2025 University of Michigan Health Medicare Certification ExamBy Brian Platte / August 1, 2024 University of Michigan Health Medicare plans do NOT require referrals for In-Network specialists. True False A member has decided to file a complaint because she feels that her Sales Agent misled her about the plan’s benefits. What is the first step the member must take to file a grievance? Contact her lawyer Contact the plan in writing or by telephone to file a grievance File an appeal with the plan. File an appeal with an Administrative Law Judge In-Network PCPs may notify their patients of their participation with University of Michigan Health Medicare plans by sending them letters. True False You can order enrollment kits through the University of Michigan Health Medicare online store. True False University of Michigan Health Medicare has chosen to brand their products through prominent local hospital systems like Covenant HealthCare. True False University of Michigan Health Medicare will pay the maximum allowable commissions by CMS in 2025. True False You should not sell University of Michigan Health Medicare products until you become Ready To Sell. True False Your University of Michigan Health Medicare producer portal allows you to enter a paper application electronically. True False What action should an agent take if a beneficiary wants to file a complaint? Provide instructions to the member of how to file a complaint in writing or telephonically Call Customer Service to file the complaint Call the beneficiary to talk them out of filing a complaint Ignore the request What options do you have to secure a Scope of Appointment (SOA) with University of Michigan Health Medicare? Telephonically by calling producer support with the beneficiary on the call In writing, upload a paper Scope of Appointment Electronic via email to include e-signatures All of the above Who is responsible for compliance? Everyone Most People University of Michigan Medicare Employees Only the Compliance Officer In which of the following settings is a Scope of Appointment (SOA) not required to be collected? A formal marketing event that a beneficiary did not pre-register to attend A one-to-one appointment occurring in the beneficiary’s home or a virtual setting An unscheduled meeting with a beneficiary who arrives at an agent’s office without an appointment and requests information All of the above scenarios require a SOA form to be collected How far in advance of an appointment with a beneficiary must a Scope of Appointment (SOA) be collected? 24 hours One Week You do not need SOA when meeting with a beneficiary 48 hours unless the beneficiary walks in your office, kiosk, or any other walk in meeting that is in-person If your client, a member of University of Michigan Health Medicare, has a question about their benefits, what should you do? Direct the member to read the “Medicare & You” booklet Answer the question Direct the member to call customer service or jointly make the call with the member to customer service None of the above What will happen if a member, your client, makes a complaint about you and alleges you misled them about the plan benefit design? A plan investigator will contact the member to research the complaint You will be notified and requested to provide details of your interaction with the member A committee will review the allegation and the investigation’s supporting materials to assess if the complaint is founded All of the above Which of the following periods provides an opportunity for a beneficiary to move from Original Medicare to a MA plan? January 1 through April 15 January 1 through March 31 October 15 through December 7 The month when the beneficiary turns 65 years of age A prospective beneficiary asks an agent if University of Michigan Health Medicare has an urgent care benefit and if so, what the benefit includes. Where would the agent find this information for University of Michigan Health Medicare? Summary of Benefits Provider Directory Evidence of Coverage None of the above If a member reaches out to a Producer because she feels she is not receiving proper assistance from Customer Service. What should the Producer do? Call Medicare Call into Customer Service with the member on the line Resolve the issue directly with the Member Call Customer Service and find out what rep they spoke to A Member tells a Producer that she takes a 10 mg capsule. On the Formulary it says only tablets are covered. Should the Producer advise the Member that the medication is covered? Yes No If a member makes contact after you have received notice the Member filed a complaint against you, what would be the best action for you to take? Refuse the call Answer and tell the member you cannot speak to them Continue to let it go to voicemail Answer the call, listen to the Member inquiry, and transfer them to Customer Service for their inquiry to be handled. Do not mention anything regarding the complaint When filling out the application, what is the best resource for a Producer to utilize to ensure that the Member name is correctly spelled on the Member ID card for the Plan? Whatever the Member says is the spelling of his/her full name The spelling of their name on their red, white, and blue Medicare card The spelling of the Members name per the Member spouse The spelling on the Member’s driver license Mr. Kalakoti calls you to inquire about a charge for a service he wants to schedule. His effective date is not for two months. Can you help him determine his cost? Yes, agents can have benefit conversations while the beneficiary is in the application stage No, agents should always direct the beneficiary to call the provider and get a cost quote While Mrs. Smith is visiting her daughter in Florida, she has chest pains and is admitted to a hospital. Her daughter calls you and asks if her mom is covered even though she is out of network. What do you tell her? Yes, she is covered. Urgent and emergent care is covered out-of-state and out-of-country No, she is not covered Her mother must drop her plan and pick up traditional Medicare to be covered Her mother must return to her home region to receive care If Mr. Duisen is admitted to the hospital within 24 hours of treatment in the Emergency Room, his ER copay is waived. True False Mr. Masters has a Part D Late Enrollment Penalty (LEP). He chooses to have his premiums paid through Social Security Auto Deduction. You should advise him that it may take 2-3 months for the Auto Deduction to begin, but they do not have to pay the LEP and premium because social security will collect past due amounts. True False Mr. Nerella wants to know what items are covered in his Over the Counter (OTC) supplemental benefit. Since we don't include this in the welcome packet, where could you help him locate an updated OTC catalog? Call the OTC company and order one Inquire at his pharmacy Call Customer Service and check Producer and Member portals Wait for one to arrive in the mail When calling a beneficiary, it is OK to tell them you are calling from Medicare. True False What types of activities can you present at an educational seminar? Enroll someone in a MA plan Talk about the benefits of a specific MA plan Provide a meal Discuss how Medicare Parts A and B work Both C and D What types of calls with a beneficiary must be recorded? All calls regardless of what is being discussed Setting appointments Calls relating to sales, marketing, and enrollment Inviting a beneficiary to an upcoming event Once you receive a call or request to contact from a beneficiary, how long after receiving this request can you call this potential enrollee? Indefinitely 2 years 12 months ResultsVote
