ANTHEM - 2026
CERTIFICATIONS
"_____________care" is defined as a non-emergency situation when
you need medical care right away because of an illness, injury or
condition that you did not expect or anticipate, but your health is not
in serious danger. - ANSWERS-Urgently needed
Which is NOT considered a preventive benefit? - ANSWERS-
Chiropractic services
Special Needs Plans (SNPs) are either HMO or PPO plans which
means all plans, regardless of type, include a contracted network of
providers. - ANSWERS-True
With specific goals and objectives for the population it serves, each
SNP is required to develop a: - ANSWERS-Model of Care
Which of the following are the types of Special Needs Plans (SNPs)?
- ANSWERS-Dual, Chronic, Institutional
In order to qualify to enroll in a DSNP, beneficiaries must be entitled
to: - ANSWERS-Both A and B above
CMS created a new monthly integrated care SEP for CY2025 to allow
full dual eligible individuals to elect an integrated Dual Eligible
, Special Needs Plan (D-SNP); for example, Fully Integrated Dual
Eligible (FIDE), Highly Integrated Dual Eligible (HIDE), and
Applicable Integrated Plan (AIP). This new SEP is allowed only when
the individual receives Medicaid through an affiliated managed care
plan. - ANSWERS-True
FIDE (Fully Integrated Dual Eligible) plans provide complete
integration of Medicare and Medicaid services within one managed
care organization. - ANSWERS-True
The SEP for Enrollment into a Chronic Care SNP will apply as long
as: - ANSWERS-The individual has the qualifying condition, and
ends once enrolled in a CSNP
Special Needs Plans are intended to provide targeted care to
beneficiaries with special needs. A "special needs individual" is
eligible for Medicare Parts A and B, and: - ANSWERS-Any of the
qualifications listed in answers A, B, or C
Chronic SNPs (CSNPs) must reconfirm a beneficiary's eligibility: -
ANSWERS-At least annually
Institutional Special Needs Plans (ISNPs) restrict enrollment to
eligible individuals who, for 90 days or longer, have had or are
expected to require an institutional level of care, or an institutional
equivalent level of care. - ANSWERS-True
CERTIFICATIONS
"_____________care" is defined as a non-emergency situation when
you need medical care right away because of an illness, injury or
condition that you did not expect or anticipate, but your health is not
in serious danger. - ANSWERS-Urgently needed
Which is NOT considered a preventive benefit? - ANSWERS-
Chiropractic services
Special Needs Plans (SNPs) are either HMO or PPO plans which
means all plans, regardless of type, include a contracted network of
providers. - ANSWERS-True
With specific goals and objectives for the population it serves, each
SNP is required to develop a: - ANSWERS-Model of Care
Which of the following are the types of Special Needs Plans (SNPs)?
- ANSWERS-Dual, Chronic, Institutional
In order to qualify to enroll in a DSNP, beneficiaries must be entitled
to: - ANSWERS-Both A and B above
CMS created a new monthly integrated care SEP for CY2025 to allow
full dual eligible individuals to elect an integrated Dual Eligible
, Special Needs Plan (D-SNP); for example, Fully Integrated Dual
Eligible (FIDE), Highly Integrated Dual Eligible (HIDE), and
Applicable Integrated Plan (AIP). This new SEP is allowed only when
the individual receives Medicaid through an affiliated managed care
plan. - ANSWERS-True
FIDE (Fully Integrated Dual Eligible) plans provide complete
integration of Medicare and Medicaid services within one managed
care organization. - ANSWERS-True
The SEP for Enrollment into a Chronic Care SNP will apply as long
as: - ANSWERS-The individual has the qualifying condition, and
ends once enrolled in a CSNP
Special Needs Plans are intended to provide targeted care to
beneficiaries with special needs. A "special needs individual" is
eligible for Medicare Parts A and B, and: - ANSWERS-Any of the
qualifications listed in answers A, B, or C
Chronic SNPs (CSNPs) must reconfirm a beneficiary's eligibility: -
ANSWERS-At least annually
Institutional Special Needs Plans (ISNPs) restrict enrollment to
eligible individuals who, for 90 days or longer, have had or are
expected to require an institutional level of care, or an institutional
equivalent level of care. - ANSWERS-True
