UHC ethics and compliance section for cert
g g g g g g
ification
Whatgisgagservicinggagent?g-
ganginactive,gnonemployeegwhoghasgsignedgagservicinggagreementgingordergtogreceivegrenewalgcommision
sgongmedicaregadvantagegandgprescriptiongdruggplangenrollmentsgongorgafterg1-1-
2014.gthegagentgmustgmaintaingangactivegresidentglicensegandgappointmentgandgpassgmedicaregbasicsgandg
ethicsgcompliancegassessmentsgongangannualgbasis
WhatgdoesgCMSgstandgfor?g-gcentergforgmedicaregandgmedicaidgservices
Whogadministersgthegmedicaregprogramgandgcontractsgwithgprivateghealthgcaregcompaniesgtogoffergmedi
caidgplans?g-gCMS
Whogholdsgthegauthoritygtogapprovegorgdisaprovegplansgthatgcangbegsold,gandgisgthegregulatinggagencygtha
tgalsogmonitorsgourgprogresses?g-gCMS
WhogregulatesgMA'sgandgPDP'sg-gCMS
Enrollinggagcustomergingagplangwhengyougaregnotgcertifiedgingthegproductgisgnon-
compliantgandgconsidered ?g-gangunqualifiedgsale
Agentsgwhogaregnotgqualifiedgtogsellgthegproductgwillgnotgbe?g-
gcompensatedgandgmaygreceivegcorrectivegandgorgdisciplinarygactiongupgtogangincludinggtermination
Whatgisgthegpurposegofgangeducationalgevent?g-
gitsgdesignedgtoginformgmedicaregconsumersgaboutgoriginalgmedicare,gmedicaregadvantage,gprescriptiong
druggandgothergmedicaregprograms.
Wheregmustgeducationalgeventsgbegconducted?g-gingagpublicgvenue
,Aregthegeducationalgeventsgunbiasedgsogthatgitgdoesn'tgsteergthegconsumergtowardsgagspecificgplangorglimi
tedgnumbergofgplans?g-gyes
WHatgisgagmarketing/salesgevent?g-
gangeventgdesignedgtogsteergorgattemptgtogsteer,gconsumersgtowardgagplangorglimitedgsetgofgplans.gAgentsg
maygdiscussgplangspecificginformationgandgcollectgapplications.
Cangmarketing/salesgbegformalgorginformal?g-gboth
Whatgdescribesgagformalgmarketing/salesgevent?g-gagfullgplangpresentation,ggivengingagpresenter-
audiencegformat.
Whatgisganginformgmarketing/salesgevent?g-
gthey'regpassivegingnaturegwheregthegconsumergapproachesgthegagentgtogengagegingconversation.gagbooth
,gtable,gorgkioskgisgtypicallygused
Whatgaregmarketinggappointments?g-
gThey'regcommonlygreferredgtogasg"inghome,gfacegtogface,gorgonegongonegappointment"gandgtypicallygtakeg
placegingthegconsumersghome.
Whatgothergplacesgcangmarketinggappointmentsghappen?g-gcoffeegshop,gorgevengovergthegphone
becausegmarketinggappointmentsgaregnotgformalgandginformalgmarketinggsalesgevents,gthey'regnotgreport
edgtogwho?g-
gUHCgorgCMS.ginstead,gagentsgmustgobtaingagcompletedgscopegofgappointmentgpriorgtogconductinggthegapp
ointment.
Togreportgevents,gwhatgshouldgagentsguse?g-gangeventgrequestgform
togensuregthatgeventsgaregingUHC'sgeventgreportinggapplicationgnoglessgthang7gcalendergdaysgpriorgtogthege
vent...g-
gsubmitgthegeventgrequestgform,gaccordinggtoginstructionsgongthegform,gNOgLESSgTHANg14gCALENDARgDA
,YS
, eventgrequestgformsgsubmittedgwithin7gcalendargdaysgwillgNOTgbegwhat?g-gprocessed
conductinggangunreportedgeventgisg ?g-gprohibited
togschedulegagsignglanguageginterpretergforgagformalgmarketing/salesgeventgorgagpersonal/individualgmark
etinggappointment,gentergthegconsumer'sgrequestgdirect;ygingbconnectedgatgleast?g-
g14gdaysgpriorgtogthegeventgorgappointment
Whatgaregmarketinggmaterialsgusedgfor?g-g1)gdrawgattentiongtogagplangsponsorgorgtheirgplan(s)gand
2)ginfluencegagconsumer'sgdecisiongwhengselectinggagplangingwhichgtogenrollgorgagmember'sgdecisiongtogre
maingenrolledgingtheirgcurrentgplan
Marketinggmaterialsgcontainginformationgaboutgthegplangorgplans:g-g1)gbenefitsgorgbenefitgstructure
2) costgsharingg(gincludinggpremiums,gcopayments,gandgdeductibles)
3) Measurementsgorgrankinggstandardsg(gsuchgasgstargratings.gcomparisonsgtogothergplans,gorgstatisticalg
studiesgorgsurveys)
Approvalgisgrequiredgfor?g-g1)gALLgmedicaregmarketinggmaterialsgor
2)gANYgmaterialgthatgmentionsgagplangsponsorg(gsuchgasg"gunitedghealthgcare")gonegofgitsgaffliatedgplansgorg
displaysganyglogos
Whatgdoesggenericgmeangwithgmarketinggmaterials?g-
gmaterialsgthatgdognotgmeetgthegmarketinggmaterialsgcriteriagandgdognotgcarryganygplangsponsorginformati
ongorglogos
doesggenericgmaterialsgrequiregpriorgapproval?g-gno
g g g g g g
ification
Whatgisgagservicinggagent?g-
ganginactive,gnonemployeegwhoghasgsignedgagservicinggagreementgingordergtogreceivegrenewalgcommision
sgongmedicaregadvantagegandgprescriptiongdruggplangenrollmentsgongorgafterg1-1-
2014.gthegagentgmustgmaintaingangactivegresidentglicensegandgappointmentgandgpassgmedicaregbasicsgandg
ethicsgcompliancegassessmentsgongangannualgbasis
WhatgdoesgCMSgstandgfor?g-gcentergforgmedicaregandgmedicaidgservices
Whogadministersgthegmedicaregprogramgandgcontractsgwithgprivateghealthgcaregcompaniesgtogoffergmedi
caidgplans?g-gCMS
Whogholdsgthegauthoritygtogapprovegorgdisaprovegplansgthatgcangbegsold,gandgisgthegregulatinggagencygtha
tgalsogmonitorsgourgprogresses?g-gCMS
WhogregulatesgMA'sgandgPDP'sg-gCMS
Enrollinggagcustomergingagplangwhengyougaregnotgcertifiedgingthegproductgisgnon-
compliantgandgconsidered ?g-gangunqualifiedgsale
Agentsgwhogaregnotgqualifiedgtogsellgthegproductgwillgnotgbe?g-
gcompensatedgandgmaygreceivegcorrectivegandgorgdisciplinarygactiongupgtogangincludinggtermination
Whatgisgthegpurposegofgangeducationalgevent?g-
gitsgdesignedgtoginformgmedicaregconsumersgaboutgoriginalgmedicare,gmedicaregadvantage,gprescriptiong
druggandgothergmedicaregprograms.
Wheregmustgeducationalgeventsgbegconducted?g-gingagpublicgvenue
,Aregthegeducationalgeventsgunbiasedgsogthatgitgdoesn'tgsteergthegconsumergtowardsgagspecificgplangorglimi
tedgnumbergofgplans?g-gyes
WHatgisgagmarketing/salesgevent?g-
gangeventgdesignedgtogsteergorgattemptgtogsteer,gconsumersgtowardgagplangorglimitedgsetgofgplans.gAgentsg
maygdiscussgplangspecificginformationgandgcollectgapplications.
Cangmarketing/salesgbegformalgorginformal?g-gboth
Whatgdescribesgagformalgmarketing/salesgevent?g-gagfullgplangpresentation,ggivengingagpresenter-
audiencegformat.
Whatgisganginformgmarketing/salesgevent?g-
gthey'regpassivegingnaturegwheregthegconsumergapproachesgthegagentgtogengagegingconversation.gagbooth
,gtable,gorgkioskgisgtypicallygused
Whatgaregmarketinggappointments?g-
gThey'regcommonlygreferredgtogasg"inghome,gfacegtogface,gorgonegongonegappointment"gandgtypicallygtakeg
placegingthegconsumersghome.
Whatgothergplacesgcangmarketinggappointmentsghappen?g-gcoffeegshop,gorgevengovergthegphone
becausegmarketinggappointmentsgaregnotgformalgandginformalgmarketinggsalesgevents,gthey'regnotgreport
edgtogwho?g-
gUHCgorgCMS.ginstead,gagentsgmustgobtaingagcompletedgscopegofgappointmentgpriorgtogconductinggthegapp
ointment.
Togreportgevents,gwhatgshouldgagentsguse?g-gangeventgrequestgform
togensuregthatgeventsgaregingUHC'sgeventgreportinggapplicationgnoglessgthang7gcalendergdaysgpriorgtogthege
vent...g-
gsubmitgthegeventgrequestgform,gaccordinggtoginstructionsgongthegform,gNOgLESSgTHANg14gCALENDARgDA
,YS
, eventgrequestgformsgsubmittedgwithin7gcalendargdaysgwillgNOTgbegwhat?g-gprocessed
conductinggangunreportedgeventgisg ?g-gprohibited
togschedulegagsignglanguageginterpretergforgagformalgmarketing/salesgeventgorgagpersonal/individualgmark
etinggappointment,gentergthegconsumer'sgrequestgdirect;ygingbconnectedgatgleast?g-
g14gdaysgpriorgtogthegeventgorgappointment
Whatgaregmarketinggmaterialsgusedgfor?g-g1)gdrawgattentiongtogagplangsponsorgorgtheirgplan(s)gand
2)ginfluencegagconsumer'sgdecisiongwhengselectinggagplangingwhichgtogenrollgorgagmember'sgdecisiongtogre
maingenrolledgingtheirgcurrentgplan
Marketinggmaterialsgcontainginformationgaboutgthegplangorgplans:g-g1)gbenefitsgorgbenefitgstructure
2) costgsharingg(gincludinggpremiums,gcopayments,gandgdeductibles)
3) Measurementsgorgrankinggstandardsg(gsuchgasgstargratings.gcomparisonsgtogothergplans,gorgstatisticalg
studiesgorgsurveys)
Approvalgisgrequiredgfor?g-g1)gALLgmedicaregmarketinggmaterialsgor
2)gANYgmaterialgthatgmentionsgagplangsponsorg(gsuchgasg"gunitedghealthgcare")gonegofgitsgaffliatedgplansgorg
displaysganyglogos
Whatgdoesggenericgmeangwithgmarketinggmaterials?g-
gmaterialsgthatgdognotgmeetgthegmarketinggmaterialsgcriteriagandgdognotgcarryganygplangsponsorginformati
ongorglogos
doesggenericgmaterialsgrequiregpriorgapproval?g-gno
