Accommodations
If needed, an interpreter must be provided within...
7 minutes
What is the name of the system we use for points research and member's rewards account issues?
Sharecare
Do all the plans include a spending card? (2025)
No (it will depend on the plan PBP)
How can a grievance be submitted?
Orally or written.
Provide 3 examples of plan materials member's have the right to receive.
Can be 3 of any of the following:
*Summary of benefits
*EOC
*VAIS
*Wellness Rewards Brochure
*Calendar
*SNP kit
*Prescription drug guide
*FAQs Brochure
*MyCarePlus Member Secure Portal Brochure
*Health and Discount OTC Mail order forms
*Availity Care Profile Letter
*Provider Directory
The member types their request/inquiry while the advocate assist the membet with their request/inquiry.
Teletypewriter (TTY)
What happen by 12/31 with the current year points?
They expire / do not roll over for the next year.
Is a monthly allowance added to a member's spending account card on the first of each month, unused amount rolls over to the next month and expires at the end of the year.
Careessentials allowance
What is a grievance?
A formal way to record and document a member’s dissatisfaction with the service, benefit, or care that the plan or its providers has administered.
(Answer doesn't need to be this specific definition :)
Is a POA able to file a grievance on behalf of a member?
Yes
Mention one (or both) guiding principles concerning members rights.
*Member rights are based on the principle of respect of the individual
*Member rights are universal to all members of CarePlus
Provide 3 examples of activities that a member can complete to earn points
3 of any of the following:
Annual wellness visit/welcome to Medicare visit, real age test, bone density test, depression screening, medical nutrition therapy, Blood sugar test, diabetic eye test, kidney health test, diabetes self-management training, mammogram, colon cancer screening, nutrition slideshows, destination steps challenges.
What will happen with member's current spending card on 2026?
Since is supported by Solutran, it will no longer work after December 31, 2025.
(Members will receive a new card supported by NationsBenefits in november-december of this year).
Where can we locate grievance submissions prior 10/02/25?
On which system do we need to document grievances on or after 10/02/24?
Grievance submissions prior 10/2 can be located on CSIM Call History, For grievances submitted on or after 10/02 we will use CRM.
What are the 3 ways you can look up a member on CSIM?
*Member ID
*Phone number
*First and Last name
What are the provider accessibility standards for timeframes for the following:
Urgent but non emergent care
Non-urgent, but in need of attention
Routine and preventative care
Urgent but non emergent care:
Within 24 hours without prior appointment
Non-urgent, but in need of attention:
Within one week
Routine and preventative care:
Within 30 days
Can the member complete the real age test with an advocate over the phone?
What are the 3 ways a member can get to complete the Real Age test?
Member can't complete the real age test with a member services agent.
They can do it:
-On Sharecare portal
-Request it via mail
-Over the phone with an automated system
What are the different allowances? (For 2026)
*CareEssentials Allowance for CSNP
*Hybrid-CareEssentials Allowance for DSNP or General Enrollment Non-Special Needs Plans
Is any expression of dissatisfaction with the benefits available through the health plan:
Benefit Package Grievance
Explain the authentication process needed on the following scenario:
Calls enter unauthenticated by Genesys.
You already asked for the member's name when you opened your call with our mandatory script.
We must get one ID number:
*Careplus ID or
*Medicare ID
And ask for two more authentication factors:
*Member's plan name
*Member's PCP
*Member's mother maiden name
*Member's zipcode
*Member's DOB
Provide 3 examples of reasonable arrangements to accommodate ADA and LEP members
Can be 3 of any of the following:
*Deaf/hard of hearing: Communications preferences in alternate format
*Blind/Vision Impaired: Communication preferences in alternate format
*Mentally, physically or cognitively disabled: Communication preferences in alternative format/member accommodated based on identified needs.
*Assistance with filling out forms and website navigation
*24/7 Support/ Complaints: After hours voicemail, member portal, careplus email correspondence request
How does rewards work each time a member completes an activity? / How does CarePlus keep track of it?/What does the member need to get the points for the completed activity?
(Only one question asked in three different ways :)
Once CarePlus receives the claim/bill for the services received, it is automatically input in our system and the points are rewarded to the member's account.
Member do not need to do anything besides of completing the activity.
If a member calls before October 1st to know eligibility criteria for the CareEssentials allowance in 2026, are we able to provide that info? And WHY
No, prior October 1st we can reference a member's ANOC and review benefits but not eligibility.
If someone other than a valid requestor attempts to submit a grievance on the member's behalf, what should you do?
(two answers)
*Attempt to obtain verbal consent
*If no consent is obtained the G&A dpt. will mail an AOR form for both invalid requestor and member.
What are the 4 member right's CMS reinforce based on what we have learned?
*Grievances
*Appeals
*Coverage Determinations (Part D approvals)
*Organization Determinations (Part C approvals)