Wellcare Medicare Plans and Prescription Drug Plans, Exams of Business Economics

Download Wellcare Medicare Plans and Prescription Drug Plans and more Exams Business Economics in PDF only on Docsity! 1 | P a g e WELLNESS ACT MASTERY CERTIFICATION EXAM 2024-2025 WITH ACTUAL QUESTIONS CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS|ALREADY GRADED A+|BRAND NEW!!!|LATEST UPDATE|GUARANTEED PASS The _________ plan is expected to have one of the lowest premiums in the country! a. Classic b. Value Plus c. Value Script c. Value Script Which of the following is not an example of Protected Health Information Library Card When verify a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligibility may affect enrollment and/or sharing. True Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formal and informal). False Which option is the preferred method to submit enrollment? Ascend Web/Mobile Applicaiton From October 1 to October 14, certain activities are Non-Permissible Activities. These include: All of these A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. False 2 | P a g e A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse n Determination (Medicare) is a/an: Appeal An SEP is a period outside of the ICEP, ARP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period? True Communication of PHI can be: (Select all that apply.) Written, Electronic, and Verbal The online Centene Workbench self-service portal enables you to: All of these If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed. True Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the _____ calendar quarters only. (Select all that apply.) First, Second, and Third Brokers/agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) Complaint Tracking Module (CTM), Grievance, and Secret Shop Finding Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: All of these Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. True Enrollment applications must be received by Wellcare no later than _____ calendar day(s) following receipt from the beneficiary. One (1) Which elements are available as part of Wellcare's Sales Support model? All of these 5 | P a g e When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligiblity may affect enrollment and/or cost sharing. True False True Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? a. Member Service b. Reputation c. Member Payments d. Serving Government Customers c. Member Payments Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a. Ascend b. Telephonic c. Paper d. All of these d. All of these Brokers/Agents can submit a support ticket online through their Centene Workbench portal. True False True An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. True False True *From October 1 to October 14, certain activities are Non-Permissible Activities. These include: a. Assist with completing an application b. Collect a completed application c. Advise the beneficiary to complete an application prior to October 15. d. All of these d. All of these *NOT a. Assist with completing an application 6 | P a g e Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. True False True Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. True False False The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). True False True Which elements are available as part of Wellcare's Sales Support model? a. Online b. Local c. Corporate d. All of these d. All of these Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: a. Member Satisfaction/Experience b. Complaints c. Rapid Disenrollment d. All of these d. All of these Which of the following is not an example of Protected Health Information (PHI)? a. Medical records b. Payment history c. Library card c. Library card Which option is the preferred method to submit enrollment? a. Centene Workbench Upload b. Ascend Web/Mobile Application c. Fax/Paper 7 | P a g e b. Ascend Web/Mobile Application With which types of inquiries can Wellcare's Corporate Sales Support team assist? a. Application and Enrollment b. Onboarding and Certifications c. Commissions d. All of these d. All of these A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an: a. Appeal b. Grievance a. Appeal The Prescription Drug Plan (PDP) network is expected to include over ____ total pharmacies. a. Sixty Thousand b. Thirty Thousand c. Twenty Thousand a. Sixty Thousand With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card 1/1/2024 and beyond. True False False ____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. a. Two b. Three c. Four d. Five d. Five Wellcare added which state to its footprint for 2024? a. Alabama b. Arkansas c. Delaware d. Oklahoma c. Delaware *Wellcare's 2024 product expansion represents a __% increase from 2023. a. One b. Two 10 | P a g e True When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True False The Mastery Exam will lock for a period of 48 hours after each failed attempt. True False False CustomPoint sales material order dates will be posted on Wellcare.com. True False False Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) a. Complaint Tracking Module (CTM) b. Yelp Review c. Grievance d. Secret Shop Finding a. Complaint Tracking Module (CTM) c. Grievance d. Secret Shop Finding When explaining the provider network for D-SNPs and C-SNPs: (Select all that apply.) a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor. c. Not explaining the provider network is a fundamental task during the enrollment process. d. None of these a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor. Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True False 11 | P a g e True A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. a. 30 b. 45 c. 60 d. 90 c. 60 When discussing prescription drug coverage, you should: (Select all that apply.) a. Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c. Explain formulary tiers as well as drug copayment amounts. d. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. a. Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c. Explain formulary tiers as well as drug copayment amounts. d. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? a. Speak with the investigator as quickly as possible. b. Answer all questions honestly and completely. c. Offer information and documents important to the investigation. d. All of these d. All of these Which is an example of a top beneficiary complaint that affects Star Ratings? a. The beneficiary was enrolled in the correct plan. b. The provider was in-network and contracted with the selected plan. c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. d. The beneficiary enrolled by the enrollment deadline. c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. 12 | P a g e ______ events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. a. Informal Sales b. Formal Sales c. Educational c. Educational Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. True False True Materials that include plan comparisons or cost-sharing do not require CMS submission. True False False For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plan will continue to offer a discount (2.5 x 30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions. a. Classic b. Value Plus c. Value Script b. Value Plus CVS Caremark Mail Order will be in-network for 2024. True False False A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need. a. Two b. Three c. Four d. Five c. Four Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True False True 15 | P a g e Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. All of these Which of the following is not an example of Protected Health Information (PHI)? Library Card When a paper SOA form is used, it must be completed __________ hosting the sales presentation. 