UHC CERTIFICATION
TESTED QUESTIONS AND COMPLETE SOLUTIONS
Question 1.
Some drugs require pre-approval by the plan. A member of their provider can ask a plan to cover the
drug.
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.
Question 2.
MA plan members whop use the OEP to disenroll from their MA plan and obtain coverage from
original medicare, may enroll in a stand alone what plan?
ANSWER
part D plan
Question 3.
Can a customer call to terminate their Med Sup plan?
ANSWER
no it must be done in writing
Question 4.
What does MMP do?
ANSWER
individuals can receive both medicare parts A &B and full medicaid benefits through one health
plan
,Question 5.
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what?
ANSWER
Stand alone PDP
Question 6.
in an employer/union-sponsored group retiree plan, or more specifically a subsidized plan, the
employer contributes to the premium, but with an endorsed plan, the employer _____?
ANSWER
does not contribute
Question 7.
MA plan should not be referred to as a
ANSWER
supplement replacement, supplement, replacement no cost, free plan or zero cost plan
Question 8.
What type of plan can either be network based or non- network based?
ANSWER
PFFO
Question 9.
If a PCP is required and the customer does not indicate one on the enrollment application, a _____ will
automatically assigned
ANSWER
PCP
Question 10.
What is a stand alone drug plan called?
ANSWER
PDP
, Question 11.
For an HMO, they customer must us IN network providers, what are the exceptions to their rule?
ANSWER
Emergencies, Urgent care, and renal dialysis services.
Question 12.
What are some examples of creditable coverage?
ANSWER
drug plan from an employer, union, TRICARE, indian health service, or department of veterans
affairs
Question 13.
Plans must ___ what is permitted in the terms and conditions of payment
ANSWER
decide
Question 14.
When OOP costs for the coverage gap reaches what amount, they will move onto the catastrophic
coverage?
ANSWER
$5,100
Question 15.
WHat type of stand alone variations to medicare can give extra benefits?
ANSWER
A+B+D
C+D
TESTED QUESTIONS AND COMPLETE SOLUTIONS
Question 1.
Some drugs require pre-approval by the plan. A member of their provider can ask a plan to cover the
drug.
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.
Question 2.
MA plan members whop use the OEP to disenroll from their MA plan and obtain coverage from
original medicare, may enroll in a stand alone what plan?
ANSWER
part D plan
Question 3.
Can a customer call to terminate their Med Sup plan?
ANSWER
no it must be done in writing
Question 4.
What does MMP do?
ANSWER
individuals can receive both medicare parts A &B and full medicaid benefits through one health
plan
,Question 5.
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what?
ANSWER
Stand alone PDP
Question 6.
in an employer/union-sponsored group retiree plan, or more specifically a subsidized plan, the
employer contributes to the premium, but with an endorsed plan, the employer _____?
ANSWER
does not contribute
Question 7.
MA plan should not be referred to as a
ANSWER
supplement replacement, supplement, replacement no cost, free plan or zero cost plan
Question 8.
What type of plan can either be network based or non- network based?
ANSWER
PFFO
Question 9.
If a PCP is required and the customer does not indicate one on the enrollment application, a _____ will
automatically assigned
ANSWER
PCP
Question 10.
What is a stand alone drug plan called?
ANSWER
PDP
, Question 11.
For an HMO, they customer must us IN network providers, what are the exceptions to their rule?
ANSWER
Emergencies, Urgent care, and renal dialysis services.
Question 12.
What are some examples of creditable coverage?
ANSWER
drug plan from an employer, union, TRICARE, indian health service, or department of veterans
affairs
Question 13.
Plans must ___ what is permitted in the terms and conditions of payment
ANSWER
decide
Question 14.
When OOP costs for the coverage gap reaches what amount, they will move onto the catastrophic
coverage?
ANSWER
$5,100
Question 15.
WHat type of stand alone variations to medicare can give extra benefits?
ANSWER
A+B+D
C+D
