Wellcare ACT Mastery – Broker and Employee Practice Exam

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• Why should clients check the provider directory before choosing a plan?
• Which statement about SEP eligibility best describes when it applies?
• How do Scope of Appointment and Medical Information Release forms differ in Medicare sales?
• Are grievance procedures separate from initial determination and appeal procedures?
• In electronic communications, when must the TPMO disclaimer be conveyed?
• How many states offer Wellcare Mutual of Omaha co-branded plans?
• What protections does HIPAA provide to consumer health information?
• Why is provider directory accuracy critical and how is it maintained?
• What is a provider directory and why is its accuracy important?
• What complexities arise with dual eligibility (Medicare and Medicaid) in plan selection?
• In what system is the Health Risk Assessment (HRA) completed after the enrollment application?
• What does an HRA help to prevent?
• What documentation is typically required to demonstrate compliance after client interactions?
• How do Part D deductibles typically affect drug coverage within a PDP?
• What are best practices for appointment scheduling and care coordination with WellCare members?
• Which document informs members of changes for the next year?
• Which statement best reflects the role of digital tools in member support?
• In Medicare Part D, which party contributes to discounts that reduce out-of-pocket costs in the coverage gap?
• What is crucial to ensure credit for submitted applications?
• How can a broker verify a client's current coverage to determine SEP eligibility?
• What constitutes an acceptable Timeframe for a requested effective date regarding SEP?
• Which statement describes an external appeal?
• Compare access to providers under HMO vs PPO plans.
• What is the purpose of prior authorization in drug coverage?
• Which statement is true regarding the Health Risk Assessment (HRA) process?
• Is Wellcare required to be informed of informal marketing or sales events where plans or materials are presented?
• Which option correctly sequences the typical enrollment steps for a WellCare MA/MAPD plan?
• What is ERISA and how does it relate to most employer-sponsored health plans?
• What is the Medicare Annual Election Period (AEP) and when does it occur?
• What is a formulary in the context of health plans?
• What element is necessary when accessing compliance resources on the Centene Workbench?
• When outlining plan benefits and costs, which approach is recommended?
• What does a 1095-B form represent and who typically receives it?
• Which item is NOT typically required to demonstrate compliance after client interactions?
• Under the MA Open Enrollment Period, which action is allowed?
• What is the expected number of total pharmacies in the Prescription Drug Plan (PDP) network?
• Which of the following can prompt an investigation on Brokers/Agents for noncompliant activities?
• How is a grievance request submitted?
• Which Prescription Drug Plan (PDP) is recommended for a dual-eligible chooser?
• From October 1 to October 14, what activities are not permitted for 2025 sales and enrollments?
• Will all Traditional Medicare Advantage Prescription Drug (MAPD) plans offer $0 copay for preventive vaccines?
• Name three common Special Enrollment Period triggers for Marketplace enrollment.
• Differentiate between a grievance and an appeal in health plans.
• Which of the following is a type of support service brokers discuss that involves coordinating care across providers?
• How should a broker handle a request to substitute a prescribed brand-name drug with a generic due to cost?
• If you enroll in a MAPD plan, does it include Part D coverage?
• When must all marketing materials be updated to reflect current year offerings?
• Which statement is true about a Special Enrollment Period (SEP)?
• What can result from failing to inform a beneficiary about an out-of-network trusted provider?
• What does a higher CMS Star Rating indicate about plan performance?
• How does a provider directory affect plan choices and member access?
• What are drug tiers in Medicare plans?
• Are compliance allegations addressed uniformly, regardless of the severity of the issue?
• How long are enrollment records typically retained for compliance?
• What is transition of care and why is it important when a member changes plans?
• Which plan type is commonly used to coordinate Medicare and Medicaid when dual eligibility exists?
• What is the purpose of a Health Risk Assessment (HRA)?
• What is the impact of provider directory accuracy on member costs and access?
• Who receives a 1095-C form?
• What is the purpose of a Medical Information Release form in Medicare sales?
• A formal review of an Action (Denial) or Adverse Plan Determination related to Medicare is called what?
• Is final 2025 plan and benefit information allowed to be discussed with beneficiaries before September 30, 2024?
• What type of feedback mechanism is required for members or providers wishing to appeal a decision?
• What is the purpose of the 1095-C form?
• Which of the following resources is included as part of member support services?
• Which actuarial value best represents a Bronze plan?
• What is the most accurate statement about network adequacy in a health plan?
• Which phase is NOT included in the new Part D benefit design effective 2025 according to the Inflation Reduction Act?
• Which statement about prescription drug cost-sharing is false?
• Which option is NOT listed as a member support service brokers should discuss?
• What is a formulary and why must brokers verify a client’s medications against it?
• What is the fundamental distinction between stand-alone PDPs and MAPD plans?
• What is the primary purpose of keeping accurate notes and consent forms after client interactions?
• What is the overall goal of discussing care management, wellness programs, digital tools, and member assistance resources with members?
• Which statement best describes Scope of Appointment in Medicare plan discussions?
• How are emergency services handled when the provider is out-of-network?
• What is the ANOC and why is it significant for members?
• What is required to be displayed prominently on TPMO websites?
• Which statement best describes SEP eligibility in Medicare?
• What does a Special Enrollment Period (SEP) allow in MA/MAPD enrollment?
• Name one key marketing compliance requirement for WellCare brokers.
• What must a Third-Party Marketing Organization (TPMO) do when selling plans for more than one Medicare Advantage (MA) provider?
• Which practice helps prevent misperceptions about plan benefits and costs?
• What is a plan's service area and why must brokers confirm it with clients?
• In which two states did Wellcare launch new tiered provider plans?
• What should a broker/agent cover before starting the enrollment process?
• What elements are included as part of Wellcare's sales support model?
• Which form is used to reconcile Premium Tax Credits on taxes?
• A Low-Income Subsidy (LIS) member could be assigned to how many copay categories based on need?
• What is prior authorization and which party makes the decision?
• What is a formulary exception and how is it obtained?
• What is a CMS Star Rating and how should brokers use it when counseling clients?
• What is one benefit of the Wellcare Mutual of Omaha co-branded plans?
• In a Marketplace plan, what is a formulary?
• Should brokers/agents confirm a beneficiary's primary care provider and specialists before enrolling them?
• What is the primary purpose of the Evidence of Coverage (EOC) and Summary of Benefits (SB) documents?
• Are disciplinary actions resulting from compliance allegations typically progressive?
• Which statement correctly describes how Part D costs are determined?
• What is prior authorization and when is it typically required?
• What aspect of member care does a Health Risk Assessment (HRA) primarily address?
• Which of the following is NOT a focus of the Health Risk Assessment (HRA)?
• Which combination of services should brokers discuss to support members?
• A standalone Medicare Part D prescription drug plan (PDP) is designed to provide drug coverage for eligible individuals. Who is eligible to enroll in a PDP?
• Which types of inquiries can Wellcare's Corporate Office support team assist with?
• Which statement best reflects how brokers should handle marketing content approvals?
• Are preventive services covered at no cost-sharing in ACA plans when using in-network providers?
• Which statement best describes the plan service area?
• What is the difference between ERISA-covered group plans and non-ERISA plans?
• What does the out-of-pocket maximum mean in Medicare Advantage plans?
• What does out-of-pocket maximum (OOPM) mean in plan design?
• What is the primary goal of the Inflation Reduction Act as it pertains to Medicare?
• Which item is listed as a member support resource?
• Will the Wellcare Spendables™ Card include Home Improvement and Safety Items on select D-SNPs starting from PY2025?
• Is it true that Wellcare allows brokers to save copies of the enrollment applications?
• Why is it important for a grievance to be filed promptly?
• Which item would not typically be included in enrollment disclosures?
• What is the broker’s primary responsibility when presenting plan options to a client?
• What does HIPAA’s Privacy Rule primarily protect?
• What should be the focus of the discussion during the Pre-Enrollment Checklist (PECL) review?
• How often should compliance reporting occur for brokers/agents?
• What is not a requirement when contacting a beneficiary about noncompliant activity?
• What is emphasized in the Wellcare Spendables™ Card for the D-SNPs program?
• What is the time frame within which an Election Period Request for Information (RFI) must be resolved?
• When emergency services are provided at an out-of-network facility, how is cost-sharing typically determined?
• If a drug is not on the formulary, what may be required to obtain coverage?
• What is the potential consequence for brokers who engage in noncompliant activities?
• Does the grievance request need to be documented in writing?
• How should the TPMO disclaimer be conveyed during a sales call?
• How should marketing messages convey company values to members?
• Where will the CustomPoint® sales material order dates be posted?
• When contacted regarding an allegation of noncompliant activity, which action must be taken?
• What does MAPD stand for and what is its scope?
• Which statement best describes a formulary in a Part D plan?
• Who typically receives the 1095-B form?
• Which action is specifically about obtaining proper documentation during enrollment?
• Is the online Member Portal available on weekends?
• What is the purpose of the annual Open Enrollment Period?
• Which marketing standard must brokers follow when presenting WellCare plans?
• When a client asks about changing plans mid-year, what steps should you take?
• Which step corresponds to ensuring enrollment accuracy by confirming alignment of the plan with the member's needs?
• During a Special Election Period (SEP), what is essential when requesting an effective date?
• How do internal and external appeals differ in the review process?
• What must the disclaimer from a TPMO be?
• When transportation barriers affect access to care, what is the recommended broker response?
• How should a broker handle PHI to protect member privacy?
• In MAPD plans, is there any copay required for Tier 6 prescriptions?
• What is the appropriate ethical approach when a client asks for non-disclosed hidden benefits?
• What should be done after completing the enrollment application?
• During enrollment, which notifications and disclosures are required?
• What should brokers avoid stating beyond policy terms?
• What is the Medicare Part D coverage gap (donut hole) and how does it affect members?
• What is the new threshold for out-of-pocket prescription drug costs in Medicare under the Inflation Reduction Act effective 2025?
• What is a pharmacy network and why is it important for drug coverage?
• How long do Special Enrollment Periods (SEPs) typically last after a qualifying event?
• How many new plans will Wellcare introduce to the market in 2025?
• What is the key difference between a copayment and coinsurance in a health plan?
• What is a formulary in Medicare Part D?
• What is the purpose of the EOC in communicating plan rights and obligations?
• List the four ACA metal levels and identify Bronze plan actuarial value.
• What does a '$0 premium' plan imply and what should brokers clarify to clients?
• What is the purpose of Advanced Premium Tax Credits (APTC) in the ACA Marketplace?
• What is the primary role of the Pre-Enrollment Checklist (PECL)?
• Which statement best describes the Evidence of Coverage (EOC) and Summary of Benefits (SB) in WellCare plans?
• Which of the following is an example of a prohibited marketing practice under CMS guidelines?
• What is interoperability in health IT and how does it impact WellCare members?
• What is the time frame for the Annual Enrollment Period (AEP) and what actions are allowed?
• What is one of the outcomes that a Health Risk Assessment (HRA) aims to achieve?
• MAPD plans combine Medicare Advantage with integrated prescription drug coverage. Which description best reflects this integration?
• How should PHI be handled during enrollment conversations?
• What is a standard onboarding step for new members in WellCare programs?
• What is a potential consequence of not confirming a beneficiary's intent to enroll?
• What is step therapy and how might it affect drug coverage?
• Are members required to pay a partial deductible due to the Inflation Reduction Act?
• What are disease management and care coordination and why are they important for WellCare members?
• Which action helps ensure enrollment accuracy during a sales interaction?
• What does Wellcare accept as methods for capturing and submitting Scopes of Appointment (SOAs)?
• What type of access does the Single Sign-On Portal provide?
• How does employer-offered coverage interact with MA/MAPD enrollment rules?
• Is marketing benefits in a service area where those benefits are not available allowed?
• Which statement about Special Enrollment Periods (SEP) is true?
• To prevent misperceptions about plan benefits and costs, what approach should a broker take?
• What is Scope of Appointment (SOA) and why is it required in Medicare sales?
• What best describes Cost-Sharing Reductions (CSR) in the ACA Marketplace?
• A grievance request must be filed no later than how many calendar days from the date of the event?
• When moving to a new residence, what must a broker verify to determine eligible plan options?
• What is step therapy and how does it impact drug coverage?
• How does a Medicare Part D plan determine drug costs and coverage?
• What impacts the type of inquiries the Corporate Office support team handles?
• Which statement regarding CustomPoint® features is FALSE?
• How should brokers address social determinants of health in enrollment conversations?
• What is a 1095-A form and who issues it?
• Which Prescription Drug Plan (PDP) has the richest formulary with the most adherence-generics on Tier 1?
• What aspect of member plans was positively impacted by the Inflation Reduction Act?
• Why is a Scope of Appointment important before Medicare plan discussions?
• What must be indicated when self-reporting a compliance issue?
• Can the names and logos of provider co-branding partners be displayed on marketing materials?
• How do drug tiers affect member cost-sharing?
• How do you differentiate a grievance from an appeal in Medicare plan terms?
• Which of the following statements is true regarding marketing materials that include plan comparisons or cost sharing?
• How does Original Medicare differ from Medicare Advantage (Part C)?
• Which factor primarily determines the actuarial value category of a health plan?
• What is the Medicare Initial Enrollment Period (IEP) and its duration?
• Which practice aligns with proper handling of PHI during enrollment conversations?
• How does the Part D donut hole discounts work in practice?
• Which pharmacy is Wellcare's Preferred Mail Order pharmacy?
• What are drug tiers and how do they impact cost sharing?
• What resources can brokers/agents access under the Shared Resources section in Centene Workbench?
• What is required before using any advertising material for WellCare plans?
• What is the role of a formulary in a Part D plan?
• What unique benefits do enrollments through Ascend offer?
• Can brokers/agents complete a Health Risk Assessment (HRA) directly in Ascend after an enrollment application?
• Do all three Prescription Drug Plans (PDPs) feature a five-tier formulary design?
• What is a primary focus of the new plans being released for Wellcare in 2025?
• Which of the following is a requirement for contracted brokers/agents under Centene's Ethics and Compliance program?
• How can grievances be prevented according to Wellcare guidelines?
• Through which channels do WellCare enrollment requests typically get submitted?
• How do WellCare and CMS marketing guidelines affect broker activities?
• Ascend is described as what in the context of broker/agent electronic enrollments?
• Which statement is true regarding Traditional Medicare Advantage Prescription Drug (MAPD) plans and Tier 6 copays?
• Which of the following is incorrect about marketing materials for multiple MA organizations?
• What is a provider directory and why must clients check it?
• What must a Third-Party Marketing Organization (TPMO) include in their marketing materials?
• Which statement about the Scope of Appointment (SOA) is FALSE?
• What does QMB stand for and how does it affect plan costs?
• Which practice best supports privacy and regulatory compliance in brokerage operations?
• What is coordination of benefits and when is it relevant?
• Regarding beneficiary-facing marketing materials developed by a TPMO for multiple MA organizations, what is true?
• During which period can MA and Part D plans be changed?
• Enrollment records retention is typically governed by policy and jurisdiction; what range is commonly cited?
• Are preventive services covered at no cost-sharing in ACA plans?
• In health plans, which action would be classified as an appeal?
• Which statement best describes the duration of Special Enrollment Periods after a qualifying event?
• What is the Extra Help (Low-Income Subsidy) program?
• Are brokers required to inform clients about the appeals process?
• Which of the following best describes wellness programs as a broker service?
• Why is compliance training essential for brokers?
• What populations does a Dual-Eligible Special Needs Plan (D-SNP) serve?
• What protections do brokers follow for protected health information (PHI)?
• Is the Pre-Enrollment Checklist (PECL) supposed to be provided after enrollment?