AHIP CERTIFICATION 2024 EXAM
QUESTIONS AND DETAILED
ANSWERS| A+ GRADE
Mr. Zachow has a condition for which three drugs are available.
He has tried two but had an allergic reaction to them. Only the
third drug works for him and it is not on his Part D plan's
formulary. What could you tell him to do? Correct Answer Mr.
Zachow has a right to request a formulary exception to obtain
coverage for his Part D drug. He or his physician could obtain
the standardized request form on the plan's website, fill it out,
and submit it to his plan.
Mr. Polanski likes the cost of an HMO plan available in his
area, but would like to be able to visit one or two doctors who
aren't participating providers. He wants to know if the Point of
Service (POS) option available with some HMOs will be of any
help in this situation. What should you tell him? Correct Answer
The POS option might be a good solution for him as it will allow
him to visit out-of-network providers, generally without prior
approval. However, he should be aware that it is likely he will
have to pay higher cost-sharing for services from out-ofnetwork providers
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