UHC UNITED HEALTHCARE UPDATED STUDY
GUIDE QUESTIONS AND ANSWERS SURE A+
✔✔What us a deemed provider? - ✔✔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 - ✔✔must participate in medicare and agree to the plans
terms and conditions of payment
✔✔PFFS member responsibilities? - ✔✔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 - ✔✔balance
✔✔Plans must ___ what is permitted in the terms and conditions of payment -
✔✔decide
, ✔✔MA plan should not be referred to as a - ✔✔supplement replacement, supplement,
replacement no cost, free plan or zero cost plan
✔✔Medicare part D is a state program or a federal program - ✔✔federal program
✔✔In order for a customer to obtain medicare part D, what must they have to do? -
✔✔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? - ✔✔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? - ✔✔Initial enrollment period
✔✔consumers can also enroll, disenroll or change coverage each year between when?
- ✔✔october 15- dec 15th during the annual election period( AEP)
✔✔AEP? - ✔✔annual enrollment period
✔✔OEP? - ✔✔Open enrollment period
✔✔MA plan members whop use the OEP to disenroll from their MA plan and obtain
coverage from original medicare, may enroll in a stand alone what plan? - ✔✔part D
plan
✔✔____ does not allow for PDP enrollment changes? - ✔✔PDP
✔✔What is a PDP? - ✔✔a stand alone medicare prescription drug plan
✔✔What do PDP's do? - ✔✔add prescription drug coverage to original medicare,
MSA's, some medicare cost plans, and some medicare private fee for service PFFS
plans
✔✔WHat type of stand alone variations to medicare can give extra benefits? -
✔✔A+B+D
C+D
✔✔When a consumer has original medicare and a prescription drug plan, they can also
have a medicare________ insurance plan - ✔✔medicare supplement insurance plan
✔✔There are 4 stages to medicare part standard prescription drug coverage; what are
they? - ✔✔1) yearly deductible
GUIDE QUESTIONS AND ANSWERS SURE A+
✔✔What us a deemed provider? - ✔✔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 - ✔✔must participate in medicare and agree to the plans
terms and conditions of payment
✔✔PFFS member responsibilities? - ✔✔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 - ✔✔balance
✔✔Plans must ___ what is permitted in the terms and conditions of payment -
✔✔decide
, ✔✔MA plan should not be referred to as a - ✔✔supplement replacement, supplement,
replacement no cost, free plan or zero cost plan
✔✔Medicare part D is a state program or a federal program - ✔✔federal program
✔✔In order for a customer to obtain medicare part D, what must they have to do? -
✔✔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? - ✔✔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? - ✔✔Initial enrollment period
✔✔consumers can also enroll, disenroll or change coverage each year between when?
- ✔✔october 15- dec 15th during the annual election period( AEP)
✔✔AEP? - ✔✔annual enrollment period
✔✔OEP? - ✔✔Open enrollment period
✔✔MA plan members whop use the OEP to disenroll from their MA plan and obtain
coverage from original medicare, may enroll in a stand alone what plan? - ✔✔part D
plan
✔✔____ does not allow for PDP enrollment changes? - ✔✔PDP
✔✔What is a PDP? - ✔✔a stand alone medicare prescription drug plan
✔✔What do PDP's do? - ✔✔add prescription drug coverage to original medicare,
MSA's, some medicare cost plans, and some medicare private fee for service PFFS
plans
✔✔WHat type of stand alone variations to medicare can give extra benefits? -
✔✔A+B+D
C+D
✔✔When a consumer has original medicare and a prescription drug plan, they can also
have a medicare________ insurance plan - ✔✔medicare supplement insurance plan
✔✔There are 4 stages to medicare part standard prescription drug coverage; what are
they? - ✔✔1) yearly deductible
