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WELLCARE ACT MASTERY EXAM 2025
Complete Q&A Study Guide (Verified
Questions & Answers)
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 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). When a paper SOA form is used, it must be completed __________ hosting the sales presentation. a. 48 Hours prior to b. During c. After - CORRECT ANSWER a. 48 Hours prior to
When verifying 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 eligiblity may affect enrollment and/or cost sharing. True False - CORRECT ANSWER True Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? a. Member Service b. Reputation c. Member Payments d. Serving Government Customers - CORRECT ANSWER c. Member Payments Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a. Ascend 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
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 Which option is the preferred method to submit enrollment? a. Centene Workbench Upload b. Ascend Web/Mobile Application c. Fax/Paper - CORRECT ANSWER b. Ascend Web/Mobile Application With which types of inquiries can Wellcare's Corporate Sales Support team assist? a. Application and Enrollment b. Onboarding and Certifications c. Commissions d. All of these - CORRECT ANSWER d. All of these A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an: a. Appeal b. Grievance - CORRECT ANSWER a. Appeal The Prescription Drug Plan (PDP) network is expected to include over ____ total pharmacies. a. Sixty Thousand b. Thirty Thousand c. Twenty Thousand - CORRECT ANSWER a. Sixty Thousand With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card 1/1/2024 and beyond. True False - CORRECT ANSWER False
____ 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 2023. 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
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums. True False - CORRECT ANSWER False Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. a. 1 b. 3 c. 5 d. 7 - CORRECT ANSWER a. 1 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. True False - CORRECT ANSWER True Once the enrollment is completed, you can save a copy of the application for your reference. 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.
Which is an example of a top beneficiary complaint that affects Star Ratings? a. The beneficiary was enrolled in the correct plan. b. The provider was in-network and contracted with the selected plan. c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. 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 In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for the remainder of the year once their total out of pocket costs reach $8,000. a. Three
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) Which elements are available as part of Wellcare's Sales Support model?
- CORRECT ANSWER All of these When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. - CORRECT ANSWER True 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. - CORRECT ANSWER Value Plus Which Prescription Drug Plan (PDP) product features no deductible on any tier? - CORRECT ANSWER Value Plus Which of the Prescription Drug Plan (PDP) product is new to the 6-tier formulary structure for 2024? - CORRECT ANSWER Classic _____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. - CORRECT ANSWER Three
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums - CORRECT ANSWER False Prior to completing the enrollment form, broker/agents should always confirm the beneficiary's primary care provider (PCP) and/or specialists - CORRECT ANSWER True At the end of this course, there will be a Mastery Exam. Agents must achieve a passing score of 85% or higher to successfully complete this course - CORRECT ANSWER True Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a - CORRECT ANSWER Complaint Tracking Module (CTM) Grievance Secret Shop Finding A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. - CORRECT ANSWER False Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formaland informal). - CORRECT ANSWER False 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. - CORRECT ANSWER True CustomPoint sales material order dates will be posted on Wellcare.com - CORRECT ANSWER False The online Centene Workbench self-service portal enables you to - CORRECT ANSWER All of these
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: - CORRECT ANSWER Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. Verbally conveyed within the first minute of a sales call. Prominently displayed on TPMO websites (regardless of content). Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. - CORRECT ANSWER All of these Which of the following is not an example of Protected Health Information (PHI)? - CORRECT ANSWER Library Card When a paper SOA form is used, it must be completed __________ hosting the sales presentation. - CORRECT ANSWER 48 Hours prior to Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. - CORRECT ANSWER True When explaining the provider network for D-SNPs and C-SNPs: - CORRECT ANSWER Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor
Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM, OH, OK, TX, and WI. - CORRECT ANSWER True All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. - CORRECT ANSWER True ____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. - CORRECT ANSWER Three Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. - CORRECT ANSWER True When verifying 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 cost sharing.
- CORRECT ANSWER True Which of the following statements about Scope of Appointment (SOA) is FALSE? - CORRECT ANSWER An electronic SOA submitted in Ascend must be in a Pending status prior to beginning the appointment. Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: - CORRECT ANSWER All of these Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no later than 30 days of use. - CORRECT ANSWER False When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. - CORRECT ANSWER True
Providers may create co-branded marketing pieces using the Wellcare name and logo, as long as they are using the current, approved logo. - CORRECT ANSWER False Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? - CORRECT ANSWER All of these Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. - CORRECT ANSWER True Which of the following is not considered a grievance? - CORRECT ANSWER A dispute of the appeal of an organization determination, coverage determination, or a Late Enrollment Penalty (LEP) determination. Brokers/Agents can access and download enrollment materials through CustomPoint. - CORRECT ANSWER True ______ 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. - CORRECT ANSWER Educational Materials that include plan comparisons or cost-sharing do not require CMS submission. - CORRECT ANSWER False Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? - CORRECT ANSWER Member Payments The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)? - CORRECT ANSWER Both
