2015 - Adp - Knowledge #1 - Sojo - 10/15/2014

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

If you are aging-in, it means that you are reaching the age where you qualify for certain benefits or insurance plans. In this context, being "Guaranteed Issue" means that you are eligible for coverage without being subject to medical underwriting or having to answer health-related questions. Therefore, the correct answer is "Yes," indicating that if you are aging-in, you are guaranteed issue for certain benefits or insurance plans.

During the Initial Coverage Election Period (ICEP), all three plan types are available. The ICEP is the period when individuals can enroll in a Medicare plan for the first time. Medicare Advantage with Prescription Drug Plan, Medicare Advantage Plan, and Prescription Drug Plan are all options that individuals can choose from during this period. Therefore, the correct answer is "All of the above."

The correct answer is Initial Coverage Election Period. This refers to the period when individuals can first enroll in a Medicare prescription drug plan or Medicare Advantage plan with prescription drug coverage. During this period, individuals have the opportunity to choose a plan that best suits their needs and coverage preferences.

Customers using ICEP can enroll at any time, not just during Annual Enrollment. ICEP stands for Initial Coverage Election Period, which is the period when individuals first become eligible for Medicare. During this time, individuals can enroll in a Medicare Advantage plan or a standalone prescription drug plan. Therefore, the statement that 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), the enrollment period used for a Legacy customer would be "I am new to Medicare." This is because the ICEP is the initial enrollment period for individuals who are new to Medicare and are enrolling in a Medicare Advantage or Medicare Prescription Drug Plan for the first time. The SEP-LEC is a special enrollment period for individuals who qualify for extra help with Medicare prescription drug costs based on their income and resources. Therefore, the combination of these two enrollment periods indicates that the customer is new to Medicare.

When a customer ages into Medicare, their Medicare Part A effective date is typically the first day of the month they turn 65. In this case, since the customer will turn 65 on December 1st, 2014, the Medicare Part A effective date should be November 1st, 2014.

Mr. Blakely's Medicare Part A effective date should be 12/01/2014. This is because when someone is aging-in, their Medicare Part A coverage begins on the first day of the month they turn 65. In this case, Mr. Blakely will turn 65 on 12/16/2014, so his Medicare Part A coverage should start on 12/01/2014.

Medicare Part B is the correct answer because being new to Medicare Part B would make a customer eligible to enroll in a Medigap plan. Medigap plans are designed to supplement Medicare coverage, and individuals must have both Medicare Part A and Part B to be eligible for a Medigap plan. Medicare Part B covers medical services such as doctor visits, outpatient care, and preventive services. Therefore, if a customer is new to Medicare Part B, they would be eligible to enroll in a Medigap plan to help cover the costs not covered by Medicare.

If a customer has ICEP (Initial Coverage Election Period) and SEP-LEC (Special Enrollment Period for Loss of Employer Coverage), the enrollment period used for a new client would be "I am losing group coverage." This is because the SEP-LEC allows individuals who are losing their employer-sponsored health insurance coverage to enroll in Medicare outside of the usual enrollment periods. The other options, such as moving from another state or being new to Medicare, do not specifically mention the loss of group coverage, which is the relevant factor in this scenario.

SEP stands for Special Enrollment Period and Special Election Period. Both options B and C are correct because they represent different contexts in which the term SEP is used. A Special Enrollment Period refers to a specific time frame during which individuals can enroll in or make changes to their health insurance plans outside of the regular enrollment period. On the other hand, a Special Election Period refers to a specific time frame during which individuals can make changes to their Medicare Advantage or Medicare Part D plans.

LEC stands for Losing Employer Coverage. This term 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 often requires individuals to seek alternative healthcare options such as purchasing private insurance or enrolling in government-sponsored programs like Medicaid or COBRA.

LEC stands for Loss of Employer Coverage. It refers to the situation where an individual loses their health insurance coverage provided by their employer. While this loss of coverage is often involuntary, such as due to job loss or reduction in work hours, it can also be voluntary. For example, an employee may choose to opt-out of their employer's health insurance plan and seek coverage elsewhere. Therefore, the statement that LEC can be a voluntary loss of employer coverage is true.

If you are losing employer coverage, you are guaranteed issue during the 3 months prior to and 63 following your loss of coverage date. This means that you have the right to purchase a health insurance plan without being denied or charged more based on your health status.

