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 Ethics and Compliance Certification
Exam| Questions and Verified Answers| A+
Graded (2023/2024 Update)
QUESTION
In leu of a SOA form, agents must announce the products that will be presented at the formal or
informal marketing/sales event
Answer:
agents may obtain an SOA for future face to face or telephonic appointments if the consumer
requests the future appointment at the marketing/sales event
QUESTION
when conducting face to face or telephonic appointments to present MA and or PDP plans, the
agent MUST
Answer:
1) obtain a signed SOA from the consumer prior to the start of the appointment
2) obtain a new SOA when the consumer or agent requests to discuss a health related product not
identified on the original SOA. once obtained, the new product may be discussed
QUESTION
SOAs must be submitted how?
Answer:
via fax or emailed within 2 business days following the scheduled appointment
QUESTION
contracted agents using the generic SOA form must also include
Answer:
the corresponding fax coversheet
QUESTION
medicare marking guidelines prohibit marketing non-healh related products (annuities, life
insurance, LT disability/disability plans) when presenting what to a consumer?
Answer:
MA plan or PDP plas
THIS IS CONSIDERED CROSS-SELLING AND IS PROHIBITED
QUESTION
SCARE TACTICS ARE
Answer:
PROHIBITED
QUESTION
what is an authorized representitive?
Answer:
is a person who is authorized under state law to complete the enrollment application, make health
care decisions on behalf of the consumer and is authorized to receive health care related on
his/her behalf
QUESTION
in order to determine if a POA or authorized representitive is needed when enrolling a consumer,
the agent MUST___?
Answer:
consider the consumers mental and physical ability to enroll themselves
QUESTION
if a consumer appears to have either a physical and or mental challenges that may impede their
ability to enroll themselves in a plan, you must ask if they have a _ or ?
Answer:
POA or authorized representitive
QUESTION
a person assisting, including an agent cannot sign the enrollment application on behalf of the
Answer:
consumer.
only the consumer, POA, or authorized representative can sign the enrollment application
QUESTION
agents can offer promotional gifts to attendees of any event type as long as such gifts are of
nominal retail value. nominal value is any item _ or less Answer: $15 or less QUESTION the combined value of all giveaway items including food, must not exceed___ per consumer
Answer:
$15
QUESTION
What types of gifts are prohibited regardless of the amount?
Answer:
cash, gift certificates, gift cards, monetary rebates, as well as charitable contributions made on
behalf of the consumers/members
QUESTION
you must state that accepting a gift or prize does not obligate a consumer to
Answer:
enroll
QUESTION
when providing gifts, you must offer to
Answer:
all persons whether or not they’re eigible for medicare
QUESTION
giving gifts to solicit business is
Answer:
prohibited
QUESTION
what is the real on meals for sales/marketing events?
Answer:
it is prohibited including personal and individual marketing appointments
QUESTION
agents may serve light refreshments providing the items cannot be combined to equal a
2023/2024 UHC Certification Exam| Real
Questions and Verified Answers| A+ Grade
QUESTION
A consumer may have to pay a Late Enrollment Penalty (LEP) 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 __.
Answer:
63 or more continuous days
QUESTION
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
QUESTION
Which of the following lists drug tiers from least expensive cost share to most expensive cost
share?
Answer:
Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred
Drug (and some higher-cost generics), Specialty
QUESTION
Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act
of 2015 (MACRA) impact to Plans C and F?
Answer:
Consumers already enrolled in Plans C or F are required to change plans.
QUESTION
Which statement is true about medicare supplements?
Answer:
Insured members have the freedom to choose any doctor who accepts Medicare patients.
QUESTION
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?
Answer:
April 1 through October 31
QUESTION
Annual Election Period (AEP) is a time when. . .
Answer:
Consumers can elect to switch to a different plan or join a Medicare Advantage plan or
Prescription Drug Plan.
QUESTION
Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been
presenting. Which statement is correct?
Answer:
Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide.
QUESTION
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 and the permission has not yet
expired.
QUESTION
Which statement is true about discussing benefits with the consumer before an enrollment?
