UHC - United Healthcare - 2026 Certifications

Consumer John provides his cell phone number on agent Mark's Permission to Contact (PTC) mechanism and indicates he wants to be called as a means of contact. What does that mean? (select all that apply)

1.Agent Mark may only call John, not text him.

2. Agent Mark may only speak to John, the person who provided the PTC.

Agent Charlie receives a Business Reply Card from consumer Rebecca. Rebecca has provided her email address only and wants information about standalone Prescription Drug Plans. What can Charlie do?

Charlie may only email Rebecca marketing material related to Prescription Drug Plans.

From the list below, select the items that should be confirmed or obtained when conducting a thorough needs assessment. (select all that apply)

1. Eligibility

2. Current coverage

3. Current providers

4. Current prescription medications

5. Daily living needs such as transportation, fitness, travel

6. Other wish list items such as network restrictions, premium amounts, national network needs

Match the election period to the correct definition.

1. MA-OEP: Consumers can switch or disenroll from their MA Plan & obtain Original Medicare

2. IEP: Newly eligible consumers can enroll 3 months prior, month of, & 3 months after turning 65

3. AEP: Annual period when any Medicare consumer can enroll in or disenroll from an MA or PDP

4. SEP: Opportunity to change plans for specific scenarios such as newly dual-eligible (Medicare and Medicaid) or new chronic condition

5. 5-star: One-time opportunity to enroll in a plan with a 5 star rating (if available)

What should you do if the consumer is interested in an MA Plan that has a 2-star rating?

You should inform the consumer that the plan has received a "below average" rating.

A member can voluntarily disenroll from an MA Plan or PDP or they can be involuntarily disenrolled by the plan. Select the reasons below for involuntary disenrollment. (select all that apply)

1. Member moves out of the plan's service area

2. Member loses entitlement to either Part A or Part B

Can you identify these terms associated with enrollment and disenrollment basics? Read each statement and then drag the matching term to the statement.

1. Appeal: Action members take if they disagree with coverage or payment decision

2. Summary of benefits: Detailed summary of plan's benefits, cost sharing and special features

3. Required involuntary disenrollment: Happens when member loses Part A or B entitlement

4. Statement of understanding: Required to be read and acknowledged by the consumer at the enrollment

5. Star Rating: Medicare's measure of a plan's quality and performance

Jared is planning a formal marketing/sales event for October 24. While it is strongly recommended that Jared reports his event at least 14 calendar days in advance, what is the last date the Event Request Form can be submitted to UnitedHealthcare?

October 17

Tori needs to cancel an event. To allow ample time for UnitedHealthcare to process the cancellation in the event reporting application, when should Tori submit a Cancel Event Request Form?

At least 6 business days prior to the date of the event

Janet is conducting an informal marketing/sales event at her local soup kitchen. When speaking to the Activities Director, Janet finds out that lunch is served daily from 11:00 AM-1:00 PM. Which of the following is a compliant time when Janet can host her event?

9 am to 11 am

Bonnie, a D-SNP member, lost her Medicaid eligibility. She has a Special Election Period available to enroll in a new plan. When does that begin?

Upon notification or effective date of the loss, which ever is earlier

Harold lost his Medicaid eligibility. What is he responsible for paying? (select all that apply)

1. Deductibles

2. Copayments

3. Coinsurance

What are the reasons a consumer can use the Special Election Period- Special Need/Chronic? (select all that apply)

1. Enrolling in a C-SNP first time

2. Enrolling in a C-SNP to cover a different condition

Mrs. Murphy has recently been diagnosed with a cardiovascular disorder and wants to enroll in a C-SNP. Joshua asked her about a provider who can verify her condition. What is true about her provider?

The provider indicated on the form does not have to be contracted with the plan.

Mrs. Murphy's effective date is February 1. She receives a letter on March 1 from the plan telling her the attempts to verify her qualifying chronic condition have been unsuccessful. What does this mean?

Her enrollment will be terminated effective March 31 if, as of March 31, the plan has not been able to verify a qualifying chronic condition

If the enrollee has not resided in the contracted SNF for 90 days at the time of enrollment, which documents qualify as additional proof to be submitted to the enrollment department? (select all that apply)

1. MDS (Minimum Data Set) forms; Sections A0100 - A1100 and Section Q0300-Q0400

2. An Optum-provided form letter signed by appropriate facility staff

3. An approved letter on facility letterhead signed by appropriate facility staff

Which election periods can be used at any time during the year to enroll an eligible consumer into an ISNP?

