HIPAA
Obtaining Information
Application Confirmation
Other Information
Disclaimers
100
What information must you, as the agent, obtain for HIPAA verification for the consumer or member?
First and Last Name, Date of Birth
100
What additional information must be obtained if the applicant lives in a long term care facility?
In addition to the street address, city, state and zip, you must also obtain the facility name, phone number, and admission date.
100
You ask the consumer for the Medicare Parts A and B effective dates and the consumer is unsure what they are. Are you able to use the information you find in MARx? Are you able to tell the consumer their effective dates?
You can use the Part A and B effective dates in MARx but you may not tell the consumer the effective dates.
100
Disclaimers and statements must be read ____________.
Verbatim
100
What is the disclaimer you must read when asking for Permission to Contact?
"If we call you, we will be able to talk to you about all products and plans offered by UnitedHealthcare, which may include Medicare Advantage and/or Prescription Drug Plans."
200
What information can you provide the caller with if you are unable to verify HIPAA?
Basic plan information only
200
On an enrollment call with a husband who is enrolling both himself and his wife (for whom he has POA), will you need to obtain the address for each application?
No. If the enrollee has POA for the second applicant, the address does not need to be repeated.
200
When completing an editable pdf application, what will you use for the confirmation number?
MM/DD/YY/last 4 of Medicare # or the number generated from the PDF
200
You have been conversing with the enrollee in English, and have had no issues understanding this person. Do you need to ask for their language preference?
Yes.
200
During enrollment you ask, "Will you be employed when this plan becomes effective?" The member answers that they will be employed for the plan's effective date. What is the disclaimer that you must read in this case?
"If you have health coverage from an employer or union right now, you could lose your employer or union health coverage if you join this plan. If you have questions, call your benefits administrator or the office who answers questions about your employer or union coverage."
300
What does HIPAA stand for, in what year was it created and why?
Health Insurance Portability and Accountability Act. HIPAA was created in 1996, and addresses a number of issues, including the protection of confidential enrollee information (Private Health Information or PHI).
300
When obtaining a permanent address, can we use a PO Box?
We may use a PO Box only in the case that the applicant is homeless. We must notate on the application that the applicant is homeless and this is the permanent address.
300
When enrolling a consumer into a plan, are you required to tell them the election period you have selected for the enrollment?
Yes, an election period must be stated during the enrollment.
300
After you have read the Other Insurance Question and disclaimer, you find that the enrollee has other insurance. What information must you ask the enrollee for about the other insurance?
You must ask for: Type of insurance, Company Name, Group ID #, Member ID #
300
Once the enrollee agrees to the enrollment into the selected plan with the selected effective date, you must read the enrollment confirmation statement. What is this statement?
"Enrollment in this plan is generally for the entire calendar year. You can leave or change this plan only during the Annual Election Period between October 15th and December 7th of each year, or under special circumstances."
400
What document in mySME will describe the process by which you can obtain verbal consent from the enrollee to speak with a third party?
HIPAA - One-Time Verbal Consent
400
While collecting information and enrolling a caller, he states his name as Robert Downey. In MARx, his name appears with the suffix Jr. Are we able to enter the suffix to match MARx or will we enter the applicant's name as he gives it?
We are able to add the suffix to match MARx if the consumer does not provide this information during enrollment.
400
If the enrollee does not know their Medicare Claim Number, are you able to ask for their Social Security number or give them any hints?
You may not ask for the Social Security number but you can say it "may be", "could be", "can sometimes be" your SSN followed by a letter.
400
When must you review the additional provider and hospital questions and read these disclaimers?
For PFFS plans; Read disclaimers verbatim, get the physician and hospital information.
400
What disclaimer is read when obtaining Scope of Appointment for an In-Home Appointment?
"When our licensed sales agent meets with you, they will be able to present all products and plans offered by UnitedHealthcare, wich may include Medicare Advantage and/or Prescription Drug Plans. Please confirm your agreement to this appointment."
500
A new prospective member calls in interested in a prescription drug plan. HIPAA has been obtained. The member is fairly certain she qualifies for LIS and would like to know what she can expect to pay for premiums and copays on her medications. What information can you giver her?
Since the member is unable to give you her subsidy level, you may give her the basic premium and copays for the plan(s), and/or you can give her the premium and copays for all subsidy levels and let her know that the amount she pays will be based on her subsidy level. Even though we are able to see the level of LIS in MARx, we are unable to give that information to the applicant.
500
When bConnected is not available, what document will you use in mySME to record enrollment information? How do you keep track of multiple contacts?
bConnected Outage Process; The "Contact Tracking List" in bConneceted has a white link that says "Copy Consumer Information to Tracking List" that you can use to copy the current contact info to Contact 1, Contact 2, etc.
500
If no Part B effective date is given or displayed in MARx when enrolling a consumer into a MAPD plan, what will you put for the date?
Not applicable. You cannot complete the enrollment into a Part C Medicare Advantage Plan if the applicant does not have Medicare Part B.
500
For a call in which a husband and wife are each enrolled into a plan, does the Quality team review both enrollments? How many evaluations will the agent get for a call with a double enrollment?
Both enrollments are reviewed in one evaluation.
500
Are you allowed to let the applicant know that you may be compensated for enrolling them into a plan?
Yes, you must read the agreement of terms that states you may be compensated based on the applicant's enrollment into the plan.
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