2024 Wellcare Mastery Exam

2024 WELLCARE MASTERY EXAM Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. a.Training Resources b.Commission Resources c.Marketing Resources d.All of these - Answerd.All of These Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a.Ascend b.Telephonic c.Paper d.All of these - Answerd.All of These Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. True False - AnswerTrue Which elements are available as part of Wellcare's Sales Support model? a.Online b.Local c.Corporate d.All of these - Answerd. All of these A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. a.30 b.45 c.60 d.90 - Answerc. 60 Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) a.Complaint Tracking Module (CTM) b.Yelp Review c.Grievance d.Secret Shop Finding - Answera.Complaint Tracking Module (CTM) c.Grievance d.Secret Shop Finding Brokers/Agents can submit a support ticket online through their Centene Workbench portal. True False - AnswerTrue When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend after the enrollment application, through the Value-Based Enrollment (VBE) portal. True False - AnswerTrue Which of the following is not an example of Protected Health Information (PHI)? a.Medical records b.Payment history c.Library card - Answerc. Library card A Health Risk Assessment (HRA): a.Provides physicians with an overview of a member's health status. b.Helps us understand the unique health situation of each of our members and allows us to make sure they receive the services that meet their needs. c.Is an important part of our quality initiative, directly impacting our Star Ratings. d.All of these - Answerd. All of these The online Centene Workbench self-service portal enables you to: a.Upload applications b.Use the self-service workflows and ticketing system c.Locate valuable documents and resources d.All of these - Answerd. All of these Communication of PHI can be: (Select all that apply.) a.Written b.Electronic c.Verbal - Answera.Written b.Electronic c.Verbal You can help prevent grievances by: (Select all that apply.) a.Always confirming availability of the beneficiary's primary and specialist providers by using the provider search tool available on the plan's website. b.Always using plan materials to clearly explain plan benefits and cost (including medications) and check for understanding. c.Always confirming a beneficiary's intent to enroll before accepting their enrollment application. - Answera.Always confirming availability of the beneficiary's primary and specialist providers by using the provider search tool available on the plan's website. b.Always using plan materials to clearly explain plan benefits and cost (including medications) and check for understanding. c.Always confirming a beneficiary's intent to enroll before accepting their enrollment application. When a paper SOA form is used, it must be completed __________ hosting the sales presentation. a.48 Hours prior to b.During c.After - Answera.48 Hours prior to Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. True False - AnswerTrue When discussing prescription drug coverage, you should: (Select all that apply.) a.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. - Answera.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Which option is the preferred method to submit enrollment? a.Centene Workbench Upload b.Ascend Web/Mobile Application c.Fax/Paper - Answerb.Ascend Web/Mobile Application A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information. True False - AnswerTrue The _________ plan is expected to have one of the lowest premiums in the country! a.Classic b.Value Plus c.Value Script - Answerc.Value Script All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True False - AnswerTrue All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. a.Zero b.Five c.Ten d.Fifteen - Answera. Zero All Prescription Drug Plans (PDPs) will continue to offer $0 Tier 1 preferred cost-sharing through Express Scripts Pharmacy (Mail Order). True False - AnswerTrue Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? a.One b.Two c.Three d.Four - Answerc. Three Which Prescription Drug Plan (PDP) product features no deductible on any tier? a.Classic b.Value Script c.Value Plus - AnswerC. Value Plus Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024? a. Express Scripts Pharmacy b.CVS Caremark c.Both A and B - Answera. Express Scripts Pharmacy For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plan will continue to offer a discount (2.5 x 30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions. a.Classic b.Value Plus c.Value Script - Answerb.Value Plus A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need. a.Two b.Three c.Four d.Five - Answerc.Four Wellcare's 2024 product expansion represents a __% increase from 2023. a.One b.Two c.Three d.Five - Answera.One With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card 1/1/2024 and beyond. True False - AnswerFalse The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)? a.PDP Only b.MAPD Only c.Both PDP & MAPD - Answerc.Both PDP & MAPD An LEP is assessed by CMS when a member goes ______ days or longer without creditable prescription drug coverage after they become Medicare-eligible. a.60 days b.63 days c.65 days d.73 days - Answerb.63 days What are some examples of steps that can be taken when safeguarding and securing PHI and PII? (Select all that apply.) a.Shred documents that contain PHI or PII using appropriate means. b.Never leave laptops, PHI, or PII in an unattended vehicle. c.Do not include PHI or PII in the subject line or body of an email. d.Secure emails that contain PHI or PII. - Answerd.Secure emails that contain PHI or PII. CustomPoint sales material order dates will be posted on Wellcare.com. True False - AnswerFalse Prior to the beginning of the enrollment process, a broker/agent is required to cover certain beneficiary specific information, including but not limited to: a.Check to see if the beneficiary's PCP and Specialists are in network, explaining they will need to choose