2014 - Qm - Final 1

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2014 - Qm - Final 1 - Quiz

Final Exam 1


Questions and Answers
  • 1. 

    Disclaimer, Disclaimer ScriptingThe customer/POA is not on the line to hear the scripting that is read prior to the disclaimer. How will QM score number 51?

    • A.

      Yes

    • B.

      Minor

    • C.

      Major

    • D.

      N/A

    Correct Answer
    B. Minor
    Explanation
    The given answer "Minor" suggests that the issue mentioned in the question, which is the customer/POA not being on the line to hear the scripting prior to the disclaimer, is considered a minor problem. This implies that it may have a slight impact on the quality management (QM) score, but it is not a significant issue that would greatly affect the overall score.

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  • 2. 

    Disclaimer, Disclaimer ScriptingThe customers are both enrolling into MAPD plans. MR is enrolling into the Aetna Medicare Value Plan HMO and MRS is enrolling into the AARP MedicareComplete HMO. The BA/ADP can play one disclaimer after the applications are completed because both plans are MAPDs. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The BA/ADP cannot play one disclaimer after the applications are completed because both plans are MAPDs.

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  • 3. 

    Disclaimer, Disclaimer ScriptingThe HIPAA can listen to the disclaimer without the customer on the line as long as the customer is back to give their voice signature. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The given statement is false. According to HIPAA regulations, the customer must be on the line and give their voice signature for the disclaimer to be recorded. The HIPAA cannot listen to the disclaimer without the customer present.

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  • 4. 

    Disclaimer, Disclaimer ScriptingIf the call disconnects during the legal disclaimer, is it acceptable for the BA to call the customer back to finish it?

    • A.

      Yes

    • B.

      No

    Correct Answer
    B. No
    Explanation
    All aspects of an enrollment must be completed on an inbound call

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  • 5. 

    Closing Script, Contact InformationThe BA/ADP must read the closing script to each customer individually when completing a joint application.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The given statement is false. The BA/ADP does not need to read the closing script to each customer individually when completing a joint application.

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  • 6. 

    Closing Script, Contact Information When providing the customer with our contact information, the customer stated that they do not need the TTY number before the BA could provide it. How would this be graded (provided all other information was given correctly)?

    • A.

      Yes

    • B.

      Minor

    • C.

      Major

    • D.

      N/A

    Correct Answer
    A. Yes
    Explanation
    The customer's statement that they do not need the TTY number before it was provided indicates that the BA successfully anticipated and addressed the customer's needs. This demonstrates effective communication and customer service skills, resulting in a positive interaction. Therefore, the answer "Yes" is correct.

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  • 7. 

    Closing Script, Contact Information  Who is eligible to receive the closing script information on their own?(Select all that apply)

    • A.

      Authorized representative

    • B.

      HIPAA

    • C.

      POA

    • D.

      Customer

    Correct Answer(s)
    C. POA
    D. Customer
    Explanation
    The closing script information can be received by both the Power of Attorney (POA) and the customer themselves. The authorized representative and HIPAA are not mentioned in the question as eligible recipients of the closing script information.

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  • 8. 

    Closing Script, Contact InformationIf the BA/ADP skips the entire second paragraph of the closing script for a MAPD, how will QM score the corresponding section?

    • A.

      Yes

    • B.

      Minor

    • C.

      Major

    • D.

      N/A

    Correct Answer
    B. Minor
    Explanation
    If the BA/ADP skips the entire second paragraph of the closing script for a MAPD, the QM score will be considered as "Minor". This means that it is a minor issue or error, but it does not have a significant impact on the overall quality of the script or the communication process.

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  • 9. 

    Closing Script and Contact InformationWhen is it acceptable for the BA/ADP to not read the closing script?

    • A.

      Never

    • B.

      After completing a Medigap application IF they will also be completing a PDP application and reading the closing script after the PDP

    • C.

      If it is the end of their shift and they want to go home

    • D.

