UHC Ethics and Compliance Section for Certification

UHC Ethics and Compliance Section for Certification What is a servicing agent? - 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? - center for medicare and medicaid services Who administers the medicare program and contracts with private health care companies to offer medicaid plans? - CMS Who holds the authority to approve or disaprove plans that can be sold, and is the regulating agency that also monitors our progresses? - CMS Who regulates MA's and PDP's - CMS Enrolling a customer in a plan when you are not certified in the product is non-compliant and considered____? - an unqualified sale Agents who are not qualified to sell the product will not be? - compensated and may receive corrective and or disciplinary action up to an including termination What is the purpose of an educational event? - its designed to inform medicare consumers about original medicare, medicare advantage, prescription drug and other medicare programs. Where must educational events be conducted? - 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? - yes WHat is a marketing/sales event? - 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? - both What describes a formal marketing/sales event? - a full plan presentation, given in a presenter-audience format. What is an inform marketing/sales event? - 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? - 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? - coffee shop, or even over the phone because marketing appointments are not formal and informal marketing sales events, they're not reported to who? - UHC or CMS. instead, agents must obtain a completed scope of appointment prior to conducting the appointment. To report events, what should agents use? - an event request form to ensure that events are in UHC's event reporting application no less than 7 calender days prior to the event... - submit the event request form, according to instructions on the form, NO LESS THAN 14 CALENDAR DAYS event request forms submitted within7 calendar days will NOT be what? - processed conducting an unreported event is _____? - prohibited to schedule a sign language interpreter for a formal marketing/sales event or a personal/individual marketing appointment, enter the consumer's request direct;y in bconnected at least? - 14 days prior to the event or appointment What are marketing materials used for? - 1) draw attention to a plan sponsor or their plan(s) and 2) influence a consumer's decision when selecting a plan in which to enroll or a member's decision to remain enrolled in their current plan Marketing materials contain information about the plan or plans: - 1) benefits or benefit structure 2) cost sharing ( including premiums, copayments, and deductibles) 3) Measurements or ranking standards ( such as star ratings. comparisons to other plans, or statistical studies or surveys) Approval is required for? - 1) ALL medicare marketing materials or 2) 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? - 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? - no