Transcription
External Distribution Channel (EDC)Agent Guide
Proprietary and confidential to UnitedHealth Group.The materials comprising this External Distribution Channel (EDC) Agent Guide (“Guide”) are providedby UnitedHealthcare Medicare Solutions (“Company”) as a service to its agents on an “as-is, asavailable” basis for informational purposes only. The Company assumes no responsibility for any errorsor omissions in these materials. While the Company endeavors to keep the information up to date andcorrect, the Company makes no representations or warranties about the completeness, accuracy, orreliability of the information, products, or services contained in the Guide for any purpose.All materials contained in this Guide are protected by copyright laws, and may not be reproduced,republished, distributed, transmitted, displayed, broadcast, or otherwise exploited in any manner withoutthe express prior written permission of the Company. The Company’s names and logos and all relatedtrademarks, trade names, and other intellectual property are the property of the Company and cannot beused without its express prior written permission.This Guide is intended for EDC agent use only.Version 1.7 Release Date – November 19, 2014 2014, UnitedHealthcareAll Rights Reserved.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 2 of 183
Table of ContentsSection 1: IntroductionWelcome to UnitedHealthcare Medicare SolutionsUsing This GuideUnitedHealth Group OverviewUnitedHealthcare Medicare Solutions OverviewSection 2: How do I Get Started?ContractingCertification and TrainingUnitedHealth Group Learning Management System Access GuideUnitedHealth Group Learning Management System Website TipsSection 3: What Tools and Resources are Available to Help Me?Distribution PortalProducer Help DeskQuick Resource Tip SheetAgent CommunicationsSection 4: Product PortfolioProduct Portfolio OverviewMedicare Advantage Health PlansMedicare Advantage Special Needs PlansMedicare Supplement Insurance PlansPrescription Drug PlansMedicare Star Rating OverviewSection 5: How do I Get Marketing and Enrollment Materials?UnitedHealthcare Agent Tool KitBrand and Logo Usage – Marketing and Advertising Materials, Web Links, and WebsitesOrdering Marketing and Enrollment Materials and SuppliesSection 6: How do I Conduct Educational and Marketing/Sales Activities?Educational and Marketing/Sales Activities and EventsEvent ReportingMarketing to Consumers with Impairments or DisabilitiesLead GenerationScope of AppointmentQuick Reference Guide: Compliant Sales PracticesMedicare Marketing GuidelinesConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 3 of 183
Table of ContentsSection 7: How do I take an Enrollment Application?Enrollment MethodsElection PeriodsEnrollment Process – Medicare Advantage and Prescription Drug PlansEnrollment Process – AARP Medicare Supplement Insurance PlansPre-Enrollment Verification ProcessPost-Enrollment Customer ExperienceGeneral Medicare Advantage and Prescription Drug Plan Enrollment Application ElementsMedicare Advantage and Prescription Drug Plan Enrollment Application Cancellation,Withdrawal, or DisenrollmentCustomer Service ResourcesSection 8: How am I Paid?Compensation OverviewCredential Validation RulesCommission Payment Schedule and Payment CalculationAgent of RecordAssignment of CommissionElectronic Funds Transfer (EFT)Commission Payment AuditPended Commission ProcessPlan ChangesDebt Repayment PlanSecureHorizon Medicare SupplementSection 9: What are Expected Performance Standards?Compliance and EthicsAgent Performance StandardsComplaints and Allegations of Agent MisconductSuspension of Sales and MarketingTermination of Non-Producing AgentAdministrative TerminationTermination Due to Unqualified SaleAgent Termination – Not-For-Cause and For-CauseSection 10: Glossary of TermsIndexConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 4 of 183
Section 1: IntroductionSection 1: IntroductionWelcome to UnitedHealthcare Medicare Solutions!Using this GuideUnitedHealth Group OverviewUnitedHealthcare Medicare Solutions OverviewConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 5 of 183
Section 1: IntroductionWelcome toUnitedHealthcare MedicareSolutions!In order to achieve our mission of providinginnovative health and well-being solutions thathelp Medicare consumers achieve healthier andmore secure lives, we rely on exceptional agents.We are committed to providing you with toolsthat enable you to be successful. One such tool isthe External Distribution Channel (EDC) AgentGuide – a comprehensive resource that willprovide you with the information you need toconduct business with UnitedHealthcareMedicare Solutions (“UnitedHealthcare”) in anefficient and compliant manner.We expect our agents to share our commitment tocompliance and to act with integrity by putting thebest interest of our consumers first in everythingthey do on behalf of the company. You will findcompliance guidelines integrated into each sectionof the guide.An electronic version of this guide is availableon www.UnitedHealthProducers.com and isupdated regularly. Your comments, suggestions,and recommendations for additional content areencouraged. Please submit feedback to yourNMA/FMO.Again, I am confident that you will find this guideto be a key resource and a tool that enables you tobe successful. Your success will ultimately driveUnitedHealthcare toward achieving our sharedmission of providing healthier and more securelives for our consumers and members.Using this GuideThe External Distribution Channel (EDC) AgentGuide has been developed for use by allNMA/FMO agents and solicitors. Throughout theguide the word “agent” is used to refer to anyNMA/FMO agent or solicitor. In instances whereinformation relates specifically to an agent, butnot a solicitor or vice versa, it will be clearlynoted. Agent – a licensed, certified, andappointed (if applicable) representativewho is contracted with UnitedHealthcarethrough an External Distribution Channel(EDC). Solicitor – an appropriately licensedcaptive agent employed by orindependently contracted with an EDCagent, appointed (if applicable) by theCompany, and is free to exercise his orher own judgment as to the time andmanner of performing services pursuant toa direct or indirect agreement between theSolicitor Agent and the EDC agent.This guide consists of answers to agents’ mostfrequently asked questions when it comes todoing business with UnitedHealthcare MedicareSolutions. It provides the business procedures toguide you through getting started with thecompany, to finding the materials needed tomarket products in your area, enrolling aconsumer, and much more.Sincerely,Tim HarrisVice President, External Distribution ChannelUnitedHealthcare Medicare & RetirementConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 6 of 183
Section 1: IntroductionUnitedHealth GroupOverviewOur mission is to help people live healthier livesand help make the health system work better foreveryone. We seek to enhance the performance ofthe health system and improve the overallhealth and well-being of the people weserve and their communities We work with health care professionalsand other key partners to expand access toquality health care so people can get thecare they need at an affordable price We support the physician/patientrelationship and empower people withinformation, guidance, and tools they needto make personal health choices anddecisionsUnitedHealthcare and Optum are empoweringindividuals, expanding consumer choice andstrengthening patient-provider relationships. Weoffer exceptional service, broad capabilities andenduring value in creating a modern health caresystem.The people of UnitedHealth Group, Optum andUnitedHealthcare are engaged in the importantwork of making quality health care moreaffordable, simpler and easier for people toaccess, while putting information into the handsof individual consumers and their physicians, sothey can make better decisions about healthybehavior and evidence-based care.us to quickly and effectively address emergingneeds in a changing health care landscape.UnitedHealthcare serves the health benefitsneeds of individual consumers and employers ofall sizes; individuals age 50 and older throughMedicare and other benefit products that fit theirunique needs; the public health marketplace,offering states innovative Medicaid solutions;active duty and retired U.S. military personneland their families; and is expanding ininternational health care markets.Optum is focused on population healthmanagement, care delivery and improving theclinical and operating elements of the system.Optum is a leader in population healthmanagement, serving the physical, mental andfinancial needs of more than 62 millionindividuals. It is one of the largest healthinformation, technology, services and consultingcompanies in the world, as well as a pharmacybenefit management leader in service,affordability and clinical quality.Together UnitedHealthcare and Optum servemore than 85 million individuals worldwide witha total workforce of more than 160,000 people,and serve members in all 50 states in the UnitedStates and more than 125 other countries. Weremain dedicated to delivering “more for less” more and better health care at lower cost toconsumers on behalf of employers andgovernments – while we modernize and helpbuild an ever more effective, simpler andconsistently high quality health care system. Wetake seriously our responsibility to serve othersand to bring forward meaningful and sustainingchange.UnitedHealth Group is a diversified health carecompany headquartered in the United States,serving the markets for health benefits throughUnitedHealthcare and the growing markets forhealth services through Optum. These twoplatforms share and build upon three corecompetencies: clinical insight, advanced data andinformation resources and enabling technology.Our business model is highly adaptable, allowingConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 7 of 183
Section 1: IntroductionUnitedHealthcare MedicareSolutions OverviewUnitedHealthcare Medicare Solutions is dedicatedto providing innovative health and well-beingsolutions that help Medicare eligible consumerslive healthier and more secure lives.UnitedHealthcare Medicare Solutions is one of thelargest businesses dedicated to the health andwell-being needs of Medicare eligible consumers.UnitedHealthcare Medicare Solutions manages afull array of products and services such as: Medicare Advantage Plans Medicare Advantage Special Needs Plans Prescription Drug Plans (PDP) Medicare Supplement Plans Retiree ServicesFor moreinformation: www.UHCMedicareSolutions.com.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 8 of 183
Section 2: How do I Get Started?Section 2: How do I Get Started?ContractingCertification and TrainingUnitedHealth Group Learning Management System AccessGuideUnitedHealth Group Learning Management System WebsiteTipsConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 9 of 183
