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AHIP2019

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  1. 1 Marks: 5 Aetna offers a variety of Aetna and Coventry Medicare Advantage plan types. Which plan type requires a person to use only network providers? (Excluding emergency or urgently needed services) Choose one answer. a. PDP plan b. HMO plan c. PPO plan d. ESRD plan Correct. Correct Marks for this submission: 5/5. Question2 Marks: 5 Which plan type allows members to see preferred doctors in network, doctors out of network and does not require referrals to a specialist? Choose one answer. a. PDP plan b. Cost plan c. PPO plan d. HMO plan Correct. Correct Marks for this submission: 5/5. Question3 Marks: 5 Most Aetna and Coventry Medicare Advantage plans are integrated with prescription drug coverage, so they are called MAPD plans. Answer: True False Correct. Correct Marks for this submission: 5/5. Question4 Marks: 5 Aetna and Coventry case management consists of registered nurses, social workers, behavioral health professionals and pharmacists who help members navigate the health care system and access services. Answer: True False Correct. Correct Marks for this submission: 5/5. Question5 Marks: 5 Aetna Medicare Advantage HMO and PPO plans have no out-of-pocket maximum. Answer: True False Correct. Correct Marks for this submission: 5/5. Question6 Marks: 5 Aetna Medicare Advantage HMO and PPO plans cover routine preventive care including an annual wellness visit, screening mammograms, and prostate cancer screenings. Answer: True False Correct. Correct Marks for this submission: 5/5. Question7 Marks: 5 A member’s cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy. Answer: True False Correct. Correct Marks for this submission: 5/5. Question8 Marks: 5 All MAPD plans have a prescription drug component. Answer: True False Correct. Correct Marks for this submission: 5/5. Question9 Marks: 5 Which of the following are true? Choose one answer. a. The Aetna and Coventry Medicare PPO plans provide access to services from doctors in the PPO network at a lower out-of-pocket cost. b. In the Aetna Medicare Open Access HMO plan, members can go to any Aetna Medicare Plan HMO network doctor they choose for covered services without a PCP referral. c. All of the Medicare Advantage plans include free monthly fitness club memberships to any facility participating within the SilverSneakers network. d. All of the above. Correct. Correct Marks for this submission: 5/5. Question10 Marks: 5 You can find a quick list of tools on aetnamedicare.com/brokers which includes information about plans, medications, and doctors. Answer: True Marks for this submission: 0/5. Question11 Marks: 5 What is a Dual eligible Special Needs Plan (D-SNP)? Choose one answer. a. A type of Medicare Advantage Prescription Drug (MAPD) plan designed to provide targeted care and services to individuals with specific needs b. A MA plan that tailors benefits, provider choices and drug formularies to meet specific needs of the groups they serve c. A MA plan for those who are eligible for Medicare and Medicaid. d. A MA plan required to contract with a state Medicaid agency e. All of the above Correct. Correct Marks for this submission: 5/5. Question12 Marks: 5 Low Income Subsidy (LIS) is a Medicare financial assistance program that helps to reduce prescription drug costs. Answer: True False Correct. Correct Marks for this submission: 5/5. Question13 Marks: 5 The difference between LIS and the Medicare Savings Program (MSP) is LIS helps reduce prescription drug costs and MSP helps with Medicare plan premiums, deductibles and copayments/coinsurance with medical services. Answer: True False Correct. Correct Marks for this submission: 5/5. Question14 Marks: 5 Which of the following is true for Low Income Subsidy: Choose one answer. a. Beneficiaries pay no more than $3.40 for a covered generic and $8.50 for each brand name drug b. There is no coverage gap c. There is no Late Enrollment Penalty d. All of the above Correct. Correct Marks for this submission: 5/5. Question15 Marks: 5 A full dual eligible means an individual has Medicare, but is only eligible for assistance with Medicare premiums and sometimes cost