1.
Which word or term below best describes the amount you must pay each year before your health plan begins paying?
Correct Answer
B. Deductible
Explanation
A deductible is the amount of money that an individual must pay out of pocket for healthcare services before their health insurance plan begins to cover the costs. It is an annual amount that needs to be paid before the insurance company starts contributing to the expenses. This term accurately describes the concept of the initial payment that needs to be made by the insured individual.
2.
What does PCP stand for?
Correct Answer
B. Primary Care pHysician
Explanation
PCP stands for Primary Care Physician. A primary care physician is a healthcare professional who serves as the first point of contact for patients seeking medical care. They provide routine check-ups, preventive care, and treatment for common illnesses and injuries. They also coordinate and manage the overall healthcare of their patients, referring them to specialists when necessary.
3.
Medicare Part A is also known as?
Correct Answer
A. Hospital
Explanation
Medicare Part A is known as Hospital because it primarily covers inpatient hospital care. This includes services such as hospital stays, skilled nursing facility care, hospice care, and limited home health services. Medicare Part A is one of the four parts of the Medicare program, which provides health insurance for individuals who are 65 or older, certain younger individuals with disabilities, and individuals with end-stage renal disease.
4.
Applications must be done in which order?
Correct Answer
D. All of the above apply
Explanation
The correct answer is "All of the above apply". This means that applications can be done in any of the mentioned orders: Vision, Dental, MAPD; Dental, Medigap, PDP; or Vision, Dental, Medigap, PDP. There is no specific order that needs to be followed, as all of these options are valid for application.
5.
What is another name for Medicare Claim Number?
Correct Answer
C. Health Insurance Claim Number (HICN)
Explanation
The correct answer is Health Insurance Claim Number (HICN). This is another name for Medicare Claim Number. It is not the same as a Social Security Number or a Driver's License Number. The HICN is a unique identifier used by Medicare to track and process claims for healthcare services.
6.
How does Automatic Reimbursement work?
Correct Answer
A. Customer pays the plan premium to insurance company; insurance company forwards receipt of the payment to OneExchange; OneExchange forwards receipt of payment to the Funding Department, and the Funding Department reimburses the customer.
Explanation
Automatic reimbursement works by following a specific process. The customer pays the plan premium to the insurance company. The insurance company then forwards the receipt of the payment to OneExchange. OneExchange further forwards the receipt of payment to the Funding Department. Finally, the Funding Department reimburses the customer. This process ensures that the customer receives their reimbursement for the plan premium they paid.
7.
True or False: HMOs require a Primary Care Physician number.
Correct Answer
A. True
Explanation
HMOs (Health Maintenance Organizations) do require a Primary Care Physician (PCP) number. In an HMO, individuals are required to choose a primary care physician who acts as their main healthcare provider and coordinates all their medical care. The PCP number is necessary for the HMO to establish a formal relationship between the individual and their chosen primary care physician. This helps in managing and directing the individual's healthcare needs, ensuring appropriate referrals to specialists, and maintaining continuity of care within the HMO network.
8.
How long does the ICEP last?
Correct Answer
B. 3 months before, the month of, and 3 months after 65th birthday
Explanation
The correct answer is 3 months before, the month of, and 3 months after 65th birthday. This is because the ICEP (Initial Enrollment Period) for Medicare Part B lasts for a total of 7 months. It begins 3 months before the individual turns 65, includes the month of their 65th birthday, and ends 3 months after their 65th birthday. During this period, individuals can enroll in Medicare Part B without facing any penalties or delays in coverage.
9.
Are you Guaranteed Issue if you are aging-in?
Correct Answer
A. Yes
Explanation
If you are aging-in, which means you are reaching the age where you become eligible for certain benefits or insurance plans, you are guaranteed issue. This means that you will be accepted for coverage regardless of any pre-existing conditions or health issues you may have. Therefore, the correct answer is "Yes."
10.
What plan types are available during the ICEP?
Correct Answer
D. All of the above
Explanation
During the Initial Coverage Election Period (ICEP), all plan types are available. This includes Medicare Advantage with Prescription Drug Plan, Medicare Advantage Plan, and Prescription Drug Plan. The ICEP is a specific period when individuals can enroll in or switch their Medicare coverage. Therefore, individuals have the option to choose any of these plan types during this period.
