Download 2023 UHC certifications 94 Questions WITH Complete Solutions and more Exams Health sciences in PDF only on Docsity!
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2023 UHC certifications 94 QUESTIONS
WITH COMPLETE SOLUTIONS
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? Correct Answer: Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility requirements. Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? Correct Answer: When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA Plan. Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? Correct Answer: Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) Correct Answer: 1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits.
- MA Plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? Correct Answer: Does not have any pre- existing conditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? Correct Answer: Members must receive covered services from contracted network providers with limited exceptions. Which of the following is NOT a correct statement about in-network provider services? Correct Answer: (INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network.
What is true about Medicare supplement open enrollment? Correct Answer: (INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 or older cannot qualify for Medicare Supplement Open Enrollment. (INCORRECT) It is the only time a consumer is eligible to purchase a Medicare Supplement Insurance Plan. Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate? Correct Answer: The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? Correct Answer: Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member must cancel their Medicare Supplement Insurance policy according to their carrier's rules. Which of the following best defines Medicare Part D? Correct Answer: It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. Which of the following is a fact about Medicare Prescription Drug Plans? Correct Answer: To enroll, member must be in plans service area What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) Correct Answer: Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage Which of the following statements does NOT correctly define prescription drug stages? Correct Answer: A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in.
An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). An MA Plan is part of Medicare and is also called Part C. Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? Correct Answer: Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? Correct Answer: HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? Correct Answer: She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? Correct Answer: A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium Which of the following statements is true about eligibility requirements for stand- alone Medicare Prescription Drug Plans? Correct Answer: A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? Correct Answer: They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? Correct Answer: Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what? Correct Answer: Utilization Management Rules A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone
prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for. Correct Answer: 63 or more continuous days Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? Correct Answer: Through subsidies such as lower or no monthly plan premiums and lower or no copayments Which of the following lists drug tiers from least expensive cost share to most expensive cost share? Correct Answer: Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? Correct Answer: Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? Correct Answer: Insured members have the freedom to choose any doctor who accepts Medicare patients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? Correct Answer: April 1 through October 31 Annual Election Period (AEP) is a time when... Correct Answer: Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? Correct Answer: Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? Correct Answer: When the consumer consented to be contacted for sales activities and the permission has not yet expired.
In what product should agents enroll consumers? Correct Answer: A product that is suitable for the consumer's needs, goals and financial resources. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? Correct Answer: Presented a plan before October 1 Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? Correct Answer: AARP endorses UnitedHealthcare MA, PDP and Medicare Supplement plans. AARP expects agents offering AARP-branded products to demonstrate five key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is. Correct Answer: Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) Correct Answer: Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information. Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare? Correct Answer: Yes, if the consumer is enrolling in a Medicare Supplement Plan. How many status levels are in the Authorized to Offer Program? Correct Answer: 2 According to AARP, there are how many individual AARP members? Correct Answer: Nearly 37 million Which of the following statements about AARP are TRUE? (Select 2) Correct Answer: The AARP motto is to serve, not be served.
