General Compliance
United Healthcare
The amount that a beneficiary must pay prior to their plan beginning to pay for Medical services.
What is a Medical Deductible?
If Medicare pays, then this type of plan will pay. If Medicare doesn't pay, then this type of plan will not pay.
What is a Medicare Supplement Plan?
$144.60
What is the Standard Part B Premium for 2020?
This means before the plan will cover a particular drug, a beneficiary must show the plan that they meet certain criteria such as medical necessity.
What is Prior-Authorization?
I am a licensed agent. You want to discuss Medicare options. Depending on where you live, we may offer a wide variety of plans, including Medicare supplement plans, Medicare Advantage plans, Prescription Drug Plans, and other health plan options. Discussing these options does not obligate you to enroll and will not impact your future Medicare enrollment status. May I go over those options with you?
What is a Scope of Appointment
This type of plan allows a beneficiary to go out of network for a higher cost. Beneficiary does not need to choose a primary care provider, and does not need referrals to see a specialist. This requires that you quote in and out of network benefits...
What is a PPO?
That the beneficiary will not need to answer medical questions in order to be accepted on the plan and they will not be subject to pre-existing condition clause on a plan.
What is Guarantee Issue?
$198
What is the Part B Deductible for 2020?
Provider's full name, street name, City and Specialty
What is required to be verified when checking network status of a beneficiary's doctor?
"Please be aware that you do not have to provide any health information to me unless it will be used to determine enrollment eligibility."
What is the Privacy Statement?
Medical Deductible, Urgent Care, Inpatient Hospital Stay, Emergency Room, Primary Care, Specialist, Max out of pocket.
What is Summary of Benefits?
A beneficiary's effective date was June 1st. It is November 30th. You enroll them using this type of enrollment period on a Medicare Supplement plan
What is open enrollment?
October 15th through December 7th
What is AEP?
This is a coverage rule that requires that you try lower cost medications on the plan's list prior to the plan covering a medication
What is Step Therapy?
Type of legal authority required to verify prior to submitting and enrollment
What is Power of Attorney with ability to make health and financial decisions
This type of plan requires a beneficiary see in network doctors except in emergency, urgent care or out of area renal dialysis. Requires a beneficiary to choose a primary care physician. Usually requires a referral to see a specialist.
What is an HMO?
Massachusetts, Minnesota, Wisconsin
What are the 3 states that have different Medicare Supplement Plans.
Medicare Advantage
What is Part C of Medicare?
Drug Name, Dosage and times per day.
Disclose the medication Tier, Formulary restrictions and All medications not covered.
What is required to accurately review and advise of coverage on the prescription portion of an MAPD/PDP?
This is important because it allows us to deliver the same service over and over. It allows us to continue our relationships with our carriers. It keeps everyone on the same page and allows us to provide a great experience for our carriers and beneficiaries.
What is quality and compliance?
A type of plan offered by a private insurance company. Generally has copays. Beneficiary needs to have Part A and B to enroll. Generally covers medical and prescription. Once enrolled, the beneficiary will ONLY show this card when they receive medical and prescription services.
What is the description of an MAPD plan?
This type of plan will help cover the 20% that Medicare leaves as the beneficiary's responsibility, it NEVER covers prescription drug coverage.
What is a Medicare supplement plan?
$1364
What is the Part A deductible for 2020?
Medications, Doctors, Incorrect explanation of plan, covering too many plans and confusing the beneficiary
What are the top causes of complaints?