UHC 2022 Ethics and Compliance Test Correct Solutions

Agent John is planning to conduct a series of events. Some will be strictly educational, others will be formal presentations of specific UnitedHealthcare plans, and others will be informal marketing events where he can generate leads and schedule future in-home marketing appointments. Of the three types of events John plans to conduct, which need to be reported 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? - 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? - ANSWER Annual Election Period (AEP) 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? - ANSWER Dino presented a plan prior to October 1. 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? - ANSWER Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Which describes the purpose of educational events? - ANSWER Educational events 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? - ANSWER Erin should tell Mrs. Rose that the plan has received a "Below Average" rating. Which of the following describes Permission to Contact guidelines? - ANSWER 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? - ANSWER No. Victor violated United Healthcare permission to contact guidelines by emailing the cousin without the cousin's permission Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage Plan? - ANSWER The consumer's spouse, who is neither a Power of Attorney nor legal guardian. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? - 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? - 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? - ANSWER Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. An agent should only enroll a consumer in a product: - ANSWER That is suitable for the consumer's needs, goals and financial resources. What is the purpose of the Statement of Understanding? - ANSWER 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. What is the definition of Abuse? - ANSWER Abuse includes any practice that results in the provision of services that are not medically necessary. Which of the following are the ways to report potential FWA? (Select 2) - ANSWER -Fraud, Waste and/or Abuse hotline -Producer Help Desk (PHD) In terms of events, which of the following is true? - ANSWER Agents must only report formal and informal marketing/sales events to UnitedHealthcare. Whose email address may the agent enter into the LEAN enrollment application? - ANSWER Only the consumer's (or leave it blank) Annual Election Period (AEP) is a time when: - ANSWER Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. Agent Kim is conducting an event that has been advertised as educational. Which activities are permitted at an educational event? - ANSWER the one with scope of appointments in the answer Educational events allow for which of the following to occur? - ANSWER 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? - ANSWER 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. 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? - ANSWER 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. To sign an Enrollment Application on behalf of a consumer, what authority must the individual have? - ANSWER 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). When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? - ANSWER Provide current marketing materials that have been approved by CMS and UnitedHealthcare. What is the definition of Waste? - ANSWER NOT***** Waste 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) - ANSWER - 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. Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? - ANSWER 5-dollar gift cards to an in-network pharmacy.