CERAP TEST EXAM QUESTIONS AND CORRECT ANSWERS|
ACCURATE REAL EXAM WITH FREQUENTLY TESTED
QUESTIONS AND RATIONALE|ALREADY A
GRADED|GUARANTEED PASS|LATEST UPDATE 2024/2025.
The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains
in 2024. - CORRECT ANSWER True
Wellcare continues to expand its reach by offering more products in a wider geography. ____
new Wellcare plans are going to market. - CORRECT ANSWER Twenty-three
All Prescription Drug Plans (PDPs) will off er a $___ copay for most Part D preventive vaccines,
regardless of which network pharmacy is used by members. - CORRECT ANSWER Zero
Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for
2024? - CORRECT ANSWER Classic
In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for
the remainder of the year once their total out of pocket costs reach $8,000. - CORRECT
ANSWER Zero
Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. -
CORRECT ANSWER True
Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM,
OH, OK, TX, and WI. - CORRECT ANSWER True
All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred
pharmacies. - CORRECT ANSWER True
____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington,
D.C. - CORRECT ANSWER Three
Noting the correct enrollment period on enrollment applications helps in preventing delayed
enrollment processing. - CORRECT ANSWER True
When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search
tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being
enrolled in and explain that changes in Medicaid eligibility may affect enrollment and/or cost
sharing. - CORRECT ANSWER True
Which of the following statements about Scope of Appointment (SOA) is FALSE? - CORRECT
ANSWER An electronic SOA submitted in Ascend must be in a Pending status prior to
beginning the appointment.
,Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for
quality are: - CORRECT ANSWER All of these
Beneficiary-facing marketing materials for multiple MA organizations or plans must be
submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no
later than 30 days of use. - CORRECT ANSWER False
When completing an enrollment, be sure to use the correct enrollment application for the desired
plan year. - CORRECT ANSWER True
Providers may create co-branded marketing pieces using the Wellcare name and logo, as long as
they are using the current, approved logo. - CORRECT ANSWER False
Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts
SOAs in which of the following methods? - CORRECT ANSWER All of these
Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the
newly selected plan can cause a sales allegation. - CORRECT ANSWER True
Which of the following is not considered a grievance? - CORRECT ANSWER A dispute of the
appeal of an organization determination, coverage determination, or a Late Enrollment Penalty
(LEP) determination.
Brokers/Agents can access and download enrollment materials through CustomPoint. -
CORRECT ANSWER True
______ events are designed to inform the people who attend about Medicare Advantage,
Prescription Drug, or other Medicare programs without going into the specifics of a particular
carrier. - CORRECT ANSWER Educational
Materials that include plan comparisons or cost-sharing do not require CMS submission. -
CORRECT ANSWER False
Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy.
Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality
driver? - CORRECT ANSWER Member Payments
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will
impact which plan(s)? - CORRECT ANSWER Both PDP & MAPD
A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending
on the level of need. - CORRECT ANSWER Four
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all
insulins and insulin-combination products that are on the formulary, regardless of tier, and are
included in the $35 cap for one month's supply. - CORRECT ANSWER True
,Wellcare's 2024 product expansion represents a __% increase from 2023. - CORRECT
ANSWER One
CVS Caremark Mail Order will be in-network for 2024. - CORRECT ANSWER False
Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence
generics on Tier 1? - CORRECT ANSWER Value Plus
Centene requires all contracted brokers/agents to read, understand, and agree to Centene's
Business Ethics and Code of Conduct Policy. - CORRECT ANSWER True
Communication of PHI can be: - CORRECT ANSWER Written, Electronic, Verbal
From October 1 to October 14, certain activities are Non-Permissible Activities. These include:
Assist with completing an application
Collect a completed application
Advise the beneficiary to complete an application prior to October 15. - CORRECT ANSWER
All of these
Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive
or Apple Cloud. - CORRECT ANSWER False
Which option is the preferred method to submit enrollment? - CORRECT ANSWER Ascend
Web/Mobile Application
When discussing prescription drug coverage, you should: - CORRECT 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.
Which is an example of a top beneficiary complaint that affects Star Ratings? - CORRECT
ANSWER The beneficiary did not understand that enrolling in a Wellcare plan would change
their current Medicare Advantage plan.
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. - CORRECT ANSWER True
, 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. - CORRECT ANSWER 60
You can help prevent grievances by: - CORRECT 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.
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. - CORRECT ANSWER True
Wellcare expanded our county footprint in _____ states for 2024. - CORRECT ANSWER Five
All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing
through Express Scripts Pharmacy (Mail Order). - CORRECT ANSWER True
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. - CORRECT
ANSWER False
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. -
CORRECT ANSWER Value Plus
Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024? -
CORRECT ANSWER Express Scripts Pharmacy
The beneficiary (or their authorized representative) must indicate the product types to be
discussed during the appointment on the Scope of Appointment (SOA). - CORRECT ANSWER
True
Prior to the beginning of the enrollment process, a broker/agent is required to cover certain
beneficiary specific information, including but not limited to: - CORRECT ANSWER All of
these
The Single Sign-On Portal provides access to several applications, including CustomPoint -
CORRECT ANSWER True
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based
solely on life events that qualify for an SEP period. - CORRECT ANSWER True
ACCURATE REAL EXAM WITH FREQUENTLY TESTED
QUESTIONS AND RATIONALE|ALREADY A
GRADED|GUARANTEED PASS|LATEST UPDATE 2024/2025.
