Clep Humanities Practice Test/ Humanities Act Practice Test Answers Updated Version | Exams Nursing

Clep Humanities Practice Test/ Humanities Act

Practice Test Answers Updated Version

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? ---------- Correct Answer ---------

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.

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? ---------- Correct Answer ---------

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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- Agents must explain in and out of

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Clep Humanities Practice Test/ Humanities Act

Practice Test Answers Updated Version

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? ---------- Correct Answer --------- 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. 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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... -------- -- Correct Answer --------- The MA/MAPD enrollment request is made prior to the Part B effective date. When can agents begin marketing to non-renewing members? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- SEP can only be used (if a valid SEP exists) because Carol has delayed Part B and is enrolling after Part B effective date. To use E-Sig to complete a FastApp Medicare enrollment, agents MUST confirm that the beneficiary has a valid.... ---------- Correct Answer --------- Email address Agent Grace is enrolling Lamar into a Humana Medicare Advantage plan and asks him if his phone number is a cell phone number. Why did Agent Grace ask if Lamar's phone number is a cell phone number? ---------- Correct Answer --------- Agent Grace asked if Lamar's phone number is a cell phone, because the FCC requires prior express written consent to contact a prospect or member via their cell phone. Which of the following is considered marketing material and requires CMS approval? --- ------- Correct Answer --------- Agent move notification letters sent to members and prior members. In which of the following situations is it acceptable to create an Email address for a beneficiary? ---------- Correct Answer --------- It is never acceptable for an agent to create an Email address for a beneficiary. What are the dates for the SEP for Non-Renewal? ---------- Correct Answer --------- December 8 - end of February 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? ---------- Correct Answer --------- 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

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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- Provider Highlighting To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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? - --------- Correct Answer --------- 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 Tamaras application? ---------- Correct Answer --------- 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 Humanas Physician Finder Plus. Is this acceptable? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- Initial Coverage Election Period Initial Coverage Enrollment Period (ICEP) can be used to enroll beneficiaries into which plans? ---------- Correct Answer --------- 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. ---------- Correct Answer --------- 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? ---------- Correct Answer --------- 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 ---------- Correct Answer --------- 5 business days When is the Medicare Advantage Disenrollment Period? ---------- Correct Answer --------- 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 ___________________. -- -------- Correct Answer --------- 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? ---------- Correct Answer --------- 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... ---------- Correct Answer --------- Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. once per year). 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 members best interest)? ---- ------ Correct Answer --------- Provider Steering Which of the following is not an automated payment option for Humana Medicare enrollments? ---------- Correct Answer --------- HumanaBill Me` Why is it important for agents to offer guidance for provider selection? ---------- Correct Answer --------- 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? ---------- Correct Answer --------- Agent Deborah must explain in and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP.

