2015 - Adp - Knowledge Assessment - Sojo #2 - 08/21/2014

The correct answer is 3 months before, the month of, and 3 months after 65th birthday. This is because the ICEP (Initial Enrollment Period) for Medicare Part B lasts for a total of 7 months. It begins 3 months before the individual turns 65, includes the month of their 65th birthday, and ends 3 months after their 65th birthday. During this period, individuals can enroll in Medicare Part B without facing any penalties or delays in coverage.

If you are aging-in, which means you are reaching the age where you become eligible for certain benefits or insurance plans, you are guaranteed issue. This means that you will be accepted for coverage regardless of any pre-existing conditions or health issues you may have. Therefore, the correct answer is "Yes."

The correct answer is Initial Coverage Election Period. The Initial Coverage Election Period refers to the time when individuals who are eligible for Medicare can enroll in a Medicare Prescription Drug Plan or a Medicare Advantage Plan with prescription drug coverage. During this period, individuals can choose to enroll in a plan that best suits their needs and preferences.

If a customer has ICEP (Initial Enrollment Period) and SEP-LEC (Special Enrollment Period for Low-Income Individuals), the enrollment period used for a Legacy customer would be "I am new to Medicare." This is because the ICEP is the initial period when someone is eligible to enroll in Medicare, and the SEP-LEC is a special enrollment period for low-income individuals who qualify for extra help. Therefore, if the customer is new to Medicare, they would be eligible to enroll during their ICEP.

The Medicare Part A effective date should be 11/01/2014 because Medicare coverage typically begins on the first day of the month in which the individual turns 65. Therefore, since the customer is turning 65 on December 1st, their Medicare Part A coverage would start on November 1st.

If a customer has ICEP (Initial Coverage Election Period) and SEP-LEC (Special Enrollment Period for Loss of Employer Coverage), the enrollment period that is used for a new client is "I am losing group coverage." This means that if the customer is losing their group coverage, they are eligible for a special enrollment period to enroll in a new Medicare plan. The ICEP and SEP-LEC are specific enrollment periods for certain circumstances, and in this case, losing group coverage triggers the SEP-LEC.

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 due to various reasons such as job loss, change in employment status, or reaching the end of the coverage period. Losing employer coverage can have significant implications for individuals, as they may need to find alternative insurance options to ensure they have continued access to healthcare services.

LEC stands for "Loss of Employer Coverage." It 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 the employer discontinuing the coverage. In some cases, an individual may choose to voluntarily terminate their employer coverage for reasons such as switching to a different insurance plan or becoming eligible for a government-sponsored healthcare program. Therefore, it is true that LEC can be a voluntary loss of employer coverage.

During the 3 months before and 63 months following the loss of employer coverage, individuals are guaranteed issue, meaning they cannot be denied health insurance coverage or charged higher premiums due to pre-existing conditions. This provision ensures that individuals have access to health insurance even if they are losing their employer coverage.

A customer can be enrolled into a plan under the SEP-LEC 3 months before the loss of coverage. This allows the customer ample time to secure new coverage before their current coverage expires.

During the SEP-LEC (Special Enrollment Period - Limited Enrollment Period), all plan types are available. This includes Medicare Advantage with prescription drug coverage (MAPD), Medicare Advantage (MA), and Medicare Part D (PDP).

The correct answer is A & B. A customer can enroll into Medicare prior to age 65 if they have End Stage Renal Disease or if they have a disability. These are specific situations that qualify individuals for early enrollment in Medicare. Asking Medicare nicely is not a valid reason for enrolling early.

The correct answer is to use the address Medicare/IRS has as their permanent address. This is because the permanent address is the most accurate and up-to-date information for the customer. Using the permanent address ensures that any important documents or correspondence related to the application will be sent to the correct location.

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 having a POA does not necessarily mean that the customer is unable to act for themselves. By treating the POA as a HIPAA Representative, the customer's privacy rights are protected, and the application can proceed with the customer's consent.

If you have answered every question "NO" on the application, it means that the application guide was not followed. As a result, the application will need to be corrected before you submit it.

The correct answer is October 15 - December 7. This is the annual enrollment period for individuals to make changes to their Medicare coverage. 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. It is important for individuals to make any desired changes during this period as it is the only time of the year when they can do so, unless they qualify for a special enrollment period.

