UHC ethics and compliance section for certification Exam Questions With Answers

UHC ethics and compliance section for certification Exam Questions With Answers What is a servicing agent? - ANSWER- an inactive, nonemployee who has signed a servicing agreement in order to receive renewal commissions 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 What does CMS stand for? - ANSWER- center for Medicare and Medicaid services Who administers the Medicare program and contracts with private health care companies to offer Medicaid plans? - ANSWER- CMS Who holds the authority to approve or disapprove plans that can be sold, and is the regulating agency that also monitors our progresses? - ANSWER- CMS Who regulates MA's and PDP's - ANSWER- CMS Enrolling a customer in a plan when you are not certified in the product is non-compliant and considered____? - ANSWER- an unqualified sale 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 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. Where educational events must be conducted? - ANSWER- in a public venue Are the educational events unbiased so that it doesn't steer the consumer towards a specific plan or limited number of plans? - ANSWER- yes 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. Can marketing/sales be formal or informal? - ANSWER- both What describes a formal marketing/sales event? - ANSWER- a full plan presentation, given in a presenter-audience format. 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 What are marketing appointments? - ANSWER- They is commonly referred to as "in home, face to face, or one on one appointment" and typically takes place in the consumer’s home. What other places can marketing appointments happen? - ANSWER- coffee shop, or even over the phone Because marketing appointments are not formal and informal marketing sales events, they're not reported to whom? - ANSWER- UHC or CMS Instead, agents must obtain a completed scope of appointment prior to conducting the appointment. To report events, what should agents use? - ANSWER- an event request form to ensure that events are in UHC's event reporting application no less than 7 calendar days prior to the event... - ANSWER- submit the event request form, according to instructions on the form, NO LESS THAN 14 CALENDAR DAYS Event request forms submitted within7 calendar days will NOT be what? - ANSWERprocessed Conducting an unreported event is _____? - ANSWER- prohibited To schedule a sign language interpreter for a formal marketing/sales event or a personal/individual marketing appointment, enter the consumer's request directly in connected at least? - ANSWER- 14 days prior to the event or appointment 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 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) 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 affiliated plans or displays any logos 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 does generic materials require prior approval? - ANSWER- no What methods are considered marketing material? - ANSWER- newspaper, TV, internet, radio advertisements, direct mail, postcards, flyers, brochures, magnets, preenrollment materials, websites and social media platforms 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? - ANSWERads, 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 purpose of marketing any UHC Medicare solutions product including MA, Prescription drug or med sup plans.