11.
What does ICEP stand for?
Correct Answer
B. Initial Coverage Election Period
Explanation
The correct answer is Initial Coverage Election Period. The Initial Coverage Election Period refers to the time when individuals who are eligible for Medicare can enroll in a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage. During this period, individuals can choose to enroll in a plan that best suits their needs and preferences.
12.
True or False: Customers using ICEP can only enroll during Annual Enrollment?
Correct Answer
B. False
Explanation
Customers using ICEP can enroll at any time, not just during the Annual Enrollment period. ICEP stands for Initial Coverage Election Period, which is the period when someone first becomes eligible for Medicare. During this period, customers can enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan. The ICEP can occur at various times, such as when someone turns 65, becomes eligible for Medicare due to a disability, or qualifies for both Medicare and Medicaid. Therefore, the statement that customers using ICEP can only enroll during Annual Enrollment is false.
13.
If a customer has ICEP and SEP-LEC, which enrollment period is used for a Legacy customer?
Correct Answer
A. I am new to Medicare.
Explanation
If a customer has ICEP (Initial Enrollment Period) and SEP-LEC (Special Enrollment Period for Low-Income Individuals), the enrollment period used for a Legacy customer would be "I am new to Medicare." This is because the ICEP is the initial period when someone is eligible to enroll in Medicare, and the SEP-LEC is a special enrollment period for low-income individuals who qualify for extra help. Therefore, if the customer is new to Medicare, they would be eligible to enroll during their ICEP.
14.
A customer aging-in to Medicare will turn 65 on December 1st 2014. What should the Medicare Part A effective date be?
Correct Answer
B. 11/01/2014
Explanation
The Medicare Part A effective date should be 11/01/2014 because Medicare coverage typically begins on the first day of the month in which the individual turns 65. Therefore, since the customer is turning 65 on December 1st, their Medicare Part A coverage would start on November 1st.
15.
Mr. Blakely is aging-in, and will turn 65 on 12/16/2014. What should his Medicare Part A effective date be?
Correct Answer
A. 12/01/2014
Explanation
Mr. Blakely's Medicare Part A effective date should be 12/01/2014 because when someone is aging-in, their Medicare coverage typically begins on the first day of the month they turn 65. Since Mr. Blakely's birthday is on 12/16/2014, his Medicare Part A coverage should start on 12/01/2014.
16.
Being new to which of the following would make a customer GI for a Medigap plan?
Correct Answer
A. Medicare Part B
Explanation
Being new to Medicare Part B would make a customer GI (Guaranteed Issue) for a Medigap plan. Medigap plans are supplemental insurance plans that help cover the costs that Original Medicare (Part A and Part B) does not cover. When someone is new to Medicare Part B, they have a guaranteed issue right, which means that insurance companies cannot deny them coverage or charge them higher premiums based on their health status. This allows the customer to enroll in a Medigap plan without any restrictions or penalties.
17.
If a customer has ICEP and SEP-LEC, which enrollment period is used for a new client?
Correct Answer
B. I am losing group coverage.
Explanation
If a customer has ICEP (Initial Coverage Election Period) and SEP-LEC (Special Enrollment Period for Loss of Employer Coverage), the enrollment period that is used for a new client is "I am losing group coverage." This means that if the customer is losing their group coverage, they are eligible for a special enrollment period to enroll in a new Medicare plan. The ICEP and SEP-LEC are specific enrollment periods for certain circumstances, and in this case, losing group coverage triggers the SEP-LEC.
18.
What does SEP stand for?
Correct Answer
D. Both B and C
Explanation
SEP stands for Special Enrollment Period and Special Election Period. Both B and C are correct because they refer to different contexts in which the term SEP is used. Special Enrollment Period is a term used in healthcare to refer to a specific time period during which individuals can enroll in or make changes to their health insurance plans. On the other hand, Special Election Period is a term used in the political context to refer to a specific time period during which voters can cast their votes in special elections.
19.
What does LEC stand for?
Correct Answer
B. Losing Employer Coverage
Explanation
LEC stands for "Losing Employer Coverage." This refers to the situation where an individual loses their health insurance coverage provided by their employer. This can occur due to various reasons such as job loss, change in employment status, or reaching the end of the coverage period. Losing employer coverage can have significant implications for individuals, as they may need to find alternative insurance options to ensure they have continued access to healthcare services.
