The benefit allows for one annual routine hearing exam at no cost to the … How would you respond to Mrs. Damon? 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. You can reach us during the following hours: Monday through Friday, from 8 a.m. to 11 p.m., Eastern time. John is an agent who has older family members on Medicare and living in several different states. The final exam consists of 20 questions over material in the Agent Guidance Reference Manual. Select the statement below that best completes the following sentence. Why are agents required to ask if the phone number being provided on an application is a cell phone number? Agent Todd can't. Agent Ted is completing an enrollment with Mr. Sampson. He enrolled into Part B after the expiration of his IEP. Letters sent by agents to current and prior members announcing the agent has changed agencies. 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. 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. Talk to your doctor about clinical breast exams. When enrolling Mary into an HMO plan for the same service area, Mary wants to select Dr. Mendez as her PCP. When enrolling a beneficiary into a plan with prescription drug coverage, which of the following should agents do to avoid issues with any applicable Late Enrollment Penalty? Which of the following actions can help agents avoid complaints about Benefits and Presentation? Mrs. Maples wants to select Dr. Grayson as her PCP. To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? In which of the following situations is it acceptable to create an Email address for a beneficiary? Humana individual dental plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Benefit Plan of Louisiana, Inc., or DentiCare, Inc. (DBA CompBenefits). 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. What should he do? Mr. Sampson tells Agent Ted that he is familiar with. Talk to your child’s doctor about the vaccine, which protects against cancers caused by HPV infection. Agent Deborah must explain in and out of network benefits and any possible Independent Provider Association (IPA) affiliations of their selected PCP. Individual applications are subject to eligibility requirements. No central point to view all claims, each person has to sign up themselves. Find an affordable healthcare plan for yourself and your loved ones. TTY users should call, 1 … Tell Mrs. Valez that Dr. Ayers is not listed as an in-network provider and request that she select another in-network PCP. 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. When enrolling a member into an Optional Supplement Benefit (OSB), what should agents be sure to tell the member about the premium payment method? Which enrollment period should Agent Wayne select for Oscar's application? Agent Ben knows that Dr. Mendez is in network for a PPO plan in a particular service area. Carol delayed Part B and wants to enroll in a Humana MA plan (No RX) plan 3 days after her Part B effective date. The Center for Medicare & Medicaid Services (CMS) announced in CR11080 that these apply to facilities with a CLIA certificate of waiver. When is the annual Open Enrollment Period (OEP) available? 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. 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. Using 87804 x 2 might result in denial. “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”). Agents must explain in and out of network benefits and any possible independent Provider Association (IPA) affiliations of their selected PCP. It is never acceptable for an agent to create an Email address for a beneficiary. 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. How long does Agent Nicky have to complete a new Conflict of Interest Disclosure and Agreement form? Carol is speaking with Agent Tomas. Test Interpretation and Feedback Previously, BrainCheck … He is only licensed in Montana. Agents can assist members requesting a PCP change and take action on their behalf. She recently picked up a second job working at Dr. Singh`s office on nights and weekends. Here are suggested guidelines for screenings and checkups for healthy adults. Saturday, from 8 a.m. to 6:30 p.m. Eastern time. If you have cardiovascular problems or diabetes, you may need a test every year. In which of the following situations is it acceptable for an agent to use their own email address for an applicant? Note: questions about passing the final exam are only in this practice exam. ... locate Dr. Ayers using Humana's Physician Finder tool. How should agent Martha handle the enrollment? When a member selects a Primary Care Physician (PCP) when enrolling into a plan, what must agents explain about their PCP? Exam should include measuring your weight, height, and body mass index (BMI). 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 … Call 1-800-379-0092. Your health care provider can also ask Humana to make an exception. 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. Go365® is not an insurance product. To ask for an approval, your health care provider can contact HCPR (Humana Clinical Pharmacy Review) at 1 … Learn about enrolling in your employer plan and find resources and support to make the most of your benefits. Sales agents must conduct the sales presentation in its entirety for telephonic presentations. The modifier QW CLIA waived test … 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. LOUISVILLE, Ky.--(BUSINESS WIRE)--Jul. The MA/MAPD enrollment request is made prior to the Part B effective date. When a member selects a PCP when enrolling into a plan, what must agents explain about their PCP? Select the statement below that best completes the following sentence. If you have cardiovascular problems or diabetes, you may need a test every year. 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. 