UHC ETHICS AND COMPLIANCE ASSESSMENT EXAM 2024-2025, Exams of Nursing

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UHC ETHICS AND COMPLIANCE

ASSESSMENT EXAM 2024-2025 WITH

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As an agent, you have an obligation to only enroll a consumer in a product: That meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration. That is suitable for the consumer's needs, goals and financial resources. That provides a financial advantage to a network of providers. That meets the interest you have in the transaction, for example commissions received for the sale. That is suitable for the consumer's needs, goals and financial resources. By signing the Statement of Understanding, the consumer: Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. Acknowledges their understanding of standard enrollment and disenrollment procedures. Acknowledges that the agent may discuss Medicare Advantage and Prescription Drug Plans with the consumer. Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. What is the definition of Abuse? Abuse includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources. Abuse includes any practice that results in the provision of services that are not medically necessary. Abuse is intentionally misrepresenting or concealing facts to obtain something of value.

Abuse includes any practice that results in the provision of services that are not medically necessary. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) Falsifying signatures or medical records. Billing for medical services or procedures that were actually provided or performed. The pharmacy splits the original prescription to receive additional dispensing fees. Using another person's medical insurance information to obtain prescriptions. Falsifying signatures or medical records.

The pharmacy splits the original prescription to receive additional dispensing fees.

Using another person's medical insurance information to obtain prescriptions. In terms of events, which of the following is true? Agents must only report formal marketing/sales events UnitedHealthcare. Agents must only report informal marketing/sales events to UnitedHealthcare. Agents must only report formal and informal marketing/sales events to UnitedHealthcare. ...

When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. The enrollment application may be denied. The agent may experience commission payment processing issues. The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? Open Enrollment Period (OEP) Special Election Period (SEP) Initial Coverage Election Period (ICEP) Annual Election Period (AEP) Annual Election Period (AEP) Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? Medicare Made Clear brochures from the UnitedHealthcare Toolkit. Pens and notepads that contain the agent's contact information. 5-dollar gift cards to an in-network pharmacy. Generic business reply cards for Medicare products. 5-dollar gift cards to an in-network pharmacy.

Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? Yes, but just one because the Nelsons are husband and wife. Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. No, because the Nelsons are current members. No, because the Nelsons walked into his office instead of scheduling an appointment in their home. Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Educational events allow for which of the following to occur? Provide objective information about the Medicare program and/or health improvement and wellness. Provide an opportunity to review benefits, premiums, and product information with consumers. Provide an opportunity to steer a consumer toward a specific or limited number of plans. Provide an opportunity to give an introductory presentation followed by an informal marketing/sales event. Provide objective information about the Medicare program and/or health improvement and wellness. How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars? Erin should let Mrs. Rose know that the rating is for agent use only and has accidentally been printed in the Enrollment Guide. Erin should tell Mrs. Rose that the plan has received a "Below Average" rating. Erin should tell Mrs. Rose that each plan has the same Star Rating and it does not accurately reflect an individual plan's performance in certain categories. ... Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? After enrolling a consumer, he mails a thank you card from the UnitedHealthcare Toolkit and encloses a few business cards for the new member to pass along to acquaintances. At each appointment he provides extra business cards to the consumer and asks that the consumer pass them along to acquaintances. At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. Consumer Gary gives his friend's telephone number and email address to agent Bethany. What should Bethany do? Bethany may accept the contact information and telephone or email Gary's friend to schedule a face-to- face meeting. Bethany may accept the information but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. Bethany should ask for Gary's friend's address so she can visit him while she is in the neighborhood.

Bethany may accept the information but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? John may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application. John may attend a personal/individual marketing appointment with his mother but has no authority to sign the Enrollment Application. John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. John may sign the Enrollment Application but does not need to provide documentation to support his claim of authority upon request by the Plan. John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When confirming receipt of mailed information. When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. When a member has voluntarily disenrolled from a plan. When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Jacob must explain that Emily will sign the Enrollment Application and that no further action on her part is required. Jacob must explain that Emily will sign the Enrollment Application and must submit documentation with the application that indicates her legal authority to enroll her father. Jacob must explain that Emily is not authorized to complete the Enrollment Application on behalf of her father. jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage or Prescription Drug Plans to consumers? Review the Summary of Benefits. Review and complete a SOA form with each Medicare-eligible consumer prior to the start of a personal/individual (e.g., in-home or telephonic) marketing appointment. Provide current materials approved by CMS and UnitedHealthcare.

Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. Next question Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation

On October 20, Aries decides to switch his PDP to a Medicare Advantage plan. Aries would like this change to be effective November 1. Which statement is true for Aries?

-He can use the Annual Election Period that runs from October 15 to December 7 and select November 1 as his plan effective date.

-There are no rules governing how often he can change plans during the year.

-He may be able to use a Special Election Period to change plans if he qualifies for one.

-He can use the Medicare Advantage Open Enrollment Period that runs from October 15 to December 7 and select November 1 as his plan effective date. He may be able to use a Special Election Period to change plans if he qualifies for one. Which of the following statements is true about election periods?

-MA Open Enrollment Period can only be used by a consumer already enrolled in an MA Plan

-Initial Election Period can only be used by a consumer already enrolled in a Medicare Advantage (MA) Plan.

-Annual Election Period can only be used by a consumer already enrolled in an MA Plan.

-5-Star SEP can only be used by a consumer already enrolled in an MA Plan. MA Open Enrollment Period can only be used by a consumer already enrolled in an MA Plan Which statement regarding Star Ratings is true?

-Medicare uses a 5-star rating system to illustrate the plan's relative popularity in a market as measured by membership and retention rates.

-Star Ratings are based on a plan's performance from the prior year and, therefore, may not accurately reflect a plan's current value.

-Medicare uses a 5-star rating system to illustrate a plan's performance and quality.

-The agent said that the Star Ratings are based on a plan's performance from two years ago and, therefore, do not accurately reflect a plan's current value. Medicare uses a 5-star rating system to illustrate a plan's performance and quality. Which of the following describes Permission to Contact (PTC) guidelines?

-PTC expires the Dec. 31 of each year regardless of when it was obtained.

-Contact can only be made by the method(s) requested by the consumer and the agent can only market the product(s) indicated by the consumer.

-The agent must obtain PTC no later than the start of a marketing appointment and can only discuss the products agreed upon by the consumer. Contact can only be made by the method(s) requested by the consumer and the agent can only market the product(s) indicated by the consumer.

What information should be obtained from the consumer when conducting a thorough needs assessment? (Select 2)

-Their favorite foods and hygiene products to determine if they are covered by a grocery allowance.

-The providers they see and medications they take to determine network and formulary status.

-Their current health care coverage, including what they like about it and what they don't. The providers they see and medications they take to determine network and formulary status.

Their current health care coverage, including what they like about it and what they don't. When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address?

-The enrollment application may be denied.

-The agent may experience commission payment processing issues.

-The consumer/member would not receive plan related correspondence intended for him/her. The consumer/member would not receive plan related correspondence intended for him/her. What is the purpose of the Statement of Understanding?

-It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application,

they are acknowledging their understanding of monthly premiums and deductibles.

-It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding of standard enrollment and disenrollment procedures.

-It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. Which of the following must an agent obtain from the consumer no less than 48 hours (unless an exception applies) before an in-person, online, or telephonic marketing appointment?

-Scope of Appointment

-Permission to Call

-Statement of Understanding Scope of Appointment Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider?

-Jane should ask another agent to take over the call because she is not getting through to Albert.

-Jane should forge ahead with the presentation and enroll Albert if he is interested.

-Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present.

-Jane should tell Albert to find the information on the plan's website. Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Select the option that describes the coverage combinations a member can be enrolled in at the same time.

-Medicare Supplement plan and MA-PD plan

-MA-Only PFFS plan and a stand-alone PDP

-MA-Only non-PFFS plan and a stand-alone PDP

MA-Only PFFS plan and a stand-alone PDP In which situation MAY the Medicare Advantage (MA) organization decide to disenroll a member from an MA plan?

-Premiums are not paid on a timely basis

-The member expresses dissatisfaction with the plan

-The member is diagnosed with a condition Premiums are not paid on a timely basis Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)?

-Dennis should disenroll from his Medicare Supplement Plan, return to Original Medicare and enroll in a stand-alone PDP.

