St. Luke's Advantage | Carrier Certification Test for Brokers • Plan Year 2027 Survey

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4. What counties will St. Luke’s offer Medicare Advantage plans in 2027?

Ada, Canyon, Elmore, Gooding, Twin Falls, and Blaine

Ada, Canyon, Elmore, Jerome, Twin Falls, and Valley

Ada, Canyon, Elmore, Jerome, Twin Falls, Valley, and Blaine

All 20 counties included in the St. Luke’s Health Plan footprint.

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5. How many dental cleanings are included in the St. Luke’s Advantage plan per year?

Dental cleanings are not a covered benefit.

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6. What is the vision hardware allowance for St. Luke’s Advantage members?

$105 for 1 year

$150 for 1 years

$200 for 2 years

There is no benefit.

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7. St. Luke’s Advantage offers a fitness benefit.

True

False

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8. How much is the pharmacy deductible for Tiers 3-5 only?

$199

$299

$399

$499

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9. Does the pharmacy deductible include insulin?

Yes

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10. How much is the copay for a one-month supply of insulin?

$25

$35

$70

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11. Where can St. Luke’s Advantage members receive in-network care?

With any contracted provider in any of the 20 counties in the St. Luke’s service area.

Anywhere in America.

Anywhere in Idaho.

With any contracted provider in the seven counties we offer Medicare Advantage plans.

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12. St. Luke’s Advantage members can receive in-network care from both St. Luke’s doctors and specialists, plus a broad network of trusted independent practitioners.

True

False

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13. The nationwide network wrap with Cigna is available on the St. Luke’s Advantage plan.

True

False

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14. Brokers can co-market and create their own materials to explain St. Luke’s Advantage plans to beneficiaries?

True

False

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15. What commissions will Brokers be paid for new or renewing St. Luke’s Advantage policies?

$20 PMPM

$200 annually

$30 PMPM

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16. St. Luke’s Advantage commissions will be paid out monthly.

True

False

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17. Commissions and sold plans can be tracked on the St. Luke’s Health Plan Broker Portal.

True

False

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18. You can find the St. Luke’s Advantage Scope of Appointment (SOA) form on our website https://medicare.stlukeshealthplan.org/forms beginning October 1.

True

False

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19. How many Medicare Advantage plans will St. Luke’s offer for plan year 2027?

Seven

Three

Two

One

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20. St. Luke’s Advantage plans are an HMO plan.

True

False

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21. How many podiatry visits are included in St. Luke’s Advantage plans?

Unlimited

Five

Six

Podiatry is not a covered benefit

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22. St. Luke’s Lifestyle Medicine is an included $0 benefit of the St. Luke’s Advantage plans.

True

False

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23. What areas of focus are included in the Lifestyle Medicine program?

Surgery and acute care

Nutrition, exercise, stress, sleep, and social health

Prescription drug adherence only

Emergency services

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24. Plan premiums vary by geography. What are the monthly premium options for the St. Luke’s Advantage Plans?

$0, $25 and $50

$77, $107 and $142

$75, $100 and $140

$50, $80 and $120

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25. How do St. Luke’s Advantage plans primarily differ from one another?

Different covered services

Different provider networks

Deductible, premium, and maximum out-of-pocket (MOOP) amounts

Prescription drug formularies only

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26. What is the maximum out-of-pocket (MOOP) range for the St. Luke’s Advantage plans?

$3,000 to $4,000

$4,500 to $5,500

$5,950 to $6,950

$7,000 to $8,000

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27. What happens once a member reaches their maximum out-of-pocket (MOOP)?

The member pays a reduced copay

The plan pays 50% of services

The member pays only for prescriptions

The plan pays 100% of covered services

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28. How much do St. Luke’s Advantage members pay for PCP visits and preventive services?

$10 copay

$25 copay

Coinsurance applies

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29. Which of the following specialists may be available at $0 cost?

Dermatology and podiatry

OBGYN, oncology, chronic care, St. Luke's Lifestyle Medicine Specialists and transitional care

Cardiology only

All specialists

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30. What is the inpatient hospital cost structure?

$200 per day for all days

$400 per day for days 1 through five and $0 after

$0 for all days

$500 per admission

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31. What are vision and hearing allowances for St. Luke’s Advantage?

$100 vison and $500 hearing annually

$150 vision annually and $1,000 hearing every three years

$200 vision and $2,000 hearing annually

No coverage

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32. Mental health office visit are a $0 benefit on St. Luke’s Advantage plans.

True

False

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33. What is the cost for Tier 1, generic, drugs?

$10

Deductible applies

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34. What is the cost for Tier 2 drugs?

$10

20% coinsurance

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35. A beneficiary asks you whether a specific plan covers urgent care services, and what costs or limitations apply. What is the most appropriate response?

Confirm only whether urgent care is covered.

Refer them to Meicare.gov.

Explain whether urgent care is covered and describe the benefit details.

Tell them to call the plan directly.

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36. Enrollment in a Medicare Advantage plan replaces the need to pay the Medicare Part B premium.