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? You can expect your refills to arrive 5 to 7 days after placing your order. Agent Todd is completing an HMO enrollment with Mrs. Valdez and she asks if she can select Dr. Ayers as her PCP. and Saturday 8 … Which of the following is the best example of what an agent should do to explain a plan's drug benefit? Agent Justin did not pass the Humana final exam on his first try. A new PCP is selected. Texas residents insured by Humana Insurance Company. What is this called? Agents can NOT perform AEP enrollments during the pre-AEP period, per CMS. How can agents help reduce paper applications being denied due to improper election type code? From October 15 to December 7, which election periods may be used? Dr. Grayson is part of the American Medical Group. covers a test to see if you have coronavirus (officially called coronavirus disease 2019 or COVID-19). Initial Coverage Enrollment Period (ICEP). Humana individual life insurance plans are offered in New York by Humana Insurance Company. If you have diabetes, these tests are recommended yearly: HbA1c test, LDL cholesterol, kidney test and retinal or dilated eye exam, May need to be more often if you have high blood pressure or diabetes, Periodically as directed by doctor; around 65 years or older, May need frequent screening after a bone fracture or if you’re at high risk for osteoporosis, Every 2-4 years to age 64, then every 1-2 years after. Humana may terminate upon discovery and report incidences of submission of applications by unlicensed agents and brokers to the authority in the State where the application was submitted as well as to CMS. We also … Use Humana's Physician Finder Plus to see if the provider is in Humana's network. 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. There are 13 new CLIA-waived tests effective April 1, 2019. once per year. You can expect your refills to arrive 5 to 7 days after placing your order. The flu vaccine protects against the influenza viruses that will be the most common during the upcoming flu season. Administered by Humana Insurance Company. Use Humana's Physician Finder Plus to see if the provider is in Humana's network. Fill in the blank. If you shop at one of our Humana Pharmacy retail locations and have a question, we're here to help. He wants to enroll all of them in Medicare Advantage Plans during AEP. Taxes will be applied to all applicable prescription and over-the-counter (OTC) orders. What can he do according to CMS? This information is available for free in other languages and formats. Age healthily by eating well, exercising, and avoiding things that hurt your life expectancy. Which of the following is not an automated payment option for Humana Medicare enrollments? Yes, you can live to 100! How should you respond to Doris? We will reply within 24 hours after we get your doctors request. 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. When is the Medicare Advantage Disenrollment Period? Agent Deborah is enrolling a beneficiary into a Humana Medicare Advantage plan. Humana dental in Illinois has been nothing but painful for this past year. Agent Juan is enrolling Mrs. Maples into a HMO plan. 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? If you’re newly-eligible or looking to switch plans, our Medicare plans include all-in-one Medicare Advantage plans, standalone Part D drug plans, and Medicare Supplement plans. 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. 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 … Agent move notification letters sent to members and prior members. It is unclear if. What must Agent Deborah explain about the new PCP? Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. 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? If you don't receive your medication-or just want to check on your order-you can call Humana Pharmacy at 1-800 … Agents cannot use the ICEP election to enroll into a PDP. You can expect your refills to arrive 5 to 7 days after placing your order. 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. 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. How should you guide Mr. Green? 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 … select an automated payment method to pay their monthly premium. Do you qualify for Extra Help with Medicare costs? According to recent CMS guidance, which of the following plan changes is NOT allowed during the annual OEP? For complete benefit details, refer to your plan’s Individual Medical Policy. 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… No, a provider may be contracted for one plan type but not another. When can agents begin marketing to non-renewing members? Exams include a digital rectal exam and a prostate-specific antigen test (PSA). 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? Agents should read through the SEPs listed on page five of the paper application and select any that apply, It allows members to obtain pricing for medications based on their future effective date. 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. Texas residents insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits). For detailed information about Humana’s claim payment inquiry process, review the claim payment inquiry process guide (300 KB)., PDF opens new window. No, because agents may never suggest that a provider is or may be joining Humana's network. Agents must ensure that members understand how their plan's drug benefits, including important benefits such as drug tier information. It allows members to obtain pricing for medications based on their future effective date. Call 1 … Initial Coverage Enrollment Period (ICEP) can be used to enroll beneficiaries into which plans? Jan. 1, 2019, Medicare and Dual Medicare-Medicaid Plans Preauthorization and Notification List – English, PDF opens in new window. Jan. 1, 2019, Commercial Preauthorization and Notification List – English, PDF opens in new window. 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). Agent Juan cannot locate Dr. Grayson in Physician Finder but he did see that American Medical Group is listed as in-network. 