Section 2: How do I Get Started?ContractingOverviewErrors and Omissions (E&O) CoverageYou must be contracted, licensed, appointed (ifapplicable), and certified (fully credentialed) inorder to market and sell the UnitedHealthcareMedicare Solutions portfolio of products.You must carry and maintain proof of E&Ocoverage (may also be known as professionalliability insurance). General Agent (GA) level andabove producers, must have individual coverage.You may be covered under your immediate up lineblanket policy, as long as, the blanket policyspecifically indicates individual names or that allemployees and contractors are included. Failure tocarry and maintain proof of E&O is grounds fortermination and you are required to providedocumentation upon request.You must also have an active insurance license inLife, Accident and Health lines of authority (asdetermined by each state’s Department ofInsurance) and be appointed, where applicable, inyour state of residence and in any state where youperform regulated activity (i.e., sales, educationalevent, etc.).The following guidelines apply:The External Distribution Channel (EDC) hascontrol over the contracting process of theirdown-line hierarchy. You must align under anEDC that is approved and contacted withUnitedHealthcare. Therefore, contracting packetsthat include all documentation required tocontract with and/or be appointed (if applicable)by UnitedHealthcare, are requested through theEDC. Completed packets are to be submitted toUnitedHealthcare by the EDC. The policy must specifically state “Errorsand Omissions” or Insurance Agent/BrokerProfessional Liability. The declaration page or certificate ofinsurance must state the policy number,policy limits, policy period (issue andexpiration dates), and carrier. Minimum insurance required:E&O/Professional Liability insurance isrequired at a minimum of 1,000,000 perclaim and/or 1,000,000 aggregate. E&O/Professional Liability for a corporationshould state who is covered by the policy(e.g., the corporation, principal, and/or itsemployees or subcontractors.) Blanket E&O coverage must explicitly statewho the policy covers: Entities that have blanket E&O coveragefor their down-line agents may provide anon-carrier produced listing of thosecovered, as long the down-line is classifiedas a solicitor. The listing must be on theentity’s letterhead, provide the solicitor’sfull legal name, and be signed by theentity’s principal. Solicitors can be addedby providing either an update to theoriginal listing or a separate letter.Welcome LetterThe writing number is emailed to you, with a copyto the EDC, by the Agent On-Boarding specialistvia the Welcome Letter. The executed copy ofyour agreement is secure delivered via email onlyto you.You are required to provide and retain a current,valid email address.You can update your contact information byupdating your user profileon www.UnitedHealthProducers.com or bysending written requests to the Agent OnBoarding group via fax to (877) 863-3105 or viaemail to uhpcred@uhc.com.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 10 of 183
Section 2: How do I Get Started? General Agent (GA) level and aboveproducers must have their own E&Ocoverage or their name must appear as thecertificate holder (or similar) on theconfirmation of insurance of a blanketpolicy. Contracted entities may provideE&O/Professional Liability coverage bysubmitting a non-carrier produced listingof covered individuals. The listing must beon carrier or business entity’s letterhead,provide covered individual’s full legalname and signed by the entity’s principalor by the carrier. In the ExternalDistribution Channel (EDC), entities mayprovide coverage for down-lineemployees, affiliated producers, agents,and/or subcontractors who are contractedat the individual agent level. E&O/Professional Liability for a principalwill cover the corporation, but notspecifically the employees or subcontractorsof the corporation. If an agent is not insured by a corporatepolicy, they may have individualE&O/Professional Liability insurance. Thepolicy should be in their name.Updated E&O coverage information can be sentvia fax to (877) 863-3105 or via emailto producer.update@uhc.com.Producer License(s)You must be licensed in your state of residenceand in all states you wish to market and sell. Youare responsible for maintaining an activelicense(s), including all educational requirements.Agent On-Boarding will verify license status usingNational Insurance Producers Registry (NIPR).Failure to maintain valid licensing or loss oflicensing is grounds for termination of your agentagreement.You will be terminated if you were notappropriately licensed at the time of the sale. Thetermination will be not-for-cause and you will notbe able to re-contract for at least 12 monthsfollowing the termination effective date.Continuing Education (CE)UnitedHealthcare is now offering discounted ratesfor online and live Continuing Education (CE)courses through Kaplan. In the past, you needed toenter vouchers and codes to access CE courses;the new process allows you to take classes withease.How do I access the CE courses?You can access online continuing educationcourses through the Kaplan website or via the linkin the Learning Center on the Distribution Portal.When you arrive at the Kaplanwebsite www.kfeducation.com/portallogin, youwill need to create an account by entering youremail address and the portal code “EDC”.What courses can I take?You can get great discounts on both online andlive CE sessions. Total access to the CE courses isonly 29.25. The total access selection will giveyou unlimited access to all credit hours.Party Identification (Party ID) NotificationYou are assigned only one Party ID in yourlifetime with UnitedHealthcare MedicareSolutions. The Party ID links all subsequentlyissued writing numbers to you.An issuance of a Party ID is not a guarantee of anissuance of a writing number. A writing numberwill be issued upon successful completion of thecontracting process.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public.Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group.EDC Agent GuideVersion 1.7November 19, 2014EDC Agent Use OnlyPage 11 of 183
Section 2: How do I Get Started?Unqualified Sale TerminationYou will be terminated if you are not licensed atthe time of a sale (see “Termination Due to anUnqualified Sale” in this guide).Access to Certification ModulesYou must complete certification requirements inorder for Agent On-Boarding to process theappointment reque
Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any port
