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The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental...
In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.
Policy Effective Date and Defined Terms. The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.
In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative. Policy Amendment without Notice. Health Net reserves the right to amend the Policies without notice to providers or Members.
In some states, prior notice or website posting is required before an amendment is deemed effective. No Medical Advice. The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions. No Authorization or Guarantee of Coverage. The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply. Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions.
Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract also known as the benefit contract, coverage document, or evidence of coverage conflicts with the Policies, the Member's contract shall govern.
The Policies do not replace or amend the Member contract. Policy Limitation: Legal and Regulatory Mandates and Requirements The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. To improve function; or 2. To create a normal appearance, to the extent possible. Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.
Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. Policy Limitations: Medicare and Medicaid Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.
You are required to review the updated slides to stay compliant. Please note, you will not have to retake the final exam for the Nondiscrimination module. To find the updated slides, scroll to the bottom of your completed transcript and click to view. The changes will occur on June 22, , at the launch of the training season. We now require that users complete all review questions before they can proceed forward with the training. Review questions will be located at the end of each module and will include feedback and sources, with an unlimited number of submissions.
We hope the review questions will serve as a study tool and help users identify which areas of the training requires more of their focus before accessing the final exam. We also have streamlined the content, and modules will now include topic headings to help users easily navigate through the training. To see how these changes will impact new and returning users, click here.
We look forward to servicing your training needs. If you have any questions, please contact Support ahipinsuranceeducation. Gregory F. Users must complete all review questions before proceeding to next training. Call our Agent Support Team at ! And remember, plan to complete this training early! The early bird gets the worm!
Uplines and principals must be fully licensed, appointed and certified in all states and markets where their downline agents or employees intend to sell. What's required to receive renewal commission? To receive renewal commission next January for business sold in prior years, you must complete the annual certification process by December You must also be licensed and appointed with us. How to access the certification site Just login to our certification site at AetnaMedicareProducerCertification. Except for Front Runners. You should still reacquaint yourself with modules , since the final exam covers all five modules. Market-specific training attestation: An attestation acknowledging that you'll need to complete market-specific training for every state and market where you plan to sell. To find and register for a market-specific training, visit AetnaMedicareAgentTraining.
You may transfer your existing AHIP certification to us through our certification site. You must still complete the other Aetna-specific requirements to finish the Aetna Individual Medicare annual certification process We look forward to working with you to prepare for the selling season! If you have any questions, please contact your local Aetna Medicare Broker Manager. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance and its affiliates Aetna. Prior to engaging in the sale of Aetna or Coventry Medicare products, producers must be ready to sell, which means certified, contracted, licensed in the applicable states, and appointed by Aetna in accordance with state law.
As permitted in certain states, Aetna will order appointments after the first sale. This communication is intended for use by brokers only and is not intended for distribution to Medicare beneficiaries. We are located at Farmington Ave, Hartford, Connecticut
However, there are some opportunities through some of our carrier partners that will give you a reduced cost. They will also offer an incentive and a reimbursement on that product if you exceed a certain amount of production during AEP. Have you taken AHIP before? Good news! While the AHIP still has the 5 core modules like in years past, for those of you who are taking AHIP for at least the second year, you're only required to complete the 4th and 5th modules, but we strongly recommend reviewing all 5.
Something to focus on this year is a 20 question review quiz for each module, so you may decide to go back through all 5 for review. The quiz isn't graded, but you must take all 5. It will tell you what you get right and wrong, so take notes. These quizzes are great study tools, and you can even download the modules as PDFs to use as study material! We have found that a large percentage of the final exam questions come from the modules and review quizzes.
We recommend paying close attention and taking notes on the modules and review quizzes. Keep in mind that all of the questions will not be straight forward definitions or identification, they will require you to apply your knowledge. After passing the final exam, you still aren't quite done. These modules also have review quizzes followed by a graded exam. As a whole, we think that this year's AHIP is well designed and fair, but that doesn't mean you don't need to prepare and study. PPO vs. MSA vs. PFFS vs. Cost Plan Educational vs. First and foremost, look for the AHIP launch button. Their comprehensive online program covers the basics of Medicare eligibility and benefits, types of Medicare Advantage and Part D prescription drug plans, eligibility and coverage, nondiscrimination training, and marketing and enrollment under the Medicare Advantage and Part D program requirements.
UnitedHealthCare opened their certification on Jun 29th, Anthem's certification was released on June 30th, Humana released their certification on June 30th, and Aetna's certification was released on July 1st. Going back to the MAPD Resource Center and clicking Sort by Carrier, you will find the Humana button to see how to do business with Humana, certification instructions, requests for ordering supplies, the agent portal, as well as accessing your certification for both the carrier and for AHIP. Every major carrier that we work with has a page that includes this information. If you are a new-to-Eldercare agent or you do not currently have access to one of the carriers you see here, feel free to call and let us know that you are interested in learning more and one of our agent partner specialists will help you get contracted or answer any questions that you may have.
We thank you for your partnership with Eldercare and for giving us the opportunity to earn and grow your business this year. Recent News.
Video Center June 23rd, Those of you that have been following my training webinars over the last several months on Medicare have been hearing me talk about the upcoming certification that will be available this summer. Guess what, that time is upon us. AHIP is being released on June 22nd. AHIP will no longer be available as of June 19th, but when you complete the certification you will also be certified for the plans. Rick Roberts Health Marketing Manager You can pick and choose which one you would like to use. If you are new and looking to get certified for the first time, then you will want to reach out to me for some guidance. If you are an agent that is looking to expand your business offerings, please take a look at how selling Medicare related product can help you add a recurring revenue stream to your agency.
There are a ton of prospects in the Medicare market. Many agents that try to focus on a few products for their clients are not really doing their client any justice. This training will go a long way in helping an agent to understand Medicare advantage and prescription drug plans. Below is a summary of the information that each carrier has released regarding the certification. To certify with us, visit AetnaMedicareProducerCertification. Last year agents had to log in to two separate portals. Just go to AetnaMedicareProducerCertification. Wellcare - Completing ACT will certify you to market and sell both and plans. Mark your calendar! We listened to your feedback and made recertification better than ever — including updates to Humana MarketPoint University itself.
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