True

False

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37. This part of Medicare covers outpatient care, physician services, and preventive services.

Part A

Part B

Part C

Part D

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38. This part of Medicare covers prescription drugs.

Part A

Part B

Part C

Part D

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39. This part of Medicare covers inpatient hospital care and limited skilled nursing.

Part A

Part B

Part C

Part D

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40. This part of Medicare offers benefits through private health plans.

Part A

Part B

Part C

Part D

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41. When does coverage begin for a beneficiary who enrolls in a Medicare Advantage plan during their Coverage Election Period?

Immediately upon application

The first of the month based on entitlement or application timing

January 1 only

After 90 days

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42. During which timeframes can most beneficiaries enroll in or switch Medicare Advantage plans?
(Select all that apply.)

October 15 to December 7

January 1 to March 31

July 1 to September 30

Year-round

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43. Which statement is true regarding Broker assistance with enrollment forms?

Brokers must disclose their role and provide their NPN when assisting

Brokers must never help complete forms

Brokers may remain anonymous

Disclosure is optional

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44. What should a beneficiary do first if they want to file a complaint about their St. Luke’s Advantage plan?

File and appeal immediately

Contact CMS

Contact the plan directly

Switch plans

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45. A beneficiary enrolled in a MSA plan will automatically be disenrolled if they enroll in a standalone Part D plan.

True

False

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46. Jaime enrolls Jim in a St. Luke's Advantage plan during AEP. During the plan year, Jim changes his Broker of Record (BOR) from Jaime to Joe.
Which broker receives commissions for the remainder of the plan year?

Jaime

Joe

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47. Under which circumstances can St. Luke’s Health Plan involuntarily disenroll a St. Luke’s Advantage member?

Only for nonpayment of premiums

Only for moving out of state

Only with CMS approval for each case

Any CMS-approved reason allowed under plan rules

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48. Who is not considered a marketing representative for the St. Luke’s Advantage plan?

A licensed Broker

A St. Luke’s Health Plan employee

A satisfied Health Plan member sharing a personal experience

A third-party marketing organization

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49. Brokers must require attendees to provide personal information before attending a marketing event.

True

False

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50. What type of food may be provided at a Medicare marketing event where plan benefits are discussed?

Full meals

Catered dinners

Light snacks and refreshments only

No food allowed

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51. When is a Scope of Appointment (SOA) required?

Only for in-person meetings

Only for agent-initiated calls

Only during AEP

Before any personal marketing appointment discussing plan details

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52. Medicare advantage sales and enrollment calls must be recorded in accordance with federal regulations.

True

False

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* 1. Name

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* 2. Agency

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* 3. NPN

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* 4. What counties will St. Luke’s offer Medicare Advantage plans in 2027?

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* 5. How many dental cleanings are included in the St. Luke’s Advantage plan per year?

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* 6. What is the vision hardware allowance for St. Luke’s Advantage members?

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* 7. St. Luke’s Advantage offers a fitness benefit.

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* 8. How much is the pharmacy deductible for Tiers 3-5 only?

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* 9. Does the pharmacy deductible include insulin?

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* 10. How much is the copay for a one-month supply of insulin?

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* 11. Where can St. Luke’s Advantage members receive in-network care?

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* 12. St. Luke’s Advantage members can receive in-network care from both St. Luke’s doctors and specialists, plus a broad network of trusted independent practitioners.

Question Title

* 13. The nationwide network wrap with Cigna is available on the St. Luke’s Advantage plan.

Question Title

* 14. Brokers can co-market and create their own materials to explain St. Luke’s Advantage plans to beneficiaries?

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* 15. What commissions will Brokers be paid for new or renewing St. Luke’s Advantage policies?

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* 16. St. Luke’s Advantage commissions will be paid out monthly.

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* 17. Commissions and sold plans can be tracked on the St. Luke’s Health Plan Broker Portal.

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* 18. You can find the St. Luke’s Advantage Scope of Appointment (SOA) form on our website https://medicare.stlukeshealthplan.org/forms beginning October 1.

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* 19. How many Medicare Advantage plans will St. Luke’s offer for plan year 2027?

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* 20. St. Luke’s Advantage plans are an HMO plan.

Question Title

* 21. How many podiatry visits are included in St. Luke’s Advantage plans?

Question Title

* 22. St. Luke’s Lifestyle Medicine is an included $0 benefit of the St. Luke’s Advantage plans.

Question Title

* 23. What areas of focus are included in the Lifestyle Medicine program?

Question Title

* 24. Plan premiums vary by geography. What are the monthly premium options for the St. Luke’s Advantage Plans?

Question Title

* 25. How do St. Luke’s Advantage plans primarily differ from one another?

Question Title

* 26. What is the maximum out-of-pocket (MOOP) range for the St. Luke’s Advantage plans?

Question Title

* 27. What happens once a member reaches their maximum out-of-pocket (MOOP)?

Question Title

* 28. How much do St. Luke’s Advantage members pay for PCP visits and preventive services?

Question Title

* 29. Which of the following specialists may be available at $0 cost?

