DEVOTED HEALTH AGENT CERTIFICATION EXAM 2024-2025, Exams of Nursing

Download DEVOTED HEALTH AGENT CERTIFICATION EXAM 2024-2025 and more Exams Nursing in PDF only on Docsity! 1 | P a g e DEVOTED HEALTH AGENT CERTIFICATION EXAM 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS |LATEST UPDATE Devoted Health HMO members... -Must choose an in-network primary care physician at the time of enrollment. -Can choose a non-participating doctor as their primary care physician. -Can choose a specialist to be their primary care physician. -Can never change their primary care physician once they have chosen one. Must choose an in-network primary care physician at the time of enrollment. Mrs. Carson is a worrier and admits that she is often confused when it comes to navigating her health plan and the healthcare system. She asks Joyce, her Devoted Sales Agent, who she can contact if she needs help once she becomes a Devoted Health member. How should Joyce respond? -"Sorry, my job is only to sign you up. Then you are on your own." -"Only call me, the member service team at the insurance company always takes a long time and doesn't give you the right answer" -"As your Devoted Sales Agent, you can always call me with questions, but additionally Devoted has an entire Guide Team dedicated to simplifying your healthcare experience. In addition to them periodically reaching out to you, you can always call them with questions. They want to hear from you." -"Healthcare is really confusing. I suggest you re-read your Evidence of Coverage, and you'll probably be fine." 2 | P a g e "As your Devoted Sales Agent, you can always call me with questions, but additionally Devoted has an entire Guide Team dedicated to simplifying your healthcare experience. In addition to them periodically reaching out to you, you can always call them with questions. They want to hear from you." What are Devoted Health's core ingredients? -Newer MA plan, CSNP, strong PCP partnerships, Devoted Guides, Devoted Medical Group -Tech platform, available in all 50 states, strong provider partnerships, Med Supp, Devoted Guides -Tech platform, available in all 50 states , strong provider partnerships, PPO, Devoted Guides -Newer MA plan, tech platform, strong provider partnerships, Devoted Guides, Devoted Medical Group Newer MA plan, tech platform, strong provider partnerships, Devoted Guides, Devoted Medical Group The Devoted Health Guides... -Consist of a team of clinical and service professionals who work together for each of our members. -Are only available to Devoted Health special needs plan members. -Do not attempt to build long lasting relationships built on trust and guidance with Devoted members. -Act as travel agents to plan vacations for Devoted members. Consist of a team of clinical and service professionals who work together for each of our members. Which of the following is not a required part of the Devoted Health sales presentation -Review the provider network and if applicable formulary -Request the beneficiary's latest physical exam report -Conduct a needs analysis to determine which plan might fit an individuals needs -Review the summary of benefits, Devoted video/presentation and star ratings Request the beneficiary's latest physical exam report Devoted Health HMO members... -Can never change their primary care physician once they have chosen one. -Can choose a specialist to be their primary care physician. -Must choose an in-network primary care physician at the time of enrollment. 5 | P a g e network. -All of these -Review the transition supply process and the process for exceptions. -Explain limitations associated with obtaining prescriptions including Prior Authorization, Step Therapy, and Quantity Limits. -Offer to look up their prescriptions and show them how they can look up their prescriptions to see if they are covered by the plan. All of these During the AEP, on October 30, Marissa enrolls in the Devoted Health HMO Medicare Advantage plan for an effective date of 1/1/2024. On November 15, Marissa meets with Janice of ABC Insurance Agency and enrolls in a stand-alone prescription drug plan (PDP) also for an effective date of 1/1/2024. If Marissa does not make any further changes to her Medicare enrollment choices, on January 1, 2024 which plan will she be on? -The Devoted Health HMO Medicare Advantage plan. -Medicare A&B and the standalone PDP plan she chose. -The Devoted Health HMO Medicare Advantage plan and the standalone PDP she chose. -Medicare A&B-only since Medicare rejects multiple enrollments made during the AEP. Medicare A&B and the standalone PDP plan she chose. On May 10, Devoted Sales Agent, Jackie, gets a call from Mr. Seinfeld stating that he is permanently moving from Cuyahoga county, Ohio to a beach condo in Palm Beach county, Florida on June 1. He wants to know if and when he should change his Devoted Health plan. What should Jackie tell him? -He must disenroll from his Devoted plan in Cuyahoga county since he will no longer be in the service area and must wait until the next Annual Enrollment Period (AEP) to enroll in the plan in Palm Beach effective January 1 of the following year. -Because Mr. Seinfeld is leaving his current plan's service area and moving to a new one, Jackie can instruct him that he must switch from the Devoted plan in Cuyahoga county to the Devoted plan in Palm Beach, and that he can do so one month prior to his