20.
True or False: LEC can be a voluntary loss of employer coverage.
Correct Answer
A. True
Explanation
LEC stands for "Loss of Employer Coverage." It refers to the situation where an individual loses their health insurance coverage provided by their employer. This loss can occur due to various reasons such as termination of employment, reduction in work hours, or the employer discontinuing the coverage. In some cases, an individual may choose to voluntarily terminate their employer coverage for reasons such as switching to a different insurance plan or becoming eligible for a government-sponsored healthcare program. Therefore, it is true that LEC can be a voluntary loss of employer coverage.
21.
True or False: You are losing employer coverage, so you are Guaranteed Issue during the 3 months prior to and 63 following your loss of coverage date.
Correct Answer
A. True
Explanation
During the 3 months before and 63 months following the loss of employer coverage, individuals are guaranteed issue, meaning they cannot be denied health insurance coverage or charged higher premiums due to pre-existing conditions. This provision ensures that individuals have access to health insurance even if they are losing their employer coverage.
22.
When are we able to enroll a customer into a plan under the SEP-LEC?
Correct Answer
C. 3 months before loss of coverage
Explanation
A customer can be enrolled into a plan under the SEP-LEC 3 months before the loss of coverage. This allows the customer ample time to secure new coverage before their current coverage expires.
23.
What is the most common SEP used at OneExchange?
Correct Answer
C. SEP-LEC
Explanation
SEP-LEC is the most common SEP used at OneExchange. This is because it is specifically designed for individuals who have lost their employer-sponsored coverage and need to enroll in a new plan. SEP-LEC stands for Special Enrollment Period for Loss of Employer Coverage, and it allows individuals to enroll in a new plan outside of the regular enrollment period. This is the most common SEP used because many people experience a loss of employer coverage at some point and need to find new insurance options.
24.
When does the SEP-LEC end?
Correct Answer
D. A and B
Explanation
The SEP-LEC (Special Enrollment Period - Loss of Employer Coverage) ends after the plan has gone into effect and also 2 months after the loss of coverage. This means that individuals have a limited time frame to enroll in a new plan after experiencing a loss of employer coverage. The combination of both options A and B ensures that individuals have sufficient time to find and enroll in a new insurance plan.
25.
What plan types are available during the SEP-LEC?
Correct Answer
D. All of the above
Explanation
During the SEP-LEC (Special Enrollment Period - Limited Enrollment Period), all plan types are available. This includes Medicare Advantage with prescription drug coverage (MAPD), Medicare Advantage (MA), and Medicare Part D (PDP).
26.
What situations would allow a customer to enroll into Medicare prior to age 65?
Correct Answer
D. A & B
Explanation
The correct answer is A & B. A customer can enroll into Medicare prior to age 65 if they have End Stage Renal Disease or if they have a disability. These are specific situations that qualify individuals for early enrollment in Medicare. Asking Medicare nicely is not a valid reason for enrolling early.
27.
If the customer has two homes (e.g."snowbirds"), which one should you use as the address on the application?
Correct Answer
B. The address Medicare/IRS has as their permanent address
Explanation
The correct answer is to use the address Medicare/IRS has as their permanent address. This is because the permanent address is the most accurate and up-to-date information for the customer. Using the permanent address ensures that any important documents or correspondence related to the application will be sent to the correct location.
28.
If you have a Power of Attorney (POA) with a customer on the line and the customer is able to act for himself/herself, how would you process the application?
Correct Answer
D. Treat the POA as a HIPAA Representative; do not complete the POA section of the application; take the voice signature from the customer.
Explanation
The correct answer is to treat the POA as a HIPAA Representative, not complete the POA section of the application, and take the voice signature from the customer. This is because having a POA does not necessarily mean that the customer is unable to act for themselves. By treating the POA as a HIPAA Representative, the customer's privacy rights are protected, and the application can proceed with the customer's consent.
29.
If you have answered every question “NO” on the application, what does that mean and what should happen?
Correct Answer
B. The application guide was not followed, and the application will need to be corrected before you submit it.
Explanation
If you have answered every question "NO" on the application, it means that the application guide was not followed. As a result, the application will need to be corrected before you submit it.