share through the Medicare Saving Program. Answer: True False Correct. Correct Marks for this submission: 5/5. Question16 Marks: 5 LIS Medicare drug plan premium and deductible costs are based on income level. Answer: True False Correct. Correct Marks for this submission: 5/5. Question17 Marks: 5 Full benefit duals meet state Medicaid eligibility requirements and are entitled to receive the Medicaid services they need. Answer: True False Correct. Correct Marks for this submission: 5/5. Question18 Marks: 5 One of Aetna’s Model of Care goals is to improve use of preventive health services. Answer: True False Correct. Correct Marks for this submission: 5/5. Question19 Marks: 5 Which are attributes of the Aetna’s Model of Care: Choose one answer. a. An Interdisciplinary Care Team approach b. Clinical Programs to improve health and well-being c. Transition of Care Program d. A and B e. All of the above Correct. Correct Marks for this submission: 5/5. Question20 Marks: 5 The Aetna DSNP care manager and care team provide a single point-of-contact to help coordinate all Medicare and Medicaid covered care and services that the member needs. Answer: True False Correct. Correct
  2. 1 Marks: 10 Members may qualify for transition of coverage if the Part D drug they’re taking is no longer on the plan’s formulary or the drug is restricted by a utilization management edit. Answer: True False Correct. Correct Marks for this submission: 10/10. Question2 Marks: 10 All markets offer three PDPs in all 50 states, plus the D.C., to meet the needs of our members. Answer: True False Correct. Correct Marks for this submission: 10/10. Question3 Marks: 10 Aetna Rx Home Delivery is the preferred mail order vendor for all PDP plans. Answer: True False Correct. Correct Marks for this submission: 10/10. Question4 Marks: 10 TrOOP for 2019 will be: Choose one answer. a. $4,950 b. $5,000 c. $5,100 d. $5,150 Correct. Correct Marks for this submission: 10/10. Question5 Marks: 10 Each PDP is assigned a formulary and a preferred pharmacy network. Answer: True False Correct. Correct Marks for this submission: 10/10. Question6 Marks: 10 Aetna places generics drugs on which tiers: Choose one answer. a. T1 b. T3 c. T5 d. All tiers Correct. Correct Marks for this submission: 10/10. Question7 Marks: 10 The Aetna Medicare Value Plus plan is: Choose one answer. a. lowest premium plan b. consolidated Value Plus and Premier Plus plan c. rebranded as Aetna for 2019 d. Both B and C Correct. Correct Marks for this submission: 10/10. Question8 Marks: 10 The Aetna Medicare Select Rx plan offers: Choose one answer. a. Standard pharmacy network b. Cost-effective preferred network P3 c. Robust preferred network P1 d. Does not require a pharmacy network Correct. Correct Marks for this submission: 10/10. Question9 Marks: 10 The Aetna Medicare Saver plan is our: Choose one answer. a. lowest premium plan b. benchmark plan for LIS enrollees c. only plan with T1/T2 gap coverage d. only plan to offer a $0 deductible Correct. Correct Marks for this submission: 10/10. Question10 Marks: 10 The Aetna Medicare Select plan is our: Choose one answer. a. lowest premium plan b. benchmark plan for LIS enrollees c. only plan with T1/T2 gap coverage d. only plan to offer a $0 deductible
  3. Section 3 - Broker Services, Reports, pg.36 What reports are available on Aetna’s Producer World? Choose one answer. a. Your Medicare book of business b. Month/YTD/Prior year commission report c. Licensing reports d. Broker readiness report e. A and B f. All of the above Correct. Correct Marks for this submission: 3/3. Question2 Marks: 3 Section 4 - Everything You Need to Be Ready to Sell, pg.40 You will need to successfully complete which requirements to have "ready-to-sell" status with Aetna Medicare? Choose one answer. a. The Aetna Individual Medicare certification process for the products you intend to sell b. Have an active contract through “nomoreforms” electronic contracting system c. Be licensed and appointed in accordance with state law in states where you intend to sell d. Pass a background investigation e. All of the above That's correct. Correct Marks for this submission: 3/3. Question3 Marks: 3 Section 5 - Compensation – Renewal commission