UHC Ethics and Compliance Section for Certification Exam – UnitedHealthcare Medicare Advantage Certification – 2026/2027 Edition | Questions with Evidence-Based Verified Answers

UHC Ethics and Compliance Section for Certification Exam – UnitedHealthcare Medicare Advantage Certification – 2026/2027 Edition | Questions with Evidence-Based Verified Answers Q: What is a servicing agent? Answer an inactive, nonemployee who has signed a servicing agreement in order to receive renewal commisions on medicare advantage and prescription drug plan enrollments on or after 1-1-2014. the agent must maintain an active resident license and appointment and pass medicare basics and ethics compliance assessments on an annual basis Q: What does CMS stand for? Answer center for medicare and medicaid services Q: Who administers the medicare program and contracts with private health care companies to offer medicaid plans? Answer CMS Q: Who holds the authority to approve or disaprove plans that can be sold, and is the regulating agency that also monitors our progresses? Answer CMS Q: Who regulates MA's and PDP's Answer CMS Q: Enrolling a customer in a plan when you are not certified in the product is non-compliant and considered____? Answer an unqualified sale Q: Agents who are not qualified to sell the product will not be? Answer compensated and may receive corrective and or disciplinary action up to an including termination Q: What is the purpose of an educational event? Answer its designed to inform medicare consumers about original medicare, medicare advantage, prescription drug and other medicare programs. Q: Where must educational events be conducted? Answer in a public venue Q: Are the educational events unbiased so that it doesn't steer the consumer towards a specific plan or limited number of plans? Answer yes Q: WHat is a marketing/sales event? Answer an event designed to steer or attempt to steer, consumers toward a plan or limited set of plans. Agents may discuss plan specific information and collect applications. Q: Can marketing/sales be formal or informal? Answer both Q: What describes a formal marketing/sales event? Answer a full plan presentation, given in a presenter-audience format. Q: What is an inform marketing/sales event? Answer they're passive in nature where the consumer approaches the agent to engage in conversation. a booth, table, or kiosk is typically used Q: What are marketing appointments? Answer They're commonly referred to as "in home, face to face, or one on one appointment" and typically take place in the consumers home. Q: What other places can marketing appointments happen? Answer coffee shop, or even over the phone Q: because marketing appointments are not formal and informal marketing sales events, they're not reported to who? Answer UHC or CMS. instead, agents must obtain a completed scope of appointment prior to conducting the appointment. Q: To report events, what should agents use? Answer an event request form Q: to ensure that events are in UHC's event reporting application no less than 7 calender days prior to the event... Answer submit the event request form, according to instructions on the form, NO LESS THAN 14 CALENDAR DAYS Q: event request forms submitted within7 calendar days will NOT be what? Answer processed Q: conducting an unreported event is _____? Answer prohibited Q: to schedule a sign language interpreter for a formal marketing/sales event or a personal/individual marketing appointment, enter the consumer's request direct;y in bconnected at least? Answer 14 days prior to the event or appointment Q: What are marketing materials used for? Answer 1) draw attention to a plan sponsor or their plan(s) and 2) influence a consumer's decision when selecting a plan in which to enroll or a member's decision to remain enrolled in their current plan Q: Marketing materials contain information about the plan or plans: Answer 1) benefits or benefit structure 2) cost sharing ( including premiums, copayments, and deductibles) 3) Measurements or ranking standards ( such as star ratings. comparisons to other plans, or statistical studies or surveys) Q: Approval is required for? Answer 1) ALL medicare marketing materials or 2) ANY material that mentions a plan sponsor ( such as " united health care") one of its affliated plans or displays any logos Q: What does generic mean with marketing materials? Answer materials that do not meet the marketing materials criteria and do not carry any plan sponsor information or logos Q: does generic materials require prior approval? Answer no Q: What methods are considered marketing material? Answer newspaper, tv, internet, radio advertisements, direct mail, postcards, flyers, brochures, magnets, pre-enrollment materials, websites and social media platforms Q: what are some examples of generic marketing materials? Answer social media sites and websites sites used to market UHC plans must be _____ by UHC and CMS prior to use Answer approved when talking about marketing materials what should the agent NOT do? Answer add, enhance, delete, modify, edit or create any content in the marketing materials provided by the health plan modify approved