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UHC Ethics and Compliance Questions & Answers
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. - Answer-...
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. - Answer-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) - Answer-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. - Answer-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. - Answer-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. - Answer-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. - Answer-...
Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant?
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. - Answer-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. - Answer-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 - Answer-Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation.
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. - Answer-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. - Answer-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. - Answer-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.
