What type of events must an agent report to United Healthcare?
-Informal marketing,/sales events only
-Formal and informal marketing/sales events
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-Formal marketing/sa[es events only
-Marketing/sales events (formal and informal) and educational events - correct answer Formal and informal marketing/sales events
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.
-The agent may experience commission payment processing issues.
-The enrollment application may be denied. - correct answer The consumer/member would not receive plan related correspondence intended for him/her.
Which election period runs from October 15 to December 7 and
allows consumers to elect to join a Medicare Advantage Plan or
switch to a different plan?
-Annual Election Period (AEP)
-Special Election Period (SEP)
-Open Enrollment Period (OEP)
-Initial Coverage Election Period (ICEP) - correct answer AEP
Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event?
-Generic business reply cards for Medicare products.
-Medicare Made Clear brochures from the UnitedHealthcare Toolkit.
-5-dollar gift cards to an in-network pharmacy.
-Pens and notepads that contain the agent's contact information. - correct answer 5-dollar gift cards to an in-network pharmacy.
Kira has scheduled an appointment and obtained a Scope of
Appointment (SOA) form to discuss Medicare Advantage Plans with a
consumer. When she arrives at the appointment, a friend of the
consumer who is Medicare-eligible is present to hear your
presentation. What should Kira do?
-Ask the consumer's friend to leave since the friend had not scheduled the appointment.
-Before Kira can start the appointment with both consumers, she must ask the consumer'S friend to complete an SOA.
-Ask the consumer's friend to complete the SOA and schedule a separate appointment.
-Tell the consumer that you will come back another day, - correct answer Before Kira can start the appointment with both consumers, she must ask the consumer'S friend to complete an SOA.
Educational events allow for which of the following to occur?
-Provide objective information about the Medicare program and/or health improvement and wellness.
-Provide an opportunity to give an introductory presentation followed by an informal marketing/sales event.
-Provide an opportunity to steer a consumer toward a specific or limited number of plans.
-Provide an opportunity to review benefits, premiums, and product information with consumers. - correct answer Provide objective information about the Medicare program and/or health improvement and wellness.
Agent Brenda is presenting Medicare Advantage plan options to her
consumer, Melanie. During the presentation, Brenda tells Melanie
that Medicare gives each plan a Star Rating. Which of the following is
not an appropriate response when Melanie asks what the Star Rating
means?
-Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories.
Brenda should tell Melanie that the Star Ratings helps consumers and members compare plans based on quality and performance.
-Brenda should tell Melanie that Medicare indicates a plan's overall performance and quality with 1 to 5 stars; 1
star denotes poor quality and 5 stars represent excellent quality.
-Brenda should tell Melanie that Medicare uses several measures to determine how well plan sponsors perform. Detecting and preventing illness is one example of the measures Medicare uses. - correct answer Brenda should tell Melanie that the Star Rating is the same for every plan and it does not accurately reflect a plan's performance in certain categories.
Which of the following describes Permission to Contact guidelines?
-It allows the agent to discuss the products identified during the marketing appointment.
-It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified),
-It does not have to be provided by the consumer but can be provided by the consumer's spouse or adult child. - correct answer It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified)
Julie, a consumer, is having difficulty understanding the information
her agent, Victor, is presenting at her in-home appointment. She
provides Victor with her cousin's telephone number and email
address and asks him to explain the plan to her cousin, who
frequently assists with her health care decisions. The next day, Victor
emails Julie's cousin. Has Victor been compliant?
-No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the
cousin's permission.
-Yes. Victor has been compliant. Victor has received permission from Julie to contact her cousin directly.
-No. Victor has violated Centers for Medicare and Medicaid Services (CMS) permission to call guidelines.
Contacting the consumer by email without their permission is prohibited. If Victor had telephoned Julie's cousin,
he would be compliant. - correct answer No. Victor violated UnitedHealthcare permission to contact guidelines by emailing Julie's cousin without the
cousin's permission.
John has Power of Attorney to act on behalf of his mother. What does
that mean when it comes to his mother enrolling in a Medicare
Advantage Plan?
-John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother.
-John may sign the Enrollment Application but does not need to provide documentation to support his claim of
authority upon request by the Plan.
-John may attend a personal/individual marketing appointment with his mother but has no authority to sign the
Enrollment Application.
-John may sign the Enrollment Application and must submit documentation that indicates his authority under
state law to enroll his mother with the application. - correct answer John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother.
When can telephonic contact with a Medicare eligible consumer be
made?
-When confirming receipt of mailed information.
-When a member has voluntarily disenrolled from a plan.
-When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired. - correct answer When the consumer consented to be contacted for sales activities, subsequent telephonic contact has not yet occurred, and the permission has not yet expired.
Who has the authority to sign an Enrollment Application?
-The consumer, the consumer's spouse, or the consumer's adult child.
-The consumer only.
-The consumer or the consumer's authorized legal representative (e.g., Power of Attorney).
-The consumer or any individual authorized by the consumer. - correct answer The consumer or the consumer's authorized legal representative (e.g., Power of Attorney).
As an agent, you must not do which of the following when marketing
UnitedHealthcare Medicare Advantage plans to consumers?
-Review out-of-pocket maximum with consumers and explain any exceptions.
-Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval.
-Provide current marketing materials that have been approved by CMS and UnitedHealthcare.
-Review and complete the Enrollment Application with consumers. - correct answer Use providers or provider groups to distribute printed information comparing benefits of different health plans without approval.
An agent should only enroll a consumer in a product:
-That meets the interest he/she has in the transaction, for example commissions received for the sale.
-That is suitable for the consumer's needs, goals and financial resources.
-That provides a financial advantage to a network of providers,
-That meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social
Security Administration. - correct answer That is suitable for the consumer's needs, goals and financial resources.
Which of the following statements is true about the Statement of
Understanding?
-It ensures when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding they are actually enrolling, in which plan they are enrolling, and standard disclosures.
-It is not required if the enrollment mechanism is electronic.
-It is only required if the enrollment mechanism is electronic. - correct answer It ensures when the consumer signs the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding they are actually enrolling, in which plan they are enrolling, and standard disclosures.
Which of the issues below are examples of Fraud, Waste and/or
Abuse? (Select 3)
A. Billing for medical services or procedures that were actually provided or performed.
B. The pharmacy splits the original prescription to receive additional dispensing fees.
Cc. Falsifying signatures or medical records.
D. Using another person's medical insurance information to obtain prescriptions. - correct answer B, C, D
What is the definition of Waste?
-Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include
inappropriate utilization and/or inefficient use of resources.
-Waste is intentionally misrepresenting or concealing facts to obtain something of value.
-Waste includes any practice that results in the provision of services that are not medically necessary. - correct answer Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include
inappropriate utilization and/or inefficient use of resources.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? - correct answer On the day he called, he can enroll in a different Medicare Advantage plan with an effective date of March 1.
Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? - correct answer Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide.
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? - correct answer Mailing a marketing brochure to the consumer via postal mail.
Which statement is true about discussing benefits with the consumer before an enrollment? - correct answer The agent must accurately and completely disclose any benefits discussed.
Which statement about discussing benefits with the consumer before an enrollment is true? - correct answer The agent must explain any provider and/or pharmacy network limitations.
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? - correct answer Leave the field requesting applicant email address blank.
What is the purpose of the Statement of Understanding? - correct answer 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. [Show Less]