2017 ethics and compliance 07152016 v1 - unitedhealth group...2.2 sales ethics 2.3 disclosure . 2017...
TRANSCRIPT
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2017 Ethics and Compliance 07152016 v1
1.1 Cover Page
1.2 Certification Requirements
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1.3 Learning Objectives
1.4 CMS
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2. Ethics Overview
2.1 Overview
Read More About It (Slide Layer)
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2.2 Sales Ethics
2.3 Disclosure
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2.4 Compensation
ISR/TS (Slide Layer)
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EDC/ICA (Slide Layer)
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2.5 Competency
2.6 Suitability
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Yield Sign (Slide Layer)
2.7 Case Study
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Caption - 1 (Slide Layer)
Caption - 2 (Slide Layer)
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Couple - 1 (Slide Layer)
2.8 Case Study Question
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Correct/Incorrect (Slide Layer)
3. Marketing Materials
3.1 Overview
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3.2 What Are Marketing Materials?
3.3 Examples of Marketing Materials?
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3.4 Compliance Rules for Marketing Materials
Must (Slide Layer)
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Must Not (Slide Layer)
3.5 Checkpoint
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Correct/Incorrect (Slide Layer)
4. Educational and Marketing/Sales Activities
4.1 Overview
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4.2 Types of Events
Educational Events (Slide Layer)
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Marketing/Sales Events (Slide Layer)
Marketing Appointment (Slide Layer)
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4.3 Compliance Rules for Marketing/Sales Events
May (Slide Layer)
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Must (Slide Layer)
Must Not (Slide Layer)
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4.4 Accommodating Consumers with Special Needs
4.5 Sensitivity to Consumer Accommodations
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5. Event Practices
5.1 Promotional Items and Giveaways and Member Rewards and Incentives
5.2 Meals and Refreshments
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5.3 Marketing in Provider Settings
May (Slide Layer)
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Must Not (Slide Layer)
6. Appropriate Contact with Consumers
6.1 Overview
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6.2 Permission to Call
6.3 Permission to Call continuedl
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Business Reply Cards (Slide Layer)
Unsolicited Contact (Slide Layer)
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Additional Requests (Slide Layer)
Consumer Referrals (Slide Layer)
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6.4 Compliance Rules for Permission to Call
May (Slide Layer)
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Must (Slide Layer)
Must Not (Slide Layer)
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6.5 Scope of Appointment
Personal/Individual (Slide Layer)
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Advertised Sales Event (Slide Layer)
Rules (Slide Layer)
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Documentation (Slide Layer)
6.6 Cross-Selling
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6.7 High Pressure or Aggressive Marketing and Sales Tactics
Example 1 (Slide Layer)
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Example 2 (Slide Layer)
Example 3 (Slide Layer)
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6.8 Is a Power of Attorney or Authorized Representative Needed?
7. Medicare Advantage Enrollment
7.1 Enrollment Basics
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7.2 Materials Required
7.3 Statement of Understanding and Disclosures
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Disclosures (Slide Layer)
7.4 Who May Complete the Enrollment Application?
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Yield Sign (Slide Layer)
7.5 Enrollment Signatures
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7.6 Web-Based Enrollment
7.7 Non-discrimination Requirements
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7.8 Plan Sponsor and Agent Requirements
7.9 Guaranteed Rights
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7.10 Appeals and Grievances
8. Medicare Advantage Disenrollment
8.1 Disenrollment Basics
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Voluntary Options (Slide Layer)
8.2 Disenrollment Basics
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Involuntary Options (Slide Layer)
8.3 Knowledge Check
Feedback when correct: That's right! You selected the correct response.
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9. Events/Contact/Enrollment Checkpoint
9.1 Checkpoint Case
9.2 Checkpoint Question
The violations are:
Since the appointment was scheduled two weeks away, it appears Nick had time to meet the requirement to obtain the SOA at least 48 hours in advance.
Nick bought Jo lunch as a thank you: An agent cannot provide/give a gift in exchange for an enrollment. Buying lunch as a thank you is prohibited.
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10. Compliance Program Overview
10.1 Overview
10.2 Introduction and Definition
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10.3 Compliance Elements
10.4 Your Role and Responsibilities
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10.5 UnitedHealth Group Code of Conduct Overview
11. Privacy and Security
11.1 Overview
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11.2 HIPAA
11.3 HIPAA continued
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What to Do (Slide Layer)
11.4 PHI and PII
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PHI (Slide Layer)
PII (Slide Layer)
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11.5 PHI and PII continued
11.6 HIPAA/PHI/PII
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Risks (Slide Layer)
Rules (Slide Layer)
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Scenarios (Slide Layer)
11.7 Checkpoint Question 1
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11.8 Checkpoint Question 2
11.9 Checkpoint Question 3
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11.10 Checkpoint Question 4
12. Fraud, Waste and Abuse
12.1 Required CMS Course
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13. Disciplinary Engagement Process
13.1 Progressive Disciplinary Engagement Process
CEC (Slide Layer)
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CAR (Slide Layer)
DAC (Slide Layer)
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Points System (Slide Layer)
14. Wrap-Up
14.1 Wrap Up
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15. Resources
15.1 Resources
16. Navigation
16.1 Navigation