AHIP Certification - Part 4
b
Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement best describes how Agent Chan may be compensated under CMS rules? a. FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October 15th -(the date open enrollment begins). If Ms. Park remains enrolled in the plan, renewal amounts will be paid. b. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year. c. FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he has successfully enrolled Ms. Park in a MA plan when she is both first eligible and a younger, and likely healthier, enrollee. d. FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July. Renewal amount will be paid thereafter if Ms. Park remains enrolled.
b
When soliciting referrals from current members of an MA or Part D plan, what may you do? a. You may offer gifts or prizes worth $15 or less in retail value to obtain referrals. b. You may request names and mailing addresses. c. You may offer gifts and prizes worth $15 or less in retail value for each individual on the list of referrals who chooses to enroll. d. You may request names and phone numbers.
c
Your colleague works at a third party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her? a. You could tell her she is wrong and that only agents employed by the plans are exempt from training and testing requirements. b. You could tell her she is right and ask if you could get a contract with the TMO too. c. You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements. d. You could tell her she was right, but new rules will require her to take the training and pass the test at least every other year.
a
Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him? a. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. b. You appreciate the opportunity and would ask the facility to provide enrollment applications for the MA-PD plans you represent. c. You appreciate the opportunity and will ask the facility to provide a plan brochure and enrollment application in every resident's room prior to the meeting to promote interest in the event. d. You appreciate the opportunity and would just need to complete scope of appointment forms on behalf of all the residents who would like to attend.
d
A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do? a. Prior to speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. b. You do not have to do anything. You may proceed with the discussion and enroll the individual, if she so desires. c. You must set an appointment for another time, at least 48 hours from the point when she walked into your office. d. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion.
b
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health information to market non-health related products such as life insurance and annuities. To do so it must obtain authorization from the enrollees. Which statement best describes the authorization process? a. The request for authorization may include a brief synopsis of non-health related content. b. Authorization may be obtained by directing a beneficiary to a website to provide consent. c. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. d. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation, since there is no anticipation of selling a non-health related product in these circumstances.
c
ABC is a long-term care facility provider. What steps may it take to inform residents of the Medicare options available to them? a. ABC may display posters about Medicare in their rooms. b. Since they are likely to be frail or suffer mental incapacity, ABC may choose plan coverages on their behalf. c. ABC may provide residents that meet the I-SNP criteria an explanatory brochure, reply card, and phone number for additional information for each I-SNP with which it contracts. d. ABC may set up appointment on their behalf with knowledgeable agents.
d
Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage before a local senior citizen civic group where he hopes to enroll some attendees. Which of the following steps should he take in order to be in compliance with Medicare marketing rules? a. Antonio should include a statement that due to the venue limitations accommodations for persons with special needs will not be available. b. Antonio should include on the invitation that food will be served and alcoholic beverages will be available free of charge. c. Antonio should indicate that in order to attend the meeting, an e-mail address must be provided on the RSVP card. d. Antonio should include on the invitation a statement that a salesperson will be present with information and applications.
d
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? a. Agent Armstrong needs to be licensed and appointed only in his state of residence. b. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. c. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. d. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located.
c
Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do? a. Solicit and complete the enrollment application in September and wait until the open enrollment date to submit it so that the client does not purchase a plan through another agent. b. Tell the client that she cannot speak to her until after open enrollment begins on January 1st of the following year. c. Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. d. Tell the client that she should also consider non-health products (such as cash value life insurance) to meet some of her health needs and offer to submit a life insurance application to see if client Jones is insurable.
d
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st. Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's service area. What impact will this have on Agent Higgins compensation? a. AB MA plan must recoup a pro rata amount of Agent Higgins' compensation and pay him only for the month of January. b. AB MA plan must recoup a pro rata amount of Agent Higgins' compensation if Mrs. O'Malley subsequently enrolls in Original Medicare and Part D c. Agent Higgins entire compensation must be recouped because Mrs. O'Malley has disenrolled within 3 months of enrollment. d. AB MA plan does not have to recoup Agent Higgins' compensation because she has moved away from its service area.
a
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? a. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. b. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. c. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. d. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred after the Annual Open Enrollment Period.
d
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. What should you tell her? a. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. b. Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. c. While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. d. Marketing representatives may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out process must be provided.
d
Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational? a. No. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. b. No. Attendees expect some "puffery" at any event on a product in which they may be potentially interested. c. Yes. Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. d. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible.
