Agent Grace is enrolling Lamar into a Humana Medicare Advantage plan and asks him if his phone number is a. Agent Todd is completing an HMO enrollment with Mrs. Valdez and she asks if she can select Dr. Ayers as her PCP. Review the Agent Guidance Reference Manual before making another attempt. What is the purpose of the Non-Discrimination notice that is included in many of Humana`s marketing materials? 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. Mr. Simpson has misplaced his new Medicare ID card and does not know his new Medicare ID number. Exam should include measuring your weight, height, and body mass index (BMI). Tell Mrs. Valez that Dr. Ayers is not listed as an in-network provider and request that she select another in-network PCP. Many Humana Gold Choice Plans combine all the benefits of Original Medicare with prescription drug coverage and more.-Affordable monthly plan premium 40 coverage for most annual screenings.-Humana … Which of the following statements is true regarding the Primary Care Provider (PCP) Change form? What should he do? ... ACCU-CHEK AVIVA PLUS TEST … He can enroll the family members that live in Montana only. It is January 15th and you are speaking with Mr. Green. Jan. 1, 2019, Part B Step Therapy Preferred Drug List – English, PDF opens in new window. What is the preferred way to determine if a provider is in network? He should explain that a full presentation of benefits is important and that it is a required for every enrollment. Agent Ted is completing an enrollment with Mr. Sampson. How should agent Martha handle the enrollment? A new PCP is selected. Note: questions about passing the final exam are only in this practice exam. Original review: Dec. 1, 2020. Agent James is enrolling a prospect into a Humana Medicare Advantage plan and it is time to choose a PCP. How can agents help reduce paper applications being denied due to improper election type code? Ben tells Mary that he knows Dr. Mendez in network for Humana plans and does NOT check Humana`s Physician Finder Plus. The premium payment option that was selected for the base MA/MAPD plan will be used to pay the monthly OSB plan premium. Agent Chris did not pass the final exam on his first try. Jim is eligible to join a Medicare Advantage plan without drug coverage for the first time. 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. Select the statement below that best completes the following sentence. Which of the MA-only plans below can be combined with a stand-alone PDP? 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. once per year. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker. Agents must explain In and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP. This information is available for free in other languages and formats. QW is Key to CLIA Waived Test Codes. Carol is speaking with Agent Tomas. Which enrollment period should Agent Sarah select for Tamara`s application? If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800 … Is this acceptable? 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. If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800-379-0092 (TTY: 711), Monday to Friday 8 a.m. to 11p.m. We will also help you in every step of your health journey. 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 shop at one of our Humana Pharmacy retail locations and have a question, we're here to help. Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. 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, 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. About Humana. The Investor Relations website contains information about Humana Inc.'s business for stockholders, potential investors, and financial analysts. In the event of a dispute, the policy as written in English is considered the controlling authority. 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. Medical Plans. Humana individual life insurance plans are offered in New York by Humana Insurance Company. Agents can NOT perform AEP enrollments during the pre-AEP period, per CMS. Find an affordable healthcare plan for yourself and your loved ones. Agents can assist members requesting a PCP change and take action on their behalf. Here are suggested guidelines for screenings and checkups for healthy adults. Which of the following actions can help agents avoid complaints about Benefits and Presentation? Jan. 1, 2019, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English, PDF opens in new window. Talk to your doctor about your risks and which test and schedule is right for you. To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? Agents not using Humana's Physician Finder tool correctly. Eye exams for glaucoma and macular degeneration—to common age-related conditions. LOUISVILLE, Ky.--(BUSINESS WIRE)--Jul. It is never acceptable under any circumstance for an agent to use their own email address for an applicant, even if they request it. Find budget-friendly plans for your company’s most valuable asset: your employees. According to recent CMS guidance, which of the following plan changes is NOT allowed during the annual OEP? Texas residents insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits). To ask for an approval, your health care provider can contact HCPR (Humana Clinical Pharmacy Review) at 1 … Limitations and exclusions. What must Agent Deborah explain about the new PCP? A 9-12 hour fast is required. Our promise is to provide more than health insurance plans. 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. 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. Get help and learn about using your benefits, how insurance works, and more. Submit by fax to 1-888-447-3430 Submit by telephone at 1-866-461-7273 All Humana MA Members: For procedures or services that are investigational, experimental or may have limited benefit coverage, or for questions regarding whether Humana … He wants to enroll all of them in Medicare Advantage Plans during AEP. Choose the answer that best explains the Telephonic Presentations policy. You are speaking with Mrs. Damon on February 3rd and she is requesting to disenroll from the MA-only HMO plan. 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? CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. Do you qualify for Extra Help with Medicare costs? Why is it important for agents to offer guidance for provider selection? In your form, you will need to explain your rationale for making this request, including a clinical justification and referencing any relevant lab test results. She is requesting to enroll in a Humana Medicare Advantage plan today. 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. The website is maintained outside of New York state and the insurer is not authorized to transact the business of insurance in New York. The MA/MAPD enrollment request is made prior to the Part B effective date. It is unclear if. Nicky must be complete a new form within 30 days. Explain that his only opportunity to make a plan change is during the Annual Election Period (AEP). For group plans, please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description/Administrative Services Only) for more information on the company providing your benefits. 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. Agent Juan is enrolling Mrs. Maples into a HMO plan. 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. Initial Coverage Enrollment Period (ICEP). Sales agents must conduct the sales presentation in its entirety for telephonic presentations. She tells Agent Sarah that she would like to enroll in a MA-only (no RX). The HumanaChoice H5216-043 (PPO… In which of the following situations is it acceptable to create an Email address for a beneficiary? Select the statement below that best completes the following sentence. Learn about enrolling in your employer plan and find resources and support to make the most of your benefits. Jan. 1, 2019, Commercial Preauthorization and Notification List – English, PDF opens in new window. How should Agent Juan handle this situation? Which enrollment period can Agent Tomas use? Humana may terminate upon discovery and report incidences of submission of applications by unlicensed agents and brokers to the authority in the State where the application was submitted as well as to CMS. For complete benefit details, refer to your plan’s Individual Medical Policy. Carol delayed Part B and wants to enroll in a Humana MA plan (No RX). Call 1-800-379-0092. The flu vaccine protects against the influenza viruses that will be the most common during the upcoming flu season. Of course, if a beneficiary has another valid election period (i.e., IEP, SEP) available during this time, enrollments can be completed. 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. It is unclear if the provider is in Humana's network. We also … Our dental plans, vision plans, and life insurance plans may also have waiting periods. The benefit allows for one annual routine hearing exam at no cost to the … ​To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? What are the dates for the SEP for Non-Renewal? Initial Coverage Enrollment Period (ICEP) can be used to enroll beneficiaries into which plans? For dates of service beginning April 1, 2020, use the new code published by the CDC, as appropriate (New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), April 1… 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. Tell him that he has the Open Enrollment Period (OEP) available and proceed with the enrollment. How should you respond to Doris? Because the FCC requires prior express written consent to contact a prospect or member via their cell phone. View a complete list of the legal entities that offer, underwrite, administer or insure insurance products and services. Which of the following statements best describes Go365? 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. Tamara is aging into Medicare and is in her 7 month initial election period. You can expect your refills to arrive 5 to 7 days after placing your order.

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