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. Review the agent guidance manual before making another attempt. 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. 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. What is the preferred way to determine if a provider is in network? Which of the MA-only plans below can be combined with a stand-alone PDP? They said... Humana - Complaint Oct 13, 2019 … SEP can only be used (if a valid SEP exists) because Carol has delayed Part B and is enrolling after Part B effective date. What is the purpose of the Non-Discrimination notice that is included in many of Humana`s marketing materials? 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. To assist enrollees and members in making an informed decision about providers that help members achieve the best possible health outcomes. Limitations and exclusions. In the event of a dispute, the policy as written in English is considered the controlling authority. 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. Which of the following is considered marketing material and requires CMS approval? What should he do? To be compliant with state and local regulations, what change will Humana Pharmacy members see to their. Visit Humana.com for 24 hour access to information like claims history, eligibility, and Humana’s drug list. Our dental plans, vision plans, and life insurance plans may also have waiting periods. Humana legal entities that offer, underwrite, administer or insure insurance products and services, View a complete list of the legal entities. Mrs. Maples wants to select Dr. Grayson as her PCP. The following links are intended to facilitate documentation and coding diagnoses and services that are provided to patients with Humana … Agent Nicky conducts educational events at Dr. Singh`s office throughout the year. 99% of Humana members who terminate for non-payment of premium do not ___________________. Form 8-Ks filed during 2019. It is unclear if the provider is in Humana's network. It is never acceptable under any circumstance for an agent to complete the AOA application on behalf of their client, even if they request it. Eye exams for glaucoma and macular degeneration—to common age-related conditions. How you sleep, eat, and relax can impact your skin. She tells Agent Sarah that she would like to enroll in a MA-only (no RX). 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. Agent Ben should have checked to see the provider was contracted for the HMO plan. Which of the following was identified as a top reason for Humana agent complaints in PY17? There you can also use the physician finder and get health news and information. Mr. Simpson has misplaced his new Medicare ID card and does not know his new Medicare ID number. On Jan. 1, 2019, Humana will update its preauthorization and notification lists, opens new window for all commercial fully insured, Medicare Advantage (MA) plans and dual Medicare-Medicaid … How can agents help Humana members receive less mail and have convenient, on-line access to plan documentation? CMS expects agents to provide a clear, concise explanation of the plan's drug benefit. ​To be compliant with state and local regulations, what change could Humana Pharmacy members see to their prescription costs? Not available with all Humana health plans. April 1… We will also help you in every step of your health journey. Encourage all members to ​receive their plan documentation digitally at the time of enrollment. She is requesting to enroll in a Humana Medicare Advantage plan today. Talk to your doctor about your risks and which test and schedule is right for you. Humana is including this hearing aid benefit on certain Medicare Advantage plans offered for the 2017 plan year in select states. 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. It is never acceptable under any circumstance for an agent to use their own email address for an applicant, even if they request it. Choose the answer that best explains the Telephonic Presentations policy. Please contact our Customer Service number at 1 … Applicable tax or taxes will be applied to all applicable prescription orders. Generally, Humana will only approve a request if a covered medicine wouldn't work as well OR would have a negative effect on your health. Carol is speaking with Agent Tomas. 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. He currently has a MAPD plan with ACME Co. and wants to enroll in a CarePlus MAPD plan. Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. Arizona residents insured by Humana Insurance Company. You are speaking with Mrs. Damon on February 3rd and she is requesting to disenroll from the MA-only HMO plan. 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. 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. Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. ... ACCU-CHEK AVIVA PLUS TEST … What are the dates for the Special Election Period (SEP) for Non-Renewal? View plan provisions or check with your sales representative. Agents not using Humana's Physician Finder tool correctly. once per year). 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 … Original review: Dec. 1, 2020. Fill-in the blank: For events advertised to the general public, a Scope of Appointment (SOA) is _________. Which of the following is an advantage for new members when they pre-register with Humana Pharmacy? 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. Nicky must be complete a new form within 30 days. This plan includes additional Medicare prescription drug (Part-D) coverage. Agent James is enrolling a prospect into a Humana Medicare Advantage plan and it is time to choose a PCP. Tamara is aging into Medicare and is in her 7 month initial election period. Note: questions about passing the final exam are only in this practice exam. This communication provides a general description of certain identified …

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