BCBS OF CA EXAM QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026
What sets Blue Shield of California apart from other healthcare plans?,We are proud to be part of a
non-profit company that has served Californians for over 80 years. At Blue Shield of California, we are
constantly innovating to transform our healthcare system so all Californians can access the
personalized affordable, and high-quality care they deserve.
What is the timeframe for a Health Plan to decide about payment for medical care or services a
member has received?,60 days
Effective January 1, 2025, the following changes were made to dual eligible enrollment options in the
state of California:,Both Answers are correct:
Enrolling in a MA (Medicare Advantage) or D-SNP in select counties will trigger automatic matching
Medi-Cal enrollment.
Dual eligible beneficiaries can elect to enroll in a non-SNP MA plan during AEP only.
Inflation Reduction Act caps out-of-pocket costs for Covered Insulin cost sharing:,At a maximum of
$35 copay per month's supply and applies to non-LIS beneficiaries throughout the deductible and
initial coverage limit
If Blue Shield denies a formulary exception request, the beneficiary is unable to appeal the
decision.,False
The amount a beneficiary pays for a prescription depends on the type of drug and its applicable cost-
sharing tier.,True
Appeals and Grievances are the two different types of complaints a beneficiary can make.,True
Blue Shield of California offers Medicare Advantage PPO plans in:,Both answers are correct:
Northern California in select counties
Southern California in select counties
A marketing/sales event cannot be held within _ hours of an educational event, at the same
location.,12 Hours
Sales Agents/ Brokers must be trained and tested on Medicare rules, regulations, and on details
specific to the plan products that they sell:,Annually
Non-Medicare covered vision benefits are:,Included with Blue Shield Medicare Advantage Plans
(MAPD)
What is Blue Shield of California's Mission?,Our mission is to ensure all Californians have access to
high-quality health care at an affordable price.
The following drug categories are covered by the plan formulary:,Immunosuppressive drugs
Use of the Medicare Benefits Card image in sales materials:,Requires CMS approval
The scope of appointment form:,
The scope of appointment form:,Should specify which products the beneficiary agrees to discuss with
the agent during their appointment.
Enrollment kits are available in Spanish and other languages based on county demographics.,True
Blue Shield of California offers Medicare Prescription Drug Plans (PDP):,Throughout the entire state of
California
There are several types of exceptions to the Plan's formulary that the beneficiary or the beneficiary's
physician can request including:,Beneficiaries can ask the Plan to cover a prescription drug even if it is
not on the formulary.
Blue Shield TotalDual Plan (HMO D-SNP) is offered in:,Southern California in select counties
Appeal or request for reconsideration, Independent Review Entity, Administrative Law Judge Hearing,
Medicare Appeals Council Review, and Judicial Review are the five levels of appeals:,True
How long does it take to receive a decision for a standard request for a coverage determination?,72
hours
Brokers and agents must be certified to sell Medicare Supplement plans for Blue Shield of California.,
Brokers and agents must be certified to sell Medicare Supplement plans for Blue Shield of
California.,False
Blue Shield Medicare Advantage Plans and standalone Blue Shield Prescription Drug Plans (PDP) will
generally cover the drugs listed in the formulary as long as:,The drug is prescribed by an individual
that is NOT on the Centers for Medicare and Medicaid Services (CMS) preclusion list.
Non-Medicare contact lenses benefit coverage is offered:,In select Blue Shield Medicare Advantage
Plans (MAPD)
What sets Blue Shield of California apart from other healthcare plans?,We are proud to be part of a
non-profit company that has served Californians for over 80 years. At Blue Shield of California, we are
constantly innovating to transform our healthcare system so all Californians can access the
personalized affordable, and high-quality care they deserve.
What is the timeframe for a Health Plan to decide about payment for medical care or services a
member has received?,60 days
Effective January 1, 2025, the following changes were made to dual eligible enrollment options in the
state of California:,Both Answers are correct:
Enrolling in a MA (Medicare Advantage) or D-SNP in select counties will trigger automatic matching
Medi-Cal enrollment.
Dual eligible beneficiaries can elect to enroll in a non-SNP MA plan during AEP only.
Inflation Reduction Act caps out-of-pocket costs for Covered Insulin cost sharing:,At a maximum of
$35 copay per month's supply and applies to non-LIS beneficiaries throughout the deductible and
initial coverage limit
If Blue Shield denies a formulary exception request, the beneficiary is unable to appeal the
decision.,False
The amount a beneficiary pays for a prescription depends on the type of drug and its applicable cost-
sharing tier.,True
Appeals and Grievances are the two different types of complaints a beneficiary can make.,True
Blue Shield of California offers Medicare Advantage PPO plans in:,Both answers are correct:
Northern California in select counties
Southern California in select counties
A marketing/sales event cannot be held within _ hours of an educational event, at the same
location.,12 Hours
Sales Agents/ Brokers must be trained and tested on Medicare rules, regulations, and on details
specific to the plan products that they sell:,Annually
Non-Medicare covered vision benefits are:,Included with Blue Shield Medicare Advantage Plans
(MAPD)
What is Blue Shield of California's Mission?,Our mission is to ensure all Californians have access to
high-quality health care at an affordable price.
The following drug categories are covered by the plan formulary:,Immunosuppressive drugs
Use of the Medicare Benefits Card image in sales materials:,Requires CMS approval
The scope of appointment form:,
The scope of appointment form:,Should specify which products the beneficiary agrees to discuss with
the agent during their appointment.
Enrollment kits are available in Spanish and other languages based on county demographics.,True
Blue Shield of California offers Medicare Prescription Drug Plans (PDP):,Throughout the entire state of
California
There are several types of exceptions to the Plan's formulary that the beneficiary or the beneficiary's
physician can request including:,Beneficiaries can ask the Plan to cover a prescription drug even if it is
not on the formulary.
Blue Shield TotalDual Plan (HMO D-SNP) is offered in:,Southern California in select counties
Appeal or request for reconsideration, Independent Review Entity, Administrative Law Judge Hearing,
Medicare Appeals Council Review, and Judicial Review are the five levels of appeals:,True
How long does it take to receive a decision for a standard request for a coverage determination?,72
hours
Brokers and agents must be certified to sell Medicare Supplement plans for Blue Shield of California.,
Brokers and agents must be certified to sell Medicare Supplement plans for Blue Shield of
California.,False
Blue Shield Medicare Advantage Plans and standalone Blue Shield Prescription Drug Plans (PDP) will
generally cover the drugs listed in the formulary as long as:,The drug is prescribed by an individual
that is NOT on the Centers for Medicare and Medicaid Services (CMS) preclusion list.
Non-Medicare contact lenses benefit coverage is offered:,In select Blue Shield Medicare Advantage
Plans (MAPD)