      The closing script is not required

    Correct Answer
    B. After completing a Medigap application IF they will also be completing a PDP application and reading the closing script after the PDP
    Explanation
    The BA/ADP is only allowed to not read the closing script after completing a Medigap application if they will also be completing a PDP application and reading the closing script after the PDP. This means that if they are going to complete both applications and read the closing script after the PDP, they do not need to read the closing script after completing the Medigap application.

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  • 10. 

    Application, page 1The customer's name is William George Johnson. On the application, he stated his first name as 'George' and on the application it appears as 'William'. What will QM do for number 28?

    • A.

      Minor because it was done but not done correctly

    • B.

      Check with a supervisor before scoring it down

    • C.

      Yes, because George is his middle name

    • D.

      Major because the application doesn't match what was heard on the recording

    Correct Answer
    B. Check with a supervisor before scoring it down
    Explanation
    The correct answer is to check with a supervisor before scoring it down. This is because there is a discrepancy between the customer's stated first name and the name that appears on the application. To ensure accuracy and avoid making a mistake, it is important to consult a supervisor for guidance before taking any action.

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  • 11. 

    Application, page 1The BA/ADP is able to answer which question(s) for the customer on page 1?Check all that apply.

    • A.

      Alternate mailing address

    • B.

      Gender

    • C.

      Desired Effective Date

    • D.

      Medicare Claim Number

    • E.

      Alternate Contact

    • F.

      POA question

    Correct Answer(s)
    C. Desired Effective Date
    E. Alternate Contact
    Explanation
    The BA/ADP is able to answer the customer's questions regarding their desired effective date and alternate contact information.

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  • 12. 

    Application, page 1What question(s) on page 1 can an ADP/BA skip and not get marked down? Check all that apply.

    • A.

      Middle Name

    • B.

      Primary Phone Number

    • C.

      Alternate Phone Number

    • D.

      Title

    • E.

      Gender

    • F.

      HICN

    • G.

      Alternate Address

    • H.

      Alternate Contact

    • I.

      Name on the Medicare card

    • J.

      Desired Effective Date

    • K.

      Email address

    Correct Answer(s)
    A. Middle Name
    C. Alternate Phone Number
    D. Title
    H. Alternate Contact
    I. Name on the Medicare card
    K. Email address
    Explanation
    An ADP/BA can skip the questions about Middle Name, Alternate Phone Number, Title, Alternate Contact, Name on the Medicare card, and Email address on page 1 without getting marked down. These questions are not necessary for the application process or for the completion of page 1.

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  • 13. 

    Application, page 1The customer said their date of birth is 5/31/36. The ADP asked the customer to restate the date of birth but give a four digit year. Which statement is most accurate?

    • A.

      The ADP knows they will lose points if they do not ask for the four digit year

    • B.

      The ADP will not lose points if they do not ask for the four digit year

    • C.

      The ADP is trying to get extra points on their QM form

    Correct Answer
    B. The ADP will not lose points if they do not ask for the four digit year
    Explanation
    The ADP will not lose points if they do not ask for the four digit year because the customer's date of birth is already provided as 5/31/36. Although it is standard practice to ask for a four digit year, it is not mandatory in this case as the customer has already stated their date of birth. Therefore, not asking for the four digit year will not result in any penalty or loss of points.

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  • 14. 

    Medigap, page 2 and beyondIf the question regarding how the customer would prefer to pay the premiums is asked twice on a Medigap application, the ADP/BA may skip it the second time it appears.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    If the question regarding how the customer would prefer to pay the premiums is asked twice on a Medigap application, the ADP/BA may skip it the second time it appears. This means that if the question is repeated, the ADP/BA has the option to not ask it again.

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  • 15. 

    Medigap, page 2 and beyond"Do you intend to replace your current healthcare coverage with this Medicare Supplement policy?"This question is always marked No on each application for every carrier.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement "This question is always marked No on each application for every carrier" is false. The question is asking whether the individual intends to replace their current healthcare coverage with the Medicare Supplement policy. The answer to this question may vary depending on the individual's circumstances and preferences. Some individuals may choose to replace their current coverage, while others may not. Therefore, the answer to this question is not always marked as "No" on every application for every carrier.

