How would you respond to Mrs. Damon? For complete benefit details, refer to your plan’s Individual Medical Policy. For detailed information about Humana’s claim payment inquiry process, review the claim payment inquiry process guide (300 KB)., PDF opens new window. Who is responsible for all applicable insurance licenses and any applicable certifications required to sell a corresponding Humana product in all states in which the agent markets such products? What should he do? A 9-12 hour fast is required. Humana individual life insurance plans are offered in New York by Humana Insurance Company. Mr. Simpson has misplaced his new Medicare ID card and does not know his new Medicare ID number. Go365® is not an insurance product. Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. On-site pharmacy information. It is October 2nd and you, the agent, are speaking with Doris. What are the dates for the Special Election Period (SEP) for Non-Renewal? Of course, if a beneficiary has another valid election period (i.e., IEP, SEP) available during this time, enrollments can be completed. The MA/MAPD enrollment request is made prior to the Part B effective date. Choose the answer that best explains the Telephonic Presentations policy. Because the FCC requires prior express written consent to contact a prospect or member via their cell phone. The Investor Relations website contains information about Humana Inc.'s business for stockholders, potential investors, and financial analysts. Your health care provider can also ask Humana to make an exception. Select the statement below that best completes the following sentence. The final exam consists of 20 questions over material in the Agent Guidance Reference Manual. Agents can NOT perform AEP enrollments during the pre-AEP period, per CMS. Tamara is aging into Medicare and is in her 7 month initial election period. ​To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? Do you qualify for Extra Help with Medicare costs? Our dental plans, vision plans, and life insurance plans may also have waiting periods. Humana Reports Fourth Quarter 2019 Financial Results; ... Net income was $2.7 billion for 2019 compared to $1.7 billion in 2018 and earnings per diluted common share increased $7.94 from $12.16 earnings per diluted common share in 2018 to $20.10 earnings per diluted common share in 2019. select an automated payment method to pay their monthly premium. Your costs in Original Medicare You pay nothing for this test when you get it from a laboratory, pharmacy, doctor , or hospital, and when Medicare covers this test … Carol is speaking with Agent Tomas. How will Humana handle applications received during Pre-AEP? Sales agents must conduct the sales presentation in its entirety for telephonic presentations. You can reach us during the following hours: Monday through Friday, from 8 a.m. to 11 p.m., Eastern time. Humana is including this hearing aid benefit on certain Medicare Advantage plans offered for the 2017 plan year in select states. Agents must ensure that members understand how their plan's drug benefits, including important benefits such as drug tier information. The website is maintained outside of New York state and the insurer is not authorized to transact the business of insurance in New York. If you’re performing a test that detects the flu via immunoassay in the office, your provider might test for two The 87804 code represents “a testing … Is it permissible for agents to select a new PCP based on the belief that the provider will be joining the Humana in the near future? Jim is eligible to join a Medicare Advantage plan without drug coverage for the first time. Agent Deborah is enrolling a beneficiary into a Humana Medicare Advantage plan. Yes, you can live to 100! This new code matches the administration of BrainCheck and should be used for most test administrations after January 1, 2019. What are the dates for the SEP for Non-Renewal? The agent should use the exact same Medicare ID number and election period for both applications so that CMS can process the applications together and label them as spousal enrollments. However, he knows that Dr. Ayers is in-network for the Humana PPO plan in ... ID number on the application since Humana will accept both the old and new Medicare ID numbers on applications through 2019. The annual OEP is available January 1st - March 31s. Fill in the blank. Age healthily by eating well, exercising, and avoiding things that hurt your life expectancy. He currently has a MAPD plan with ACME Co. and wants to enroll in a CarePlus MAPD plan. What must Agent Deborah explain about the new PCP? The agent clicks the test submit button or the test timer reaches 35 minutes. When is the Medicare Advantage Disenrollment Period? They said... Humana - Complaint Oct 13, 2019 … Agents should advise beneficiaries that they need to respond promptly to Humana's request for Creditable Coverage, if applicable. This communication provides a general description of certain identified … When it comes to Dual Eligible SNPs, it is imperative the dual eligible beneficiary is aware of ... All plans available in their area emphasizing those plans that best meet the beneficiary's needs. 99% of Humana members who terminate for non-payment of premium do not ___________________. Agent Chris did not pass the final exam on his first try. In the event of a dispute, the policy as written in English is considered the controlling authority. John is an agent who has older family members on Medicare and living in several different states. When a member selects a PCP when enrolling into a plan, what must agents explain about their PCP? Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc. Humana group life plans are offered by Humana Insurance Company or Humana Insurance Company of Kentucky. Asking the beneficiary to consult with their doctor or pharmacist to obtain generic medications that are covered on the formulary. The following links are intended to facilitate documentation and coding diagnoses and services that are provided to patients with Humana … Agents can assist members requesting a PCP change and take action on their behalf. Which enrollment period should Agent Sarah select for Tamara`s application? Mrs. Maples wants to select Dr. Grayson as her PCP. What enrollment period will he use? TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. Arizona residents insured by Humana Insurance Company. When enrolling a member into an Optional Supplement Benefit (OSB), what should agents be sure to tell the member about the premium payment method? Agents are responsible for all applicable insurance licenses and any applicable certifications required to sell a corresponding Humana product in all states in which the agent markets such products, ICEP is for enrollment into MA/MAPD only. Individual applications are subject to eligibility requirements. Agent Juan is enrolling Mrs. Maples into a HMO plan. Why are agents required to ask if the phone number being provided on an application is a cell phone number? Fax: 1 (800) 555-2546; Phone: 1 (877) 486-2621; Humana … How should agent Martha handle the enrollment? Agent Juan should advise Mrs. Maples that she will need to select another PCP since Dr. Grayson is not listed as an in-network provider. Test Interpretation and Feedback Previously, BrainCheck … A new PCP is selected. Agents must have a valid resident or non-resident license and any required appointments issued from a state where the Medicare beneficiary permanently resides in order to market or sell a Humana MA and/or PDP plan. Review the Agent Guidance Reference Manual before making another attempt. Go365 rewards up to $300 per member per year in redeemable gift cards for completion of preventive screenings and participation in healthy habits. 1 Fact Sheet - 2020 Part C and D Star Ratings Note: The information included in this Fact Sheet is based on the 2020 Star Ratings published on the Medicare Plan Finder on October 9, 2019. If you have cardiovascular problems or diabetes, you may need a test every year. How long does Agent Nicky have to complete a new Conflict of Interest Disclosure and Agreement form? Humana review rated 1.3/5.0: I called Humana to see if my Dr. was in the Providers list & they told me they couldn't find the Dr. on any of their plans. Slim-down successfully by setting realistic goals and making your weight-loss journey an enjoyable trip. What is it called when an agent guides a member towards a particular provider because it is in the best interest of the provider or agent (versus the member`s best interest)? Which of the following is the best example of what an agent should do to explain a plan's drug benefit? Which of the following statements best describes Go365? What is this called? He is meeting with Agent Wayne and Oscar is requesting to enroll in a Humana MAPD plan in the 3 months prior to his Part B effective date. The flu vaccine protects against the influenza viruses that will be the most common during the upcoming flu season. Humana individual vision plans are insured by Humana Insurance Company, The Dental Concern, Inc., or Humana Insurance Company of New York, or Humana Health Benefit Plan of Louisiana, Inc. Arizona residents insured by Humana Insurance Company. The applications will be denied and marked for investigation. Our promise is to provide more than health insurance plans. Doris has an SEP from her permanent move to Los Angeles. Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah, CompBenefits Company, CompBenefits Insurance Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., or DentiCare, Inc. (DBA CompBenefits). Preventive care keeps you healthy, prevents illness and detects disease in the early stages –when it’s easier to treat. Which of the following is considered marketing material and requires CMS approval ? Saturday, from 8 a.m. to 6:30 p.m. Eastern time. From October 15 to December 7, which election periods may be used? No central point to view all claims, each person has to sign up themselves. When a member selects a Primary Care Physician (PCP) when enrolling into a plan, what must agents explain about their PCP? What is the preferred way to determine if a provider is in network? How should Agent Juan handle this situation? Letters sent by agents to current and prior members announcing the agent has changed agencies. Ben tells Mary that he knows Dr. Mendez in network for Humana plans and does NOT check Humana`s Physician Finder Plus. Applicable tax or taxes will be applied to all applicable prescription orders. The purpose of the Non-Discrimination notice is to inform people about their ability to receive information in another language and give directions on how to file a complaint should they feel they have been discriminated against. Agent Deborah must explain in and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker. Initial Coverage Enrollment Period (ICEP) can be used to enroll beneficiaries into which plans? covers a test to see if you have coronavirus (officially called coronavirus disease 2019 or COVID-19). Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. Exam should include measuring your weight, height, and body mass index (BMI). When is the annual Open Enrollment Period (OEP) available? Explain that because she has called during the Medicare Advantage Disenrollment Period (MADP), she is eligible to disenroll from her current plan and enroll in a stand-alone PDP. SEP can only be used (if a valid SEP exists) because Carol has delayed Part B and is enrolling after Part B effective date. This plan includes additional Medicare prescription drug (Part-D) coverage. Agent Grace asked if Lamar's phone number is a cell phone, because the FCC requires prior express written consent to contact a prospect or member via their cell phone. Agents may provide guidance to members about providers who excel at value-based care that could improve member health outcomes. Agent Nicky conducts educational events at Dr. Singh`s office throughout the year. For group plans, please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description/Administrative Services Only) for more information on the company providing your