new ones or pay out of pocket if not. b.Check the beneficiary's prescriptions are on the formulary and their pharmacy is in network, explaining they will need to choose a new pharmacy or may have to pay the full price of their prescriptions if not. c.Check for other health care needs like Durable Medical Equipment and Physical Therapy. d.All of these - Answerd.All of these Ascend is a fast, easy, and compliant way for brokers/agents to submit agentassisted electronic enrollments. True False - AnswerTrue Materials that include plan comparisons or cost-sharing do not require CMS submission. True False - AnswerFalse If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed True False - AnswerTrue The online Centene Workbench self-service portal enables you to a.Upload applications b.Use the self-service workflows and ticketing system c.Locate valuable documents and resources d.All of these - Answerd. All of these 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: (Select all that apply. a.Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b.Verbally conveyed within the first minute of a sales call. c.Prominently displayed on TPMO websites (regardless of content). d.Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). Answera.Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b.Verbally conveyed within the first minute of a sales call. c.Prominently displayed on TPMO websites (regardless of content). d.Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligiblity may affect enrollment and/or cost sharing. True False - AnswerTrue When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True False - AnswerTrue Brokers/Agents can access and download enrollment materials through CustomPoint. True False - AnswerTrue The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all insulins and insulin-combination products that are on the formulary, regardless of tier, and are included in the $35 cap for one month's supply. True False - AnswerTrue The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. True False - AnswerTrue Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser? a.Value Script b.Value Plus c.Classic - AnswerC. Classic Wellcare expanded our county footprint in _____ states for 2024. a.One b.Two c.Four d.Five - Answerd. five Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True False - AnswerTrue Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. a.Training Resources b.Commission Resources c.Marketing Resources d.All of these - Answerd. All of these Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a.Ascend b.Telephonic c.Paper d.All of these - Answerd. All of these Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. True False - AnswerTrue When discussing prescription drug coverage, you should: (Select all that apply.) a.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception - Answera.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c.Explain formulary tiers as well as drug copayment amounts. d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? a.One b.Two c.Three d.Four - Answerc. Three Brokers/Agents MUST complete a Wellcare Contract Recertification case in Centene Workbench (CWB) every two years. True False - AnswerFalse Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? a.Speak with the investigator as quickly as possible. b.Answer all questions honestly and completely. c.Offer information and documents important to the investigation. d.All of these - Answerd. All of theses Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formal and informal). True False - AnswerFalse Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? a.Member Service b.Reputation c.Member Payments d.Serving Government Customers - Answerc. Member payments An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. True False - AnswerTrue From October 1 to October 14, certain activities are Non-Permissible Activities. These include: a.Assist with completing an application b.Collect a completed application c.Advise the beneficiary to complete an applciation prior to October 15. d.All of these - Answerd. All of these Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only. (Select all that apply.) a.First b.Second c.Third d.Fourth - Answera.First b.Second c.Third A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. True False - AnswerFalse The Mastery Exam will lock for a period of 48 hours after each failed attempt. True False - AnswerFalse Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no later than 30 days of use. True False - AnswerFalse Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. True False - AnswerTrue Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True False - AnswerTrue Once the enrollment is completed, you can save a copy of the application for your reference. True False - AnswerFalse With which types of inquiries can Wellcare's Corporate Sales Support team assist? a.Application and Enrollment b.Onboarding and Certifications c.Commissions d.All of thes - Answerd. All of these Members who fail to pay the required premiums before the end of the grace period (Wellcare has a three-month grace period) will be terminated. True False - AnswerTrue CVS Caremark Mail Order will be in-network for 2024. True False - AnswerFalse Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? a.Classic b.Value Script c.Value Plus - Answerc. Value Script ____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. a.Two b.Three c.Four d.Five - Answerb. Three 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. a.Three b.Five c.Ten d.Zero - Answerd.Zero Wellcare's _____ plan is designed for Low-Income Subsidy members. a.Classic b.Value Plus c.Value Script - Answera. Classic Wellcare continues to expand its reach by offering more products in a wider geography. ____ new Wellcare plans are going to market. a.Twenty-three b.Twenty-seven c.Thirty-five - Answera. Twenty-three Which of the Prescription Drug Plan (PDP) products is new to the 6-tier formulary structure for 2024? a.Classic b.Value Script c.Value Plus - Answera. Classic