Qm - Quiz 1 - Quiz, Flashcards & Trivia

1. ADP reads Plan F benefits: Covers 100% of the yearly Part B deductible ($147.00 for 2013). The ADP read: Covers 100% of the yearly Part B deductible ($147.00), but did not say for 2013. This is a 2014 plan. Should this line item be marked down?

Yes

No

No, I would not change the benefits because it covers 100%

Explanation

No, I would not change the benefits because it covers 100%

2. If the BA doesn't review all the information pertaining to the specific drug asked about, this should be scored as a red flag.

True

False

True, this could cause an escalation if the Customer is not aware that there are limitations on their medications.

Explanation

True, this could cause an escalation if the Customer is not aware that there are limitations on their medications.

3. On a joint application, Customers are on the line and also have a HIPAA. The HIPAA scripting must be read to each spouse and then again for the HIPAA?

True

False

Yes, they would have to authorize each spouse as a HIPAA (required for joint) and the again for the HIPAA on the line.

Explanation

Yes, they would have to authorize each spouse as a HIPAA (required for joint) and the again for the HIPAA on the line.

4. CID: 14850751; 14850752 Call ID: 7111108 Time stamp 00:40:03-00:41:39 Listen to the call at the time stamp provided. How would you score this section?

Wouldn't mark down as the information is correct

Coaching since the ADP stated "but they reserve the right"

Prohibited Practice

Minor under line item 12/Potential Medicare Supplement Plan rate increase

Prohibited Practice: 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

At time stamp 00:41:28, stated "It's not very likely that they will up the rates on you though." We score by what was stated last

Explanation

Prohibited Practice: 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

At time stamp 00:41:28, stated "It's not very likely that they will up the rates on you though." We score by what was stated last

5. Mr. and Mrs. call in with an appoved HIPAA on the line. Both of their full names are obtained, but during secure the call, the HIPAA provides Mr.'s DOB and Mrs. DOB. Mrs. then provides her last 4 and Mr. then provides his last 4. Is the account fully secured?

Yes

No

Yes, the if the HIPAA is already approved, then the it is acceptable to obtain information from

Explanation

Yes, the if the HIPAA is already approved, then the it is acceptable to obtain information from

6. When verifing that the Customer has an AARP membership prior to enrolling the Customer into the AARP Plan N, the ADP informs the Customer that he shows that they have a membership, but it has expired. The ADP then informs the Customer that AARP will contact the Customer to get the membership renewed by mail. This is correct, since the Customer previoulsy had an AARP membership and a membership is only required for Plan F.

True

False

If the Customer is enrolling into a AARP Medigap plan, an active AARP membership is required at the time of enrollment. This should be Red Flagged as it could cause the application to be rejected.

Explanation

If the Customer is enrolling into a AARP Medigap plan, an active AARP membership is required at the time of enrollment. This should be Red Flagged as it could cause the application to be rejected.

7. If an BA tells the customer they're eligible for a 5% spouse discount and it's not available in the customers state

Coaching

Red Flag

Prohibited Practice

None of the above since it's not a required benefit

If a BA misquotes benefits then it would be a prohibited practice

Explanation

If a BA misquotes benefits then it would be a prohibited practice

8. CSR takes call from the Customer who is calling in to enroll into a plan. CSR verifies the profile information, asks situation analysis questions and then reads the MIR. After reading the MIR, the CSR transfers to the BA. BA would not need to read the MIR again since the CSR read it prior to transferring the call.

True

False

The MIR must be read by the BA prior to presenting plans or adding them to the cart. CSR's are not required to read the MIR.

Explanation

The MIR must be read by the BA prior to presenting plans or adding them to the cart. CSR's are not required to read the MIR.

9. Mrs. Lois Black is completing her Medigap application with her daughter on the line to assist. The HIPAA scripting was not read during the opening script. When the ADP asks the question "Have you had coverage under any other health insurance within the last 63 days ?", Mrs. Black does not answer, so her daughter says "No". The Customer then says "oh sorry, no" Should this be marked down and if so where?

#40-Minor-Someone other than the Customer provided the answer

#10-Major-Skipped the HIPAA scripting

#47-Minor-Someone other than the Customer provided the answer

None of the above

If the Customer repeats the answer, then this line item should not be marked down

Explanation

If the Customer repeats the answer, then this line item should not be marked down

10. Customer calls in and has already placed a plan in their cart. The attribution shows the BA's name; however, the BA went straight to the application. The MIR does not need to be read, since they did not go over the plan benefits or quote premiums.

True

False

When ever a plan is placed in the cart, the MIR must be read

Explanation

When ever a plan is placed in the cart, the MIR must be read