Humana questions AAHIP questions and answers, 2022 update, graded A+

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Humana questions AAHIP questions and answers, 2022 update, graded A+ What are the dates for the SEP for Non-Renewal? - ✔✔December 8 - end of February CMS expects agents to provide a clea ... r, concise explanation of the plan's drug benefit. Which of the following actions is prohibited by Humana and CMS? - ✔✔Asking the beneficiary to consult with their doctor or pharmacist to obtain generic medications is not an acceptable explanation of the plan's drug benefit What constitutes an "attempt" on Humana`s final exam? Note: questions about passing the final exam are only in this practice exam - ✔✔The agent clicks the test submit button or the test timer reaches 35 minutes MA enrollees using the Medicare Advantage Disenrollment Period (MADP) to disenroll from their MA plan are eligible for a SEP to enroll in... - ✔✔stand-alone PDP How many questions are on Humana`s final exam and what material do they test on? Note: questions about passing the final exam are only in this practice exam. - ✔✔The final exam consists of 20 questions over material in the Agent Guidance Reference Manual. Oscar delayed his Part B when he was first eligible. He enrolled into Part B after the expiration of his IEP. He is meeting with Agent Wayne and Oscar is requesting to enroll in a Humana MAPD plan in the 3 months prior to his Part B effective date. Which enrollment period should Agent Wayne select for Oscar's application? - ✔✔ICEP Who is responsible for all applicable insurance licenses and any applicable certifications required to sell a corresponding Humana product in all states in which the agent markets such products? - ✔✔The Agent What is the purpose of the Non-Discrimination notice that is included in many of Humana`s marketing materials? - ✔✔To inform people about their ability to receive information in another language and give directions on how to file a complaint should they feel they have been discriminated against Individuals who belong to a qualified State Pharmaceutical Assistance Program (SPAP) are eligible for an SEP to - ✔✔Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. once per year Why are agents required to ask if the phone number being provided on an application is a cell phone number? - ✔✔Because the FCC requires prior express written consent to contact a prospect or member via their cell phone Which of the following actions should be avoided when completing spousal enrollments? - ✔✔The agent should use the exact same Medicare ID number and election period for both applications so that CMS can process the applications together and label them as spousal enrollments From October 15 to December 7, which election periods may be used? - ✔✔AEP, IEP/ICEP and any SEP Agent James is enrolling a prospect into a Humana Medicare Advantage plan and it is time to choose a PCP. It is unclear if the provider is in Humana's network. What is the preferred way to determine if a provider is in network? - ✔✔Use Humana's Physician Finder Plus to see if the provider is in Humana's network Agents may provide guidance to members about providers who excel at value-based care that could improve member health outcomes. What is this called? - ✔✔Provider Highlighting To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? - ✔✔Taxes will be applied to all applicable prescription and over-the-counter (OTC) orders. Agent Mike is speaking with Betty Ann and she is asking how to determine if her medication is covered by Part B or Part D. What is the preferred way for Agent Mike to determine if a medication is on Humana's formulary? - ✔✔Use Humana's RX look up tools to determine if a medication is on Humana's formulary. Which of the following is an advantage for new members when they pre-register with Humana Pharmacy? - ✔✔It allows members to obtain pricing for medications based on their future effective date. Can agents create their own Medicare marketing materials, such as letters and flyers? - ✔✔No, because agents will use only Humana and CMS or State approved materials/scripts, as applicable, to market to prospective enrollees. Tamara is aging into Medicare and is in her 7 month initial election period. She tells Agent Sarah that she would like to enroll in a MA-only (no RX). Which enrollment period should Agent Sarah select for Tamara`s application? - ✔✔Initial Coverage Enrollment Period (ICEP) Agent Ben knows that Dr. Mendez is in network for a PPO plan in a particular service area. When enrolling Mary into an HMO plan for the same service area, Mary wants to select Dr. Mendez as her PCP. Ben tells Mary that he knows Dr. Mendez in network for Humana plans and does NOT check Humana`s Physician Finder Plus. Is this acceptable? - ✔✔No, a provider may be contracted for one plan type but not another. Agent Ben should have checked to see the provider was contracted for the HMO plan. Jim is eligible to join a Medicare Advantage plan without drug coverage for the first time. What enrollment period will he use? - ✔✔Initial Coverage Election Period Initial Coverage Enrollment Period (ICEP) can be used to enroll beneficiaries into which plans? - ✔✔MA/MAPD only Agent Justin did not pass the Humana final exam on his first try. What should he do? Note: questions about passing the final exam are only in this practice exam. - ✔✔Review the Agent Guidance Reference Manual before making another attempt. Agent Mike is speaking with Betty Ann and she is asking how to determine if her medication is covered by Part B or Part D. What is the preferred way for Agent Mike to determine if a medication is on Humana's formulary? - ✔✔Use Humana's RX look up tools to determine if a medication is on Humana's formulary. Fill in the blank. In the event an allegation of misconduct is lodged against an agent, the agent will provide a detailed written response to the complaint within ______________ of notification of the complaint - ✔✔5 business days When is the Medicare Advantage Disenrollment Period? - ✔✔January 1 - February 14th Select the statement below that best completes the following sentence. 