ELECTIONS
You can only use this election to enroll if passively enrolled, auto enrolled, facility enrolled or was reassigned into a plan by CMS or the State.
What is DIF Election
Mr. Mejia's A & B was effective 02/01/2025, Lina enrolled him into a Humana MAPD plan on 03/10th however his Dr's were not in network. Today is 4/07th, does Mr. Mejia have an opportunity to enroll in a new plan? If so what is the opportunity?
What is Yes/ OEP-N
When reviewing PPO plan benefits what must be given throughout the entire presentation?
What are In and Out of Network Benefits
When you are validating Providers in the carrier network, what are the 4 items that must be validated?
What is the Provider's full name, complete address, telephone #, and network status
My part A & B are more than ____ days apart, what election can I qualify for_____?
What is 90 days and ICEP.
In order to use the INT Election, what Medicaid levels must the member have?
What is FBDE, QMB+, SLMB +
Today is 03/26/2025, Customer made a recent change in plan on 03/01/2025 because they have moved to another county. Their Extra Help also changed from 100% Level 1 to 50% Level 2. Do they have another opportunity to enroll in a plan? Is so which opportunity?
What is Yes, I can use NLS
Your customer goes to the VA clinic for all his medical needs however he is inquiring about benefits available to him. He is in great condition, takes no medications and is paying his Part B premium. You have an MAO give back plan and a $27 premium plan, which plan would you offer and why?
What is an MAO plan and because it has a $0 premium and is providing benefits he is looking for.
I am a required benefit however I am only found in the Humana EOC- Evidence of Coverage, what benefit am I?
World Wide Coverage
Today is March 26, 2025. My customer's plan ended 02/01/2025, I check MARx and there is an unlawful presence end date of 02/28/2025. Do we have an opportunity if so what is the opportunity?
What is LAW election
What are the requirements to use a DST Election?
What is a missed election, DST in state and county customer resides in, DST still have an active date, no changes after election was lost.
Your customer calls stating they received a letter that they were disenrolled from a C-SNP due to condition not being verified. They are needing transportation and would like a food card. Do you have an opportunity if so what is it and what is the timeframe?
What is yes, they can use CSN and they have the month of the loss or notification plus 2 additional months to make a change, whichever is later.
Your customer had a Diabetic Chronic Plan and was changed on 02/01/25 into an Anthem HMO regular plan. Today is 05/05/2025 and you have a Humana C-SNP Plan available, your customer states they are still monitoring their blood sugar level daily and taking Insulin, do they have an opportunity if so, what election can you use?
What is Yes they can use CHR
My call has dropped during plan presentation, I get the customer back on the line, what are the required disclosures I must state on the 2nd call?
What is Introduction, TCPA, & TPMO
What is Social Security Administration
Your customer calls in on 4/3/2025 and states they started receiving extra help for their Rx as of 3/1, do they have an election opportunity? If so what is the opportunity?
What is yes they have NLS
My Part A was effective 04/01/2024, my Part B became effective 02/01/2025. Arley enrolled me into an MAPD plan on 02/15/2025. What is the last day that I can change my plan if I have an opportunity, if so what is my election?
What is 04/30th and OEP-N
Who is Eligible for Indiana Pathways for Aging?
What is individuals aged 60 and older with full Medicaid benefits
In order to have a compliant needs assessment we must ask minimum of which needs questions?
What is PCP, Dental, Vision, Hearing & Rx
When speaking to a customer with employer coverage, what steps should you take?
What is read employer disclosure that recommends they call their benefits administrator for more information before making any changes to their coverage.
If I have a chronic election available and an OEP election available, which should be my primary choice?
What is OEP- follow hierarchy
Your customer has an regular Alignment MAPD plan with an effective date of 01/01/2025, he is looking for a food card since he has FBDE. You have confirmed carrier eligibility tool, customer does qualify for the plan however state requires MCO to match MA plan carrier, do you have another opportunity if so, what is it?
What is I can use OEP instead of INT
Your customer has Mass Health and is calling for silver sneakers and more vision benefits. You pitch a plan that has a $27 monthly premium. When you are presenting the SOB what premium amount will you tell the customer?
What is $27 monthly premium however once the level of Medicaid is validated it may, could, should help with the $27 premium.
Your customer calls in from NY and during qualifying process you uncover they have EPIC, does this provide an opportunity? If so what is the opportunity?
What is SPAP- State Pharmaceutical Assistance Program