materials in any way, no matter how minor ask health related or health screening questions on generic, agent created materials What must an agent do when talking about marketing materials? Answer use marketing materials only for products they are certified to market/sell What does PTC stand for? Answer permission to contract What does SOA stand for? Answer Scope of appointment What does permission to contact mean? Answer is permission given by the consumer to be called or otherwise contacted by an agent for the purpse of marketng any UHC medicare solutions product includeing MA, Prescription drug or med sup plans. PTC must be______? Answer documented, retained and available upon request for 10 years PTC must also be? Answer Method specific, short term and event specific What does method specific mean? Answer contact can only be made by the method permitted by the consumer. Permission to telephone only enables the agent to dial the number provided. AN AGENT MUST RECEIVE EXPLICIT PERMISSION TO TEXT OR EMAIL THE CONSUMER having access to a phone number or email address does not imply permission from the consumer What is short term? Answer PTC expires once the agent has made contact with the consumer or 9 months after the date the PTC was received. PTC expires 90 days after the receipt for consumers requesting info on med sup's or who are on the federal DNC list. What does event specific mean? Answer the agent can only contact the consumer to discuss the products indicated in he PTC mechanism what does BRC mean? Answer business reply cards agents who telephone a consumer in response to a BRC that has specific products documented on the card, may only ____ Answer discuss the products that were indicated within the BRC BRC's are only intended to obtain permission to contact Answer it does not satisfy the SOA requirement SOA does not secure permission to contact it confirms permission to discuss product types during an individual appointment If a BRC is returned by the consumer without a valid phone number, agents____ may NOT look up or search for consumer information in order to contact the consumer either by telphone or a visit. What is a Scope of appointment (SOA)? captures the consumers permission to discuss certain products. Where are SOA forms available? in enrollment guides and as standalone documents on the sales material portal accessible on jarvis a SOA is required from each Medicare eligible consumer present at any face to face or telephonic marketing appkintment to discuss MA and or PDP plans including____ authoried legal representitives and each spouse ( if a married couple is present) When a consumer walks into an agent's office or a UHC medicarestore, the agent must obtain an SOA prior to discussion In leu of a SOA form, agents must announce the products that will be presented at the formal or informal marketing/sales event agents may obtain an SOA for future face to face or telephonic appointments if the consumer requests the future appointment at the marketing/sales event when conducting face to face or telephonic appointments to present MA and or PDP plans, the agent MUST 1) obtain a signed SOA from the consumer prior to the start of the appointment 2) obtain a new SOA when the consumer or agent requests to discuss a health related product not identified on the original SOA. once obtained, the new product may be discussed SOAs must be submitted how? via fax or emailed within 2 business days following the scheduled appointment contracted agents using the generic SOA form must also include the corresponding fax coversheet medicare marking guidelines prohibit marketing non-healh related products (annuities, life insurance, LT disability/disability plans) when presenting what to a consumer? MA plan or PDP plas THIS IS CONSIDERED CROSS-SELLING AND IS PROHIBITED SCARE TACTICS ARE PROHIBITED what is an authorized representitive? is a person who is authorized under state law to complete the enrollment application, make health care decisions on behalf of the consumer and is authorized to receive health care related on his/her behalf in order to determine if a POA or authorized representitive is needed when enrolling a consumer, the agent MUST___? consider the consumers mental and physical ability to enroll themselves if a consumer appears to have either a physical and or mental challenges that may impede their ability to enroll themselves in a plan, you must ask if they have a ____ or ____? POA or authorized representitive a person assisting, including an agent cannot sign the enrollment application on behalf of the consumer. only the consumer, POA, or authorized representative can sign the enrollment application agents can offer promotional gifts to attendees of any event type as long as such gifts are of nominal retail value. nominal value is any item _____ or less $15 or less the combined value of all giveaway items including food, must not exceed______ per consumer $15 What types of gifts are prohibited regardless of the amount? cash, gift certificates, gift cards, monetary rebates, as well as charitable contributions made on behalf of the consumers/members you must state that accepting a gift or prize does not obligate a consumer to enroll when providing gifts, you must offer to all persons whether or not they're eigible for medicare giving gifts to solicit business is prohibited what is the real on meals for sales/marketing events? it is prohibited including personal and individual marketing appointments agents may serve light refreshments providing the items cannot be combined to equal a meal. Are you required to disclose compensation? no Define compensation according to CMS? monetary or non-monetary remuneration of any kind relating to the sale or renewal of a policy including, but not limited to, commission, bonuses, gifts, prizes, awards, and referral/finder's fees. What does compensation not involve? payment of fees to comply with stat appointment laws.: costs related to training, certification, and testing requirements; reimbursement for mileage to and from educational and marketing/sales events or marketing appointments with consumers What does ISR stand for? internal sales representitives What is a sales incentive plan? Employed agents are paid an incentive when specific goals have been met. referral/finder's fees? UHC does not sponsor a lead referral program; therefore, no payment is made in exchange for a referral or as a result of referred consumer's enrollment Marketing fees? Agents are prohibited from charging a consimer or member any type of fee for the marketing of a Medicare insurance product, including but not limited to : entrance fees to attend educational or marketing/sales events, fees to conduct a personal/individual meeting appointment, or to cover the cost of materials What is another name for compensation recovery? charge backs What is compensation recovery? Incentive amounts are deducted from a SIP participant's incentive payment for previously paid advances on sales that aren't earned. generally the result of a member's rapid disenrollment from their plan, but can occur for other reasons. When does rapid dis-enrollment occur? it occurs when a member voluntarily dis-enrolls or moves from one UHC plan to another prior to the member's FOURTH month effective date following the original effective date. What does EDC stand for? external distribution channel What does ICA stand for? independent career agent How does UHC pay non-employee agents in the EDC and ICA? pays on commission for enrollment of a consumer into a UHC medicare solutions MA plan, PDP, or med sup insurance policies according to the terms of their agent agreement. How are commissions paid on sales written by a solicitor? paid to the solicitor's up-line. for each MA, MA-PD and PDP enrollment, CMS determines if hte enrollment qualifies for Initial or renewal compensation If a member disenrolls from one plan and enrolls in another, CMS determines the compensation type for the ______ new enrollment What is initial compensation? is paid at an amount at or below the fair market value (FMV) When a member enrolls in a plan and has no prior plan history, the plan sponsor may pay the full year initial compensation amount or a ? pro-rated amount based on the number of months the member is enrolled What happens when the member changes plans during the initial year? The plan sponsor must pay the agent at a pro-rated initial year rate based on the number of months the member is enrolled. How is renewal compensation paid in any amount up to 50% of the current FMV, published by CMS annually foer the members 2nd and subsequent enrollment years when they enroll in a new " like plan type" Renewal compensation must always be? pro-rated for the actual months the member is enrolled in the plan What is the compensation cycle? compensation paid for the plan enrollment is based on the current year enrollment. Payments must NOT be paid until Jan 1st and must be paid in full by dec 31st of the enrollment year. How may plan sponsors pay compensation? annually, quarterly, monthly or utilizing other schedules marketing to consumers through direct, unsolicited contact is ____ prohibited without documented permission,, the following forms of outreach are considered to be unsolicited contact door to door soliciting text messaging emailing telemarketing cold calling Is soliciting by direct mail permitted? yes its permitted during contact with a consumer, agents must update the lead status or permission to call within the company tracking system with____ the customers preference if an agent does not have access to bconnected, they must havr a system that enables themto document and retain PTC for a minimum of 10 years and provide documentation upon request. if you are soliciting a call for medicare supplement with a client and the customer requests more information on a MA or PDP product, can a discussion be held at that time for those products, or must it be done at a later time? it can be done at that time on the MA or PDP product May an agent contact a referred customer, or must that referred customer be the first one to contact the agent the referred customer must contact the agent, not the other way around _____ are permitted to return phone calls or emails received from a referred individual agents