WELLCARE ACT MASTERY EXA1
COMPLETE QUESTIONS AND DETAILED SOLUTIONS LATEST UPDATE THIS
YEAR JUST RELEASED
Question 1: Member PHI can be stored on an external hard drive or
a cloud storage service like Google Drive or Apple Cloud.
Answer:
False
Question 2: Which option is the preferred method to submit
enrollment?
Answer:
Ascend Web/Mobile Application
Question 3: When discussing prescription drug coverage, you
should:
Answer:
Explain how to use the formulary to look up limitations and exclusions (e.g., step
therapy, quantity limits).. Confirm coverage of the beneficiary's current and/or
anticipated prescriptions. Explain formulary tiers as well as drug copayment
amounts. For drugs that are not covered by the new plan, explain the Transition
Fill program and how to request a coverage exception.
Question 4: Which is an example of a top beneficiary complaint that
affects Star Ratings?
Answer:
The beneficiary did not understand that enrolling in a Wellcare plan would
change their current Medicare Advantage plan.
,Question 5: Members who fail to pay the required premiums before
the end of the grace period (Wellcare has a three-month grace
period) will be terminated.
Answer:
True
Question 6: A grievance request, or any evidence concerning a
grievance, must be fi led orally or in writing no later than _____
calendar days from the date of the event or the date the member is
made aware of the issue.
Answer:
60
Question 7: You can help prevent grievances by:
Answer:
Always confirming availability of the beneficiary's primary and specialist providers
by using the provider search tool available on the plan's website.. Always using
plan materials to clearly explain plan benefits and cost (including medications)
and check for understanding. Always confirming a beneficiary's intent to enroll
before accepting their enrollment application.
Question 8: A broker/agent may be terminated for cause if they fail
to comply with a compliance investigation, encourage others to
avoid the compliance interview process, or fail to provide truthful
or complete information.
Answer:
True
Question 9: Wellcare expanded our county footprint in _____ states
for 2024.
Answer:
, Five
Question 10: All Prescription Drug Plans (PDPs) will continue to
offer $0 Tier 1 preferred cost-sharing through Express Scripts
Pharmacy (Mail Order).
Answer:
True
Question 11: With the Pharmacy Benefit Manager (PBM) migration
to Express Scripts effective 1/1/2024, existing members can
continue to use their current ID card 1/1/2024 and beyond.
Answer:
False
Question 12: For Prescription Drug Plan (PDP) Medication Home
Delivery, the ____ plan will continue to off er a discount (2.5 x
30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions.
Answer:
Value Plus
Question 13: Which is the Prescription Drug Plan (PDP) Preferred
Mail Order network for 2024?
Answer:
Express Scripts Pharmacy
Question 14: The beneficiary (or their authorized representative)
must indicate the product types to be discussed during the
appointment on the Scope of Appointment (SOA).
Answer:
True
COMPLETE QUESTIONS AND DETAILED SOLUTIONS LATEST UPDATE THIS
YEAR JUST RELEASED
Question 1: Member PHI can be stored on an external hard drive or
a cloud storage service like Google Drive or Apple Cloud.
Answer:
False
Question 2: Which option is the preferred method to submit
enrollment?
Answer:
Ascend Web/Mobile Application
Question 3: When discussing prescription drug coverage, you
should:
Answer:
Explain how to use the formulary to look up limitations and exclusions (e.g., step
therapy, quantity limits).. Confirm coverage of the beneficiary's current and/or
anticipated prescriptions. Explain formulary tiers as well as drug copayment
amounts. For drugs that are not covered by the new plan, explain the Transition
Fill program and how to request a coverage exception.
Question 4: Which is an example of a top beneficiary complaint that
affects Star Ratings?
Answer:
The beneficiary did not understand that enrolling in a Wellcare plan would
change their current Medicare Advantage plan.
,Question 5: Members who fail to pay the required premiums before
the end of the grace period (Wellcare has a three-month grace
period) will be terminated.
Answer:
True
Question 6: A grievance request, or any evidence concerning a
grievance, must be fi led orally or in writing no later than _____
calendar days from the date of the event or the date the member is
made aware of the issue.
Answer:
60
Question 7: You can help prevent grievances by:
Answer:
Always confirming availability of the beneficiary's primary and specialist providers
by using the provider search tool available on the plan's website.. Always using
plan materials to clearly explain plan benefits and cost (including medications)
and check for understanding. Always confirming a beneficiary's intent to enroll
before accepting their enrollment application.
Question 8: A broker/agent may be terminated for cause if they fail
to comply with a compliance investigation, encourage others to
avoid the compliance interview process, or fail to provide truthful
or complete information.
Answer:
True
Question 9: Wellcare expanded our county footprint in _____ states
for 2024.
Answer:
, Five
Question 10: All Prescription Drug Plans (PDPs) will continue to
offer $0 Tier 1 preferred cost-sharing through Express Scripts
Pharmacy (Mail Order).
Answer:
True
Question 11: With the Pharmacy Benefit Manager (PBM) migration
to Express Scripts effective 1/1/2024, existing members can
continue to use their current ID card 1/1/2024 and beyond.
Answer:
False
Question 12: For Prescription Drug Plan (PDP) Medication Home
Delivery, the ____ plan will continue to off er a discount (2.5 x
30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions.
Answer:
Value Plus
Question 13: Which is the Prescription Drug Plan (PDP) Preferred
Mail Order network for 2024?
Answer:
Express Scripts Pharmacy
Question 14: The beneficiary (or their authorized representative)
must indicate the product types to be discussed during the
appointment on the Scope of Appointment (SOA).
Answer:
True