-Dennis should disenroll from his Medicare Supplement Plan and enroll in any of the Medicare Advantage Plans that have prescription drug coverage included.

-Dennis should stay enrolled in his Medicare Supplement Plan and enroll in a Medicare Advantage Plan with prescription drug coverage included.

-Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. In what product should agents enroll consumers?

-A product that meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration.

-A product that meets the interest the agent has in the transaction, for example commissions received for the sale.

-A product that is suitable for the consumer's needs, goals and financial resources.

-A product that provides a financial advantage to a network of providers. A product that is suitable for the consumer's needs, goals and financial resources.

To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3)

-Unsubstantiated

-Complete

-Factual

-Accurate Complete

Factual

Accurate

Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? April 1 through October 31 Which of the following statements is true about using a five star special enrollment period (SEP)? It can be used once from December 8 through November 30 and coverage will start the first of the month following recipient of the enrollment application Which statement regarding star ratings is true Medicare uses a five star rating system to illustrate the plans performance and quality In which of the following situations can a telephonic contract be made with a Medicare eligible consumer? When the consumer consented to be contracted for sales activities, and the permission has not yet expired What information should be obtained from the consumer when conducting a thorough needs assessment? (Select 2)

• their current health care coverage, including what they like about it, and what they don't
• the providers they see in medication they take to determine network and formulary status

Will using LEAN to complete an enrollment application with the consumer agent Jeff learns the consumer does not have an email address. What should Jeff do? The consumer/member would not receive plan related, corresponds, intent for him/her What is the purpose of the statement of understanding? It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. What is scope of appointment? The agreement obtained from the consumer to that identifies the scope of products that can be discussed at a personal/individual marketing appointment Which statement is accurate when a consumer has a power of authority (POA) If the POA signed the enrollment application, they must be able to provide documentation upon request for the plan that indicates authority under state law to enroll the consumer What happens on the plan effective date when a member enrolled in a Medicare supplement insurance plan and standalone PDP enroll in a Medicare vantage plan that includes drug coverage Automatic disenrollment from the standalone PDP In which situation, MAY the Medicare advantage (MA) organization decide to disenroll a member from an MA plan? Premiums are not paid on a timely basis Dennis a consumer is currently enrolled in the original Medicare, plus a Medicare supplement plan. His current plan is suitable for his Medicare needs, but he would like to add prescription drug coverage only since Dennis wants to keep his current coverage which option is available to Dennis (assuming he is in a valid election period)? Dennis should stay enrolled in original Medicare and his Medicare supplement plan and enroll in a standalone PDP In what product should agents and roll consumers? A product that is suitable for the consumers needs, goals and financial resources Dino an agent received a phone call on September 29 from a consumer interested in Medicare advantage plans for the new plan year. Dino proceeded to verify the consumers Medicare eligibility, describe the cost and benefit coverage of the plan and explain that he could not accept an enrollment application until October 15. What did Daniel do? That was not compliant. Dino presented a plan prior to October 1 Which of the following are examples of advertisements and consumer may see that may make them call you into your call center?

When must you provide your name your role as a license, insurance agent, and the name of the agency you represent? At the beginning of the call What must you keep in mind when receiving a call from a consumer (Select 2)

• The consumer may have misunderstood, or been confused by what they read or heard in a advertisement
• the consumer may be relying on a single benefit or description provided in the advertisement Consumer asked to be enrolled in a medical advantage plan that allows them to see Specialist without needing a referral. What do you do next? Conduct a thorough needs assessment to make sure I gather information about the situation and preferences What is the purpose of a needs assessment? To gather as much information about the consumer as possible to ensure I am recommending the plan that is the best fit for the consumer Which of the following are components that at minimum should be included in a thorough needs assessment
• identifying their current providers, including primary care, specialist hospitals in pharmacies and the medication they take
• identifying the last time the consumer visited a doctor or hospital
• Deterring consumer eligibility Which of the following statements are true when selling Medicare plans over the phone? (Select 2) I must rely on what I hear, which includes the tone of the consumers voice, the questions they ask her even there pauses in the conversation I don't have the benefit of seen the consumers facial expressions or body language in order to assess their comprehension Inez a consumer call the number on a piece of mail she received during the annual election period when you answer you can hear a lot of background noise. What action should you take to help ensure Inez will understand the information you share with her Speak clearly in an appropriate volume in a modern piece Ask if someone assist her with making enrollment decisions and make sure that person is presented to participate in the call Ask her to either move into another room, or turn off the TV to help her, hear me clearly in without distraction When should you assess consumer comprehension during a call? At all stages of the call

