Download UHC Ethics And Compliance Section For Certification |174 Questions And Answers. and more Exams Medical ethics in PDF only on Docsity!
UHC Ethics And Compliance Section For
Certification |174 Questions And Answers.
What is a servicing agent? - Correct answer an inactive, nonemployee who has signed a servicing agreement in order to receive renewal commisions on medicare advantage and prescription drug plan enrollments on or after 1-1-2014. the agent must maintain an active resident license and appointment and pass medicare basics and ethics compliance assessments on an annual basis What does CMS stand for? - Correct answer center for medicare and medicaid services Who administers the medicare program and contracts with private health care companies to offer medicaid plans? - Correct answer CMS Who holds the authority to approve or disaprove plans that can be sold, and is the regulating agency that also monitors our progresses? - Correct answer CMS Who regulates MA's and PDP's - Correct answer CMS Enrolling a customer in a plan when you are not certified in the product is non-compliant and considered____? - Correct answer an unqualified sale Agents who are not qualified to sell the product will not be? - Correct answer compensated and may receive corrective and or disciplinary action up to an including termination What is the purpose of an educational event? - Correct answer its designed to inform medicare consumers about original medicare,
medicare advantage, prescription drug and other medicare programs. Where must educational events be conducted? - Correct answer in a public venue Are the educational events unbiased so that it doesn't steer the consumer towards a specific plan or limited number of plans? - Correct answer yes WHat is a marketing/sales event? - Correct answer an event designed to steer or attempt to steer, consumers toward a plan or limited set of plans. Agents may discuss plan specific information and collect applications. Can marketing/sales be formal or informal? - Correct answer both What describes a formal marketing/sales event? - Correct answer a full plan presentation, given in a presenter-audience format. What is an inform marketing/sales event? - Correct answer they're passive in nature where the consumer approaches the agent to engage in conversation. a booth, table, or kiosk is typically used What are marketing appointments? - Correct answer They're commonly referred to as "in home, face to face, or one on one appointment" and typically take place in the consumers home. What other places can marketing appointments happen? - Correct answer coffee shop, or even over the phone because marketing appointments are not formal and informal marketing sales events, they're not reported to who? - Correct answer UHC or CMS. instead, agents must obtain a completed scope of appointment prior to conducting the appointment.
Approval is required for? - Correct answer 1) ALL medicare marketing materials or
- ANY material that mentions a plan sponsor ( such as " united health care") one of its affliated plans or displays any logos What does generic mean with marketing materials? - Correct answer materials that do not meet the marketing materials criteria and do not carry any plan sponsor information or logos does generic materials require prior approval? - Correct answer no What methods are considered marketing material? - Correct answer newspaper, tv, internet, radio advertisements, direct mail, postcards, flyers, brochures, magnets, pre-enrollment materials, websites and social media platforms what are some examples of generic marketing materials? - Correct answer social media sites and websites sites used to market UHC plans must be _____ by UHC and CMS prior to use - Correct answer approved when talking about marketing materials what should the agent NOT do? - Correct answer add, enhance, delete, modify, edit or create any content in the marketing materials provided by the health plan modify approved materials in any way, no matter how minor ask health related or health screening questions on generic, agent created materials What must an agent do when talking about marketing materials? - Correct answer use marketing materials only for products they are certified to market/sell
What does PTC stand for? - Correct answer permission to contract What does SOA stand for? - Correct answer Scope of appointment What does permission to contact mean? - Correct answer is permission given by the consumer to be called or otherwise contacted by an agent for the purpse of marketng any UHC medicare solutions product includeing MA, Prescription drug or med sup plans. PTC must be______? - Correct answer documented, retained and available upon request for 10 years PTC must also be? - Correct answer Method specific, short term and event specific What does method specific mean? - Correct answer contact can only be made by the method permitted by the consumer. Permission to telephone only enables the agent to dial the number provided. AN AGENT MUST RECEIVE EXPLICIT PERMISSION TO TEXT OR EMAIL THE CONSUMER having access to a phone number or email address does not imply permission from the consumer What is short term? - Correct answer PTC expires once the agent has made contact with the consumer or 9 months after the date the PTC was received. PTC expires 90 days after the receipt for consumers requesting info on med sup's or who are on the federal DNC list.