30.
When is AEP (Annual Enrollment Period)?
Correct Answer
C. October 15 – December 7
Explanation
The correct answer is October 15 - December 7. This is the annual enrollment period for individuals to make changes to their Medicare coverage. During this time, individuals can switch from Original Medicare to a Medicare Advantage plan, or vice versa. They can also switch between different Medicare Advantage plans or between different prescription drug plans. It is important for individuals to make any desired changes during this period as it is the only time of the year when they can do so, unless they qualify for a special enrollment period.
31.
What does HMO stand for?
Correct Answer
A. Health Maintenance Organization
Explanation
HMO stands for Health Maintenance Organization. This type of healthcare plan provides comprehensive medical services to its members for a fixed fee. It focuses on preventive care and encourages patients to use a network of doctors and hospitals. HMOs often require members to select a primary care physician who coordinates their healthcare and refers them to specialists when needed. This model aims to keep costs down and promote overall health and wellness through regular check-ups and preventive measures.
32.
Which of the following best describes an arrangement by employers to set aside pre-tax money for medical expenses for their employees?
Correct Answer
A. Health Reimbursement Arrangement (HRA) or Funding
Explanation
A Health Reimbursement Arrangement (HRA) or Funding is the best description of an arrangement by employers to set aside pre-tax money for medical expenses for their employees. This allows employees to be reimbursed for qualified medical expenses, such as doctor visits, prescriptions, and medical supplies, using funds provided by their employer. The money contributed to an HRA is tax-free for both the employer and the employee, making it a cost-effective way to provide healthcare benefits.
33.
What does HIPAA stand for?
Correct Answer
B. Health Insurance Portability and Accountability Act
Explanation
HIPAA stands for Health Insurance Portability and Accountability Act. This act was enacted in 1996 and it aims to protect the privacy and security of patients' health information. It sets standards for the electronic exchange, privacy, and security of health information. The act also provides individuals with certain rights regarding their health information, such as the right to access and amend their records. HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates who handle health information. It helps ensure the confidentiality and integrity of patients' sensitive health data.
34.
When securing the call with the customer, which pieces of information must be obtained in order to be compliant?
Correct Answer
B. Full Name, Last 4 of Social Security Number, Date of Birth, & pHone Number
Explanation
To be compliant when securing a call with a customer, the pieces of information that must be obtained are the customer's full name, last 4 digits of their social security number, date of birth, and phone number. This information helps to verify the identity of the customer and ensure that the call is being conducted securely and in accordance with regulations.
35.
True or False: The POA can complete the entire enrollment process even if the customer is not present.
Correct Answer
A. True
Explanation
The statement is true because a Power of Attorney (POA) has the legal authority to act on behalf of the customer. This means that they can complete the enrollment process even if the customer is not physically present. The POA is granted the power to make decisions and sign documents on behalf of the customer, allowing them to carry out tasks such as enrollment without the customer's presence.
36.
Mr. and Mrs. Smith chose the same plans, and they are completing both applications jointly. They have their son and daughter-in-law on the phone assisting. Who does Mrs. Smith have to authorize as a HIPAA Approved Representative?
Correct Answer
C. The son, daughter-in-law, & Mr. Smith
Explanation
Mrs. Smith has to authorize the son, daughter-in-law, and Mr. Smith as HIPAA Approved Representatives because they are completing both applications jointly and they are all involved in the process.
37.
The BA put the AARP membership number in the notes for Mr. and Mrs. Smith’s Medigap applications. What action do you take?
Correct Answer
D. A & C
Explanation
The correct answer is A & C. This means that you should verify both Mr. Smith's and Mrs. Smith's membership numbers. The BA put the AARP membership number in the notes for their Medigap applications, but it is important to double-check and confirm the accuracy of both numbers to ensure that there are no mistakes or discrepancies.
38.
When should you use the Application Guide?
Correct Answer
B. Always
Explanation
The Application Guide should always be used because it provides valuable information and guidance for completing the application. It helps ensure that all necessary information is included and that the application is filled out correctly. By using the Application Guide, applicants can increase their chances of submitting a successful application.
39.
True or False: An Approved Representative (HIPAA Rep) can authorize another Approved Representative (HIPAA Rep).
