2021 United HealthCare - Ethics and
Compliance
In terms of events, which of the following is true? ans: 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? ans: The consumer/member
would not receive plan related correspondence intended for him/her.
Annual Election Period (AEP) is a time when: ans: 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? ans:
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? ans: 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? ans: 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? ans:
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? ans: 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? ans: 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? ans: 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?
ans: 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? ans: 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: ans: That is suitable for the
consumer's needs, goals, and financial resources.
What is the purpose of the Statement of Understanding? ans: 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? ans: 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)? ans: - 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? ans: Only the
consumer's (or leave it blank).
Which election period occurs from October 15 to December 7? ans: Annual Election Period (AEP)
Which of the following materials is an agent NOT permitted to display and/or distribute at a
marketing /sales event? ans: 5 dollar gift cards to an in-network pharmacy.
Providing objective information about the Medicare program and/or health improvement and wellness
at public venues is the purpose of which of the following? ans: Educational events
Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT
compliant? ans: At each appointment he asks the consumer for the name and phone number of at least
one acquaintance who is 65 or older and calls the referred individual.
Consumer Gary his friend's telephone number and email address to agent Bethany. What should
Bethany do? ans: Bethany may accept the information, but must observe permission to contact and
unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend.
Compliance
In terms of events, which of the following is true? ans: 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? ans: The consumer/member
would not receive plan related correspondence intended for him/her.
Annual Election Period (AEP) is a time when: ans: 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? ans:
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? ans: 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? ans: 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? ans:
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? ans: 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? ans: 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? ans: 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?
ans: 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? ans: 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: ans: That is suitable for the
consumer's needs, goals, and financial resources.
What is the purpose of the Statement of Understanding? ans: 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? ans: 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)? ans: - 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? ans: Only the
consumer's (or leave it blank).
Which election period occurs from October 15 to December 7? ans: Annual Election Period (AEP)
Which of the following materials is an agent NOT permitted to display and/or distribute at a
marketing /sales event? ans: 5 dollar gift cards to an in-network pharmacy.
Providing objective information about the Medicare program and/or health improvement and wellness
at public venues is the purpose of which of the following? ans: Educational events
Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT
compliant? ans: At each appointment he asks the consumer for the name and phone number of at least
one acquaintance who is 65 or older and calls the referred individual.
Consumer Gary his friend's telephone number and email address to agent Bethany. What should
Bethany do? ans: Bethany may accept the information, but must observe permission to contact and
unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend.