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  • 16. 

    Medigap, page 2 and beyondIf the ADP does not ask for the AARP membership number on the first page, QM scores Major on number 41 because there is no line item for this question for the AARP membership field. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The explanation for the answer being False is that the statement in the question suggests that if the ADP (presumably a form or document) does not ask for the AARP membership number on the first page, then the QM (quality management) scores Major on question number 41. However, this does not necessarily mean that the answer is False. It is possible that the QM scores Major on question number 41 in this scenario, making the statement True. Therefore, the given answer is not a correct explanation for the answer being False.

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  • 17. 

    Medigap, page 2 and beyondQM will score line item 41 as a Major if the BA skips the following questions on a guaranteed issue application: Current Age, Height, Weight, BMI.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement is false because according to the given information, if the BA skips the questions about Current Age, Height, Weight, and BMI on a guaranteed issue application, the QM will score line item 41 as a Major. Therefore, the correct answer should be True, not False.

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  • 18. 

    Medigap, page 2 and beyondIf the ADP has to clarify a question on page 4 for the customer and then does not re-state the question, which carrier would that be acceptable for?

    • A.

      Blue Shield of Maryland

    • B.

      Aetna

    • C.

      BCBS of KY

    • D.

      Humana

    • E.

      Carefirst BlueCross BlueShield of Maryland

    Correct Answer
    E. Carefirst BlueCross BlueShield of Maryland
    Explanation
    If the ADP has to clarify a question on page 4 for the customer and then does not re-state the question, it would be acceptable for Carefirst BlueCross BlueShield of Maryland.

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  • 19. 

    BenefitsADP/BA is completing a Medigap Plan N. What benefits are they required to read?

    • A.

      Doctor and Hospital Choice-“You can go to any doctor, supplier, hospital, or other facility that is enrolled in Medicare and is accepting new Medicare patients.”

    • B.

      Medical Expenses-Covers 100% of Part B coinsurance after you meet your yearly Part B deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.

    • C.

      Part B Excess

    • D.

      All of the Above

    • E.

      None of the Above-Benefits are not required to be read on any Medigap plans

    Correct Answer
    B. Medical Expenses-Covers 100% of Part B coinsurance after you meet your yearly Part B deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.
    Explanation
    The correct answer is "Medical Expenses-Covers 100% of Part B coinsurance after you meet your yearly Part B deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits." This is the correct answer because it accurately describes the specific benefits related to medical expenses that are required to be read for a Medigap Plan N. It mentions the coverage for Part B coinsurance, the yearly deductible, and the additional copayments for office visits and ER visits.

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  • 20. 

    BenefitsCustomer is enrolling into a High Deductible Plan F. Which benefits are required to be read to the Customer?

    • A.

      None. The benefits are not required for the Plan F

    • B.

      Doctor and Hospital Choice

    • C.

      Deductible for Medical Only

    • D.

      Doctor Office Visit

    Correct Answer
    C. Deductible for Medical Only
  • 21. 

    BenefitsFill in the Blank:Medigap Plan N-Covers 100% of Part B coinsurance after you meet your yearly Part ____ deductible ($147.00 for 2014). You have to pay an additional copayment of up to $20 for some office visits and up to $50 for ER visits.

    • A.

      A

    • B.

      B

    • C.

      C

    • D.

      D

    Correct Answer
    B. B
    Explanation
    Medigap Plan N covers 100% of Part B coinsurance after you meet your yearly Part B deductible. This means that once you have paid the deductible amount ($147.00 for 2014), the plan will cover the remaining coinsurance costs for Part B services. However, for some office visits, you may still have to pay a copayment of up to $20, and for emergency room visits, you may have to pay a copayment of up to $50. Therefore, the correct answer is B, indicating that the deductible that needs to be met is Part B.