Customers are able to enroll in a plan under the SEP-LEC three months before the loss of coverage. This allows customers to have sufficient time to select and enroll in a new plan before their current coverage expires. It also ensures that there is no gap in their healthcare coverage.

SEP-LEC is the most common SEP used at OneExchange. This is because SEP-LEC stands for Special Enrollment Period - Loss of Employer Coverage, which allows individuals to enroll in a new health insurance plan outside of the regular enrollment period if they have lost their employer-provided coverage. Since many individuals may experience a loss of employer coverage at some point, SEP-LEC is likely to be the most commonly used SEP at OneExchange.

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 health insurance plan after their employer coverage has ended. The combination of both options A and B ensures that individuals have sufficient time to find a suitable alternative for their health insurance needs.

During the SEP-LEC, all plan types mentioned 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."

The correct answer is A & B. Customers can enroll into Medicare prior to age 65 if they have End Stage Renal Disease or if they have a disability. These situations qualify individuals for early enrollment in Medicare, allowing them to access healthcare benefits before reaching the standard age requirement of 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 address that is recognized by the government and other organizations. It is important to use this address for accurate record-keeping and communication purposes. Using any other address may lead to confusion and potential issues in the future.

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 a Power of Attorney (POA) allows the designated individual (in this case, the customer) to act on behalf of another person (the POA). However, if the customer is able to act for themselves, the POA is only needed as a HIPAA Representative to ensure compliance with privacy laws. Therefore, the application should be processed by addressing the customer and taking their voice signature, while acknowledging the presence of the POA as a HIPAA Representative.

The correct answer suggests that if every question is answered "NO" on the application, it means that the application guide was not followed. As a result, the application will need to be corrected before it can be submitted. This implies that answering "NO" to every question is not the correct way to complete the application and adjustments need to be made to ensure the application is filled out correctly.

The correct answer is October 15 - December 7. This is the time period when individuals can enroll in or make changes to their Medicare coverage. It is also known as the Annual Enrollment Period (AEP). During this time, individuals can switch from Original Medicare to Medicare Advantage, or vice versa. They can also switch between different Medicare Advantage plans or enroll in a Part D prescription drug plan. Outside of this period, individuals may only make changes to their coverage under certain circumstances, such as qualifying for a Special Enrollment Period.

HMO stands for Health Maintenance Organization, which is a type of health insurance plan that provides healthcare services through a network of doctors, hospitals, and other healthcare providers. HMOs typically require members to choose a primary care physician who acts as a gatekeeper for accessing specialized care. This model emphasizes preventive care and focuses on managing and coordinating healthcare services to keep costs down and improve overall health outcomes.

A Health Reimbursement Arrangement (HRA) or Funding is an arrangement by employers to set aside pre-tax money for medical expenses for their employees. This allows employees to be reimbursed for eligible medical expenses not covered by their insurance plans. It is a benefit offered by employers to help employees manage their healthcare costs and provide them with financial assistance for medical expenses.

A deductible refers to the amount of money that an individual must pay out of pocket before their health insurance plan starts covering the expenses.

PCP stands for Primary Care Physician. A primary care physician is a healthcare professional who serves as the first point of contact for a patient's medical needs. They provide preventive care, diagnose and treat common illnesses, and refer patients to specialists if needed. The term PCP is commonly used in healthcare settings to refer to this essential role in the healthcare system.

Medicare Part A is known as Hospital because it covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health care services. It does not cover medical services or prescription drugs, which are covered under Medicare Part B and Part D respectively. Therefore, the correct answer is Hospital.

HIPAA stands for Health Insurance Portability and Accountability Act. This act was enacted in 1996 in the United States to protect the privacy and security of individuals' health information. It establishes guidelines 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. Additionally, HIPAA sets standards for healthcare providers, health plans, and other entities that handle health information to ensure compliance and safeguard patient privacy.

In order to be compliant when securing the call with the customer, the pieces of information that must be obtained are the full name, last 4 of the social security number, date of birth, and phone number. This information is crucial for verifying the customer's identity and ensuring compliance with regulations regarding customer data protection.

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 applying for these different types of applications.

The correct answer is Health Insurance Claim Number (HICN). This is because the Medicare Claim Number is also referred to as the Health Insurance Claim Number (HICN). It is a unique identification number assigned to individuals who are eligible for Medicare benefits. The HICN is used to process and track Medicare claims and ensure accurate reimbursement for healthcare services provided to Medicare beneficiaries. The other options, Social Security Number and Driver's License Number, are not alternative names for the Medicare Claim Number.

Automatic Reimbursement works by following a specific process. The customer pays the plan premium to the insurance company, who 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 premiums paid.

HMOs (Health Maintenance Organizations) do require a Primary Care Physician (PCP) number. In an HMO, individuals are required to choose a PCP who acts as their primary healthcare provider and coordinates all their medical care. The PCP number is necessary for tracking and managing the healthcare services provided to the individual within the HMO network. Therefore, the statement "HMOs require a Primary Care Physician number" is true.

The statement is true because a Power of Attorney (POA) is a legal document that grants an individual the authority to act on behalf of someone else. In the context of the enrollment process, if the customer has granted a POA to another person, then that person can complete the entire enrollment process on behalf of the customer, even if the customer is not physically present. The POA allows the designated individual to make decisions and take actions as if they were the customer 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 they are assisting Mrs. Smith on the phone.

The correct answer is A & C. In this scenario, the BA (Business Analyst) mistakenly put the AARP membership number in the notes for Mr. and Mrs. Smith's Medigap applications. To rectify this error, it is necessary to verify both Mr. Smith's and Mrs. Smith's numbers separately. By doing so, the correct membership numbers can be accurately recorded for their respective applications.

The Application Guide should be used always because it provides valuable information and guidance for filling out the application. It ensures that all necessary information is included and helps to avoid mistakes or omissions. By using the Application Guide consistently, applicants can increase their chances of submitting a complete and accurate application.

According to the given statement, an Approved Representative (HIPAA Rep) cannot authorize another Approved Representative (HIPAA Rep). This means that one HIPAA Rep does not have the authority to grant authorization to another HIPAA Rep. Therefore, the correct answer is False.

A POA (Power of Attorney) can indeed authorize an Approved Representative, also known as a HIPAA Rep (Health Insurance Portability and Accountability Act Representative). This individual is granted legal authority to make healthcare decisions on behalf of the person who granted the POA. The HIPAA Rep is responsible for ensuring the privacy and confidentiality of the patient's medical information, as mandated by HIPAA regulations. Therefore, the statement "A POA can authorize an Approved Representative (HIPAA Rep)" is true.

The customer is losing employer coverage on 11/30/2014, which qualifies them for a Special Enrollment Period (SEP). The SEP for Loss of Employer Coverage (LEC) allows individuals to enroll in Medicare outside of the Annual Enrollment Period (AEP). Since the customer is Medicare-eligible due to disability, they can use the SEP-LEC to enroll in Medicare. Therefore, the correct answer is SEP-LEC.

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No, the POA cannot give the voice signature. The customer started the application but left before completing it. Therefore, the customer's presence is required to provide the voice signature.

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 can only be provided by the official sources. Giving the customer their own effective dates may lead to confusion and misinformation. It is important to direct the customer to the appropriate resources for accurate and official information regarding their Medicare coverage.

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. It also mentions that you still have to secure the call for Mr. Jones. Therefore, the correct answer is True, indicating that you need to secure the call for Mr. Jones despite his current situation.

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, while the checking account numbers are to the right.

The explanation for the given correct answer is that AARP only accepts Debit/Credit Card 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/Credit Card to make the payment. Other payment methods like cash, check, or online wallets are not accepted for online membership completion.

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 and the agent should wait for the customer to call back. It is the most suitable option in this situation as it allows the agent to be available for the customer's return call and continue the conversation or provide assistance as needed.

The correct answer is to do a 3-way call with AARP and the customer. This option allows for clear communication between the customer, the company, and AARP to ensure that the payment can be processed correctly. By involving all parties in the call, any questions or concerns can be addressed and resolved in real-time, providing a satisfactory solution for the customer.

The statement "If a customer gives you their AARP membership number, you DO NOT have to look it up" is false. If a customer provides their AARP membership number, it is essential to look it up in order to verify their membership and provide any applicable benefits or discounts associated with it. Failing to look up the membership number may result in the customer not receiving the benefits they are entitled to.