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Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? - Mr. Zachow has a rig

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Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? - Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. Mr. Polanski likes the cost of an HMO plan available in his area, but would like to be able to visit one or two doctors who aren't participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him? - The POS option might be a good solution for him as it will allow him to visit out-of-network providers, generally without prior approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for services from out-of-network providers. Mr. Barker had surgery recently and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? - You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP? - a. Yes. All SNPs are required to provide Part D coverage for prescription drugs. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare prescription drug plan that they sign up for independent of their enrollment in the SNP. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not. = ????? Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment site, which of the following must Phiona consider? - II. All data elements required to complete an enrollment request must be captured. III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll Now" or "I Agree" type of button or tool. Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called "step therapy" and is wondering if you can explain what that is. What should you tell her? - Step therapy involves using one or more lower priced drugs before trying a more expensive drug when all are used to treat the same condition. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? - He may receive health care services from ANY doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? - Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? - Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? - a. Due to the provisions of MACRA, his Part B and D coverage will be combined and covered through a low-cost Medigap policy to supplement his Part A coverage. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay the lowest monthly premium rates for Part B and Part D. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay reduced premiums for Part B and Part D. ????? Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' communication and Marketing Guidelines to ensure he is compliant for which type of products? - Medicare Advantage (MA) and Prescription Drug (PDP) plans Correct Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans? - a. States often volunteer to review marketing materials on behalf of the Medicare agency. She should check with her Department of Insurance to see if such a review is available and would satisfy CMS requirements.

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GDL Contract Law Revision Notes(Distinction Level) 2023
GRADED A

Contract Law Notes


Agreement and Contractual Intention

Agreement:

In order for parties to reach an agreement, one party must make an offer which is acceptedby the
other.



‘Offer’: Professor Treitel: ‘an expression of willingness to contract on certain terms, madewith the
intention that it shall become binding as soon as it is accepted by the person to whom it is addressed.’

‘Offeror’: Person who makes the offer. ‘Offeree’:

Person to whom the offer is made.

‘Expression’: May take different forms, e.g. a letter, newspaper advertisement, fax and conduct, as
long as it communicates the basis on which the offeror is prepared to contract.

‘Intention’: Does not necessarily mean the offeror’s actual intention. Smith v Hughes: Objective test.
Courts look at what was said and done between the parties, from the pointof view of a ‘reasonable
person’, and try to decide what a reasonable person would have thought was going on.

Allied Marine Transport: If the offeror so acts that his conduct, objectively considered, constitutes an
offer, and the offeree, believing the conduct of the offeror represents hisactual intention, accepts the
offer, then a contract will come into existence. Subjective element of the offeree must believe the
offeror intended to make an offer.


Offer or Invitation to Treat:

Offers are distinct from inviting negotiation E.g. ‘I am thinking of selling my car, £7,000 would be a
realistic asking price, would you be interested in buying it?’ – An ‘invitation totreat’ is where there is no
such intention to be bound.

Goods on display are invitations to treat, as otherwise as soon as the customer put selectedthe goods
and put them in the trolley they might be regarded as accepting the offer. The customer offers to buy
the goods when presenting them at the payment point, and acceptance takes place when the shop
takes payment. (Pharmaceutical Society of Great Britain v Boots Cash Chemists).

,Advertisements: Generally regarded as invitations to treat. Partridge v Crittenden: Defendant not
guilty with ‘offering for sale’ a live wild bird contrary to law, by placing an advertisement in a periodical.
Seen as an invitation to treat, as if it was an offer anyone asking for the advertised goods would be
accepting an offer which would be problematic ifthey had run out of stock.

Advertisements of rewards traditionally treated as an offer, as there is intention to be bound as soon as
the information is given (Williams v Carwadine). Payment has to be madeonce information supplied,
no negotiation is involved – Encouraging people to come forward.

In exceptional circumstances, advertisements may be an offer if there is a clear intention to be bound.
Carlill v Carbolic Smoke Co: Company manufactured a product designed to prevent flu. Their
advertisement in the newspaper stated a reward of £100 would be paid toanyone who contracted flu or
a cold after using the smoke ball 3 times per day for 2 weeks according to supplied directions.
Advertisement also stated company had deposited £1,000 with a named bank to show the sincerity of
its offer. Claimant contracted flue whilst using it.Company raised 3 defences: (a) Advertisement was
mere puff sales (dismissed, as £1,000 had been deposited as evidence of sincerity – meaning a
reasonable person would treat
£100 promise seriously); (b) No offer to any particular person (dismissed, as offer was to anyone who
fulfilled conditions stated); (c) Claimant gave no notice of acceptance (dismissed, as held that
company could not have been expected every user of product to contact them). Case is the authority
for the proposition that an advertisement can constitute an offer to ‘the world’, and that it may, by the
way in which it is stated, waive theneed for communication of acceptance prior to a claim under it.

Unilateral and Bilateral Contracts:

Bilateral Contract: Arises where one party makes a promise in return for a promise from theother
party. Both parties are immediately bound.

