2022 AHIP
A client wants to give you an enrollment application on October 1 before the beginning
of the Annual Election Period because he is leaving on vacation for two weeks and does
not want to forget about turning it in. What should you tell him? - Answer You must tell
him you are not permitted to take the form. If he sends the form directly to the plan, the
plan will process the enrollment on the day the Annual Election Period begins.
A Medicare beneficiary has walked into your office and requested that you sit down with
her and discuss her options under the Medicare Advantage program. Before engaging
in such a discussion, what should you do? - Answer You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then
proceed with the discussion.
A Medicare beneficiary has walked into your office and requested that you sit down with
her and discuss her options under the Medicare Advantage program. Before engaging
in such a discussion, what should you do? - Answer You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then
proceed with the discussion.
A person drops off a prescription for a beneficiary who is a "regular" customer. The
prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have
concerns about possible forgery. What is your next step? - Answer Call the prescriber to
verify the quantity
A sales agent, employed by the Sponsor's first-tier, downstream, or related entity (FDR),
submitted an application for processing and requested two things: 1) to back-date the
enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary.
What should you do? - Answer Process the application properly (without the requested
revisions)—inform your supervisor and the compliance officer about the sales agent's
request
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities.
Which statement best describes ABC's obligation to its enrollees regarding marketing
such products? - Answer It must obtain a HIPAA complaint authorization from an
enrollee that indicates the plan or plan sponsor may use their information for marketing
purposes.
Abuse involves payment for items or services when there is no legal entitlement to that
payment and the provider has not knowingly or intentionally misrepresented facts to
obtain payment. - Answer True
,ACA Section 1557 rules for disability concern - Answer Policies and procedures,
physical access, and communication.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
Answer Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent Chan is conducting a sales presentation on senior issues where he hopes to
enroll some attendees in the Medicare Advantage (MA) plans he represents. What
action(s) may Agent Chan take during the event? - Answer Discuss plan specific
information such as premiums and benefits.
Agent Harriet Walker has recently begun marketing Medicare Advantage and related
products aimed at meeting the needs of senior citizens. Client Mildred Jones has
expressed interest in a Medicare Advantage plan. It is now the beginning of September.
If you were in Agent Walker's position, what would you do? - Answer Inquire whether
the client qualifies for a special enrollment period, and if not, solicit an enrollment
application once the annual open enrollment election period begins on October 15th.
Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at
an event that has been advertised as educational? - Answer Yes. When an event has
been advertised as "educational," discussing plan-specific premiums is impermissible.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
drug benefits. How would you advise Agent John Miller to proceed? - Answer Tell
prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks
you for advice as to whether this is possible. What should you tell her? - Answer
Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided.
Agent Marvin Millner wants to reach out to his current clients for referrals. What advice
would you give to Marvin? - Answer Marvin should understand that under CMS
guidelines he can no longer provide gifts, even of minimal value, in exchange for
referrals. NOT SURE
,Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA)
Medicare health plan. The MSA plan does not offer prescription drug coverage, so
Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan (PDP).
What CMS compensation rules apply to this situation? - Answer This situation is
considered a "dual enrollment," and CMS compensation rules are applied to the two
plans at once and independently of each other.
Agent Willis had several clients who disenrolled from the plans he represents during the
AEP to enroll in Medicare Advantage plans that are competitors of his. Agent Willis
believes that the choices they made are not ideal for them and would like to get their
business back during the Medicare Advantage Open Enrollment Period (MA-OEP).
What can agent Willis do? - Answer He can call them to let them know that if they do
not like their new plans, they can change back during the MA-OEP.
Alice is a marketing representative employed by a health plan. Betty is a captive agent
of a health plan who markets to multiple plans and sponsors. Carl is a captive agent
who markets to only one plan/sponsor. Denise is an independent agent who markets to
different types of groups. Edward is an independent agent who markets only to
employer and union groups. CMS marketing representative compensation rules
generally apply to: - Answer Betty and Denise, but not Alice (the employee) or Carl or
Edward (to whom exceptions apply).
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - Answer She is likely to qualify
for a SEP. She can choose an effective date of up to three months after the month in
which the enrollment form is received by the new plan, but the effective date may not be
earlier than the date of her permanent move.
