WELLNESS CARE
Who is the vendor that offers Meals Benefit for our member?
Mom's Meal
Under what category in your verbal grievance would you choose if member is expressing dissatisfaction about a medication not covered by UHC?
Plan
When speaking to the member, we need to use the term ____ when referring to the vendor of the UCARD.
Healthy Benefits Plus (KM1282900)
A program designed to spread out the cost of the member's prescription.
Medicare Prescription Payment Plan
Term used for those that would require a referral for specialist.
Gatekeeper
Renew Active members who have an existing confirmation code from previous years, do not need to generate a new confirmation code. True or False?
True
A decision about Part D payments or benefits to which a member believes he or she is entitled to.
Coverage Determination
Advocates should NEVER provide a member with their complete UCard number, this poses a security risk. True or False?
TRUE (KM1483204)
Under what tab in the Review Rx Benefits would you check the member's current Coverage Level?
Coverage Stage Info
If the member would want to know how much is her OOP Max for Part C, what specific tab in the Review Medical Benefits would you click?
PLAN LEVEL LIABILITIES
Who should we contact first to ask for a referral if member is seeking for coverage for his meals benefit? (No abbreviation)
United Clinical Services (UCS)
What does the abbreviation MIOD stands for?
Member Initiated Organization Determination
Give us one of the reasons as to why UHC has decided to remove PCP information in the member's UCARD.
* Using digital self-service tools to identify a member’s assigned PCP and verify eligibility ensures the use of the most current plan information. * Improves the member experience by reducing the need for card replacement. * Improved privacy to keep health information more secure. (KM1483204 )
If member would want to apply for LIS, who should you call for MAPD members?
SOCIAL AND GOVERNMENT REFERRAL SERVICES
Under OTC Products, do we consider cosmetic moisturizers as part of the covered items she can purchase using her OTC benefits? Yes or No?
NO (KM1831350)
In booking for a transportation, members need to call 72 hours in advance EXCEPT for situations where it is considered as life-sustaining appointment. Give us an example of life sustaining-appointment for transportation.
Dialysis, Chemo/radiation treatments, wound care, urgent care for non emergency room services, or inpatient facility discharge
The turnaround time for Medical Part C (Post Service) standard appeals review is?
60 calendar days
For Get Moving Monthly Challenge, members must complete how many minutes of physical activity and how many steps per day for her to be eligible for the rewards?
30 minutes of physical activity
5,000 steps per day
(KM1753110)
What do you call when a member may be required to try one or more lower-cost drugs first that would treat the same medical condition as the drug that's not covered.
Step Therapy
What do you call the counterpart of EOC before which is used for NICE account but is no longer working today?
IBAAG
What is the other term for dental riders?
Optional Supplemental Benefits
What specific type of MIOD are we initiating for members who want to request an extended care from their current health care professional if they are no longer working with our health plan and are now considered out-of-network?
CONTINUITY OF CARE
There are two options to earn a reward for Meet Your 2025 UCard, what are those options?
1. Members must watch the UCard video online.
2. Member must speak with customer service to get an overview of the UCARD.
(KM1753110)
These drugs act on the nervous system to relieve pain. Usually, it has a 7-day supply limit for first time use.
Opioid
Member is looking for a speech generating device, what benefit type would you choose in your Review Medical Benefits intent?
DME/ Durable Medical Equipment