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WELLCARE ACT MASTERY EXAM 2025
Complete Q&A Study Guide (Verified
Questions & Answers)
When a paper SOA form is used, it must be completed __________ hosting the sales presentation. - CORRECT ANSWER Prior to A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. - CORRECT ANSWER False A Health Risk Assessment (HRA) can be completed for C-SNP and DSNP plans only, before the enrollment application process in Ascend through the Value Based Enrollment (VBE) portal. - CORRECT ANSWER False Health risk assessment (HRA) - CORRECT ANSWER All of the above Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? - CORRECT ANSWER All of the above Low-Income Subsidy (LIS)/Medicaid Lookup status verification in Ascend is: (Select all that apply.) - CORRECT ANSWER - Available for LIS level searches in all states
- Available for Medicaid status searches in select states.
- A way to assist brokers/agents with enrolling beneficiaries into the right plan based on their extra help status. When discussing prescription drug coverage, you should: (Select all that apply.) - CORRECT ANSWER - Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits).
- Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
- Explain formulary tiers as well as drug copayment amounts.
- For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception Communication of PHI can be: (Select all that apply.) - CORRECT ANSWER Written Electronic Verbal Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 minutes after the event start time.
- CORRECT ANSWER False Which elements are available as part of Wellcare's sales support model? - CORRECT ANSWER All of the above Brokers/Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products. - CORRECT ANSWER True
The information contained within ACT will equip brokers/agents to certify, market, and sell which health plans? - CORRECT ANSWER All of the above The _________ plan is expected to have one of the lowest premiums in the country! - CORRECT ANSWER Value Script ____ PDPs will be offered across all 50 U.S. states and Washington, D.C. - CORRECT ANSWER Three For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions. - CORRECT ANSWER Value Plus The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023. - CORRECT ANSWER True Value Script and Value Plus PDP products have a ___-tier formulary structure for 2023. - CORRECT ANSWER 6 Centene has new PPO D-SNP product expansion in CT, IN, KS, KY, MS, OH, OK, PA, SC, and a new HMO D-SNP in LA. - CORRECT ANSWER True Which standalone Prescription Drug Plan is best for a dual-eligible chooser? - CORRECT ANSWER Classic The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on all Value Script, Value Plus PDPs, and select Wellcare MAPD plans. - CORRECT ANSWER True
There are ___ LIS copay categories that could be assigned to a member, depending on the level of need. - CORRECT ANSWER Four For 2023, Ascension Complete added 27 new counties to their footprint.
- CORRECT ANSWER True All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order). - CORRECT ANSWER True Centene continues to expand its reach by offering more products in a wider geography. ____ new Wellcare and Ascension Complete plans are going to market. - CORRECT ANSWER Forty-eight Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. True False - CORRECT ANSWER True The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be: (Select all that apply.) a. Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b. Verbally conveyed within the first minute of a sales call. c. Prominently displayed on TPMO websites (regardless of content). d. Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). - CORRECT ANSWER a. Included in any marketing materials, including print materials and
b. Telephonic c. Paper d. All of these - CORRECT ANSWER d. All of these Brokers/Agents can submit a support ticket online through their Centene Workbench portal. True False - CORRECT ANSWER True An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. True False - CORRECT ANSWER True *From October 1 to October 14, certain activities are Non-Permissible Activities. These include: a. Assist with completing an application b. Collect a completed application c. Advise the beneficiary to complete an application prior to October
d. All of these - CORRECT ANSWER d. All of these *NOT a. Assist with completing an application Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. True False - CORRECT ANSWER True
Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. True False - CORRECT ANSWER False The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). True False - CORRECT ANSWER True Which elements are available as part of Wellcare's Sales Support model? a. Online b. Local c. Corporate d. All of these - CORRECT ANSWER d. All of these Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: a. Member Satisfaction/Experience b. Complaints c. Rapid Disenrollment d. All of these - CORRECT ANSWER d. All of these Which of the following is not an example of Protected Health Information (PHI)? a. Medical records b. Payment history c. Library card - CORRECT ANSWER c. Library card
____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. a. Two b. Three c. Four d. Five - CORRECT ANSWER d. Five Wellcare added which state to its footprint for 2024? a. Alabama b. Arkansas c. Delaware d. Oklahoma - CORRECT ANSWER c. Delaware *Wellcare's 2024 product expansion represents a __% increase from
a. One b. Two c. Three d. Five - CORRECT ANSWER c. Three
