Insurance Benefits Outside the US

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Questions and Answers

What should the Agent inquire about after reviewing additional benefits with the beneficiary?

  • The provider network status of the plan
  • Whether the beneficiary is interested in reviewing other benefits (correct)
  • The beneficiary's medical history
  • The cancellation policy of the enrollment

What should the Agent review with the beneficiary during the enrollment process?

  • The provider network status of the plan
  • The pharmacy network status of the plan
  • Dental, Vision, and Hearing benefits (correct)
  • The beneficiary's income level

What is a requirement for the Agent during the enrollment process?

  • To answer all additional questions asked by the applicant or their legal representative (correct)
  • To review the plan's network status
  • To provide the beneficiary with a list of providers
  • To provide the beneficiary with a hard copy of the EOC

What should the Agent offer to review with the beneficiary during the enrollment process?

<p>The provider network status, current prescriptions, hospital network status, and facility network status (B)</p> Signup and view all the answers

What is a resource available to the Agent during the enrollment process?

<p>A Job Aid: DMS 214 Medicare Presentation of Benefits Page 14 (C)</p> Signup and view all the answers

What is the PCP copayment in the described plan?

<p>$5 (C)</p> Signup and view all the answers

What should the agent do if Humana is not the best plan for the consumer?

<p>Explain the reasoning and suggest alternative options (A)</p> Signup and view all the answers

What is the purpose of recapping the important benefits with the beneficiary?

<p>To reiterate why the Humana plan is a good choice (D)</p> Signup and view all the answers

How should the agent engage the beneficiary during the plan presentation?

<p>Speak clearly and pause to gauge understanding (D)</p> Signup and view all the answers

What is the primary goal of the agent during the plan presentation?

<p>To portray Humana and its partners in a positive light (D)</p> Signup and view all the answers

Why should the agent ask the beneficiary to recap their reasons for choosing Humana?

<p>To ensure the beneficiary understands the plan benefits (A)</p> Signup and view all the answers

What is the purpose of 42 CFR § 422.111(a),(b) in regards to MA organizations?

<p>To require MA organizations to disclose information in clear, accurate, and standardized form (D)</p> Signup and view all the answers

What is required to be reviewed during telephonic enrollments according to 42 CFR § 422.2267(e)(4)?

<p>The PECL, including EOC, providers, medications, premiums, and plan-type rules (C)</p> Signup and view all the answers

What is the purpose of 42 CFR § 422.2274(c)(9)(i) in regards to MA organizations?

<p>To require MA organizations to establish a system for confirming beneficiary understanding of the product (D)</p> Signup and view all the answers

What is required to be explained to beneficiaries according to the approved script requirement?

<p>All of the above, plus maximum out-of-pocket responsibility and preventive care examples (D)</p> Signup and view all the answers

What is required to be reviewed by MA organizations according to 42 CFR § 422.2264(c)(3)(ii)(D)?

<p>The individual's health care needs, history, and commonly used medications (A)</p> Signup and view all the answers

What is the purpose of 42 CFR § 422.2262(a)(1)(i),(iii) in regards to MA organizations?

<p>To prohibit MA organizations from engaging in activities that mislead or confuse beneficiaries (A)</p> Signup and view all the answers

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