payments, pg. 74 Any voluntary disenrollment occurring within three months of the membership effective date is considered a rapid disenrollment, and will result in a chargeback of the full commission paid. Answer: True False True. Correct Marks for this submission: 3/3. Question4 Marks: 3 Section 7 - Compliance & Agent Oversight – How to Report Compliance and FWA Concerns, pg. 98 To report compliance or fraud, waste, and abuse concerns to Aetna you should: Choose one answer. a. Make an anonymous call to AlertLine (1-888-891-8910) b. Visit AlertLine on the web at Aetna.alertline.com c. Fax the information to the closest Social Security office. d. Email Medicare Compliance at [email protected] or [email protected] e. A, B and D Correct. Correct Marks for this submission: 3/3. Question5 Marks: 3 Section 7 - Compliance & Agent Oversight – Agent Oversight, pgs. 100-101 Agent Oversight routinely monitors agent performance against CMS and internal standards. We monitor: Choose one answer. a. Cancellation and rapid disenrollment rates b. Enrollment application turnaround time c. Scope of Appointment (SOA) forms d. Third party secret shopper surveillance program of formal and informal marketing/sales events e. Complaints and marketing incidents f. Marketing/sales seminar reporting, cancellations and updates g. All of the above Correct. Correct Marks for this submission: 3/3. Question6 Marks: 3 Section 7 - Compliance & Agent Oversight – Agent Oversight, pg. 102 Our Agent Oversight team will implement corrective action when there are CMS infractions and prohibited tactics. Disciplinary or corrective action may include: Choose one answer. a. Focused training or monitoring sessions b. Verbal or written warnings c. Full re-training and re-testing d. Placement on an agent "watch list" e. Suspension or probationary period, with or without commissions f. Contract termination, with or without cause g. All of the above Correct. Correct Marks for this submission: 3/3. Question7 Marks: 3 Section 7 - Compliance & Agent Oversight – Agent Oversight, pg. 103 Failure to respond within the required timeframe to Aetna or CMS requests for information may result in suspension or termination of an agent, broker or producer’s ability to market, sell and receive commissions. Answer: True False Correct Correct Marks for this submission: 3/3. Question8 Marks: 3 Section 7 - Compliance & Agent Oversight – Marketing/sales events, pg. 105 You can receive commission for any sale that results from an unreported marketing/sales event. Answer: answer is False Marks for this submission: 0/3. Question9 Marks: 3 Section 7 - Compliance & Agent Oversight – Marketing/sales events, pg. 106 A prohibited marketing activity is: Choose one answer. a. Conducting health screenings that give the impression of “cherry picking”. b. Requiring beneficiaries to provide contact information as a prerequisite for attending an event. c. Asking a beneficiary for a referral. d. Using superlative language such as “the best”, “one of the best” or “rated number1”unless substantiated by data provided by CMS. e. Claiming you are recommended or endorsed by CMS. f. All of the above. Correct. Correct Marks for this submission: 3/3. Question10 Marks: 3 Section 7 Compliance & Agent Oversight – Scope of Appointment requirements, pg. 112 How long are you required to maintain Scope of Appointment (SOA) documentation? Choose one answer. a. 2 years b. 5 years c. 10 years d. Forever Correct. Correct Marks for this submission: 3/3. Question11 Marks: 3 Section 7 - Compliance & Agent Oversight – Scope of Appointment requirements, pg. 113 If a beneficiary requests to discuss other products not originally documented on the SOA, you must document a second SOA for the additional product type, and then the appointment may continue. Answer: True False That is correct. Correct Marks for this submission: 3/3. Question12 Marks: 3 Section 7 Compliance & Agent Oversight – Scope of Appointment requirements, pg. 114 When obtaining a Scope of Appointment, you may NOT: Choose one answer. a. Discuss plan options not agreed to by the beneficiary b. Ask for referrals c. Market non-health care products such as annuities or life insurance (cross selling) d. All of the above