b
Ajax Agency is targeting potential enrollees for MSA plans. Which of the following statements best describes the rules that apply to the MSA materials it distributes? a. The materials must make clear that beneficiaries are automatically enrolled in a prescription drug plan as part of the MSA. b. The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan. c. The materials must make clear that those who enroll must make monthly deposits into the custodial savings account associated with plan. d. The materials must make clear that money in the MSA custodial account can be used for all medical expenses and both Medicare-covered and non-covered expenses count toward the beneficiary's deductible.
b
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to: a. All of these people. b. Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply). c. Denise and Edward (the independent agents), but not Alice (the employee) or Betty or Carl (the captive agents). d. All of these people except Alice, the employee.
c
Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement? a. Your coworker is correct. You may use any marketing techniques that do not involve providing misinformation to potential enrollees. b. Your coworker is correct because employed agents have to follow a stricter set of rules than do independent agents, such as yourself. c. Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. d. Your coworker is correct. You are subject only to requirements issued by your state department of insurance.
c
Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual? a. Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such individuals for each violation. b. Her name will be reported to a publicly accessible database and could be advertised in local newspapers. c. The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. d. Plans must immediately terminate their contracts with such individuals.
d
BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response? a. Under Federal privacy statutes, BestCare is not obligated to provide information about marketing representatives to the state and should refuse to do so. b. Immediately meet with the marketing representatives and suggest they obtain licensing in another jurisdiction. c. Immediately terminate all the agents involved as a precaution against potential legal liability. d. Cooperate with the state and supply requested information.
a
By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information? a. You may present comparative information that has been created and approved by the Medicare agency (CMS), such as a print-out from the Medicare plan comparison website. b. To obtain information about another plan's benefits, you must refer clients to those other plans, because you may not provide comparative information, regardless of the source, to demonstrate any differences among the plans. c. You have clear evidence that your plan is the best and can say so to your clients. d. You may create a chart that lists each plan in the beneficiary's service area along with the benefits of the plan you represent, compared to those of the other available plans.
d
During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the correct statement to say to her? Choose one answer. a. This Medicare Advantage plan is a 5-star rated plan due to its high rating in customer service. b. The Medicare Advantage plan received the best star rating in customer service and care coordination. c. The Medicare Advantage plan is a top rated plan. d. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4-stars.
c
During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. What should you tell her? a. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. b. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare c. Tell her that the Medicare agency does not endorse or recommend any plan. d. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan.
b
If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities? a. You may ask passers-by to provide you with their names, addresses and phone numbers so that you could contact them later with information about the plan(s) you represent. b. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. c. You may set up personal sales appointments with any beneficiary who expresses interest. d. You may have a stack of enrollment forms on the table in your booth, but may only pass them out to individuals who request one.
d
Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways? a. CMS requires plan sponsors to publish in local newspapers the names and misdeeds of the marketing representatives who have not complied with the terms of their contracts, so that potential clients can know whom to avoid. b. CMS requires the dismissal of senior plan management. c. CMS cannot penalize the plan sponsor for marketing representative non-compliance. That is the role of the state. d. CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor's contract.
b
Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees a. I, II and III only b. I, II, and IV only c. I and II only d. I, II, III, and IV
b
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency? a. He can do this because the gift is not a cash gift and is not readily converted to cash. b. He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15. c. He can do this because the ads for the event are distributed both to enrollees and non-enrollees, so no restrictions apply d. He cannot do this because the total value of the gift exceeds the maximum $15 retail gift value.
b
Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted with regard to the marketing of Medicare health plans, he doesn't have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under? a. Organizations sponsoring Medicare health plans are not responsible for enforcing compliance with applicable law and guidance. This job belongs solely to the Medicare agency. b. Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted representatives and will be conducting monitoring activities to ensure compliance with all applicable Federal law and guidance and plan policies. Furthermore, state agent licensure laws are not preempted and he must abide by their requirements. c. The Medicare agency conducts only complaint-based oversight and he can market the products he represents as he sees fit, as long as he does so in a manner that would be considered ethical by a reasonable lay person. d. The state sets most requirements for marketing Medicare health plans, but each plan has different policies that he must adhere to.
a
Mr. Murphy is an agent. A neighbor invited him to discuss the Medicare Advantage (MA) and Part D plans he sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Mr. Murphy tell his neighbor about the kinds of food that can be provided to potential enrollees who attend the sales presentation? a. The neighbors may not provide a meal, but light snacks would be permitted. b. Any type of meal or food is allowed, as long as it is available to the general public and not just to those who are eligible to enroll in the plans. c. Any meal is allowed, as long as it is valued at less than $15. d. The neighbors may not provide anything to either eat or drink during the sales presentation.
