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Questions and Answers
CVS Caremark Mail Order will be in-network for 2024.
CVS Caremark Mail Order will be in-network for 2024.
False
Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1?
Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1?
How many Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C.?
How many Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C.?
In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for the remainder of the year once their total out of pocket costs reach $8,000.
In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for the remainder of the year once their total out of pocket costs reach $8,000.
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Wellcare's _____ plan is designed for Low-Income Subsidy members.
Wellcare's _____ plan is designed for Low-Income Subsidy members.
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How many new Wellcare plans are going to market?
How many new Wellcare plans are going to market?
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Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024?
Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024?
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Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. What are they?
Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. What are they?
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Wellcare accepts SOAs in which of the following methods?
Wellcare accepts SOAs in which of the following methods?
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Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading.
Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading.
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Which elements are available as part of Wellcare's Sales Support model?
Which elements are available as part of Wellcare's Sales Support model?
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A grievance request must be filed orally or in writing no later than _____ calendar days from the date of the event.
A grievance request must be filed orally or in writing no later than _____ calendar days from the date of the event.
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Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a:
Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a:
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Brokers/Agents can submit a support ticket online through their Centene Workbench portal.
Brokers/Agents can submit a support ticket online through their Centene Workbench portal.
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When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend.
When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend.
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Which of the following is not an example of Protected Health Information (PHI)?
Which of the following is not an example of Protected Health Information (PHI)?
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A Health Risk Assessment (HRA):
A Health Risk Assessment (HRA):
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The online Centene Workbench self-service portal enables you to:
The online Centene Workbench self-service portal enables you to:
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Communication of PHI can be:
Communication of PHI can be:
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You can help prevent grievances by:
You can help prevent grievances by:
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When a paper SOA form is used, it must be completed __________ hosting the sales presentation.
When a paper SOA form is used, it must be completed __________ hosting the sales presentation.
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Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task.
Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task.
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When discussing prescription drug coverage, you should:
When discussing prescription drug coverage, you should:
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What is the preferred method to submit enrollment?
What is the preferred method to submit enrollment?
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A broker/agent may be terminated for cause if they fail to comply with a compliance investigation.
A broker/agent may be terminated for cause if they fail to comply with a compliance investigation.
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The _________ plan is expected to have one of the lowest premiums in the country!
The _________ plan is expected to have one of the lowest premiums in the country!
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All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies.
All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies.
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All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines.
All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines.
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All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing through Express Scripts Pharmacy.
All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing through Express Scripts Pharmacy.
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Which LIS category is assigned to members whose costs are fully subsidized?
Which LIS category is assigned to members whose costs are fully subsidized?
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Which Prescription Drug Plan (PDP) product features no deductible on any tier?
Which Prescription Drug Plan (PDP) product features no deductible on any tier?
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Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024?
Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024?
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For Prescription Drug Plan (PDP) Medication Home Delivery, which plan will continue to offer a discount for Tier 2, 3, and 6 prescriptions?
For Prescription Drug Plan (PDP) Medication Home Delivery, which plan will continue to offer a discount for Tier 2, 3, and 6 prescriptions?
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A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need.
A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need.
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Wellcare's 2024 product expansion represents a __% increase from 2023.
Wellcare's 2024 product expansion represents a __% increase from 2023.
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With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card.
With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card.
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The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)?
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)?
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An LEP is assessed by CMS when a member goes ______ days or longer without creditable prescription drug coverage.
An LEP is assessed by CMS when a member goes ______ days or longer without creditable prescription drug coverage.
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What are some examples of steps that can be taken when safeguarding and securing PHI and PII?
What are some examples of steps that can be taken when safeguarding and securing PHI and PII?
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CustomPoint sales material order dates will be posted on Wellcare.com.
CustomPoint sales material order dates will be posted on Wellcare.com.
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Prior to the beginning of the enrollment process, what must a broker/agent cover?
Prior to the beginning of the enrollment process, what must a broker/agent cover?
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Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments.
Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments.
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Materials that include plan comparisons or cost-sharing do not require CMS submission.
Materials that include plan comparisons or cost-sharing do not require CMS submission.
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If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe.
If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe.
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The online Centene Workbench self-service portal enables you to:
The online Centene Workbench self-service portal enables you to:
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The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be:
The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be:
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When verifying a D-SNP beneficiary's Medicaid eligibility, you should confirm their Medicaid status qualifies for the selected D-SNP.
When verifying a D-SNP beneficiary's Medicaid eligibility, you should confirm their Medicaid status qualifies for the selected D-SNP.
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When completing an enrollment, be sure to use the correct enrollment application for the desired plan year.
When completing an enrollment, be sure to use the correct enrollment application for the desired plan year.
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Brokers/Agents can access and download enrollment materials through CustomPoint.
Brokers/Agents can access and download enrollment materials through CustomPoint.
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The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays.
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays.
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The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024.
The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024.
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Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser?
Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser?
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Wellcare expanded its county footprint in _____ states for 2024.
Wellcare expanded its county footprint in _____ states for 2024.
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Members are no longer required to pay a partial deductible due to the Inflation Reduction Act.
Members are no longer required to pay a partial deductible due to the Inflation Reduction Act.
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Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?
Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?
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Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented.
Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented.
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Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Which of the following is not a Wellcare quality driver?
Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Which of the following is not a Wellcare quality driver?
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An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on qualifying life events.
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on qualifying life events.
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From October 1 to October 14, certain activities are Non-Permissible Activities. These include:
From October 1 to October 14, certain activities are Non-Permissible Activities. These include:
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Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only.
Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only.
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A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan.
A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan.
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The Mastery Exam will lock for a period of 48 hours after each failed attempt.
The Mastery Exam will lock for a period of 48 hours after each failed attempt.
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Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module within 30 days of use.
Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module within 30 days of use.
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Failure to inform a beneficiary that a trusted provider is out-of-network can cause a sales allegation.
Failure to inform a beneficiary that a trusted provider is out-of-network can cause a sales allegation.
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Noting the correct enrollment period on enrollment applications helps in preventing delayed processing.
Noting the correct enrollment period on enrollment applications helps in preventing delayed processing.
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Once the enrollment is completed, you can save a copy of the application for your reference.
Once the enrollment is completed, you can save a copy of the application for your reference.
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With which types of inquiries can Wellcare's Corporate Sales Support team assist?
With which types of inquiries can Wellcare's Corporate Sales Support team assist?
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Members who fail to pay the required premiums before the end of the grace period will be terminated.
Members who fail to pay the required premiums before the end of the grace period will be terminated.
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Study Notes
Wellcare Mastery Exam Key Points
- Brokers and agents have access to various resources in Centene Workbench, including training, commission, and marketing materials.
- Wellcare accepts Statements of Understanding (SOAs) submitted through Ascend, telephonic means, or paper; all methods are valid.
- Marketing benefits in areas where they are unavailable is prohibited unless unavoidable for media reasons.
- Wellcare's Sales Support model includes online, local, and corporate elements for assistance.
- A grievance request must be filed within 60 calendar days from the incident or awareness of the issue.
- Noncompliant activities may trigger investigations via Complaint Tracking Module (CTM), grievances, or secret shop findings.
- Brokers and agents can submit support tickets through Centene Workbench online.
- Health Risk Assessments (HRAs) can be completed directly in Ascend following an enrollment application.
- Protected Health Information (PHI) examples exclude non-health-related documents like a library card.
- HRAs help provide insights into a member's health status and improve care services tailored to their needs.
- The Centene Workbench portal allows uploading applications, utilizing workflows, and accessing documents/resources.
- PHI communication can occur through written, electronic, or verbal means.
- Grievance prevention strategies include confirming provider availability, using plan materials for clarity, and verifying enrollment intentions.
- Paper SOA forms must be completed 48 hours prior to sales presentations.
- Requests for PHI should contain only the minimum necessary information to fulfill their purpose.
- When discussing prescription drug coverage, it is essential to explain formulary usage, confirm coverage of prescribed items, and discuss drug copayments.
- Ascend is the preferred method for submitting electronic enrollments.
- Broker/agent compliance is crucial; noncompliance may result in contract termination or corrective action plans.
- The Value Script plan is anticipated to have low premiums nationwide.
- All Prescription Drug Plans (PDPs) will now include a $0 copay for most preventive vaccines.
- Low-Income Subsidy (LIS) members receiving full subsidies fall into Category Three.
- Wellcare's product expansion for 2024 represents a 1% increase from 2023.
- The Pharmacy Benefit Manager (PBM) migration to Express Scripts affects both PDP & MAPD plans.
- Medicare beneficiaries can qualify for a Low-Income Subsidy if without creditable prescription coverage for 63 days or longer.
- Correct handling of PHI and PII includes shredding documents, ensuring secure email communication, and not leaving sensitive information unattended.
- Brokers/agents must report all marketing events to Wellcare.
- Six drivers of Wellcare's quality focus do not include member payments.
- Special Enrollment Periods (SEPs) allow for enrollment based on qualifying life events.
- Non-permissible activities during specified periods must be avoided by brokers.
- Brokers/agents must use the correct enrollment application for the desired plan year and can access enrollment materials via CustomPoint.
- Wellcare's quality initiative is significantly influenced by Medicare Star Ratings.
- Failing to pay premiums after a three-month grace period results in termination.
- Wellcare continues expanding its product offerings across five new states for 2024.
- Wellcare aims to enhance service delivery with three new PDPs across all states, including Washington D.C.
- Once total out-of-pocket costs reach $8,000 in the Catastrophic Coverage stage, members pay $0 for drugs for the remainder of the year.
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Description
Test your knowledge with these flashcards designed for the 2024 Wellcare Mastery Exam. These cards cover key concepts, resources, and submission methods available to brokers and agents at Wellcare. Perfect for reinforcing your understanding before the exam.