benefits. By submitting this form, the pharmacist may be able to have the medication covered by Humana. We also … Carol is speaking with Agent Tomas. Not available with all Humana health plans. Note: questions about passing the final exam are only in this practice exam. Use Humana's RX look up tools to determine if a medication is on Humana's formulary. Use Humana's Physician Finder Plus to see if the provider is in Humana's network. Carol delayed Part B and wants to enroll in a Humana MA plan (No RX). Talk to your doctor about your risks and which Pap testing schedule is best, especially if you’ve had a hysterectomy or are 65 or older. once per year). Agent Martha is completing an MAPD enrollment for Mr. Simpson. Agent Mike is speaking with Betty Ann and she is asking how to determine if her medication is covered by Part B or Part D. What is the preferred way for Agent Mike to determine if a medication is on Humana's formulary? Before applying for group coverage, please refer to the pre-enrollment disclosures for a description of plan provisions which may exclude, limit, reduce, modify or terminate your coverage. Under what circumstances is it Under what circumstances is it acceptable for an agent to complete an Agent Online Application, or AOA , application on behalf of their client? In the event an allegation of misconduct is lodged against an agent, the agent will provide a detailed written response to the complaint within ______________ of notification of the complaint. HumanaChoice H5216-043 (PPO) H5216-043 is a 2019 Medicare Advantage or Medicare Part-C plan by Humana available to residents in Texas. It is January 15th and you are speaking with Mr. Green. View a complete list of the legal entities that offer, underwrite, administer or insure insurance products and services. You can expect your refills to arrive 5 to 7 days after placing your order. If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800 … Agent Todd can't. April 1… She is requesting to enroll in a Humana Medicare Advantage plan today. When a beneficiary moves out of a plan`s service area, when must they enroll into a plan servicing the new area to avoid a lapse in coverage? Tell him that he has the Open Enrollment Period (OEP) available and proceed with the enrollment. Advise Mrs. Maples that she will need to select another PCP since Dr. Grayson is not listed as an in-network provider. Upon discovery, how will Humana respond? Encourage all members to ​receive their plan documentation digitally at the time of enrollment. Our successful … When can agents begin marketing to non-renewing members? Review the agent guidance manual before making another attempt. To inform people about their ability to receive information in another language and give directions on how to file a complaint should they feel they have been discriminated against, Individuals who belong to a qualified State Pharmaceutical Assistance Program (SPAP) are eligible for an SEP to, Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. Use Humana's Physician Finder Plus to see if the provider is in Humana's network. Find budget-friendly plans for your company’s most valuable asset: your employees. Agent Anna is not licensed in Nebraska. Agent Juan cannot locate Dr. Grayson in Physician Finder but he did see that American Medical Group is listed as in-network. Note: questions about passing the final exam are only in this practice exam, The agent clicks the test submit button or the test timer reaches 35 minutes. Learn about enrolling in your employer plan and find resources and support to make the most of your benefits. Which of the following is not an automated payment option for Humana Medicare enrollments? Oscar delayed his Part B when he was first eligible. Find information, forms, and assistance for your Humana plan. Which enrollment period should Agent Wayne select for Oscar's application? Agents not using Humana's Physician Finder tool correctly. How should you guide Mr. Green? It is unclear if. once per year). once per year. Eye exams for glaucoma and macular degeneration—to common age-related conditions. Agents must explain In and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP. Medical Plans. Can agents create their own Medicare marketing materials, such as letters and flyers? Which of the MA-only plans below can be combined with a stand-alone PDP? She tells Agent Sarah that she would like to enroll in a MA-only (no RX). The HumanaChoice H5216-043 (PPO… Individuals who belong to a qualified State Pharmaceutical Assistance Program (SPAP) are eligible for an SEP to... Make one enrollment request (both MAPD and PDP) at any time through the end of each calendar year (i.e. Mr. Sampson tells Agent Ted that he is familiar with. Talk to your doctor about your risks and which test and schedule is best for you; most recommend a yearly fecal occult blood test, a flexible sigmoidoscopy every five years, or a colonoscopy every 10 years. He wants to enroll all of them in Medicare Advantage Plans during AEP. The Telephonic Presentations policy provides guidance for licensed, appointed and certified sales agents representing a Humana Medicare Advantage (MA), in a non-call center setting, to perform a compliant telephonic Medicare sales presentation, Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is, For events advertised to the general public, a Scope of Appointment (SOA) is not required, as the advertisement serves as a collective SOA. Individuals with a family history of certain diseases and those with other risk factors should discuss preventive health measures with their primary care doctor. The modifier QW CLIA waived test … Taxes will be applied to all applicable prescription and over-the-counter (OTC) orders. Before completing the enrollment, agents should take the time to perform a thorough review all features and benefits of the plan and make them understandable to the beneficiary, Agents should encourage members to ​receive their plan documentation digitally at the time of enrollment. Why is it important for agents to offer guidance for provider selection? To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? According to recent CMS guidance, which of the following plan changes is NOT allowed during the annual OEP? Doris tells you that she moved to Los Angeles last month to be near her grandchildren. He should explain that a full presentation of benefits is important and that it is a required for every enrollment. Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is _________. There are 13 new CLIA-waived tests effective April 1, 2019. MA enrollees using the Medicare Advantage Disenrollment Period (MADP) to disenroll from their MA plan are eligible for a SEP to enroll in... How many questions are on Humana`s final exam and what material do they test on? Using 87804 x 2 might result in denial. Which of the following actions is prohibited by Humana and CMS? The benefit allows for one annual routine hearing exam at no cost to the … To avoid a lapse in coverage, the beneficiary must enroll on or before the last day of the month of the move. If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800-379-0092 (TTY: 711), Monday to Friday 8 a.m. to 11p.m. Talk to your doctor about your physical activity. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, or Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc. For Arizona residents, plans are offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. The dates for the SEP for Non-Renewal are December 8 - end of February. Dr. Grayson is part of the American Medical Group. Carol delayed Part B and wants to enroll in a Humana MA plan (No RX) plan 3 days after her Part B effective date. Texas residents insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits). Agents must explain in and out of network benefits and any possible independent Provider Association (IPA) affiliations of their selected PCP. Find an affordable healthcare plan for yourself and your loved ones. “Humana” is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (“Humana Entities”). Agent Juan is enrolling Mrs. Maples into a HMO plan. Which of the following actions should be avoided when completing spousal enrollments? He is only licensed in Montana. To ask for an approval, your health care provider can contact HCPR (Humana Clinical Pharmacy Review) at 1 … Form 8-Ks filed during 2019. CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. What can he do according to CMS? No. For dates of service prior to April 1, ... to have COVID-19, and the test results for the exposed individual are either unknown or negative. Which of the following statements is true regarding the Primary Care Provider (PCP) Change form? For dates of service beginning April 1, 2020, use the new code published by the CDC, as appropriate (New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), April 1… SEP can only be used (if a valid SEP exists) because Carol has delayed Part B and is enrolling after her Part B effective date. For details on … Select the statement below that best completes the following sentence. Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state. Which of the following was identified as a top reason for Humana agent complaints in PY17? Call 1-800-379-0092. She asks you if she can enroll in a stand-alone PDP, instead. To be compliant with state and local regulations, what change will Humana Pharmacy members see to their. Our health benefit plans, dental plans, vision plans, and life insurance plans have exclusions, limitations and terms under which the coverage may be continued in force or discontinued. The Center for Medicare & Medicaid Services (CMS) announced in CR11080 that these apply to facilities with a CLIA certificate of waiver. Agent Todd is completing an HMO enrollment with Mrs. Valdez and she asks if she can select Dr. Ayers as her PCP. We will reply within 24 hours after we get your doctors request. Agent move notification letters sent to members and prior members. Is there a difference in length between the Telephonic Presentation and the in-person presentation? How can agents help reduce paper applications being denied due to improper election type code? 1, 2019-- Humana Inc. (NYSE: HUM) will release its financial results for the second quarter 2019 (2Q19) on Wednesday, July 31, 2019 at 6:30 a.m. eastern time.The company will host a conference call at 9:00 a.m. eastern time that morning to discuss its financial results for the quarter and earnings guidance for 2019. Submit by fax to 1-888-447-3430 Submit by telephone at 1-866-461-7273 All Humana MA Members: For procedures or services that are investigational, experimental or may have limited benefit coverage, or for questions regarding whether Humana … What should he do? In which of the following situations is it acceptable for an agent to use their own email address for an applicant? To receive these preventive services, make an appointment with your doctor and bring this checklist to talk about which screenings you may need. Which of the following is considered marketing material and requires CMS approval? It is never acceptable for an agent to create an Email address for a beneficiary. Agent Ben should have checked to see the provider was contracted for the HMO plan. Agent Justin did not pass the Humana final exam on his first try. No, because agents will use only Humana and CMS or State approved materials/scripts, as applicable, to market to prospective enrollees. Limitations and exclusions. Mrs. Maples wants to select Dr. Grayson as her PCP. ... ACCU-CHEK AVIVA PLUS TEST … We will also help you in every step of your health journey. TTY users should call, 1 … Nicky must be complete a new form within 30 days. This information is available for free in other languages and formats. Tell Mrs. Valez that Dr. Ayers is not listed as an in-network provider and request that she select another in-network PCP. Original review: Dec. 1, 2020. Asking the beneficiary to consult with their doctor or pharmacist to obtain generic medications is not an acceptable explanation of the plan's drug benefit, What constitutes an "attempt" on Humana`s final exam?

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