b
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services' Marketing Guidelines to ensure he is compliant for which type of products? a. Medigap plans b. Medicare Advantage (MA) and Prescription Drug (PDP) plans c. Section 1332 waiver plans. d. Long-Term Care policies for Medicare beneficiaries
a
Mr. Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to explain it to Mr. Valesquez? a. It is not Original Medicare and it works differently than a Medicare supplement plan. b. It is like a Medicare supplement or Medigap plan. c. It is a type of Medicare Advantage plan that allows you to go to any doctor anywhere. d. It is the same as Original Medicare, but offered by a private company.
a
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do? a. You may provide her with the required enrollment materials and take her completed enrollment application. b. You may leave enrollment kits for several MA plans and offer to discuss a Medigap and Part D prescription drug plan she might like. c. You may leave an enrollment kit and discuss a new life insurance product she might like. d. You may take her completed enrollment application and ask her to provide names of any of her friends who may be interested in enrolling.
c
Next week you will be participating in your first "educational event" for prospective enrollees. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? a. You should plan to conduct sales presentations, but must not accept enrollment forms. b. You should plan to answer questions and accept enrollment forms. c. You should plan to ensure that the educational event is a social event, and must not conduct a sales presentation or distribute or accept enrollment forms at the event. d. You should plan to conduct sales presentations and accept enrollment forms
a
One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? a. This could be considered discriminatory activity and a prohibited practice. b. This is not a discriminatory activity since this is merely a widely recommended sales practice. c. This is not a discriminatory activity since it is based on the incomes of likely prospects and not based on race or gender. d. This could be considered discriminatory activity, but it is not a prohibited practice.
c
Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling Medicare Advantage or Part D products, how might you solicit referrals? a. You may call current MA and Part D enrollees to solicit referrals and offer thank you gifts of less than $15 for each referral received. b. You may send an e-mail to all current plan members who have given permission to email them asking for the names, e-mail addresses, and phone numbers of referrals. c. You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price for the item, although you may not inform enrollees of the availability of the gift in your letter soliciting referrals. d. You may enter referring individuals in a drawing for substantial prizes as long as they are not told in advance of the drawing the value of the prize.
d
Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing Medicare Advantage and Part D plans apply to this practice? a. Third parties may make initial calls to a potential client, but they must then pass the name and phone number on to you and it will be your responsibility to set up the sales appointment and obtain a completed scope of appointment form. b. Third parties may only make initial contact with a beneficiary if they first obtain certification from the Medicare agency as an approved marketing entity and are licensed under applicable state law. c. This is an acceptable practice, as long as the third party clearly states, during a call that it is calling on behalf of a Medicare Advantage or Part D plan, or the plan's marketing representative. d. Third parties may not make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of Medicare Advantage or Part D plans.
b
Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? a. You may provide any gift to induce enrollment, as long as its retail value does not exceed $15 in value. b. You may not provide any gift or prize as an inducement to enroll. c. You may provide cash promotions or giveaways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public. d. You may give enrollees post-enrollment gifts to compensate them for their time.
d
Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it after their enrollment is complete. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? a. You may provide cash promotions or give-aways as long they are offered to everyone, whether they are a Medicare beneficiary or the general public b. You may give enrollees post-enrollment gifts to compensate them for their time. c. You may provide any gift to induce enrollment, as long as its retail value does not exceed $15 in value. d. You may not provide any gift or prize as an inducement to enroll.
c
Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? a. Market non-Medicare health-related products, such as financial planning, to current members as permitted by HIPAA Privacy Rules. b. Market non-health related products, such as life insurance, to current members without the need to consider HIPAA Privacy Rules. c. Market non-Medicare health-related products, such as dental insurance, to current members as permitted by HIPAA Privacy Rules. d. Market contact information lists of current member to third-party vendors of ancillary health products as permitted by HIPAA Privacy Rules.
a
Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them a. He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15 b. Gifts and prizes are not permitted under the Marketing Guidelines promulgated by the Medicare agency c. Only a single prize or give away can be made at any one event, regardless of its value d. He is correct. He can offer multiple prizes or give-aways at a single event, as long as no one item has a retail value that exceeds $15
c
This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do? a. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. b. You may only contact the retirees after the employer has notified them that they will be receiving a call. c. You may go ahead and call them. d. You may call them, but must record every call.
d
Which of the following is a correct statement about state laws as they pertain to marketing representatives? a. State licensure laws are pre-empted and do not apply to marketing representatives marketing MA and Part D plans b. Plan sponsors can use any marketing representative, as long as they are licensed in at least one state. c. Plans must contract only with marketing representatives who reside in the state where they intend to work. d. Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative.