move and up to two months following the move. Additionally he can do so by calling Devoted Health to make the plan change and Jackie w Because Mr. Seinfeld is leaving his current plan's service area and moving to a new one, Jackie can instruct him that he must switch from the Devoted plan in Cuyahoga county to the Devoted plan in Palm Beach, and that he can do so one month prior to his move and up to two months following the move. 6 | P a g e Additionally he can do so by calling Devoted Health to make the plan change and Jackie will remain as his agent of record (AOR) In which of the following settings is a Scope of Appointment form NOT required to be collected? -A one-on-one appointment occurring in the beneficiary's home. -An unscheduled meeting with a beneficiary who arrives at an agent's office without an appointment and requests information. -A sales seminar advertised in the local newspaper. -All of these scenarios require a Scope of Appointment form be collected. A sales seminar advertised in the local newspaper. What are the different plan options offered by Devoted Health? -HMO, PPO, DSNP, Medicare Supplements -C-SNP, D-SNP, PPO, PFFS -PPO, PDPs -HMO, PPO, DSNP, CSNP, HMO MA-only, PPO MA-only HMO, PPO, DSNP, CSNP, HMO MA-only, PPO MA-only Which of the following is a main component of our model of care? -All of these -Provider network -Quality of performance and improvement -Population description -Care coordination All of these Which answer best describes some of the extra benefits offered on Devoted Health plans? -Money to use on wellness items, Silver Sneakers, Devoted dollars for preventive care -All of these are extra benefits, plus more.... 7 | P a g e -Hearing aid coverage and vision benefits -Food and Utility card and Dental benefits All of these are extra benefits, plus more.... What can Devoted Health members expect after enrollment? -Welcome call, welcome Kit with ID card and mailed full directory and formulary. -Welcome text message, if the individual has transition needs a welcome call and a welcome kit with ID card and benefit guide. -All of these can be expected for all new Devoted Health members after enrollment -Welcome kit with ID card and a mailed evidence of coverage. Welcome text message, if the individual has transition needs a welcome call and a welcome kit with ID card and benefit guide. Mrs. Davis is a Devoted Health HMO member and on March 21st calls Angie her Devoted sales agent stating that she wants to switch her primary care physician (PCP). What can Angie tell Mrs. Davis? -That she must first get a letter signed by her current PCP agreeing for her to switch and then a second letter from the new PCP who she wants to see in order for Devoted to approve the change -She can call her Devoted Guide Team and they would be happy to assist her in choosing a new one to be effective the beginning of April. -That Devoted never allows members to change PCPs. -That she can only change her PCP during the annual enrollment period and will have to wait until then to do so. She can call her Devoted Guide Team and they would be happy to assist her in choosing a new one to be effective the beginning of April. What type of events must an agent report to UnitedHealthcare? Only the marketing/sales events, both formal and informal. (WRONG) While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do? Leave any field requesting a consumer email address blank. 10 | P a g e Building from the ground up means that we have not wasted time revising clunky systems or outdated tech. When everyone builds the company together, there is no pre-existing corporate culture that needs to be changed. Devoted Tech Platform Our results: Faster claims processing - we pay specialists within 5 business days, 90% of the time. Prior authorizations processing within 72 hours. Credentialing process - less than 2 weeks to credential new providers. Faster commission payments. Partnerships with strong PcP's Partner with high-performing Pcp Devoted Health Guides Navigators, Problem-Solvers, Supporters We Stand By What We Say -When it comes to answering the phones..... Our average speed of answer is 24 seconds. 82% of calls are answered in less than 30 seconds. -When it come to solving our member's issues.....> 80% of member issues are resolved same-day.> 90% of member issues are resolved within 3 days. Devoted Medical Group Devoted Medical Group (DMG) is designed to help provide additional virtual and in-home care above and beyond the care they receive from their physicians now. Our team is comprised of doctors, nurse practitioners, and nurses providing care in members homes and over the phone. DMG picks up where the PCP's capabilities leave off. Our team works along with your PCP to provide excellent care right in the member's home. For in-home visits, we can identify any living conditions concerns that may impact that member's health. This service is FREE of charge to Devoted Health Plan members.