UHC Ethic and Compliance (Questions And Answers) 2022

What is the definition of Abuse? - ANSWER-Abuse includes any practice that results in the provision of services that are not medically necesary An agent should only enroll a consumer in a product: - ANSWER-That is suitable for the consumer's needs, goals and financial resources. When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? - ANSWER-Provide current marketing materials that have been approved by CMS and UnitedHealthcare. 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? - 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. When can telephonic contact with a Medicare eligible consumer be made? - ANSWERWhen the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. An individual with Power of Attorney is an example of what authority? - ANSWER-Legal authority under state law to act on behalf of another individual. 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: - ANSWER-Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period. Educational events allow for which of the following to occur? - ANSWER-Provide objective information about the Medicare program and/or health improvement and wellness. 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? - ANSWER-Dino presented a plan prior to October 1. Annual Election Period (AEP) is a time when: - ANSWER-Consumers can elect to join a Medicare Advantage Plan or switch to a different plan. What type of events must an agent report to UnitedHealthcare? - ANSWER-Formal and informal marketing/sales events Which of the following are the ways to report potential FWA? - ANSWER-Producer Help Desk (DHP) Fraud, Waste and/or Abuse hotline What is the definition of Fraud? - ANSWER-Fraud is intentionally misrepresenting or concealing facts to obtain something of value. What is the purpose of the Statement of Understanding? - 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. In what product should agents enroll consumers? - ANSWER-A product that is suitable for the consumer's needs, goals and financial resources. As an agent, you must not do which of the following when marketing UnitedHealthcare Medicare Advantage plans to consumers? - ANSWER-Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval. To sign an Enrollment Application on behalf of a consumer, what authority must the individual have? - 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). In which of the following situations can telephonic contact be made with a Medicare eligible consumer? - ANSWER-When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and that the permission has not yet expired. Julie, a consumer, is having difficulty understanding the information her agent, Victor, is presenting at her in-home appointment. She provides Victor with her cousin's telephone number and email address and asks him to explain the plan to her cousin, who frequently assists with her health care decisions. The next day, Victor emails Julie's cousin. Has Victor been compliant? - ANSWER-No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the cousin's permission. When does Permission to Contact for Medicare Advantage and/or Prescription Drug Plans expire? - ANSWER-Once contact is made or 9 months from the date the consumer provided permission (e.g. consumer signature date on BRC) or 90 days if on federal do not call list, whichever comes first. Agent Brenda is presenting Medicare Advantage plan options to her consumer, Melanie. During the presentation, Brenda tells Melanie that Medicare gives each plan a Star Rating. Which of the following is not an appropriate response when Melanie asks what the Star Rating means? - ANSWER-Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories. Providing objective information about the Medicare program and/or health improvement and wellness at public venues is the purpose of which of the following? - ANSWEREducational events Kira has scheduled an appointment and obtained a Scope of Appointment (SOA) form to discuss Medicare Advantage Plans with a consumer. When she arrives at the appointment, a friend of the consumer who is Medicare-eligible is present to hear your presentation. What should Kira do? - ANSWER-Before Kira can start the presentation with both consumers, she must ask the consumer's friend to complete an SOA. Which of the following material is an agent NOT permitted to display and/or distribute at a marketing/sales event? - ANSWER-5-dollar gift cards to an in-network pharmacy. 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? - ANSWERAnnual Election Period (AEP). When completing a 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? - ANSWER-The consumer/member would not receive plan related correspondence intended for him/her.