AHIP Module 4 QUESTIONS AND
ANSWERS
1. A Medicare beneficiary has walked into your office and asked which you take a seat
down with her and speak her options under the Medicare Advantage software. Before
accomplishing this kind of discussion, what should you do? - ANSWER-You ought to
have her sign a scope of appointment form, indicating which merchandise she
desires to discuss. You may additionally then continue with the dialogue. Correct
2. ABC is a Medicare Advantage (MA) plan sponsor. It would really like to use its enrollees'
protected health facts to marketplace non-fitness associated products including
existence coverage and annuities. To accomplish that it ought to gain authorization from
the enrollees. Which declaration satisfactory describes the authorization method? -
ANSWER-Authorization may be acquired by way of directing a beneficiary to a
website to provide consent as long as the website consists of a mechanism for an
digital signature this is legitimate beneath relevant law.
3. Agent Armstrong is hired via XYZ Agency, that's beneath contract with ABC Health Plan,
a Medicare Advantage (MA) plan that offers plans in a couple of states. XYZ Agency
continues a website advertising the MA plans with which it has contracts. Agent
Armstrong follows up with those who request extra facts about ABC MA plans thru the
website and attempts to influence them to enroll in ABC plans. What declaration quality
describes the advertising and compliance rules that follow to Agent Armstrong? -
ANSWER-Agent Armstrong desires to be certified and appointed in each nation in
which beneficiaries to whom he markets ABC MA plans are placed.
4. Agent Harriet Walker has these days begun advertising and marketing Medicare
Advantage and related products aimed toward assembly the needs of senior citizens.
Client Mildred Jones has expressed hobby in a Medicare Advantage plan. It is now the
start of September. If you have been in Agent Walker's role, what could you do? -
ANSWER-Inquire whether the consumer qualifies for a unique enrollment period,
and if not, solicit an enrollment application once the annual open enrollment
election period starts on October 15th.
5. Agent Higgins facilitates Mrs. O'Malley to sign up for AB Medicare Advantage (MA) plan
all through the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date
is January 1st. Subsequently, Mrs. O'Malley disenrolls on February twelfth following a
flow out of doors the plan's service region. What effect will this have on Agent Higgins
repayment? - ANSWER-AB MA plan does now not should recoup Agent Higgins'
reimbursement because she has moved faraway from its service location.
6. Agent Lopez facilitates Ralph to sign up for Top Choice Medicare Advantage plan at
some stage in the Annual Open Enrollment Period. Ralph's effective enrollment date is
January 1st. Ralph disenrolls on February 12th because he did now not understand that
the plan did not cowl services provided by way of numerous of his longtime vendors.
Which of the following statements great describes the impact of Ralph's motion upon
, Agent Lopez's reimbursement? - ANSWER-Agent Lopez's complete repayment must
be recouped because Ralph disenrolled within 3 months of enrollment.
7. Agent Martinez needs to solicit Medicare Advantage possibilities via electronic mail and
asks you for recommendation as to whether or not this is viable. What must you inform
her? - ANSWER-Marketing representatives might also initiate electronic contact
thru e-mail however the difficulty line have to say "marketing" and an choose-out
process should be provided.
8. Agent Mary Jennings makes a presentation on Medicare marketed as an educational
occasion. Agent Jennings distributes materials which might be solely academic in
nature. However, she gives a quick presentation that mentions plan-specific charges. Is
this a prohibited activity at an event that has been advertised as educational? -
ANSWER-Yes. When an event has been marketed as "instructional," discussing
plan-specific rates is impermissible.
9. Alice is a advertising consultant employed via a health plan. Betty is a captive agent of a
health plan who markets to a couple of plans and sponsors. Carl is a captive agent who
markets to handiest one plan/sponsor. Denise is an independent agent who markets to
one-of-a-kind forms of companies. Edward is an independent agent who markets only to
agency and union businesses. CMS marketing consultant repayment guidelines usually
observe to: - ANSWER-Betty and Denise, but not Alice (the worker) or Carl or
Edward (to whom exceptions apply).
10.Another agent operating for your enterprise claims that because you aren't hired through
the Medicare Advantage plans which you represent, you aren't difficulty to the identical
necessities because the plans themselves. How must you reply to the sort of
declaration? - ANSWER-Your coworker isn't accurate. Marketing on behalf of a plan
is taken into consideration marketing via the plan and calls for that each one
shriveled and hired sellers observe all Medicare advertising rules.
11.Another agent you know has engaged in misconduct that has been proven by the plan
she represented. What sort of penalty would possibly the plan impose in this character? -
ANSWER-The plan can also withhold fee, require retraining, report the misconduct
to a nation branch of coverage or terminate the settlement.
12.BestCare Health Plan has obtained a request from a state coverage department in
connection with the research of numerous advertising representatives certified via the
state who sell Medicare Advantage plans. What action(s) ought to BestCare soak up
reaction? - ANSWER-Cooperate with the nation and supply requested statistics.
13.By contacting plans available on your place, you have got found out that the plan you
represent has a significantly decrease month-to-month top class than the others.
Furthermore, you notice that the plan you represent has a unique gain package. What
have to you do to make sure your customers know about these pieces of statistics? -
ANSWER-You may also make comparisons among plans if you could help them by
means of studies or statistical statistics and such comparisions are factually
primarily based.