--------- Correct Answer --------- It is never acceptable under any circumstance for an agent to complete the AOA application on behalf of their client, even if they request it. How can agents help reduce paper applications being denied due to improper election type code? ---------- Correct Answer --------- Agents should read through the SEPs listed on page five of the paper application and select any that apply Which of the following is an advantage for new members when they pre-register with Humana Pharmacy? ---------- Correct Answer --------- It allows members to obtain pricing for medications based on their future effective date According to recent CMS guidance, which of the following plan changes is NOT allowed during the annual OEP? ---------- Correct Answer --------- PDP to PDP It is January 15th and you are speaking with Mr. Green. He currently has a MAPD plan with ACME Co. and wants to enroll in a CarePlus MAPD plan. How should you guide Mr. Green? ---------- Correct Answer --------- Tell him that he has the Open Enrollment Period (OEP) available and proceed with the enrollment. In which of the following situations is it acceptable for an agent to use their own email address for an applicant? ---------- Correct Answer --------- It is never acceptable under any circumstance for an agent to use their own email address for an applicant, even if they request it. Agent Martha is completing an MAPD enrollment for Mr. Simpson. Mr. Simpson has misplaced his new Medicare ID card and does not know his new Medicare ID number. How should agent Martha handle the enrollment? ---------- Correct Answer --------- Agent Martha can enter Mr. Simpsons old Medicare ID number on the application since Humana will accept both the old and new Medicare ID numbers on applications through 2019 Choose the answer that best explains the Telephonic Presentations policy. ---------- Correct Answer --------- The Telephonic Presentations policy provides guidance for licensed, appointed and certified sales agents representing a Humana Medicare Advantage (MA), in a non-call center setting, to perform a compliant telephonic Medicare sales presentation Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is ---------- Correct Answer --------- For events advertised to the general public, a Scope of Appointment (SOA) is not required, as the advertisement serves as a collective SOA What is the purpose of the Non-Discrimination notice that is included in many of Humanas marketing materials? ---------- Correct Answer --------- The purpose of the Non-Discrimination notice is 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. Is there a difference in length between the Telephonic Presentation and the in-person presentation? ---------- Correct Answer --------- No. Sales agents must conduct the sales presentation in its entirety for telephonic presentations CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. Which of the following is the best example of what an agent should do to explain a plan's drug benefit? ---------- Correct Answer --------- Agents must ensure that members understand how their plan's drug benefits, including important benefits such as drug tier information. Which of the following actions can help agents avoid complaints about Benefits and Presentation? ---------- Correct Answer --------- Before completing the enrollment, agents should take the time to perform a thorough review all features and benefits of the plan and make them understandable to the beneficiary How can agents help Humana members receive less mail and have convenient, on-line access to plan documentation? ---------- Correct Answer --------- Agents should encourage members to receive their plan documentation digitally at the time of enrollment Agent Nicky conducts educational events at Dr. Singhs office throughout the year. She recently picked up a second job working at Dr. Singhs office on nights and weekends. How long does Agent Nicky have to complete a new Conflict of Interest Disclosure and Agreement form? ---------- Correct Answer --------- Nicky must be complete a new form within 30 days. Which of the following statements best describes Go365? ---------- Correct Answer ------- -- Go365 rewards up to $300 per member per year in redeemable gift cards for completion of preventive screenings and participation in healthy habits It is October 2nd and you, the agent, are speaking with Doris. Doris tells you that she moved to Los Angeles last month to be near her grandchildren. She is requesting to enroll in a Humana Medicare Advantage plan today. How should you respond to Doris? ---------- Correct Answer --------- Agents can NOT perform AEP enrollments during the pre-AEP period, per CMS. Of course, if a beneficiary has another valid election period (i.e., IEP, SEP) available during this time, enrollments can be completed. Doris has an SEP from her permanent move to Los Angeles When enrolling a beneficiary into a plan with prescription drug coverage, which of the following should agents do to avoid issues with any applicable Late Enrollment Penalty? ---------- Correct Answer --------- Agents should advise beneficiaries that they need to respond promptly to Humana's request for Creditable Coverage, if applicable.

Correct Answer --------- Agent Juan should advise Mrs. Maples that she will need to select another PCP since Dr. Grayson is not listed as an in-network provider When a beneficiary moves out of a plan`s service area, when must they enroll into a plan servicing the new area to avoid a lapse in coverage? ---------- Correct Answer ------- -- To avoid a lapse in coverage, the beneficiary must enroll on or before the last day of the month of the move When enrolling a member into an Optional Supplement Benefit (OSB), what should agents be sure to tell the member about the premium payment method? ---------- Correct Answer --------- The premium payment option that was selected for the base MA/MAPD plan will be used to pay the monthly OSB plan premium Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is _________. ---------- Correct Answer --------- For events advertised to the general public, a Scope of Appointment (SOA) is not required, as the advertisement serves as a collective SOA Agent Anna enrolled a prospect in a Humana MAPD plan for Nebraska. Agent Anna is not licensed in Nebraska. Upon discovery, how will Humana respond? ---------- Correct Answer --------- Humana may terminate upon discovery and report incidences of submission of applications by unlicensed agents and brokers to the authority in the State where the application was submitted as well as to CMS. When is the annual Open Enrollment Period (OEP) available? ---------- Correct Answer - -------- The annual OEP is available January 1st - March 31s What are the dates for the Special Election Period (SEP) for Non-Renewal? ---------- Correct Answer --------- The dates for the SEP for Non-Renewal are December 8 - end of February

Clep Humanities Practice Test/ Humanities Act Practice Test Answers Updated Version, Exams of Nursing

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Download Clep Humanities Practice Test/ Humanities Act Practice Test Answers Updated Version and more Exams Nursing in PDF only on Docsity!

Clep Humanities Practice Test/ Humanities Act

Practice Test Answers Updated Version