Correct. Correct Marks for this submission: 3/3. Question13 Marks: 3 Section 7 - Compliance & Agent Oversight – Permission-to-Contact form, pg. 116 The Permission-to-Contact form is used by Aetna sales representatives and external agents to contact beneficiaries, and must be completed prior to conducting an outbound call to a Medicare prospect. Answer: True False That's correct. Correct Marks for this submission: 3/3. Question14 Marks: 3 Section 7 - Compliance & Agent Oversight – Permission-to-Contact form, pg. 116 The Permission-to-Contact form is required when a prospect calls in to RSVP for a meeting. Answer: True False That’s correct. Correct Marks for this submission: 3/3. Question15 Marks: 3 Section 7 - Compliance & Agent Oversight – Contact with Medicare beneficiaries, pg. 117 You may not contact your own clients by telephone and plans may not contact current members by telephone at any time to discuss plan business. Answer: True False That’s correct. Correct Marks for this submission: 3/3. Question16 Marks: 3 Section 8 - Marketing Materials - Marketing Policy Overview, pg. 122 Producers may only use CMS and Aetna-approved marketing materials that have been created by our marketing team, approved by us and filed with CMS by us when discussing Aetna or Coventry Individual Medicare plans. Answer: True False That's correct. Correct Marks for this submission: 3/3. Question17 Marks: 3 Section 8 - Marketing Materials – Sales Presentation, pg.123 Every time you meet with beneficiaries to discuss MA/MAPD or PDP products use the CMS-approved consumer sales presentations from beginning to end. If you use the MA/MAPD or PDP sales video, it must be used in conjunction with the approved sales presentation. Answer: True False True Correct Marks for this submission: 3/3. Question18 Marks: 3 Section 9 - Enrollment, How to order your sales kits pg. 135 To order enrollment kits for Aetna Medicare products, you access Aetna-branded kits through a single point of entry, and use your NPN to log in. Answer: True False That is correct. Correct Marks for this submission: 3/3. Question19 Marks: 3 Section 10 - Enrollment Process – Enrollment application turnaround time, pg.139 Annual Election Period is from: Choose one answer. a. October 1 – December 7 b. October 15 – December 15 c. October 15 – December 7 d. October 1 – December 15 Correct. The answer is all of the above. Correct Marks for this submission: 3/3. Question20 Marks: 3 Section 10 - Enrollment Process – Enrollment application turnaround time, pg.142 A signed Medicare enrollment must reach us within two calendar days of when you receive it from the beneficiary. Answer: True False That is correct. Correct Marks for this submission: 3/3. Question21 Marks: 3 Section 10 - Enrollment Process – Aetna enrollment options, pgs.143-144 Aetna Medicare plan applications can be submitted by mail, e-mail, over the phone or through the online Ascend virtual sales office app. Answer: True False Correct. Correct Marks for this submission: 3/3. Question22 Marks: 3 Section 10 - Enrollment Process – What you need to know, pg.150 It’s not necessary to verify that the consumer has Medicare Parts A and B at the time of enrollment. Answer:False answer is False Marks for this submission: 0/3. Question23 Marks: 3 Section 10 - Enrollment Process – Referral-only sales, pg.154 You are prohibited from soliciting referral clients through cold calling, door-to-door visits or other actions prohibited under state or federal law. Answer: True False Correct. Correct Marks for this submission: 3/3. Question24 Marks: 3 Section 11 - Member Experience – After submitting the application, pg.158 Following enrollment, the client will hear from us within about 14 days of their acceptance into the plan. Answer: True False Correct. Correct Marks for this submission: 3/3. Question25 Marks: 3 Section 11 - Member Experience – Enrollment application cancellation, withdrawal or disenrollment, pg.162 You must direct all requests to cancel, withdraw, or terminate enrollment applications to the same location where the application was originally sent or call the Member Services number on the member ID card. Answer: True False
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