2015 - Adp - Using Resources #1 - Sojo - 10/15/2014

Since Mr. Ripley has just aged-in to Medicare, it can be inferred that he is currently within 6 months of his 65th birthday. Therefore, the answer to the question "Are you within 6 months of your 65th birthday (before or after)?" would be "Yes".

The question asks if Mrs. Flood's plan effective date will be within 6 months of her 65th birthday and her Medicare Part B effective date. Since her 65th birthday is on October 19, 2014, and her Medicare Part B effective date is October 1, 2014, the plan effective date will be within 6 months of both dates. Therefore, the answer is Yes.

The statement is true because when the application asks for the customer's age, it is specifically referring to the age as of the month their plan goes into effect. This means that the age provided should be the age the customer will be at the time their plan starts, rather than their current age at the time of filling out the application.

The effective date for under an SEP-LEC is determined by the employer and is set as the first of the month following the date of coverage loss. This means that once an individual loses their coverage, they will be eligible for coverage under an SEP-LEC starting from the first day of the following month. The employer has the authority to determine the date of coverage loss, which then determines the effective date for the SEP-LEC.

When a customer is enrolling under GI (Guaranteed Issue) due to LEC (Loss of Employer Coverage), it means that they are eligible for health insurance coverage without being subject to medical underwriting or pre-existing condition exclusions. In order to qualify for GI, the customer must have had coverage within the past 63 days. Therefore, the statement "True" indicates that the customer has indeed had coverage within the specified time frame.

If an application is being completed after December 7th, the enrollment period that would need to be used for a new client losing group coverage is SEP-LEC. This stands for Special Enrollment Period - Loss of Essential Coverage. This means that the client is eligible for a special enrollment period due to losing their group coverage, allowing them to enroll in a new plan outside of the regular enrollment period.

If the Medicare Claim Number (HICN) is incorrect, you would contact InfoSource to change it.

If the Medicare Part B effective date is wrong, the correct action to take is to transfer the issue to LBS (Local Benefits Specialist). This suggests that LBS is the appropriate department or team responsible for handling and resolving issues related to Medicare Part B effective dates. By transferring the issue to LBS, they can address and correct the incorrect effective date to ensure accurate and timely coverage for the individual.

In this scenario, the customer wants mail to be sent to a P.O. Box, but it is not pre-populated. The correct answer suggests that the individual should change the information themselves in their personal profile. This implies that the customer has the ability to update their own personal profile and make the necessary changes without needing to contact anyone else for assistance.

In this situation, the correct answer is to authorize Mrs. Jones' daughter as an Approved Representative (HIPAA Rep). This means that she is allowed to be on the phone call and participate in the application process. By authorizing her, you are ensuring that she has the necessary permissions and qualifications to be involved in the conversation. This is important to comply with HIPAA regulations and protect the privacy and confidentiality of sensitive information.

The BMI (Body Mass Index) is a measure of body fat based on height and weight. To calculate it, the weight in pounds is divided by the square of the height in inches, and then multiplied by a conversion factor of 703. In this case, the person's height is 5'4" (64 inches) and weight is 120 pounds. Dividing 120 by 64 squared and multiplying by 703 gives a BMI of approximately 20.6.

The explanation for the given correct answer "No" is that the question is asking if the customer intends to replace their current coverage with the Medicare supplement policy. Since the customer is losing their employer coverage, they may not have any other coverage to replace it with. Therefore, the answer would be "No" as they do not intend to replace their current coverage with the Medicare supplement policy.

The correct answer is "Yes" because the question is asking if the new Medigap plan will be replacing a Medicare supplement or a Medicare Advantage plan. Since the customer is losing employer coverage, they will need to replace it with either a Medicare supplement or a Medicare Advantage plan, so the new Medigap plan will be replacing one of these options.

The correct number that an IBM customer can call to reach OneExchange is 855-359-7380.

The customer's HRA funding will rollover to the next year.

VSP will take out the first payment 1-2 weeks before the effective date. This means that the customer will need to make the payment in advance to ensure their enrollment into VSP.

The customer's TX Humana Medigap application for Losing Employer Coverage will allow other payment methods if they do not want to give out their banking information.

Presbyterian's headquarters are located in Albuquerque, NM.

To add Mrs. Jones to her husband's AARP membership, you would need to call the phone number 888-687-2277.

The correct answer is to call an LBS. This is because the BA entered a phone number in the PCP field, which is not the correct place for it. The LBS (Local Business Specialist) will be able to assist in correcting the mistake and ensuring that the phone number is entered in the correct field.

If a P.O. Box is listed as the primary address and no change is needed to the zip code or county, the correct action to take is to update the address on the application and refresh the record. This means that the P.O. Box should be entered as the primary address in the application and the record should be updated to reflect this change. This ensures that the correct address is associated with the record and any future correspondence or communication will be sent to the P.O. Box.

If a HICN (Health Insurance Claim Number) is incorrect, the suggested action is to "Ping InfoSource." Pinging InfoSource refers to sending a request or query to InfoSource, which is a source of information. In this context, it likely means to contact InfoSource to verify the correct HICN or to obtain the correct information related to the incorrect HICN. This action is recommended instead of continuing with the incorrect HICN, changing it, or calling an LBS (Location-based service).

The customer is enrolling using the SEP-LEC on 9/12/14, and his group coverage ends on 10/31/14. The plans in the cart have a 12/1/14 effective date. Since the customer's group coverage ends before the effective date of the plans in the cart, it is necessary to contact an LBS (Licensed Broker Support) to address this issue and find a solution.

The HMO-POS options can be found in the Summary of Benefits. This document provides a detailed overview of the benefits and coverage offered by the HMO-POS plan, including information on in-network and out-of-network services, copayments, deductibles, and any additional features or limitations. By referring to the Summary of Benefits, individuals can make informed decisions about their healthcare options and understand the specific details of the HMO-POS plan.

To get to the correct application guide for a specific carrier, the steps are as follows: Choose Application Guide, Select a State, Select a Plan, Select a Carrier, and finally, Select an Enrollment Reason. This sequence ensures that the user is first directed to the general application guide, then narrows down the options by selecting a specific state, plan, carrier, and finally the reason for enrollment. By following this order, the user will be able to access the application guide that is most relevant to their needs.

The correct answer is "Losing group coverage." This is because when you choose "Other" for the reason, it implies that your current insurance is being terminated or you are losing group coverage. This option is not specific to New York, as it can apply to any location.

The correct answer includes the four benefits that must be read for HMO-POS plans. These benefits are Inpatient Acute Hospital Care, Primary Care Physician, Physician Specialist Services, and Ambulance. This means that when considering an HMO-POS plan, it is important to understand the coverage and availability of these services.

The correct answer is that the POA is completing the application for the customer. This means that if a Power of Attorney (POA) is filling out the application on behalf of the customer, then the POA section on the application must be filled out. This is important to ensure that the application is properly authorized and that the POA's actions are legally valid.

The Medicare Annual Enrollment Period (AEP) begins on October 15 and ends on December 7. During this period, Medicare beneficiaries can make changes to their Medicare coverage, such as switching from Original Medicare to a Medicare Advantage plan or vice versa, or changing their prescription drug coverage. This is an important time for individuals to review their current coverage and make any necessary changes to ensure they have the best coverage for their needs in the upcoming year.

If a customer enrolls during the AEP (Annual Enrollment Period), their effective date will be January 1. This means that their coverage will begin on January 1, regardless of when they enrolled during the AEP.

The correct order in which the applications should be completed is Vision, Dental, Medigap, PDP.

The given correct answer is "No". This implies that dental or VSP plans do not follow the AEP (Annual Enrollment Period) rules. It suggests that neither dental plans nor VSP (Vision Service Plan) plans adhere to the regulations and guidelines set for the AEP.

CMS (Medicare) regulates MAs, MAPDs, and PDPs. CMS stands for the Centers for Medicare and Medicaid Services, which is a federal agency within the U.S. Department of Health and Human Services. They are responsible for administering the Medicare program and ensuring that Medicare Advantage (MAs), Medicare Advantage Prescription Drug (MAPDs), and Prescription Drug Plans (PDPs) comply with the regulations and guidelines set by Medicare. This includes overseeing the enrollment process, monitoring plan performance, and ensuring that beneficiaries receive the necessary healthcare services.