48 Hours prior to Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. True When explaining the provider network for D-SNPs and C-SNPs: Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct time frame for the member based on their eligibility date or change date needed. True Wellcare's _____ plan is designed for Low-Income Subsidy members. Classic Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? Three The _________ plan is expected to have one of the lowest premiums in the country! Value Script The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. True Wellcare continues to expand its reach by offering more products in a wider geography. ____ new Wellcare plans are going to market. 16 | P a g e Twenty-three All Prescription Drug Plans (PDPs) will off er a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. Zero Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024? Classic In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for the remainder of the year once their total out of pocket costs reach $8,000. Zero Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM, OH, OK, TX, and WI. True All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True ____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. Three Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligibility may affect enrollment and/or cost sharing. True Which of the following statements about Scope of Appointment (SOA) is FALSE? An electronic SOA submitted in Ascend must be in a Pending status prior to beginning the appointment. Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: All of these Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no later than 30 days of use. 17 | P a g e False When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True Providers may create co-branded marketing pieces using the Wellcare name and logo, as long as they are using the current, approved logo. False Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? All of these Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. True Which of the following is not considered a grievance? A dispute of the appeal of an organization determination, coverage determination, or a Late Enrollment Penalty (LEP) determination. Brokers/Agents can access and download enrollment materials through CustomPoint. True ______ events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. Educational Materials that include plan comparisons or cost-sharing do not require CMS submission. False Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? Member Payments The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)? Both PDP & MAPD A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need. Four 20 | P a g e Value Plus Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024? Express Scripts Pharmacy The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). True Prior to the beginning of the enrollment process, a broker/agent is required to cover certain beneficiary specific information, including but not limited to: All of these The Single Sign-On Portal provides access to several applications, including CustomPoint True An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. True The Mastery Exam will lock for a period of 48 hours after each failed attempt. False When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend after the enrollment application, through the Value-Based Enrollment (VBE) portal. True Brokers/Agents MUST complete a Wellcare Contract Recertifi cation case in Centene Workbench (CWB) every two years. False Brokers/Agents can submit a support ticket online through their Centene Workbench portal. True Wellcare added which state to its footprint for 2024? Delaware What are some examples of steps that can be taken when safeguarding and securing PHI and PII? (Select all that apply.) Shred documents that contain PHI or PII using appropriate means. Never leave laptops, PHI, or PII in an unattended vehicle. 21 | P a g e Do not include PHI or PII in the subject line or body of an email. Secure emails that contain PHI or PII. Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task True Marketing materials that have been developed by a third-party marketing organization (TPMO) for multiple MA organizations or plansmust be pre-reviewed by each MA organization, submitted to CMS in the Health Plan Management System (HPMS), and opted-in by thePlan prior to distribution. True The Prescription Drug Plan (PDP) network is expected to include over ____ total pharmacies. Sixty Thousand With which types of inquiries can Wellcare's Corporate Sales Support team assist? All of these Which Prescription Drug Plan (PDP) product features no deductible on any tier? Value Plus A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an: a. Appeal Enrollments through Ascend off er the following unique benefits: Validation of important data to help prevent incorrect or missing information Search for providers and formularies to validate physician and prescription availability Extra help eligibility status. Digital capture of the broker's/agent's and benefi ciary's electronic signatures through Send for Signature at any timethroughout the enrollment application. An LEP is assessed by CMS when a member goes ______ days or longer without creditable prescription drug coverage after they become Medicare-eligible. 63 days Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted. 22 | P a g e True Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser? Classic Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only. First, Second , Third A Health Risk Assessment (HRA) All of these Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? All of these Once the enrollment is completed, you can save a copy of the application for your reference. False True Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. True False d. All of the above Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? a. Speak with the investigator as quickly as possible. b. Answer all questions honestly and completely. c. Offer information and documents important to the investigation. d. All of the above a, b, c Communication of PHI can be: (Select all that apply.) 25 | P a g e Which of the following is not an example of Protected Health Information (PHI)? a. Medical records b. Payment history c. Library card a. Prior to When a paper SOA form is used, it must be completed __________ hosting the sales presentation. a. Prior to b. During c. After d. All of the above Which resources are available for download from the Shared Resources section found within Centene Workbench? a. Contacts & Communications b. Marketing Resources c. Benefits Resources d. All of the above True A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information. Select one: True False c. A dispute of the appeal of an organization determination, coverage determination or a Late Enrollment Penalty (LEP) determination. Which of the following is not considered a grievance? a. 26 | P a g e An agent contacting a beneficiary without consent. b. Premium and copay complaints. c. A dispute of the appeal of an organization determination, coverage determination or a Late Enrollment Penalty (LEP) determination. d. Enrollment or disenrollment concerns. Clear my choice c. Member Payments Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? a. Member Service b. Reputation c. Member Payments d. Serving Government Customers Clear my choice d. All of the above Wellcare offers a range of Medicare plans to provide members with affordable access to: a. Doctors b. Hospitals c. Specialists d. All of the above True All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies. Select one: True False True 27 | P a g e All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order). Select one: True False b.Value Plus For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions. a. Classic b.Value Plus c.Value Script c. Value Script The _________ plan is expected to have one of the lowest premiums in the country! a. Classic b. Value Plus c. Value Script b. 209 Wellcare added ___ counties to their footprint for 2023. a. 122 b. 209 c. 284 d. 327 Clear my choice True Centene has new PPO D-SNP product expansion in CT, IN, KS, KY, MS, OH, OK, PA, SC, and a new HMO D- SNP in LA. Select one: True False