Medicare Contact Regulations Quiz with UHC Guidelines

Questions and Answers

On the date of the call, what can Gene do about his coverage?

He can enroll in a different Medicare Advantage plan with an effective date of March 1.

Where can Mrs. Violet find the Star Rating for the plan?

On Medicare.gov or in the Enrollment Guide.

Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules?

In-person visits without appointment

Emailing marketing material

Telemarketing calls

Mailing a marketing brochure via postal mail (correct)

What must the agent accurately and completely disclose before discussing benefits with the consumer?

Any benefits discussed. Signup and view all the answers

What should Jeff do if a consumer does not have an email address while using LEAN?

Leave the field requesting applicant email address blank. Signup and view all the answers

What is the purpose of the Statement of Understanding?

It ensures consumers acknowledge their enrollment and understand which plan they are enrolling in. Signup and view all the answers

What is Scope of Appointment?

The agreement obtained from the consumer identifying the scope of products that can be discussed. Signup and view all the answers

What should Jane do if Albert is confused about a Prescription Drug plan?

Ask Albert if someone who helps him make decisions should be present. Signup and view all the answers

Under what condition may the Medicare Advantage organization disenroll a member?

If premiums are not paid on a timely basis. Signup and view all the answers

What option is available to Dennis if he wants to keep his current coverage and add prescription drug coverage?

Stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. Signup and view all the answers

Agents have an obligation to enroll a consumer in a product that is suitable for what?

The consumer's needs, goals, and financial resources. Signup and view all the answers

What statement is true regarding the Star Rating system used for Medicare plans?

Medicare uses a 5-star rating system to illustrate the plan's performance and quality. Signup and view all the answers

What benefit information are agents required to provide before starting an enrollment?

Accurately and completely disclose any benefits discussed. Signup and view all the answers

Whose email address can the agent enter in the applicant information section of the LEAN enrollment application?

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

The __________ ensures that consumers acknowledge their plan enrollment during telephonic enrollment.

Statement of Understanding Signup and view all the answers

What option is available to Aries who wants to add additional medical coverage?

Enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. Signup and view all the answers

What type of information must the agent provide when presenting a plan to avoid confusing the consumer? (Select 3)

Factual Signup and view all the answers

What should Josh tell Janine about changing her plan to a 5-star plan?

She can only change her current plan to a 5-star plan during the Annual Election Period. Signup and view all the answers

Why must an agent present accurate, complete, and factual plan information to consumers? (Select 3)

To help avoid confusing the consumer Signup and view all the answers

Which election period runs from October 15 to December 7 allowing changes to Medicare plans?

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

A one-on-one marketing appointment requires the consumer's _____ agreement prior to the appointment.

Scope of Appointment Signup and view all the answers

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

Legally authorized in the state to act on behalf of the consumer. Signup and view all the answers

Why is an agent prohibited from entering their own email address in LEAN?

The consumer/member would not receive plan-related correspondence intended for him/her. Signup and view all the answers

By agreeing to the Statement of Understanding, what does the consumer acknowledge?

They understand they are enrolling in a specific plan. Signup and view all the answers

What option is available to Rosanna who wants to add prescription drug coverage while in a MA-Only PFFS plan?

Stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP. Signup and view all the answers

Study Notes

Enrollment and Coverage Changes

Gene can change his Medicare Advantage plan during a call in February, with coverage effective March 1.
Premiums must be paid timely; failure to do so may lead to disenrollment from the plan.

Medicare Plan Ratings and Resources

Star Ratings for Medicare plans can be found on Medicare.gov or in the Enrollment Guide.
Medicare uses a 5-star rating system to evaluate plan performance and quality.

Compliance and Communication

Mailing marketing brochures is not classified as unsolicited contact under CMS regulations.
Agents must accurately disclose benefits and any provider/pharmacy network limitations before enrollment.
The information provided during a plan presentation must be factual, accurate, and complete to avoid consumer confusion.

Application Processes and Requirements

If a consumer lacks an email address, that field can remain blank in the LEAN application.
The Statement of Understanding confirms consumer comprehension of their enrollment and plan details.
A Scope of Appointment is required before one-on-one marketing appointments to outline the products that can be discussed.

Consumer Options and Decisions

Dennis can maintain his Original Medicare and Medicare Supplement while enrolling in a stand-alone Prescription Drug Plan (PDP).
Aries can switch from a stand-alone PDP to a Medicare Advantage Plan that includes drug coverage.
Rosanna can keep her MA-Only PFFS plan while adding a stand-alone PDP.

Agent Obligations and Ethical Practices

Agents are obligated to enroll consumers in plans that suit their needs and financial abilities.
Consent for telephonic enrollment encompasses acknowledging plan details and standard disclosures.
Agents should assess if a consumer needs assistance understanding plan details, especially if confusion is evident.

Important Enrollment Periods

The Annual Election Period (AEP) runs from October 15 to December 7, allowing changes to Medicare Advantage Plans.
Agents must not use their own email addresses in the consumer's email field to ensure proper correspondence delivery.

Understanding Consumer Agreements

Agreeing to the Statement of Understanding indicates that consumers recognize the specifics of their enrollment in a plan.

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Description

Test your knowledge on UHC Ethics & Compliance with this quiz. Focused on Medicare regulations, it will help you understand patient coverage options and compliance requirements for 2022. Perfect for healthcare agents and compliance professionals.

UHC Ethics & Compliance 2022