If a beneficiary is enrolled in a MA-only PPO and they also sign up for a PDP plan, they will be automatically dropped from their MA plan. - True Which of the following statements regarding eligibility criteria for Medicare Advantage PPO plans is true? - All of the above statements are true. Emergency care is always considered to be in network. - True Which is NOT considered a preventive benefit? - Chiropractic services The Plan deductible always needs to be satisfied before preventive services are covered by the plan. - False Prescription drug costs under Part D do not apply toward the medical out-of-pocket maximum. - True A copayment is defined as: - A fixed dollar amount Which expenses listed below do not apply to the out-of-pocket maximum, even when they are covered? - All of the Above For a beneficiary who enrolled in a MA-only plan during the Annual Election Period, they will not be able to enroll in a plan that offers prescription drug coverage until the following Annual Election Period; unless the beneficiary chooses to use their one-time election during the Open Enrollment Period or qualifies for a Special Election Period. - True Which of the following statements is true? - None of the Above A PPO is a plan in which enrollees pay less if they use doctors, hospitals, and providers that belong to the network. Services obtained from doctors, hospitals and providers outside the network will result in additional costs to the member - unless the services are classified as an emergency. - True If during the year, costs for certain services reach the annual out-of-pocket limit amount, the member will not pay any further costs for these network provided covered services for the remainder of the calendar year. – True Anthem - Risk Prevention Assessment 2022 If a beneficiary currently has drug coverage through another carrier, you must verify their prescriptions would be covered under our plan's formulary, too. The drugs that are actually covered may vary from one carrier to another or one plan to another. - True You MUST tell your PPO plan clients they will have to pay more when seeking nonemergent eligible services outside of the network. - True You receive a questionnaire regarding a sales misrepresentation inquiry. The questionnaire regarding the complaint must be completed and returned promptly. When must you return your response? - Within 48 hours You MUST EXPLAIN the Part D late enrollment penalty. - True Not all providers are contracted to serve as a primary care physician (PCP). Use the online tool to find/verify the PCP indicator information. - True If a beneficiary wants you to hold an enrollment form/application, you must explain that you can either submit or cancel the enrollment form/application following established procedures. - True Agents are permitted to call former members who have voluntarily disenrolled or current members in the process of disenrolling to market plans or products. - False Provider Networks may be accessed through what methods? - Both A and B may be used When a beneficiary is trying to decide between plans during a sales appointment, it is okay to omit information critical to the beneficiary if they don't ask pointed questions. - False Documents with beneficiary information (such as withdrawn, incomplete, or incorrect applications, or records at the end of the required retention period) must be properly disposed of via cross cut shredding and NOT reused or placed into regular recycling or trash containers. - True Agents/Brokers are allowed to offer gifts as a condition of enrollment. - False