IFP

SEED

100

This system is a Market Place system. 

True or False? 

TRUE

200

This system can be used to locate information such as plan eligibility, premium info, subscribers, and broker information. 

True or False?

TRUE

300

Share your screen and show where you can find broker information for plan segment dates: 

01/01/2024 - 12/31/2024 

Family link: 0003497907

Answer: Rodney Brown

400

What was the members premium amount for 01/01/2023 - 12/31/2023 according to SEED? 

$421.75

500

Member called in stating their name is spelled incorrectly in the UHC system. Member stated her name is  Angel Smith, maestro shows Angela Smith. 

After verifying you notice it also populates as Angela Smith in SEED. 

What would we advise the member to do to get this fixed? 

We would advise the member to contact the MP. Since the MP has member listed as Angela Smith, we must mirror SEED.

If member disagrees she must contact MP. 

ALVAR

100

We can cancel member plans in SEED.

True or False? 

FALSE.

Member must go to MP to cancel their plan. 

We can NOT make any edits in Alvar. 

200

What states use Alvar? 

•CO

•MD

•WA

•NJ

•NM

•VA

•GA (2025)

300

What is the TOT Res Amt in Alvar? 

The members monthly premium AFTER their subsidy. 

400

What does the APTC amount mean in Alvar? 

The members subsidy. 

500

What does maintenance type 030 mean in Alvar? 

030 Audit (Do not use. Close by clicking the chevron again)

B&E

100

What does B&E stand for? 

Billing & Enrollment

200

What are the different route queues for billing & enrollment macess routes? 

B&E Standard Queue 

B&E Urgent Queue 

300

Refunds over $1000 are allowed with supervisor approval.

True or False? 

FALSE. 

Is the amount owed to the member over $1000?

Yes: Send a refund request route to ESC Team Only B&E Standard.

400

Scenario: Mrs. Davis always pays 2 months ahead for her premium (she has already paid for Sept/Oct) Member decided they would like a refund for her October payment that was made by EFT (bank draft) on 08/15/2025. 

You are taking this call today 08/21. 

Would you be able to refund the member this payment while on this call? 

NO. 

Any EFT (bank draft) payments must wait 15 business days before a refund can be processed. 

Pend your ETI and call member back on the 15th business day to process her refund. 

500

What is the refund template used when noting a refund request? 

Attachment Description

ESC NOTES: REFUND REQUEST

Note

Date: XX. XX. XXXX
Amount:
UPG REFERENCE:
BACK TO ACCOUNT ENDING IN: XXXX

Maestro SR Number: 

SOPs

100

What SOP do we use for IFP member rewards? 

FP Member Rewards (Incentives)
KM1291550

200

What SOP would you use for information about Macess Routing IFP B&E issues? 

IFP and Medicaid Escalations Team - Index

KM1428201

Macess Routing - IFP B&E Issues tab 

300

According to the IFP Behavioral Health (BH) SOP, what states offer ABA services? 

ABA services are available for AL, AZ, CO, FL, GA, IA, IL, IN, KS, LA, MD, MI, MO, MS, NC, NE, NJ, NM, OH, OK, SC, TN, TX, VA, WA, WI and WY Individual and Family Plan members.

Behavioral Health (IFP)

KM1249455

 

400

According to the IFP and Medicaid Escalations Team - Index what should we expect when receiving calls from Corporate Switchboard? 

• When receiving a call from the Corporate Switchboard, they will identify themselves.
• They do not verify HIPAA and usually do not have any PHI to identify the member.
• They have been instructed to get the member over to the Escalation Team.
•  It is our responsibility to take the transfers without hesitation, identify the member, and resolve the caller’s concerns.

500

Topic: IFP member plan cancellations/disenroll. 

What SOP advises the following information: 

Voluntary Termination / Termination of Benefits
Note: The member's plan has been terminated by the marketplace. The health plan is not given the reason for termination when it originates from the marketplace. Do not use the term Voluntary Termination when speaking with member.

IFP Enrollment Eligibility and Cancellation - Index

KM1236637 

Under:

Eligibility Inquiries - Termed Accounts

MISC

100

What system do we use to process refunds? 

UPG. 

(100 bonus points if you can name the NEW system we will be using soon) 

200

For OFF EXGN members: 

What is the process if the member wants to cancel/disenroll their plan. 

Members must include the following information when sending their written request to the address: 

UnitedHealthcare Individual and Family Plan
P.O. Box 30753
Salt Lake City, UT 84130
Fax: [phone]

• Name:
• DOB:
• Social Security Number:
• Address:
• Gender:
• Subscriber ID:
• Effective date:
• Reason for change:

Notes: 

• Termination date must be for the end of requested month (i.e., August 31, 2022).
• The written cancellation/disenrollment request needs to specify who will be affected, providing the same information above for each.

Important:

• Be aware and ensure that policy holders know that any changes/disenrollment requests made by the subscriber may impact the dependents listed on the account.

300

What is a 10-day free look back? 

UnitedHealthcare allows a 10-day free-look period. The policy is cancelled as if it was never effective.

•The first 10 days after the member's effective date are called the free look period. The member can call UHC during this time and cancel their policy.

•The member's account will be cancelled immediately as never effective, and all payments received are refunded. The coverage is cancelled for the member and all dependents.

•If the member wants to remove some but not all members from their policy, they must contact the Marketplace.

400

Once processed (meaning refund was completed) what TAT should be advise for paper/money check order?

2-3 weeks

500

Medical Prior Auth Call Handling (IFP) 

What is the TAT for standard prior auth request for New Jersey members?  

15 calendar days

Medical Prior Auth Call Handling (IFP)

KM1236073