat_vision/client1/result.json +++ b/tests/snapshots/test_app/test_chat_vision/client1/result.json @@ -39,7 +39,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini" + "model": "gpt-4.1-mini" }, "title": "Prompt to generate search query" }, diff --git a/tests/snapshots/test_app/test_chat_vision/client1/result.jsonlines b/tests/snapshots/test_app/test_chat_vision/client1/result.jsonlines index 4ac90fdfbf..dd48a91ae7 100644 --- a/tests/snapshots/test_app/test_chat_vision/client1/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_vision/client1/result.jsonlines @@ -1,3 +1,3 @@ {"choices": [{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": [{"url": "data:image/png;base64,iVBOR1BORw0KGgoAAAANSUhEUgAAAAEAAAABAQAAAAA3bvkkAAAACklEQVR4nGMAAQAABQABDQ0tuhsAAAAASUVORK5CYII=", "detail": "auto"}]}, "thoughts": [{"title": "Original user query", "description": "Are interest rates high?", "props": null}, {"title": "Generated search query", "description": "The capital of France is Paris. [Benefit_Options-2.pdf].", "props": {"semanticCaptions": false, "vector_fields": "textAndImageEmbeddings"}}, {"title": "Results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "embedding": null, "imageEmbedding": null, "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}]}], "props": null}, {"title": "Prompt", "description": ["{'role': 'system', 'content': \"\\n You are an intelligent assistant helping analyze the Annual Financial Report of Contoso Ltd., The documents contain text, graphs, tables and images.\\n Each image source has the file name in the top left corner of the image with coordinates (10,10) pixels and is in the format SourceFileName:\\n Each text source starts in a new line and has the file name followed by colon and the actual information\\n Always include the source name from the image or text for each fact you use in the response in the format: [filename]\\n Answer the following question using only the data provided in the sources below.\\n If asking a clarifying question to the user would help, ask the question.\\n Be brief in your answers.\\n For tabular information return it as an html table. Do not return markdown format.\\n The text and image source can be the same file name, don't use the image title when citing the image source, only use the file name as mentioned\\n If you cannot answer using the sources below, say you don't know. Return just the answer without any input texts.\\n \\n \\n \"}", "{'role': 'user', 'content': [{'text': 'Are interest rates high?', 'type': 'text'}, {'text': '\\n\\nSources:\\nBenefit_Options-2.pdf: There is a whistleblower policy.', 'type': 'text'}, {'image_url': {'url': 'data:image/png;base64,iVBOR1BORw0KGgoAAAANSUhEUgAAAAEAAAABAQAAAAA3bvkkAAAACklEQVR4nGMAAQAABQABDQ0tuhsAAAAASUVORK5CYII=', 'detail': 'auto'}, 'type': 'image_url'}]}"], "props": null}]}, "session_state": null, "finish_reason": null, "index": 0}], "object": "chat.completion.chunk"} -{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} -{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} diff --git a/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.json b/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.json index 932e1aa371..ad8ff0b447 100644 --- a/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.json +++ b/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.json @@ -36,7 +36,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -96,7 +96,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.jsonlines b/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.jsonlines index 2abf0ba691..af508450f6 100644 --- a/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_vision_vectors/client0/result.jsonlines @@ -1,3 +1,3 @@ {"choices": [{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."]}, "thoughts": [{"title": "Original user query", "description": "Are interest rates high?", "props": null}, {"title": "Generated search query", "description": null, "props": {"semanticCaptions": false, "has_vector": true}}, {"title": "Results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "embedding": null, "imageEmbedding": null, "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}]}], "props": null}, {"title": "Prompt", "description": ["{'role': 'system', 'content': \"Assistant helps the company employees with their healthcare plan questions, and questions about the employee handbook. Be brief in your answers.\\n Answer ONLY with the facts listed in the list of sources below. If there isn't enough information below, say you don't know. Do not generate answers that don't use the sources below. If asking a clarifying question to the user would help, ask the question.\\n For tabular information return it as an html table. Do not return markdown format. If the question is not in English, answer in the language used in the question.