Consumer Lily tells you she is enrolled in a Medicare vantage plan where she is required to see in network providers to receive coverage except in emergencies. She is interested in a plan that offers more net work flexibility provided she can see her current primary care provider. PCP which of the following best describes steps you must take in your sales and enrollment process. I must ensure the consumer understands what they are gaining and what they may be given up by enrolling in the new plan I must complete a thorough needs assessment I must compare with the consumer any plan I recommend to their current MA plan, including benefits, cost network and drug coverage Which of the following are examples of phrases that must not be spoken by an agent when it consumer is contemplating a plan change (Select 2)

• everything will be the same
• nothing will change Simon is currently enrolled in a Medicare advantage. Plan he calls saying he saw an ad on TV that says he can get a plan with dental coverage of 3500 per year what guidelines supposed to follow before recommended a new plan to Simon?
• conduct a thorough needs assessment together, comprehensive information related to the consumer situation and needs

Which of the following best describes why is important to compare plan options to the consumers current coverage? I want to make sure the consumer understands what they give up and what they gain by changing plans What are examples of phrases you should avoid using with a consumer when comparing plans? Nothing will change Everything will be the same I am recommending a plan that will add benefits to your current coverage Prior to enrolling the consumer what must you make sure the consumer understands (select 3) If the plan is network-based, that the providers they want to use are in the new plants that work That their current plan in the new plan that I am recommending, are not the same If the plan has drug coverage, the medication they use are on the plans formulary what tier they are in, and any utilization management limitations The ___________ ensures that when consumers provide the verbal agreement during the telephone enrollment the knowledge understand they are actually enrolling in which plan they are in rolling, as well as standard disclosures. Statement of Understanding Select the option that describes the coverage combinations a member can be enrolled in at the same time

Which of the following are examples of lead generation materials that might result in an inbound call from my Medicare eligible consumer Direct mail, TV ads, billboards On October 20 Aries decide to switch his PDP to a Medicare Anast Penn erens would like this change to be effective November 1 which statement is true for Aries He may be able to qualify Which statement about discussing benefits with a consumer before an enrollment is true The agent must explain any prior and/or pharmacy network limitation Rosanna is enroll in a Medicare advantage only MA only private fee for service plan Which statement regarding star rating is true Medicaid, as if I start reason to illustrate plans, performance, and quality Which of the following options will enable a consumer to obtain prescription drug coverage select 2 Is currently a member of a standalone PDP it was would like to have an additional Medicare coverage throwing his nose is indicates a Medicare. Advantage plan would be a good fit. There are plans available in his area and he is in a valid election. Which option is available to Aries Aries can enroll in a Medicare advantage plan with prescription drug coverage which will disenroll him from his PDP Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Which of the following statements is true about election periods? MA open enrollment period. Can only be used by consumer already enrolled in an MA plan. When a customer asked why an MA plan has a two star rating the agent should tell the consumer one That the plan has received a Below Average rating Whose email address may the agent enter into the applicant information section of LEAN enrollment application? Only the consumer email or leave it blank

Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. An agent is explaining Medicare Advantage plan options to a consumer. During the conversation, the agent explains that Medicare gives each plan a Star Rating. Which statement is true? The agent said that Medicare uses a 5-star rating system to illustrate the plan's performance and quality. Which of the following describes Permission to Contact guidelines? it allows the agent to discuss the products identified during the marketing appointment Which statement about discussing benefits with the consumer before an enrollment is true? When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. What is the purpose of the Statement of Understanding? It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures. What is Scope of Appointment? The agreement obtained from the consumer that identifies the scope of products that can be discussed at a personal/individual marketing appointment (in-person or telephonic) To complete an Enrollment Application on behalf of a consumer, what authority must the individual have? The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). melanie is currently enrolled in an HMO MAPD, and she is talking to sales agent Brenda about enrolling in a Medicare Supplement Insurance Plan. What should Brenda tell Melanie? Brenda should tell her that she is automatically disenrolled from her MA Plan if she enrolls in a Medicare Supplement Insurance Plan