* In-home services help keep patients healthier, happier, out of the hospital and in their homes. Devoted Plan Design Original Medicare Benefits, Built in Part D, Additional Benefits Qualify for Devoted Health Plan -Must live in the plan's service area ✅Must be eligible for Part A and Enrolled in Part B ✅Must have a qualifying election period 🚫Cannot have ESRD (only for 2020 - in 2021 enrollment eligibility will not be impacted by ESRD) Devoted Core HMO 11 | P a g e This is a Medicare Advantage HMO plan with a $0 monthly premium. It provides all Medicare benefits. It includes competitive cost sharing and additional benefits. Under this HMO, referrals are required* for some specialist visits and a PCP must be selected. This plan is available in all markets Devoted Prime HMO (Select in AZ) This plan has a low monthly premium, however, 100% is allocated to Part D - Great choice for beneficiaries with 100% LIS subsidyLow member cost sharingStrong supplemental benefits are included in the planReferrals and required for some specialist visits* and a PCP must be selected. This plan may be a good fit for:Individuals who are willing to pay a premium for lower cost sharingIndividuals with partial MedicaidIndividuals with Low-Income Subsidy (LIS) (depending on level will pick up some or all of premium)Since these folks cannot qualify for a Dual Eligible Special-Needs plan since they do not qualify for Medicaid, they typically just join the standard HMO plan offering but are subject to paying all of the copays. With Devoted Prime HMO the LIS recipient will benefit from very low copays, rich supplemental benefits, and subsidized premium and Part D benefits. Prior to enrolling a prospect, make sure you confirm their LIS status before you tell them that they do not have to pay a premium. Devoted Essentials HMO Medicare Advantage HMO plan with a Part B "giveback" Givebacks reduce the Part B premium that most Medicare beneficiaries are responsible for paying on a monthly basis.A giveback will increase the value of a member's monthly social security check, since they are not paying as much for their Part B.If an individual is not paying their Part B, they will not see an increase in their social security check.If an individual is not receiving a social security check, they will see a reduction in the amount they owe monthly for their Medicare Part B.It is important to note that it may take up to 3 months for an individual's Part B reduction to show up in their social security check. Payments will be retroactive for the months that were missed.As a result in receiving money back for their Part B premium, members will have higher cost sharing and fewer additional benefits than those offered on the other Devoted Health plans. Referrals for some specialists are required under this plan* and a PCP must be selected Devoted Flex HMO Only Offered in AZ for 2021 The Flex plan will offer comprehensive medical and prescription drug coverage with moderate member cost sharing and a low monthly plan premium.Additionally, this plan puts members in the driver's seat anchored by a consumer-driven supplemental benefit package called MyFlex. The MyFlex benefit will provide a quarterly allowance and permit members to choose which eligible supplemental benefits within the package to utilize with no restriction to network.Eligible supplemental benefits in the MyFlex benefit package will include: Preventive and comprehensive dental Gym memberships / Yoga classes / Personal training Wearable fitness devices (e.g. Apple watch, FitBit) 12 | P a g e Personal fitness equipment Therapeutic massage Eyewear and more... Devoted DSNP The Devoted DSNP is a dual special needs plan, which means there are specific requirements related to enrollment and continuation within the plan. Members under this special needs plan will not have cost sharing for covered services in network.This plan will have a premium listed, but this premium will be picked up by the individual's subsidy. Referrals are required for some specialist services and a PCP must be selected. Prior to enrollment, agents must confirm current Medicaid status. For assistance, agents may contact Agent Support at 1-877-764-9446. Before processing an enrollment into the dual eligible SNP (D-SNP), Devoted must confirm eligibility, including both MA eligibility and Medicaid eligibility. To qualify for the D-SNP, individuals must be one of the following Medicaid Levels: QMB, SLMB QMB+, SLMB+, or FBDE (see below for descriptions of these terms). Devoted Sales Process Scope of Appointment, Needs Analysis, Enrollment Presentation, Finalize the Sale, Completing the Enrollment Button up the Sale DAY 0- App is Submitted DAY 1-3 - App is approved by CMS and member gets welcome text DAY 4-7 - Member receives welcome kit DAY 8-14 - Welcome Call Registering For an Event All Events requests must be submitted to Devoted at least 14 days in advance, Have all the materials you need prior to the event, Additional event reminders, You must market and enroll only Devoted products Educational Events Educational events are designed to inform beneficiaries about Medicare Advantage, Prescription Drug, or other Medicare programs. The rules in the table below apply to all educational events. Marketing Sales Events Marketing/Sales Events are designed to steer (or attempt to steer) enrollees toward a plan. The rules in the table below apply to all marketing/sales events. Pre-Aep Enrollment Period Reminders -Agents are not permitted to market for an upcoming plan year prior to October 1st. -Starting October 1st, agents can assist prospects in completing paper applications, but cannot solicit or take possession of applications from 10/1-10/14. 