2024 Ethics and Compliance
Assessment UHC
Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July
1. Using her Initial Election Period (IEP), when can she submit an application for a
Medicare Advantage or Prescription Drug plan? - answersApril 1 through October 31
Which of the following statements is true about using a five star special enrollment
period (SEP)? - answersIt can be used once from December 8 through November 30
and coverage will start the first of the month following recipient of the enrollment
application
Which statement regarding star ratings is true - answersMedicare uses a five star rating
system to illustrate the plans performance and quality
In which of the following situations can a telephonic contract be made with a Medicare
eligible consumer? - answersWhen the consumer consented to be contracted for sales
activities, and the permission has not yet expired
What information should be obtained from the consumer when conducting a thorough
needs assessment? (Select 2) - answers• their current health care coverage, including
what they like about it, and what they don't
• the providers they see in medication they take to determine network and formulary
status
Will using LEAN to complete an enrollment application with the consumer agent Jeff
learns the consumer does not have an email address. What should Jeff do? -
answersThe consumer/member would not receive plan related, corresponds, intent for
him/her
What is the purpose of the statement of understanding? - answersIt ensures that when
consumers complete 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 scope of appointment? - answersThe agreement obtained from the consumer to
that identifies the scope of products that can be discussed at a personal/individual
marketing appointment
, Which statement is accurate when a consumer has a power of authority (POA) -
answersIf the POA signed the enrollment application, they must be able to provide
documentation upon request for the plan that indicates authority under state law to
enroll the consumer
What happens on the plan effective date when a member enrolled in a Medicare
supplement insurance plan and standalone PDP enroll in a Medicare vantage plan that
includes drug coverage - answersAutomatic disenrollment from the standalone PDP
In which situation, MAY the Medicare advantage (MA) organization decide to disenroll a
member from an MA plan? - answersPremiums are not paid on a timely basis
Dennis a consumer is currently enrolled in the original Medicare, plus a Medicare
supplement plan. His current plan is suitable for his Medicare needs, but he would like
to add prescription drug coverage only since Dennis wants to keep his current coverage
which option is available to Dennis (assuming he is in a valid election period)? -
answersDennis should stay enrolled in original Medicare and his Medicare supplement
plan and enroll in a standalone PDP
In what product should agents and roll consumers? - answersA product that is suitable
for the consumers needs, goals and financial resources
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
consumers Medicare eligibility, describe the cost and benefit coverage of the plan and
explain that he could not accept an enrollment application until October 15. What did
Daniel do? That was not compliant. - answersDino presented a plan prior to October 1
Which of the following are examples of advertisements and consumer may see that may
make them call you into your call center? - answers
When must you provide your name your role as a license, insurance agent, and the
name of the agency you represent? - answersAt the beginning of the call
What must you keep in mind when receiving a call from a consumer (Select 2) -
answers• The consumer may have misunderstood, or been confused by what they read
or heard in a advertisement
• the consumer may be relying on a single benefit or description provided in the
advertisement
Consumer asked to be enrolled in a medical advantage plan that allows them to see
Specialist without needing a referral. What do you do next? - answersConduct a
thorough needs assessment to make sure I gather information about the situation and
preferences
Assessment UHC
Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July
1. Using her Initial Election Period (IEP), when can she submit an application for a
Medicare Advantage or Prescription Drug plan? - answersApril 1 through October 31
Which of the following statements is true about using a five star special enrollment
period (SEP)? - answersIt can be used once from December 8 through November 30
and coverage will start the first of the month following recipient of the enrollment
application
Which statement regarding star ratings is true - answersMedicare uses a five star rating
system to illustrate the plans performance and quality
In which of the following situations can a telephonic contract be made with a Medicare
eligible consumer? - answersWhen the consumer consented to be contracted for sales
activities, and the permission has not yet expired
What information should be obtained from the consumer when conducting a thorough
needs assessment? (Select 2) - answers• their current health care coverage, including
what they like about it, and what they don't
• the providers they see in medication they take to determine network and formulary
status
Will using LEAN to complete an enrollment application with the consumer agent Jeff
learns the consumer does not have an email address. What should Jeff do? -
answersThe consumer/member would not receive plan related, corresponds, intent for
him/her
What is the purpose of the statement of understanding? - answersIt ensures that when
consumers complete 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 scope of appointment? - answersThe agreement obtained from the consumer to
that identifies the scope of products that can be discussed at a personal/individual
marketing appointment
, Which statement is accurate when a consumer has a power of authority (POA) -
answersIf the POA signed the enrollment application, they must be able to provide
documentation upon request for the plan that indicates authority under state law to
enroll the consumer
What happens on the plan effective date when a member enrolled in a Medicare
supplement insurance plan and standalone PDP enroll in a Medicare vantage plan that
includes drug coverage - answersAutomatic disenrollment from the standalone PDP
In which situation, MAY the Medicare advantage (MA) organization decide to disenroll a
member from an MA plan? - answersPremiums are not paid on a timely basis
Dennis a consumer is currently enrolled in the original Medicare, plus a Medicare
supplement plan. His current plan is suitable for his Medicare needs, but he would like
to add prescription drug coverage only since Dennis wants to keep his current coverage
which option is available to Dennis (assuming he is in a valid election period)? -
answersDennis should stay enrolled in original Medicare and his Medicare supplement
plan and enroll in a standalone PDP
In what product should agents and roll consumers? - answersA product that is suitable
for the consumers needs, goals and financial resources
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
consumers Medicare eligibility, describe the cost and benefit coverage of the plan and
explain that he could not accept an enrollment application until October 15. What did
Daniel do? That was not compliant. - answersDino presented a plan prior to October 1
Which of the following are examples of advertisements and consumer may see that may
make them call you into your call center? - answers
When must you provide your name your role as a license, insurance agent, and the
name of the agency you represent? - answersAt the beginning of the call
What must you keep in mind when receiving a call from a consumer (Select 2) -
answers• The consumer may have misunderstood, or been confused by what they read
or heard in a advertisement
• the consumer may be relying on a single benefit or description provided in the
advertisement
Consumer asked to be enrolled in a medical advantage plan that allows them to see
Specialist without needing a referral. What do you do next? - answersConduct a
thorough needs assessment to make sure I gather information about the situation and
preferences
