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UHC CERTIFICATION UPDATED EXAM
WITH VERIFIED SOLUTIONS.
If a member is switching from one MA plan to another, does the
member have to be apart of the same carrier to retain his/her
MOOP expenses? - correct answer -yes. if the member is from a
different carrier, the MOOP expense will NOT carry over to the
new plans yearly deductible
What type of plans are network based plans? - correct answer -
HMO's, POS's, and PPO's
What type of plan can either be network based or non- network
based? - correct answer -PFFO
Before enrolling a customer in a MA plan, you must verify the
network status of each provider the customer currently uses or
intends to use by checking what? - correct answer -the plans
provider directory or by contacting the plan. If possible, use an
online directory over a printed directory as they are more current.
Remind the customer to check their providers status before
receiving care to ensure that their network status has not
changed. ( see provider search job aid on jarvis, UHC's agent
portal)
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Is emergency care covered in a PFFO plan regardless of whether
the provider agrees to accept the plans payment? - correct
answer -yes it is`
Who allows the PFFS plan to decide if balance billing is
permitted? - correct answer -CMS. Plans must disclose what is
permitted in the terms and conditions
Does the OEP( Open enrollment period) allow for PDP changes?
- correct answer -No you cant make changes to PDP during the
OEP
If a customer enrolled in a MAP( with or without prescription drug
coverage), will be automatically ________from that plan and
returned to original medicare upon enrolling in a PDP ( except
MA-only PFFS plans) - correct answer -disenrolled
what happens when a customer is enrolled in a employee or
union sponsored health plan and decides to enroll in a PDP? -
correct answer -the customer MAY lose coverage for themselves
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and their dependents upon enrollment in a PDP, and may not be
able to re-enroll in the employer or union plan at a later date
in an employer/union-sponsored group retiree plan, or more
specifically a subsidized plan, the employer contributes to the
premium, but with an endorsed plan, the employer _____? -
correct answer -does not contribute
WHat kind of medicare plan is only available through employer
groups? - correct answer -employer senior supplement group
retiree plans
does an employer senior supplement group retiree plan help pay
for some or all the costs not covered by original medicare? -
correct answer -yes. not only that but they have similar coverage
as medicare supplement insurance plans and members can go to
any provider that accepts medicare
Medicare - correct answer -Federal health insurance program
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Medicare is administered by whom? - correct answer -CMS (
Centers for medicare and medicaid services)
Parts A & B of medicare are - correct answer -federal health
insurance program referred to as original medicare
Part A? - correct answer -Hospital insurance
Part B? - correct answer -Medical insurance
What doesnt medicare cover? - correct answer -routine dental,
eye care hearing exam,deductibles, coinsurance and copayments
Part C? - correct answer -Medicare Advantage Plans
MA covers? - correct answer -Part A &B coverage, and some part
D coverage
UHC CERTIFICATION UPDATED EXAM
WITH VERIFIED SOLUTIONS.
If a member is switching from one MA plan to another, does the
member have to be apart of the same carrier to retain his/her
MOOP expenses? - correct answer -yes. if the member is from a
different carrier, the MOOP expense will NOT carry over to the
new plans yearly deductible
What type of plans are network based plans? - correct answer -
HMO's, POS's, and PPO's
What type of plan can either be network based or non- network
based? - correct answer -PFFO
Before enrolling a customer in a MA plan, you must verify the
network status of each provider the customer currently uses or
intends to use by checking what? - correct answer -the plans
provider directory or by contacting the plan. If possible, use an
online directory over a printed directory as they are more current.
Remind the customer to check their providers status before
receiving care to ensure that their network status has not
changed. ( see provider search job aid on jarvis, UHC's agent
portal)
, Page | 2
Is emergency care covered in a PFFO plan regardless of whether
the provider agrees to accept the plans payment? - correct
answer -yes it is`
Who allows the PFFS plan to decide if balance billing is
permitted? - correct answer -CMS. Plans must disclose what is
permitted in the terms and conditions
Does the OEP( Open enrollment period) allow for PDP changes?
- correct answer -No you cant make changes to PDP during the
OEP
If a customer enrolled in a MAP( with or without prescription drug
coverage), will be automatically ________from that plan and
returned to original medicare upon enrolling in a PDP ( except
MA-only PFFS plans) - correct answer -disenrolled
what happens when a customer is enrolled in a employee or
union sponsored health plan and decides to enroll in a PDP? -
correct answer -the customer MAY lose coverage for themselves
, Page | 3
and their dependents upon enrollment in a PDP, and may not be
able to re-enroll in the employer or union plan at a later date
in an employer/union-sponsored group retiree plan, or more
specifically a subsidized plan, the employer contributes to the
premium, but with an endorsed plan, the employer _____? -
correct answer -does not contribute
WHat kind of medicare plan is only available through employer
groups? - correct answer -employer senior supplement group
retiree plans
does an employer senior supplement group retiree plan help pay
for some or all the costs not covered by original medicare? -
correct answer -yes. not only that but they have similar coverage
as medicare supplement insurance plans and members can go to
any provider that accepts medicare
Medicare - correct answer -Federal health insurance program
, Page | 4
Medicare is administered by whom? - correct answer -CMS (
Centers for medicare and medicaid services)
Parts A & B of medicare are - correct answer -federal health
insurance program referred to as original medicare
Part A? - correct answer -Hospital insurance
Part B? - correct answer -Medical insurance
What doesnt medicare cover? - correct answer -routine dental,
eye care hearing exam,deductibles, coinsurance and copayments
Part C? - correct answer -Medicare Advantage Plans
MA covers? - correct answer -Part A &B coverage, and some part
D coverage
