2014 - Qm - Red Flag

8 Questions | Total Attempts: 97

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2014 - Qm - Red Flag

Questions and Answers
  • 1. 
    A customer calls to activate his funding; to qualify for the HRA the customer must be enrolled in a Medical plan through One Exchange. The customer tells the BA that he wants the same Medicare Advantage plan he currently has with his employer, so the BA enrolled him in the exact same plan. Which Red Flag would you use?
    • A. 

      Gave incorrect funding amount or qualification information.

    • B. 

      Enrolled customer into same carrier or plan as individual CMS plan the customer already has.

    • C. 

      Other.

    • D. 

      Gave incorrect information on AR or AR time frames.

  • 2. 
    The customer called on December 8th to make a change to his drug plan. The BA submitted an application for the customer thinking that the carrier would accept it being only 1 day after the annual enrollment period. Which Red Flag would you use?
    • A. 

      Other.

    • B. 

      BA did not transfer to SST when prompted to do so.

    • C. 

      Doing an enrollment when there is not an applicable enrollment period.

  • 3. 
    The BA did not look up the customer's PCP number for the HMO plan they were enrolling in. Rather than getting an LBS on the line, the ADP placed the customer on hold and looked up the number online. What is the appropriate action to take?
    • A. 

      Coach the ADP to get an LBS on the line to look up PCP numbers.

    • B. 

      Red Flag the ADP for using a third party website.

    • C. 

      Give that ADP extra credit! They went above and beyond to get the information for the application.

    • D. 

      Red Flag the ADP for looking up the PCP number.

  • 4. 
    BAs may use medicare.gov to verify a prescription if it doesn't show up in the SSC drug profiler; however, they may not advise the customer they are using a third-party website.
    • A. 

      True

    • B. 

      False

  • 5. 
    Per the client, the customer can only use their HRA funding for reimbursement of premiums; the BA enrolled the customer into a $0 premium MAPD plan and did not advise them of the HRA restriction. Would this be coached or red flagged?
    • A. 

      Red Flag- Gave incorrect information on AR or AR time frames.

    • B. 

      Red Flag- Gave incorrect funding amount or qualification information.

    • C. 

      Red Flag- Other.

    • D. 

      Coach

  • 6. 
    The customer is losing group coverage on 9/30/2014 and the new plan will start 10/1/2014. The SSC funding tab shows that the customer's funding amount is $1200 annually, but the BA advised the customer that they will receive the full allocation of $1200 on October 1st 2014 and again on January 1st 2015. Select the correct Red Flag to be used on the form.  
    • A. 

      Gave incorrect information on AR or AR time frames.

    • B. 

      Other.

    • C. 

      Gave incorrect funding amount or qualification information.

  • 7. 
    The BA advised the customer to call back after the enrollment if they have questions as the ADP would not be able to answer anything regarding plan benefits. Which Red Flag would you use?
    • A. 

      Spoke critically about a client, carrier or One Exchange.

    • B. 

      Encouraged customer to call back after enrollment with questions.

    • C. 

      Other.

    • D. 

      Didn't show professionalism such as rudeness or offensive language.

  • 8. 
    During the call, the customer and the BA established a really good rapport. Before ending the call, the BA said jokingly "You will receive a survey to fill out about your experience today. You better give me a good score!". The customer laughed and said they would give the BA a good review. Would we Red Flag this? 
    • A. 

      Yes

    • B. 

      No

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