In which situation must the Medicare Advantage (MA) organization disenroll a member from an MA plan? The member loses entitlement to either Medicare Part A or Part B Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)? Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. In what product should agents enroll consumers? A product that is suitable for the consumer's needs, goals and financial resources To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3) Accurate Complete Factual Annual Election Period (AEP) is a time when... Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? April 1 through October 31 Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When the consumer consented to be contacted for Sales Activities and the permission has not yet expired Before starting an enrollment, what benefit information are agents required to provide to the consumer? The agent must accurately and completely disclose any benefits discussed

While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do? Leave the field requesting applicant email address blank Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Melanie is currently enrolled in a MAPD, and she is interested in enrolling in a PDP. Which statement is true? An agent should only enroll a consumer in a product That is suitable for the consumer's needs, goals and financial resources Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? AEP What is the definition of Abuse? Abuse includes any practice that results in the provision of services that are not medically necesary An agent should only enroll a consumer in a product: That is suitable for the consumer's needs, goals and financial resources. When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? Provide current marketing materials that have been approved by CMS and UnitedHealthcare. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. When can telephonic contact with a Medicare eligible consumer be made? When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. An individual with Power of Attorney is an example of what authority? Legal authority under state law to act on behalf of another individual.

Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Educational events allow for which of the following to occur? Provide objective information about the Medicare program and/or health improvement and wellness. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? Dino presented a plan prior to October 1. Annual Election Period (AEP) is a time when: Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. What type of events must an agent report to UnitedHealthcare? Formal and informal marketing/sales events Which of the following are the ways to report potential FWA? Producer Help Desk (DHP) Fraud, Waste and/or Abuse hotline What is the definition of Fraud? Fraud is intentionally misrepresenting or concealing facts to obtain something of value. What is the purpose of the Statement of Understanding? It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling and standard disclosures. In what product should agents enroll consumers? A product that is suitable for the consumer's needs, goals and financial resources. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. To sign an Enrollment Application on behalf of a consumer, what authority must the individual have?

The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g. Power of Attorney). In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and that the permission has not yet expired. Julie, a consumer, is having difficulty understanding the information her agent, Victor, is presenting at her in-home appointment. She provides Victor with her cousin's telephone number and email address and asks him to explain the plan to her cousin, who frequently assists with her health care decisions. The next day, Victor emails Julie's cousin. Has Victor been compliant? No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the cousin's permission. When does Permission to Contact for Medicare Advantage and/or Prescription Drug Plans expire? Once contact is made or 9 months from the date the consumer provided permission (e.g. consumer signature date on BRC) or 90 days if on federal do not call list, whichever comes first. Agent Brenda is presenting Medicare Advantage plan options to her consumer, Melanie. During the presentation, Brenda tells Melanie that Medicare gives each plan a Star Rating. Which of the following is not an appropriate response when Melanie asks what the Star Rating means? Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories. Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? Educational events Kira has scheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When she arrives at the appointment, a friend of the consumer who is Medicare-eligible is present to hear your presentation. What should Kira do? Before Kira can start the presentation with both consumers, she must ask the consumer's friend to complete an SOA. Which of the following material is an agent NOT permitted to display and/or distribute at a marketing/sales event? 5-dollar gift cards to an in-network pharmacy. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? Annual Election Period (AEP). When completing a enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address?

The consumer/member would not receive plan related correspondence intended for him/her.

What is a servicing agent? an inactive, nonemployee who has signed a servicing agreement in order to receive renewal commisions on medicare advantage and prescription drug plan enrollments on or after 1-1-2014. the agent must maintain an active resident license and appointment and pass medicare basics and ethics compliance assessments on an annual basis What does CMS stand for? center for medicare and medicaid services Who administers the medicare program and contracts with private health care companies to offer medicaid plans? CMS Who holds the authority to approve or disaprove plans that can be sold, and is the regulating agency that also monitors our progresses? CMS Who regulates MA's and PDP's CMS Enrolling a customer in a plan when you are not certified in the product is non-compliant and considered____? an unqualified sale Agents who are not qualified to sell the product will not be? compensated and may receive corrective and or disciplinary action up to an including termination What is the purpose of an educational event? its designed to inform medicare consumers about original medicare, medicare advantage, prescription drug and other medicare programs. Where must educational events be conducted? in a public venue Are the educational events unbiased so that it doesn't steer the consumer towards a specific plan or limited number of plans? yes

