AHIP 2026 Anthem Certification Exam
Test Bank | Verified Q&As to Pass
First Time
The Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals
previously allowed one time per-calendar-quarter during the first nine months of the
year was replaced beginning Calendar Year 2025 with a monthly SEP to enroll in a
standalone PDP. Eligible beneficiaries can switch PDPs or leave a MA/MAPD plan for
Original Medicare plus a standalone PDP. - Answer--True
Which of the following statements is NOT true about a disenrollment? -
Answer--Disenrollment requests can be taken verbally
How does a cancellation differ from a disenrollment? - Answer--Both A and B are
correct
A. A cancellation applies if a request is received prior to a member's effective date or by
the date on the Outbound Enrollment Verification (OEV) letter
B. Cancellation requests are initiated by the member and can be received either
verbally or in writing
FEMA disaster SEPs can only be used if members missed a valid enrollment period. -
Answer--True
A monthly integrated care SEP beginning calendar year 2025 allows 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 SEP is allowed only when the individual
receives Medicaid through an affiliated managed care plan. - Answer--True
, A member can add or drop prescription drug coverage during the Annual Election
Period (AEP). - Answer--True
If a beneficiary has agreed to an in-home appointment to discuss a PDP product, an
agent can discuss an HMO product with them during that same meeting, if the
beneficiary requests it and a new scope of appointment form is completed. -
Answer--True
The Open Election Period (OEP) is for beneficiaries who are enrolled in a MA-only or
MA-PD plan, or those who are enrolled in Original Medicare, including those enrolled in
stand-alone PDPs. - Answer--False
Which of the following is not a valid reason for involuntary disenrollment? -
Answer--Moving to a new address in the same plan service area
Prior to making an enrollment decision, beneficiaries must review and complete the
pre-enrollment checklist. - Answer--True
If a beneficiary currently has drug coverage through another carrier, you must verify
their prescriptions would be covered under our plan's formulary, too. The drugs that are
actually covered may vary from one carrier to another or one plan to another. -
Answer--True
You MUST tell your PPO plan clients they will have to pay more when seeking
non-emergent eligible services outside of the network. - Answer--True
You receive a questionnaire regarding a sales misrepresentation inquiry. You must
respond within the designated time frame, addressing all concerns in the allegation and
include any pertinent notes from your sales appointment, event, etc. that may apply to
the allegation. - Answer--True
You MUST EXPLAIN the Part D late enrollment penalty. - Answer--True
CMS will allow Third-Party Marketing Organizations (TPMOs) to continue sharing a
beneficiary's data as long as they obtain prior express written consent through a clear
and conspicuous disclosure for each TPMO that will receive the beneficiary's data and
contact them. - Answer--True
Test Bank | Verified Q&As to Pass
First Time
The Special Election Period (SEP) for Dual Eligible and Other LIS Eligible Individuals
previously allowed one time per-calendar-quarter during the first nine months of the
year was replaced beginning Calendar Year 2025 with a monthly SEP to enroll in a
standalone PDP. Eligible beneficiaries can switch PDPs or leave a MA/MAPD plan for
Original Medicare plus a standalone PDP. - Answer--True
Which of the following statements is NOT true about a disenrollment? -
Answer--Disenrollment requests can be taken verbally
How does a cancellation differ from a disenrollment? - Answer--Both A and B are
correct
A. A cancellation applies if a request is received prior to a member's effective date or by
the date on the Outbound Enrollment Verification (OEV) letter
B. Cancellation requests are initiated by the member and can be received either
verbally or in writing
FEMA disaster SEPs can only be used if members missed a valid enrollment period. -
Answer--True
A monthly integrated care SEP beginning calendar year 2025 allows 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 SEP is allowed only when the individual
receives Medicaid through an affiliated managed care plan. - Answer--True
, A member can add or drop prescription drug coverage during the Annual Election
Period (AEP). - Answer--True
If a beneficiary has agreed to an in-home appointment to discuss a PDP product, an
agent can discuss an HMO product with them during that same meeting, if the
beneficiary requests it and a new scope of appointment form is completed. -
Answer--True
The Open Election Period (OEP) is for beneficiaries who are enrolled in a MA-only or
MA-PD plan, or those who are enrolled in Original Medicare, including those enrolled in
stand-alone PDPs. - Answer--False
Which of the following is not a valid reason for involuntary disenrollment? -
Answer--Moving to a new address in the same plan service area
Prior to making an enrollment decision, beneficiaries must review and complete the
pre-enrollment checklist. - Answer--True
If a beneficiary currently has drug coverage through another carrier, you must verify
their prescriptions would be covered under our plan's formulary, too. The drugs that are
actually covered may vary from one carrier to another or one plan to another. -
Answer--True
You MUST tell your PPO plan clients they will have to pay more when seeking
non-emergent eligible services outside of the network. - Answer--True
You receive a questionnaire regarding a sales misrepresentation inquiry. You must
respond within the designated time frame, addressing all concerns in the allegation and
include any pertinent notes from your sales appointment, event, etc. that may apply to
the allegation. - Answer--True
You MUST EXPLAIN the Part D late enrollment penalty. - Answer--True
CMS will allow Third-Party Marketing Organizations (TPMOs) to continue sharing a
beneficiary's data as long as they obtain prior express written consent through a clear
and conspicuous disclosure for each TPMO that will receive the beneficiary's data and
contact them. - Answer--True