All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard coverage? - Answer Standard Part D
coverage would require payment of an annual deductible, and once past the
catastrophic coverage threshold, the beneficiary pays whichever is greater of either the
co-pays for generic and brand name drugs or coinsurance of 5%.
Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he
is enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should you tell her? -
Answer You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
, Another agent working for your agency claims that because you are not employed by
the Medicare Advantage plans that you represent, you are not subject to the same
marketing requirements as the plans themselves. How should you respond to such a
statement? - Answer Your coworker is not correct. Marketing on behalf of a plan is
considered marketing by the plan and requires that all contracted and employed agents
comply with all Medicare marketing rules.
Another agent you know has engaged in misconduct that has been verified by the plan
she represented. What sort of penalty might the plan impose on this individual? -
Answer The plan may withhold commission, require retraining, report the misconduct to
a state department of insurance or terminate the contract.
Any person who knowingly submits false claims to the Government is liable for five
times the Government's damages caused by the violator plus a penalty. - Answer False
As a result of violations of ACA Section 1557 nondiscrimination rules, - Answer a health
plan may revoke an agent or broker's appointment with the health plan.
At a minimum, an effective compliance program includes four core requirements. -
Answer False
Auxiliary aids and services must be provided to individuals with disabilities, such as
those suffering from vision or hearing impairments, free of charge, and in a timely
manner. Auxiliary aids and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software - Answer I, II, III, and IV
BestCare Health Plan has received a request from a state insurance department in
connection with the investigation of several marketing representatives licensed by the
state who sell Medicare Advantage plans. What action(s) should BestCare take in
response? - Answer Cooperate with the state and supply requested information.
Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud by the person making as well as the
person receiving them. - Answer True
By contacting plans available in your area, you have learned that the plan you represent
has a significantly lower monthly premium than the others. Furthermore, you see that
the plan you represent has a unique benefits package. What should you do to make
sure your clients know about these pieces of information? - Answer You may make
comparisons between plans if you can support them by studies or statistical data and
such comparisons are factually based
A client wants to give you an enrollment application on October 1 before the beginning
of the Annual Election Period because he is leaving on vacation for two weeks and does
not want to forget about turning it in. What should you tell him? - Answer You must tell
him you are not permitted to take the form. If he sends the form directly to the plan, the
plan will process the enrollment on the day the Annual Election Period begins.
A Medicare beneficiary has walked into your office and requested that you sit down with
her and discuss her options under the Medicare Advantage program. Before engaging
in such a discussion, what should you do? - Answer You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then
proceed with the discussion.
A Medicare beneficiary has walked into your office and requested that you sit down with
her and discuss her options under the Medicare Advantage program. Before engaging
in such a discussion, what should you do? - Answer You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then
proceed with the discussion.
A person drops off a prescription for a beneficiary who is a "regular" customer. The
prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have
concerns about possible forgery. What is your next step? - Answer Call the prescriber to
verify the quantity
A sales agent, employed by the Sponsor's first-tier, downstream, or related entity (FDR),
submitted an application for processing and requested two things: 1) to back-date the
enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary.
What should you do? - Answer Process the application properly (without the requested
revisions)—inform your supervisor and the compliance officer about the sales agent's
request
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities.
Which statement best describes ABC's obligation to its enrollees regarding marketing
such products? - Answer It must obtain a HIPAA complaint authorization from an
enrollee that indicates the plan or plan sponsor may use their information for marketing
purposes.
Abuse involves payment for items or services when there is no legal entitlement to that
payment and the provider has not knowingly or intentionally misrepresented facts to
obtain payment. - Answer True
,ACA Section 1557 rules for disability concern - Answer Policies and procedures,
physical access, and communication.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
Answer Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent Chan is conducting a sales presentation on senior issues where he hopes to
enroll some attendees in the Medicare Advantage (MA) plans he represents. What
action(s) may Agent Chan take during the event? - Answer Discuss plan specific
information such as premiums and benefits.
Agent Harriet Walker has recently begun marketing Medicare Advantage and related
products aimed at meeting the needs of senior citizens. Client Mildred Jones has
expressed interest in a Medicare Advantage plan. It is now the beginning of September.
