2025 Excellus Univera Product Training ExamBy Brian Platte / August 1, 2024 All Excellus and Univera Medicare Advantage Prescription Drug Plans include two types of in network pharmacies. a. Standard and Preferred pharmacies - preferred pharmacies have lower co pays b. Large Chain and Local Pharmacies all with identical co pays c. In NY state and out of state Pharmacies each with different co pays In 2025, all Excellus and most Univera Medicare Advantage plans include comprehensive dental at a $0 deductible, $0 cost-share,$1,000 annual benefit maximum. True False Complete the following statement: "All Excellus and Univera Medicare Advantage plans include Urgent care and Emergency room coverage both in and out of network....." a. With the same co payments for both in and out of network claims b. With higher co payments out of network Members enrolling in the Univera SeniorChoice Medicare Advantage Plans must reside in which of the following counties? a. Orleans, Genesee, or Wyoming county b. Erie or Niagara county c. Cattaraugus, Chautauqua, or Allegany county d. In any of the above 8 Counties Univera SeniorChoice Medicare Advantage plan members can receive in network benefits with participating providers in the Western NY 8 county service area as well as the 6 county Rochester Region: True False In 2025 the Medicare Blue Choice Extra HMO Plan in Rochester includes a $0 premium and a $20 monthly Part B Give Back: True False Excellus BlueCross BlueShield's Rochester Region for MedicareAdvantage includes: a. Monroe, Wayne only b. Livingston, Yates only c. Seneca, Ontario only d. All 6 of the above counties In 2025, the home delivered meal program, Mom's Meals is included in the following Medicare Advantage Plans: a. Medicare BlueSalute (PPO), Medicare BlueEnhanced (PPO) b. Univera Medicare Freedom (HMO-POS), Univera SeniorChoice Secure (HMO-POS) c. Medicare Blue Choice Optimum (HMO-POS), Medicare Blue Choice Freedom (HMO-POS) d. All of the above Excellus and Univera HMO and HMO-POS plans do not require referrals True False Welvie is an easy-to-use online decision support tool, the program illustrates how a member can work with their doctor to: a. Confirm they have the correct diagnosis b. Explore their treatment options c. Prepare for and recover from surgery (if surgery is the right choice for them) d. All of the above In 2025 all Excellus Medicare Advantage Plans and most Univera Medicare Advantage plans will include Preventative Dental (class 1) and Comprehensive Dental coverage, which includes both network and out of network Dental providers. True False In-Network diagnostic radiology member cost sharing for Univera, Excellus CNY, and Excellus Rochester Region Medicare Advantage plans: a. Include a 20% coinsurance for all plans b. Have fixed dollar co-payments in network In 2025 Excellus Rochester, Excellus CNY, and Univera Medicare product regions will offer a $0 premium Medicare Advantage Prescription Drug (MAPD) plan option. True False HMO plans have in network benefits only, while HMO-POS Plans include a benefit for out of area coverage up to a specific dollar amount annually. True False The following Univera and Excellus Medicare Advantage Plans include an Over the Counter (OTC) benefit in 2025: a. Medicare BlueSalute (PPO) b. Univera Medicare Freedom (HMO-POS), Univera SeniorChoice Secure (HMO-POS), Univera SeniorChoice Basic (HMO), Univera SeniorChoice Advanced (HMO-POS), Univera Senior Choice Extra (HMO), Univera SeniorChoice Value Plus (HMO-POS) c. Medicare Blue Choice Optimum (HMO-POS), Medicare Blue Choice Freedom (HMO-POS), Medicare Blue Choice Value Plus (HMO-POS), Medicare Blue Choice Select (HMO), Medicare Blue Choice Advanced (HMO-POS), Medicare Blue Choice Extra (HMO) d. A, B & C Medicare Advantage Univera and Rochester Region plans consists of: a. Medicare Advantage HMO plans b. Medicare Advantage HMO-POS plans c. Medicare Advantage PPO plans d. All of the above Effective 1/1/2025, the Medicare Prescription Payment Plan (M3P) requires Part D sponsors to provide all Part en rollees the option to pay their out-of-pocket Part D ("OOP") prescription drug costs in monthly installments over the course of the< plan year versus paying OOP costs at the point of sale ("POS"). True False The Medicare Blue PPO Plans include: a. In Network benefits only b. Out of Network benefits with increased member cost sharing only c. Both A & B Excellus and Univera Medicare Advantage plans use TruHearing as their hearing aid vendor. True False All Excellus and Univera Medicare Advantage Prescription Drug Plans include: a. 90-day prescriptions filled at 2x the 30-day co pay rate (Medicare BluePlus PPO Plan excluded) b. Standard and Preferred pharmacies - preferred pharmacies feature lower co pays c. Formulary featuring a 5-tier drug selection d. All of the above Where can Univera Medicare Advantage plan members access network provider lists, prescription drug formulary details, member related forms, and plan information? a. Medicareplans.net b. Medicare.com c. Medicare.Univerahealthcare.com To be eligible to enroll in a Medicare Blue Dual or Univera Medicare Dual plan, members must have Medicare Parts A & B and be eligible for full Medicaid benefits (QMB+ & FBDE dual eligible categories). True False In 2025, the health plan Flex Card benefit providing members with $250 for covered hearing, dental, and vision after the medical benefit is used, is available on the Univera SeniorChoice Access PPO (CNY). Members will have access to the full amount on their effective date. True False Beginning in 2025, Univera PPO plans will include access to out-of-area provider coverage through the MultiPlan network. True False FitOn, the new fitness vendor for 2025 will offer members the benefit of: a. Access to a large network of gyms, studios, and community facilities (11,700+) b. Access to FitOn's #1 rated app which contains wellness content c. Flexibility to use credits each month for a variety of fitness experiences and to purchase at-home fitness accessories and equipment d. All of the above In 2025 the Rochester Blue Choice Access (PPO) Plan will be discontinued. Also in 2025, a new PPO Plan, Blue Choice Discovery (PPO) will be offered in the Rochester Region with a premium of $37. True False A new plan will be offered in the WNY region in 2025 called Univera SeniorChoice Core PPO. This plan offers: a. $2,000 INN OOP b. $0 PCP/$15 Specialist In-Network Copay c. Access to the MultiPlan Network d. All of the above Where can Excellus Medicare Advantage plan members access network provider lists, prescription drug formulary details, member related forms, and plan information? a. Medicare.Excellusbcbs.com b. Medicare.com b. Medicare.com Excellus CNY region's 2025 BlueActive PPO plan's eyewear allowance is: a. A $50 annual allowance b. A $250 annual allowance c. A $100 annual allowance All Excellus and Univera Medicare Advantage Prescription Drug Plans(MAPD) include: a. Formulary featuring a 5-tier drug selection, each tier with different co pays b. Formulary featuring a 2-tier drug selection, each tier with different co pays c. No prescription drug coverage The Part D Maximum Out of Pocket "MOOP" is changing from $8,000 in 2024 to in 2025: a. $6,000 b. $1,000 c. $4,000 d. $2,000 The counties that are part of the DSNP service area include: a. Erie, Orleans b. Monroe, Livingston, Ontario, Wayne, Yates, Seneca c. Onondaga, Oneida, Broome, Otsego, Herkimer d. All of the above ResultsVote