HMO stands for Health Maintenance Organization. This type of healthcare plan provides comprehensive medical services to its members for a fixed fee. It focuses on preventive care and encourages patients to use a network of doctors and hospitals. HMOs often require members to select a primary care physician who coordinates their healthcare and refers them to specialists when needed. This model aims to keep costs down and promote overall health and wellness through regular check-ups and preventive measures.

A Health Reimbursement Arrangement (HRA) or Funding is the best description of an arrangement by employers to set aside pre-tax money for medical expenses for their employees. This allows employees to be reimbursed for qualified medical expenses, such as doctor visits, prescriptions, and medical supplies, using funds provided by their employer. The money contributed to an HRA is tax-free for both the employer and the employee, making it a cost-effective way to provide healthcare benefits.

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

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 provide routine check-ups, preventive care, and treatment for common illnesses and injuries. They also coordinate and manage the overall healthcare of their patients, referring them to specialists when necessary.

Medicare Part A is known as Hospital because it primarily covers inpatient hospital care. This includes services such as hospital stays, skilled nursing facility care, hospice care, and limited home health services. Medicare Part A is one of the four parts of the Medicare program, which provides health insurance for individuals who are 65 or older, certain younger individuals with disabilities, and individuals with end-stage renal disease.

HIPAA stands for Health Insurance Portability and Accountability Act. This act was enacted in 1996 and it aims to protect the privacy and security of patients' health information. It sets standards for the electronic exchange, privacy, and security of health information. The act also provides individuals with certain rights regarding their health information, such as the right to access and amend their records. HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates who handle health information. It helps ensure the confidentiality and integrity of patients' sensitive health data.

To be compliant when securing a call with a customer, the pieces of information that must be obtained are the customer's full name, last 4 digits of their social security number, date of birth, and phone number. This information helps to verify the identity of the customer and ensure that the call is being conducted securely and in accordance with regulations.

The correct answer is "All of the above apply". This means that applications can be done in any of the mentioned orders: Vision, Dental, MAPD; Dental, Medigap, PDP; or Vision, Dental, Medigap, PDP. There is no specific order that needs to be followed, as all of these options are valid for application.

Automatic reimbursement works by following a specific process. The customer pays the plan premium to the insurance company. The insurance company then forwards the receipt of the payment to OneExchange. OneExchange further forwards the receipt of payment to the Funding Department. Finally, the Funding Department reimburses the customer. This process ensures that the customer receives their reimbursement for the plan premium they paid.

HMOs (Health Maintenance Organizations) do require a Primary Care Physician (PCP) number. In an HMO, individuals are required to choose a primary care physician who acts as their main healthcare provider and coordinates all their medical care. The PCP number is necessary for the HMO to establish a formal relationship between the individual and their chosen primary care physician. This helps in managing and directing the individual's healthcare needs, ensuring appropriate referrals to specialists, and maintaining continuity of care within the HMO network.

The statement is true because a Power of Attorney (POA) has the legal authority to act on behalf of the customer. This means that they can complete the enrollment process even if the customer is not physically present. The POA is granted the power to make decisions and sign documents on behalf of the customer, allowing them to carry out tasks such as enrollment without the customer's presence.

The correct answer is A & C. This means that you should verify both Mr. Smith's and Mrs. Smith's membership numbers. The BA put the AARP membership number in the notes for their Medigap applications, but it is important to double-check and confirm the accuracy of both numbers to ensure that there are no mistakes or discrepancies.

The Application Guide should always be used because it provides valuable information and guidance for completing the application. It helps ensure that all necessary information is included and that the application is filled out correctly. By using the Application Guide, applicants can increase their chances of submitting a successful application.

An Approved Representative (HIPAA Rep) cannot authorize another Approved Representative (HIPAA Rep) because the authority to authorize other representatives lies with the covered entity or the business associate. HIPAA Reps are individuals designated by covered entities or business associates to act on their behalf in matters related to the Health Insurance Portability and Accountability Act (HIPAA).

A POA, or Power of Attorney, is a legal document that grants an individual, known as the agent or attorney-in-fact, the authority to act on behalf of another person, known as the principal. This authority can include making healthcare decisions and accessing medical records. Therefore, it is possible for a POA to authorize an Approved Representative, also known as a HIPAA Rep, who can act on behalf of the principal in matters related to the Health Insurance Portability and Accountability Act (HIPAA).

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The POA cannot give the voice signature because the customer started the application and is required to provide their own signature. The POA does not have the authority to provide the customer's signature on their behalf.

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 are not within the control of the customer or the organization providing the coverage. The customer will be notified of their effective dates by the government once they have enrolled in Medicare.