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  • 22. 

    BenefitsBA's are allowed to skip benefits for a Plan F, but ADPs are not.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    This statement is false. Both BenefitsBA's and ADPs are allowed to skip benefits for a Plan F.

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  • 23. 

    BenefitsThe ADP must read additional benefits from the Full Summary of Benefits on a HMO-POS plan. What are those benefits?

    • A.

      Chiropractic Services

    • B.

      Inpatient Hospital Care/Hospital Stays

    • C.

      Ambulatory Surgical Center

    • D.

      Primary Care Physician

    • E.

      Physical Therapy

    • F.

      Physician Specialist Services

    • G.

      Diagnostic Radiological Services

    • H.

      Ambulance Services

    Correct Answer(s)
    B. Inpatient Hospital Care/Hospital Stays
    D. Primary Care Physician
    F. Physician Specialist Services
    H. Ambulance Services
  • 24. 

    BenefitsIf the ADP read the entire portion from the HMO-POS section, would QM score them down?

    • A.

      No. The ADP went above and beyond what they had to read and should not be marked down.

    • B.

      Yes. The ADP only has to read four benefits as listed in the definitions

    • C.

      No. As long as long as they read them all accurately.

    Correct Answer
    C. No. As long as long as they read them all accurately.
    Explanation
    The correct answer is "No. As long as they read them all accurately." This answer states that the ADP should not be marked down as long as they read all the benefits accurately. It implies that reading more than the required four benefits from the HMO-POS section does not result in a lower QM score.

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  • 25. 

    BenefitsOut of the 16 line items in the Benefits section, how many can be scored as a Major?

    • A.

      None

    • B.

      One

    • C.

      Three

    • D.

      Sixteen

    Correct Answer
    B. One
    Explanation
    In the Benefits section, only one line item can be scored as a Major. This implies that out of the 16 line items, only a single item meets the criteria to be considered as a major benefit.

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  • 26. 

    BenefitsWhat additional benefits must be read if the customer resides in a nursing home?

    • A.

      Home Health Care

    • B.

      Hospice

    • C.

      Long Term Care Pharmacy Drug Tiers

    • D.

      Outpatient Rehabilitation Services

    • E.

      Skilled Nursing Facility (SNF)

    Correct Answer
    C. Long Term Care Pharmacy Drug Tiers
  • 27. 

    BenefitsIf the drug deductible is $0, the BA/ADP does not have to read it to the customer during the benefits section. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    If the drug deductible is $0, it means that there is no deductible amount that the customer needs to pay before their drug benefits kick in. In this case, the BA/ADP does not need to mention the drug deductible to the customer during the benefits section because there is no deductible amount to be discussed. Therefore, the statement that the BA/ADP does not have to read it to the customer during the benefits section is true.

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  • 28. 

    BenefitsHere is the verbiage for Catastrophic Coverage:Catastrophic CoverageAfter your yearly out-of-pocket drug costs reach $4,550, you pay the greater of:-5% coinsurance, or- $2.55 copay for generic (including brand drugs treated as generic) and a $6.35 copay for all other drugs.The BA/ADP did not read (including brand drugs treated as generic). How should QM score number 24?

    • A.

      Yes

    • B.

      Minor

    • C.

      Major

    • D.

      N/A

    Correct Answer
    A. Yes
    Explanation
    The BA/ADP did not read the phrase "including brand drugs treated as generic" in the verbiage for Catastrophic Coverage. This phrase indicates that even brand drugs that are treated as generic will have a copay of $2.55. Since the BA/ADP did not include this information in their reading, it suggests that they did not fully understand the coverage details. Therefore, the QM score number 24 should be marked as Major, indicating a significant error in understanding the information.

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  • 29. 

    Opening Script How would you grade the following statement and why?"My name is Fi Schneider, today is Friday July 11th. This call will be recorded. Do I have your permission to record this conversation to confirm your enrollment?"

    • A.

      Yes- There is nothing wrong with the statement.

    • B.