\\n Each source has a name followed by colon and the actual information, always include the source name for each fact you use in the response. Use square brackets to reference the source, for example [info1.txt]. Don't combine sources, list each source separately, for example [info1.txt][info2.pdf].\\n \\n \\n \"}", "{'role': 'user', 'content': 'Are interest rates high?\\n\\nSources:\\nBenefit_Options-2.pdf: There is a whistleblower policy.'}"], "props": null}]}, "session_state": null, "finish_reason": null, "index": 0}], "object": "chat.completion.chunk"} -{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} -{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} diff --git a/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.json b/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.json index fc622bcca7..31b7fba112 100644 --- a/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.json +++ b/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.json @@ -39,7 +39,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini" + "model": "gpt-4.1-mini" }, "title": "Prompt to generate search query" }, diff --git a/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.jsonlines b/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.jsonlines index 064a1c8b4a..584c61139a 100644 --- a/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.jsonlines +++ b/tests/snapshots/test_app/test_chat_vision_vectors/client1/result.jsonlines @@ -1,3 +1,3 @@ {"choices": [{"delta": {"role": "assistant"}, "context": {"data_points": {"text": ["Benefit_Options-2.pdf: There is a whistleblower policy."], "images": [{"url": "data:image/png;base64,iVBOR1BORw0KGgoAAAANSUhEUgAAAAEAAAABAQAAAAA3bvkkAAAACklEQVR4nGMAAQAABQABDQ0tuhsAAAAASUVORK5CYII=", "detail": "auto"}]}, "thoughts": [{"title": "Original user query", "description": "Are interest rates high?", "props": null}, {"title": "Generated search query", "description": null, "props": {"semanticCaptions": false, "vector_fields": "textAndImageEmbeddings"}}, {"title": "Results", "description": [{"id": "file-Benefit_Options_pdf-42656E656669745F4F7074696F6E732E706466-page-2", "content": "There is a whistleblower policy.", "embedding": null, "imageEmbedding": null, "category": null, "sourcepage": "Benefit_Options-2.pdf", "sourcefile": "Benefit_Options.pdf", "oids": null, "groups": null, "captions": [{"additional_properties": {}, "text": "Caption: A whistleblower policy.", "highlights": []}]}], "props": null}, {"title": "Prompt", "description": ["{'role': 'system', 'content': \"\\n You are an intelligent assistant helping analyze the Annual Financial Report of Contoso Ltd., The documents contain text, graphs, tables and images.\\n Each image source has the file name in the top left corner of the image with coordinates (10,10) pixels and is in the format SourceFileName:\\n Each text source starts in a new line and has the file name followed by colon and the actual information\\n Always include the source name from the image or text for each fact you use in the response in the format: [filename]\\n Answer the following question using only the data provided in the sources below.\\n If asking a clarifying question to the user would help, ask the question.\\n Be brief in your answers.\\n For tabular information return it as an html table. Do not return markdown format.\\n The text and image source can be the same file name, don't use the image title when citing the image source, only use the file name as mentioned\\n If you cannot answer using the sources below, say you don't know. Return just the answer without any input texts.\\n \\n \\n \"}", "{'role': 'user', 'content': [{'text': 'Are interest rates high?', 'type': 'text'}, {'text': '\\n\\nSources:\\nBenefit_Options-2.pdf: There is a whistleblower policy.', 'type': 'text'}, {'image_url': {'url': 'data:image/png;base64,iVBOR1BORw0KGgoAAAANSUhEUgAAAAEAAAABAQAAAAA3bvkkAAAACklEQVR4nGMAAQAABQABDQ0tuhsAAAAASUVORK5CYII=', 'detail': 'auto'}, 'type': 'image_url'}]}"], "props": null}]}, "session_state": null, "finish_reason": null, "index": 0}], "object": "chat.completion.chunk"} -{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} -{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4o-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": null, "function_call": null, "role": "assistant", "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} +{"id": "test-id", "choices": [{"delta": {"content": "The capital of France is Paris. [Benefit_Options-2.pdf].", "function_call": null, "role": null, "tool_calls": null}, "finish_reason": null, "index": 0}], "created": 1, "model": "gpt-4.1-mini", "object": "chat.completion.chunk", "system_fingerprint": null} diff --git a/tests/snapshots/test_app/test_chat_with_history/client0/result.json b/tests/snapshots/test_app/test_chat_with_history/client0/result.json