UHC Ethics and Compliance Section for Certification Exam

What is a servicing agent? - 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 What does CMS stand for? - center for medicare and medicaid services Who administers the medicare program and contracts with private health care companies to offer medicaid plans? - CMS Who holds the authority to approve or disaprove plans that can be sold, and is the regulating agency that also monitors our progresses? - CMS Who regulates MA's and PDP's - CMS Enrolling a customer in a plan when you are not certified in the product is non-compliant and considered____? - an unqualified sale Agents who are not qualified to sell the product will not be? - compensated and may receive corrective and or disciplinary action up to an including termination What is the purpose of an educational event? - its designed to inform medicare consumers about original medicare, medicare advantage, prescription drug and other medicare programs. Where must educational events be conducted? - 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? - yesWHat is a marketing/sales event? - 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? - both What describes a formal marketing/sales event? - a full plan presentation, given in a presenteraudience format. What is an inform marketing/sales event? - 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? - They're commonly referred to as "in home, face to face, or one on one appointment" and typically take place in the consumers home. What other places can marketing appointments happen? - coffee shop, or even over the phone because marketing appointments are not formal and informal marketing sales events, they're not reported to who? - UHC or CMS. instead, agents must obtain a completed scope of appointment prior to conducting the appointment. To report events, what should agents use? - an event request form