Download UHC Ethics and Compliance Exam: 200 Questions with Verified Answers and more Exams Management of Health Service in PDF only on Docsity!
UHC ETHICS AND COMPLIANCE EXAM|| 2025 -
2026||ACTUAL 200 QUESTIONS WITH CORRECT
DETAILED AND VERIFIED ANSWERS||A+ GRADE
What is a servicing agent? ANSWER 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? ANSWER center for medicare and medicaid services Who administers the medicare program and contracts with private health care companies to offer medicaid plans? ANSWER CMS Who holds the authority to approve or disaprove plans that can be sold, and is the regulating agency that also monitors our progresses? ANSWER CMS Who regulates MA's and PDP's ANSWER CMS
Enrolling a customer in a plan when you are not certified in the product is nonANSWERcompliant and considered? ANSWER an unqualified sale Agents who are not qualified to sell the product will not be? ANSWER compensated and may receive corrective and or disciplinary action up to an including termination What is the purpose of an educational event? ANSWER i ts designed to inform medicare consumers about original medicare, medicare advantage, prescription drug and other medicare programs. Where must educational events be conducted? ANSWER 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? ANSWER yes WHat is a marketing/sales event? ANSWER 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.
to ensure that events are in UHC's event reporting application no less than 7 calender days prior to the event... ANSWER 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? ANSWER processed conducting an unreported event is? ANSWER 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? ANSWER 14 days prior to the event or appointment What are marketing materials used for? ANSWER
- draw attention to a plan sponsor or their plan(s) and
- 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: ANSWER 1)
benefits or benefit structure
- cost sharing ( including premiums, copayments, and deductibles)
- Measurements or ranking standards ( such as star ratings. comparisons to other plans, or statistical studies or surveys) Approval is required for? ANSWER 1) ALL medicare marketing materials or
- 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? ANSWER 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? ANSWER no
marketing materials only for products they are certified to market/sell What does PTC stand for? ANSWER permission to contract What does SOA stand for? ANSWER Scope of appointment What does permission to contact mean? ANSWER 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? ANSWER documented, retained and available upon request for 10 years PTC must also be? ANSWER Method specific, short term and event specific What does method specific mean? ANSWER 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? ANSWER 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? ANSWER the agent can only contact the consumer to discuss the products indicated in he PTC mechanism what does BRC mean? ANSWER business reply cards agents who telephone a consumer in response to a BRC that has specific products documented on the card, may only ANSWER discuss the products that were indicated within the BRC BRC's are only intended to obtain permission to contact ANSWER it does not satisfy the SOA requirement SOA does not secure permission to contact ANSWER it confirms permission to
agent must obtain an SOA ANSWER 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 ANSWER 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 ANSWER 1) obtain a signed SOA from the consumer prior to the start of the appointment
- 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? ANSWER via fax or emailed within 2 business days following the scheduled appointment contracted agents using the generic SOA form must also include ANSWER the corresponding fax coversheet medicare marking guidelines prohibit marketing non-health related products
(annuities, life insurance, LT disability/disability plans) when presenting what to a consumer? ANSWER MA plan or PDP plas THIS IS CONSIDERED CROSSANSWERSELLING AND IS PROHIBITED SCARE TACTICS ARE ANSWER PROHIBITED what is an authorized representitive? ANSWER 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? ANSWER 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? ANSWER POA or authorized representitive a person assisting, including an agent cannot sign the enrollment application on behalf of the ANSWER consumer.
giving gifts to solicit business is ANSWER prohibited
what is the real on meals for sales/marketing events? ANSWER it is prohibited including personal and individual marketing appointments agents may serve light refreshments providing the items cannot be combined to equal a ANSWER meal. Are you required to disclose compensation? ANSWER no Define compensation according to CMS? ANSWER 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? ANSWER 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? ANSWER internal sales representitives What is a sales incentive plan? ANSWER Employed agents are paid an incentive
member's FOURTH month effective date following the original effective date. What does EDC stand for? ANSWER external distribution channel What does ICA stand for? ANSWER independent career agent
How does UHC pay non-employee agents in the EDC and ICA? ANSWER pays on commission for enrollment of a consumer into a UHC medicare solutions MA plan, PDP, or med sup insurance policies according to the terms of their agent agreement. How are commissions paid on sales written by a solicitor? ANSWER paid to the solicitor's up-line. for each MA, MA-PD and PDP enrollment, CMS determines if hte enrollment qualifies for ANSWER Initial or renewal compensation If a member disenrolls from one plan and enrolls in another, CMS determines the compensation type for the ANSWER new enrollment What is initial compensation? ANSWER is paid at an amount at or below the fair market value (FMV) When a member enrolls in a plan and has no prior plan history, the plan sponsor may pay the full year initial compensation amount or a? ANSWER pro-rated amount based on the number of months the member is enrolled
text messaging emailing telemarketin g cold calling
Is soliciting by direct mail permitted? ANSWER yes its permitted during contact with a consumer, agents must update the lead status or permission to call within the company tracking system with ANSWER the customers preference if an agent does not have access to bconnected, they must havr a system that enables themto document and retain PTC for a minimum of ANSWER 10 years and provide documentation upon request. if you are soliciting a call for medicare supplement with a client and the customer requests more information on a MA or PDP product, can a discussion be held at that time for those products, or must it be done at a later time? ANSWER it can be done at that time on the MA or PDP product May an agent contact a referred customer, or must that referred customer be the first one to contact the agent ANSWER the referred customer must contact the agent, not the other way around are permitted to return phone calls or emails received from a referred individual ANSWER agents