index 866d9f287d..df320106d2 100644 --- a/tests/snapshots/test_app/test_chat_with_history/client0/result.json +++ b/tests/snapshots/test_app/test_chat_with_history/client0/result.json @@ -44,7 +44,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -112,7 +112,7 @@ } ], "props": { - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/snapshots/test_app/test_chat_with_history/client1/result.json b/tests/snapshots/test_app/test_chat_with_history/client1/result.json index fa161f267f..6ac51e75a3 100644 --- a/tests/snapshots/test_app/test_chat_with_history/client1/result.json +++ b/tests/snapshots/test_app/test_chat_with_history/client1/result.json @@ -45,7 +45,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, @@ -114,7 +114,7 @@ ], "props": { "deployment": "test-chatgpt", - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "token_usage": { "completion_tokens": 896, "prompt_tokens": 23, diff --git a/tests/test_app_config.py b/tests/test_app_config.py index ed440ca75a..0c52da1eab 100644 --- a/tests/test_app_config.py +++ b/tests/test_app_config.py @@ -15,7 +15,7 @@ def minimal_env(monkeypatch): monkeypatch.setenv("AZURE_SEARCH_INDEX", "test-search-index") monkeypatch.setenv("AZURE_SEARCH_SERVICE", "test-search-service") monkeypatch.setenv("AZURE_OPENAI_SERVICE", "test-openai-service") - monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4o-mini") + monkeypatch.setenv("AZURE_OPENAI_CHATGPT_MODEL", "gpt-4.1-mini") monkeypatch.setenv("AZURE_OPENAI_EMB_MODEL_NAME", "text-embedding-3-large") monkeypatch.setenv("AZURE_OPENAI_EMB_DIMENSIONS", "3072") yield diff --git a/tests/test_chatapproach.py b/tests/test_chatapproach.py index c9417d7b0e..70c5ace4c1 100644 --- a/tests/test_chatapproach.py +++ b/tests/test_chatapproach.py @@ -35,7 +35,7 @@ def chat_approach(): agent_client=None, auth_helper=None, openai_client=None, - chatgpt_model="gpt-4o-mini", + chatgpt_model="gpt-4.1-mini", chatgpt_deployment="chat", embedding_deployment="embeddings", embedding_model=MOCK_EMBEDDING_MODEL_NAME, @@ -55,7 +55,7 @@ def test_get_search_query(chat_approach): "id": "chatcmpl-81JkxYqYppUkPtOAia40gki2vJ9QM", "object": "chat.completion", "created": 1695324963, - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "prompt_filter_results": [ { "prompt_index": 0, @@ -117,7 +117,7 @@ def test_get_search_query(chat_approach): def test_get_search_query_returns_default(chat_approach): - payload = '{"id":"chatcmpl-81JkxYqYppUkPtOAia40gki2vJ9QM","object":"chat.completion","created":1695324963,"model":"gpt-4o-mini","prompt_filter_results":[{"prompt_index":0,"content_filter_results":{"hate":{"filtered":false,"severity":"safe"},"self_harm":{"filtered":false,"severity":"safe"},"sexual":{"filtered":false,"severity":"safe"},"violence":{"filtered":false,"severity":"safe"}}}],"choices":[{"index":0,"finish_reason":"function_call","message":{"content":"","role":"assistant"},"content_filter_results":{}}],"usage":{"completion_tokens":19,"prompt_tokens":425,"total_tokens":444}}' + payload = '{"id":"chatcmpl-81JkxYqYppUkPtOAia40gki2vJ9QM","object":"chat.completion","created":1695324963,"model":"gpt-4.1-mini","prompt_filter_results":[{"prompt_index":0,"content_filter_results":{"hate":{"filtered":false,"severity":"safe"},"self_harm":{"filtered":false,"severity":"safe"},"sexual":{"filtered":false,"severity":"safe"},"violence":{"filtered":false,"severity":"safe"}}}],"choices":[{"index":0,"finish_reason":"function_call","message":{"content":"","role":"assistant"},"content_filter_results":{}}],"usage":{"completion_tokens":19,"prompt_tokens":425,"total_tokens":444}}' default_query = "hello" chatcompletions = ChatCompletion.model_validate(json.loads(payload), strict=False) query = chat_approach.get_search_query(chatcompletions, default_query) @@ -186,7 +186,7 @@ async def test_search_results_filtering_by_scores( agent_client=None, auth_helper=None, openai_client=None, - chatgpt_model="gpt-4o-mini", + chatgpt_model="gpt-4.1-mini", chatgpt_deployment="chat", embedding_deployment="embeddings", embedding_model=MOCK_EMBEDDING_MODEL_NAME, diff --git a/tests/test_chatvisionapproach.py b/tests/test_chatvisionapproach.py index 7039cae395..95740c2fab 100644 --- a/tests/test_chatvisionapproach.py +++ b/tests/test_chatvisionapproach.py @@ -53,7 +53,7 @@ def chat_approach(openai_client, mock_confidential_client_success): blob_container_client=None, vision_endpoint="endpoint", vision_token_provider=lambda: "token", - chatgpt_model="gpt-4o-mini", + chatgpt_model="gpt-4.1-mini", chatgpt_deployment="chat", gpt4v_deployment="gpt-4v", gpt4v_model="gpt-4v", @@ -80,7 +80,7 @@ def test_get_search_query(chat_approach): "id": "chatcmpl-81JkxYqYppUkPtOAia40gki2vJ9QM", "object": "chat.completion", "created": 1695324963, - "model": "gpt-4o-mini", + "model": "gpt-4.1-mini", "prompt_filter_results": [ { "prompt_index": 0,