WHAT'S WAPPENING?

Answers to Your Top 3 Medicare Insurance Compliance Questions

Posted by Jean A. Lentsch on 11/5/19, 2:47 PM

medicare-insurance-compliance

Welcome to the halfway mark of AEP!  We know how busy things are learning the new products, retaining your current book of business and finding as many new clients as possible.

We want you to know how much we appreciate your partnership and all that you do during AEP and year-round. 

We hope you have been able to experience our new training website TheMedicareLibrary.com. It is a valuable tool. If you have at least three of the core carriers with us, please make sure to register, as there are a plethora of training resources available to you 24/7. Also be sure to use the agent portal at WesternAssetProtection.com to access carrier certification and benefit information. You can order carrier supplies here

To help your AEP season go smoothly, below are answers to three of the most frequently asked compliance questions.

1. AM I CERTIFIED AND READY TO SELL?

medicare-insurance-compliance

  • If you enroll a member to a plan year in which you are NOT certified/Ready to Sell (RTS) for, this is considered non-compliant activity and plans WILL NOT pay you for the sale. When in doubt, check it out.
  • Do not assume that just because you have attended a carrier event, done the online certification, or received an award letter that you are OK to sell. ALWAYS DOUBLE CHECK with your broker manager to confirm the effective date of your writing number.
  • If your carrier has a broker portal, you may be able to confirm if you are active.
  • Create a library of your writing numbers so you can access them remotely.

2. WHAT ARE THE MARKETING DOs and DON’TS?

Medicare-insurance-compliance

Do:

  • Create generic marketing materials to prospect with your agency/agent names letting beneficiaries know your availability. You may contact your current book of business to discuss their annual notice of change.
  • Use a font that is equivalent in size to the font Times New Roman 12pt on all your materials.
  • Make sure that you are using the proper disclaimers on your pieces. For example:
  • By calling this number you will be speaking with a licensed agent.
  • Include the TTY:711 number next to your phone number in the SAME font. (Agents must put the state’s relay number to appeal to special needs.)
  • Check your carrier portals, which will have CMS/carrier approved marketing materials that contain benefit information.
  • Always check with your carrier to make sure you are using the most current publications for 2020 if you are writing for 1/1/2020.

Do NOT:

  • Do not use any carrier logos, discuss specific benefits or cite dollar amounts of copays or premiums on your generic materials.
  • Do not use images of Medicare cards or Medicare symbols on your generic
  • Do not alter the CMS approved materials in any area other than the allowable <Caret Fields>.

If you have any questions regarding marketing and/or necessary disclaimers, do not hesitate to reach out to our compliance officer. We highly recommend submitting your pieces to our compliance/marketing team for review before you go to print or distribution. Contact us.                                                            

3. WHAT ARE THE RULES FOR INFORMAL/FORMAL SEMINARS?

Medicare-insurance-compliance

Make sure that you are submitting your seminar requests to the carrier in a timely fashion. If you are not certain of this process or the timeframes for submission, please contact your carrier’s broker manager. You can find that information on our website at www.westernassetprotection.com.

Always make sure that you have been APPROVED by the carrier for your seminar. Submitting your request to the carrier does not mean that your event has been approved. 

  • Be certain to be early/on time for your scheduled events. Please contact us if you experience any issues.
  • If an event must be cancelled, you must give at least 48 hours’ notice to the carrier.   
  • Shoppers are out there, and some plans will require a shopper to be present at all scheduled events this year, so make sure you know the ins and outs and dos and don’ts of seminars.

Educational Seminars  

  • Must be held in a public venue – cannot be held at an in-home or one-on-one setting.
  • Meals ARE allowed.
  • NEW FOR 2019: You may have a “filed and approved” sales seminar immediately following an educational event.
  • Must be explicitly advertised as educational.
  • No marketing or steering to any plan or benefits.
  • Only discuss the ABCDs and basics of Medicare – respond to general questions.
  • You may have business cards present and you may scope.

Informal Seminars   

  • This is a less structured presentation or informal environment. (For example, with a table/kiosk.)
  • Can’t be held where health services/screenings are being performed.
  • Sign-in sheets or other attempts at obtaining contact information should clearly indicate that it is OPTIONAL.
  • Do not file informals with the intent to have multiple plans showing at the same setting without receiving written permission from each carrier. Most carriers have strict policies in place for multi-plan marketing. Each plan must agree and provide written acknowledgement that you may have other carriers present their products side-by-side.
  • Use only the most current CMS approved plan materials.

Formal Seminars

  • These are structured in an audience/presenter style.
  • Must follow the carrier’s CMS approved sales presentation. (For example, PowerPoint, flip chart or video.)
  • Check with your carriers. Some carriers limit this allowance to agents who have auditioned.
  • NO MEALS – light snacks, coffee and tea are OK.
  • No scope is needed if enrolling at the event. Code the enrollment as a seminar. If the beneficiary wants to meet at a later date, then scope.
  • No multi-plan marketing allowed.
  • SECRET shoppers are usually attending formal events.

Remember, WAP is here to support your success. If you have other compliance questions, please contact us.

Topics: Medicare insurance compliance

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