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UHC CERTIFICATION EXAM WITH VERIFIED
QUESTIONS AND ANSWERS LATEST UPDATE
2025/2026
If a member is switching from one MA plan to another, does the
member have to be apart of the same carrier to retain his/her
MOOP expenses? - correct answer -yes. if the member is from a
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different carrier, the MOOP expense will NOT carry over to the
new plans yearly deductible
What type of plans are network based plans? - correct answer
HMO's, POS's, and PPO's
What type of plan can either be network based or non- network
based? - correct answer -PFFO
Before enrolling a customer in a MA plan, you must verify the
network status of each provider the customer currently uses or
intends to use by checking what? - correct answer -the plans
provider directory or by contacting the plan. If possible, use an
online directory over a printed directory as they are more current.
Remind the customer to check their providers status before
receiving care to ensure that their network status has not
changed. ( see provider search job aid on jarvis, UHC's agent
portal)
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Is emergency care covered in a PFFO plan regardless of whether
the provider agrees to accept the plans payment? - correct
answer -yes it is`
Who allows the PFFS plan to decide if balance billing is
permitted? - correct answer -CMS. Plans must disclose what is
permitted in the terms and conditions
Does the OEP( Open enrollment period) allow for PDP changes?
- correct answer -No you cant make changes to PDP during the
OEP
If a customer enrolled in a MAP( with or without prescription drug
coverage), will be automatically ________from that plan and
returned to original medicare upon enrolling in a PDP ( except
MA-only PFFS plans) - correct answer -disenrolled
what happens when a customer is enrolled in a employee or
union sponsored health plan and decides to enroll in a PDP? -
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correct answer -the customer MAY lose coverage for themselves
and their dependents upon enrollment in a PDP, and may not be
able to re-enroll in the employer or union plan at a later date
in an employer/union-sponsored group retiree plan, or more
specifically a subsidized plan, the employer contributes to the
premium, but with an endorsed plan, the employer _____? -
correct answer -does not contribute
WHat kind of medicare plan is only available through employer
groups? - correct answer -employer senior supplement group
retiree plans
does an employer senior supplement group retiree plan help pay
for some or all the costs not covered by original medicare? -
correct answer -yes. not only that but they have similar coverage
as medicare supplement insurance plans and members can go to
any provider that accepts medicare
UHC CERTIFICATION EXAM WITH VERIFIED
QUESTIONS AND ANSWERS LATEST UPDATE
2025/2026
If a member is switching from one MA plan to another, does the
member have to be apart of the same carrier to retain his/her
MOOP expenses? - correct answer -yes. if the member is from a
, Page | 2
different carrier, the MOOP expense will NOT carry over to the
new plans yearly deductible
What type of plans are network based plans? - correct answer
HMO's, POS's, and PPO's
What type of plan can either be network based or non- network
based? - correct answer -PFFO
Before enrolling a customer in a MA plan, you must verify the
network status of each provider the customer currently uses or
intends to use by checking what? - correct answer -the plans
provider directory or by contacting the plan. If possible, use an
online directory over a printed directory as they are more current.
Remind the customer to check their providers status before
receiving care to ensure that their network status has not
changed. ( see provider search job aid on jarvis, UHC's agent
portal)
, Page | 3
Is emergency care covered in a PFFO plan regardless of whether
the provider agrees to accept the plans payment? - correct
answer -yes it is`
Who allows the PFFS plan to decide if balance billing is
permitted? - correct answer -CMS. Plans must disclose what is
permitted in the terms and conditions
Does the OEP( Open enrollment period) allow for PDP changes?
- correct answer -No you cant make changes to PDP during the
OEP
If a customer enrolled in a MAP( with or without prescription drug
coverage), will be automatically ________from that plan and
returned to original medicare upon enrolling in a PDP ( except
MA-only PFFS plans) - correct answer -disenrolled
what happens when a customer is enrolled in a employee or
union sponsored health plan and decides to enroll in a PDP? -
, Page | 4
correct answer -the customer MAY lose coverage for themselves
and their dependents upon enrollment in a PDP, and may not be
able to re-enroll in the employer or union plan at a later date
in an employer/union-sponsored group retiree plan, or more
specifically a subsidized plan, the employer contributes to the
premium, but with an endorsed plan, the employer _____? -
correct answer -does not contribute
WHat kind of medicare plan is only available through employer
groups? - correct answer -employer senior supplement group
retiree plans
does an employer senior supplement group retiree plan help pay
for some or all the costs not covered by original medicare? -
correct answer -yes. not only that but they have similar coverage
as medicare supplement insurance plans and members can go to
any provider that accepts medicare