      Minor- The BA/ADP did not read the statement verbatim (the year was not stated)

    • C.

      Major-The BA/ADP skipped part of the statement (the year was not stated)

    • D.

      N/A

    Correct Answer
    B. Minor- The BA/ADP did not read the statement verbatim (the year was not stated)
    Explanation
    The correct answer is "Minor- The BA/ADP did not read the statement verbatim (the year was not stated)". This is because the statement mentioned the day and month but did not include the year, which is part of reading the statement verbatim.

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  • 30. 

    Opening ScriptThe HIPAA statement/question (number 10) must be read/asked on every application. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement/question (number 10) does not need to be read/asked on every application according to HIPAA regulations.

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  • 31. 

    Opening ScriptOn which applications must the MIR be read?(Hint: This refers to the MIR in the Opening Script, not the MIR that is read before quoting plans)Select all that apply.

    • A.

      Medigap-GI

    • B.

      Vision Plan

    • C.

      Cost Plan

    • D.

      Medigap-Underwritten

    • E.

      Medicare Advantage Plan

    • F.

      Dental Plan

    • G.

      Prescription Drug Plan

    Correct Answer(s)
    A. Medigap-GI
    C. Cost Plan
    E. Medicare Advantage Plan
    G. Prescription Drug Plan
    Explanation
    The MIR (Marketing Information Request) must be read on the following applications: Medigap-GI, Cost Plan, Medicare Advantage Plan, and Prescription Drug Plan. These applications require the MIR to be read in order to provide the necessary information to the applicant. The MIR is not required for Vision Plan, Medigap-Underwritten, Dental Plan, as stated in the options.

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  • 32. 

    Opening ScriptThe BA/ADP asks for permission to record the conversation on a joint application- Mr. Wayne says "Yes you do.", however Mrs. Wayne says nothing. How should this be graded?

    • A.

      Yes

    • B.

      Major- The BA/ADP skipped this line completely.

    • C.

      Minor- The ADP/BA did not obtain consent to record the call.

    Correct Answer
    C. Minor- The ADP/BA did not obtain consent to record the call.
    Explanation
    The correct answer is "Minor- The ADP/BA did not obtain consent to record the call." This is because Mrs. Wayne did not provide explicit consent to record the conversation, which is a requirement. Even though Mr. Wayne said "Yes you do," it does not cover both parties and therefore the ADP/BA did not obtain proper consent.

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  • 33. 

    Opening ScriptDr. Cooper has Power of Attorney for her husband, however he will be completing his own enrollment with assistance from his wife. The BA/ADP must ask the POA question (number 9), read the POA statement to Dr. Cooper and obtain verbal confirmation that she holds Power of Attorney. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The BA/ADP does not need to ask the POA question and obtain verbal confirmation from Dr. Cooper because it is stated that she already has Power of Attorney for her husband. Therefore, the correct answer is False.

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  • 34. 

    Opening ScriptIf the POA started the application (The customer was not on the line during the Opening Script) and the customer completes it by giving their voice signature after the disclaimer, what line items on the QM form should be marked down? 

    • A.

      3-10 only

    • B.

      6-10 only

    • C.

      9 only

    • D.

      53 only

    • E.

      We would only coach this

    Correct Answer
    A. 3-10 only
    Explanation
    If the POA started the application and the customer completes it by giving their voice signature after the disclaimer, only line items 3-10 on the QM form should be marked down. This means that the customer provided their voice signature and completed the necessary steps from line 3 to line 10. The other options, 6-10 only, 9 only, and 53 only, do not accurately reflect the scenario described. The final option, "We would only coach this," suggests that coaching would be provided in this situation, but it does not specify which line items should be marked down on the QM form.

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  • 35. 

    Sales callsWhat questions should you ask yourself when searching for a Sales Call? Check all that apply.

    • A.

      Did the BA verify the customer's profile?

    • B.

      Did the BA present plans?

    • C.

      Did the BA ask the customer Situation Analysis questions?

    • D.