failure to report an insurance of suspected misconduct could result in disciplinary action. What is the MA enrollment period( MA-OEP)? jan 1st- march 31st MA plan members enrolled effective jan 1st can make a one time election annually from jan 1st through march 31st to switch MA plans( with or without drug coverage), or to disenroll from a MA planand obtain coverage through original medicare (with or without a stand alone PDP) newly eligible MA individuals who enroll in an MA plan can use the MA OEP, but only during the first 3 months in which they have both part A and part B Agents are not ______to target marketing to any carriers ( UHC or another) MA/MA-PD members to entice or encourage them to use the MA OEP election code to make a plan____ change What is the period of time where an eligible customer can enroll or disenroll from an MA or PDP plan? Special election period ( SEP) How many different types of SEPs and are not limited to dual eligibles. customers who move into reside in, or move out of a nursing home , and those who have qualifying chronic conditions. A member may disenroll from their MA plan and return to original medicare during which time SEP's A customer with original medicare may enroll in a MA plan, during which time? SEP's A member of one MA plan may enroll in a different MA plan during which time? SEP's For a SEP, when is the members start date? 1st day of the month following receipt of election. Note: for some SEP's consumers may choose effective date up to 3 months after plan receives enrollment request. Note: if the SEP is due to a move, the plan effective date CANNOT be earlier than that of the move date or receipt of the enrollment request If a customer is eligible for AEP, can they also be eligible for a SEP at the same time? yes WHat does ICEP stand for? initial coverage election period What does IEP stand for? initial enrollment period What is the enrollment period for a MA only plan? ICEP ( initial coverage election period) What is the enrollment period for a stand alone PDP or M-PD plan? initial enrollment period What is ICEP used for? is for customers newly eligible for medicare parts Aand B who elect an MA-only plan what is IEP used for? for customers newly eligible for medicare parts A and B who elect a stand alone PDP or MA-PD plan What is the time period for medicare advantage and prescription drug plans? 7 month enrollment period that includes 3 months prior to their eligibility, the month they are eligible and 3 months following the month of eligibility What is a 5- star special election period? its an election period available to consumers that allows them to enroll in a 5 star rated plan. consumers can use this SEP once during the benefit year. Can consumers join a 5 star MA plan if one is not available in their area? no they cannot Consumers who use this SEP to enroll in a 5 star MA-only PFFS plan also have a coordinating SEP to enroll in a PDP even if its not 5-star rated NOTE: consumers may lose their prescription drug coverage if they move from a MA plan that has drug coverage to a MAP that does NOT. if the above scenario happens, members will have to wait until the next AEP to obtain drug coverage, and customers will have to pay a late enrollment penalty When is AEP? oct 15th through Dec 7th What does AEP stand for Annual election period AEP can be used with Medicare open enrollment What is the AEP used for? a medicare consumer can enroll in or disenroll from a MA or PDP plan. All AEP enrollment elections become effective janurary 1st and disenrollments elections become effective Dec 31st For AEP, agents may not begin marketing until what date october 1st for AEP, agents may not accept or solicit submission of enrollment applications prior to october 15th october 15th If the plan receives an unsolicited enrollment application prior to AEP, the plan must retain the appliction and process the enrollment application beginning on the first day of the AEP with an application date of the same date. The____ will receive an acknowledgment letter when the plan receives an early enrollment application the consumer Are Med sup plans restricted by election periods? no theyre not. comsumers with original medicare may enroll/disenroll from med sups at any time, provided they meet the plans requirements Consumers considering a med sup plan must have a valid election period if they are already enrolled in a MAP or want to enroll in a PDP at the same time enrolling in a med sup plan does not automatically disenroll a member from their MAP or vice versa. If a consumer has a MAP, it is non-compliant to sell them a med sup plan unless they are able to disenroll from their MA plan and go to original medicare does a med sup plan pay the cost sharing of a MA plan? no it doesn't When must the enrollment guide be presented to the consumer? at the time of enrollment What does the enrollment guide include? summary of benefits, language interpreter disclaimer, plan ratings information, and enrollment application Whats included with a summary of benefits detailed info on plan benefits, explanations of cost sharing, and lists special features What included with a language