The given answer "True" suggests that even though Mr. Jones is on the phone with Mrs. Jones and not completing his applications today, it is still necessary to secure the call for him. This implies that the call might be important or sensitive, and it is essential to ensure its privacy or confidentiality.

The correct location of the checking account number and routing number on the customer's check is that the routing numbers are on the bottom left and the checking account numbers are to the right.

The explanation for the given correct answer is that AARP only accepts debit/credit cards as the payment method for membership completed online. This means that if someone wants to become a member of AARP through their website or online platform, they can only use a debit or credit card to make the payment. Other payment methods like cash, checks, or other forms of electronic payment are not accepted for online membership completion.

If a call is disconnected, the appropriate disposition option 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. It allows the agent to keep track of the call status and be prepared for a potential return call from the customer.

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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, it is necessary to look it up. Looking up the membership number ensures that the customer's information is accurately recorded and any benefits or discounts associated with their membership can be applied.

Customers wishing to enroll into a UHC/AARP plan must have an AARP membership for Medigap plans. Medigap plans are supplemental health insurance plans that help cover the gaps in Original Medicare coverage. UHC/AARP offers Medigap plans specifically for AARP members, so in order to enroll in these plans, customers must have an AARP membership. This requirement does not apply to PDP (Prescription Drug Plans) or MAPD (Medicare Advantage Prescription Drug) plans. Therefore, the correct answer is Medigap plans.

If the primary spouse on the AARP membership is deceased, the appropriate action would be to call AARP with the customer on the line and have the spouse purchase a membership or have them remove the deceased spouse as primary from the membership. This ensures that the membership is updated and reflects the correct information regarding the deceased spouse. Apologizing for their loss is a considerate gesture, but it does not address the issue at hand. Telling them to call AARP and get it straightened out then call back may cause unnecessary confusion or inconvenience for the customer. Therefore, the best course of action is to contact AARP and resolve the membership status with the customer present.

The question asks if the new Medigap plan will replace a Medicare Supplement or a Medicare Advantage plan, and the correct answer is NY. This means that in all states except for NY, the new Medigap plan will not replace either of these plans.

The given question states that for the State of NY, the answer to the question "Will this new Medigap plan be replacing a Medicare Supplement or a Medicare Advantage plan (individual plan, not group plan)" is always "Yes". The reason for this selection could be that the State of NY has specific regulations or requirements that make it mandatory for individuals to replace their existing Medicare Supplement or Medicare Advantage plans with a new Medigap plan. However, without further information, it is not possible to determine the exact reason for this requirement.

The purpose of the Annual Enrollment Period is to provide beneficiaries with the chance to make changes to their MA, MADP, or PDP plan. This includes the option to add, drop, or switch plans based on their needs and preferences. It allows beneficiaries to review their current coverage and make any necessary adjustments for the upcoming year. The Annual Enrollment Period ensures that beneficiaries have the opportunity to find the most suitable plan for their healthcare needs.

A beneficiary who did not enroll in a Medicare Advantage or Prescription Drug Plan when they were first eligible for Medicare can still enroll during the Annual Enrollment Period. The Annual Enrollment Period is a specific time frame when individuals can make changes to their Medicare coverage, including enrolling in a Medicare Advantage or Prescription Drug Plan. Therefore, it is true that beneficiaries can enroll during this period if they missed their initial enrollment opportunity.

The correct answer is "No, the last plan sticks." This means that there is no limit to the number of elections during AEP (Annual Enrollment Period). Once an individual selects a plan during AEP, that plan will remain in effect until the next AEP, regardless of any subsequent elections made by the individual.

During the Annual Enrollment Period (AEP), individuals have the option to make changes to their Medicare coverage. This includes dropping or changing their prescription coverage. Therefore, it is true that during the AEP, one can drop their prescription coverage completely if they choose to do so.

The correct answer is Health Insurance Claim Number (HICN). This is another name for Medicare Claim Number. It is not the same as a Social Security Number or a Driver's License Number. The HICN is a unique identifier used by Medicare to track and process claims for healthcare services.

SEP-LEC is the most common SEP used at OneExchange. This is because it is specifically designed for individuals who have lost their employer-sponsored coverage and need to enroll in a new plan. SEP-LEC stands for Special Enrollment Period for Loss of Employer Coverage, and it allows individuals to enroll in a new plan outside of the regular enrollment period. This is the most common SEP used because many people experience a loss of employer coverage at some point and need to find new insurance options.