99% of Humana members who terminate for non-payment of premium do not ___________________. - ✔✔select an automated payment method to pay their monthly premium. How can agents help Humana members receive less mail and have convenient, on-line access to plan documentation? - ✔✔Encourage all members to receive their plan documentation digitally at the time of enrollment. Individuals who belong to a qualified State Pharmaceutical Assistance Program (SPAP) are eligible for an SEP to... - ✔✔Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. once per year). You are speaking with Mrs. Damon on February 3rd and she is requesting to disenroll from the MA-only HMO plan. She asks you if she can enroll in a stand-alone PDP, instead. How would you respond to Mrs. Damon? - ✔✔Explain that because she has called during the Medicare Advantage Disenrollment Period (MADP), she is eligible to disenroll from her current plan and enroll in a stand-alone PDP. What is it called when an agent guides a member towards a particular provider because it is in the best interest of the provider or agent (versus the member`s best interest)? - ✔✔Provider Steering Which of the following is not an automated payment option for Humana Medicare enrollments? - ✔✔Humana `Bill Me` Why is it important for agents to offer guidance for provider selection? - ✔✔To assist enrollees and members in making an informed decision about providers that help members achieve the best possible health outcomes. Agent Deborah is enrolling a beneficiary into a Humana Medicare Advantage plan. A new PCP is selected. What must Agent Deborah explain about the new PCP? - ✔✔Agent Deborah must explain in and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP. Which of the following is considered marketing material and requires CMS approval ? - ✔✔Letters sent by agents to current and prior members announcing the agent has changed agencies. Which of the MA-only plans below can be combined with a stand-alone PDP? - ✔✔PFFS CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. Which of the following actions is prohibited by Humana and CMS? - ✔✔Asking the beneficiary to consult with their doctor or pharmacist to obtain generic medications that are covered on the formulary When it comes to Dual Eligible SNPs, it is imperative the dual eligible beneficiary is aware of ... - ✔✔All plans available in their area emphasizing those plans that best meet the beneficiary's needs. Is it permissible for agents to select a new PCP based on the belief that the provider will be joining the Humana in the near future? - ✔✔No, because agents may never suggest that a provider is or may be joining Humana's network. Individuals who belong to a qualified State Pharmaceutical Assistance Program (SPAP) are eligible for an SEP to... - ✔✔Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. once per year). To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? - ✔✔Taxes will be applied to all applicable prescription and over-the-counter (OTC) orders. Agent Todd is completing an HMO enrollment with Mrs. Valdez and she asks if she can select Dr. Ayers as her PCP. Agent Todd can't locate Dr. Ayers using Humana's Physician Finder tool. However, he knows that Dr. Ayers is in-network for the Humana PPO plan in the area. What should Agent Todd do in this situation? - ✔✔Tell Mrs. Valez that Dr. Ayers is not listed as an in-network provider and request that she select another in-network PCP. Agent Ted is completing an enrollment with Mr. Sampson. Mr. Sampson tells Agent Ted that he is familiar with the plan benefits since his wife has the same plan. What should Agent Ted do to remain compliant in this situation? - ✔✔He should explain that a full presentation of benefits is important and that it is a required for every enrollment. Which of the following was identified as a top reason for Humana agent complaints in PY17? - ✔✔Agents not using Humana's Physician Finder tool correctly. Agent Juan is enrolling Mrs. Maples into a HMO plan. Mrs. Maples wants to select Dr. Grayson as her PCP. Dr. Grayson is part of the American Medical Group. Agent Juan can't locate Dr. Grayson in Physician Finder but he did see that American Medical Group is listed as in-network. How should Agent Juan handle this situation? - ✔✔Advise Mrs. Maples that she will need to select another PCP since Dr. Grayson is not listed as an in-network provider. Agent James is enrolling a prospect into a Humana Medicare Advantage plan and it is time to choose a PCP. It is unclear if the provider is in Humana's network. What is the preferred way to determine if a provider is in network? - ✔✔Use Humana's Physician Finder Plus to see if the provider is in Humana's network. When a member selects a PCP when enrolling into a plan, what must agents explain about their PCP? - ✔✔Agents must explain in and out of network benefits and any possible independent Provider Association (IPA) affiliations of their selected PCP. Which of the following statements is true regarding the Primary Care Provider (PCP) Change form? - ✔✔Agents can assist members requesting a PCP change and take action on their behalf. In cases where the applicant has delayed their Part B, ICEP can only be used if... - ✔✔The MA/MAPD enrollment request is made prior to the Part B effective date. When can agents begin marketing to non-renewing members? - ✔✔October 2nd Carol is speaking with Agent Tomas. Carol delayed Part B and wants to enroll in a Humana MA plan (No RX) plan 3 days after her Part B effective date. Which enrollment period can Agent Tomas use? - ✔✔SEP can only be used (if a valid SEP exists) because Carol has delayed [Show More]

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