exam 1
what is the part D penalty
1% of the national base beneficiary premium
what is the medicare part b hospital deductable
$1,676
what type of plan provides coverage in and out of network
PPO
True or false
The TPCA must be read in its entirety when gathering phone number or email
True
Who pays for vaccines administered under you part d coverage
Part D
True or false
you can have both Medicare supplement and HMO
False, you can have a PDP and a supplemental
using ICEP with an effective date of April 1st, when is the last day to complete an enrollment
March, 31 st
what is it called when you can travel outside of your service area and still see Aetna participating providers
Seamless network or travel pass
what is the standard part b premium or 2025
$185
True or False
A prime plan is a good choice foe someone who likes to travel
False
seven-month period surrounding a person's Medicare eligibility for MA/ MA-PD and PDP
IEP/ ICEP
CVS Caremark
When can OSB be added
at the time of enrollment or up to 30 days after the plan goes into effect
True or false
ALL HMO plans require a referral
True
plan became effective less than 30 days what is your next step
submit a new application
if you have state license, certification, appointment by Aetna and an active contract then you are what?
RTS
90%
True or False
You must be appointed in All states to be RTS
FALSE
*If system shows no plan in the area it means
you are not RTS and must transfer to LA
What must be reviewed before you can start the application
Benefit information and TE checklist
What are three formulary Utilization managment steps
ST- step therapy
PA- Prior Authorization
QL- Quantity Limits
what are 3 telehealth service covers?
Primary care, Urgent care, Mental Health services
Alex turns 65 June 15 what is his enrollment time frame
March- September
Fide plan allows a quarterly SEP with full Medicaid
Monthly SEP with full medicaide
How many days must we inform members before the formulary changes?
30 days