interpreter disclaimer? includes info on how to request an interpreter whats another name for plan ratings information star ratings What included with plan ratings information req document that shows the stars rating for specific plan being sold, ranging from 1 to 5 stars How does the medicare program rate plans? theyre based on quality an performance what does LPI stand for? low performance icon how does a plan receive a LPI? if a plan receives a starrating of 2.5 or below for 3 consecutive years in any combination of its part C or D rating wll receive a LPI status What time of the year does the CMS issue star ratings? october for the following year the plan publishes star rating information in materials such as the enrollment guide within how many calendar days as required by CMS? 21 calendar days Agents must clearly state the overall star rating, inc LPI for ___plan they present to the consumer and indicate that additional information on the star ratings can be found in the enrollment guide/ each plan Where can you find the penalties for late enrollment? the "medicare and you" handbook What does SOU stand for? statement of understanding What is the SOU? is a REQ element for enrollment and the agent must review it with the consumer at the point of sale By signing the SOU, the consumer is clearly saying they understand the enrollment application and that they are 1) understanding what they are actually enrolling in 2) understand the plan in which they are enrolling can the SOU vary between the different plans? yes they can What is the EOC also known as and what does it do evidence of coverage, and is known as the member contract subscriber agreement. it will list services the plan covers , as well as the plans terms and conditions If a service isnt listed in the EOC or approved by the plan, medicare and the plan will________ not pay for it if an agent indicates their agent writing number on the enrollment application prior to meeting with the consumer or assists the consumer in completing the MA or PDP enrollment application, the agent MUST clearly indicate this by checking the appropriate box on the enrollment application on the enrollment application, have the POA or authorized representative sign the application and print their name.... contact info and relationship to the consumer what must the authorized representative or POA sign on the application they must sign an attestation on the application attesting that they have necessary legal authority to act on the consumers behalf NOTE: documention of this authority MUST be available upon request by the plan or CMS, but you CANNOT require it for the purposes of enrollment someone who provides assistance to the consumer, but is not authorized to act on the consumers behalf cannot what? sign the enrollment application Do agents need to collect POA or authorized representation documentation? no they dont Will who request the documentation directly from the authorized representative if needed medicare Should you ever sign the consumers name? no should agents ever send LEAN remote signature emails to themselves in order to facilitate consumer digital enrollment application signatures? no they shouldn't Who must provide their own email address and complete their own digital signatures? consumers Never put your name on the enrollment application as the agent of record if you dont what present the plan to the customer why? ( consumers become confused when they see an agent named tied to their enrollment that they do not recognize) What is provided in the enrollment application? provides notice acknowledging receipt of the completed enrollment request. for electronic enrollments, the consumer should be provided what? a confirmation number or tracking number as evidence of the enrollment request was received. how many hours is the maximum allotted time for an agent to submit an enrollment application receipt? 24 hours if the consumer sees a provider and their enrollment request is not approved by CMS, the consumer will be what responsible for all costs What is a grievance? a type of complain consumers and members may make about the health plan, a health plan agent, one of its network providers and pharmacies, or quality of care. This type of complaint does NOT incolve coverage or payment disputes When a member enrolls in a MA plan or PDP during AEP or a qualifying SEP, they will be ______ dis-enrolled from their current MA or PDP plan, even if its offered by a different provider. automatically When is the effective date of termination for AEP or SEP? last day of the month prior to the effective date of the new enrollment. The action members may take if they disagree with a coverage plan or payment decision made by their medicare plan appeal Offers a detailed summary of the plan's benefits, explanation of cost sharing, and lists special features summary of benefits This happens when the member loses entitlement to medicare Part A or Part B A required disclosure that must be read and acknowledged by the consumer at the time of enrollment statement of understanding Medicare's measure of a plan's quality and performance on a scale of 1-5 star rating