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Ethics and Compliance Assessment – MC
Questions and Answers.
On October 20, Aries decides to switch his PDP to a Medicare Advantage plan. Aries would like this change to be effective November 1. Which statement is true for Aries? - Correct answer He may be able to use a Special Election Period to change plans if he qualifies for one. Annual Election Period (AEP) is a time when.. - Correct answer Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Which statement regarding Star Ratings is true? - Correct answer Medicare uses a 5-star rating system to illustrate a plan's performance and quality. Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? - Correct answer Mailing a marketing brochure to the consumer via postal mail. What information should be obtained from the consumer when conducting a thorough needs assessment? (Select 2) - Correct answer Their current health care coverage, including what they like about it and what they don't. The providers they see and medications they take to determine network and formulary status. Whose email address may the agent enter into the applicant information section of LEAN enrollment application? - Correct answer Only the consumer's email (or leave it blank).
The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. - Correct answer Statement of Understanding Which of the following must an agent obtain from the consumer no less than 48 hours (unless an exception applies) before an in- person, online, or telephonic marketing appointment? - Correct answer Scope of Appointment Which statement is accurate when a consumer has a Power of Attorney (POA)? - Correct answer If the POA signs the Enrollment Application, they must be able to provide documentation upon request by the Plan that indicates authority under state law to enroll the consumer. What happens on the plan effective date when a member enrolled in a Medicare Supplement Insurance Plan and stand-alone PDP enrolls in a Medicare Advantage plan that includes drug coverage? - Correct answer When MUST an MA Plan or stand-alone PDP disenroll a member? - Correct answer When eligibility requirements are no longer met Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? - Correct answer Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP.
ensure I am recommending the plan that is the best fit for the consumer A thorough needs assessment will include which of the following components? (Select 3) - Correct answer Identifying what healthcare coverage attributes are most important to the consumer and what tradeoffs they might be willing to make Identifying their current providers (including primary care, specialists, hospitals, and pharmacies) and the medications they take Learning about their level of education and former career field Learning about their current coverage, lifestyle and financial characteristics What must you do if the consumer indicates that someone assists them with making decisions such as enrolling in health insurance coverage? - Correct answer Ask if that person can join the call or advise the consumer to call back when that person can be with them on the call Which of the following are guidelines you should follow to help consumers understand the information you present? (Select 3) - Correct answer When you discover a consumer is already enrolled in a Medicare Advantage plan, what must you do prior to making a plan recommendation and enrolling the consumer in a new plan? - Correct answer must compare with the consumer any plan I recommend to their current MA plan, including benefits, costs, network, and drug coverage Sandra is currently enrolled in a Medicare Advantage plan that offers a variety of benefits beyond what is covered by Original Medicare, such as transportation to appointments and an over- the-counter debit card. When comparing an alternative plan,
which of the following must you not use to describe benefits of the new plan? - Correct answer No two plans are the same, so let's be sure you enroll in the plan that best meets your needs" Wrong Which of the following guidelines must you follow before recommending a plan change? (Select 3) - Correct answer Conduct a thorough needs assessment Only recommend a plan that is the best fit plan, which may be the consumer's current plan Do not rely only on and become biased by the consumer's stated reason for calling Next question 4 Questions remaining Select the three elements you must compare when a consumer is considering changing plans. (Select 3) - Correct answer The providers that the consumer sees and how access to those providers might be different by enrolling in the new plan The consumer's current coverage and costs with the coverage and costs of the new plan that I want to recommend The providers that the consumer sees and how access to those providers might be different by enrolling in the new plan The consumer's current coverage and costs with the coverage and costs of the new plan that I want to recommend What should the consumer understand before they agree to proceed with enrolling in a new plan? (Select 3) - Correct answer If the plan is network-based, that the providers they want to use are in the new plan's network If the plan has drug coverage, that the medications they use are on the plan's formulary and, if they are, what tier they are in and any utilization management limitations That their current plan and the new plan that I am recommending are not the same
enrolling, in which plan they are enrolling, and standard disclosures. When must the Scope of Appointment be obtained from the consumer for an in-person or telephonic sales presentation (unless an exception applies)? - Correct answer 48 ane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? - Correct answer Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Which of the following options will enable a consumer to obtain prescription drug coverage? (Select 2) - Correct answer Enroll in a PFFS MA-Only plan and a stand-alone PDP Enroll in any MA-PD plan In which situation will a member be involuntarily disenrolled from their MA plan? - Correct answer The member did not pay plan premiums on a timely basis. Wrong Rosanna is enrolled in a Medicare Advantage Only (MA-Only) Private Fee-for-Service (PFFS) Plan. The plan is suitable for her needs and service area. She has decided she wants to add prescription drug coverage. Which option is available to Rosanna (assuming she is in a valid election period)? - Correct answer Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP. In what product should agents enroll consumers? - Correct answer A product that is suitable for the consumer's needs, goals and financial resources.