Question Title

* 30. What is the inpatient hospital cost structure?

Question Title

* 31. What are vision and hearing allowances for St. Luke’s Advantage?

Question Title

* 32. Mental health office visit are a $0 benefit on St. Luke’s Advantage plans.

Question Title

* 33. What is the cost for Tier 1, generic, drugs?

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* 34. What is the cost for Tier 2 drugs?

Question Title

* 35. A beneficiary asks you whether a specific plan covers urgent care services, and what costs or limitations apply. What is the most appropriate response?

Question Title

* 36. Enrollment in a Medicare Advantage plan replaces the need to pay the Medicare Part B premium.

Question Title

* 37. This part of Medicare covers outpatient care, physician services, and preventive services.

Question Title

* 38. This part of Medicare covers prescription drugs.

Question Title

* 39. This part of Medicare covers inpatient hospital care and limited skilled nursing.

Question Title

* 40. This part of Medicare offers benefits through private health plans.

1. Name

2. Agency

3. NPN

4. What counties will St. Luke’s offer Medicare Advantage plans in 2027?

5. How many dental cleanings are included in the St. Luke’s Advantage plan per year?

6. What is the vision hardware allowance for St. Luke’s Advantage members?

7. St. Luke’s Advantage offers a fitness benefit.

8. How much is the pharmacy deductible for Tiers 3-5 only?

9. Does the pharmacy deductible include insulin?

10. How much is the copay for a one-month supply of insulin?

11. Where can St. Luke’s Advantage members receive in-network care?

12. St. Luke’s Advantage members can receive in-network care from both St. Luke’s doctors and specialists, plus a broad network of trusted independent practitioners.

13. The nationwide network wrap with Cigna is available on the St. Luke’s Advantage plan.

14. Brokers can co-market and create their own materials to explain St. Luke’s Advantage plans to beneficiaries?

15. What commissions will Brokers be paid for new or renewing St. Luke’s Advantage policies?

16. St. Luke’s Advantage commissions will be paid out monthly.

17. Commissions and sold plans can be tracked on the St. Luke’s Health Plan Broker Portal.

18. You can find the St. Luke’s Advantage Scope of Appointment (SOA) form on our website https://medicare.stlukeshealthplan.org/forms beginning October 1.

19. How many Medicare Advantage plans will St. Luke’s offer for plan year 2027?

20. St. Luke’s Advantage plans are an HMO plan.

21. How many podiatry visits are included in St. Luke’s Advantage plans?

22. St. Luke’s Lifestyle Medicine is an included $0 benefit of the St. Luke’s Advantage plans.

23. What areas of focus are included in the Lifestyle Medicine program?

24. Plan premiums vary by geography. What are the monthly premium options for the St. Luke’s Advantage Plans?

25. How do St. Luke’s Advantage plans primarily differ from one another?

26. What is the maximum out-of-pocket (MOOP) range for the St. Luke’s Advantage plans?

27. What happens once a member reaches their maximum out-of-pocket (MOOP)?

28. How much do St. Luke’s Advantage members pay for PCP visits and preventive services?

29. Which of the following specialists may be available at $0 cost?

30. What is the inpatient hospital cost structure?

31. What are vision and hearing allowances for St. Luke’s Advantage?

32. Mental health office visit are a $0 benefit on St. Luke’s Advantage plans.

33. What is the cost for Tier 1, generic, drugs?

34. What is the cost for Tier 2 drugs?

35. A beneficiary asks you whether a specific plan covers urgent care services, and what costs or limitations apply. What is the most appropriate response?

36. Enrollment in a Medicare Advantage plan replaces the need to pay the Medicare Part B premium.

37. This part of Medicare covers outpatient care, physician services, and preventive services.

38. This part of Medicare covers prescription drugs.

39. This part of Medicare covers inpatient hospital care and limited skilled nursing.

40. This part of Medicare offers benefits through private health plans.

41. When does coverage begin for a beneficiary who enrolls in a Medicare Advantage plan during their Coverage Election Period?

42. During which timeframes can most beneficiaries enroll in or switch Medicare Advantage plans?
(Select all that apply.)

43. Which statement is true regarding Broker assistance with enrollment forms?

44. What should a beneficiary do first if they want to file a complaint about their St. Luke’s Advantage plan?

45. A beneficiary enrolled in a MSA plan will automatically be disenrolled if they enroll in a standalone Part D plan.

46. Jaime enrolls Jim in a St. Luke's Advantage plan during AEP. During the plan year, Jim changes his Broker of Record (BOR) from Jaime to Joe.
Which broker receives commissions for the remainder of the plan year?

47. Under which circumstances can St. Luke’s Health Plan involuntarily disenroll a St. Luke’s Advantage member?

48. Who is not considered a marketing representative for the St. Luke’s Advantage plan?

49. Brokers must require attendees to provide personal information before attending a marketing event.

50. What type of food may be provided at a Medicare marketing event where plan benefits are discussed?

51. When is a Scope of Appointment (SOA) required?

52. Medicare advantage sales and enrollment calls must be recorded in accordance with federal regulations.