AHIP Marketing, Sales Compliance, and Ethics 2 — Questions and Answers
Question 1: Which of the following is a permissible activity for an agent when conducting a community education event?
- Distributing enrollment applications and accepting completed forms
- Providing objective educational information about Medicare without promoting a specific plan (Correct answer)
- Conducting one-on-one sales presentations during the event
- Asking attendees to provide their Medicare numbers for a plan comparison
Correct answer: Providing objective educational information about Medicare without promoting a specific plan
Community education events are intended for objective Medicare education; agents may not conduct sales activities, distribute enrollment forms, or promote specific plans at these events.
Question 2: An agent receives a referral lead from a friend who is a doctor. Under the Anti-Kickback Statute, what must the agent be careful about?
- Verifying the beneficiary's Medicare number before meeting
- Avoiding providing any compensation or anything of value to the doctor for the referral (Correct answer)
- Obtaining written consent from the beneficiary before the appointment
- Filing the referral with CMS within 48 hours
Correct answer: Avoiding providing any compensation or anything of value to the doctor for the referral
Providing compensation or anything of value to a physician in exchange for Medicare referrals could violate the Anti-Kickback Statute.
Question 3: Under CMS rules, unsolicited contact with Medicare beneficiaries via telephone (cold calling) is:
- Permitted if the agent is licensed in the beneficiary's state
- Prohibited unless the beneficiary has given prior permission (Correct answer)
- Allowed once per calendar year per beneficiary
- Permitted during AEP regardless of prior consent
Correct answer: Prohibited unless the beneficiary has given prior permission
CMS prohibits unsolicited telephone contact (cold calling) with Medicare beneficiaries; agents may only call beneficiaries who have requested to be contacted.
Question 4: An agent must retain the Scope of Appointment (SOA) form for a minimum of:
- 1 year
- 6 months
- 10 years (Correct answer)
- 3 years
Correct answer: 10 years
CMS requires that SOA forms be retained for a minimum of 10 years.
Question 5: When a beneficiary is enrolled in a Medicare plan, the agent must provide them with:
- Only the Summary of Benefits
- The Evidence of Coverage (EOC), Summary of Benefits, and Annual Notice of Change (if applicable) (Correct answer)
- The Annual Notice of Change only
- A verbal summary of the plan; written materials are optional
Correct answer: The Evidence of Coverage (EOC), Summary of Benefits, and Annual Notice of Change (if applicable)
Plans are required to provide enrollees with key documents including the Evidence of Coverage (EOC), Summary of Benefits, and the Annual Notice of Change.
Question 6: Which of the following statements about Medicare marketing rules for door-to-door sales is correct?
- Agents may conduct door-to-door sales if wearing an approved ID badge
- Door-to-door solicitation is permitted only during the AEP
- Uninvited door-to-door sales contact with Medicare beneficiaries is prohibited (Correct answer)
- Door-to-door contact is allowed if the beneficiary's name is on a public list
Correct answer: Uninvited door-to-door sales contact with Medicare beneficiaries is prohibited
CMS prohibits uninvited door-to-door solicitation of Medicare beneficiaries to protect them from high-pressure sales tactics.
AHIP Marketing, Sales Compliance, and Ethics 2
Which of the following is a permissible activity for an agent when conducting a community education event?