uhc ethics and compliance section for certification questions and answers with complete solution rated a
what is a servicing agent
what does cms stand for
who administers the medicare program and
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UHC Ethics And Compliance Section For
Certification
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? - yes
WHat 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
presenter-audience 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
to ensure that events are in UHC's event reporting application no less than 7 calender days
prior to the event... - submit the event request form, according to instructions on the form,
NO LESS THAN 14 CALENDAR DAYS
event request forms submitted within7 calendar days will NOT be what? - processed
conducting an unreported event is _____? - prohibited
to schedule a sign language interpreter for a formal marketing/sales event or a
personal/individual marketing appointment, enter the consumer's request direct;y in
bconnected at least? - 14 days prior to the event or appointment
What are marketing materials used for? - 1) draw attention to a plan sponsor or their
plan(s) and
2) influence a consumer's decision when selecting a plan in which to enroll or a member's
decision to remain enrolled in their current plan
Marketing materials contain information about the plan or plans: - 1) benefits or benefit
structure
2) cost sharing ( including premiums, copayments, and deductibles)
3) Measurements or ranking standards ( such as star ratings. comparisons to other plans,
or statistical studies or surveys)
Approval is required for? - 1) ALL medicare marketing materials or
2) ANY material that mentions a plan sponsor ( such as " united health care") one of its
affliated plans or displays any logos
What does generic mean with marketing materials? - materials that do not meet the
marketing materials criteria and do not carry any plan sponsor information or logos
does generic materials require prior approval? - no
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