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? - Correct answer Dino presented a plan prior to October 1. What information must you provide to the consumer (at minimum) when you conduct your call greeting? - Correct answer My name, my title that indicates I am a licensed insurance agent, and the name of the agency I represent Jane, a consumer, calls your call center and asks to be enrolled in the plan that will put money back into her Social Security every month. What do you keep in mind when you hear the consumer mention a specific plan benefit from an ad? (Select 3) - Correct answer I remember to not overlook the importance of a thorough needs assessment I make sure whatever plan I recommend has that stated benefit because I know it will be the best fit plan for the consumer While I take note of what might be important to the consumer, I do not want to rely on one benefit and become biased as to what type of plan to recommend Wrong When are you required to conduct a thorough needs assessment? - Correct answer I am required to complete a needs assessment prior to making any plan recommendations What might happen if you fail to conduct a needs assessment or conduct an incomplete assessment? - Correct answer The consumer may be enrolled in a plan that does not best meet their needs
Sandra is currently enrolled in a Medicare Advantage plan that offers a variety of benefits beyond what is covered by Original Medicare, such as transportation to appointments and an over- the-counter debit card. When comparing an alternative plan, which of the following must you not use to describe benefits of the new plan? - Correct answer I want to make sure you understand what your current plan has that this plan doesn't so there are no surprises" "Nothing will change" or "Everything will be the same" Wrong Simon is currently enrolled in a Medicare Advantage plan. He calls saying he saw an ad on TV that says he can get a plan with dental coverage of $3500 per year. What guidelines must you follow before recommending a new plan to Simon? (Select 3) - Correct answer Only recommend a plan that is the best fit plan, which may be the consumer's current plan Conduct a thorough needs assessment to gather comprehensive information related to the consumer's situation and needs Make sure that the consumer's current dental coverage is less than what the ad stated is available Wrong What might happen when a member assumes that their new plan has everything their old plan had and more? (\ - Correct answer disatified complans What are examples of phrases you should avoid using with a consumer when comparing plans? (Select 3) - Correct answer "Everything will be the same" "Nothing will change" "No two plans are the same, so let's be sure you enroll in the plan that best meets your needs" Wrong What should the consumer understand before they agree to proceed with enrolling in a new plan? (Select 3) - Correct answer
Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? - Correct answer On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Which statement about discussing benefits with the consumer before an enrollment is true? - Correct answer The agent must explain any provider and/or pharmacy network limitations. 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? - Correct answer The consumer/member would not receive plan related correspondence intended for him/her. The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. - Correct answer Statement of Understanding What is Scope of Appointment? - Correct answer The agreement obtained no less than 48 hours prior to the start of the appointment (unless an exception applies) from the consumer that identifies the scope of products that can be discussed at a personal/individual marketing appointment (in-person or telephonic) To complete an Enrollment Application on behalf of a consumer, what authority must the individual have? - Correct answer The individual must be legally authorized in the state in which the
Which of the following are guidelines you should follow to help consumers understand the information you present? (Select 3) - Correct answer Follow the approved call flow and sales and/or enrollment scripts precisely Speak clearly, at an appropriate volume, and at a moderate pace Ask if someone assists the consumer with making enrollment decisions and make sure that person is present to participate in the call Mail or email the Enrollment Guide for the plan recommended to the consumer so they can review it in advance of completing the enrollment application WRONG When should you proceed with an enrollment? (Select 3) - Correct answer If I am certain the consumer understands what they are gaining and what they may be giving up by enrolling in the new plan Anytime I can get the consumer to consent to enroll If I am certain the consumer understands and agrees they are enrolling When the person who assists the consumer make healthcare coverage decisions is present on the call, when applicable Which of the following are examples of phrases that must not be spoken by an agent when a consumer is contemplating a plan change? (Select 2) - Correct answer "Nothing will change" "Everything will be the same" What might happen when a member assumes that their new plan has everything their old plan had and more? (Select 2) - Correct answer Member dissatisfaction Member complaints
Select the three elements you must compare when a consumer is considering changing plans. (Select 3) - Correct answer The providers that the consumer sees and how access to those providers might be different by enrolling in the new plan The consumer's current coverage and costs with the coverage and costs of the new plan that I want to recommend The medications the consumer uses and how coverage and costs might be different by enrolling in the new plan Prior to enrolling the consumer, what must you make sure the consumer understands? (Select 3) - Correct answer If the plan is network-based, that the providers they want to use are in the new plan's network If the plan has drug coverage, if the medications they use are on the plan's formulary, what tier they are in, and any utilization management limitations That all the features of their current plan will be available in the new plan, including providers, medications, and benefits That their current plan and the new plan that I am recommending are not the same
