UHC CERTIFICATION FINAL PAPER 2026
COMPLETE QUESTIONS AND ANSWERS
GRADED A+
⩥ If a PCP is required and the customer does not indicate one on the
enrollment application, a _____ will automatically assigned. Answer:
PCP
⩥ To avoid member complaints, encourage customers to select a
____and make sure the _____ is accepting new patients. Answer: PCP
⩥ In which plan ( HMO/POS) are out of network benefits available at a
higher cost? Answer: POS
⩥ With a PFFS plan, does a PCP need to be selected? and are prior
authorizations or referrals from a PCP required? Answer: No, NO
⩥ once a member with a MAP reaches the maximum OOP expenses, is
there cost sharing for any additional services? Answer: no
⩥ MA plans with an OON component may or may not have an? Answer:
OOP maximum for OON services depending on the plan
,⩥ All medicare covered ( part A and part B) services count torward the?
Answer: OOP maxium with MAP's
⩥ Services and deatures that do not count toward the maxium OOP in a
MAP include? 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? Answer:
Yes
⩥ UHC strongly discourages Dual-eligible customers, from enrolling
into a PFFS plan due to? Answer: having potential negative impacts to
the customer
⩥ What does dual eligible customers mean? Answer: having both
medicare and medicaid
⩥ Before enrolling any customer into a PFFS plan, ask if they are
enrolled in a state _____ program? Answer: medicaid
⩥ If a customer is enrolled in a state medicaid program, explain to them
that a PFFS plan may 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? 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 Answer:
enrolling
⩥ What type of plan can be network based or non-network based?
Answer: PFFS
⩥ UHC does not offer network-based ___ plans? Answer: PFFS
⩥ what is deeming? 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? 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
COMPLETE QUESTIONS AND ANSWERS
GRADED A+
⩥ If a PCP is required and the customer does not indicate one on the
enrollment application, a _____ will automatically assigned. Answer:
PCP
⩥ To avoid member complaints, encourage customers to select a
____and make sure the _____ is accepting new patients. Answer: PCP
⩥ In which plan ( HMO/POS) are out of network benefits available at a
higher cost? Answer: POS
⩥ With a PFFS plan, does a PCP need to be selected? and are prior
authorizations or referrals from a PCP required? Answer: No, NO
⩥ once a member with a MAP reaches the maximum OOP expenses, is
there cost sharing for any additional services? Answer: no
⩥ MA plans with an OON component may or may not have an? Answer:
OOP maximum for OON services depending on the plan
,⩥ All medicare covered ( part A and part B) services count torward the?
Answer: OOP maxium with MAP's
⩥ Services and deatures that do not count toward the maxium OOP in a
MAP include? 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? Answer:
Yes
⩥ UHC strongly discourages Dual-eligible customers, from enrolling
into a PFFS plan due to? Answer: having potential negative impacts to
the customer
⩥ What does dual eligible customers mean? Answer: having both
medicare and medicaid
⩥ Before enrolling any customer into a PFFS plan, ask if they are
enrolled in a state _____ program? Answer: medicaid
⩥ If a customer is enrolled in a state medicaid program, explain to them
that a PFFS plan may 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? 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 Answer:
enrolling
⩥ What type of plan can be network based or non-network based?
Answer: PFFS
⩥ UHC does not offer network-based ___ plans? Answer: PFFS
⩥ what is deeming? 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? 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
