UHC Ethics and Compliance Exam 2022/2023

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What type of events must an agent report to UnitedHealthcare? -Informal marketing, /sales events only -Formal and informal marketing/sales events -Formal marketing/sa[es events only -Marketing... /sales events (formal and informal) and educational events - THE CORRECT ANSWER IS Formal and informal marketing/sales events 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 agent may experience commission payment processing issues. -The enrollment application may be denied. - THE CORRECT ANSWER IS 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? -Annual Election Period (AEP) -Special Election Period (SEP) -Open Enrollment Period (OEP) -Initial Coverage Election Period (ICEP) - THE CORRECT ANSWER IS AEP Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? -Generic business reply cards for Medicare products. -Medicare Made Clear brochures from the UnitedHealthcare Toolkit. -5-dollar gift cards to an in-network pharmacy. -Pens and notepads that contain the agent's contact information. - THE CORRECT ANSWER IS 5-dollar gift cards to an in-network pharmacy. 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? -Ask the consumer's friend to leave since the friend had not scheduled the appointment. -Before Kira can start the appointment with both consumers, she must ask the consumer'S friend to complete an SOA. -Ask the consumer's friend to complete the SOA and schedule a separate appointment. -Tell the consumer that you will come back another day, - THE CORRECT ANSWER IS Before Kira can start the appointment with both consumers, she must ask the consumer'S friend to complete an SOA. 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 give an introductory presentation followed by an informal marketing/sales event. -Provide an opportunity to steer a consumer toward a specific or limited number of plans. -Provide an opportunity to review benefits, premiums, and product information with consumers. - THE CORRECT ANSWER IS Provide objective information about the Medicare program and/or health improvement and wellness. 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. Brenda should tell Melanie that the Star Ratings helps consumers and members compare plans based on quality and performance. -Brenda should tell Melanie that Medicare indicates a plan's overall performance and quality with 1 to 5 stars; 1 star denotes poor quality and 5 stars represent excellent quality. -Brenda should tell Melanie that Medicare uses several measures to determine how well plan sponsors perform. Detecting and preventing illness is one example of the measures Medicare uses. - THE CORRECT ANSWER IS 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. Which of the following describes Permission to Contact guidelines? -It allows the agent to discuss the products identified during the marketing appointment. -It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified), -It does not have to be provided by the consumer but can be provided by the consumer's spouse or adult child. - THE CORRECT ANSWER IS It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified) 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. -Yes. Victor has been compliant. Victor has received permission from Julie to contact her cousin directly. -No. Victor has violated Centers for Medicare and Medicaid Services (CMS) permission to call guidelines. Contacting the consumer by email without their permission is prohibited. If Victor had telephoned Julie's cousin, he would be compliant. - THE CORRECT ANSWER IS No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the cousin's permission. 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 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 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 submit documentation that indicates his authority under state law to enroll his mother with the application. - THE CORRECT ANSWER IS 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. When can telephonic contact with a Medicare eligible consumer be made? -When confirming receipt of mailed information. -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. - THE CORRECT ANSWER IS When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Who has the authority to sign an Enrollment Application? -The consumer, the consumer's spouse, or the consumer's adult child. -The consumer only. -The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). -The consumer or any individual authorized by the consumer. - THE CORRECT ANSWER IS The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? -Review out-of-pocket maximum with consumers and explain any exceptions. -Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. -Provide current marketing materials that have been approved by CMS and UnitedHealthcare. -Review and complete the Enrollment Application with consumers. - THE CORRECT ANSWER IS Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. An agent should only enroll a consumer in a product: -That meets the interest he/she has in the transaction, for example commissions received for the sale. -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 sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration. - THE CORRECT ANSWER IS That is suitable for the consumer's needs, goals and financial resources. Which of the following statements is true about the Statement of Understanding? -It ensures when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding they are actually enrolling, in which plan they are enrolling, and standard disclosures. -It is not required if the enrollment mechanism is electronic. -It is only required if the enrollment mechanism is electronic. - THE CORRECT ANSWER IS It ensures when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding they are actually enrolling, in which plan they are enrolling, and standard disclosures. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) A. Billing for medical services or procedures that were actually provided or performed. B. The pharmacy splits the original prescription to receive additional dispensing fees. Cc. Falsifying signatures or medical records. D. Using another person's medical insurance information to obtain prescriptions. - THE CORRECT ANSWER IS B, C, D What is the definition of Waste? -Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources. -Waste is intentionally misrepresenting or concealing facts to obtain something of value. -Waste includes any practice that results in the provision of services that are not medically necessary. - THE CORRECT ANSWER IS Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use o [Show More]

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