2015 - Adp - Knowledge Assessment - Sojo - St. George #1 - 08/20/2014

The correct answer is 3 months before, the month of, and 3 months after 65th birthday. This is because the Initial Enrollment Period (IEP) for Medicare lasts for a total of 7 months. It begins 3 months before the month of an individual's 65th birthday, includes the month of their birthday, and extends for an additional 3 months after their birthday. This is the period during which individuals can enroll in Medicare Part A and/or Part B without paying any late enrollment penalties.

If you are aging-in, which means you are reaching a certain age (usually 65) and becoming eligible for Medicare, you are guaranteed issue. This means that insurance companies cannot deny you coverage or charge you higher premiums based on your age or pre-existing conditions. This guarantee ensures that individuals who are aging-in have access to health insurance coverage without any discrimination.

During the Initial Coverage Election Period (ICEP), all three plan types are available. Medicare beneficiaries have the option to choose from Medicare Advantage with Prescription Drug Plan, Medicare Advantage Plan, and Prescription Drug Plan. This means that individuals can select the plan that best suits their healthcare needs and preferences during this enrollment period.

ICEP stands for Initial Coverage Election Period. This is the period when individuals who are eligible for Medicare can enroll in a Medicare Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage for the first time. During this period, individuals have the opportunity to choose a plan that best meets their needs and provides coverage for their prescription medications.

Customers using ICEP can enroll at any time, not just during Annual Enrollment. ICEP stands for Initial Coverage Election Period, which is a specific enrollment period for individuals who are newly eligible for Medicare. During this period, customers can enroll in a Medicare Advantage or Prescription Drug Plan. After the ICEP, customers may have other opportunities to enroll or make changes to their plan, such as during the Annual Enrollment Period or Special Enrollment Periods. Therefore, the statement "Customers using ICEP can only enroll during Annual Enrollment" is false.

If a customer has ICEP (Initial Coverage Election Period) and SEP-LEC (Special Enrollment Period for Low-Income Individuals who are Eligible for Both Medicare and Medicaid), the enrollment period used for a Legacy customer would be "I am new to Medicare." This is because the ICEP is the enrollment period for individuals who are newly eligible for Medicare, and it allows them to enroll in a Medicare plan. The SEP-LEC is a special enrollment period for individuals who are eligible for both Medicare and Medicaid, but it does not specify whether the individual is new to Medicare or not. Therefore, the ICEP enrollment period would take precedence in this scenario.

The Medicare Part A effective date should be 11/01/2014 because it is common for Medicare Part A coverage to start on the first day of the month in which the individual turns 65. Since the customer is turning 65 on December 1st, their coverage should begin on November 1st.

Mr. Blakely should have his Medicare Part A effective date on 12/01/2014. This is because when someone is aging-in, their Medicare Part A coverage starts on the first day of the month they turn 65. Since Mr. Blakely will turn 65 on 12/16/2014, his Medicare Part A coverage should start on 12/01/2014.

Being new to Medicare Part B would make a customer eligible for a Medigap plan. Medigap plans are supplemental insurance policies that help cover the costs that Original Medicare (Part A and Part B) doesn't pay for, such as deductibles, copayments, and coinsurance. So, if a customer is new to Medicare Part B, they would be eligible to enroll in a Medigap plan to help fill in the gaps in their Medicare coverage.

The correct answer is "I am losing group coverage." This is because if a customer has ICEP (Initial Coverage Election Period) and SEP-LEC (Special Enrollment Period for Loss of Employer Coverage), it means that they are losing their group coverage. The ICEP is for individuals who are new to Medicare, but since the customer also has SEP-LEC, it indicates that they are losing their employer coverage, making them eligible for a special enrollment period. Therefore, the enrollment period used for a new client in this scenario would be when they are losing group coverage.

SEP stands for Special Enrollment Period and Special Election Period. Both B and C are correct because they refer to different contexts in which the term SEP is used. Special Enrollment Period is a period of time during which individuals can enroll in or change their health insurance plan outside of the regular open enrollment period. Special Election Period, on the other hand, is a period during which individuals can make changes to their Medicare Advantage or Medicare prescription drug coverage outside of the regular enrollment periods.

LEC stands for Losing Employer Coverage. This refers to the situation where an individual loses their health insurance coverage provided by their employer. This can occur when someone leaves their job, gets laid off, or experiences a change in employment status. Losing employer coverage often requires individuals to seek alternative health insurance options, such as purchasing their own insurance or enrolling in a government program like Medicaid or COBRA.

LEC stands for "Loss of Employer Coverage," which refers to the situation where an individual loses their health insurance coverage provided by their employer. This loss can occur due to various reasons, such as termination of employment, reduction in work hours, or eligibility changes. In some cases, an individual may choose to voluntarily terminate their employer coverage for personal reasons, such as switching to a different insurance plan. Therefore, it is possible for LEC to be a voluntary loss of employer coverage, making the statement "True."

If you are losing employer coverage, you are guaranteed issue during the 3 months before and 63 months following your loss of coverage date. This means that during this time period, you have the right to purchase health insurance without being denied or charged more due to pre-existing conditions. This protection ensures that individuals have access to health insurance even if they have recently lost their employer coverage. Therefore, the statement is true.

Customers are able to enroll in a plan under the SEP-LEC three months before the loss of coverage. This allows them ample time to explore their options and make an informed decision about their healthcare coverage. Enrolling early also helps to ensure a smooth transition and continuity of coverage for the customer.

SEP-LEC is the most common SEP used at OneExchange. This can be inferred from the information provided in the question. The other options, ICEP (Age-in), SEP-LTC, and SEP-MOV, are not mentioned as common SEPs used at OneExchange. Therefore, SEP-LEC is the correct answer.

The SEP-LEC (Special Enrollment Period - Loss of Employer Coverage) ends after the plan has gone into effect and also 2 months after the loss of coverage. This means that individuals have a limited time frame to enroll in a new plan after their previous coverage has ended. The combination of both options A and B ensures that individuals have sufficient time to find and enroll in a new plan without a coverage gap.

During the SEP-LEC, all plan types are available. This includes Medicare Advantage with prescription drug coverage (MAPD), Medicare Advantage (MA), and Medicare Part D (PDP). Therefore, the correct answer is "All of the above."

Customers can enroll in Medicare prior to age 65 if they have End Stage Renal Disease (ESRD) or if they have a disability. ESRD refers to the final stage of chronic kidney disease, where the kidneys are no longer able to function properly. Disability refers to a condition that significantly impairs a person's ability to perform daily activities and is expected to last for a long period of time. Therefore, options A and B are both situations that would allow a customer to enroll in Medicare prior to age 65.

The correct answer is to use the address that Medicare/IRS has as their permanent address. This is because the permanent address is the official and legal address of the customer, which is registered with government agencies like Medicare and IRS. Using this address ensures that the customer's information is accurate and consistent across different platforms and organizations.

The correct answer is to treat the POA as a HIPAA Representative, not complete the POA section of the application, and take the voice signature from the customer. This is because if the customer is able to act for himself/herself, the POA is only acting as a representative for HIPAA purposes and does not need to complete the POA section. The customer's voice signature is sufficient in this case.

If the customer has answered every question "NO" on the application, it means that they have not followed the application guide. As a result, the application will need to be corrected before it can be submitted.

The correct answer is October 15 - December 7. This is the time period during which individuals can make changes to their Medicare coverage. It is important to note that this period is specifically for Medicare beneficiaries and is not applicable to other types of insurance. During this time, individuals can switch from Original Medicare to a Medicare Advantage plan, or vice versa. They can also switch between different Medicare Advantage plans or between different prescription drug plans.

HMO stands for Health Maintenance Organization. This is a type of health insurance plan that provides comprehensive medical services for a fixed fee. HMOs typically require members to choose a primary care physician who coordinates their healthcare and refers them to specialists when necessary. The main goal of an HMO is to focus on preventive care and promote overall health maintenance.

