UHC Ethic and Compliance 2022 QUESTIONS AND ANSWERS

UHC Ethic and Compliance 2022 What is the definition of Abuse? Correct Answer: Abuse includes any practice that results in the provision of services that are not medically necesary An agent should only enroll a consumer in a product: Correct Answer: That is suitable for the consumer's needs, goals and financial resources. When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? Correct Answer: Provide current marketing materials that have been approved by CMS and UnitedHealthcare. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Correct Answer: Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. When can telephonic contact with a Medicare eligible consumer be made? Correct Answer: When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. An individual with Power of Attorney is an example of what authority? Correct Answer: Legal authority under state law to act on behalf of another individual. Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: Correct Answer: Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Educational events allow for which of the following to occur? Correct Answer: Provide objective information about the Medicare program and/or health improvement and wellness. 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. Annual Election Period (AEP) is a time when: Correct Answer: Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. What type of events must an agent report to UnitedHealthcare? Correct Answer: Formal and informal marketing/sales events Which of the following are the ways to report potential FWA? Correct Answer: Producer Help Desk (DHP) Fraud, Waste and/or Abuse hotline What is the definition of Fraud? Correct Answer: Fraud is intentionally misrepresenting or concealing facts to obtain something of value. What is the purpose of the Statement of Understanding? Correct Answer: 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. In what product should agents enroll consumers? Correct Answer: A product that is suitable for the consumer's needs, goals and financial resources. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? Correct Answer: Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. To sign 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 consumer resides to act on behalf of the consumer (e.g. Power of Attorney). In which of the following situations can telephonic contact be made with a Medicare eligible consumer? Correct Answer: When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and that the permission has not yet expired.