FREE INSURANCE AND STUDY GAMES ABOUT AHIP

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FREE INSURANCE AND STUDY GAMES ABOUT AHIP

MODULE 4 EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -38 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: What continuing education criteria do marketing reps employed (or

contracted) need to meet? What is the exception?

Answer:

pass a written test each year, unless they ONLY sell union/employer group coverage

Question 2: What can't a sales agent do at an ed event?

Answer:

require contact info, RSVP conditions, conduct health screenings or like activities, provide meals or multiple snacks/refreshments bundled and provided as if a meal, regardless of value

Question 3: What are some characteristics of Marketing Events?

Answer:

• held in public, hosted by plan/part D sponsor or outside entity
• put on by providers or other groups and sponsored by one ore more health plans
• immediately following an education event (in the same general location) ok to start marketing event

Question 4: Which type of Medicare health plan may have different rules for marketing based on the state?

Answer:

MMP Question 5: True or False: an agent asks a family member to give their cards to patients at the hospital where they work, that is not a violation because the family member is the one giving it out, not the agent

Answer:

False

Question 6: What is marketing intent?

Answer:

draw prospect/current enrollees attention to a plan or group of plans to influence a bene decision Question 7: What is marketing content? Some examples:

Answer:

marketing activities and materials like info on benefits or premiums/cost sharing, comparisons to other plans, rankings, Star ratings etc.

Question 8: What may marketing reps do during individual appointments?

Answer:

distribute plan materials (kits, marketing materials), provide educational info, provide and collect enrollment forms Question 9: True or False: Plan sponsors who wish to market in a specific state must contract with or employ marketing representatives who are licensed by the state in question

Answer:

True Question 10: What three items must be received by the bene is provided with enrollment instructions/form? What about for D-SNPs?

Answer:

plan ratings info, summary of benefits, pre-enrollment checklist if D-SNP - must include medicaid benefits too

Question 11: What can't marketing reps do during individual appointments?

Answer:

discuss plan options not agreed to in scope of appt (unless bene asks during appt unprompted), market non-health care related products, solicit/accept enrollment request for 01/01 effective date prior to start of AEP unless bene has SEP Question 12: True or False: for appts made over phone, if the call that went over scope of meeting was not recorded, the rep MUST obtain written agreement signed by bene and authorized by rep before appt

Answer:

True Question 13: What items are required to be available anytime through the Plans website? What questions can they help answer?

Answer:

evidence of coverage, summary of benefits, annual notice of change, provider directory, pharmacy directory, formulary

q's: whether bene providers are in network, whether drugs a bene takes are on plans formulary, whether the plan matches bene needs Question 14: What is considered a "gift of a nominal value"? What is the limit for gifts to the same bene per year on different occassions?

Answer:

$15 or less (combined not per item) and not in cash or cash equivalents multiple gifts - $75 or less Question 15: True or False: HIPAA authorization from enrollee in question if firm wishes to use his/her personal data to market non-health related items/services

Answer:

True

Question 16: What is the one exception to the review/approve process?

Answer:

if the materials are developed for us with employer/union group members

Question 17: What two terms are important to know when it comes to confidentiality and sensitive information?

Answer:

PHI and HIPAA Question 18: What are the 5 types of medicare health plans and Part D plans that the CMS rules apply to?

Answer:

MA, MA-PD, PDPs. 1876 Cost Plans, MMPs

Question 19: What can't a marketing agent do at an ed event?

Answer:

conduct sales presentations, discuss/display/distribute plan specific info, engage in marketing activities, distribute/collect enrollment apps Question 20: True or False: Marketing Representatives from third party marketing firms are exempt from CMS regulations

Answer:

False, same rules apply up and down stream from plan Question 21: True or False: it is fine if a life insurance agent calls a (legal) life insurance lead and at the end of the call asks if the client would like to learn more about MA

Answer:

False, that is unsolicited and a sales rep is considered a marketing rep

Question 22: What can a sales agent do at an ed event if approved by CMS?

Answer:

discuss plan specific info, merits of plan, distribute and collect apps, distribute adverts for plan and related marketing information, provide refreshments and light snacks of a nominal value (not bundled with meal) Question 23: What must be included when documenting the SOA for Plans/Part D sponsors?

Answer:

product type, date of appt, bene contact info, written/verbal auth bene accepted this meeting, statement (bene no obligated to enroll, no risk)