Correct Answer
B. False
Explanation
An Approved Representative (HIPAA Rep) cannot authorize another Approved Representative (HIPAA Rep) because the authority to authorize other representatives lies with the covered entity or the business associate. HIPAA Reps are individuals designated by covered entities or business associates to act on their behalf in matters related to the Health Insurance Portability and Accountability Act (HIPAA).
40.
True or False: A POA can authorize an Approved Representative (HIPAA Rep).
Correct Answer
A. True
Explanation
A POA, or Power of Attorney, is a legal document that grants an individual, known as the agent or attorney-in-fact, the authority to act on behalf of another person, known as the principal. This authority can include making healthcare decisions and accessing medical records. Therefore, it is possible for a POA to authorize an Approved Representative, also known as a HIPAA Rep, who can act on behalf of the principal in matters related to the Health Insurance Portability and Accountability Act (HIPAA).
41.
The customer is 58 years old and Medicare-eligible due to disability. They are losing employer coverage on 11/30/2014. Which enrollment period do you use?
Correct Answer
A. SEP-LEC
Explanation
The correct answer is SEP-LEC (Special Enrollment Period for Loss of Employer Coverage). This enrollment period is applicable for individuals who are losing their employer coverage and becoming eligible for Medicare. Since the customer is 58 years old and Medicare-eligible due to disability, they can use the SEP-LEC to enroll in Medicare.
42.
If a customer has elected AR, when will they receive their first reimbursement?
Correct Answer
C. Within 2-3 months of the effective date of the plan
43.
You are filling out an application with the POA and the customer. The customer started the application but is not feeling well and leaves to take a nap. Can the POA give the voice signature?
Correct Answer
B. No
Explanation
The POA cannot give the voice signature because the customer started the application and is required to provide their own signature. The POA does not have the authority to provide the customer's signature on their behalf.
44.
True or False: It is acceptable to give the customer their Part A and Part B effective dates.
Correct Answer
B. False
Explanation
It is not acceptable to give the customer their Part A and Part B effective dates. The effective dates for Part A and Part B of Medicare are determined by the government and are not within the control of the customer or the organization providing the coverage. The customer will be notified of their effective dates by the government once they have enrolled in Medicare.
45.
True or False: Mr. Jones, who has plans in the cart, is on the phone with Mrs. Jones, but he is not completing his applications today. You still have to secure the call for Mr. Jones.
Correct Answer
A. True
Explanation
The given answer "True" suggests that even though Mr. Jones is on the phone with Mrs. Jones and not completing his applications today, it is still necessary to secure the call for him. This implies that the call might be important or sensitive, and it is essential to ensure its privacy or confidentiality.
46.
What is the correct location of the checking account number and routing number on the customer’s check?
Correct Answer
B. Routing numbers are on the bottom left. Checking account numbers are to the right.
Explanation
The correct location of the checking account number and routing number on the customer's check is that the routing numbers are on the bottom left and the checking account numbers are to the right.
47.
The only payment method accepted for AARP membership completed online is Debit/Credit Card?
Correct Answer
A. True
Explanation
The explanation for the given correct answer is that AARP only accepts debit/credit cards as the payment method for membership completed online. This means that if someone wants to become a member of AARP through their website or online platform, they can only use a debit or credit card to make the payment. Other payment methods like cash, checks, or other forms of electronic payment are not accepted for online membership completion.
48.
If a call is disconnected, you should choose which disposition option?
Correct Answer
D. Call Interrupted–Wait for Customer Call Back
Explanation
If a call is disconnected, the appropriate disposition option would be "Call Interrupted–Wait for Customer Call Back." This option indicates that the call was interrupted or disconnected, and the agent should wait for the customer to call back. It allows the agent to keep track of the call status and be prepared for a potential return call from the customer.
49.
If a customer wants to pay for their AARP membership with a check you should…
Correct Answer
D. Do a 3-way call with AARP and the customer.
50.
True or False: If a customer gives you their AARP membership number, you DO NOT have to look it up.
Correct Answer
B. False
Explanation
The statement "If a customer gives you their AARP membership number, you DO NOT have to look it up" is false. This means that if a customer provides their AARP membership number, it is necessary to look it up. Looking up the membership number ensures that the customer's information is accurately recorded and any benefits or discounts associated with their membership can be applied.