      Did the BA go through the quoting screens?

    • E.

      Did the BA offer dental/vision plans?

    • F.

      Did the BA add a plan to the cart?

    • G.

      Did the BA do a Needs Analysis?

    Correct Answer(s)
    B. Did the BA present plans?
    D. Did the BA go through the quoting screens?
    F. Did the BA add a plan to the cart?
    G. Did the BA do a Needs Analysis?
    Explanation
    The correct answer is to ask yourself whether the BA presented plans, went through the quoting screens, added a plan to the cart, and did a Needs Analysis. These questions are important to ensure that the sales call was conducted effectively and all necessary steps were taken to understand the customer's needs and offer appropriate solutions. Verifying the customer's profile, asking Situation Analysis questions, and offering dental/vision plans are not mentioned as necessary steps in this context.

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  • 36. 

    Sales callsThe customer called and discussed plan options with the BA on Monday. The customer needed more time to decide on a selection and called back on Friday and spoke with the same BA. Would the BA need to read the MIR prior to quoting even if it was read on the initial call?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    The BA would need to read the MIR prior to quoting even if it was read on the initial call because the customer called back on a different day. It is important for the BA to refresh their memory and ensure they have the most up-to-date information before providing a quote to the customer.

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  • 37. 

    Sales callsAdjusting the words in the MIR is acceptable as long as it does not change the meaning. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Adjusting the words in the MIR (Message Impact Ratio) is acceptable as long as it does not change the meaning. This means that salespeople can modify their sales calls to better suit their audience or to emphasize certain points, as long as the overall message remains the same. This allows for flexibility in communication and tailoring the sales pitch to individual customers without compromising the core message.

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  • 38. 

    Sales CallsThe BA read the Medical Information Release after giving two Medigap premiums but did not discuss any plan benefits. Would this be Non-Compliant?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    The BA's failure to discuss any plan benefits during the sales calls after providing two Medigap premiums indicates non-compliance. It is essential for the BA to inform and discuss the plan benefits with the customers to ensure transparency and compliance with regulations. By not doing so, the BA is not fulfilling their responsibilities and may be violating compliance standards.

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  • 39. 

    Sales CallsWhich version of the MIR would not cause the call to be Non-Compliant?The correct statement reads:'As we proceed, you are not required to answer any health or prescription related questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?'

    • A.

      Coming up, you are not required to answer health or prescription questions. If you do answer those questions, your answers won't affect your eligibility to enroll in a plan.

    • B.

      I might ask some questions regarding health or prescriptions. You do not have to answer them but I recommend you do.

    • C.

      Some of the plans will want to know what prescriptions you take and may want to know about your current health. You don't have to answer any questions though because you are guaranteed issue.

    • D.

      As we move forward, you do not have to answer any prescription or health questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?

    • E.

      As we proceed, you are required to answer any health or prescription related questions. Your answers will affect your eligibility to enroll in a Medicare plan.

    Correct Answer
    D. As we move forward, you do not have to answer any prescription or health questions. If you do, your answers will not affect your eligibility to enroll in a Medicare plan. Okay?
    Explanation
    The correct answer is the one that clearly states that the individual is not required to answer any health or prescription related questions, and that their answers will not affect their eligibility to enroll in a Medicare plan. This statement ensures that the call is compliant because it does not put any pressure on the individual to answer the questions and does not imply that their eligibility will be affected by their answers.

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  • 40. 

    Sales CallsIf an LBS is brought on the line by an ADP and the LBS puts a new plan in the cart, does the LBS have to read the intent to enroll scripting before dropping off the call?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    The LBS is required to read the intent to enroll scripting before dropping off the call when a new plan is added to the cart. This ensures that the customer is fully informed about the plan and its details before making a decision.

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  • 41. 

    Sales CallsThe customer told the BA they were very helpful and answered all of their questions. Would the BA still need to ask if the customer had additional questions prior to transferring to an ADP?

    • A.

      Yes

    • B.

