1. An agent has an agreement with a provider's office that states for every member the agent enrolls in a
Medicare plan and chooses the provider as the
... [Show More] primary PCP, the agent will receive 20 dollars. Is this acceptable?
Yes, as long as the agent has documented the agreement with the state DOI and the member is told up front that the agent has an agreement with the provider, the agent may accept compensation when members choose the provider as their primary PCP
No, this situation constitutes a conflict of interest (COI) because the agent will have a personal financial interest when members choose the PCP.
No
What is the definition of a critical Section A violation?
-Accidentally entering the members Medicare ID number incorrectly on an application
-Typically a willful action reported to Humana by the Medicare beneficiary
-Violations committed by personnel in the Section A department
-A presentation done over the telephone with a competent Medicare beneficiary
Typically a willful action reported to Humana by the Medicare beneficiary
3. Penalties and sanctions for HIPAA privacy violations potentially include:
-Up to 50% reduction of all commissions
-A handwritten letter of apology to the member
-A transfer to another department
-Fines and possible imprisonment
Fines and possible imprisonment
4. Agent Deane works alongside several other agents while she conducts calls. Her headset can make her ear sore by the afternoon, so she likes to put clients on speaker phone. Is this acceptable?
-Yes. Agent Deane can put her customers on speaker phone so long as her colleagues are also licensed
agents and will not be disturbed by her doing so.
-No. Agent Deane should avoid putting her customers on speaker phone in an open environment as
personal health and financial protected information might be shared and overheard by others.
No.
5. During a presentation, a beneficiary clearly does not understand the plan concept. The Humana sales Agent should:
-Stop the presentation and ask if a spouse/family member/ caregiver is available. You may be able to question if the beneficiary is competent and determine if they can make their own healthcare decisions.
-Call back 2-4 hours later
-Continue the presentation.
-Complete the enrollment and explain that they can review all pertinent plan information when it arrives in
the mail in 7-10 business days.
Stop the presentation and ask if a spouse/family member/ caregiver is available. You may be able to question if the beneficiary is competent and determine if they can make their own healthcare decisions.
Taking reasonable efforts to limit access of protected information to only those individuals who have a need to know the information to perform a job duty' best describes the concept of:
-Average Diligence
-Maximum Protection
-Reasonable Disclosures
-Minimum Necessary
Minimum Necessary
Corrective action for committing a violation may include which of the following:
-Placement in another job role and reporting to a different manager
-A written apology to the beneficiary
-A reduction of pay
-Additional Training
Additional Training
Agent Richrath is meeting a fellow agent for lunch in a very nice part of town. Her messenger bag containing her laptop she uses for work is in the backseat. What should she do to safeguard her work
computer, which may contain customer's personal information?
-She has placed the items in a bag already, so it is already concealed. -She needs to do nothing more
-Since it is a nice part of town, all she needs to do is lock the car doors
-She should place the bag and all protected information in the trunk of her car or conceal the bag if she does not have a trunk
-The bag contains protected information, so she must take the bag with her into the restaurant
She should place the bag and all protected information in the trunk of her car or conceal the bag if she does not have a trunk
Agent Jackson received the names and phone numbers of several people who are members of a bowling league for seniors. She is pretty sure they would appreciate learning about all of Humana's great Medicare plans, so she decides to text them and ask that, if interested, they call her to learn more. Is this acceptable?
-No, use of telephonic solicitation, including text messages and leaving electronic voicemail messages is
prohibited.
-Yes, since she is not cold calling the people on the list and her texts are passive outreach requiring the
erson to call her back, then her actions are permissible.
No
An agent is wrapping up an enrollment and asks the member to refer their friends and family who might also benefit from a Humana plan. The member has several referrals and proceeds to provide their
contact information. How should the agent respond?
-Agents are not allowed to request referrals and the agent cannot have any form of contact with any
person referred to them by a member.
-Thank the member, but rather than call the referrals directly, the agent should send them a text message
instead
-Thank the member for the referrals, but advise the member that their referrals must make contact with the agent first. The agent should provide his or her contact information to the member to pass along.
-Thank the member for the referrals and eagerly start making calls to the referrals.
Thank the member for the referrals, but advise the member that their referrals must make contact with the agent first. The agent should provide his or her contact information to the member to pass along. [Show Less]