An arrangement by employers to set aside pre-tax money for medical expenses for their employees is called a Health Reimbursement Arrangement (HRA) or Funding. This allows employees to be reimbursed for qualified medical expenses, such as deductibles, co-payments, and other out-of-pocket costs. The funds set aside in an HRA are not subject to income tax, providing a tax advantage for both the employer and the employee.

A deductible is the amount of money that an individual must pay out of pocket for their healthcare expenses before their health insurance plan starts covering the costs. It is a fixed annual amount that needs to be paid before the insurance company begins to pay for medical services. This term accurately describes the concept of the initial payment that needs to be made before the health plan kicks in.

PCP stands for Primary Care Physician. A primary care physician is a healthcare professional who serves as the first point of contact for patients seeking medical care. They are responsible for providing preventive care, diagnosing and treating common illnesses, and managing chronic conditions. The role of a primary care physician is crucial in coordinating and managing a patient's overall healthcare needs, including referrals to specialists when necessary.

Medicare Part A is known as Hospital because it specifically covers inpatient hospital care. It includes services such as hospital stays, skilled nursing facility care, hospice care, and some home health care. Medicare Part A is one of the four parts of the government health insurance program for people aged 65 and older, as well as certain younger individuals with disabilities. It is important to distinguish between the different parts of Medicare to understand what services are covered under each.

HIPAA stands for Health Insurance Portability and Accountability Act. This act was passed in 1996 to protect the privacy and security of individuals' health information. It sets standards for the electronic exchange, privacy, and security of health information. The act also provides guidelines for the use and disclosure of protected health information by healthcare providers, health plans, and other covered entities. The main goal of HIPAA is to ensure that individuals' health information is kept confidential and secure while allowing for the efficient flow of information necessary for healthcare operations and treatment.

To be compliant when securing a call with a customer, the pieces of information that must be obtained are the Full Name, Last 4 of Social Security Number, Date of Birth, and Phone Number. This information is crucial for verifying the identity of the customer and ensuring that the call is secure and compliant with regulations. The Full Name and Date of Birth help confirm the customer's identity, while the Last 4 of Social Security Number and Phone Number provide additional layers of verification and authentication.

The correct answer is "All of the above apply". This means that applications can be done in any order, whether it is for Vision, Dental, MAPD, Dental, Medigap, PDP, or any combination of these. There is no specific order that needs to be followed when submitting applications for these different categories.

The correct answer is Health Insurance Claim Number (HICN). This is another name for Medicare Claim Number. It is a unique identification number assigned to individuals who have Medicare health insurance. It is used to process and track Medicare claims and benefits. The other options, Social Security Number and Driver's License Number, are not alternative names for Medicare Claim Number.

Automatic Reimbursement works by the customer paying the plan premium to the insurance company. The insurance company then forwards the receipt of payment to OneExchange. OneExchange further forwards the receipt of payment to the Funding Department. Finally, the Funding Department reimburses the customer. This process eliminates the need for the customer to fill out a claim form or make a call to the Funding Department.

An HMO (Health Maintenance Organization) is a type of health insurance plan that requires members to select a primary care physician (PCP). The PCP acts as a gatekeeper for all medical care and referrals within the HMO network. The PCP number is necessary for identifying and coordinating the member's healthcare services. Therefore, the statement "HMOs require a Primary Care Physician number" is true.

The statement is true. A POA (Power of Attorney) is a legal document that grants a person the authority to act on behalf of another person. In the context of the enrollment process, if a customer has given their POA the authority to complete the process on their behalf, the POA can proceed without the customer being physically present. This allows for flexibility and convenience, especially in situations where the customer may not be available or capable of participating in the enrollment process themselves.

Mrs. Smith has to authorize the son, daughter-in-law, and Mr. Smith as HIPAA Approved Representatives because they are completing both applications jointly and have their son and daughter-in-law assisting them on the phone. This means that all three individuals are involved in the application process and have the authority to act on behalf of Mrs. Smith in matters related to HIPAA.

The correct answer is A & C. The BA put the AARP membership number in the notes for Mr. and Mrs. Smith's Medigap applications. Therefore, it is important to verify both Mr. Smith's number and Mrs. Smith's number to ensure accuracy and avoid any potential mistakes or discrepancies. Trusting that the BA verified the number may not be sufficient as it is always better to double-check and verify the information independently.

The Application Guide should always be used because it provides important information and instructions for completing the application. It serves as a helpful resource when you are unsure about how to answer certain questions or need clarification on specific requirements. By referring to the Application Guide, you can ensure that you are providing accurate and complete information, increasing your chances of a successful application.

An Approved Representative (HIPAA Rep) cannot authorize another Approved Representative (HIPAA Rep). HIPAA (Health Insurance Portability and Accountability Act) allows individuals to designate a representative to act on their behalf in matters related to their protected health information. However, this designation does not grant the representative the authority to further delegate their responsibilities to another representative. Each representative must be authorized directly by the individual they are representing. Therefore, the statement that an Approved Representative (HIPAA Rep) can authorize another Approved Representative (HIPAA Rep) is false.

A POA (Power of Attorney) can indeed authorize an Approved Representative, also known as a HIPAA Rep. A Power of Attorney is a legal document that grants someone the authority to make decisions and take actions on behalf of another person. In the context of healthcare, a Power of Attorney can include the authorization for an Approved Representative to access and disclose the individual's protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). This allows the Approved Representative to assist in managing the individual's healthcare and making informed decisions. Therefore, the statement "A POA can authorize an Approved Representative (HIPAA Rep)" is true.

The correct answer is SEP-LEC (Special Enrollment Period for Loss of Employer Coverage). This enrollment period is used when a person is losing their employer coverage. Since the customer is 58 years old and Medicare-eligible due to disability, they can take advantage of this special enrollment period to enroll in Medicare. The SEP-LEC allows them to enroll in Medicare outside of the usual enrollment periods.

If a customer has elected AR (Automatic Reimbursement), they will receive their first reimbursement within 2-3 months of the effective date of the plan. This means that after the plan becomes effective, it will take 2-3 months for the customer to receive their first reimbursement.

The POA cannot give the voice signature because the customer started the application and is required to complete it themselves.

It is not acceptable to give the customer their Part A and Part B effective dates. The effective dates for Part A and Part B of Medicare are determined by the government and cannot be provided by the customer or any other party. These dates are based on factors such as the customer's age and enrollment period, and are typically communicated by the government through official channels. Therefore, it is incorrect to say that it is acceptable to give the customer their Part A and Part B effective dates.

The given statement states that Mr. Jones is on the phone with Mrs. Jones and he has plans in the cart, but he is not completing his applications today. The statement also mentions that you still have to secure the call for Mr. Jones. Therefore, the correct answer is true, indicating that you need to ensure the call is secure for Mr. Jones despite him not completing his applications that day.

The correct location of the checking account number and routing number on the customer's check is as follows: routing numbers are on the bottom left, while checking account numbers are to the right.

The given statement is true because it states that the only payment method accepted for AARP membership completed online is Debit/Credit Card. This implies that no other payment methods like cash, check, or online wallets are accepted for online membership payments.

If a call is disconnected, the appropriate disposition option to choose would be "Call Interrupted–Wait for Customer Call Back." This option indicates that the call was interrupted or disconnected, and the agent should wait for the customer to call back. This allows the agent to maintain a record of the call and be prepared to assist the customer when they reconnect.

The correct answer is to do a 3-way call with AARP and the customer. This option suggests a proactive approach to assist the customer in finding a solution. By initiating a 3-way call, the customer can directly communicate with AARP to discuss alternative payment methods or resolve any issues related to paying with a check. This approach demonstrates good customer service and problem-solving skills.

The statement "If a customer gives you their AARP membership number, you DO NOT have to look it up" is false. This means that if a customer provides their AARP membership number, you are required to look it up. Looking up the membership number is necessary to verify the customer's eligibility for any associated benefits or discounts.