2021/2022 United HealthCare - Ethics and Compliance V2: (MBA 505) Q & A; Northern Illinois

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2021/2022 United HealthCare - Ethics and Compliance V2: (MBA 505) Q & A; Northern Illinois 1. In terms of events, which of the following is true? A) Agents must report formal marketing/sales event... s only to UHC B) Agents must report informal marketing/sales events only to UHC C) Agents must report all marketing/sales and educational events to UHC D) Agents must report formal and informal marketing/sales events only to UHC 2. Whose email address may the agent enter into the LEAN enrollment application? A) The consumer's or another individual's provided by the consumer, such as a friend's or relative's B) Only the consumer's (or leave it blank) C) Either the consumer's or the agent's, but only if the consumer authorizes it 3. 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? A) Special Election Period (SEP) B) Initial Coverage Election Period (ICEP) C) Open Enrollment Period (OEP) D) Annual Election Period (AEP) 4. Dino, an agent, received a phone call on Sept. 29 from a consumer interested in Medicare Advantage plans for the new 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 Oct. 15. What did Dino do that was NOT compliant? A) Dino did nothing that was non-compliant B) Dino refused to take the enrollment application until Oct. 15 C) Dino presented a plan prior to Oct. 1 5. You have scheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When you arrive at the appointment, a friend of the consumer who is Medicare-eligible is present to hear your presentation. What should you do? A) Before you can start the appointment with both consumers, ask the consumer's friend to complete an SOA B) Ask the consumer's friend to complete the SOA and schedule a separate appointment C) Tell the consumer that you will come back on another day D) Ask the consumer's friend to leave since she had not scheduled the appointment. 6. Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? A) Formal marketing/sales events. B) Educational events C) Personal/individual marketing appointments D) Informal marketing/sales events 7. Janine, currently enrolled in a 3-star plan, discovers there is a 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: A) Josh should tell Janine that she can change her current plan to a 5-star plan since one is available in the area where she lives. B)Josh should tell Janine that she can only use the 5-star SEP once per calendar year C) Josh should tell Janine that the new coverage will start the first month after she enrolls in the 5 star plan D) Josh should tell Janine that she can only change her current plan to a 5 star plan during the Annual Election Period 8. Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? A) At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older B) At each appointment he provides extra business cards to the consumer and asks that they pass them along to acquaintances C) After enrolling a consumer, he mails a thank you card from the UHC Toolkit and encloses a few business cards for the new member to pass along to acquaintances. 9. Agent Ralph wants to market Advantage Plans in his neighborhood - an area that consists of single-family houses, an assisted living facility, a church, and public library. Which of the following methods of contact is permitted? A) Ralph sends a flyer inviting consumers to a marketing/sales event to each resident via postal mail B) Ralph puts a flyer inviting consumers to a marketing/sales event on the door of each house. C) Ralph stands in the lobby of the assisted living facility and hands out to the residents a flyer inviting them to a marketing/sales event. D) Ralph puts a flyer inviting consumers to a marketing/sales event on the windshield of each car in the church parking lot on Sunday morning. 10. 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? A) 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 B) John may sign the Enrollment Application, but does not need to provide documentation to support his claim of authority upon request by the plan C) John may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application D) John may attend a personal.individual marketing appointment with his mother, but has no authority to sign the Enrollment Application 11. When can telephonic contact with a Medicare eligible consumer be made? A) When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. B) When confirming receipt of mailed information C) When a member has voluntary disenrolled from a plan 12. Who has the authority to sign an Enrollment Application? A) The consumer or the consumer's authorized legal rep (e.g. Power of Attorney) B) The consumer or any individual authorized by the consumer C) The consumer, the consumer's spouse, or the consumer's adult child D) The consumer only 13. As an agent, you MUST NOT do which of the following when marketing UHC Medicare Advantage plans to consumers? A) Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval B) Review and complete the Enrollment Application with consumers C) Provide current marketing materials that have been approved by CMS and UHC D) Review out-of-pocket maximum with consumers and explain any exceptions 14. As an agent, you have an obligation to only enroll a consumer in a product: A) That meets the interest you have in the transaction, for example commissions received for the sale B) That is suitable for the consumer's needs, goals and financial resources C) That meets the sales goal of the Centers for Medicare and Medicaid Services, UHC and the SSA D) That provides a financial advantage to a network of providers 15. By signing the Statement of Understanding the consumer: A) Acknowledges that the agent may discuss Medicare Advantage and Prescription Drug Plans with the consumer B) Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling C) Acknowledges their understanding of standard enrollment and disenrollment procedures 16. What is the definition of Abuse? A) Abuse includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources B) Abuse includes any practice that results in the provision of services that are not medically necessary C) Abuse is intentionally misrepresenting or concealing facts to obtain something of value 17. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) A) The pharmacy splits the original prescription to receive additional dispensing fees B) Using another person's medical insurance information to obtain prescriptions C) Billing for medical services or procedures that were actually provided or performed D) Falsifying signatures or medical records 18. In terms of events, which of the following is true? 19. You have a scheduled appointment with a Consumer to discuss DSNPs. The consumer has completed the SOA form. Two days before the appointment, the consumer calls and requests to discuss PDP plans, which you are also certified to sell. What should you tell the consumer? 20. which election period occurs from October 15 to December 17? 21. You are invite to give a presentation on Medicare Advantage Plans during a marketing/sales event. You display and distribute business cards, brochures, and plan-approved business reply cards and lead cards. Is this permitted? 22. You have rescheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When you arrive at the appointment, a friend of the consumer is present to hear your presentation, What should you do? 23. Educational events allow for which of the following to occur? 24. 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 complaint? 25. Which of the consumers below would not likely have the authority to enroll a consumer in a Medicare Advantage Plan? 26. When can telephonic contact with a Medicare eligible consumer be made? 27. When marketing United Healthcare Medicare plans to consumers, which of the following must an agent do? 28. In what product should agents enroll consumers? 29. Based on the CMS Fraud, Waste, and Abuse (FWA) training, any person who knowingly submits false claims to the Government is liable for _____ times the Government's damages caused by the violator plus a penalty 30. Based on the CMS Fraud, Waste, and Abuse (FWA) training, which of the issues below should be reported to a Compliance Department? (Select 3) 31. Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? 32. How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 Stars? 33. Consumer Gary gives his friend's telephone number and email address to Bethany. What should Bethany do? 34. 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? 35. Educational events allow for which of the following to occur? 36. Who has the authority to sign an Enrollment Application? 37. When marketing United Healthcare Medicare plans to consumers, which of the following must and agent do? 38. Which of the following statements are true about the Statement of Understanding? 39. 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? 40. As an agent, you must not do which of the following when marketing United Healthcare Medicare plans to consumers? 41. When does the Special Election Period (SEP) for DNSP members that lose their Medicaid eligibility begin? 42. Which of the following consumers may be interested in a DNSP? 43. Members of a either a CSNP or a DSNP may have unique health care needs. Which of the following is available to support these members? 44. Which of the following is one of the features of a DSNP? 45. Confirming the consumer's level of state Medicaid and that the consumer is entitled Medicare is a requirement of: 46. Which of the following consumers may not be a good candidate for a DSNP 47. The following is a characteristic of consumer for whom a CSNP may be most appropriate. 48. On July 19, each of the following consumers met with an agent. based on the information provided, which consumer must wait until the Annual Election Period (AEP) to enroll? 49. A consumer whose care management risk level is categorized as low to moderate would not receive which of the following? 50. Which of the following statements are true about physician information on Chronic Condition Verification Form? 51. Which of the following is true about the Medicaid program? 52. Alice is enrolling in a DSNP. Her agent should remind her of which of the following? 53. How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? 54. If a DSNP member loses his eligibility due to a change or loss of Medicaid status, for what cost sharing si he responsible while in the grace period? 55. All fo the following statements about Medicare Supplement Insurance Plans (other than Medicare Select plans) are true, except: 56. Which of the following is not true of a consumer who qualifies for Guaranteed issue? 57. Which of the following is true about Medicare Supplement Insurance Plans? 58. Which of the following statements are correct about Medicare Supplemtn Open Enrollment? 59. Which of the following are true about consumer eligibility for a Medicare Supplement Insurance Plan? 60. Which of the following is a reason a consumer would not be eligible to enroll in a AARP Medicare Supplement Insurance Plan if he/she was not in a Guaranteed issue situation or Medicare Supplement Open Enrollment period? 61. The "free look" evaluation period for a new Medicare Supplement Insurance policy is: 62. If a consumer is eligible for Guaranteed Issue, which of the following is not true? 63. For a consumer who is 69 years old and does not have ESRD, which of the following is a reason he/she may not be eligible for an AARP Medicare Supplement Insurance Plan if he/she is subject to underwriting? 64. In states where eligibility underwriting criteria applies for AARP Medicare Supplement Insurance Plans, when are consumers subject to underwriting? 65. Which of the following is true of AARP Medicare Supplement Insurance? 66. Which statement is not true about members of a Medicare Advantage (MA) Plan who want to enroll in a Medicare Supplement Insurance Plan? 67. Jason is 72 and became eligible for Medicare at age 65. He was previously covered under a competitors Medicare Supplement Insurance Plan and is looking to enroll in an AARP Medicare Supplement Insurance Plan. In most states, which of the following is true? 68. Which of the following is not true of Medicare Supplement Insurance Plans? 69. Which of the following underwriting questions are asked on the application to determine a consumer's eligibility? 70. If a consumer is eligible for Guaranteed Issue, which of the following statements is not true? 71. Which of the following are true about the Medicare access and CHIP Re-authorization Act of 2015 (MACRA) Plans and the impact to Plans C and F. [Show More]

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