UHC CERTIFICATION EXAM (2 VERSIONS) |
NEWEST ACTUAL EXAM COMPREHENSIVE
QUESTIONS AND VERIFIED ANSWERS
GRADED A+ | 100% PASS | 2025 UPDATE!
What is strep up therapy? - ✔✔✔ Correct Answer > its an effective,
clinically proven, lower-cost alternative to some drugs that treat the
same health condition. A plan may require that a member try an
alternate drug before covering the requested drug. if a member has
already tried other drugs or a provider thinks other drugs are not right
for the situation, a member or their doctor can ask the plan to cover
these drugs
What are the different types of MA plans? - ✔✔✔ Correct Answer >
HMO, POS, PPO, RPPO, PFFS, SNP, and MSA
Who qualifies for a medication therapy management program? - ✔✔✔
Correct Answer > members enrolled in a medicare prescription drug
plan who take medications for multiple medical conditions may qualify
at no additional cost, for a medication therapy management program(
MTM)
,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
To ensure safe and efficient use of a drug, the plan and/or medicare
sets a quantity limit that defines how much of a medication a member
can receive at a time. some drugs require approval from the plan prior
to the member filling their prescription. - ✔✔✔ Correct Answer > if a
member is prescribed or requires more of a medication than allows, the
member or their doctor can contact the plan and ask for an exception.
Some drugs require pre-approval by the plan. A member of their
provider can ask a plan to cover the drug. - ✔✔✔ Correct Answer >
the plan may ask the member or provider for additional information to
help ensure the drug is appropriate for medicare-eligible health
conditions. A member might be asked to try another drug on the
formulary before the plan will cover the drug they are requesting.
How does the MTM program work? - ✔✔✔ Correct Answer > it helps
physicians and members ensure their medications are working to help
improve their health
, To be enrolled in a MTM, a customer MUST - ✔✔✔ Correct Answer >
1) have a chronic health condition
2) member takes several different medications
3) Member's medications have a combined cost of more than $3,919
per year
to be enrolled in the MTM program ( medication therapy program) the
enrolled member must meet all of the following - ✔✔✔ Correct
Answer > 1) member has more than one chronic health condition
2) Member takes several different medications
3) Member's medications have a combined cost of more than $3,919
per year
( the dollar amount can change per year) is estimated based on OOP
costs and the costs the plan pays for the medications each calendar
year. the plan can help members determine if they may reach this
dollar limit.
A list of drugs covered within the part D benefit plan - ✔✔✔ Correct
Answer > formulary
Money spent ( excluding premiums) during the Deductible, initial
coverage and coverage gap stages count toward ____, which
determines when a member moves from the drug coverage stage to
the next - ✔✔✔ Correct Answer > TrOOP
NEWEST ACTUAL EXAM COMPREHENSIVE
QUESTIONS AND VERIFIED ANSWERS
GRADED A+ | 100% PASS | 2025 UPDATE!
What is strep up therapy? - ✔✔✔ Correct Answer > its an effective,
clinically proven, lower-cost alternative to some drugs that treat the
same health condition. A plan may require that a member try an
alternate drug before covering the requested drug. if a member has
already tried other drugs or a provider thinks other drugs are not right
for the situation, a member or their doctor can ask the plan to cover
these drugs
What are the different types of MA plans? - ✔✔✔ Correct Answer >
HMO, POS, PPO, RPPO, PFFS, SNP, and MSA
Who qualifies for a medication therapy management program? - ✔✔✔
Correct Answer > members enrolled in a medicare prescription drug
plan who take medications for multiple medical conditions may qualify
at no additional cost, for a medication therapy management program(
MTM)
,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
To ensure safe and efficient use of a drug, the plan and/or medicare
sets a quantity limit that defines how much of a medication a member
can receive at a time. some drugs require approval from the plan prior
to the member filling their prescription. - ✔✔✔ Correct Answer > if a
member is prescribed or requires more of a medication than allows, the
member or their doctor can contact the plan and ask for an exception.
Some drugs require pre-approval by the plan. A member of their
provider can ask a plan to cover the drug. - ✔✔✔ Correct Answer >
the plan may ask the member or provider for additional information to
help ensure the drug is appropriate for medicare-eligible health
conditions. A member might be asked to try another drug on the
formulary before the plan will cover the drug they are requesting.
How does the MTM program work? - ✔✔✔ Correct Answer > it helps
physicians and members ensure their medications are working to help
improve their health
, To be enrolled in a MTM, a customer MUST - ✔✔✔ Correct Answer >
1) have a chronic health condition
2) member takes several different medications
3) Member's medications have a combined cost of more than $3,919
per year
to be enrolled in the MTM program ( medication therapy program) the
enrolled member must meet all of the following - ✔✔✔ Correct
Answer > 1) member has more than one chronic health condition
2) Member takes several different medications
3) Member's medications have a combined cost of more than $3,919
per year
( the dollar amount can change per year) is estimated based on OOP
costs and the costs the plan pays for the medications each calendar
year. the plan can help members determine if they may reach this
dollar limit.
A list of drugs covered within the part D benefit plan - ✔✔✔ Correct
Answer > formulary
Money spent ( excluding premiums) during the Deductible, initial
coverage and coverage gap stages count toward ____, which
determines when a member moves from the drug coverage stage to
the next - ✔✔✔ Correct Answer > TrOOP