Open Enrollment Period for Institutionalized Individuals (OEPI)

Now that you read the Provider Activity Guidelines, which statement below is true?

The skilled nursing facility staff member cannot provide a completed BRC directly to an agent but may put it in a drop box or folder used to collect completed BRCs.

Authorization for Disclosure of Contact Information: Signed within the previous twelve-month period

Required

Authorization for Disclosure of Contact Information: No expiration date

Not Required

Authorization for Disclosure of Contact Information: Anyone from the contracted skill nursing facility can sign

Not Required

Authorization for Disclosure of Contact Information: A description of entities to which the information is to be released

Required

Authorization for Disclosure of Contact Information: Information will be given to a health care plan

Required

Authorization for Disclosure of Contact Information: Indicates someone will contact them

Required

Authorization for Disclosure of Contact Information: Individual will be enrolled in an I-SNP

Not Required

Who cannot answer the questions for the Institutional Level of Care (LOC) assessment?

Agent

What are the eligibility requirements for the UHC SCO plan?

1. Be 65 years of age or older

2. Be enrolled in MassHealth Standard or MassHealth CommonHealth

3. Reside in service area

4. Not have any other comprehensive health insurance, except Medicare

Richard wants to determine if Jon is enrolled in PACE or another SCO plan. What questions could he ask?

Correct:

1. Do you currently pay copayments for your prescription drugs?

2. May I see your current insurance card?

3. Do you attend an Adult Day Health Center (ADHC) on a regular basis?

Incorrect:

1. Do you go to fitness classes?

2. Do you see a specialist in addition to your Primary Care Provider?

3. May I see your Medicare card?

Which election periods apply to the UHC SCO? (select all that apply)

1. Medicare Initial Enrollment Period

2. Medicare Advantage Open Enrollment Period (MA OEP)

3. SEP - Integrated Care once per month throughout the year

4. Annual Election Period (AEP)

What sales support tools are available to agents for questions about SCO related materials?

1. UHC Agent Toolkit

2. Producer Help Desk

3. JarvisWrap

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?

April 1 through October 31

Which of the following statements is true about using a 5-Star Special Election Period (SEP)?

A 5-Star SEP can only be used by a consumer already enrolled in an MA Plan

What should an agent tell a consumer who asks what a 2-star rating means?

That the Plan has received a "Below Average" rating.

Which of the following describes Permission to Contact (PTC) guidelines?

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 is suitable for the consumer's needs, goals and financial resources.

While using JarvisEnroll to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do?

Leave the field requesting a consumer email address blank.

By agreeing to the Statement of Understanding, the consumer:

Acknowledges that they clearly understand they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling.

What is Scope of Appointment?

The agreement obtained from the consumer no less than 48 hours (unless an exception applies) prior to the start of an in-person or telephonic personal/individual marketing appointment that identifies the scope of products that can be discussed

Which statement is accurate when a consumer has a Power of Attorney (POA)?

If the POA signs the Enrollment Application, they must be able to provide documentation upon request by the Plan that indicates authority under state law to enroll the consumer.

Which of the following options will enable a consumer to obtain prescription drug coverage? (Select 2)

1. Enroll in a Private Fee-For-Service (PFFS) MA-Only Plan and a standalone PDP

2. Enroll in any MA-PD Plan

Jane, a consumer, calls and asks to be enrolled in the plan that will put money back into her Social Security every month. What guidelines do you keep in mind when you hear the consumer mention a specific plan benefit from an ad? (Select 3)

1. I remember that a thorough needs assessment is required for each enrollment.

2. 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.

3. Consumers may have misunderstood or been confused by something they heard or read in an ad.

Aries is currently a member of a standalone 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?

Aries can enroll into a Medicare Advantage Plan with prescription drug coverage, which will disenroll him from his PDP.

A thorough needs assessment will include, among other elements, which of the following components? (Select 3)

1. Learning about their current coverage, lifestyle and financial characteristics.

2. Identifying the consumer's current providers (including primary care, specialists, hospitals, and pharmacies) and the medications they take.

3. Identifying what healthcare coverage attributes are most important to the consumer and what tradeoffs they might be willing to make.

When should you proceed with an enrollment application? (Select 3)

1. When the person who assists the consumer in making healthcare coverage decisions is present, when applicable.

2. If I am certain the consumer understands what they are gaining and what they may be giving up by enrolling in the new plan.

3. If I am certain the consumer understands and agrees they are enrolling into a plan.

Which of the following best describes a "like" plan change?

When a consumer enrolls in a plan that is of the same type as their current plan, such as any Medicare Advantage Plan to any other Medicare Advantage Plan.

Prior to enrolling the consumer, what must you make sure the consumer understands? (Select 3)

1. That their current plan and the new plan that I am recommending are not the same.

2. If the plan is network-based, whether the providers they want to use are in the new plan's network.

3. If the plan has drug coverage, if the medications they use are on the plan's formulary, what tier they are in, and any utilization management limitations.

Which of the following is TRUE about UnitedHealthcare Medicare plans carrying the AARP name?

AARP does not endorse any UnitedHealthcare MA and PDP plans but does endorse the AARP Medicare Supplement Insurance Plans.

To live up to the five Consumer Commitment Standards, agents offering AARP-branded products should help their customers feel their relationship with AARP is ____________________.

Effortless and inspiring

Which of the following is NOT one of the standards Authorized to Offer agents are encouraged to embrace?

Serve the needs of the organization

Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare?

Yes, if the consumer is enrolling in a Medicare Supplement Insurance Plan.

Which of the following statements is FALSE?

AARP sets rates for the Medicare Supplement Insurance Plans.

Which of the following statements about AARP are TRUE? (Select 2)

1. AARP is dedicated to empowering Americans 50 and older to choose how they live as they age.

2. AARP is the nation's largest nonprofit, nonpartisan organization.

Which of the following statements about AARP are TRUE? (Select 2)

1. AARP produces the nation's largest circulation publications, AARP The Magazine and AARP Bulletin.

2. AARP has a nationwide presence.

Where can agents find the Authorized to Offer Guidelines?

Jarvis

Which AARP entity manages provider relationships and performs quality control oversight for products and services that carry the AARP name?

AARP Services Inc. (ASI)

Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3)

1. Medicare Advantage Plans

2. Medicare Supplement Insurance Plans

3. Prescription Drug Plans

The three types of Special Needs Plans are:

Dual-Eligible, Chronic Condition and Institutional

Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment?

She will enter a grace period during which she may be responsible for plan cost-sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

D-SNP benefits are designed for the consumer who______________.

Is eligible for Medicare and Medicaid

Which consumers can use the Integrated Care SEP to enroll into an Integrated D-SNP where available?

Full Dual-Eligibles

Select the statement that best describes a feature of D-SNPs.

The monthly Part D premium is at or below the Low Income Subsidy benchmark to ensure members are not charged a premium for their Part D Coverage.

Melanie wants to enroll in a D-SNP. Which of the following must her agent do?

Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level.

In general, consumers with Medicare and Medicaid, collectively known as dual-eligibles, are good candidates for which plan type(s)?

Dual Eligible Special Needs Plan

Which Medicare-eligible consumer is best suited for a C-SNP?

Mary, who has been seeing a specialist for a qualifying chronic condition

Which two consumers can use the Special Election Period "SEP-Special Need/Chronic"? (Select 2)

1. Mark, currently enrolled in a Medicare Supplement Plan and a stand-alone Prescription Drug Plan, was just diagnosed with a cardiovascular disorder and would like to enroll in a C-SNP that covers the condition.

2. Thu is enrolled in a C-SNP that only covers diabetes. Newly diagnosed with a cardiovascular disorder, she wants to enroll in a C-SNP that covers her new condition.

What program is available to support members of a C-SNP and D-SNP who may have unique health care needs?

A care management program that varies depending upon the level of the member's health risk

It is very important for consumers enrolling in a C-SNP to know the following about accessing providers:

Some C-SNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers for covered services, generally with higher cost-sharing.

Which statement is true about the Medicaid program?

Benefits vary from state to state.

You must advise Full Dual-Eligible consumers enrolling in a D-SNP that:

Generally, they are not required to pay copayments for Medicare-covered services received from a D-SNP in-network provider if they are Full Dual-Eligible in the state in which they live.

How long do plans that use the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request?

Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer)

A D-SNP member loses his eligibility due to a change or loss of Medicaid status. What cost-sharing is he responsible for while in the grace period?

Loss of Medicaid eligibility generally means the member will have to pay premiums, deductibles, copayments, and coinsurance during the grace period.

On October 20, Aries decides talks with an agent to switch his PDP that he has had since January 1 to a Medicare Advantage plan. What election period will Aries need to use (if eligible) to get a November 1 effective date?

He can use a Special Election Period (SEP) if he qualifies for one.