UHC 2022 Ethics and Compliance Test

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Questions and Answers

Of the three types of events John plans to conduct, which need to be reported to UnitedHealthcare?

Formal and informal marketing events

Why is an agent prohibited from entering his or her own email address in the consumer's email address field in LEAN?

The consumer/member would not receive plan related correspondence intended for him/her.

Which election period runs from October 15 to December 7 allowing consumers to elect or switch to a Medicare Advantage Plan?

Annual Election Period (AEP)

What did Dino do that was NOT compliant when discussing Medicare Advantage plans?

Dino presented a plan prior to October 1. Signup and view all the answers

Does Jake need to obtain a Scope of Appointment (SOA) form from Mr. and Mrs. Nelson?

Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Signup and view all the answers

What is the purpose of educational events?

Educational events provide objective information about the Medicare program and/or health improvement and wellness. Signup and view all the answers

How should agent Erin respond when Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars?

Erin should tell Mrs. Rose that the plan has received a 'Below Average' rating. Signup and view all the answers

Which describes the Permission to Contact guidelines?

It is method specific, short term, and event specific. Signup and view all the answers

Has Victor been compliant when he emailed Julie's cousin without permission?

No, Victor violated United Healthcare permission to contact guidelines. Signup and view all the answers

Which individual would not likely have the authority to enroll a consumer in a Medicare Advantage Plan?

The consumer's spouse, who is neither a Power of Attorney nor legal guardian. Signup and view all the answers

In which situation can telephonic contact be made with a Medicare eligible consumer?

When the consumer consented to be contacted for sales activities, and permission has not yet expired. Signup and view all the answers

What must Jacob explain to Emily when completing an Enrollment Application for her father?

Jacob must explain that Emily will sign the Enrollment Application and provide documentation upon request. Signup and view all the answers

Which must you not do when marketing UnitedHealthcare Medicare Advantage or Prescription Drug Plans to consumers?

Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. Signup and view all the answers

An agent should only enroll a consumer in a product that is suitable for their needs, goals, and what?

Financial resources. Signup and view all the answers

What is the purpose of the Statement of Understanding?

It ensures that consumers acknowledge their understanding when enrolling in a plan. Signup and view all the answers

What is the definition of Abuse?

Abuse includes any practice that results in the provision of services that are not medically necessary. Signup and view all the answers

Which of the following are ways to report potential Fraud, Waste, and Abuse? (Select 2)

Producer Help Desk (PHD) Signup and view all the answers

In terms of events, which statement is true?

Agents must only report formal and informal marketing/sales events to UnitedHealthcare. Signup and view all the answers

Whose email address may the agent enter into the LEAN enrollment application?

Only the consumer's or leave it blank. Signup and view all the answers

When can consumers elect to join a Medicare Advantage Plan or switch plans?

During the Annual Election Period (AEP). Signup and view all the answers

Which activities are permitted at an educational event?

Activities that provide objective information about the Medicare program. Signup and view all the answers

What must occur at educational events?

They must provide objective information about the Medicare program and/or health improvement. Signup and view all the answers

What should Brenda tell Melanie regarding the Star Rating?

Brenda should not tell Melanie that the Star Rating is the same for every plan. Signup and view all the answers

What does Power of Attorney allow John to do for his mother?

It allows John to sign the Enrollment Application on her behalf. Signup and view all the answers

What authority must an individual have to sign an Enrollment Application on behalf of a consumer?

The individual must be legally authorized in the state to act on behalf of the consumer. Signup and view all the answers

What must an agent provide when marketing UnitedHealthcare Medicare Advantage plans?

Current marketing materials that have been approved by CMS and UnitedHealthcare. Signup and view all the answers

What is the definition of Waste?

Waste includes any practice that results in the provision of services that are not medically necessary. Signup and view all the answers

Which of the issues below are examples of Fraud, Waste, and/or Abuse? (Select 3)

The pharmacy splits the original prescription to receive additional fees Signup and view all the answers

What materials is an agent NOT permitted to display at a marketing/sales event?

5-dollar gift cards to an in-network pharmacy. Signup and view all the answers

What should Connor do when Rina brings her friend Shelley to the appointment?

Ask Shelley to complete an SOA before the start of the meeting. Signup and view all the answers

What do educational events allow for?

They provide objective information about the Medicare program and/or health improvement. Signup and view all the answers

Which lead generating activity is NOT compliant?

Asking the consumer for the name and phone number of an acquaintance during appointments. Signup and view all the answers

Which is not considered unsolicited contact according to regulations?

Mailing a marketing brochure to the consumer via postal mail. Signup and view all the answers

What must agents not do when marketing UnitedHealthcare Medicare Advantage plans?

Use providers to distribute printed information without approval. Signup and view all the answers

What does signing the Statement of Understanding mean for the consumer?

The consumer acknowledges understanding what they are enrolling in. Signup and view all the answers

Study Notes

Events and Reporting

Agent John must report formal and informal marketing/sales events to UnitedHealthcare.
Educational events aim to provide objective information about Medicare and wellness, not for selling plans.

Enrollment and Applications

Agents cannot enter their email as a consumer's email to ensure correspondence reaches the member.
The Annual Election Period (AEP) occurs from October 15 to December 7 for consumers to switch Medicare Advantage Plans.
Agents must obtain a Scope of Appointment (SOA) form from consumers prior to discussing Medicare Advantage plans.
During enrollment, agents must explain their legal authority to act on behalf of consumers when assisted by a Power of Attorney.

Compliance and Guidelines

Agents may only contact Medicare eligible consumers if consent has been provided and not expired.
Agents must not misrepresent Star Ratings; a rating of 2 stars is considered "Below Average."
Violation of permission to contact guidelines occurs if agents communicate with individuals without their explicit authorization.

Fraud, Waste, and Abuse (FWA)

Examples of FWA include falsifying signatures or using another person's insurance information.
Agents must report potential FWA through designated hotlines.
Waste is defined as unnecessary services provided but is not to be confused with abuse.

Marketing Practices

Only approved marketing materials should be used; agents must avoid distributing inappropriate incentives like gift cards.
Agents should avoid unsolicited contacts, such as direct solicitation without prior consumer consent.

Consumer Understanding

Signing the Statement of Understanding confirms consumers know they are enrolling in a specific Medicare plan.
Educational events are limited to providing information, not conducting sales, ensuring consumers understand the services available.

Appropriate Conduct

Lead generation must be compliant; agents cannot cold-call prospective leads based on referrals from existing clients.
Legal representatives or authorized individuals may assist consumers, but documentation must be available upon request.

Ethical Standards

All interactions require transparency regarding the services provided and the agent's authority.
Abiding by Permission to Contact guidelines is essential to maintain ethical standards in marketing practices.

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Description

Test your knowledge on UHC's ethics and compliance guidelines with this quiz. Focus on types of events and reporting requirements that Agent John needs to consider. Perfect for anyone involved with UnitedHealthcare events and compliance.