2025 AmeriHealth Caritas PABy Brian Platte / July 25, 2024 Keystone First VIP Choice covers Bucks, Chester, Delaware, Montgomery and Philadelphia counties and AmeriHealth Caritas VIP Care in Pennsylvania covers the remaining counties of Pennsylvania. True False Referrals are not needed for Specialist on both PA plans. True False SLMB Plus and QMB Plus members are responsible to pay their Part B premium. True False Some of the members will have to pay Part C cost-sharing, Part B premium, or deductible for these plans. True False Which key documents should an agent always have available when meeting a prospect? Attestation of Eligibility Enrollment Application Pre-Enrollment Checklist All of the above The supplemental benefits for both plans will include a Meal Benefit for those who have been discharged from Inpatient Hospital stay or Skilled Nursing Facility and received a referral. True False These plans offer the SilverSneakers fitness benefit. The benefit includes ____________. Access to participating SilverSneakers facilities Online wellness resources Classes All of the above If a member requires more than a 7-day supply of an opioid prescription, the member or his/her provider will have to submit a prior authorization demonstrating medical necessity for an opioid supply greater than a 7-day supply. True False The plans cover two dental X-rays every year. True False Members of both plans do not have a deductible for Part D drug. True False Members of both plans have 2-hour, 7 day a week access to a physician via the Telemedicine benefit. True False Cultural competence refers to the ability to demonstrate in a competent manner toward beneficiaries with diverse values, beliefs, and behaviors. What are the needs to be considered for effective cross-cultural communication? Economical, Educational, and Geographical needs Social, Cultural, linguistic needs These plans offers a combined annual coverage of $50,000 Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation. True False Prior Authorization is needed for the following services. Inpatient psychiatric hospital Home health Ambulatory surgical center services All of the above QMB+ members receive full Medicaid benefits. True False Both plans offer one year of provider follow-up visits with the purchase of the TruHearing's Advanced hearing aids. True False Which statement is true for Keystone First VIP transportation benefit? 72 one-way trips per year 35 one-way trips per year 100 one-way trips per year Unlimited one-way trips per year Will AmeriHealth Caritas VIP Care cover out of network providers? Yes No Which sentence is correct to describe the eligibility requirements to enroll in the plans? Live in the service area Enrolled in Medicare Part A and B Is enrolled in the Pennsylvania Medicaid program All of the above Which statement is true for AmeriHealth Caritas VIP Pennsylvania transportation benefit? 72 one-way trips per year 40 one-way trips per year 100 one-way trips per year Unlimited one-way trips per year ResultsVote
