2025 UHC Ethics and Compliance AssessmentBy Brian Platte / July 18, 2024 Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? July 1 through December 30 June 1 through July 31 April 1 through October 31 March 1 through July 31 Which of the following statements is true about using a 5-Star Special Enrollment Period (SEP)? It can be used once anytime during the calendar year to enroll in or disenroll from a 5-Star plan and the election will take effect the first of the month following receipt of the election request. It can be used once, from December 8 of the current year through November 30 of the next year, to enroll in a 5-star rated plan; coverage will start the first of the month following receipt of the enrollment application. It can be used once per quarter during the first nine months of the year and coverage will start the first of the month following receipt of the enrollment application. Which statement regarding Star Ratings is true? Star Ratings are based on a plan's performance from the prior year and, therefore, may not accurately reflect a plan's current value. Medicare uses a 5-star rating system to illustrate the plan’s relative popularity in a market as measured by membership and retention rates. Medicare uses a 5-star rating system to illustrate a plan's performance and quality. The agent said that the Star Ratings are based on a plan's performance from two years ago and, therefore, do not accurately reflect a plan's current value. Which of the following describes Permission to Contact (PTC) guidelines? The agent must obtain PTC no later than the start of a marketing appointment and can only discuss the products agreed upon by the consumer. PTC expires December 31 of each year regardless of when it was obtained. Contact is limited to the methods (e.g., phone, email) and products (e.g., Medicare Advantage, Part D plans) indicated by the consumer at the time PTC is obtained. As an agent, you have an obligation to only enroll a consumer in a product: 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. That includes both medical and prescription drug coverage. That is suitable for the consumer's needs, goals and financial resources. Whose email address may the agent enter into the applicant information section of the JarvisEnroll enrollment application? Only the consumer's email (or leave it blank). Either the email of the consumer or the agent, but only if the consumer authorizes it. A made-up email, such as noemail@noemail.com, instead of leaving it blank. 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 Authorized Representative Disclaimer Permission to Contact Disclosure of Benefits When must the Scope of Appointment be obtained from the consumer for an in-person or telephonic sales presentation (unless an exception applies)? When the marketing appointment has concluded No less than 48 hours before the marketing appointment Before the start of a marketing appointment Anytime during the marketing appointment Which statement is accurate when a consumer has a Power of Attorney (POA)? The POA may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application. The POA may attend a personal/individual marketing appointment with the consumer but has no authority to sign the Enrollment Application. If the POA signs the Enrollment Application, they must be able to provide documentation upon request by the Plan that indicates authority under applicable state law to enroll the consumer. Which of the following options will enable a consumer to obtain prescription drug coverage? (Select 2) Enroll in any MA plan and a stand-alone PDP Enroll in a PFFS MA-Only plan and a stand-alone PDP Enroll in any MA-PD plan While I take note of what might be important to the consumer, I do not want to rely on one benefit and become biased as to what type of plan to recommend. I make sure whatever plan I recommend has that stated benefit because I know it will be the best fit plan for the consumer. Consumers may have misunderstood or been confused by something they heard or read in an ad. I remember that a thorough needs assessment is required for each enrollment. 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. Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Advantage Prescription Drug (MA-PD) plan. Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Supplement Plan. Rosanna could disenroll from her MA-Only PFFS plan and enroll in an MA-Only HMO plan and a stand-alone PDP. A thorough needs assessment will include which of the following components? (Select 3) Learning about their level of education and former career field. Identifying what healthcare coverage attributes are most important to the consumer and what tradeoffs they might be willing to make. Identifying the consumer’s current providers (including primary care, specialists, hospitals, and pharmacies) and the medications they take. Learning about their current coverage, lifestyle and financial characteristics. When should you proceed with an enrollment? (Select 3) Anytime I can get the consumer to consent to enroll. If I am certain the consumer understands what they are gaining and what they may be giving up by enrolling in the new plan. If I am certain the consumer understands and agrees they are enrolling into a plan. When the person who assists the consumer make healthcare coverage decisions is present, when applicable. Which of the following must you ensure a consumer who is making a plan change understands? (Select 2) I must make sure the consumer understands the benefits, costs, and limitations of the new plan. I must make sure the consumer understands that nothing will change when they enroll in the new plan. I must make sure the consumer understands what they are giving up by enrolling in the new plan I'm recommending. I must make sure the consumer understands I am only upgrading their plan. Select three elements you must compare when a consumer is considering changing plans. (Select 3) The medications the consumer uses and how coverage and costs might be different by enrolling in the new plan. The claim processing turn-around-time for each plan. The providers that the consumer sees and how access to those providers might be different by enrolling in the new plan. The consumer's current coverage and costs with the coverage and costs of the new plan that I want to recommend. ResultsVote