If you were in Agent Walker's position, what would you do? - Answer Inquire whether
the client qualifies for a special enrollment period, and if not, solicit an enrollment
application once the annual open enrollment election period begins on October 15th.
Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at
an event that has been advertised as educational? - Answer Yes. When an event has
been advertised as "educational," discussing plan-specific premiums is impermissible.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
drug benefits. How would you advise Agent John Miller to proceed? - Answer Tell
prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks
you for advice as to whether this is possible. What should you tell her? - Answer
Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided.
Agent Marvin Millner wants to reach out to his current clients for referrals. What advice
would you give to Marvin? - Answer Marvin should understand that under CMS
guidelines he can no longer provide gifts, even of minimal value, in exchange for
referrals. NOT SURE
,Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA)
Medicare health plan. The MSA plan does not offer prescription drug coverage, so
Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan (PDP).
What CMS compensation rules apply to this situation? - Answer This situation is
considered a "dual enrollment," and CMS compensation rules are applied to the two
plans at once and independently of each other.
Agent Willis had several clients who disenrolled from the plans he represents during the
AEP to enroll in Medicare Advantage plans that are competitors of his. Agent Willis
believes that the choices they made are not ideal for them and would like to get their
business back during the Medicare Advantage Open Enrollment Period (MA-OEP).
What can agent Willis do? - Answer He can call them to let them know that if they do
not like their new plans, they can change back during the MA-OEP.
Alice is a marketing representative employed by a health plan. Betty is a captive agent
of a health plan who markets to multiple plans and sponsors. Carl is a captive agent
who markets to only one plan/sponsor. Denise is an independent agent who markets to
different types of groups. Edward is an independent agent who markets only to
employer and union groups. CMS marketing representative compensation rules
generally apply to: - Answer Betty and Denise, but not Alice (the employee) or Carl or
Edward (to whom exceptions apply).
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - Answer She is likely to qualify
for a SEP. She can choose an effective date of up to three months after the month in
which the enrollment form is received by the new plan, but the effective date may not be
earlier than the date of her permanent move.
All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard coverage? - Answer Standard Part D
coverage would require payment of an annual deductible, and once past the
catastrophic coverage threshold, the beneficiary pays whichever is greater of either the
co-pays for generic and brand name drugs or coinsurance of 5%.
Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he
is enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should you tell her? -
Answer You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
, Another agent working for your agency claims that because you are not employed by
the Medicare Advantage plans that you represent, you are not subject to the same
marketing requirements as the plans themselves. How should you respond to such a
statement? - Answer Your coworker is not correct. Marketing on behalf of a plan is
considered marketing by the plan and requires that all contracted and employed agents
comply with all Medicare marketing rules.
Another agent you know has engaged in misconduct that has been verified by the plan
she represented. What sort of penalty might the plan impose on this individual? -
Answer The plan may withhold commission, require retraining, report the misconduct to
a state department of insurance or terminate the contract.
Any person who knowingly submits false claims to the Government is liable for five
times the Government's damages caused by the violator plus a penalty. - Answer False
As a result of violations of ACA Section 1557 nondiscrimination rules, - Answer a health
plan may revoke an agent or broker's appointment with the health plan.
At a minimum, an effective compliance program includes four core requirements. -
Answer False
Auxiliary aids and services must be provided to individuals with disabilities, such as
those suffering from vision or hearing impairments, free of charge, and in a timely
manner. Auxiliary aids and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software - Answer I, II, III, and IV
BestCare Health Plan has received a request from a state insurance department in
connection with the investigation of several marketing representatives licensed by the
state who sell Medicare Advantage plans. What action(s) should BestCare take in
response? - Answer Cooperate with the state and supply requested information.
Bribes or kickbacks of any kind for services that are paid under a Federal health care
program (which includes Medicare) constitute fraud by the person making as well as the
person receiving them. - Answer True
By contacting plans available in your area, you have learned that the plan you represent
has a significantly lower monthly premium than the others. Furthermore, you see that
the plan you represent has a unique benefits package. What should you do to make
sure your clients know about these pieces of information? - Answer You may make
comparisons between plans if you can support them by studies or statistical data and
such comparisons are factually based
