Humana 2025/2026 MAPD & PDP Certification
Exam Prep - Ultimate Study Guide to Pass on
Your First Try
Section A vs. Agent Misconduct Allegations - Answer--Section A - An issue committed
during the marketing, sale or enrollment with a Medicare beneficiary. Outcome reported
to CMS
Agent Misconduct Allegations - Issues from a source other than a Medicare beneficary
falls under different guideline as a Section A.
Critical Violation - Answer--typically a willful action,
Non Critical * a negligent action
Founded violation, evidence supports allegation
Unfounded , evidence does not support
An inconclusive does not support either a founded or unfounded allegation
EXAMPLES OF UNACCEPTABLE QUESTIONS - Answer--How often do you see a dr?
Are you in good health?
What health conditions? Do you have chronic health conditions? When last
hospitalized? What conditions do you have that require medicine? What prescriptions
do you take? Do you smoke? Do you exercise?
Chronic Condition Special Needs Plans - Answer--DO NOT ASK THE BENEFICIARY
DIRECTLY IF THEY HAVE BEEN DIAGNOZED WITH THE CONDITION THAT IS A
REQUIREMENT FOR ENROLLMENT INTO THE PLAN
PHASE QUESTION LIKE THIS:
HUMANA ALSO OFFERS PLANS IN YOUR AREA SPECIFICALLY FOR PEOPLE
WITH CERTAIN CHRONIC CONDITIONS SUCH AS DIABETES, HEART FAILURE,
CARDIOVASCULAR DISEASE
Exam Prep - Ultimate Study Guide to Pass on
Your First Try
Section A vs. Agent Misconduct Allegations - Answer--Section A - An issue committed
during the marketing, sale or enrollment with a Medicare beneficiary. Outcome reported
to CMS
Agent Misconduct Allegations - Issues from a source other than a Medicare beneficary
falls under different guideline as a Section A.
Critical Violation - Answer--typically a willful action,
Non Critical * a negligent action
Founded violation, evidence supports allegation
Unfounded , evidence does not support
An inconclusive does not support either a founded or unfounded allegation
EXAMPLES OF UNACCEPTABLE QUESTIONS - Answer--How often do you see a dr?
Are you in good health?
What health conditions? Do you have chronic health conditions? When last
hospitalized? What conditions do you have that require medicine? What prescriptions
do you take? Do you smoke? Do you exercise?
Chronic Condition Special Needs Plans - Answer--DO NOT ASK THE BENEFICIARY
DIRECTLY IF THEY HAVE BEEN DIAGNOZED WITH THE CONDITION THAT IS A
REQUIREMENT FOR ENROLLMENT INTO THE PLAN
PHASE QUESTION LIKE THIS:
HUMANA ALSO OFFERS PLANS IN YOUR AREA SPECIFICALLY FOR PEOPLE
WITH CERTAIN CHRONIC CONDITIONS SUCH AS DIABETES, HEART FAILURE,
CARDIOVASCULAR DISEASE
