2022, 2023, 2024 UHC Ethics and Compliance 2023 Exam with All Questions from the Actual, Exams of Law

Download 2022, 2023, 2024 UHC Ethics and Compliance 2023 Exam with All Questions from the Actual and more Exams Law in PDF only on Docsity! 2022, 2023, 2024 UHC Ethics and Compliance 2023 Exam with All Questions from the Actual Exam and 100% Correct Answers from Expert New Updated Version 2022 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. 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. Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? -------- Correct Answer --------- Mailing a marketing brochure to the consumer via postal mail. Which statement is true about discussing benefits with the consumer before an enrollment? -------- Correct Answer --------- The agent must accurately and completely disclose any benefits discussed. Which statement about discussing benefits with the consumer before an enrollment is true? -------- Correct Answer --------- The agent must explain any provider and/or pharmacy network limitations. 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. 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) 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 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. Melanie is currently enrolled in a MAPD, and she is interested in enrolling in a PDP. Which statement is true? --------- Correct Answer -------- An agent should only enroll a consumer in a product --------- Correct Answer -------- That is suitable for the consumer's needs, goals and financial resources 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? --------- Correct Answer -------- AEP 2024 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 consumers Medicare eligibility, describe the cost and benefit coverage of the plan and explain that he could not accept an enrollment application until October 15. What did Daniel do? That was not compliant. ------- Correct Answer ---------- Dino presented a plan prior to October 1 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 Which of the following are examples of advertisements and consumer may see that may make them call you into your call center? ------- Correct Answer ---------- When must you provide your name your role as a license, insurance agent, and the name of the agency you represent? ------- Correct Answer ---------- At the beginning of the call What must you keep in mind when receiving a call from a consumer (Select 2) ------- Correct Answer ---------- • The consumer may have misunderstood, or been confused by what they read or heard in a advertisement • the consumer may be relying on a single benefit or description provided in the advertisement Consumer asked to be enrolled in a medical advantage plan that allows them to see Specialist without needing a referral. What do you do next? ------- Correct Answer -------- -- Conduct a thorough needs assessment to make sure I gather information about the situation and preferences What is the purpose of a needs assessment? ------- Correct Answer ---------- To gather as much information about the consumer as possible to ensure I am recommending the plan that is the best fit for the consumer Which of the following are components that at minimum should be included in a thorough needs assessment ------- Correct Answer ---------- • identifying their current providers, including primary care, specialist hospitals in pharmacies and the medication they take • identifying the last time the consumer visited a doctor or hospital • Deterring consumer eligibility Which of the following statements are true when selling Medicare plans over the phone? (Select 2) ------- Correct Answer ---------- I must rely on what I hear, which includes the tone of the consumers voice, the questions they ask her even there pauses in the conversation I don't have the benefit of seen the consumers facial expressions or body language in order to assess their comprehension Inez a consumer call the number on a piece of mail she received during the annual election period when you answer you can hear a lot of background noise. What action should you take to help ensure Inez will understand the information you share with her - ------ Correct Answer ---------- Speak clearly in an appropriate volume in a modern piece Ask if someone assist her with making enrollment decisions and make sure that person is presented to participate in the call Ask her to either move into another room, or turn off the TV to help her, hear me clearly in without distraction When should you assess consumer comprehension during a call? ------- Correct Answer ---------- At all stages of the call 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