2015 - Adp - Using Resources #1 - Sojo - 10/15/2014
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Questions and Answers
- 1.
Mr. Ripley has just aged-in to Medicare. How would you answer the following question: “Are you within 6 months of your 65th birthday (before or after)?”
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
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".Rate this question:
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- 2.
Mrs. Flood, an Agilent customer, is unsure of how to answer the following question: “Will your plan effective date be within 6 months of your 65th birthday and your Medicare Part B effective date?” She turns 65 October 19, 2014, and her Medicare Part A and B will go into effect October 1st of 2014. How should this question be answered?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
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.Rate this question:
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- 3.
True or False: When the application asks for the customer's age, it’s referring to the age as of the month their plan goes into effect.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 4.
In general, what determines the effective date for under an SEP-LEC?
- A.
The first of the month following the date of coverage loss (as determined by the employer)
- B.
Whatever date the ADP selects
- C.
The date of notification of loss of coverage
- D.
The date COBRA expires
Correct Answer
A. The first of the month following the date of coverage loss (as determined by the employer)Explanation
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.Rate this question:
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- 5.
True or False: When a customer is enrolling under GI due to LEC, they have had coverage within the past 63 days?
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 6.
If an application was being completed after December 7th, which enrollment period would need to be used for a new client losing group coverage?
- A.
SEP-LEC
- B.
ICEP
- C.
A & B
- D.
None of the above
Correct Answer
A. SEP-LECExplanation
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.Rate this question:
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- 7.
If the Medicare Claim Number (HICN) is incorrect, who do you contact to change it?
- A.
LBS
- B.
Supervisor
- C.
InfoSource
- D.
CSR
Correct Answer
C. InfoSourceExplanation
If the Medicare Claim Number (HICN) is incorrect, you would contact InfoSource to change it.Rate this question:
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- 8.
If the Medicare Part B effective date is wrong, what do you do?
- A.
Transfer to LBS
- B.
Change it yourself in the personal profile.
- C.
Ping InfoSource
- D.
Get your Supervisor
Correct Answer
A. Transfer to LBSExplanation
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.Rate this question:
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- 9.
The customer wants mail to go to a P.O. Box, but it’s not pre-populated. Who do you contact?
- A.
LBS
- B.
No one; change it yourself in the personal profile.
- C.
Supervisor
- D.
InfoSource
Correct Answer
B. No one; change it yourself in the personal profile.Explanation
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.Rate this question:
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- 10.
You are in the middle of an application and Mrs. Jones’ daughter joins the phone call. What do you do?
- A.
Politely tell her that she cannot be on the phone because she is not an Authorized Representative ( HIPAA Rep).
- B.
Continue the application as if she was not on the phone.
- C.
Authorize her as an Approved Representative (HIPAA Rep).
- D.
None of the above
Correct Answer
C. Authorize her as an Approved Representative (HIPAA Rep).Explanation
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.Rate this question:
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- 11.
Based on the BMI calculator, what is the BMI for someone who is 5’4” and 120 pounds?
- A.
22.1
- B.
17.9
- C.
19.4
- D.
20.6
Correct Answer
D. 20.6Explanation
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.Rate this question:
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- 12.
For BCBS of TX Medigap, Losing Employer Coverage, what is the answer to “Do you intend to replace your current coverage with this Medicare supplement policy?”
- A.
Yes
- B.
No
- C.
Whichever answer the customer gives
- D.
This answer is always yes.
Correct Answer
B. NoExplanation
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.Rate this question:
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- 13.
For AARP/UHC of NY, Losing Employer Coverage, what is the answer to “Will this new Medigap plan be replacing a Medicare supplement or a Medicare Advantage (individual plan, not a group plan)?”
- A.
Yes
- B.
No
- C.
Whichever answer the customer gives
Correct Answer
A. YesExplanation
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.Rate this question:
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- 14.
You are talking to an IBM customer; what number can they call to reach OneExchange?
- A.
855-359-7380
- B.
800-796-9876
- C.
866-823-0996
- D.
855-873-0101
Correct Answer
A. 855-359-7380Explanation
The correct number that an IBM customer can call to reach OneExchange is 855-359-7380.Rate this question:
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- 15.
You are talking to a DuPont customer in the Losing Group Medical Only campaign. Will his HRA funding rollover to the next year?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
The customer's HRA funding will rollover to the next year.Rate this question:
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- 16.
Your customer is enrolling into VSP. When will VSP take out the first payment?
- A.
3-5 Business days
- B.
The effective date
- C.
Upon receipt of the application
- D.
1-2 weeks before the effective date
Correct Answer
D. 1-2 weeks before the effective dateExplanation
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.Rate this question:
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- 17.
Your customer does NOT want to give out their banking information. Will their TX Humana Medigap application for Losing Employer Coverage allow other payment methods?
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
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.Rate this question:
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- 18.
Your customer is enrolling into a Presbyterian MAPD and they would like to know where Presbyterian’s headquarters are. What do you tell them?
- A.
Give them the customer service number for Presbyterian so they can call and ask themselves.
- B.
Add an LBS to the line
- C.
Albuquerque, NM
- D.
Detroit, MI
Correct Answer
C. Albuquerque, NMExplanation
Presbyterian's headquarters are located in Albuquerque, NM.Rate this question:
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- 19.
You need to add Mrs. Jones to her husband’s AARP membership. What phone number do you call?
- A.
800-523-5800
- B.
800-972-9719
- C.
888-381-8581
- D.
888-687-2277
Correct Answer
D. 888-687-2277Explanation
To add Mrs. Jones to her husband's AARP membership, you would need to call the phone number 888-687-2277.Rate this question:
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- 20.
The BA entered a phone number in the PCP field (as well as in the notes). What do you do?
- A.
Leave it alone; it is the BA’s job; not yours.
- B.
Call an LBS.
- C.
Look in the client guide to find out how you look up a PCP number.
- D.
Ask your supervisor.
Correct Answer
B. Call an LBS.Explanation
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.Rate this question:
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- 21.
If a P.O. Box is listed as the primary address and no change is needed to the zip code or county, what should you do?
- A.
Ping InfoSource
- B.
Call an LBS
- C.
Ask your supervisor to change the address
- D.
Update the address on the application and refresh the record
Correct Answer
D. Update the address on the application and refresh the recordExplanation
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.Rate this question:
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- 22.
If a HICN is incorrect, you should…
- A.
Continue, and tell them to contact Social Security
- B.
Change it
- C.
Ping InfoSource
- D.
Call an LBS
Correct Answer
C. Ping InfoSourceExplanation
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).Rate this question:
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- 23.
The customer is enrolling using the SEP-LEC on 9/12/14. His group coverage ends on 10/31/14. The plans in the cart have a 12/1/14 effective date. How should you proceed?
- A.
Contact InfoSource
- B.
Call an LBS
- C.
Do nothing; the effective dates are correct
- D.
None of the above; this cannot happen
Correct Answer
B. Call an LBSExplanation
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.Rate this question:
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- 24.
Where do you find the HMO-POS options?
- A.
Summary of Benefits
- B.
Situation Analysis
- C.
InfoSource
Correct Answer
A. Summary of BenefitsExplanation
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.Rate this question:
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- 25.
How do you get to the correct application guide for a specific carrier?
- A.
Choose Application Guide, Select Enrollment Reason, Select a Plan, Select a State, Select a Carrier
- B.
Choose Application Guide, Select a State, Select a Plan, Select a Carrier, Select an Enrollment Reason
- C.
Either way will get you to the correct application guide
Correct Answer
B. Choose Application Guide, Select a State, Select a Plan, Select a Carrier, Select an Enrollment ReasonExplanation
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.Rate this question:
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- 26.
When you choose “Other” for the reason on the “Will this new Medigap plan be replacing a Medicare Supplement or a Medicare Advantage plan (individual plan, not group plan)?” you MUST put…
- A.
Because it is New York
- B.
F
- C.
My insurance is being terminated
- D.
Losing group coverage
Correct Answer
D. Losing group coverageExplanation
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.Rate this question:
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- 27.
What are the four benefits you must read for HMO-POS plans?
- A.
Inpatient Acute Hospital Care, Primary Care Physician, Physician Specialist Services, Ambulance
- B.
Inpatient Care, Physician Specialist, Prescriptions, Auxiliary Services
- C.
Emergency Services, Doctor & Hospital, Psychiatric Services, Outpatient Care
- D.
None of the above
Correct Answer
A. Inpatient Acute Hospital Care, Primary Care Physician, Physician Specialist Services, AmbulanceExplanation
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.Rate this question:
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- 28.
The POA section on the application must be filled out if…
- A.
The POA is on the call.
- B.
There is a POA listed in the Personal Profile.
- C.
The customer tells you they have a POA.
- D.
The POA is completing the application for the customer.
Correct Answer
D. The POA is completing the application for the customer.Explanation
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.Rate this question:
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- 29.
When does the Medicare AEP begin and when does it end?
- A.
It begins February 15 and ends March 31.
- B.
It begins October 1 and ends December 31.
- C.
It begins October 15 and ends December 7.
- D.
It begins January 1 and ends
Correct Answer
C. It begins October 15 and ends December 7.Explanation
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.Rate this question:
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- 30.
What will be the customer’s effective date if they enroll during the AEP?
- A.
December 1
- B.
January 1
- C.
November 1
- D.
October 1
Correct Answer
B. January 1Explanation
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.Rate this question:
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- 31.
In what order should the applications be completed?
- A.
Vision, Medigap, PDP, Dental
- B.
Vision, Dental, Medigap, PDP
- C.
Dental, PDP, Medigap, Vision
- D.
None of the above
Correct Answer
B. Vision, Dental, Medigap, PDPExplanation
The correct order in which the applications should be completed is Vision, Dental, Medigap, PDP.Rate this question:
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- 32.
Do dental or VSP plans follow the AEP rules?
- A.
Yes
- B.
No
- C.
Vision plans do, but Dental plans do not
- D.
Denatl plans do, but Vision plans do not
Correct Answer
B. NoExplanation
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.Rate this question:
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- 33.
Who regulates MAs, MAPDs, and PDPs?
- A.
The State Department of Insurance (DOI)
- B.
The Carriers
- C.
CMS (Medicare)
- D.
The FAA
Correct Answer
C. CMS (Medicare)Explanation
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.Rate this question:
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