UNITED HEALTHCARE (UHC) – ETHICS
AND COMPLIANCE LATEST 2023-2024
EXAM| ACTUAL QUESTIONS AND
VERIFIED ANSWERS |A+ GRADE
Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized
legal representative for her father. What must Jacob explain to Emily when completing an
Enrollment Application for her father?
Answer:
Jacob must explain that Emily will sign the Enrollment Application and must be able to provide
documentation upon request by the Plan that indicates her legal authority to enroll her father.
Q: Which of the following must you not do when marketing UnitedHealthcare Medicare
Advantage or Prescription Drug Plans to consumers?
Answer:
Provide only those items from the plan’s Enrollment Guide that are most relevant to the
consumer’s situation.
Q: An agent should only enroll a consumer in a product:
Answer:
That is suitable for the consumer’s needs, goals and financial resources.
Q: What is the purpose of the Statement of Understanding?
Answer:
It ensures that when consumers sign 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.
Q: What is the definition of Abuse?
Answer:
Abuse includes any practice that results in the provision of services that are not medically
necessary.
Q: Which of the following are the ways to report potential FWA? (Select 2)
Answer:
-Fraud, Waste and/or Abuse hotline
-Producer Help Desk (PHD)
Q: In terms of events, which of the following is true?
Answer:
Agents must only report formal and informal marketing/sales events to UnitedHealthcare.
Q: Whose email address may the agent enter into the LEAN enrollment application?
Answer:
Only the consumer’s (or leave it blank)
Q: Annual Election Period (AEP) is a time when:
Answer:
Consumers can elect to join a Medicare Advantage Plan or switch to a different plan.
UNITED HEALTHCARE (UHC) – ETHICS
AND COMPLIANCE LATEST 2023-2024
EXAM| ACTUAL QUESTIONS AND
VERIFIED ANSWERS Version 2 |A+
GRADE
Q: 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?
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.
Q: In which of the following situations can telephonic contact be made with a Medicare eligible
consumer?
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.
Q: To sign an enrollment application on behalf of a consumer, what authority must the
individual have?
Answer:
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).
Q: Which of the following must you not do when marketing UnitedHealthcare Medicare
Advantage or Prescription Drug Plans to consumers?
Answer:
Q: In what product should agents enroll consumers?
Answer:
A product that is suitable for the consumer’s needs, goals and financial resources.
Q: What is the purpose of the Statement of Understanding?
Answer:
It ensures that when consumers sign 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.
Q: What is the definition of Abuse?
Answer:
Abuse includes any practice that results in the provision of services that are not medically
necessary.
Q: Which of the following are the ways to report potential FWA? (Select 2)
Answer:
Fraud, Waste and/or Abuse hotline
&
Producer Help Desk (PHD)
Q: Agent John is planning to conduct a series of events. Some will be strictly educational,
others will be formal presentations of specific UnitedHealthcare plans, and others will be
informal marketing events where he can generate leads and schedule future in-home marketing
appointments. Of the three types of events John plans to conduct, which need to be reported to
UnitedHealthcare?
Answer:
Only the marketing/sales events, both formal and informal.
Q: Annual Election Period (AEP) is a time when:
Answer:
Consumers can elect to join a Medicare Advantage Plan or switch to a different plan.
Q: Dino, an agent, received a phone call on September 29 from a consumer interested in
Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer’s
Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he
could not accept an enrollment application until October 15. What did Dino do that was NOT
compliant?
Answer:
Dino presented a plan prior to October 1.
Q: Providing objective information about the Medicare program and/or health improvement
and wellness at public venues is the purpose of which of the following?
Answer:
Educational events
Q: Agent Ralph wants to market Medicare Advantage Plans in his neighborhood – an area that
consists of single-family houses, an assisted living facility, a church, and public library. Which
of the following methods of contact is permitted?
UNITED HEALTHCARE (UHC) – ETHICS
AND COMPLIANCE LATEST 2023-2024
EXAM| ACTUAL QUESTIONS AND
VERIFIED ANSWERS Version 3 |A+
GRADE
Q: 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)?
Answer:
Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll
in a stand-alone PDP.
Q: 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:
Answer:
That is suitable for the consumer’s needs, goals and financial resources.
Q: 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?
Answer:
The agent said that Medicare uses a 5-star rating system to illustrate the plan’s performance and
quality.
Q: Before starting an enrollment, what benefit information are agents required to provide to the
consumer?
Answer:
The agent must accurately and completely disclose any benefits discussed
Q: Whose email address may the agent enter into the applicant information section of LEAN
enrollment application?
Answer:
Only the consumer’s email (or leave it blank).
Q: 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.
Answer:
Statement of Understanding
Q: 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?
Answer:
Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will
disenroll him from his PDP.
Q: To avoid confusing or misleading a consumer, what type of information must the agent
provide when presenting a plan? (Select 3)
Answer:
Factual
Accurate
Complete
Q: 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:
Answer:
Josh should tell Janine that she can only change her current plan to a 5-star plan during the
Annual Election Period.
Q: Why must an agent present accurate, complete, and factuals plan information to consumers?
(select 3
Answer:
To help avoid misunderstandings
To help the consumer focus on plan-specific information, such as benefits and costs
To help avoid confusing the consumer
Q: 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?
Answer:
Annual Election Period (AEP)
Q: 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.
Answer:
UHC Certifications 2023/2024 Exam| Actual
Questions and Verified Answers| Graded A
Q: What are two options for Medicare consumers to get Part D prescription drug coverage
(assuming they meet all eligibility requirements)? (Select 2)
Answer:
Enroll in a stand-alone Medicare Prescription Drug Plan (PDP)
Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription
drug coverage
Q: Which of the following statements does NOT correctly define prescription drug stages?
Answer:
A deductible is the amount the member must pay for every prescription medication, regardless of
what stage they are in.
Q: Which of these statements is NOT true about the drug utilization management (UM) rules?
Answer:
(INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM
rules
Q: What is the amount added to the member’s monthly plan premium if they did NOT enroll in
a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they
were first eligible for Medicare Parts A and/or B or went without creditable prescription drug
coverage for 63 or more continuous days?
Answer:
Late Enrollment Penalty (LEP)
Q: Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their
part of Medicare Part D costs?
Answer:
Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments
Q: Formulary is defined as:
Answer:
A list of medications covered within the benefit plan, based on CMS guidelines and developed in
collaboration with physicians and pharmacists.
Q: Which of the following is true about Medicare Supplement Insurance underwriting criteria
in states where underwriting applies?
Answer:
Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment
period or does not meet Guaranteed Issue criteria.
Q: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into
effect January 1, 2020, applies to all carriers offering Medicare supplement plans.
Answer:
True
Q: Which of the following is NOT true of Medicare Supplement Insurance Plans?
Answer:
(INCORRECT) Plan benefit amounts automatically update when Medicare changes cost sharing
amounts, such as deductibles, coinsurance and copayments.
Q: Which of the following consumers are eligible for Medicare if other eligibility requirements
are met?
Answer:
Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more
than 24 months and consumers of all ages with ESRD or ALS
Q: Which of the following defines a Medicare Advantage (MA) Plan? (Select 3)
Answer:
An MA Plan is a health plan option approved by Medicare and offered by private insurance
companies.
An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B)
and often includes Medicare prescription drug coverage (Part D).
An MA Plan is part of Medicare and is also called Part C.
Q: Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an
eligibility requirement?
Answer:
Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD)
Q: Which of the following are MA Plans that focus on using network providers to maximize
the benefits and reduce out-of-network expenses?
Answer:
HMO, POS, PPO
UHC Ethics and Compliance Certification
2023/2024 Exam| Questions and Verified
Answers| Graded A
Q: What does generic mean with marketing materials?