b
Which of the following statements best describes how business reply cards (BRCs) may be employed in the marketing of Medicare Advantage products? a. A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval. b. A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call. c. Since they are a common marketing technique, plan sponsors simply need to have them approved by their internal compliance departments. d. Since they are a common marketing technique, agents can simply send them to lists of prospects.
c
While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointment? a. You cannot present any line of business other than MA or Part D during such a presentation, regardless of whether or not it is health care related. b. You can present only end of life and life insurance lines of business. c. You can present only health care related lines of business, but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission. d. You can present any line of business you represent as long as you obtain the beneficiary's permission first.
b
Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like to learn more." Which of the following best describes the obligation(s) of Winthrop Brokerage regarding the advertisement? a. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval and may also include in the advertisement information about the plans' benefit structures and star rankings. b. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefit structures, cost sharing, or information about measures or ranking standards. c. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered general audience marketing. d. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it meets the definition of marketing material.
b
You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind? a. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up sheet. b. You may request RSVPs, but you are not permitted to require contact information. c. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are coming. d. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation.
d
You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss Medicare Advantage plans. During the meeting, she asks to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place? a. You must refer Mrs. Hall to another agent in order for her to be able to engage in such a discussion. b. Since Mrs. Hall is leaving the state, you can immediately present her with information on the prescription drug plan, so she can make a decision before it is too late. c. You must make a telephone call from a location outside Mrs. Hall's home to ensure that the discussion of the prescription drug plan can take place. d. Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan.
b
You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do? a. Determine whether the beneficiaries present are healthy enough for the plan. b. Clearly state that no obligation exists to enroll if a gift or prize is being offered. c. Make sure that those present provide leads. d. Explain, in your own words, how the plan you represent compares to other companies' plans.
b
You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation? a. Your name will be registered with the Medicare agency by the plans you are seeking to represent and you will be unable to contract with any Medicare Advantage or Part D plan. b. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. c. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. d. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting.
a
You are working with a number of plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. b. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. c. You must only ensure that the advertisement is factually accurate. d. Plans may not participate in advertising such an event. All advertising must be done by the community organizations.
a
You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns? a. Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. b. Tell her that if a plan obtains permission from CMS for a marketing event in a provider facility, the event may go forward, regardless of where it occurs in the facility. c. Tell her that Medicare guidelines only allow you to conduct marketing activities in areas of the facility where individuals are waiting to receive health care services, but not in places where they would be receiving health care such as an examining room. d. Tell her that Medicare guidelines allow you to conduct marketing activities anywhere in the facility, so long as the affected providers agree to that event.
a
You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? a. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. b. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. c. As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation. d. There is no limitation on meals. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit.
b
You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? a. Seven days prior to the appointment, you must notify the company(s) you represent regarding which products you will be presenting, so they can report the nature of your meeting to the Medicare agency. b. Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present. c. Prior to arriving at her home, request approval from CMS to use special materials that you developed to explain the plan benefits instead of the plan's materials, which you think are confusing. d. At the time you arrive for the appointment, let her know which products you will be going over.
c
You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them? a. So long as the hospital or its physician staff don't object, marketing anywhere in the hospital is an acceptable practice. b. As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place.
a
You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? a. You will have to avoid calling any potential client, unless he or she initiates contact with you and specifically asks that you give him or her a call. b. Because the Medicare health plans are important federal programs for beneficiaries, federal law regarding the "Do Not Call" registry is waived so you will be able to call and enroll beneficiaries over the telephone. c. As long as you market only health-related products, you can make an initial call to any beneficiary, but then must honor "do not call again" requests. d. You only need to comply with requirements of federal and state "Do Not Call" registries.
a
You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion? a. You should tell your colleague no because participation in an educational event may not include a sales presentation. b. As long as your sales presentation includes information that is about healthy living or clinically effective screening exams, you could talk about the Medicare plans in your presentation. c. Whether or not a sales presentation is allowed at this educational event is entirely up to the sponsor of the event. d. You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational event.
b
You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? Choose one answer. a. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. b. Gift cards or gift certificates of $15 or less that can be readily converted to cash. c. Gifts of nominal retail value ($15 or less) d. Two or more gifts whose combined value does not exceed $15.
c
You work for a company that has marketed Medigap products for many years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes? a. Only scripts and marketing practices must be approved by CMS, so you do not need to do anything further with your marketing materials, as long as you make them available to anyone who attends the marketing event b. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. c. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. d. You need to include a statement that the plans you are marketing are approved by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.
c
You would like to market an MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans? a. You may not market in a pharmacy if you are not a pharmacist or do not have the pharmacist's permission. b. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. c. You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. d. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions.