The dates for the SEP for Non-Renewal are December 8 - end of February. Why is it important for agents to offer guidance for provider selection? When enrolling a member into an Optional Supplement Benefit (OSB), what should agents be sure to tell the member about the premium payment method? It is January 15th and you are speaking with Mr. Green. We will also help you in every step of your health journey. The purpose of the Non-Discrimination notice is to inform people about their ability to receive information in another language and give directions on how to file a complaint should they feel they have been discriminated against. Agent Chris did not pass the final exam on his first try. Explain that his only opportunity to make a plan change is during the Annual Election Period (AEP). Which of the following is the best example of what an agent should do to explain a plan's drug benefit? If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800 â¦ 1, 2019-- Humana Inc. (NYSE: HUM) will release its financial results for the second quarter 2019 (2Q19) on Wednesday, July 31, 2019 at 6:30 a.m. eastern time.The company will host a conference call at 9:00 a.m. eastern time that morning to discuss its financial results for the quarter and earnings guidance for 2019. Agent Juan should advise Mrs. Maples that she will need to select another PCP since Dr. Grayson is not listed as an in-network provider. Carol is speaking with Agent Tomas. Dr. Grayson is part of the American Medical Group. Which of the following is not an automated payment option for Humana Medicare enrollments? Note: questions about passing the final exam are only in this practice exam. Agents may provide guidance to members about providers who excel at value-based care that could improve member health outcomes. Do you qualify for Extra Help with Medicare costs? Agents are responsible for all applicable insurance licenses and any applicable certifications required to sell a corresponding Humana product in all states in which the agent markets such products, ICEP is for enrollment into MA/MAPD only. He wants to enroll all of them in Medicare Advantage Plans during AEP. These services may be covered at no out of pocket cost to you when you visit a PCP in your health plan’s network. Agent move notification letters sent to members and prior members. Under what circumstances is it Under what circumstances is it acceptable for an agent to complete an Agent Online Application, or AOA , application on behalf of their client? Can agents create their own Medicare marketing materials, such as letters and flyers? It is October 2nd and you, the agent, are speaking with Doris. select an automated payment method to pay their monthly premium. How can agents help reduce paper applications being denied due to improper election type code? To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? For complete benefit details, refer to your plan’s Individual Medical Policy. Use Humana's Physician Finder Plus to see if the provider is in Humana's network. Saturday, from 8 a.m. to 6:30 p.m. Eastern time. He currently has a MAPD plan with ACME Co. and wants to enroll in a CarePlus MAPD plan. When enrolling a beneficiary into a plan with prescription drug coverage, which of the following should agents do to avoid issues with any applicable Late Enrollment Penalty? Because the FCC requires prior express written consent to contact a prospect or member via their cell phone. Initial Coverage Enrollment Period (ICEP) can be used to enroll beneficiaries into which plans? once per year). For details on â¦ Review the agent guidance manual before making another attempt. Learn how to keep it looking youthful. Select the statement below that best completes the following sentence. Talk to your doctor about your physical activity. Use Humana's RX look up tools to determine if a medication is on Humana's formulary. Talk to your doctor about clinical breast exams. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. How would you respond to Mrs. Damon? If you’re newly-eligible or looking to switch plans, our Medicare plans include all-in-one Medicare Advantage plans, standalone Part D drug plans, and Medicare Supplement plans. Of course, if a beneficiary has another valid election period (i.e., IEP, SEP) available during this time, enrollments can be completed. Asking the beneficiary to consult with their doctor or pharmacist to obtain generic medications that are covered on the formulary. Agents can NOT perform AEP enrollments during the pre-AEP period, per CMS. Humana Reports Fourth Quarter 2019 Financial Results; ... Net income was $2.7 billion for 2019 compared to $1.7 billion in 2018 and earnings per diluted common share increased $7.94 from $12.16 earnings per diluted common share in 2018 to $20.10 earnings per diluted common share in 2019. View plan provisions or check with your sales representative. Which of the following is an advantage for new members when they pre-register with Humana Pharmacy? He is only licensed in Montana. If you shop at one of our Humana Pharmacy retail locations and have a question, we're here to help. The benefit allows for one annual routine hearing exam at no cost to the â¦ Visit Humana.com for 24 hour access to information like claims history, eligibility, and Humanaâs drug list. Our dental plans, vision plans, and life insurance plans may also have waiting periods. Medical Plans. To avoid a lapse in coverage, the beneficiary must enroll on or before the last day of the month of the move. Your costs in Original Medicare You pay nothing for this test when you get it from a laboratory, pharmacy, doctor , or hospital, and when Medicare covers this test â¦ No. By submitting this form, the pharmacist may be able to have the medication covered by Humana. About Humana. A new PCP is selected. Mrs. Maples wants to select Dr. Grayson as her PCP. Get help and learn about using your benefits, how insurance works, and more. Is it permissible for agents to select a new PCP based on the belief that the provider will be joining the Humana in the near future? Agents must ensure that members understand how their plan's drug benefits, including important benefits such as drug tier information. Talk to your doctor about your risks and which test and schedule is best for you; most recommend a yearly fecal occult blood test, a flexible sigmoidoscopy every five years, or a colonoscopy every 10 years. 99% of Humana members who terminate for non-payment of premium do not ___________________. CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. Fill in the blank. What is the purpose of the Non-Discrimination notice that is included in many of Humana`s marketing materials? Individuals who belong to a qualified SPAP are eligible for an SEP to make one enrollment request at any time through the end of each calendar year (i.e. There are 13 new CLIA-waived tests effective April 1, 2019. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, or Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. On-site pharmacy information. Mr. Simpson has misplaced his new Medicare ID card and does not know his new Medicare ID number. Explain that because she has called during the Medicare Advantage Disenrollment Period (MADP), she is eligible to disenroll from her current plan and enroll in a stand-alone PDP. Nicky must be complete a new form within 30 days. Talk to your doctor about your risks and which Pap testing schedule is best, especially if you’ve had a hysterectomy or are 65 or older. Which enrollment period can Agent Tomas use? Tell him that he has the Open Enrollment Period (OEP) available and proceed with the enrollment. SEP can only be used (if a valid SEP exists) because Carol has delayed Part B and is enrolling after her Part B effective date. Note: questions about passing the final exam are only in this practice exam, The agent clicks the test submit button or the test timer reaches 35 minutes. He can enroll the family members that live in Montana only. When is the annual Open Enrollment Period (OEP) available? On Jan. 1, 2019, Humana will update its preauthorization and notification lists, opens new window for all commercial fully insured, Medicare Advantage (MA) plans and dual Medicare-Medicaid â¦ Advise Mrs. Maples that she will need to select another PCP since Dr. Grayson is not listed as an in-network provider. Jan. 1, 2019, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List â English, PDF opens in new window. She is requesting to enroll in a Humana Medicare Advantage plan today. The Investor Relations website contains information about Humana Inc.'s business for stockholders, potential investors, and financial analysts. How you sleep, eat, and relax can impact your skin. LOUISVILLE, Ky.--(BUSINESS WIRE)--Jul. What is the preferred way to determine if a provider is in network? Find budget-friendly plans for your company’s most valuable asset: your employees. What are the dates for the SEP for Non-Renewal? Generally, Humana will only approve a request if a covered medicine wouldn't work as well OR would have a negative effect on your health. Carol delayed Part B and wants to enroll in a Humana MA plan (No RX). Which of the following actions should be avoided when completing spousal enrollments? Agent Todd is completing an HMO enrollment with Mrs. Valdez and she asks if she can select Dr. Ayers as her PCP. Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. Arizona residents insured by Humana Insurance Company. Sales agents must conduct the sales presentation in its entirety for telephonic presentations. The annual OEP is available January 1st - March 31s. Use Humana's Physician Finder Plus to see if the provider is in Humana's network. Preventive care keeps you healthy, prevents illness and detects disease in the early stages –when it’s easier to treat. The agent clicks the test submit button or the test timer reaches 35 minutes. To receive these preventive services, make an appointment with your doctor and bring this checklist to talk about which screenings you may need. Taxes will be applied to all applicable prescription and over-the-counter (OTC) orders. From October 15 to December 7, which election periods may be used? If your doctor feels there is no other covered option, he or she can call Humana Pharmacy Clinical Review at 1-800-555-2546 to ask for an exception. In which of the following situations is it acceptable to create an Email address for a beneficiary? Agent Deborah is enrolling a beneficiary into a Humana Medicare Advantage plan. The HumanaChoice H5216-043 (PPOâ¦ Agent James is enrolling a prospect into a Humana Medicare Advantage plan and it is time to choose a PCP. Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800 â¦ How should Agent Juan handle this situation? Talk to your doctor about your risks and which test and schedule is right for you. When a beneficiary moves out of a plan`s service area, when must they enroll into a plan servicing the new area to avoid a lapse in coverage? Which of the following is considered marketing material and requires CMS approval ? Find an affordable healthcare plan for yourself and your loved ones. Here are suggested guidelines for screenings and checkups for healthy adults. You are speaking with Mrs. Damon on February 3rd and she is requesting to disenroll from the MA-only HMO plan. We will reply within 24 hours after we get your doctors request. Which of the MA-only plans below can be combined with a stand-alone PDP? A 9-12 hour fast is required. How should you respond to Doris? When it comes to Dual Eligible SNPs, it is imperative the dual eligible beneficiary is aware of ... All plans available in their area emphasizing those plans that best meet the beneficiary's needs. Jim is eligible to join a Medicare Advantage plan without drug coverage for the first time. No, because agents may never suggest that a provider is or may be joining Humana's network. Go365 rewards up to $300 per member per year in redeemable gift cards for completion of preventive screenings and participation in healthy habits. What should he do? Agent Ben knows that Dr. Mendez is in network for a PPO plan in a particular service area. In the event of a dispute, the policy as written in English is considered the controlling authority. Before completing the enrollment, agents should take the time to perform a thorough review all features and benefits of the plan and make them understandable to the beneficiary, Agents should encourage members to receive their plan documentation digitally at the time of enrollment. Agent Deborah must explain in and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP. Agent Juan is enrolling Mrs. Maples into a HMO plan. There you can also use the physician finder and get health news and information. Exams include a digital rectal exam and a prostate-specific antigen test (PSA). Upon discovery, how will Humana respond? Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is _________. What must Agent Deborah explain about the new PCP? Which of the following is considered marketing material and requires CMS approval? Go365® is not an insurance product. When a member selects a PCP when enrolling into a plan, what must agents explain about their PCP? He is meeting with Agent Wayne and Oscar is requesting to enroll in a Humana MAPD plan in the 3 months prior to his Part B effective date. Note: questions about passing the final exam are only in this practice exam. Agents must have a valid resident or non-resident license and any required appointments issued from a state where the Medicare beneficiary permanently resides in order to market or sell a Humana MA and/or PDP plan. For dates of service prior to April 1, ... to have COVID-19, and the test results for the exposed individual are either unknown or negative. How long does Agent Nicky have to complete a new Conflict of Interest Disclosure and Agreement form? Carol delayed Part B and wants to enroll in a Humana MA plan (No RX) plan 3 days after her Part B effective date. TTY users should call, 1 â¦ John is an agent who has older family members on Medicare and living in several different states. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana â¦ Agent Anna is not licensed in Nebraska. Asking the beneficiary to consult with their doctor or pharmacist to obtain generic medications is not an acceptable explanation of the plan's drug benefit, What constitutes an "attempt" on Humana`s final exam? If you have cardiovascular problems or diabetes, you may need a test every year. It is never acceptable under any circumstance for an agent to complete the AOA application on behalf of their client, even if they request it. Agent Todd can't. Choose the answer that best explains the Telephonic Presentations policy. When enrolling Mary into an HMO plan for the same service area, Mary wants to select Dr. Mendez as her PCP. If you have diabetes, these tests are recommended yearly: HbA1c test, LDL cholesterol, kidney test and retinal or dilated eye exam, May need to be more often if you have high blood pressure or diabetes, Periodically as directed by doctor; around 65 years or older, May need frequent screening after a bone fracture or if you’re at high risk for osteoporosis, Every 2-4 years to age 64, then every 1-2 years after. once per year. Humana individual life insurance plans are offered in New York by Humana Insurance Company. You can reach us during the following hours: Monday through Friday, from 8 a.m. to 11 p.m., Eastern time. It is unclear if the provider is in Humana's network. Younger women should follow their doctor’s recommendations. Agents should advise beneficiaries that they need to respond promptly to Humana's request for Creditable Coverage, if applicable. Limitations and exclusions. Not available with all Humana health plans. Doris has an SEP from her permanent move to Los Angeles. Doris tells you that she moved to Los Angeles last month to be near her grandchildren. Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc. Humana group life plans are offered by Humana Insurance Company or Humana Insurance Company of Kentucky. The Telephonic Presentations policy provides guidance for licensed, appointed and certified sales agents representing a Humana Medicare Advantage (MA), in a non-call center setting, to perform a compliant telephonic Medicare sales presentation, Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is, For events advertised to the general public, a Scope of Appointment (SOA) is not required, as the advertisement serves as a collective SOA. HumanaChoice H5216-043 (PPO) H5216-043 is a 2019 Medicare Advantage or Medicare Part-C plan by Humana available to residents in Texas. Mr. Sampson tells Agent Ted that he is familiar with. This plan includes additional Medicare prescription drug (Part-D) coverage. Agent Grace is enrolling Lamar into a Humana Medicare Advantage plan and asks him if his phone number is a. Which of the following statements best describes Go365? Form 8-Ks filed during 2019. When a member selects a Primary Care Physician (PCP) when enrolling into a plan, what must agents explain about their PCP? The agent should use the exact same Medicare ID number and election period for both applications so that CMS can process the applications together and label them as spousal enrollments. Agents can assist members requesting a PCP change and take action on their behalf. Original review: Dec. 1, 2020. Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state. Agents not using Humana's Physician Finder tool correctly. He enrolled into Part B after the expiration of his IEP. What can he do according to CMS? 1 Fact Sheet - 2020 Part C and D Star Ratings Note: The information included in this Fact Sheet is based on the 2020 Star Ratings published on the Medicare Plan Finder on October 9, 2019. She tells Agent Sarah that she would like to enroll in a MA-only (no RX). Call 1 â¦ Agent James is enrolling a prospect into a Humana Medicare Advantage plan and it is time to choose a PCP. How should you guide Mr. Green? Encourage all members to receive their plan documentation digitally at the time of enrollment. Call 1-800-379-0092. Which of the following was identified as a top reason for Humana agent complaints in PY17? Mrs. Maples wants to select Dr. Grayson as her PCP. What is it called when an agent guides a member towards a particular provider because it is in the best interest of the provider or agent (versus the member`s best interest)? Is this acceptable? Letters sent by agents to current and prior members announcing the agent has changed agencies. To ask for an approval, your health care provider can contact HCPR (Humana Clinical Pharmacy Review) at 1 â¦ covers a test to see if you have coronavirus (officially called coronavirus disease 2019 or COVID-19). This communication provides a general description of certain identified â¦ You can expect your refills to arrive 5 to 7 days after placing your order. The premium payment option that was selected for the base MA/MAPD plan will be used to pay the monthly OSB plan premium. She recently picked up a second job working at Dr. Singh`s office on nights and weekends. Tamara is aging into Medicare and is in her 7 month initial election period. Talk to your child’s doctor about the vaccine, which protects against cancers caused by HPV infection. How can agents help Humana members receive less mail and have convenient, on-line access to plan documentation? MA enrollees using the Medicare Advantage Disenrollment Period (MADP) to disenroll from their MA plan are eligible for a SEP to enroll in... How many questions are on Humana`s final exam and what material do they test on? Select the statement below that best completes the following sentence. once per year). Test Interpretation and Feedback Previously, BrainCheck â¦ What should he do? When is the Medicare Advantage Disenrollment Period? You can expect your refills to arrive 5 to 7 days after placing your order. Agent Martha is completing an MAPD enrollment for Mr. Simpson. If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800 â¦ Humana dental in Illinois has been nothing but painful for this past year. Fax: 1 (800) 555-2546; Phone: 1 (877) 486-2621; Humana â¦ The modifier QW CLIA waived test â¦ Individuals who belong to a qualified State Pharmaceutical Assistance Program (SPAP) are eligible for an SEP to... Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. Our successful â¦ Initial Coverage Enrollment Period (ICEP). Agent Nicky conducts educational events at Dr. Singh`s office throughout the year. Which of the following actions is prohibited by Humana and CMS? Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Applicable tax or taxes will be applied to all applicable prescription orders. According to recent CMS guidance, which of the following plan changes is NOT allowed during the annual OEP? Agents cannot use the ICEP election to enroll into a PDP. The final exam consists of 20 questions over material in the Agent Guidance Reference Manual. Agents should read through the SEPs listed on page five of the paper application and select any that apply, It allows members to obtain pricing for medications based on their future effective date. Your health care provider can also ask Humana to make an exception. Jan. 1, 2019, Commercial Preauthorization and Notification List â English, PDF opens in new window. If youâre performing a test that detects the flu via immunoassay in the office, your provider might test for two The 87804 code represents âa testing â¦ SEP can only be used (if a valid SEP exists) because Carol has delayed Part B and is enrolling after Part B effective date. For detailed information about Humanaâs claim payment inquiry process, review the claim payment inquiry process guide (300 KB)., PDF opens new window. The following links are intended to facilitate documentation and coding diagnoses and services that are provided to patients with Humana â¦ Which enrollment period should Agent Wayne select for Oscar's application? To assist enrollees and members in making an informed decision about providers that help members achieve the best possible health outcomes. Why are agents required to ask if the phone number being provided on an application is a cell phone number? The Center for Medicare & Medicaid Services (CMS) announced in CR11080 that these apply to facilities with a CLIA certificate of waiver. They said... Humana - Complaint Oct 13, 2019 â¦ To be compliant with state and local regulations, what change will Humana Pharmacy members see to their. What enrollment period will he use? and Saturday 8 â¦ Eye exams for glaucoma and macular degeneration—to common age-related conditions.
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