Answer:
materials that do not meet the marketing materials criteria and do not carry any plan sponsor
information or logos
Q: does generic materials require prior approval?
Answer:
no
Q: What methods are considered marketing material?
Answer:
newspaper, tv, internet, radio advertisements, direct mail, postcards, flyers, brochures, magnets,
pre-enrollment materials, websites and social media platforms
Q: what are some examples of generic marketing materials?
Answer:
social media sites and websites
Q: sites used to market UHC plans must be _ by UHC and CMS prior to use
Answer:
approved
Q: when talking about marketing materials what should the agent NOT do?
Answer:
add, enhance, delete, modify, edit or create any content in the marketing materials provided by
the health plan
modify approved materials in any way, no matter how minor
ask health related or health screening questions on generic, agent created materials
Q: What must an agent do when talking about marketing materials?
Answer:
use marketing materials only for products they are certified to market/sell
Q: What does PTC stand for?
Answer:
permission to contract
Q: What does SOA stand for?
Answer:
Scope of appointment
Q: What does permission to contact mean?
Answer:
is permission given by the consumer to be called or otherwise contacted by an agent for the
purpse of marketng any UHC medicare solutions product includeing MA, Prescription drug or
med sup plans.
Q: PTC must be______?
Answer:
documented, retained and available upon request for 10 years
Q: PTC must also be?
Answer:
Method specific, short term and event specific
Q: What does method specific mean?
Answer:
contact can only be made by the method permitted by the consumer. Permission to telephone
only enables the agent to dial the number provided.
AN AGENT MUST RECEIVE EXPLICIT PERMISSION TO TEXT OR EMAIL THE
CONSUMER
having access to a phone number or email address does not imply permission from the consumer
Q: What is short term?
Answer:
PTC expires once the agent has made contact with the consumer or 9 months after the date the
PTC was received.
PTC expires 90 days after the receipt for consumers requesting info on med sup’s or who are on
the federal DNC list.
Q: What does event specific mean?
Answer:
the agent can only contact the consumer to discuss the products indicated in he PTC mechanism
Q: what does BRC mean?
Answer:
business reply cards
Q: agents who telephone a consumer in response to a BRC that has specific products
documented on the card, may only __
Answer:
discuss the products that were indicated within the BRC
Q: BRC’s are only intended to obtain permission to contact
Answer:
it does not satisfy the SOA requirement
Q: SOA does not secure permission to contact
Answer:
it confirms permission to discuss product types during an individual appointment
UHC Certification 2023/2024 Exam| Actual
Questions and Verified Answers| A Grade
Q: A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescription drug coverage describes which of the
following:
Answer:
Medicare Parts A and B
Q: Which of the following statements is true about eligibility requirements for Medicare
Prescription Drug Plans?
Answer:
A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B
Q: What are two options for Medicare consumers to get Part D prescription drug coverage
(assuming they meet all eligibility requirements)? (Select 2)
Answer:
Q: Which of the following statements is not true about the Coverage Gap?
Answer:
All members reach the Coverage Gap
Q: Which of the following options are drug utilization management (UM) rules? (Select 3)
Answer:
Q: Which of the following best describes the Late Enrollment Penalty (LEP)?
Answer:
The amount added to the member’s monthly plan premium if they did not enroll in a Medicare
Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first
eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for
63 continuous days or more.
Q: Through which means is financial assistance offered to a consumer who qualifies for Low
Income Subsidy for their part of Medicare Part D costs?
Answer:
Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Q: Medications that are covered in a Plan’s formulary have various levels of associated member
cost-sharing (copayments or coinsurance). What are these drug levels called?
Answer:
Drug tiers
Q: In states where Medicare Supplement Insurance underwriting criteria can apply, all of the
following underwriting criteria apply EXCEPT:
Answer:
Consumers may be underwritten to determine their acceptance and, if applicable, their rate.