 |
Memorandum Of Understanding
Regarding Volunteer Counselor
Responsibilities And Obligations |
_______________________________________________________
Name of Volunteer | Date
_______________________________________________________
Address | Telephone
As a certified Volunteer Counselor in the Senior Health Insurance Counseling
for Kansas Program, I agree to follow all program guidelines and regulations.
Neither the Senior Health Insurance Counseling for Kansas Program nor
the Sponsoring Organization is responsible for my activities or responsibilities
other than those stated in these program guidelines. Any action beyond
those covered in the guidelines will be taken at my personal risk.
- NATURE OF SERVICE
I understand that my basic responsibilities as a Volunteer Counselor
include providing accurate and objective counseling and assistance with
Medicare, health insurance, and related health coverage plans for Medicare
beneficiaries, their representatives or persons soon to be eligible
for Medicare, and educating the public on Medicare and health insurance
issues that affect older citizens. I agree to take the Initial Training
Certification and continuing Update Training as required under this
program. I understand that I may conduct counseling sessions at specified
counseling sites, by telephone, or at clients’ homes if their health
conditions require. I agree to complete the Contact Report Forms and
to submit them each month to my Coordinator.
- CONFIDENTIALITY
It is understood that in the performance of my duties, I will have access
to certain sensitive information about the client, and that such information
may include medical, insurance, financial and other personal and confidential
data. I agree to restrict my use of such information to the performance
of my counseling duties described in the program guidelines and understand
that there is to be no discussion of cases or mentioning of clients’
names except when in direct contact with Medicare, insurance companies,
providers of medical services/supplies, and/or members of the Senior
Health Insurance Counseling for Kansas program staff.
- CONFLICT OF INTEREST
The Senior Health Insurance Counseling for Kansas Program requires that
counselors shall not promote private or personal interests in conjunction
with the performance of duties covered in the state program guidelines.
To comply with these requirements, I agree to the following:
- A. I will in no way attempt to conduct market research or solicit,
persuade, or coerce clients to purchase a specific type of medical
insurance coverage, to convert an existing policy to another carrier,
to go to a specific provider of service for treatment, or to direct
a client to a specific agent/broker or any profit-based billing
service. I understand that this means that neither I nor a member
of my immediate family may be currently in the business of health
insurance
- B. I will not disclose nor use confidential information obtained
as a result of my association with or access to any client for personal
gain or advantage for my employer or any other parties.
- ACKNOWLEDGMENT
I hereby acknowledge my obligation to respect the confidentiality of
the client and to exercise good faith and integrity in all dealings
with the client in the performance of my duties as a Certified Volunteer
Counselor in the Senior Health Insurance Counseling for Kansas program.
I understand that a breach of confidentiality or conflict of interest
will make me personally liable for my actions regarding the client’s
right to privacy and confidentiality, and could be grounds for de-certification
as a Volunteer Counselor.
_______________________________________________________
Volunteer’s Signature | Date
