2025 Wellcare ACT Mastery Exam - Broker -
Employee 55 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) ALREADY GRADED A+
2025 NEW UPDATE
A grievance request, or any evidence concerning a grievance, must be filed orally or in
writing no
later than _____ calendar days from the date of the event or the date the member is
made aware of the
issue. - CORRECT ANSWER: 60
A Health Risk Assessment (HRA) provides an overview of a member's health status,
gives us the
opportunity to improve member care, and prevent further health challenges. -
CORRECT ANSWER: True
A Low-Income Subsidy (LIS) member could be assigned one of ____ copay categories
depending on the level of need. - CORRECT ANSWER: Four
A request to the plan from a member or provider for a formal review of an Action
(Denial) or
Adverse Plan Determination (Medicare) is a/an: - CORRECT ANSWER: Appeal
All three Prescription Drug Plans (PDPs) will offer a five-tier formulary design. -
CORRECT ANSWER: true
All Traditional Medicare Advantage Prescription Drug (MAPD) plans will offer $0 copay
for most Part
, D preventive vaccines regardless of network pharmacy used by members. - CORRECT
ANSWER: True
All Traditional Medicare Advantage Prescription Drug (MAPD) plans with drug coverage
include a $0
copay Tier 6 at all in-network pharmacy locations. - CORRECT ANSWER: True
Although options for capturing and submitting Scopes of Appointment (SOAs) vary by
health plan, Wellcare accepts SOAs in which of the following methods? - CORRECT
ANSWER: All of these
An Election Period Request for Information (RFI) must be resolved within 7 calendar
days, or the
application will be denied. - CORRECT ANSWER: True
As part of Centene's Ethics and Compliance program, Centene requires all contracted
brokers/agents to review and agree to its Business Ethics and Code of Conduct Policy. -
CORRECT ANSWER: True
Ascend is the fast, easy, and compliant way for brokers/agents to submit agent-assisted
electronic
enrollments. - CORRECT ANSWER: True
Beneficiary-facing marketing materials developed by a Third-Party Marketing
Organization (TPMO)
for multiple Medicare Advantage (MA) organizations or plans can be reviewed by just
one MA
organization, submitted to the Centers for Medicare & Medicaid Services (CMS) in the
Health Plan
Management System (HPMS), and opted in by the health plan after distribution. -
CORRECT ANSWER: False
Employee 55 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) ALREADY GRADED A+
2025 NEW UPDATE
A grievance request, or any evidence concerning a grievance, must be filed orally or in
writing no
later than _____ calendar days from the date of the event or the date the member is
made aware of the
issue. - CORRECT ANSWER: 60
A Health Risk Assessment (HRA) provides an overview of a member's health status,
gives us the
opportunity to improve member care, and prevent further health challenges. -
CORRECT ANSWER: True
A Low-Income Subsidy (LIS) member could be assigned one of ____ copay categories
depending on the level of need. - CORRECT ANSWER: Four
A request to the plan from a member or provider for a formal review of an Action
(Denial) or
Adverse Plan Determination (Medicare) is a/an: - CORRECT ANSWER: Appeal
All three Prescription Drug Plans (PDPs) will offer a five-tier formulary design. -
CORRECT ANSWER: true
All Traditional Medicare Advantage Prescription Drug (MAPD) plans will offer $0 copay
for most Part
, D preventive vaccines regardless of network pharmacy used by members. - CORRECT
ANSWER: True
All Traditional Medicare Advantage Prescription Drug (MAPD) plans with drug coverage
include a $0
copay Tier 6 at all in-network pharmacy locations. - CORRECT ANSWER: True
Although options for capturing and submitting Scopes of Appointment (SOAs) vary by
health plan, Wellcare accepts SOAs in which of the following methods? - CORRECT
ANSWER: All of these
An Election Period Request for Information (RFI) must be resolved within 7 calendar
days, or the
application will be denied. - CORRECT ANSWER: True
As part of Centene's Ethics and Compliance program, Centene requires all contracted
brokers/agents to review and agree to its Business Ethics and Code of Conduct Policy. -
CORRECT ANSWER: True
Ascend is the fast, easy, and compliant way for brokers/agents to submit agent-assisted
electronic
enrollments. - CORRECT ANSWER: True
Beneficiary-facing marketing materials developed by a Third-Party Marketing
Organization (TPMO)
for multiple Medicare Advantage (MA) organizations or plans can be reviewed by just
one MA
organization, submitted to the Centers for Medicare & Medicaid Services (CMS) in the
Health Plan
Management System (HPMS), and opted in by the health plan after distribution. -
CORRECT ANSWER: False