- NOT c. Three The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. True False - CORRECT ANSWER True *Wellcare continues to expand its reach by offering more products in a wider geography. ____ new Wellcare plans are going to market. a. Twenty-three b. Twenty-seven
c. Thirty-five - CORRECT ANSWER b. Twenty-seven *NOT c. Thirty-five *Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? a. Classic b. Value Script c. Value Plus - CORRECT ANSWER a. Classic *NOT b. Value Script All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True False - CORRECT ANSWER True All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. a. Zero b. Five c. Ten d. Fifteen - CORRECT ANSWER a. Zero Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted. True
False - CORRECT ANSWER False Members who fail to pay the required premiums before the end of the grace period (Wellcare has a three-month grace period) will be terminated. True False - CORRECT ANSWER True When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True False - CORRECT ANSWER The Mastery Exam will lock for a period of 48 hours after each failed attempt. True False - CORRECT ANSWER False CustomPoint sales material order dates will be posted on Wellcare.com. True False - CORRECT ANSWER False Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) a. Complaint Tracking Module (CTM) b. Yelp Review c. Grievance d. Secret Shop Finding - CORRECT ANSWER a. Complaint Tracking Module (CTM) c. Grievance
d. Secret Shop Finding When explaining the provider network for D-SNPs and C-SNPs: (Select all that apply.) a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an innetwork doctor. c. Not explaining the provider network is a fundamental task during the enrollment process. d. None of these - CORRECT ANSWER a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an innetwork doctor. Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True False - CORRECT ANSWER True A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. a. 30 b. 45 c. 60 d. 90 - CORRECT ANSWER c. 60
d. The beneficiary enrolled by the enrollment deadline. - CORRECT ANSWER c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. ______ events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. a. Informal Sales b. Formal Sales c. Educational - CORRECT ANSWER c. Educational Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. True False - CORRECT ANSWER True Materials that include plan comparisons or cost-sharing do not require CMS submission. True False - CORRECT ANSWER False For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plan will continue to offer a discount (2.5 x 30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions. a. Classic b. Value Plus c. Value Script - CORRECT ANSWER b. Value Plus CVS Caremark Mail Order will be in-network for 2024. True
False - CORRECT ANSWER False A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need. a. Two b. Three c. Four d. Five - CORRECT ANSWER c. Four Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True False - CORRECT ANSWER True Which Prescription Drug Plan (PDP) product features no deductible on any tier? a. Classic b. Value Script c. Value Plus - CORRECT ANSWER c. Value Plus Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024? a. Express Scripts Pharmacy b. CVS Caremark c. Both A and B - CORRECT ANSWER a. Express Scripts Pharmacy The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)? a. PDP Only b. MAPD Only c. Both PDP & MAPD - CORRECT ANSWER c. Both PDP & MAPD
When verify a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligibility may affect enrollment and/or sharing. - CORRECT ANSWER True Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formal and informal). - CORRECT ANSWER False Which option is the preferred method to submit enrollment? - CORRECT ANSWER Ascend Web/Mobile Applicaiton From October 1 to October 14, certain activities are Non-Permissible Activities. These include: - CORRECT ANSWER All of these A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. - CORRECT ANSWER False A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse n Determination (Medicare) is a/an: - CORRECT ANSWER Appeal An SEP is a period outside of the ICEP, ARP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period? - CORRECT ANSWER True Communication of PHI can be: (Select all that apply.) - CORRECT ANSWER Written, Electronic, and Verbal
The online Centene Workbench self-service portal enables you to: - CORRECT ANSWER All of these If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed. - CORRECT ANSWER True Dual-eligible and LIS beneficiaries that are not at-risk may use a DualEligible SEP once per each of the _____ calendar quarters only. (Select all that apply.) - CORRECT ANSWER First, Second, and Third Brokers/agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) - CORRECT ANSWER Complaint Tracking Module (CTM), Grievance, and Secret Shop Finding Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: - CORRECT ANSWER All of these Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. - CORRECT ANSWER True Enrollment applications must be received by Wellcare no later than _____ calendar day(s) following receipt from the beneficiary. - CORRECT ANSWER One (1)