The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains
in 2024. - CORRECT ANSWER True
Wellcare continues to expand its reach by offering more products in a wider geography. ____
new Wellcare plans are going to market. - CORRECT ANSWER Twenty-three
All Prescription Drug Plans (PDPs) will off er a $___ copay for most Part D preventive vaccines,
regardless of which network pharmacy is used by members. - CORRECT ANSWER Zero
Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for
2024? - CORRECT ANSWER Classic
In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for
the remainder of the year once their total out of pocket costs reach $8,000. - CORRECT
ANSWER Zero
Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. -
CORRECT ANSWER True
Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM,
OH, OK, TX, and WI. - CORRECT ANSWER True
All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred
pharmacies. - CORRECT ANSWER True
____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington,
D.C. - CORRECT ANSWER Three
Noting the correct enrollment period on enrollment applications helps in preventing delayed
enrollment processing. - CORRECT ANSWER True
When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search
tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being
enrolled in and explain that changes in Medicaid eligibility may affect enrollment and/or cost
sharing. - CORRECT ANSWER True
Which of the following statements about Scope of Appointment (SOA) is FALSE? - CORRECT
ANSWER An electronic SOA submitted in Ascend must be in a Pending status prior to
beginning the appointment.
,Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for
quality are: - CORRECT ANSWER All of these
Beneficiary-facing marketing materials for multiple MA organizations or plans must be
submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no
later than 30 days of use. - CORRECT ANSWER False
When completing an enrollment, be sure to use the correct enrollment application for the desired
plan year. - CORRECT ANSWER True
Providers may create co-branded marketing pieces using the Wellcare name and logo, as long as
they are using the current, approved logo. - CORRECT ANSWER False
Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts
SOAs in which of the following methods? - CORRECT ANSWER All of these
Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the
newly selected plan can cause a sales allegation. - CORRECT ANSWER True
Which of the following is not considered a grievance? - CORRECT ANSWER A dispute of the
appeal of an organization determination, coverage determination, or a Late Enrollment Penalty
(LEP) determination.
Brokers/Agents can access and download enrollment materials through CustomPoint. -
CORRECT ANSWER True
______ events are designed to inform the people who attend about Medicare Advantage,
Prescription Drug, or other Medicare programs without going into the specifics of a particular
carrier. - CORRECT ANSWER Educational
Materials that include plan comparisons or cost-sharing do not require CMS submission. -
CORRECT ANSWER False
Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy.
Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality
driver? - CORRECT ANSWER Member Payments
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will
impact which plan(s)? - CORRECT ANSWER Both PDP & MAPD
A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending
on the level of need. - CORRECT ANSWER Four
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all
insulins and insulin-combination products that are on the formulary, regardless of tier, and are
included in the $35 cap for one month's supply. - CORRECT ANSWER True
,Wellcare's 2024 product expansion represents a __% increase from 2023. - CORRECT
ANSWER One
CVS Caremark Mail Order will be in-network for 2024. - CORRECT ANSWER False
Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence
generics on Tier 1? - CORRECT ANSWER Value Plus
Centene requires all contracted brokers/agents to read, understand, and agree to Centene's
Business Ethics and Code of Conduct Policy. - CORRECT ANSWER True
Communication of PHI can be: - CORRECT ANSWER Written, Electronic, Verbal
From October 1 to October 14, certain activities are Non-Permissible Activities. These include:
Assist with completing an application
Collect a completed application
Advise the beneficiary to complete an application prior to October 15. - CORRECT ANSWER
All of these
Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive
or Apple Cloud. - CORRECT ANSWER False
Which option is the preferred method to submit enrollment? - CORRECT ANSWER Ascend
Web/Mobile Application
When discussing prescription drug coverage, you should: - CORRECT 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.
Which is an example of a top beneficiary complaint that affects Star Ratings? - CORRECT
ANSWER The beneficiary did not understand that enrolling in a Wellcare plan would change
their current Medicare Advantage plan.
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. - CORRECT ANSWER True
, 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. - CORRECT ANSWER 60
You can help prevent grievances by: - CORRECT 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.
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. - CORRECT ANSWER True
Wellcare expanded our county footprint in _____ states for 2024. - CORRECT ANSWER Five
All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing
through Express Scripts Pharmacy (Mail Order). - CORRECT ANSWER True
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. - CORRECT
ANSWER False
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. -
CORRECT ANSWER Value Plus
Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024? -
CORRECT ANSWER Express Scripts Pharmacy
The beneficiary (or their authorized representative) must indicate the product types to be
discussed during the appointment on the Scope of Appointment (SOA). - CORRECT ANSWER
True
Prior to the beginning of the enrollment process, a broker/agent is required to cover certain
beneficiary specific information, including but not limited to: - CORRECT ANSWER All of
these
The Single Sign-On Portal provides access to several applications, including CustomPoint -
CORRECT ANSWER True
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based
solely on life events that qualify for an SEP period. - CORRECT ANSWER True
