2021 United HealthCare - Ethics and
Compliance
In terms of events, which of the following is true? –
WRONG - Agents must report formal marketing/sales events only to
UnitedHealthcare
When completing an enrollment application in LEAN, why is an agent prohibited from
entering their 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.
Annual Election Period (AEP) is a time when: -
Consumers can elect to join a Medicare Advantage Plan or switch to a different
plan.
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? –
Before you can start the appointment with both consumers, 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.
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.
When does Permission to Contact for Medicare Advantage and/or Prescription Drug
Plans expire? –
Once contact is made or 9 months from the date the consumer provided
permission (e.g. consumer signature date on BRC) or 90 days if on federal do not
call list, whichever comes first.
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 United Healthcare permission to contact guidelines by
emailing the 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.
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? –
Mailing a marketing brochure to the consumer via postal mail.
To sign an enrollment application on behalf of a consumer, what authority must the
individual have? –
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).
As an agent, you must not do which of the following when marketing UnitedHealthcare
Medicare Advantage plans to consumers? –
Use providers or provider groups to distribute printed information comparing
benefits of different health plans without approval.
As an agent, you have an obligation to only enroll a consumer in a product: -
That is suitable for the consumer's needs, goals, and financial resources.
What is the purpose of the Statement of Understanding? –
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 Fraud? –
Fraud is intentionally misrepresenting or concealing facts to obtain something of
value.
Which of the items listed are examples of Fraud, Waste, and Abuse (FWA)? – -
Submitting claims for services or supplies that were never provided
- Consulting with a number of doctors in order to obtain multiple prescriptions for
the same drug.
- Billing for brand name drugs when generics were dispensed.
Whose email address may the agent enter into the LEAN enrollment application? –
Compliance
In terms of events, which of the following is true? –
WRONG - Agents must report formal marketing/sales events only to
UnitedHealthcare
When completing an enrollment application in LEAN, why is an agent prohibited from
entering their 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.
Annual Election Period (AEP) is a time when: -
Consumers can elect to join a Medicare Advantage Plan or switch to a different
plan.
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? –
Before you can start the appointment with both consumers, 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.
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.
When does Permission to Contact for Medicare Advantage and/or Prescription Drug
Plans expire? –
Once contact is made or 9 months from the date the consumer provided
permission (e.g. consumer signature date on BRC) or 90 days if on federal do not
call list, whichever comes first.
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 United Healthcare permission to contact guidelines by
emailing the 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.
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? –
Mailing a marketing brochure to the consumer via postal mail.
To sign an enrollment application on behalf of a consumer, what authority must the
individual have? –
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).
As an agent, you must not do which of the following when marketing UnitedHealthcare
Medicare Advantage plans to consumers? –
Use providers or provider groups to distribute printed information comparing
benefits of different health plans without approval.
As an agent, you have an obligation to only enroll a consumer in a product: -
That is suitable for the consumer's needs, goals, and financial resources.
What is the purpose of the Statement of Understanding? –
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 Fraud? –
Fraud is intentionally misrepresenting or concealing facts to obtain something of
value.
Which of the items listed are examples of Fraud, Waste, and Abuse (FWA)? – -
Submitting claims for services or supplies that were never provided
- Consulting with a number of doctors in order to obtain multiple prescriptions for
the same drug.
- Billing for brand name drugs when generics were dispensed.
Whose email address may the agent enter into the LEAN enrollment application? –
