2025 BCBS of South Carolin Medicare Certification Exam

A member has the right to access, inspect and copy his or her PHI.

Protected health information (PHI) includes names, addresses, birthdates, phone numbers, fax numbers, email addresses, Social Security numbers, medical record numbers, health plan numbers, account numbers, etc.

As a business associate, should a breach in privacy occur, you and your agency employees must report to BlueCross any unauthorized use or disclosure of PHI. Which of these must you include in your report?

HIPAA restricts the use and disclosure of PHI in all data formats.

Individuals can be prosecuted for HIPAA violations.

Any potential breach of PHI must be reported to BlueCross within _______.

PHI stands for _________.

Agents are bound by the same HIPAA privacy requirements as BlueCross BlueShield of South Carolina.

A(n)_______ is often authorized to act on behalf of a covered entity.

HIPAA protects the privacy of individuals by restricting the use and disclosure of PHI in which of these forms?

The process used to electronically encode data, so it remains secure to unauthorized viewers is called _________.

Which of these is an example of a PHI breach?

If a drug is on the formulary, make sure to also check the drug strength and dosage to confirm the drug will be covered.

Some drugs are not available through mail order. This means the member would need to purchase them at a local pharmacy.

For 2025, CMS requires at least 48 hours between completion of a Scope of Appointment (SOA) and a meeting with a beneficiary with three exceptions.

CMS requires a disclaimer agents must convey within the first minute of a call.

Stand-alone PDP members cannot change PDP plans during the open enrollment period (OEP) from Jan. 1 – March 31.

If someone is new to Medicare and you enroll them in a South Carolina BlueCross Medicare Advantage plan, they will have at least 36 months to change to a South Carolina BlueCross Medicare Supplement on a Guaranteed Issue basis.

After someone enrolls in a Medicare Advantage plan, Original Medicare continues to pay 80 percent of the approved medical bills.

CMS requires that an agent record all sales and enrollment telephone calls and the audio portion of video calls. CMS also requires the agent maintain these recordings for 10 years.

Prior to enrolling a member, you should tell him or her to expect that an exception for a noncovered drug will always be approved.

Agents can use a 2025 sales booklet to market to a prospective member requesting a 2024 effective date.

BlueCross determines the late enrollment penalty (LEP).

For 2025 certifications, you have 3 attempts to pass this BlueCross Medicare Advantage plan-specific test.

Agents only need to certify once (instead of yearly) with BlueCross when they first get appointed.

Once a beneficiary is enrolled in a Medicare Advantage plan and has paid his or her plan-specific monthly premium, he or she no longer needs to pay the Part B premium.

A member can save on prescription costs by using preferred pharmacies or by using 90-day mail order.

Agents can go to www.SCBluesMedAdvantage.com to look up a Medicare beneficiary's current doctors and prescriptions.

Where can an agent order BlueCross Medicare Advantage sales kits?

The BlueCross Medicare Advantage Agent Resource Guide has the most comprehensive information on selling our Medicare Advantage plans, including why you should sell BlueCross Medicare Advantage plans, tools to help you succeed, coverage maps, value-added benefits, information on whom to call, and information on customer service and additional agent services.

Optum Rx® is an independent company that provides pharmacy benefit management on behalf of BlueCross.

To ensure all CMS-required submission time limits are met, paper enrollment applications must be submitted to the company within 24 hours of receiving a signed application.

All three BlueCross PPO Medicare Advantage plans are available in the exact same South Carolina counties.

The Visitor/Travel Program is for BlueCross PPO members who will be staying in an area for less than six months. In how many states can our PPO members use this program in 2025?

Agents are responsible to retain all completed Scope of Appointment forms for the 10-year record retention period mandated by the CMS, regardless of whether an application is taken.

What part of Medicare lets beneficiaries get private health plan coverage instead of Original Medicare (i.e., Part A and Part B) through Medicare Advantage plans?

BlueCross Medicare Advantage plan members can pay their premiums by which of these methods?

During which of the following enrollment periods can a beneficiary move from Original Medicare to a Medicare Advantage plan?

What is the key chapter in the Evidence of Coverage (EOC) (specific for each plan) that is the best place to find details on benefits for each of our Medicare Advantage plans?

An agent should always tell a customer that some procedures may require prior authorization.

The BlueCross drug formulary cannot change after Jan. 1 until the end of the year.

An agent of record (writing agent) may call Customer Service to do one of the following:

Agents can market and discuss 2025 Medicare Advantage and prescription drug plans starting Sept. 1, 2024.

Prescription drug coverage is creditable if it offers benefits as good as or better than what is offered on Medicare Part D’s prescription drug coverage.

Someone on a Medicare Advantage-only plan cannot sign up on a stand-alone Part D prescription drug plan unless they’re on a private fee-for-service (PFFS) plan, a medical savings account or a Medicare Cost plan.

For 2025 the coverage gap (donut hole) under Part D will be eliminated from the Part D stages.

The Part D plan will pay 60% of the total drug costs in the catastrophic phase.

Original Medicare has a limit to out of pocket costs to a beneficiary.

Beginning in 2025, Medicare beneficiaries will have an out-of-pocket threshold of $2,000 (TROOP) for their prescriptions before entering the catastrophic

Medicare eligibility begins 24 months after the beneficiary begins receiving Social Security Administration or Railroad Retirement Board disability benefits.