2020, 2021, 2022, 2023, 2024 UHC Ethics and Compliance New Latest Updated Version, Exams of Science education

Download 2020, 2021, 2022, 2023, 2024 UHC Ethics and Compliance New Latest Updated Version and more Exams Science education in PDF only on Docsity! 2020, 2021, 2022, 2023, 2024 UHC Ethics and Compliance New Latest Updated Version with All Questions and 100% Correct Answers from Expert (Best Studying Resource) When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? --------- Correct Answer -------- The consumer/member would not receive plan related correspondence intended for him/her. Which election period runs from October 15 to December 7 and allows consumers to elect to join a Medicare Advantage Plan or switch to a different plan? Open Enrollment Period (OEP) Special Election Period (SEP) Initial Coverage Election Period (ICEP) Annual Election Period (AEP) --------- Correct Answer --------- Annual Election Period (AEP) Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? Medicare Made Clear brochures from the UnitedHealthcare Toolkit. Pens and notepads that contain the agent's contact information. 5-dollar gift cards to an in-network pharmacy. Generic business reply cards for Medicare products. --------- Correct Answer --------- 5- dollar gift cards to an in-network pharmacy. 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? ------- Correct Answer ---------- April 1 through October 31 Which of the following statements is true about using a five star special enrollment period (SEP)? ------- Correct Answer ---------- It 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 ------- Correct Answer ---------- Medicare 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? ------- Correct Answer ---------- When 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) ------- Correct Answer ---------- • 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? ------- Correct Answer ---------- The consumer/member would not receive plan related, corresponds, intent for him/her What is the purpose of the statement of understanding? ------- Correct Answer ---------- It 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? ------- Correct Answer ---------- The 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) ------- Correct Answer ---------- If 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 ------- Correct Answer ---------- Automatic disenrollment from the standalone PDP In which situation, MAY the Medicare advantage (MA) organization decide to disenroll a member from an MA plan? ------- Correct Answer ---------- Premiums 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)? ------- Correct Answer ---------- Dennis 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? ------- Correct Answer ---------- A 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 The ___________ ensures that when consumers provide the verbal agreement during the telephone enrollment the knowledge understand they are actually enrolling in which plan they are in rolling, as well as standard disclosures. ------- Correct Answer ---------- Statement of Understanding Select the option that describes the coverage combinations a member can be enrolled in at the same time ------- Correct Answer ---------- Which of the following are examples of lead generation materials that might result in an inbound call from my Medicare eligible consumer ------- Correct Answer ---------- Direct mail, TV ads, billboards On October 20 Aries decide to switch his PDP to a Medicare Anast Penn erens would like this change to be effective November 1 which statement is true for Aries ------- Correct Answer ---------- He may be able to qualify Which statement about discussing benefits with a consumer before an enrollment is true ------- Correct Answer ---------- The agent must explain any prior and/or pharmacy network limitation Rosanna is enroll in a Medicare advantage only MA only private fee for service plan ----- -- Correct Answer ---------- Which statement regarding star rating is true ------- Correct Answer ---------- Medicaid, as if I start reason to illustrate plans, performance, and quality Which of the following options will enable a consumer to obtain prescription drug coverage select 2 ------- Correct Answer ---------- Is currently a member of a standalone PDP it was would like to have an additional Medicare coverage throwing his nose is indicates a Medicare. Advantage plan would be a good fit. There are plans available in his area and he is in a valid election. Which option is available to Aries ------- Correct Answer ---------- Aries can enroll in a Medicare advantage plan with prescription drug coverage which will disenroll him from his PDP Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage? ------- Correct Answer ---------- On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1. Which of the following statements is true about election periods? ------- Correct Answer - --------- MA open enrollment period. Can only be used by consumer already enrolled in an MA plan. When a customer asked why an MA plan has a two star rating the agent should tell the consumer one ------- Correct Answer ---------- That the plan has received a Below Average rating Whose email address may the agent enter into the applicant information section of LEAN enrollment application? ------- Correct Answer ---------- Only the consumer email or leave it blankMr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? Yes, but just one because the Nelsons are husband and wife. Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. No, because the Nelsons are current members. No, because the Nelsons walked into his office instead of scheduling an appointment in their home. --------- Correct Answer --------- Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Which of the following describes Permission to Contact guidelines? --------- Correct Answer -------- it allows the agent to discuss the products identified during the marketing appointment Which statement about discussing benefits with the consumer before an enrollment is true? --------- Correct Answer -------- What is the purpose of the Statement of Understanding? --------- Correct Answer -------- It 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? --------- Correct Answer -------- The agreement obtained from the consumer that identifies the scope of products that can be discussed at a personal/individual marketing appointment (in-person or telephonic) To complete an Enrollment Application on behalf of a consumer, what authority must the individual have? --------- Correct Answer -------- The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). melanie is currently enrolled in an HMO MAPD, and she is talking to sales agent Brenda about enrolling in a Medicare Supplement Insurance Plan. What should Brenda tell Melanie? --------- Correct Answer -------- Brenda should tell her that she is automatically disenrolled from her MA Plan if she enrolls in a Medicare Supplement Insurance Plan In which situation must the Medicare Advantage (MA) organization disenroll a member from an MA plan? --------- Correct Answer -------- The member loses entitlement to either Medicare Part A or Part B Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical 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)? --------- Correct Answer -------- Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. In what product should agents enroll consumers? --------- Correct Answer -------- A product that is suitable for the consumer's needs, goals and financial resources To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3) --------- Correct Answer -------- Accurate Complete Factual Annual Election Period (AEP) is a time when. . . --------- Correct Answer -------- Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. 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? --------- Correct Answer -------- April 1 through October 31 Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? --------- Correct Answer -------- Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? --------- Correct Answer -------- When the consumer consented to be contacted for Sales Activities and the permission has not yet expired Before starting an enrollment, what benefit information are agents required to provide to the consumer? --------- Correct Answer -------- The agent must accurately and completely disclose any benefits discussed While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do? --------- Correct Answer -------- Leave the field requesting applicant email address blank Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? --------- Correct Answer -------- Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Consumer Gary gives his friend's telephone number and email address to agent Bethany. What should Bethany do? --------- Correct Answer --------- Bethany may accept the information, but must observe permission to contact and unsolicited contact guidelines, which will limit her to using postal mail to contact Bethany's friend. John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? --------- Correct Answer --- ------ John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? --------- Correct Answer --------- When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. To sign an enrollment application on behalf of a consumer, what authority must the individual have? --------- Correct Answer --------- The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage or Prescription Drug Plans to consumers? --------- Correct Answer --------- In what product should agents enroll consumers? --------- Correct Answer --------- A product that is suitable for the consumer's needs, goals and financial resources. What is the purpose of the Statement of Understanding? --------- Correct Answer --------- It ensures that when consumers sign 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 the definition of Abuse? --------- Correct Answer --------- Abuse includes any practice that results in the provision of services that are not medically necessary. Which of the following are the ways to report potential FWA? (Select 2) --------- Correct Answer --------- Fraud, Waste and/or Abuse hotline & Producer Help Desk (PHD) Agent John is planning to conduct a series of events. Some will be strictly educational, others will be formal presentations of specific UnitedHealthcare plans, and others will be informal marketing events where he can generate leads and schedule future in-home marketing appointments. Of the three types of events John plans to conduct, which need to be reported to UnitedHealthcare? --------- Correct Answer --------- Only the marketing/sales events, both formal and informal. Annual Election Period (AEP) is a time when: --------- Correct Answer --------- Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. 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 consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? --------- Correct Answer --------- Dino presented a plan prior to October 1. Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? --------- Correct Answer --------- Educational events Agent Ralph wants to market Medicare Advantage Plans in his neighborhood - an area that consists of single-family houses, an assisted living facility, a church, and public library. Which of the following methods of contact is permitted? --------- Correct Answer - -------- Ralph sends a flyer inviting consumers to a marketing/sales event to each resident via postal mail. Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage Plan? --------- Correct Answer --------- The consumer's spouse, who is neither a Power of Attorney or legal guardian. When can telephonic contact with a Medicare eligible consumer be made? --------- Correct Answer --------- When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? --------- Correct Answer --------- Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. As an agent, you have an obligation to only enroll a consumer in a product: --------- Correct Answer --------- That is suitable for the consumer's needs, goals and financial resources. In terms of events, which of the following is true? Agents must only report formal marketing/sales events UnitedHealthcare. Agents must only report informal marketing/sales events to UnitedHealthcare. Agents must only report formal and informal marketing/sales events to UnitedHealthcare. --------- Correct Answer --------- ... When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. The enrollment application may be denied. The agent may experience commission payment processing issues. --------- Correct Answer --------- The consumer/member would not receive plan related correspondence intended for him/her. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When confirming receipt of mailed information. When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. When a member has voluntarily disenrolled from a plan. --------- Correct Answer --------- When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. 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 must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Jacob must explain that Emily will sign the Enrollment Application and that no further action on her part is required. Jacob must explain that Emily will sign the Enrollment Application and must submit documentation with the application that indicates her legal authority to enroll her father. Jacob must explain that Emily is not authorized to complete the Enrollment Application on behalf of her father. --------- Correct Answer --------- jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates her legal authority to enroll her father. Which of the following must you not do when marketing UnitedHealthcare Medicare Advantage or Prescription Drug Plans to consumers? Review the Summary of Benefits. Review and complete a SOA form with each Medicare-eligible consumer prior to the start of a personal/individual (e.g., in-home or telephonic) marketing appointment. Provide current materials approved by CMS and UnitedHealthcare. Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. Next question --------- Correct Answer --------- Provide only those items from the plan's Enrollment Guide that are most relevant to the consumer's situation. As an agent, you have an obligation to only enroll a consumer in a product: What is Scope of Appointment? --------- Correct Answer --------- The agreement obtained from the consumer that identifies the scope of products that can be discussed at a personal/individual marketing appointment (in-person or telephonic) Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? --------- Correct Answer --------- Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. In which situation MAY the Medicare Advantage (MA) organization disenroll a member from an MA plan? (if question says *must* it is not the same answer) --------- Correct Answer --------- Premiums are not paid on a timely basis. Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical 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)? --------- Correct Answer --------- Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. As an agent, you have an obligation to enroll a consumer in a product: OR An agent should only enroll a consumer in a product: --------- Correct Answer --------- That is suitable for the consumer's needs, goals and financial resources. An agent is explaining Medicare Advantage plan options to a consumer. During the conversation, the agent explains that Medicare gives each plan a Star Rating. Which statement is true? --------- Correct Answer --------- The agent said that Medicare uses a 5-star rating system to illustrate the plan's performance and quality. Before starting an enrollment, what benefit information are agents required to provide to the consumer? --------- Correct Answer --------- The agent must accurately and completely disclose any benefits discussed Whose email address may the agent enter into the applicant information section of LEAN enrollment application? --------- Correct Answer --------- Only the consumer's email (or leave it blank). The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. --------- Correct Answer --------- Statement of Understanding Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? --------- Correct Answer --------- Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3) --------- Correct Answer --------- Factual Accurate Complete Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: --------- Correct Answer --------- Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Why must an agent present accurate, complete, and factuals plan information to consumers? (select 3 --------- Correct Answer --------- To help avoid misunderstandings To help the consumer focus on plan-specific information, such as benefits and costs To help avoid confusing the consumer Which election period runs from October 15 to December 7 and allows consumers to join a Medicare Advantage Plan or switch to a different plan? --------- Correct Answer ---- ----- Annual Election Period (AEP) A one-on-one marketing appointment, whether in-person or telephonic, is always considered a marketing/sales event, but it is not reported to UnitedHealthcare or CMS; instead the consumer must provide_____ agreement prior to the start of the appointment. --------- Correct Answer --------- Scope of Appointment To complete an Enrollment Application on behalf of a consumer, what authority must the individual have? --------- Correct Answer --------- The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? --------- Correct Answer --------- The consumer/member would not receive plan related correspondence intended for him/her. By agreeing to the Statement of Understanding, the consumer: --------- Correct Answer - -------- Acknowledges that they clearly understand they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? --------- Correct Answer --------- Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Rosanna is enrolled in a Medicare Advantage Only (MA-Only) Private Fee-for-Service (PFFS) Plan. The plan is suitable for her needs and service area. She has decided she wants to add prescription drug coverage. Which option is available to Rosanna (assuming she is in a valid election period)? --------- Correct Answer --------- Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP.