2017 Ethics and Compliance 07152016 v1 Page 1 of 58

2017 Ethics and Compliance 07152016 v1

1.1 Cover Page

1.2 Certification Requirements

2017 Ethics and Compliance 07152016 v1 Page 2 of 58

1.3 Learning Objectives

1.4 CMS

2017 Ethics and Compliance 07152016 v1 Page 3 of 58

2. Ethics Overview

2.1 Overview

Read More About It (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 4 of 58

2.2 Sales Ethics

2.3 Disclosure

2017 Ethics and Compliance 07152016 v1 Page 5 of 58

2.4 Compensation

ISR/TS (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 6 of 58

EDC/ICA (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 7 of 58

2.5 Competency

2.6 Suitability

2017 Ethics and Compliance 07152016 v1 Page 8 of 58

Yield Sign (Slide Layer)

2.7 Case Study

2017 Ethics and Compliance 07152016 v1 Page 9 of 58

Caption - 1 (Slide Layer)

Caption - 2 (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 10 of 58

Couple - 1 (Slide Layer)

2.8 Case Study Question

2017 Ethics and Compliance 07152016 v1 Page 11 of 58

Correct/Incorrect (Slide Layer)

3. Marketing Materials

3.1 Overview

2017 Ethics and Compliance 07152016 v1 Page 12 of 58

3.2 What Are Marketing Materials?

3.3 Examples of Marketing Materials?

2017 Ethics and Compliance 07152016 v1 Page 13 of 58

3.4 Compliance Rules for Marketing Materials

Must (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 14 of 58

Must Not (Slide Layer)

3.5 Checkpoint

2017 Ethics and Compliance 07152016 v1 Page 15 of 58

Correct/Incorrect (Slide Layer)

4. Educational and Marketing/Sales Activities

4.1 Overview

2017 Ethics and Compliance 07152016 v1 Page 16 of 58

4.2 Types of Events

Educational Events (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 17 of 58

Marketing/Sales Events (Slide Layer)

Marketing Appointment (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 18 of 58

4.3 Compliance Rules for Marketing/Sales Events

May (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 19 of 58

Must (Slide Layer)

Must Not (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 20 of 58

4.4 Accommodating Consumers with Special Needs

4.5 Sensitivity to Consumer Accommodations

2017 Ethics and Compliance 07152016 v1 Page 21 of 58

5. Event Practices

5.1 Promotional Items and Giveaways and Member Rewards and Incentives

5.2 Meals and Refreshments

2017 Ethics and Compliance 07152016 v1 Page 22 of 58

5.3 Marketing in Provider Settings

May (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 23 of 58

Must Not (Slide Layer)

6. Appropriate Contact with Consumers

6.1 Overview

2017 Ethics and Compliance 07152016 v1 Page 24 of 58

6.2 Permission to Call

6.3 Permission to Call continuedl

2017 Ethics and Compliance 07152016 v1 Page 25 of 58

Business Reply Cards (Slide Layer)

Unsolicited Contact (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 26 of 58

Additional Requests (Slide Layer)

Consumer Referrals (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 27 of 58

6.4 Compliance Rules for Permission to Call

May (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 28 of 58

Must (Slide Layer)

Must Not (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 29 of 58

6.5 Scope of Appointment

Personal/Individual (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 30 of 58

Advertised Sales Event (Slide Layer)

Rules (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 31 of 58

Documentation (Slide Layer)

6.6 Cross-Selling

2017 Ethics and Compliance 07152016 v1 Page 32 of 58

6.7 High Pressure or Aggressive Marketing and Sales Tactics

Example 1 (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 33 of 58

Example 2 (Slide Layer)

Example 3 (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 34 of 58

6.8 Is a Power of Attorney or Authorized Representative Needed?

7. Medicare Advantage Enrollment

7.1 Enrollment Basics

2017 Ethics and Compliance 07152016 v1 Page 35 of 58

7.2 Materials Required

7.3 Statement of Understanding and Disclosures

2017 Ethics and Compliance 07152016 v1 Page 36 of 58

Disclosures (Slide Layer)

7.4 Who May Complete the Enrollment Application?

2017 Ethics and Compliance 07152016 v1 Page 37 of 58

Yield Sign (Slide Layer)

7.5 Enrollment Signatures

2017 Ethics and Compliance 07152016 v1 Page 38 of 58

7.6 Web-Based Enrollment

7.7 Non-discrimination Requirements

2017 Ethics and Compliance 07152016 v1 Page 39 of 58

7.8 Plan Sponsor and Agent Requirements

7.9 Guaranteed Rights

2017 Ethics and Compliance 07152016 v1 Page 40 of 58

7.10 Appeals and Grievances

8. Medicare Advantage Disenrollment

8.1 Disenrollment Basics

2017 Ethics and Compliance 07152016 v1 Page 41 of 58

Voluntary Options (Slide Layer)

8.2 Disenrollment Basics

2017 Ethics and Compliance 07152016 v1 Page 42 of 58

Involuntary Options (Slide Layer)

8.3 Knowledge Check

Feedback when correct: That's right! You selected the correct response.

2017 Ethics and Compliance 07152016 v1 Page 43 of 58

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.

2017 Ethics and Compliance 07152016 v1 Page 44 of 58

10. Compliance Program Overview

10.1 Overview

10.2 Introduction and Definition

2017 Ethics and Compliance 07152016 v1 Page 45 of 58

10.3 Compliance Elements

10.4 Your Role and Responsibilities

2017 Ethics and Compliance 07152016 v1 Page 46 of 58

10.5 UnitedHealth Group Code of Conduct Overview

11. Privacy and Security

11.1 Overview

2017 Ethics and Compliance 07152016 v1 Page 47 of 58

11.2 HIPAA

11.3 HIPAA continued

2017 Ethics and Compliance 07152016 v1 Page 48 of 58

What to Do (Slide Layer)

11.4 PHI and PII

2017 Ethics and Compliance 07152016 v1 Page 49 of 58

PHI (Slide Layer)

PII (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 50 of 58

11.5 PHI and PII continued

11.6 HIPAA/PHI/PII

2017 Ethics and Compliance 07152016 v1 Page 51 of 58

Risks (Slide Layer)

Rules (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 52 of 58

Scenarios (Slide Layer)

11.7 Checkpoint Question 1

2017 Ethics and Compliance 07152016 v1 Page 53 of 58

11.8 Checkpoint Question 2

11.9 Checkpoint Question 3

2017 Ethics and Compliance 07152016 v1 Page 54 of 58

11.10 Checkpoint Question 4

12. Fraud, Waste and Abuse

12.1 Required CMS Course

2017 Ethics and Compliance 07152016 v1 Page 55 of 58

13. Disciplinary Engagement Process

13.1 Progressive Disciplinary Engagement Process

CEC (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 56 of 58

CAR (Slide Layer)

DAC (Slide Layer)

2017 Ethics and Compliance 07152016 v1 Page 57 of 58

Points System (Slide Layer)

14. Wrap-Up

14.1 Wrap Up

2017 Ethics and Compliance 07152016 v1 Page 58 of 58

15. Resources

15.1 Resources

16. Navigation

16.1 Navigation