2023 Wellcare ACT Mastery Exam LATEST VERSION |NEW UPDATE |GUARANTEED PASS| |BEST STUDYING MATERIAL

1. When a paper SOA form is used, it must be completed __________ hosting the sales presentation. A) Prior to B) During C) After D) Within 24 hours Correct Answer: A) Prior to Rationale: The Scope of Appointment (SOA) form must be completed prior to hosting the sales presentation to ensure the beneficiary's consent is documented before any discussion of Medicare products. 2. A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. A) True B) False Correct Answer: B) False Rationale: A Corrective Action Plan (CAP) can be issued for noncompliance regardless of whether the broker/agent has had prior verbal warnings, as compliance is expected at all times. 3. A Health Risk Assessment (HRA) can be completed for C-SNP and D-SNP plans only, before the enrollment application process in Ascend through the Value-Based Enrollment (VBE) portal. A) True B) False : B) False Rationale: The Health Risk Assessment (HRA) can be completed for C-SNP and D-SNP plans, but it can be done after the enrollment application process, not necessarily before it through the VBE portal. 4. Health risk assessment (HRA) A) Provides physicians with an overview of a member's health status. B) Ensures members are able to access care and receive services that meet their needs. C) Is an important part of our quality initiative, directly impacting our Star Ratings. D) All of the above Correct Answer: D) All of the above Rationale: The Health Risk Assessment (HRA) helps in understanding the health status of members, ensuring proper care access, and plays a crucial role in improving quality initiatives that affect Medicare Star Ratings. 5. Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? A) Paper B) Electronic C) Telephonic D) All of the above Correct Answer: D) All of the above Rationale: Wellcare accepts various methods for submitting Scope of Appointment (SOA) forms, including paper, electronic, and telephonic, based on the preferences of the beneficiary and the method of communication. 6. Low-Income Subsidy (LIS)/Medicaid Lookup status verification in Ascend is: (Select all that apply.) A) Available for LIS level searches in all states B) Available for Medicaid status searches in select states C) A way to assist brokers/agents with enrolling beneficiaries into the right plan based on their extra help status D) All of the above : D) All of the above Rationale: Ascend provides tools to verify LIS and Medicaid status, assisting brokers/agents in enrolling beneficiaries in the correct plan based on their extra help eligibility and state-specific availability. 7. When discussing prescription drug coverage, you should: (Select all that apply.) A) Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). B) Confirm coverage of the beneficiary's current and/or anticipated prescriptions. C) Explain formulary tiers as well as drug copayment amounts. D) For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Correct Answer: A) Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). B) Confirm coverage of the beneficiary's current and/or anticipated prescriptions. C) Explain formulary tiers as well as drug copayment amounts. D) For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Rationale: All of the above actions are important when discussing prescription drug coverage to ensure beneficiaries understand what is covered and how to handle any non-covered drugs. 8. Communication of PHI can be: (Select all that apply.) A) Written B) Electronic C) Verbal Correct Answer: A) Written B) Electronic C) Verbal Rationale: Protected Health Information (PHI) can be communicated in written, electronic, or verbal formats, as long as it adheres to privacy and security standards. 9. Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 minutes after the event start time. A) True B) False : B) False Rationale: Wellcare requires notice of event changes or cancellations as soon as possible, but the timing requirement is typically longer than 30 minutes after the event starts. 10. Which elements are available as part of Wellcare's sales support model? A) Online B) Local C) Corporate D) All of the above Correct Answer: D) All of the above Rationale: Wellcare's sales support model includes online, local, and corporate resources to help brokers/agents succeed in their roles. 11. Brokers/Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products. A) True B) False Correct Answer: A) True Rationale: Brokers and agents must meet the required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare products, ensuring they are properly prepared to represent the plans. 12. What are some examples of what can trigger a beneficiary complaint? (Select all that apply.) A) Did not consent to enroll in the plan. B) Received incorrect plan benefit information or were dissatisfied with plan benefits. C) Had enrollment/disenrollment issues (e.g., disenrollment/cancellation requests, late enrollment penalty, loss of entitlement). D) Were misled about which providers were in-network Correct Answer: A) Did not consent to enroll in the plan. B) Received incorrect plan benefit information or were dissatisfied with plan benefits. C) Had enrollment/disenrollment issues (e.g., disenrollment/cancellation requests, late enrollment penalty, loss of entitlement). D) Were misled about which providers were in-network Rationale: Any of the listed situations can trigger a beneficiary complaint, which is why it's important for brokers/agents to ensure full transparency and compliance during the sales process. 13. Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. A) True B) False Correct Answer: A) True Rationale: Noting the correct enrollment period helps prevent delays in the enrollment process, ensuring beneficiaries are enrolled in the correct plan during the appropriate time frame. 14. Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: A) Member Satisfaction/Experience B) Complaints C) Rapid Disenrollment D) All of the above Correct Answer: D) All of the above Rationale: Brokers/agents play a role in member satisfaction, reducing complaints, and minimizing rapid disenrollment, all of which impact the Medicare Star Ratings. 15. Health plan fax numbers vary for health plans that offer fax enrollment submissions. A) True B) False Correct Answer: A) True Rationale: Health plan fax numbers may vary depending on the health plan and enrollment process, so brokers/agents must verify the correct fax number for submitting enrollment applications. 16. Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? A) Speak with the investigator as quickly as possible. B) Answer all questions honestly and completely. C) Offer information and documents important to the investigation. D) All of the above Correct Answer: D) All of the above Rationale: When contacted regarding an allegation of noncompliant activity, brokers/agents must cooperate fully by speaking with the investigator, answering all questions truthfully, and providing relevant documentation.