UHC certification DUE 25 OCTOBER 2023

UHC certification DUE 25 OCTOBER 2023 Medicare - CORRECT ANSWER-Federal health insurance program Medicare is administered by whom? - CORRECT ANSWER-CMS ( Centers for medicare and medicaid services) Parts A & B of medicare are - CORRECT ANSWER-federal health insurance program referred to as original medicare Part A? - CORRECT ANSWER-Hospital insurance Part B? - CORRECT ANSWER-Medical insurance What doesnt medicare cover? - CORRECT ANSWER-routine dental, eye care hearing exam,deductibles, coinsurance and copayments Part C? - CORRECT ANSWER-Medicare Advantage Plans MA covers? - CORRECT ANSWER-Part A &B coverage, and some part D coverage MA plans are not? - CORRECT ANSWER-Medicare supplement insurance plans What offers lower monthly premiums MADP or supplement? - CORRECT ANSWERMADP do MAP's have a annual maximum OOP maximum that limits the amount of money a member must spend every year for covered services? - CORRECT ANSWER-YES MA plans integrate what type of additonal coverage? - CORRECT ANSWER-part D prescription drug coverage If a customer wants to keep their stand alone prescription drug plan, what may the customer want to enroll in? - CORRECT ANSWER-MA-only PFFS plan What is a stand alone drug plan called? - CORRECT ANSWER-PDP WHat is PFFS? - CORRECT ANSWER-Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or hospital that accepts their terms If a customer lives in a rural area, what type of plan may they want because it gives them freedom to access doctors that may not be in their network? - CORRECT ANSWER-PFFS plan Do HMO's require referals? - CORRECT ANSWER-Yes Do PPO's require a referal? - CORRECT ANSWER-No When a member enrolls in a MA plan, they receive their coverage from medicare or the MA plan? - CORRECT ANSWER-MA plan When a customer is enrolled in a MA plan, they must continue paying their premiums for what other plan? - CORRECT ANSWER-Part B MA plans have a maxium annual limit on OOP costs called a? - CORRECT ANSWERMOOP amount ( Maxium out of pocket) When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA plan or PDP( prescription drug plan) in which they are enrolled as of the new plans_____? - CORRECT ANSWER-effective date An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? - CORRECT ANSWER-Stand alone PDP If a member enrolls in a MA plan, what must the member do? - CORRECT ANSWERCancel in writing their medicare supplement insurance policy with the carrier after their request to enroll in MA plan has been approved. Medicare supplement insurance policies cannot be used in conjunction with what type of plan? - CORRECT ANSWER-MA plan A medicare supplement insurance plan helps to cover some of the OOP costs associated with? - CORRECT ANSWER-original medicare. A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan? - CORRECT ANSWER-MA plan when a client enrolls in a MA plan, will it automatically terminate their MA plan? - CORRECT ANSWER-NO Can a customer call to terminate their Med Sup plan? - CORRECT ANSWER-no it must be done in writing What are the different types of MA plans? - CORRECT ANSWER-HMO, POS, PPO, RPPO, PFFS, SNP, and MSA For an HMO, they customer must us IN network providers, what are the exceptions to their rule? - CORRECT ANSWER-Emergencies, Urgent care, and renal dialysis services. In a HMO plan, does a member have to choose a PCP? and do they require referrals to see a specialist? - CORRECT ANSWER-Yes In a POS plan, does a member need a referral from their PCP to see a specialist? - CORRECT ANSWER-yes Can a member with a POS plan see a specialist? - CORRECT ANSWER-Yes, but they may have to pay a higher cost, and there coverage limits With a PFFS plan, can a member seek treatment from any medicare eligible provider who agrees to accept the plans conditions and payment rates? - CORRECT ANSWERYes Does a PCP need to be selected with a PFFS plan? - CORRECT ANSWER-No What is the only plan to offer non-network PFFS plans? - CORRECT ANSWER-UHC What are SNP's for? ( Dual SNP) - CORRECT ANSWER-People who have both medicare and Medicaid Institutional SNP? - CORRECT ANSWER-Nursing homes Chronic condition SNP? - CORRECT ANSWER-people who have certain chronic medical conditions MSA? - CORRECT ANSWER-Medical savings account What does a MSA do? - CORRECT ANSWER-Combines a high deductible medicare advantage plan and a bank account How does MSA plans work? - CORRECT ANSWER-the plan deposits money from emdicare in the account which can then be used to pay for medical expenses until their deductible is met Does UHC currently offer a MSA? - CORRECT ANSWER-no MA plans include some key features such as? - CORRECT ANSWER-Prescription drug coverage, PCPs and a OOP maxium In a MA-Part D plan, A member will be disenrolled from their stand alone PDP upon enrollment in a ? - CORRECT ANSWER-MA-PD in a MA-part D plan, A member will be disenrolled from their MA-PD upon enrollment in? - CORRECT ANSWER-a stand-alone PDP With MA only, a member will be disenrolled from their stand alone PDP upon enrolling in a? - CORRECT ANSWER-Non-PFFS MA-only plan in MA-only, a member will be disenrolled from their non-PFFS MA-only plan upon enrolling in a? - CORRECT ANSWER-Stand alone PDP most MA plans require a what? although not all plans require that the chosen____ cordinate the members care - CORRECT ANSWER-PCP selection If a PCP is required and the customer does not indicate one on the enrollment application, a _____ will automatically assigned - CORRECT ANSWER-PCP To avoid member complaints, encourage customers to select a ____and make sure the _____ is accepting new patients - CORRECT ANSWER-PCP In which plan ( HMO/POS) are out of network benefits available at a higher cost? - CORRECT ANSWER-POS With a PFFS plan, does a PCP need to be selected? and are prior authorizations or referrals from a PCP required? - CORRECT ANSWER-No, NO once a member with a MAP reaches the maximum OOP expenses, is there cost sharing for any additional services? - CORRECT ANSWER-no MA plans with an OON component may or may not have an? - CORRECT ANSWEROOP maximum for OON services depending on the plan All medicare covered ( part A and part B) services count torward the? - CORRECT ANSWER-OOP maxium with MAP's Services and deatures that do not count toward the maxium OOP in a MAP include? - CORRECT ANSWER-plan premium, part D prescription drugs and any non-medicare covered services such as eyewear and hearing aids Is the OOP maximum amount different between MA plans? - CORRECT ANSWER-Yes UHC strongly discourages Dual-eligible customers, from enrolling into a PFFS plan due to? - CORRECT ANSWER-having potential negative impacts to the customer What does dual eligible customers mean? - CORRECT ANSWER-having both medicare and medicaid Before enrolling any customer into a PFFS plan, ask if they are enrolled in a state _____ program? - CORRECT ANSWER-medicaid If a customer is enrolled in a state medicaid program, explain to them that a PFFS plan may - CORRECT 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? - CORRECT 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 - CORRECT ANSWER-enrolling What type of plan can be network based or non-network based? - CORRECT ANSWER-PFFS UHC does not offer network-based ___ plans? - CORRECT ANSWER-PFFS what is deeming? - CORRECT 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? - CORRECT 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 - CORRECT ANSWER-must participate in medicare and agree to the plans terms and conditions of payment PFFS member responsibilities? - CORRECT 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 - CORRECT ANSWER-balance Plans must ___ what is permitted in the terms and conditions of payment - CORRECT ANSWER-decide MA plan should not be referred to as a - CORRECT ANSWER-supplement replacement, supplement, replacement no cost, free plan or zero cost plan Medicare part D is a state program or a federal program - CORRECT ANSWER-federa