UHC Ethics & Compliance 2022
While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do?
Leave the field requesting applicant email address blank.
In which situation MAY the Medicare Advantage (MA) organization disenroll a member from an MA plan? (if question says *must* it is not the same answer)
Premiums are not paid on a timely basis.
Rosanna is enrolled in a Medicare Advantage Only (MA-Only) Private Fee-for-Service (PFFS) Plan. The plan is suitable for her needs and service area. She has decided she wants to add prescription drug coverage. Which option is available to Rosanna (assuming she is in a valid election period)?
Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP.
A one-on-one marketing appointment, whether in-person or telephonic, is always considered a marketing/sales event, but it is not reported to UnitedHealthcare or CMS; instead the consumer must provide_____ agreement prior to the start of the appointment.
Scope of Appointment
By agreeing to the Statement of Understanding, the consumer:
Acknowledges that they clearly understand they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling.
Which election period runs from October 15 to December 7 and allows consumers to join a Medicare Advantage Plan or switch to a different plan?
Annual Election Period (AEP)
Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries?
Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP.
Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)?
Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP.
To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3)
Factual Accurate Complete
What is the purpose of the Statement of Understanding?
It ensures that when consumers complete 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.
Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider?
Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present.
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:
Josh should tell Janine that she can only change her current plan to a 5-star plan during the Annual Election Period.
Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures?
Mailing a marketing brochure to the consumer via postal mail.
Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct?
Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide.
Gene got Medicare before he turned 65 and enrolled into a Medicare Advantage plan. He calls in February the month before his 65th birthday and is unhappy with his current plan. On the date of the call, what can Gene do about his coverage?
On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1.
Whose email address may the agent enter into the applicant information section of LEAN enrollment application?
Only the consumer's email (or leave it blank).
Which statement is true about discussing benefits with the consumer before an enrollment?
The agent must accurately and completely disclose any benefits discussed.
Which statement about discussing benefits with the consumer before an enrollment is true?
The agent must explain any provider and/or pharmacy network limitations.
An agent is explaining Medicare Advantage plan options to a consumer. During the conversation, the agent explains that Medicare gives each plan a Star Rating. Which statement is true?
The agent said that Medicare uses a 5-star rating system to illustrate the plan's performance and quality.
As an agent, you have an obligation to enroll a consumer in a product: OR An agent should only enroll a consumer in a product:
That is suitable for the consumer's needs, goals and financial resources.
Before starting an enrollment, what benefit information are agents required to provide to the consumer?
The agent must accurately and completely disclose any benefits discussed
The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures.
Statement of Understanding
Why must an agent present accurate, complete, and factuals plan information to consumers? (select 3
To help avoid misunderstandings To help the consumer focus on plan-specific information, such as benefits and costs To help avoid confusing the consumer
What is Scope of Appointment?
The agreement obtained from the consumer that identifies the scope of products that can be discussed at a personal/individual marketing appointment (in-person or telephonic)
When completing an 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?
The consumer/member would not receive plan related correspondence intended for him/her.
To complete an Enrollment Application on behalf of a consumer, what authority must the individual have?
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).
