Aetna Questions and Answers (2022/2023) Graded A+

Document Content and Description Below

Aetna Questions and Answers (2022/2023) Graded A+ Aetna offers a variety of Aetna and Coventry Medicare Advantage plan types. Which plan type requires a person to use only network providers? (exclu... ding emergency or urgently needed services) ✔✔HMO plan Which plan type allows members to see preferred doctors out of network and does not require referrals to a specialist? ✔✔PPO Plan Most Aetna and Coventry Medicare Advantage plans are integrated with prescription drug coverage, so they are called MAPD plans. ✔✔True Aetna and Coventry case Management consists of registered nurses, social workers, behavioral health professionals and pharmacists who help members navigate the health care system and access services. ✔✔True Aetna Medicare Advatage HMO and PPO plans have no out-of-pocket maximum. ✔✔False Aetna Medicare Advantage HMO and PPO plans cover routine preventive care including an annual wellness visit, screening mammograms, and prostate cancer screenings. ✔✔True A member's cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy. ✔✔True All MAPD plans have a prescription drug component. ✔✔True Which of the following are true? ✔✔All of the above. You can find a quick list of tools on aetnamedicare.com/brokers which includes information about plans, medications, and doctors. ✔✔True What is a Dual eligible Special Needs Plan (D-SNP)? ✔✔All of the above Low Income Subsidy (LIS) is a Mediare finacial program that helps to reduce prescription drug costs. ✔✔True The difference between LIS and the Medicare Savings Program (MSP) is LIS helps reduce prescription drug costs and MSP helps with Medicare plan premiums, deductibles and copayments/coinsurance with medical services. ✔✔True Individuals can apply for Extra Help through: ✔✔All of the above. A full dual eligible means an individual has Medicare, but is only eligible for assistance with Medicare premiums and sometimes cost share through the Medicare Saving Program. ✔✔False. LIS Medicare drug plan premium and deductible costs are based on income level. ✔✔True Full benefit duals meet state Medicaid eligibility requirements and are entitled to receive the Medicaid services they need. ✔✔True One of Aetna's model of Care goals is to improve use of preventive health services. ✔✔True Which are attributes of the Aetna's Model of Care: ✔✔All of the above The Aetna DSNP care manager and care team provide a single point-of-contact to help coordinate all Medicare and Medicaid covered care and services that the member needs. ✔✔True Members may qualify for transition of coverage if they Part D drug they're taking is no longer on the plan's formulary or the drug is restricted by a utilization management edit. ✔✔True All markets offer three PDPs in all 50 states, plus the D.C., to meet the needs of our members. ✔✔True Aetna Rx Home Delivery is the preferred mail order vendor for all PDP plans. ✔✔True TrOOP for 2019 will be: ✔✔$5,100 Each PDP is assigned a formulary and preferred pharmacy network. ✔✔True Aetna places generic drugs on which tiers ✔✔All tiers The Aetna Medicare Value Plus plan is: ✔✔Both B and C The Aetna Medicare Select Rx plan offers: ✔✔Cost-effective preferred network P3 The Aetna Medicare Select plan is our: ✔✔Lowest premium plan What reports are available on Aetna's Producer World? ✔✔All of the above You will need to successfully complete which requirements to have "ready-to-sell" status with Aetna Mediare? ✔✔All of the above Any voluntary disenrollment occurring within three months of the membership effective date is considered a rapid disenrollment, and will result in a chargeback on the full commission paid. ✔✔True Agent Oversight routinely monitors agent performance against CMS and internal standards. We monitor: ✔✔All of the above To report compliance or fraud, waste, and abuse concerns to Aetna you should? ✔✔A,B and D Our Agent oversight team with implement corrective action when there are CMS infractions and prohibited tactics disciplinary or corrective action may include: ✔✔All of the above Failure to respond within the required time frame to Aetna or CMS requests for information may result in suspension or termination of an agent, broker or producer's ability to market, sell and receive commissions. ✔✔True You can receive commission for any sale that results from an unreported marketing/sales event. ✔✔False A prohibited marketing activity is: ✔✔All of the above. How long are you required to maintain Scope of Appointment (SOA) documentation? ✔✔10 years. If a beneficiary requests to discuss other products not originally documented on the SOA, you must document a second SOA for the additional product type, and then the appointment may continue ✔✔True. When obtaining a Scope of Appointment, you may not: ✔✔All of the above. The Permission-to-Contact form is used by Aetna sales representatives and external agents to cntact beneficiaries, and must be completed prior to conducting an outbound call to a Medicare prospect. ✔✔True. The Permission-to-Contact form is required when a prospect calls in to RSVP for a meeting. ✔✔False You may not contact your own clients by telephone and plans may not contact current members by telephone at any time to discuss plan business. ✔✔False Producers may only use CMS and Aetna-approved marketing materials that have been created by our marketing team, approved by us and filed with CMS by us when discussing Aetna or Coventry Individuals Medicare plans. ✔✔True [Show More]

Last updated: 2 years ago

Preview 1 out of 7 pages