UHC certification Questions and Answers
100% Solved
If a PCP is required and the customer does not indicate one on the enrollment application, a
_____ will automatically assigned Correct Answ_PCP
To avoid member complaints, encourage customers to select a ____and make sure the _____ is
accepting new patients Correct Answ_PCP
In which plan ( HMO/POS) are out of network benefits available at a higher cost? Correct
Answ_POS
With a PFFS plan, does a PCP need to be selected? and are prior authorizations or referrals from
a PCP required? Correct Answ_No, NO
once a member with a MAP reaches the maximum OOP expenses, is there cost sharing for any
additional services? Correct Answ_no
,MA plans with an OON component may or may not have an? Correct Answ_OOP maximum
for OON services depending on the plan
All medicare covered ( part A and part B) services count torward the? Correct Answ_OOP
maxium with MAP's
Services and deatures that do not count toward the maxium OOP in a MAP include? Correct
Answ_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 Answ_Yes
UHC strongly discourages Dual-eligible customers, from enrolling into a PFFS plan due to?
Correct Answ_having potential negative impacts to the customer
What does dual eligible customers mean? Correct Answ_having both medicare and medicaid
Before enrolling any customer into a PFFS plan, ask if they are enrolled in a state _____
program? Correct Answ_medicaid
, If a customer is enrolled in a state medicaid program, explain to them that a PFFS plan may
Correct Answ_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 Answ_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 Answ_enrolling
What type of plan can be network based or non-network based? Correct Answ_PFFS
UHC does not offer network-based ___ plans? Correct Answ_PFFS
what is deeming? Correct Answ_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 Answ_one that is
100% Solved
If a PCP is required and the customer does not indicate one on the enrollment application, a
_____ will automatically assigned Correct Answ_PCP
To avoid member complaints, encourage customers to select a ____and make sure the _____ is
accepting new patients Correct Answ_PCP
In which plan ( HMO/POS) are out of network benefits available at a higher cost? Correct
Answ_POS
With a PFFS plan, does a PCP need to be selected? and are prior authorizations or referrals from
a PCP required? Correct Answ_No, NO
once a member with a MAP reaches the maximum OOP expenses, is there cost sharing for any
additional services? Correct Answ_no
,MA plans with an OON component may or may not have an? Correct Answ_OOP maximum
for OON services depending on the plan
All medicare covered ( part A and part B) services count torward the? Correct Answ_OOP
maxium with MAP's
Services and deatures that do not count toward the maxium OOP in a MAP include? Correct
Answ_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 Answ_Yes
UHC strongly discourages Dual-eligible customers, from enrolling into a PFFS plan due to?
Correct Answ_having potential negative impacts to the customer
What does dual eligible customers mean? Correct Answ_having both medicare and medicaid
Before enrolling any customer into a PFFS plan, ask if they are enrolled in a state _____
program? Correct Answ_medicaid
, If a customer is enrolled in a state medicaid program, explain to them that a PFFS plan may
Correct Answ_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 Answ_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 Answ_enrolling
What type of plan can be network based or non-network based? Correct Answ_PFFS
UHC does not offer network-based ___ plans? Correct Answ_PFFS
what is deeming? Correct Answ_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 Answ_one that is