WHat is a marketing/sales event? an event designed to steer or attempt to steer, consumers toward a plan or limited set of plans. Agents may discuss plan specific information and collect applications. Can marketing/sales be formal or informal? both What describes a formal marketing/sales event? a full plan presentation, given in a presenter-audience format. What is an inform marketing/sales event? they're passive in nature where the consumer approaches the agent to engage in conversation. a booth, table, or kiosk is typically used What are marketing appointments? They're commonly referred to as "in home, face to face, or one on one appointment" and typically take place in the consumers home. What other places can marketing appointments happen? coffee shop, or even over the phone because marketing appointments are not formal and informal marketing sales events, they're not reported to who? UHC or CMS. instead, agents must obtain a completed scope of appointment prior to conducting the appointment. To report events, what should agents use? an event request form to ensure that events are in UHC's event reporting application no less than 7 calender days prior to the event... submit the event request form, according to instructions on the form, NO LESS THAN 14 CALENDAR DAYS event request forms submitted within7 calendar days will NOT be what? processed conducting an unreported event is _____? prohibited to schedule a sign language interpreter for a formal marketing/sales event or a personal/individual marketing appointment, enter the consumer's request direct;y in bconnected at least? 14 days prior to the event or appointment

What are marketing materials used for?

1. draw attention to a plan sponsor or their plan(s) and
2. influence a consumer's decision when selecting a plan in which to enroll or a member's decision to remain enrolled in their current plan Marketing materials contain information about the plan or plans:
3. benefits or benefit structure
4. cost sharing ( including premiums, copayments, and deductibles)
5. Measurements or ranking standards ( such as star ratings. comparisons to other plans, or statistical studies or surveys) Approval is required for?
6. ALL medicare marketing materials or
7. ANY material that mentions a plan sponsor ( such as " united health care") one of its affliated plans or displays any logos What does generic mean with marketing materials? materials that do not meet the marketing materials criteria and do not carry any plan sponsor information or logos does generic materials require prior approval? no What methods are considered marketing material? newspaper, tv, internet, radio advertisements, direct mail, postcards, flyers, brochures, magnets, pre- enrollment materials, websites and social media platforms what are some examples of generic marketing materials? social media sites and websites sites used to market UHC plans must be _____ by UHC and CMS prior to use approved when talking about marketing materials what should the agent NOT do? add, enhance, delete, modify, edit or create any content in the marketing materials provided by the health plan

modify approved materials in any way, no matter how minor

ask health related or health screening questions on generic, agent created materials What must an agent do when talking about marketing materials? use marketing materials only for products they are certified to market/sell

What does PTC stand for? permission to contract What does SOA stand for? Scope of appointment What does permission to contact mean? is permission given by the consumer to be called or otherwise contacted by an agent for the purpse of marketng any UHC medicare solutions product includeing MA, Prescription drug or med sup plans. PTC must be______? documented, retained and available upon request for 10 years PTC must also be? Method specific, short term and event specific What does method specific mean? contact can only be made by the method permitted by the consumer. Permission to telephone only enables the agent to dial the number provided.

AN AGENT MUST RECEIVE EXPLICIT PERMISSION TO TEXT OR EMAIL THE CONSUMER

having access to a phone number or email address does not imply permission from the consumer What is short term? PTC expires once the agent has made contact with the consumer or 9 months after the date the PTC was received.

PTC expires 90 days after the receipt for consumers requesting info on med sup's or who are on the federal DNC list. What does event specific mean? the agent can only contact the consumer to discuss the products indicated in he PTC mechanism what does BRC mean? business reply cards agents who telephone a consumer in response to a BRC that has specific products documented on the card, may only ____ discuss the products that were indicated within the BRC BRC's are only intended to obtain permission to contact it does not satisfy the SOA requirement

SOA does not secure permission to contact it confirms permission to discuss product types during an individual appointment If a BRC is returned by the consumer without a valid phone number, agents____ may NOT look up or search for consumer information in order to contact the consumer either by telphone or a visit. What is a Scope of appointment (SOA)? captures the consumers permission to discuss certain products. Where are SOA forms available? in enrollment guides and as standalone documents on the sales material portal accessible on jarvis a SOA is required from each Medicare eligible consumer present at any face to face or telephonic marketing appkintment to discuss MA and or PDP plans including____ authoried legal representitives and each spouse ( if a married couple is present) When a consumer walks into an agent's office or a UHC medicarestore, the agent must obtain an SOA prior to discussion In leu of a SOA form, agents must announce the products that will be presented at the formal or informal marketing/sales event agents may obtain an SOA for future face to face or telephonic appointments if the consumer requests the future appointment at the marketing/sales event when conducting face to face or telephonic appointments to present MA and or PDP plans, the agent MUST

1. obtain a signed SOA from the consumer prior to the start of the appointment
2. obtain a new SOA when the consumer or agent requests to discuss a health related product not identified on the original SOA. once obtained, the new product may be discussed SOAs must be submitted how? via fax or emailed within 2 business days following the scheduled appointment contracted agents using the generic SOA form must also include the corresponding fax coversheet medicare marking guidelines prohibit marketing non-healh related products (annuities, life insurance, LT disability/disability plans) when presenting what to a consumer? MA plan or PDP plas

THIS IS CONSIDERED CROSS-SELLING AND IS PROHIBITED

SCARE TACTICS ARE

PROHIBITED

what is an authorized representitive? is a person who is authorized under state law to complete the enrollment application, make health care decisions on behalf of the consumer and is authorized to receive health care related on his/her behalf in order to determine if a POA or authorized representitive is needed when enrolling a consumer, the agent MUST___? consider the consumers mental and physical ability to enroll themselves if a consumer appears to have either a physical and or mental challenges that may impede their ability to enroll themselves in a plan, you must ask if they have a ____ or ____? POA or authorized representitive a person assisting, including an agent cannot sign the enrollment application on behalf of the consumer.

only the consumer, POA, or authorized representative can sign the enrollment application agents can offer promotional gifts to attendees of any event type as long as such gifts are of nominal retail value. nominal value is any item _____ or less $15 or less the combined value of all giveaway items including food, must not exceed______ per consumer $15 What types of gifts are prohibited regardless of the amount? cash, gift certificates, gift cards, monetary rebates, as well as charitable contributions made on behalf of the consumers/members you must state that accepting a gift or prize does not obligate a consumer to enroll when providing gifts, you must offer to all persons whether or not they're eigible for medicare giving gifts to solicit business is prohibited what is the real on meals for sales/marketing events? it is prohibited including personal and individual marketing appointments

agents may serve light refreshments providing the items cannot be combined to equal a meal. Are you required to disclose compensation? no Define compensation according to CMS? monetary or non-monetary remuneration of any kind relating to the sale or renewal of a policy including, but not limited to, commission, bonuses, gifts, prizes, awards, and referral/finder's fees. What does compensation not involve? payment of fees to comply with stat appointment laws.: costs related to training, certification, and testing requirements; reimbursement for mileage to and from educational and marketing/sales events or marketing appointments with consumers What does ISR stand for? internal sales representitives What is a sales incentive plan? Employed agents are paid an incentive when specific goals have been met. referral/finder's fees? UHC does not sponsor a lead referral program; therefore, no payment is made in exchange for a referral or as a result of referred consumer's enrollment Marketing fees? Agents are prohibited from charging a consimer or member any type of fee for the marketing of a Medicare insurance product, including but not limited to : entrance fees to attend educational or marketing/sales events, fees to conduct a personal/individual meeting appointment, or to cover the cost of materials What is another name for compensation recovery? charge backs What is compensation recovery? Incentive amounts are deducted from a SIP participant's incentive payment for previously paid advances on sales that aren't earned. generally the result of a member's rapid disenrollment from their plan, but can occur for other reasons. When does rapid dis-enrollment occur? it occurs when a member voluntarily dis-enrolls or moves from one UHC plan to another prior to the member's FOURTH month effective date following the original effective date.