MAPD
How does a PPO work?
The client will be able to go to physicians accepting the plan in network, and if they go out of network the doctor/hospital just has to ACCEPT the terms of the plan!
How long do you have to sell an account?
100 extra points if you know if you put in Awaiting decision on Saturday when you have to close it on Monday?
24 hours
Extra Credit answer:
12:00pm
What font does QA use?
- Cosmic sans
What are some examples of a qualifying event to become Guaranteed Issue (GI)?
- Move or lose MA/MAPD
- Retire and lose group coverage
-Lose creditable retirement coverage
- Spouse removes them from plan
How can you use the SEP: FEMA -or- SEP: Governor?
If your client missed a VALID SEP during the SEP Start date
Which carrier(s) can we list a facility as a PCP?
- Aetna (must have provider ID and primary care ID)
- BCBS MI (must have PCP ID)
- Humana (must have PCP ID)
- WellCare (must have PCP ID or IPA)
If you lose your client/become disconnected, what should you do immediately afterwards to protect your lead?
Put that lead ID into Await. Dec. ASAP
or
message me if you lose your VPN and I will put it in await. dec. for you
Who is the manager of QA?
Arien Jackson
Which 2 states have BIRTHDAY rules?
What state has an anniversary rule?
Birthday Rule:
- CA
- OR
Anniversary Rule:
- MO
What is IEP2? And what are the dates?
When someone has a plan or OM already and finally age into medicare. 3-1-3
- Cigna
- UHC
(WellCare isn't required, but preferred)
**YOU must still VERIFY their PCP is either IN/OUT of network and you MUST review that with your client!
How many days do you have to wait to submit a client into the DVH queue if already submitted?
7 days the lead ID becomes fair game.
Which one is correct:
1) This plan gives you $1,000 for dental!
This plan gives you free cleanings!
or
2) The plan offers $1,000 per year for preventive and comprehensive dental services with a copay of $0 for 2 cleanings per year!"
2) The plan offers $1,000 per year for preventive and comprehensive dental services with a copay of $0 for 2 cleanings per year!"
Which states offer NO medical underwriting?
- Connecticut
- Massachusetts
- New York
- Vermont no u/w with MOO and Humana
- Washington if client has a current medigap plan)
What is SPAP? And how many times a year can I use that SEP?
State Pharmaceutical Assistance Program and ONCE a year
POA vs. Witness
What carrier(s) allows a POA to complete the enrollment?
What carrier(s) allow a WITNESS to complete the enrollment? (400 extra points if you can tell me the process on how a witness can complete the enrollment).
POA:
- Humana
- BCBS MI
Wintess:
- Aetna
- Anthem
- Cigna
- WellCare
- UHC
- Kaiser
You should never apply what two (2) statues on a SOLD lead?
1.) No Sale
2.) Invalid
What required statement do you have to say when a client refuses/unable to give you their medications?
"By not providing the names of the prescription medications you are currently taking, we could possibly be putting you into a plan that does not cover all of your drugs. If your prescription is not covered, you are responsible for 100% of that payment no matter the price. Do you wish to continue?"
What states offer no excess charges?
What is an excess charge?
- Massachusetts
- Pennsylvania
- Minnesota
- Rhode Island
- New York
- Vermont
What is the institutional SEP and what are the dates surrounding the SEP?
If the client is in a SNF or Rehab center with an expected stay of 90 days, or have left recently after a stay of 90 day sor more. Continuous SEP while residing in institution + month of discharge and 2 months after
What are the required benefits you need to review with your client on the checklist?
* Total Plan Premium (in addition to your part b premium) *Medical deductible (in/out of network) *Drug deductible (in/out of network) *Inpatient Hospital (in/out of network) *PCP Copay (in/out of network) *Specialist copay (in/out of network) *ER Copay *Urgent care/Urgently needed services *Medicaid Number (if applicable) *MOOP *Selected PCP *All stages of drug phases *30 day rxs copays *Prior Auth. *Quantity Limits *Step therapy *Non covered drugs
If Elli enrolled her client with a 7/1/2021 effective date, when does that lead become fair game?
If Elli applied a "transfer to dental after enrollment" status, how long is it protected?
1.) Becomes fair game as of 7/1/21
2.) 48 hours from first status
How many categories are you scored on and what are they?
- MAG 1
- GENERAL
- MAG 2 (MAPD)
- WRAP UP SCRIPT
If your client has A/B before 2021: What plans are they allowed in?
If your client got A/B after 2021: What plans are they allowed in?
1.) A, B, C, F, K and L
2.) A, B, D, G, K and L
How do you use the VA SEP?
Take a client from either a MAPD or a PDP and move them into a MA only plan AFTER verifying they get all of their prescriptions from the VA.