PHP Medicare Certification Exam 2024

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?

PHP Medicare plans do NOT require referrals for In-Network specialists.

In-Network PCP’s may notify their patients of their participation with PHP Medicare plans by sending them letters.

You can order enrollment kits through the PHP Medicare producer portal.

PHP Medicare has chosen to brand their products through prominent local hospital systems like Sparrow, Covenant HealthCare, and University of Michigan Health.

PHP Medicare will pay the maximum allowable commissions by CMS in 2024.

You should not sell PHP Medicare products until you become Ready To Sell.

Your PHP Medicare producer portal allows you to enter a paper application electronically.

What action should an agent take if a beneficiary wants to file a complaint?

What options do you have to secure a Scope of Appointment (SOA) with PHP Medicare?

Who is responsible for compliance?

In which of the following settings is a Scope of Appointment (SOA) not required to be collected?

How far in advance of an appointment with a beneficiary must a Scope of Appointment (SOA) be collected?

If your client, a member of PHP Medicare, has a question about their benefits, what should you do?

What will happen if a member, your client, makes a complaint about you and alleges you misled them about the plan benefit design?

Which of the following periods provides an opportunity for a beneficiary to move from Original Medicare to a MA plan?

A prospective beneficiary asks an agent if PHP Medicare has an urgent care benefit and if so, what the benefit includes. Where would the agent find this information for PHP Medicare?

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?

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?

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?

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?

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?

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?

If Mr. Duisen is admitted to the hospital within 24 hours of treatment in the Emergency Room, his ER copay is waived.

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.

Mr. Nerella wants to know what items are covered in his Over The Counter (OTC) supplemental benefit. He does not receive a catalog as part of his welcome packet. Where could you help him locate an updated OTC catalog?

When calling a beneficiary, it is OK to tell them you are calling from Medicare.

What types of activities can you present at an educational seminar?

What types of calls with a beneficiary must be recorded?

Once you receive a call or request to contact from a beneficiary, how long after receiving this request can you call this potential enrollee?