UHC CERTIFICATION EXAM SCRIPT 2026
FULL SOLUTION QUESTIONS AND
ANSWERS GRADED A+
⩥ If a customer is enrolled in a state medicaid program, explain to them
that a PFFS plan may
Answer: Impact their ability to continue seeing their current providers,
and may create OOP expenses they may not be able to afford.
⩥ If a customer on medicaid applies for a PFFS plan, the customer may
be responsible for?
Answer: cost sharing
⩥ Only enroll a dual eligible customer into a PFFS plan if the customer
insists on enrolling and disclose the potential impacts of
Answer: enrolling
⩥ What type of plan can be network based or non-network based?
Answer: PFFS
⩥ UHC does not offer network-based ___ plans?
Answer: PFFS
,⩥ what is deeming?
Answer: a key feature of a PFFS plan is that the member can choose
their health care provider both at home and when they travel in the US
⩥ What us a deemed provider?
Answer: one that is
A) aware in advance of furnishing health care services that the
individual receiving the services is enrolled in a PFFS plan
B) Has reasonable access to the plans terms and conditions of payment
in advance of furnishing services
C) furnishes services that are covered by the plan
⩥ What is a deemed provider
Answer: must participate in medicare and agree to the plans terms and
conditions of payment
⩥ PFFS member responsibilities?
Answer: the member must choose to use medicare-eligible provides who
agree to the plan's terms and conditions of payment in order to receive
coverage under the plan
present the member ID and inform provider of the PFFS membership
prior to each visit and before receiving covered services
⩥ CMS allows the PFFS plan to decide if balance ____ is permitted
, Answer: balance
⩥ Plans must ___ what is permitted in the terms and conditions of
payment
Answer: decide
⩥ MA plan should not be referred to as a
Answer: supplement replacement, supplement, replacement no cost, free
plan or zero cost plan
⩥ Medicare part D is a state program or a federal program
Answer: federal program
⩥ In order for a customer to obtain medicare part D, what must they
have to do?
Answer: they must enroll individually in a plan offered by a private
insurance company approved by medicare
⩥ In order to be eligible for part D, what must a client also have?
Answer: Part A and B
⩥ When a client enrolls in part D prescription drug coverage when they
first become eligible, what is that time period often called?
FULL SOLUTION QUESTIONS AND
ANSWERS GRADED A+
⩥ If a customer is enrolled in a state medicaid program, explain to them
that a PFFS plan may
Answer: Impact their ability to continue seeing their current providers,
and may create OOP expenses they may not be able to afford.
⩥ If a customer on medicaid applies for a PFFS plan, the customer may
be responsible for?
Answer: cost sharing
⩥ Only enroll a dual eligible customer into a PFFS plan if the customer
insists on enrolling and disclose the potential impacts of
Answer: enrolling
⩥ What type of plan can be network based or non-network based?
Answer: PFFS
⩥ UHC does not offer network-based ___ plans?
Answer: PFFS
,⩥ what is deeming?
Answer: a key feature of a PFFS plan is that the member can choose
their health care provider both at home and when they travel in the US
⩥ What us a deemed provider?
Answer: one that is
A) aware in advance of furnishing health care services that the
individual receiving the services is enrolled in a PFFS plan
B) Has reasonable access to the plans terms and conditions of payment
in advance of furnishing services
C) furnishes services that are covered by the plan
⩥ What is a deemed provider
Answer: must participate in medicare and agree to the plans terms and
conditions of payment
⩥ PFFS member responsibilities?
Answer: the member must choose to use medicare-eligible provides who
agree to the plan's terms and conditions of payment in order to receive
coverage under the plan
present the member ID and inform provider of the PFFS membership
prior to each visit and before receiving covered services
⩥ CMS allows the PFFS plan to decide if balance ____ is permitted
, Answer: balance
⩥ Plans must ___ what is permitted in the terms and conditions of
payment
Answer: decide
⩥ MA plan should not be referred to as a
Answer: supplement replacement, supplement, replacement no cost, free
plan or zero cost plan
⩥ Medicare part D is a state program or a federal program
Answer: federal program
⩥ In order for a customer to obtain medicare part D, what must they
have to do?
Answer: they must enroll individually in a plan offered by a private
insurance company approved by medicare
⩥ In order to be eligible for part D, what must a client also have?
Answer: Part A and B
⩥ When a client enrolls in part D prescription drug coverage when they
first become eligible, what is that time period often called?