Unilateral Contract: A promise in return for an act – Commitment is one-sided. The promisor is
bound to perform if, and only if, the person(s) to whom the promise is madeperforms the specified act.
E.g. An offer of reward.


Auctions: s.57(2) Sale of Goods Act 1979: A sale by auction is complete on the fall of the
auctioneer’s hammer. Bids are offers which can be withdrawn at any time before acceptance.
Auctioneers calling for bids is an invitation to treat.

Sale in auction ‘without reserve’: Barry v Davies: Refusal of auctioneer to sell due to bid price being
exceptionally low. Claimant could sue as there was a contract between auctioneer and bidder if good
advertised ‘without reserve’ – Auctioneer is promising to sell to the highest bidder (unilateral contract).
Bidder had accepted auctioneer’s unilateral offerby making the highest bid. Claimant could not sue
owner of goods as there was no contractbetween them.

,Tenders: Businesses outsourcing work will invite contractors to submit tenders for the job(invitations to treat).
The tenders will be offers which may or may not be accepted by the businesses.

In certain situations, tenders can constitute offers. Blackpool & Fylde Aero Club: Council invited
tenders to operate pleasure flights from Blackpool airport (invitations sent to 7 interested parties).
Invitation stated that tenders had to be received not later than 12 noon 17th March. The Aero Club
posted their tender at 11am 17th March, however due to an oversight the letterbox was not emptied at
noon on 17th March and therefore tender was recorded as late and not considered. Held, that invitation
had laid down a ‘clear, orderly andfamiliar procedure’ so that the tenderers obviously would assume
that if they submitted a conforming tender they would have the right to have it considered along with
the rest. The council should have specified the terms on which tenders would be considered, but they
had not done so, and accordingly were bound by the reasonable expectation of the tenderers. Council
had a contract with the accepted tender, but also a unilateral contract with the Aero Club (to consider
all tenders submitted on time). The Club had accepted this offer by submitting such a tender, and
therefore the Council was liable for damages for loss of opportunity.



Termination of Offer:

An offer may be terminated in 3 ways:
- Revocation;
- Rejection by the offeree;
- Lapse of time.

Revocation:

General Rule: Offer can be withdrawn at any time before acceptance. Once an offer hasbeen accepted
it is irrevocable (Routledge v Grant).

Routledge v Grant: Promises to Keep offers open for a certain period of time are not bindingif they are
gratuitous promises (in the sense that the offeree has not given, or promised anything in return for the
promise to keep the offer open).

Offeror can revoke the offer within the specified time as long as it has not been accepted.

Exception to the rule in Mountford v Scott: Claimant paid £1 for the option to buy Vs housefor
£10,000. Option was exercisable within 6 months. V purported to revoke the offer.
Claimant subsequently sought to exercise the option. Held, that the offer was irrevocable as the
Claimant had paid for the option. In paying, the Claimant had given consideration for theOfferor’s
promise to leave the offer open for 6 months. Offeree has given (or promised) something to the Offeror
in return for keeping the offer open.

, Revocation must be communicated to the Offeree in order to be effective (not when it isposted)
(Byrne & Co.).

Professor Treitel: Some exceptions to the general rule that a revocation must be communicated.
Examples include: Withdrawal sent to Offeree’s last known address if they have moved without
notifying Offeror, or a withdrawal that reaches the Offeree who simplychooses not to read it.

Revocation of offers made to the public should be at least as prominent as the original
advertisement in the same format/section/publication etc. (Shuey v United States – USAuthority,
therefore not binding on English Courts).

Notice of Revocation Sent to Businesses: Brimnes: ‘if a notice arrives at the address of the person
to be notified, at such a time and by such a means of communication that it would inthe normal course
of business come to the attention of that person on its arrival, that person cannot rely on some failure
of himself or his servants to act in a normal business like manner in respect of taking cognisance of the
communication so as to postpone the effective time of the notice until some later time when it in fact
came to his attention.’ If notice arrives during office hours, it is likely to be effective at that point, even if
not read until the next day – Depends on what is reasonable, bearing in mind the context and the
situation as a whole. Mention in an answer, even if not business situation.


Revocation must be communicated by a reliable third party (Dickinson v Dodds): Need nothave
been authorised by the Offeror to communicate notice of revocation, but he must be objectively
perceived as being reasonable.


Revocation of Offers of Unilateral Contracts: Professor Treitel: With unilateral contracts no
obligations arise until the specified act is completed; Acceptance only occurs when performance is
complete.

Errington v Errington and Woods: Father bought a house in his name, and allowed his Son and
Daughter-in-Law to live in it. He promised them that if they paid the mortgage instalments he would
transfer the house to them (an offer of a unilateral contract, as the couple did not promise to pay the
mortgage, they simply did so). When the father died, his widow sought possession of the property.
Held, that the father’s promise was irrevocable solong as the couple continued to pay the instalments.
Reference to an implied promise not todispossess the couple as long as they paid the mortgage
instalments. Likely that the Offeror cannot revoke once the Offeree has started to perform the act of
acceptance.

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