SMMC Refresher Quiz #11

7 Questions | By AHSFLTrainer | Updated: Mar 20, 2022 | Attempts: 176

Questions

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HealthTrack Member Information

Questions and Answers

1.

This enrollee wants to enroll into a plan. How should you proceed?
- A.
  
  Advise the enrollee they are unable to enroll into a plan and offer to file a complaint.
- B.
  
  Refer the enrollee to DCF/SSA and educate the enrollee on the Reinstatement period, and that if eligibility is regained within 6 months the previous plan will reinstate.
- C.
  
  Tell the enrollee there is nothing you can do and refer them to DCF.
- D.
  
  Inform the enrollee they are no longer eligible for Medicaid and refer to the AHCA Medicaid Helpline to complain.
Correct Answer
B. Refer the enrollee to DCF/SSA and educate the enrollee on the Reinstatement period, and that if eligibility is regained within 6 months the previous plan will reinstate.
2.

Can this enrollee change the plan? Why/Why not?
- A.
  
  No, because the ACWM Code is MA R.
- B.
  
  Yes, because Staywell does not cover as many services as the other plans.
- C.
  
  Yes, because the enrollee is currently in their 120 day change period.
- D.
  
  No, because the enrollee does not have an exemption on file.
Correct Answer
C. Yes, because the enrollee is currently in their 120 day change period.
3.

Can this enrollee change the plan? Why/Why not?
- A.
  
  Yes, because they are Mandatory for MMA, and all Mandatory enrollees can change the plan at any time.
- B.
  
  No, because they are enrolled in a Comprehensive Plan.
- C.
  
  Yes, because the ACWM code is MO Y.
- D.
  
  No, because they are in the Lock-in period and will need a state-approved Good Cause.
Correct Answer
D. No, because they are in the Lock-in period and will need a state-approved Good Cause.
4.

What can you inform the enrollee about their coverage?
- A.
  
  The enrollee is Mandatory for MMA and LTC and is enrolled in a Comprehensive Plan. Sunshine Health will provide both MMA and LTC services. The enrollee is currently in their 120 day change period.
- B.
  
  The enrollee is Mandatory for MMA and LTC, which means they have to be enrolled in a comprehensive plan.
- C.
  
  The enrollee has Sunshine Health for their comprehensive plan, but they should change plans because Sunshine will not cover them as much as other plans will.
- D.
  
  The enrollee is Mandatory for MMA and LTC and is currently Locked in. The enrollee will need a Good Cause reason to be able to change the plan.
Correct Answer
A. The enrollee is Mandatory for MMA and LTC and is enrolled in a Comprehensive Plan. Sunshine Health will provide both MMA and LTC services. The enrollee is currently in their 120 day change period.
5.

This enrollee wants to enroll into a plan. How should you proceed? Choose the answer that most accurately describes the case.
- A.
  
  Inform the enrollee they are no longer eligible and refer to DCF.
- B.
  
  Refer the enrollee to the AHCA Medicaid Helpline to file a complaint since they are listed as deceased.
- C.
  
  Refer to DCF to remove the Demise Date.
- D.
  
  Inform the enrollee they are no longer eligible and refer to DCF to remove the Demise Date and for any eligibility questions.
Correct Answer
D. Inform the enrollee they are no longer eligible and refer to DCF to remove the Demise Date and for any eligibility questions.
6.

Can this enrollee change the plan? Why/Why not?
- A.
  
  Yes, because United Healthcare of Florida does not cover as many services as the other plans.
- B.
  
  Yes, because the enrollee is currently in their Open Enrollment period.
- C.
  
  No, because they do not have an exemption on file.
- D.
  
  No, because the ACWM code is MA R.
Correct Answer
B. Yes, because the enrollee is currently in their Open Enrollment period.
7.

To accurately inform the member about their coverage and options to receive services, what information should you provide?
- A.
  
  The enrollee is Voluntary and can either stay with the plan or disenroll and receive coverage through FFS.
- B.
  
  The enrollee is currently enrolled with United Healthcare of Florida.
- C.
  
  The enrollee has a TPL 14 on file.
- D.
  
  The enrollee is Voluntary with a TPL 14 on file, and can either stay with United Healthcare of Florida or disenroll and receive coverage through FFS and the private insurance.
Correct Answer
D. The enrollee is Voluntary with a TPL 14 on file, and can either stay with United Healthcare of Florida or disenroll and receive coverage through FFS and the private insurance.