UHC ethics and compliance section for cer
g g g g g g
tification
Whatgisgagservicinggagent?g-
ganginactive,gnonemployeegwhoghasgsignedgagservicinggagreementgingordergtogreceivegrenewalgcommisi
onsgongmedicaregadvantagegandgprescriptiongdruggplangenrollmentsgongorgafterg1-1-
2014.gthegagentgmustgmaintaingangactivegresidentglicensegandgappointmentgandgpassgmedicaregbasicsga
ndgethicsgcompliancegassessmentsgongangannualgbasis
WhatgdoesgCMSgstandgfor?g-gcentergforgmedicaregandgmedicaidgservices
Whogadministersgthegmedicaregprogramgandgcontractsgwithgprivateghealthgcaregcompaniesgtogoffergm
edicaidgplans?g-gCMS
Whogholdsgthegauthoritygtogapprovegorgdisaprovegplansgthatgcangbegsold,gandgisgthegregulatinggagency
gthatgalsogmonitorsgourgprogresses?g-gCMS
WhogregulatesgMA'sgandgPDP'sg-gCMS
Enrollinggagcustomergingagplangwhengyougaregnotgcertifiedgingthegproductgisgnon-
compliantgandgconsidered ?g-gangunqualifiedgsale
Agentsgwhogaregnotgqualifiedgtogsellgthegproductgwillgnotgbe?g-
gcompensatedgandgmaygreceivegcorrectivegandgorgdisciplinarygactiongupgtogangincludinggtermination
Whatgisgthegpurposegofgangeducationalgevent?g-
gitsgdesignedgtoginformgmedicaregconsumersgaboutgoriginalgmedicare,gmedicaregadvantage,gprescriptio
ngdruggandgothergmedicaregprograms.
Wheregmustgeducationalgeventsgbegconducted?g-gingagpublicgvenue
,Aregthegeducationalgeventsgunbiasedgsogthatgitgdoesn'tgsteergthegconsumergtowardsgagspecificgplangorg
limitedgnumbergofgplans?g-gyes
WHatgisgagmarketing/salesgevent?g-
gangeventgdesignedgtogsteergorgattemptgtogsteer,gconsumersgtowardgagplangorglimitedgsetgofgplans.gAge
ntsgmaygdiscussgplangspecificginformationgandgcollectgapplications.
Cangmarketing/salesgbegformalgorginformal?g-gboth
Whatgdescribesgagformalgmarketing/salesgevent?g-gagfullgplangpresentation,ggivengingagpresenter-
audiencegformat.
Whatgisganginformgmarketing/salesgevent?g-
gthey'regpassivegingnaturegwheregthegconsumergapproachesgthegagentgtogengagegingconversation.gagbo
oth,gtable,gorgkioskgisgtypicallygused
Whatgaregmarketinggappointments?g-
gThey'regcommonlygreferredgtogasg"inghome,gfacegtogface,gorgonegongonegappointment"gandgtypicallygt
akegplacegingthegconsumersghome.
Whatgothergplacesgcangmarketinggappointmentsghappen?g-gcoffeegshop,gorgevengovergthegphone
becausegmarketinggappointmentsgaregnotgformalgandginformalgmarketinggsalesgevents,gthey'regnotgrep
ortedgtogwho?g-
gUHCgorgCMS.ginstead,gagentsgmustgobtaingagcompletedgscopegofgappointmentgpriorgtogconductinggtheg
appointment.
Togreportgevents,gwhatgshouldgagentsguse?g-gangeventgrequestgform
togensuregthatgeventsgaregingUHC'sgeventgreportinggapplicationgnoglessgthang7gcalendergdaysgpriorgtogt
hegevent...g-
gsubmitgthegeventgrequestgform,gaccordinggtoginstructionsgongthegform,gNOgLESSgTHANg14gCALENDARg
,DAYS
, eventgrequestgformsgsubmittedgwithin7gcalendargdaysgwillgNOTgbegwhat?g-gprocessed
conductinggangunreportedgeventgisg ?g-gprohibited
togschedulegagsignglanguageginterpretergforgagformalgmarketing/salesgeventgorgagpersonal/individualgm
arketinggappointment,gentergthegconsumer'sgrequestgdirect;ygingbconnectedgatgleast?g-
g14gdaysgpriorgtogthegeventgorgappointment
Whatgaregmarketinggmaterialsgusedgfor?g-g1)gdrawgattentiongtogagplangsponsorgorgtheirgplan(s)gand
2)ginfluencegagconsumer'sgdecisiongwhengselectinggagplangingwhichgtogenrollgorgagmember'sgdecisiongtog
remaingenrolledgingtheirgcurrentgplan
Marketinggmaterialsgcontainginformationgaboutgthegplangorgplans:g-g1)gbenefitsgorgbenefitgstructure
2) costgsharingg(gincludinggpremiums,gcopayments,gandgdeductibles)
3) Measurementsgorgrankinggstandardsg(gsuchgasgstargratings.gcomparisonsgtogothergplans,gorgstatisti
calgstudiesgorgsurveys)
Approvalgisgrequiredgfor?g-g1)gALLgmedicaregmarketinggmaterialsgor
2)gANYgmaterialgthatgmentionsgagplangsponsorg(gsuchgasg"gunitedghealthgcare")gonegofgitsgaffliatedgplans
gorgdisplaysganyglogos
Whatgdoesggenericgmeangwithgmarketinggmaterials?g-
gmaterialsgthatgdognotgmeetgthegmarketinggmaterialsgcriteriagandgdognotgcarryganygplangsponsorginfor
mationgorglogos
doesggenericgmaterialsgrequiregpriorgapproval?g-gno