Answer:
The agent must accurately and completely disclose any benefits discussed.
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?
Answer:
The consumer/member would not receive plan related correspondence intended for him/her.
QUESTION
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
QUESTION
What is Scope of Appointment?
Answer:
United Health Care Insurance Exam|
Questions and Verified Answers| Grade A
(2023/2024 New Update)
QUESTION
Do consumers have to be an AARP member to enroll in an AARP-branded plan with
UnitedHealthcare?
Answer:
Yes, if the consumer is enrolling in a Medicare Supplement Plan
QUESTION
How many status levels are in the Authorized to Offer Program?
Answer:
2
QUESTION
According to AARP, there are how many individual AARP members?
Answer:
Nearly 37 million
QUESTION
Which of the following statements about AARP are TRUE? (Select 2)
Answer:
The AARP motto is to serve, not be served
AARP advocates for the 50+ population in congress for legislation to lower medical costs
QUESTION
Which of the following is TRUE about the production requirement for the Authorized to Offer
Elite status?
Answer:
Each calendar year, agents need to have at least 30 commission-eligible, accepted, and paid
AARP Medicare Supplement Plan and/or Medicare Select Plan sales or retain a book of business
of 150 or more active members
QUESTION
The value proposition for the AARP brand is seen in what kinds of benefits for the members?
(Select 3)
Answer:
Quality of products offered
Security and reputation of the AARP name
Efforts to improve the lives of members.
QUESTION
Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3)
Answer:
Medicare Supplement Plans
Medicare Advantage Plans
Prescription Drug Plans
QUESTION
The three types of Special Needs Plans are:
Answer:
1)Dual
2)Chronic Condition
3)Institutional/Institutional-Equivalent
QUESTION
Which statement is true about how the loss of Medicaid affects a member’s enrollment in a DSNP?
Answer:
Special Election Period (SEP Dual/LIS Change in Status) is available for D-SNP members that
lose their Medicaid eligibility
QUESTION
Which statement describes the primary characteristic of a consumer who may benefit from a DSNP?
Answer:
Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost
sharing paid by the state in which they reside
QUESTION
Which statement best describes a care management program that varies depending upon the level
of the member’s health risk?
Answer:
Support provided to C-SNP and D-SNP members that may have unique health care needs
QUESTION
Select the statement that best describes a feature of D-SNPs
UHC Certification Exam (Latest 2023/2024) |
Actual Questions and Verified Answers| A+
Grade
QUESTION
Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months,
and being any age with ESRD or ALS are each eligibility requirements for which program?
Medicaid
Original Medicare
Low Income Subsidy
Answer:
Original Medicare
QUESTION
To be eligible for this plan type, consumers must meet the following requirements:- Entitled to
Medicare Part A and enrolled in Part B- Reside in the plan’s service areaWhich plan is being
described?
Medicare Advantage
Prescription Drug
Medicaid
Original Medicare
Answer:
Medicare Advantage
QUESTION
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization)
MA Plan? (Select 3)
They must see contracted network providers in order to receive coverage under the plan.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal
dialysis services, which can be obtained from out-of-network providers.
Answer:
QUESTION
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization)
MA Plan? (Select 3)
They must see contracted network providers in order to receive coverage under the plan.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal
dialysis services, which can be obtained from out-of-network providers.
Answer:
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal
dialysis services, which can be obtained from out-of-network providers.
QUESTION
When does Medicare Supplement Open Enrollment take place?
During the three months prior to the consumer’s 65th birthday, the month of their birthday, and
the three months following the month of their 65th birthday and enrolled in Medicare Part B.
During the first six months a consumer is 65 or older and enrolled in Medicare Part B.
Annually from October 15 to December 7.
During the first three months a consumer is 65 or older and enrolled in Medicare Part B.
Answer:
During the first six months a consumer is 65 or older and enrolled in Medicare Part B.
QUESTION
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work?
The OOP maximum is a feature that limits the amount of money a consumer will have to spend
on Medicare-covered health care services each year.
The OOP maximum is a feature that limits the amount of money a consumer will have to spend
on all health care services each year.
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