When a consumer walks into an agent's office or a UHC medicarestore, the agent must obtain an SOA - Correct answer prior to discussion In leu of a SOA form, agents must announce the products that will be presented at the formal or informal marketing/sales event - Correct answer agents may obtain an SOA for future face to face or telephonic appointments if the consumer requests the future appointment at the marketing/sales event when conducting face to face or telephonic appointments to present MA and or PDP plans, the agent MUST - Correct answer
- obtain a signed SOA from the consumer prior to the start of the appointment
- obtain a new SOA when the consumer or agent requests to discuss a health related product not identified on the original SOA. once obtained, the new product may be discussed SOAs must be submitted how? - Correct answer via fax or emailed within 2 business days following the scheduled appointment contracted agents using the generic SOA form must also include - Correct answer the corresponding fax coversheet medicare marking guidelines prohibit marketing non-healh related products (annuities, life insurance, LT disability/disability plans) when presenting what to a consumer? - Correct answer MA plan or PDP plas THIS IS CONSIDERED CROSS-SELLING AND IS PROHIBITED SCARE TACTICS ARE - Correct answer PROHIBITED
what is an authorized representitive? - Correct answer is a person who is authorized under state law to complete the enrollment application, make health care decisions on behalf of the consumer and is authorized to receive health care related on his/her behalf in order to determine if a POA or authorized representitive is needed when enrolling a consumer, the agent MUST___? - Correct answer consider the consumers mental and physical ability to enroll themselves if a consumer appears to have either a physical and or mental challenges that may impede their ability to enroll themselves in a plan, you must ask if they have a ____ or ____? - Correct answer POA or authorized representitive a person assisting, including an agent cannot sign the enrollment application on behalf of the - Correct answer consumer. only the consumer, POA, or authorized representative can sign the enrollment application agents can offer promotional gifts to attendees of any event type as long as such gifts are of nominal retail value. nominal value is any item _____ or less - Correct answer $15 or less the combined value of all giveaway items including food, must not exceed______ per consumer - Correct answer $ What types of gifts are prohibited regardless of the amount? - Correct answer cash, gift certificates, gift cards, monetary rebates, as well as charitable contributions made on behalf of the consumers/members
referral/finder's fees? - Correct answer UHC does not sponsor a lead referral program; therefore, no payment is made in exchange for a referral or as a result of referred consumer's enrollment Marketing fees? - Correct answer Agents are prohibited from charging a consimer or member any type of fee for the marketing of a Medicare insurance product, including but not limited to : entrance fees to attend educational or marketing/sales events, fees to conduct a personal/individual meeting appointment, or to cover the cost of materials What is another name for compensation recovery? - Correct answer charge backs What is compensation recovery? - Correct answer Incentive amounts are deducted from a SIP participant's incentive payment for previously paid advances on sales that aren't earned. generally the result of a member's rapid disenrollment from their plan, but can occur for other reasons. When does rapid dis-enrollment occur? - Correct answer it occurs when a member voluntarily dis-enrolls or moves from one UHC plan to another prior to the member's FOURTH month effective date following the original effective date. What does EDC stand for? - Correct answer external distribution channel What does ICA stand for? - Correct answer independent career agent How does UHC pay non-employee agents in the EDC and ICA? - Correct answer pays on commission for enrollment of a consumer into a UHC medicare solutions MA plan, PDP, or med sup
insurance policies according to the terms of their agent agreement. How are commissions paid on sales written by a solicitor? - Correct answer paid to the solicitor's up-line. for each MA, MA-PD and PDP enrollment, CMS determines if hte enrollment qualifies for - Correct answer Initial or renewal compensation If a member disenrolls from one plan and enrolls in another, CMS determines the compensation type for the ______ - Correct answer new enrollment What is initial compensation? - Correct answer is paid at an amount at or below the fair market value (FMV) When a member enrolls in a plan and has no prior plan history, the plan sponsor may pay the full year initial compensation amount or a? - Correct answer pro-rated amount based on the number of months the member is enrolled What happens when the member changes plans during the initial year? - Correct answer The plan sponsor must pay the agent at a pro-rated initial year rate based on the number of months the member is enrolled. How is renewal compensation paid - Correct answer in any amount up to 50% of the current FMV, published by CMS annually foer the members 2nd and subsequent enrollment years when they enroll in a new " like plan type" Renewal compensation must always be? - Correct answer pro- rated for the actual months the member is enrolled in the plan
or must it be done at a later time? - Correct answer it can be done at that time on the MA or PDP product May an agent contact a referred customer, or must that referred customer be the first one to contact the agent - Correct answer the referred customer must contact the agent, not the other way around _____ are permitted to return phone calls or emails received from a referred individual - Correct answer agents failure to report an insurance of suspected misconduct could result in - Correct answer disciplinary action. What is the MA enrollment period( MA-OEP)? - Correct answer jan 1st- march 31st MA plan members enrolled effective jan 1st can make a one time election annually from jan 1st through march 31st to switch - Correct answer MA plans( with or without drug coverage), or to disenroll from a MA planand obtain coverage through original medicare (with or without a stand alone PDP) newly eligible MA individuals who enroll in an MA plan can use the MA OEP, but only during the first 3 months in which they have both - Correct answer part A and part B Agents are not ______to target marketing to any carriers ( UHC or another) MA/MA-PD members to entice or encourage them to use the MA OEP election code to make a plan____ - Correct answer change What is the period of time where an eligible customer can enroll or disenroll from an MA or PDP plan? - Correct answer Special election period
( SEP)
How many different types of SEPs and are not limited to - Correct answer dual eligibles. customers who move into reside in, or move out of a nursing home , and those who have qualifying chronic conditions. A member may disenroll from their MA plan and return to original medicare during which time - Correct answer SEP's A customer with original medicare may enroll in a MA plan, during which time? - Correct answer SEP's A member of one MA plan may enroll in a different MA plan during which time? - Correct answer SEP's For a SEP, when is the members start date? - Correct answer 1st day of the month following receipt of election. Note: for some SEP's consumers may choose effective date up to 3 months after plan receives enrollment request. Note: if the SEP is due to a move, the plan effective date CANNOT be earlier than that of the move date or receipt of the enrollment request If a customer is eligible for AEP, can they also be eligible for a SEP at the same time? - Correct answer yes WHat does ICEP stand for? - Correct answer initial coverage election period What does IEP stand for? - Correct answer initial enrollment period What is the enrollment period for a MA only plan? - Correct answer ICEP ( initial coverage election period)
When is AEP? - Correct answer oct 15th through Dec 7th What does AEP stand for - Correct answer Annual election period AEP can be used with - Correct answer Medicare open enrollment What is the AEP used for? - Correct answer a medicare consumer can enroll in or disenroll from a MA or PDP plan. All AEP enrollment elections become effective janurary 1st and disenrollments elections become effective Dec 31st For AEP, agents may not begin marketing until what date - Correct answer october 1st for AEP, agents may not accept or solicit submission of enrollment applications prior to october 15th - Correct answer october 15th If the plan receives an unsolicited enrollment application prior to AEP, the plan must - Correct answer retain the appliction and process the enrollment application beginning on the first day of the AEP with an application date of the same date. The____ will receive an acknowledgment letter when the plan receives an early enrollment application - Correct answer the consumer Are Med sup plans restricted by election periods? - Correct answer no theyre not. comsumers with original medicare may enroll/disenroll from med sups at any time, provided they meet the plans requirements
Consumers considering a med sup plan must have a - Correct answer valid election period if they are already enrolled in a MAP or want to enroll in a PDP at the same time enrolling in a med sup plan does not automatically disenroll a member from their - Correct answer MAP or vice versa. If a consumer has a MAP, it is non-compliant to sell them a - Correct answer med sup plan unless they are able to disenroll from their MA plan and go to original medicare does a med sup plan pay the cost sharing of a MA plan? - Correct answer no it doesn't When must the enrollment guide be presented to the consumer? - Correct answer at the time of enrollment What does the enrollment guide include? - Correct answer summary of benefits, language interpreter disclaimer, plan ratings information, and enrollment application Whats included with a summary of benefits - Correct answer detailed info on plan benefits, explanations of cost sharing, and lists special features What included with a language interpreter disclaimer? - Correct answer includes info on how to request an interpreter whats another name for plan ratings information - Correct answer star ratings What included with plan ratings information - Correct answer req document that shows the stars rating for specific plan being sold, ranging from 1 to 5 stars
can the SOU vary between the different plans? - Correct answer yes they can What is the EOC also known as and what does it do - Correct answer evidence of coverage, and is known as the member contract subscriber agreement. it will list services the plan covers , as well as the plans terms and conditions If a service isnt listed in the EOC or approved by the plan, medicare and the plan will________ - Correct answer not pay for it if an agent indicates their agent writing number on the enrollment application prior to meeting with the consumer or assists the consumer in completing the MA or PDP enrollment application, the agent MUST - Correct answer clearly indicate this by checking the appropriate box on the enrollment application on the enrollment application, have the POA or authorized representative sign the application and print their name.... - Correct answer contact info and relationship to the consumer what must the authorized representative or POA sign on the application - Correct answer they must sign an attestation on the application attesting that they have necessary legal authority to act on the consumers behalf NOTE: documention of this authority MUST be available upon request by the plan or CMS, but you CANNOT require it for the purposes of enrollment someone who provides assistance to the consumer, but is not authorized to act on the consumers behalf cannot what? - Correct answer sign the enrollment application
Do agents need to collect POA or authorized representation documentation? - Correct answer no they dont Will who request the documentation directly from the authorized representative if needed - Correct answer medicare Should you ever sign the consumers name? - Correct answer no should agents ever send LEAN remote signature emails to themselves in order to facilitate consumer digital enrollment application signatures? - Correct answer no they shouldn't Who must provide their own email address and complete their own digital signatures? - Correct answer consumers Never put your name on the enrollment application as the agent of record if you dont what - Correct answer present the plan to the customer why? ( consumers become confused when they see an agent named tied to their enrollment that they do not recognize) What is provided in the enrollment application? - Correct answer provides notice acknowledging receipt of the completed enrollment request. for electronic enrollments, the consumer should be provided what? - Correct answer a confirmation number or tracking number as evidence of the enrollment request was received. how many hours is the maximum allotted time for an agent to submit an enrollment application receipt? - Correct answer 24 hours