14.During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
five-star rating in customer support and care coordination, and received an general plan
overall performance score of a 4-big name, which of the following could be the precise
ANSWERS
1. A Medicare beneficiary has walked into your office and asked which you take a seat
down with her and speak her options under the Medicare Advantage software. Before
accomplishing this kind of discussion, what should you do? - ANSWER-You ought to
have her sign a scope of appointment form, indicating which merchandise she
desires to discuss. You may additionally then continue with the dialogue. Correct
2. ABC is a Medicare Advantage (MA) plan sponsor. It would really like to use its enrollees'
protected health facts to marketplace non-fitness associated products including
existence coverage and annuities. To accomplish that it ought to gain authorization from
the enrollees. Which declaration satisfactory describes the authorization method? -
ANSWER-Authorization may be acquired by way of directing a beneficiary to a
website to provide consent as long as the website consists of a mechanism for an
digital signature this is legitimate beneath relevant law.
3. Agent Armstrong is hired via XYZ Agency, that's beneath contract with ABC Health Plan,
a Medicare Advantage (MA) plan that offers plans in a couple of states. XYZ Agency
continues a website advertising the MA plans with which it has contracts. Agent
Armstrong follows up with those who request extra facts about ABC MA plans thru the
website and attempts to influence them to enroll in ABC plans. What declaration quality
describes the advertising and compliance rules that follow to Agent Armstrong? -
ANSWER-Agent Armstrong desires to be certified and appointed in each nation in
which beneficiaries to whom he markets ABC MA plans are placed.
4. Agent Harriet Walker has these days begun advertising and marketing Medicare
Advantage and related products aimed toward assembly the needs of senior citizens.
Client Mildred Jones has expressed hobby in a Medicare Advantage plan. It is now the
start of September. If you have been in Agent Walker's role, what could you do? -
ANSWER-Inquire whether the consumer qualifies for a unique enrollment period,
and if not, solicit an enrollment application once the annual open enrollment
election period starts on October 15th.
5. Agent Higgins facilitates Mrs. O'Malley to sign up for AB Medicare Advantage (MA) plan
all through the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date
is January 1st. Subsequently, Mrs. O'Malley disenrolls on February twelfth following a
flow out of doors the plan's service region. What effect will this have on Agent Higgins
repayment? - ANSWER-AB MA plan does now not should recoup Agent Higgins'
reimbursement because she has moved faraway from its service location.
6. Agent Lopez facilitates Ralph to sign up for Top Choice Medicare Advantage plan at
some stage in the Annual Open Enrollment Period. Ralph's effective enrollment date is
January 1st. Ralph disenrolls on February 12th because he did now not understand that
the plan did not cowl services provided by way of numerous of his longtime vendors.
Which of the following statements great describes the impact of Ralph's motion upon
, Agent Lopez's reimbursement? - ANSWER-Agent Lopez's complete repayment must
be recouped because Ralph disenrolled within 3 months of enrollment.
7. Agent Martinez needs to solicit Medicare Advantage possibilities via electronic mail and
asks you for recommendation as to whether or not this is viable. What must you inform
her? - ANSWER-Marketing representatives might also initiate electronic contact
thru e-mail however the difficulty line have to say "marketing" and an choose-out
process should be provided.
8. Agent Mary Jennings makes a presentation on Medicare marketed as an educational
occasion. Agent Jennings distributes materials which might be solely academic in
nature. However, she gives a quick presentation that mentions plan-specific charges. Is
this a prohibited activity at an event that has been advertised as educational? -
ANSWER-Yes. When an event has been marketed as "instructional," discussing
plan-specific rates is impermissible.
9. Alice is a advertising consultant employed via a health plan. Betty is a captive agent of a
health plan who markets to a couple of plans and sponsors. Carl is a captive agent who
markets to handiest one plan/sponsor. Denise is an independent agent who markets to
one-of-a-kind forms of companies. Edward is an independent agent who markets only to
agency and union businesses. CMS marketing consultant repayment guidelines usually
observe to: - ANSWER-Betty and Denise, but not Alice (the worker) or Carl or
Edward (to whom exceptions apply).
10.Another agent operating for your enterprise claims that because you aren't hired through
the Medicare Advantage plans which you represent, you aren't difficulty to the identical
necessities because the plans themselves. How must you reply to the sort of
declaration? - ANSWER-Your coworker isn't accurate. Marketing on behalf of a plan
is taken into consideration marketing via the plan and calls for that each one
shriveled and hired sellers observe all Medicare advertising rules.
11.Another agent you know has engaged in misconduct that has been proven by the plan
she represented. What sort of penalty would possibly the plan impose in this character? -
ANSWER-The plan can also withhold fee, require retraining, report the misconduct
to a nation branch of coverage or terminate the settlement.
12.BestCare Health Plan has obtained a request from a state coverage department in
connection with the research of numerous advertising representatives certified via the
state who sell Medicare Advantage plans. What action(s) ought to BestCare soak up
reaction? - ANSWER-Cooperate with the nation and supply requested statistics.
13.By contacting plans available on your place, you have got found out that the plan you
represent has a significantly decrease month-to-month top class than the others.
Furthermore, you notice that the plan you represent has a unique gain package. What
have to you do to make sure your customers know about these pieces of statistics? -
ANSWER-You may also make comparisons among plans if you could help them by
means of studies or statistical statistics and such comparisions are factually
primarily based.
14.During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
five-star rating in customer support and care coordination, and received an general plan
overall performance score of a 4-big name, which of the following could be the precise
