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If a member has an HMO plan with the seamless network can they see providers outside of their service are for non-emergencies? (Select all that apply)
A. No, HMO plans do not provide out of network benefits
B. Yes, the member can see any provider out side of their service are that is contracted with their plan
C. No, HMO plans do not have the seamless network
D. Yes, member will pay in-network cost for non-emergencies services if they the provider is contracted with their plan
B. Yes, the member can see any provider out side of their service are that is contracted with their plan
D. Yes, member will pay in-network cost for non-emergencies services if they the provider is contracted with their plan
What action much a prospect complete to receive a reward card?
A. Agree to receive a quick quote, agree to a LACB or agree to an In home appointment
B. Agree to receive a quick quote
C. Attend a member meeting or seminar
D. Agree to a LACB
A. Agree to receive a quick quote, agree to a LACB or agree to an in-home appointment
It’s ok to promote the $10 reward card to members or prospect to increase your sales
A. True
B. False
B. False
If a member returns back to Original Medicare, picks up a PDP & later that year they’re admitted to the hospital what is their deductible responsibility?
A. $1480
B. $1408
C. $1464
D. $1410
B. $1408
During AEP whoever calls in will be eligible to receive a reward card
A. True
B. False
B. False
If an individual is new to Medicare and Part A and Part B effective dates are the same and they want to enroll into a MAPD plan what election period is selected
A. ICEP
B. IEP
C. SEP
B. IEP
If a member relocates to a new service at the end of September when does their SEP end?
A. September 30
B. August 31
C. November 30
D. October 31
C. November 30
In order for a member to receive a $10 reward card they must do what?
A. Attend a member meeting
B. Complete a survey
C. Enroll into a plan
D. Attend a seminar
B. Complete a survey
If a current Aetna member has a valid SEP and the contract number are the same how would you complete the member’s enrollment into the new plan
A. Complete a new enrollment in CNRx
B. Send Quick Quote with enrollment application attached
C. Set up a License Agent Call Back to complete enrollment
D. Complete new enrollment using the short form
D. Complete new enrollment using the short form
What is the quantity amount a member can receive for a prescription filled out – of – network?
A. 15 day supply at standard cost sharing
B. 10 day supply at preferred cost sharing
C. 15 day supply at preferred cost sharing
D. 10 day supply at standard cost sharing
E. There is no coverage for prescriptions out of network
D. 10 day supply at standard cost sharing
If a member changes their plan and their current prescriptions are not covered under the new plan or there is a change in the prescription restriction how does Aetna handle their members regarding transition of coverage?
A. Member will receive a 30 day supply within the first 90 days of enrollment
B. Member will receive a 60 day supply within the first 90 days of enrollment
C. Member will receive a 31 day supply within the first 90 days of enrollment
D. Member will need to contact doctor to get another prescription. The plan will not provide any transition of coverage.
A. Member will receive a 30 day supply within the first 90 days of enrollment
If a member is getting a vaccine administered under Part D coverage how are their fees covered?
A. All vaccines are covered under Part B even though administered under Part D
B. Vaccines administered under Part D means the members fees are covered under Part D
C. Vaccines administered under Part D are covered under primary care doctor benefit
D. Vaccines administered under Part D are covered at 100% under Original Medicare
B. Vaccines administered under Part D means the members fees are covered under Part D
If someone is subject to a part D penalty that means
A. They will pay a 1% penalty for every month they did not have creditable Part D coverage
B. They will pay a 10% penalty for every 12 months they did not have creditable Part D coverage
C. They will pay a 1% penalty for every 12 months they did not have creditable Part D coverage
D. They will pay a 10% penalty for every month they did not have creditable Part D coverage
A. They will pay a 1% penalty for every month they did not have creditable Part D coverage
A beneficiary that received Part A in 2015 and had a Part B effective date for October 1st what was the last day they could enroll into a MA/MAPD?
A. August 31st
B. November 30th
C. October 31st
D. September 30th
D. September 30
Formulary exception that are approved are covered at what Tier?
A. Tier 3
B. Tier 1 or Tier 2
C. Tier 3 or Tier 4
D. Tier 5
E. Tier 4
E. Tier 4
A member calls in outside of AEP and advises you their plan terminated 6 months ago and their Medicare became active 12 months ago but now they are in need of coverage, how would you assist the caller?
A. Do a needs analysis and probe for a SEP
B. Refer them to call Social Security
C. Connect them with MSO
D. Use SEP Loss of Employer Coverage
A. Do a needs analysis and probe for a SEP
An existing Aetna MAPD member recently moved to a new service area 2 weeks ago and calls in to tell you they want to add and OSB for the current plan year. Which of the following statements are true?
A. Member can add an OSB anytime throughout the year
B. The short enrollment form will be used to add the OSB if eligible
C. OSB can be added within 30 days of plan effective date. The member still has time to add the OSB.
D. Member can only add an OSB from January 1st – January 31st of each year
WHAT IS -
C. OSB can be added within 30 days of plan effective date. The member still has time to add the OSB.
Price differences can occur between a drug price quoted and the drug cost when it’s filled because
A. Manufacture drug price increase
B. Delays between price increases
C. The benefit phase the member is in (DED, initial, coverage gap, catastrophic)
D. Agent or member could have looked up a different drug, dosage, strength, or format than what was filled
E. All the above
E. All the above
If you are not RTS the no plans will come up in CNRx under the zip you entered
A. True
B. False
WHAT IS -
A. True
What states are Aetna targeting current Aetna Medicare members to introduce new MAPD plan? B
A. AZ, CA, DE, GA, KY, NV, OH, PA, TX, NJ, WA
B. AZ, CA, DE, GA, KY NY, OH, PA, TX, WV, WA
C. AZ, CA, DE, GA, KY, NV, OR, PA, TN, WI, WA
D. AZ, CA, DE, GA, KY, NV, OH, PA, TX, NY, WY
WHAT IS -
A. AZ, CA, DE, GA, KY, NV, OH, PA, TX, NJ, WA
If Aetna member is doing a plan to plan change which type of records may require member to submit an override request?
A. Authorization Records
B. Clinical Records
C. Administrative Records
D. Physician Referral request
WHAT IS -
C. Administrative Records
If an Aetna member expresses concerns with paying their plan premium, medical or Rx copays etc how will you handle this call?
A. Warm transfer to SHIP department
B. Warm transfer to Social Security
C. Warm transfer to MSO
D. Warm transfer to My Advocate
E. Warm transfer them to Medicaid
WHAT IS -
D. Warm transfer to My Advocate
Which plans Clinical and Administrative Records do not automatically transfer for a plan to plan change member?
A. Prime Plans
B. Traditional HMO
C. Joint Venture (JV) and Aetna DE-SNP
D. Total Care Plans
WHAT IS -
C. Joint Venture (JV) and Aetna DE-SNP
When handling plan migration calls what must you be sure to do?
A. Set up RSVP
B. Transfer to MSO to go over plan benefits
C. Always complete long form enrollment
D. Use MAP Tool to compare current plan with new plan
WHAT IS -
D. Use MAP Tool to compare current plan with new plan
A. April 1st
B. March 1st
C. February 1st
D. January 1st
WHAT IS -
C. February 1st