UHC: United Healthcare – Ethics and
Compliance Exam V1| Real Questions and
Verified Answers (NEW 2023-2024) |A+
GRADE
QUESTION
When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the
following must an agent do?
Answer:
Provide current marketing materials that have been approved by CMS and UnitedHealthcare.
QUESTION
What is the definition of Waste?
Answer:
NOT* Waste includes any practice that results in the provision of services that are not
medically necessary.
QUESTION
Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3)
Answer:
- Falsifying signatures or medical records.
- The pharmacy splits the original prescription to receive additional dispensing fees.
- Using another person’s medical insurance information to obtain prescriptions.
QUESTION
Which of the following materials is an agent NOT permitted to display and/or distribute at a
marketing/sales event?
Answer:
5-dollar gift cards to an in-network pharmacy.
QUESTION
Rina, a consumer, has requested an appointment with Connor, an agent, to discuss DSNPs. Prior
to the appointment Rina completed a Scope of Appointment (SOA) form. On the day of the
appointment, Rina brings her friend Shelley, who is Medicare-eligible, to the meeting. Shelley
also wants to talk about DSNPs. What should Connor do when he sees both Rina and Shelley at
the appointment?
Answer:
Ask Shelley to complete an SOA before the start of the meeting.
QUESTION
Educational events allow for which of the following to occur?
Answer:
Provide objective information about the Medicare program and/or health improvement and
wellness.
QUESTION
Agent Bryan wants to grow his book of business. Which of the following lead generating
activities is NOT compliant?
Answer:
At each appointment he asks the consumer for the name and phone number of at least one
acquaintance who is 65 or older and calls the referred individual.
QUESTION
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?
Answer:
UHC: United Healthcare – Ethics and
Compliance Exam V2| Real Questions and
Verified Answers (NEW 2023-2024) |A+
GRADE
QUESTION
Select the option that describes the coverage combinations a member can be enrolled in at the
same time.
MA-Only PFFS plan and a stand-alone PDP
MA-Only non-PFFS plan and a stand-alone PDP
Medicare Supplement plan and MA-PD plan
Answer:
Medicare Supplement plan and MA-PD plan – WRONG
QUESTION
In which situation will a member be involuntarily disenrolled from their MA plan?
The member lost entitlement to either Medicare Part A or Part B.
The member did not pay plan premiums on a timely basis.
The member engaged in disruptive behavior.
Premiums are not paid on a timely basis.
Answer:
The member lost entitlement to either Medicare Part A or Part B.
QUESTION
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 disenroll from her MA-Only PFFS plan and enroll in an MA-Only HMO plan and
a stand-alone PDP.
Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Supplement
Plan.
Answer:
Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Advantage
Prescription Drug (MA-PD) plan. – WRONG
Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP –
CORRECT
QUESTION
In what product should agents enroll consumers?
A product that meets the sales goal of the Centers for Medicare and Medicaid Services,
UnitedHealthcare and the Social Security Administration.
A product that provides a financial advantage to a network of providers.
A product that meets the interest the agent has in the transaction, for example commissions
received for the sale.
A product that is suitable for the consumer’s needs, goals and financial resources.
Answer:
A product that is suitable for the consumer’s needs, goals and financial resources.
QUESTION
Why must an agent present accurate, complete, and factual plan information to consumers?
(Select 3)
To help avoid confusing the consumer
To help the consumer focus on plan-specific information, such as benefits and costs
To help the consumer gain confidence in the agent’s expertise
To help avoid misunderstandings
Answer:
To help avoid confusing the consumer
To help the consumer focus on plan-specific information, such as benefits and costs
To help avoid misunderstandings
QUESTION
Which statement about discussing benefits with the consumer before an enrollment is true?
The agent does not need to cover any benefits, provided the Summary of Benefits is emailed to
the consumer.
The agent does not need to disclose the monthly premium.
The agent only needs to review benefits in which the consumer is interested.
The agent must explain any provider and/or pharmacy network limitations.
Answer:
The agent only needs to review benefits in which the consumer is interested. – WRONG
QUESTION
Whose email address may the agent enter into the applicant information section of the LEAN
enrollment application?
Answer:
Only the Consumer’s email
QUESTION
When must the Scope of Appointment be obtained from the consumer for an in-person or
telephonic sales presentation (unless an exception applies)?
No less than 48 hours before the marketing appointment
Anytime during the marketing appointment
When the marketing appointment has concluded
Before the start of a marketing appointment
Answer:
No less than 48 hours before the marketing appointment
QUESTION
What happens on the plan effective date when a member enrolled in a Medicare Supplement
Insurance Plan and stand-alone PDP enrolls in a Medicare Advantage plan that includes drug
coverage?
Automatic disenrollment from the Medicare Supplement Insurance Plan and the stand-alone
PDP.
UHC: United Healthcare – Ethics and
Compliance Exam V3| Real Questions and
Verified Answers (NEW 2023-2024) |A+
GRADE
QUESTION
What type of events must an agent report to UnitedHealthcare?
-Informal marketing,/sales events only
-Formal and informal marketing/sales events
-Formal marketing/sa[es events only
-Marketing/sales events (formal and informal) and educational events
Answer:
Formal and informal marketing/sales events
QUESTION
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.
Answer:
The consumer/member would not receive plan related correspondence intended for him/her.
QUESTION
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)
Answer:
AEP
QUESTION
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.
Answer:
5-dollar gift cards to an in-network pharmacy.
QUESTION
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,
Answer:
Before Kira can start the appointment with both consumers, she must ask the consumer’S friend
to complete an SOA.
QUESTION
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.
Answer:
Provide objective information about the Medicare program and/or health improvement and
wellness.
QUESTION
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.
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.
QUESTION
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.
Answer: