This practice quiz is designed for new hires at SMMC to understand and handle Good Cause reasons for plan changes in health insurance scenarios.
GC1620
GC9
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GC14
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Ensure the member has called the AHCA Medicaid Helpline to file a complaint.
Ensure the member deserves a plan change.
Ensure the member has contacted the plan first to see if the issue could be resolved.
Ensure the member is 18 years or older.
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True
False
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Tell the caller they must complete the grievance process first, before the Good Cause can be submitted to AHCA.
Tell the caller they must wait until open enrollment to change the health plan.
Refer the caller to the AHCA Medicaid Helpline for an exemption.
For extreme circumstances, submit a supervisor task to verify if the SNU needs to review the issue. In the meantime, advise the caller to contact the plan case manager.
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GC17
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GC4
GC1622
GC17
GC1612
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GC4
GC17
GC9
GC1622
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GC1622
GC1620
GC17
GC1621
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