15 | P a g e This plan may be a good fit for:Individuals who are willing to pay a premium for lower cost sharingIndividuals with partial MedicaidIndividuals with Low-Income Subsidy (LIS) (depending on level will pick up some or all of premium)Since these folks cannot qualify for a Dual Eligible Special-Needs plan since they do not qualify for Medicaid, they typically just join the standard HMO plan offering but are subject to paying all of the copays. With Devoted Prime HMO the LIS recipient will benefit from very low copays, rich supplemental benefits, and subsidized premium and Part D benefits. Prior to enrolling a prospect, make sure you confirm their LIS status before you tell them that they do not have to pay a premium. Devoted Essentials HMO Medicare Advantage HMO plan with a Part B "giveback" Givebacks reduce the Part B premium that most Medicare beneficiaries are responsible for paying on a monthly basis.A giveback will increase the value of a member's monthly social security check, since they are not paying as much for their Part B.If an individual is not paying their Part B, they will not see an increase in their social security check.If an individual is not receiving a social security check, they will see a reduction in the amount they owe monthly for their Medicare Part B.It is important to note that it may take up to 3 months for an individual's Part B reduction to show up in their social security check. Payments will be retroactive for the months that were missed.As a result in receiving money back for their Part B premium, members will have higher cost sharing and fewer additional benefits than those offered on the other Devoted Health plans. Referrals for some specialists are required under this plan* and a PCP must be selected Devoted Flex HMO Only Offered in AZ for 2021 The Flex plan will offer comprehensive medical and prescription drug coverage with moderate member cost sharing and a low monthly plan premium.Additionally, this plan puts members in the driver's seat anchored by a consumer-driven supplemental benefit package called MyFlex. The MyFlex benefit will provide a quarterly allowance and permit members to choose which eligible supplemental benefits within the package to utilize with no restriction to network.Eligible supplemental benefits in the MyFlex benefit package will include: Preventive and comprehensive dental Gym memberships / Yoga classes / Personal training Wearable fitness devices (e.g. Apple watch, FitBit) Personal fitness equipment Therapeutic massage Eyewear and more... Devoted DSNP The Devoted DSNP is a dual special needs plan, which means there are specific requirements related to enrollment and continuation within the plan. Members under this special needs plan will not have cost sharing for covered services in network.This plan will have a premium listed, but this premium will be picked up by the individual's subsidy. 16 | P a g e Referrals are required for some specialist services and a PCP must be selected. Prior to enrollment, agents must confirm current Medicaid status. For assistance, agents may contact Agent Support at 1-877-764-9446. Before processing an enrollment into the dual eligible SNP (D-SNP), Devoted must confirm eligibility, including both MA eligibility and Medicaid eligibility. To qualify for the D-SNP, individuals must be one of the following Medicaid Levels: QMB, SLMB QMB+, SLMB+, or FBDE (see below for descriptions of these terms). Devoted Sales Process Scope of Appointment, Needs Analysis, Enrollment Presentation, Finalize the Sale, Completing the Enrollment Button up the Sale DAY 0- App is Submitted DAY 1-3 - App is approved by CMS and member gets welcome text DAY 4-7 - Member receives welcome kit DAY 8-14 - Welcome Call Registering For an Event All Events requests must be submitted to Devoted at least 14 days in advance, Have all the materials you need prior to the event, Additional event reminders, You must market and enroll only Devoted products Educational Events Educational events are designed to inform beneficiaries about Medicare Advantage, Prescription Drug, or other Medicare programs. The rules in the table below apply to all educational events. Marketing Sales Events Marketing/Sales Events are designed to steer (or attempt to steer) enrollees toward a plan. The rules in the table below apply to all marketing/sales events. Pre-Aep Enrollment Period Reminders -Agents are not permitted to market for an upcoming plan year prior to October 1st. -Starting October 1st, agents can assist prospects in completing paper applications, but cannot solicit or take possession of applications from 10/1-10/14. I-f a paper application is completed with a prospect prior to 10/15, the date and signature must be left blank. Agents should remind the prospect to complete the application and mail into Devoted on or after 10/15. -Alternatively, agents may return to the members home following 10/15 to complete a paper or electronic application. -Applications received prior to 10/15 for which there is an indication of sales agent/broker involvement in the submission of the request will be investigated for possible agent solicitation. -Agents found to have solicited application prior to 10/15 will be subject to disciplinary action. -Soliciting definition - taking possession of an application prior to 10/15, submitting an application prior to 10/15, or instructing submission of application prior to 10/15. 17 | P a g e Compliance reporting Metrics Rapid disenrollment, application timeliness, Agent Allegation Investigations