      No

    Correct Answer
    B. No
    Explanation
    The customer already mentioned that they had all their questions answered and found the BA to be helpful. Therefore, it can be inferred that the customer does not have any additional questions. Hence, the BA does not need to ask if the customer has additional questions before transferring to an ADP.

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  • 42. 

    BA Prohibited PracticesWhen the customer called, he already knew what plan he wanted. The BA added the plan to the cart and transferred the call to the enrollment team without going over the premium or plan benefits.Would QM score this as a Prohibited Practice because the BA did not go over the benefits or premium?

    • A.

      Yes

    • B.

      No

    Correct Answer
    B. No
    Explanation
    The question asks whether the Quality Management (QM) would score this situation as a Prohibited Practice because the BA did not go over the benefits or premium. The answer is "No" because the customer already knew what plan he wanted, so there was no need for the BA to go over the benefits or premium. The QM would not consider this as a Prohibited Practice as long as the customer's needs and preferences were already known and met.

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  • 43. 

    BA Prohibited PracticesIf the BA states that the customer's HICN is the same as their social security number with a letter, would this be marked as a Prohibited Practice?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    If the BA states that the customer's HICN (Health Insurance Claim Number) is the same as their social security number with a letter, it would be marked as a Prohibited Practice. This is because disclosing or using a social security number in conjunction with other identifiers is considered a prohibited practice under HIPAA regulations.

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  • 44. 

    BA Prohibited PracticesThe BA and the customer do not have a good phone connection so the customer asks the BA to email some information on the plan they are discussing. The BA copies the plan information from the Summary of Benefits and sends it to the customer. Is this a Prohibited Practice?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    Yes, this is a prohibited practice. The BA is copying and sending plan information from the Summary of Benefits to the customer via email. This violates the rules and regulations set by the organization, as it is not allowed to transmit sensitive information through insecure channels like email. The BA should have found an alternative method to communicate the plan information securely, such as using a secure messaging platform or arranging a face-to-face meeting.

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  • 45. 

    BA Prohibited PracticesWhich of the following phrases would be marked down for the BA using an absolute superlative?Check all that apply. 

    • A.

      This plan is the most comprehensive.

    • B.

      Plan F is the Cadillac of Medigap plans.

    • C.

      You will have the lowest copay if you fill your drugs at the preferred pharmacy which, for this plan, is Walmart.

    • D.

      This plan is projected to be the most cost effective for you.

    • E.

      This Medigap plan is the top of the line.

    • F.

      It's projected that this plan will be very cost effective for you

    • G.

      This plan will save you more money throughout the year.

    Correct Answer(s)
    A. This plan is the most comprehensive.
    D. This plan is projected to be the most cost effective for you.
    E. This Medigap plan is the top of the line.
    Explanation
    The BA would mark down phrases that use absolute superlatives, which are words or phrases that indicate the highest or lowest degree of something without any room for comparison. In this case, the phrases "This plan is the most comprehensive," "This plan is projected to be the most cost effective for you," and "This Medigap plan is the top of the line" all use absolute superlatives, indicating that they are the highest or best in their respective categories.

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  • 46. 

    BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use: The Medicare Annual Enrollment Period is from October 7th to December 15th every year.

    • A.

      This statement would not be considered a Prohibited Practice

    • B.

      Mislead, confuse, or misrepresent to potential members about Medicare or competitive plans

    • C.

      Using high pressure sales tactics

    • D.

      Market or sell plans that a Benefit Advisor is not licensed or appointed for

    Correct Answer
    B. Mislead, confuse, or misrepresent to potential members about Medicare or competitive plans
    Explanation
    The statement provided does not mislead, confuse, or misrepresent to potential members about Medicare or competitive plans. It simply states the correct information about the Medicare Annual Enrollment Period. Therefore, it would not be considered a Prohibited Practice.

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  • 47. 

    BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use: The Plan F is the cream of the crop. 

    • A.

      This statement would not be considered a Prohibited Practice

    • B.

      Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.