g g g g g g
tification
Whatgisgagservicinggagent?g-
ganginactive,gnonemployeegwhoghasgsignedgagservicinggagreementgingordergtogreceivegrenewalgcommisi
onsgongmedicaregadvantagegandgprescriptiongdruggplangenrollmentsgongorgafterg1-1-
2014.gthegagentgmustgmaintaingangactivegresidentglicensegandgappointmentgandgpassgmedicaregbasicsga
ndgethicsgcompliancegassessmentsgongangannualgbasis
WhatgdoesgCMSgstandgfor?g-gcentergforgmedicaregandgmedicaidgservices
Whogadministersgthegmedicaregprogramgandgcontractsgwithgprivateghealthgcaregcompaniesgtogoffergm
edicaidgplans?g-gCMS
Whogholdsgthegauthoritygtogapprovegorgdisaprovegplansgthatgcangbegsold,gandgisgthegregulatinggagency
gthatgalsogmonitorsgourgprogresses?g-gCMS
WhogregulatesgMA'sgandgPDP'sg-gCMS
Enrollinggagcustomergingagplangwhengyougaregnotgcertifiedgingthegproductgisgnon-
compliantgandgconsidered ?g-gangunqualifiedgsale
Agentsgwhogaregnotgqualifiedgtogsellgthegproductgwillgnotgbe?g-
gcompensatedgandgmaygreceivegcorrectivegandgorgdisciplinarygactiongupgtogangincludinggtermination
Whatgisgthegpurposegofgangeducationalgevent?g-
gitsgdesignedgtoginformgmedicaregconsumersgaboutgoriginalgmedicare,gmedicaregadvantage,gprescriptio
ngdruggandgothergmedicaregprograms.
Wheregmustgeducationalgeventsgbegconducted?g-gingagpublicgvenue
,Aregthegeducationalgeventsgunbiasedgsogthatgitgdoesn'tgsteergthegconsumergtowardsgagspecificgplangorg
limitedgnumbergofgplans?g-gyes
WHatgisgagmarketing/salesgevent?g-
gangeventgdesignedgtogsteergorgattemptgtogsteer,gconsumersgtowardgagplangorglimitedgsetgofgplans.gAge
ntsgmaygdiscussgplangspecificginformationgandgcollectgapplications.
Cangmarketing/salesgbegformalgorginformal?g-gboth
Whatgdescribesgagformalgmarketing/salesgevent?g-gagfullgplangpresentation,ggivengingagpresenter-
audiencegformat.
Whatgisganginformgmarketing/salesgevent?g-
gthey'regpassivegingnaturegwheregthegconsumergapproachesgthegagentgtogengagegingconversation.gagbo
oth,gtable,gorgkioskgisgtypicallygused
Whatgaregmarketinggappointments?g-
gThey'regcommonlygreferredgtogasg"inghome,gfacegtogface,gorgonegongonegappointment"gandgtypicallygt
akegplacegingthegconsumersghome.
Whatgothergplacesgcangmarketinggappointmentsghappen?g-gcoffeegshop,gorgevengovergthegphone
becausegmarketinggappointmentsgaregnotgformalgandginformalgmarketinggsalesgevents,gthey'regnotgrep
ortedgtogwho?g-
gUHCgorgCMS.ginstead,gagentsgmustgobtaingagcompletedgscopegofgappointmentgpriorgtogconductinggtheg
appointment.
Togreportgevents,gwhatgshouldgagentsguse?g-gangeventgrequestgform
togensuregthatgeventsgaregingUHC'sgeventgreportinggapplicationgnoglessgthang7gcalendergdaysgpriorgtogt
hegevent...g-
gsubmitgthegeventgrequestgform,gaccordinggtoginstructionsgongthegform,gNOgLESSgTHANg14gCALENDARg
,DAYS
, eventgrequestgformsgsubmittedgwithin7gcalendargdaysgwillgNOTgbegwhat?g-gprocessed
conductinggangunreportedgeventgisg ?g-gprohibited
togschedulegagsignglanguageginterpretergforgagformalgmarketing/salesgeventgorgagpersonal/individualgm
arketinggappointment,gentergthegconsumer'sgrequestgdirect;ygingbconnectedgatgleast?g-
g14gdaysgpriorgtogthegeventgorgappointment
Whatgaregmarketinggmaterialsgusedgfor?g-g1)gdrawgattentiongtogagplangsponsorgorgtheirgplan(s)gand
2)ginfluencegagconsumer'sgdecisiongwhengselectinggagplangingwhichgtogenrollgorgagmember'sgdecisiongtog
remaingenrolledgingtheirgcurrentgplan
Marketinggmaterialsgcontainginformationgaboutgthegplangorgplans:g-g1)gbenefitsgorgbenefitgstructure
2) costgsharingg(gincludinggpremiums,gcopayments,gandgdeductibles)
3) Measurementsgorgrankinggstandardsg(gsuchgasgstargratings.gcomparisonsgtogothergplans,gorgstatisti
calgstudiesgorgsurveys)
Approvalgisgrequiredgfor?g-g1)gALLgmedicaregmarketinggmaterialsgor
2)gANYgmaterialgthatgmentionsgagplangsponsorg(gsuchgasg"gunitedghealthgcare")gonegofgitsgaffliatedgplans
gorgdisplaysganyglogos
Whatgdoesggenericgmeangwithgmarketinggmaterials?g-
gmaterialsgthatgdognotgmeetgthegmarketinggmaterialsgcriteriagandgdognotgcarryganygplangsponsorginfor
mationgorglogos
doesggenericgmaterialsgrequiregpriorgapproval?g-gno