AARP advocates for the 50+ population in congress for legislation to lower medical costs. Which of the following is TRUE about the production requirement for the Authorized to Offer Elite status? Correct Answer: Each calendar year, agents need to have at least 30 commission-eligible, accepted, and paid AARP Medicare Supplement Plan and/or Medicare Select Plan sales or retain a book of business of 150 or more active members. The value proposition for the AARP brand is seen in what kinds of benefits for the members? (Select 3) Correct Answer: Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3) Correct Answer: MA, PDP, Supplements Dual Special Needs Plans (D-SNP) are defined as which of the following: Correct Answer: Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid. When does the Special Election Period for Dual/LIS Change in Status begin for D- SNP members that lose Medicaid eligibility? Correct Answer: Upon notification or effective date of the loss, whichever is earlier Which consumer might benefit the most by enrolling in a D-SNP? Correct Answer: Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) Which statement best describes a care management program that varies depending upon the level of the member's health risk? Correct Answer: Support provided to C-SNP and D-SNP members that may have unique health care needs Select the statement that best describes a feature of D-SNPs. Correct Answer: D- SNPs are network-based When selling D-SNPs, agents must: Correct Answer: Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B Which consumer may be a good candidate for a D-SNP? Correct Answer: Anne, who does not pay a percentage of charges when she receives medical care
What type of event must an agent conduct when they want to be able to collect consumer information, schedule future appointments, and accept enrollment applications? Correct Answer: Marketing/sales event Which of the following does not describe a personal/individual marketing appointment? Correct Answer: It needs to be reported to UnitedHealthcare prior to advertising and not less than 7 calendar days prior to the date of the event When conducting an event, agents should select a site that is compliant with the Americans with Disabilities Act (ADA). Which of the following is not an ADA requirement? Correct Answer: Extra-wide sidewalks that accommodate wheelchairs Which of the following elements does not need to be entered on the NEW Event Request Form when reporting a new event? Correct Answer: The event venue manager/contact person Jeff has an informal marketing/sales event scheduled this afternoon, but a consumer has requested an in-home appointment during that time. He would like to cancel or reschedule the event because he is certain to get an enrollment application at the appointment. Which of the statements below is correct about Jeff's event? Correct Answer: Jeff is prohibited from canceling the event because it is within 1 business day and is not due to inclement weather. Jeff must hold his event or he could work with his manager to get a replacement to conduct the event. On October 1, Sam reported the formal marketing/sales event he has scheduled for 9 a.m. on November 19. Luckily, before he had flyers printed, he remembered he has an 8 a.m. dentist appointment November 19. Just to make sure he can get to his event on time, he advertises the event to start at 9:30 a.m. What event reporting infraction(s) might Sam incur? Correct Answer: (INCORRECT) None, Sam reported the event prior to advertising and not less than 7 calendar days prior to the date of the event Marcus is planning an educational event and has decided to place an advertisement in the local paper. What must the advertisement include? Correct Answer: A statement that makes it clear that the event is for educational purposes only. Which of the following food and beverage options may be provided at an educational event if the nominal retail value of the items when combined with
other giveaways does not exceed $15 per person? (Select 2) Correct Answer: Coffee, juice, fresh fruit, and pastries Boxed lunch with assorted non-alcoholic beverages If you conduct an educational event and invite a provider or vendor to be a part of the event, the provider/vendor must not do which of the following? Correct Answer: Provide free health screenings such as blood pressure checks or hearing tests as a marketing activity Agent John Rogers is planning a formal marketing/sales event and has decided to place an advertisement in the local paper. What disclaimers must John include in the advertisement? Correct Answer: "For accommodation of persons with special needs at sales meetings, call 555-555-1234, TTY 711." Janine is conducting a marketing/sales event in a senior center cafeteria. The cafeteria generally provides a dinner meal from 5pm to 6pm. Can Janine conduct her marketing/sales meeting in the cafeteria between 5pm and 6pm? Correct Answer: No, she can conduct an event that ends no later than 5pm or wait until after 6pm. Agent Rita Garcia must not do which of the following while conducting a marketing/sales event? Correct Answer: State the plan she is presenting is the best plan on the market. At a formal marketing/sales event, an agent presented information about prescription drug coverage. Which statement is not accurate? Correct Answer: Members and providers are not able to ask the plan for exceptions to any utilization management rules At an informal marketing/sales event, which of the following activities is not permitted? Correct Answer: Approaching consumers as they pass by your booth/kiosk/table Agent Santana has developed a relationship with Dr. Westberry, a Primary Care Provider contracted with several Medicare Advantage Plans. Dr. Westberry is asked to attend a formal marketing/sales event conducted by Agent Santana. Which of Dr. Westberry's actions is non-compliant? Correct Answer: Offers blood pressure screenings as consumers wait for the event to begin