    • C.

      Make any statement, claim, or promise that conflicts with, alters, or erroneously expands upon the information contained within CMS-approved materials, this includes misquoting plan benefits.

    Correct Answer
    B. Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.
    Explanation
    The given statement, "The Plan F is the cream of the crop," would be considered a Prohibited Practice. This is because it uses an absolute superlative, asserting that Plan F is the best plan. Prohibited Practices include making statements that claim a certain plan is the best or lowest cost, which this statement does.

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  • 48. 

    BA Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use:"The Plan N has no deductibles"

    • A.

      Make any statement, claim, or promise that conflicts with, alters, or erroneously expands upon the information contained within CMS-approved materials, this includes misquoting plan benefits.

    • B.

      This statement would not be considered a Prohibited Practice

    • C.

      Using high pressure sales tactics.

    • D.

      Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.

    Correct Answer
    A. Make any statement, claim, or promise that conflicts with, alters, or erroneously expands upon the information contained within CMS-approved materials, this includes misquoting plan benefits.
    Explanation
    The statement "The Plan N has no deductibles" would be considered a Prohibited Practice because it conflicts with the information contained within CMS-approved materials. It is misquoting the plan benefits by stating that there are no deductibles when there actually might be.

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  • 49. 

    ADP Prohibited PracticesIs the following statement a Prohibited Practice and if so, which Prohibited Practice would you use:"This is a great plan and I think it will work well for you!"

    • A.

      Use absolute superlatives such as asserting that a certain plan is “the best” plan or “the lowest cost”.

    • B.

      Explain, interpret or offer opinions, advice or recommendations on, insurance coverage’s, exposures, limits, premiums, rates, deductibles, payment plans, or any other insurance contract, or potential insurance contract, terms to any potential insurance customer.

    • C.

      This statement would not be considered a Prohibited Practice

    • D.

      Misrepresent themselves as an agent of Medicare, Social Security or any agency of the federal government.

    • E.

      Attempt to solicit (urge or persuade a customer to buy insurance) or negotiate (provide opinions, advice or recommendations on insurance coverage’s or the substantive benefits, terms or conditions of) a contract of insurance.

    Correct Answer
    B. Explain, interpret or offer opinions, advice or recommendations on, insurance coverage’s, exposures, limits, premiums, rates, deductibles, payment plans, or any other insurance contract, or potential insurance contract, terms to any potential insurance customer.
    Explanation
    The given statement does not fall under the category of a Prohibited Practice. It does not involve explaining, interpreting, or offering opinions, advice, or recommendations on insurance coverage, terms, or any other insurance contract to a potential insurance customer. Instead, it simply expresses a positive opinion about a plan without providing any specific details or advice related to insurance.

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  • 50. 

    ADP Prohibited PracticesIs the following scenario a Prohibited Practice and if so, which Prohibited Practice would you use:The ADP told the customer that he works for the Centers of Medicare and Medicaid Services.

    • A.

      Effectuate, or represent that you have the authority to effectuate or bind, coverage under an insurance policy.

    • B.

      Misrepresent themselves as an agent of Medicare, Social Security or any agency of the federal government.

    • C.

      Attempt to solicit (urge or persuade a customer to buy insurance) or negotiate (provide opinions, advice or recommendations on insurance coverage’s or the substantive benefits, terms or conditions of) a contract of insurance.

    • D.

      Mislead, confuse or misrepresent to potential members about Medicare or competitive plans.

    • E.

      This statement would not be considered a Prohibited Practice

    Correct Answer
    B. Misrepresent themselves as an agent of Medicare, Social Security or any agency of the federal government.
    Explanation
    The statement in the scenario where the ADP tells the customer that he works for the Centers of Medicare and Medicaid Services would be considered a Prohibited Practice. This is because the ADP is misrepresenting themselves as an agent of Medicare, Social Security, or any agency of the federal government.

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Quiz Review Timeline +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 17, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Aug 21, 2014
    Quiz Created by
    Bthorup
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