Agent Compliance Resources
Compliance Is Critical!
While you’re working with current clients and new prospects, it’s vital to follow the rules and regulations of the Federal and respective State Governments as well as the policies and procedures established by the carriers and marketing organizations that you represent. For easy reference Savers Marketing provides Agent Compliance Resources to help professional insurance agents excel in the field.
New CMS Rules For 2024 AEP Have Been Published!
The Centers for Medicare and Medicaid Services (CMS) has recently published 2024 Policy and Technical Changes for the Medicare Advantage (MA) and Prescription Drug Programs (PDP).
Below is a summary of the changes and clarifications that will affect you as an agent.
(Remember, when you see “TPMO”, that stands for Third Party Marketing Organization and that means you!)
SCOPE OF APPOINTMENT (SOA)
- New clarification now requires an SOA to be obtained at least 48 hours prior to a sales meeting/appointment with a beneficiary.
- Two exceptions:
- In-person walk-ins
- Beneficiary is within the last 4 days of a valid election period
THE MEDICARE NAME, MARKS & LOGO
- The use of the Medicare name, CMS logo, or products or information issued by the Federal Government (such as the Medicare ID card) in a misleading manner is prohibited.
- The use of an image of the Medicare card will require prior approval from CMS
- Marketing of benefits in a service area where those benefits are not available is prohibited, unless unavoidable because of the use of local or regional media that covers the service area – we’re hoping carriers provide a little more clarity on this rule, we’ll keep you updated with what we hear
- Marketing materials cannot advertise beneficiary savings based on comparisons to an uninsured individual
- Requires TPMOs to list or mention all MA and/or Part D organizations that they represent on “marketing” materials
- CMS clarified that the requirement to record calls between TPMOs and beneficiaries is only applicable to Sales (marketing) and enrollment calls
- Also clarified is that the recording requirement applies to virtual connections such as video conferencing and other virtual telepresence methods (i.e. Zoom, Skype, etc.)
- The TPMO disclaimer now needs to include SHIPs as an option for beneficiaries to obtain additional help.
- The TPMO disclaimer must state the number of organizations (carriers) represented by the TPMO as well as the number of plans.
- The TPMO disclaimer is now required even if the TPMO offers all plans in a service area but there is alternate language
- UPDATED TPMO DISCLAIMER: “We/I do not offer every plan available in your area. Currently we/I represent organizations which offer products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”
- A marketing/sales event occurring within 12 hours of an educational event at the same location is prohibited (same location means the same building or any adjacent buildings)
- Scheduling future marketing appointments (individual sales appointments) at an educational event is prohibited
- Collection of Scope of Appointment forms at educational events is prohibited
- Clarification: you may distribute and collect BRC (business reply card) / PTC (permission to contact) forms at educational events. The request to be contacted must be optional and at the request of the beneficiary
- Clarification: a BRC or PTC does not give an agent permission to show up unscheduled at a beneficiary’s residence.
We understand that some of these new rules may be vague and open to interpretation. We are working with Integrity compliance experts to clarify rules and identify examples and precedents to assist you with staying compliant with your marketing efforts. In the meantime, let your Agent Advisor know if you have any questions. You can also download the compliance assets below:
How to Avoid Unqualified Sales
Some of the most basic compliance concerns to remember:
- Verify that your State Appointments are kept up-to-date with each Carrier.
- Ensure that any product certifications required by the carrier, particularly for Medicare products are completed prior to soliciting business.
- Make sure your state license(s) are current and your Continuing Education (CE) requirements are up to date.
- Do you have downline agents? It is your responsibility to ensure that they are compliant as well so training them on insurance compliance issues is an important part of running your agency.
Educational and Sales Events for AEP
During the Medicare Advantage Annual Enrollment Period (AEP), many agents use educational or sales events to get in front of clients and prospects to create new sales opportunities. Ensure that you are meeting the compliance standards set forth by CMS and the carriers that you represent.
We understand how important it is for you to promote your company and advertise yourself as an insurance professional. However, it is important to adhere to the laws and guidelines set forth by the Federal and State governments as well as the requirements of the carriers that you represent. If you are developing your own advertising or marketing (print, digital, radio, television, etc.) that has not already been preapproved, make sure you contact your Agent Advisor or Compliance Officer for steps on review and approval.
Agent Website Compliance
Unless you obtain permission from each relevant carrier, avoid using carrier logos and branding. One should also avoid listing particular plan names, benefits, and expenses. To make things more precise, you can pick from a variety of agent titles. Don’t use words or phrases that would mislead customers into thinking you’re associated with the Government or the Medicare Program. If selling Medicare, do not use the term “Medicare” in your title (i.e. Medicare Expert, Medicare Benefits Specialist, etc.). If you are an insurance salesperson who is licensed to sell, express that with your title (ex. Licensed Sales Agent, Sales Representative, Independent Insurance Agent, Licensed Insurance Representative). Also, ensure that the current TPMO disclosure is listed prominently on your website. Ask your Agent Advisor or Compliance Officer if you have any questions about making your website compliant.
More Agent Compliance Resources
The ultimate function of Savers Marketing is to help insurance agents reach their full potential. Are you interested in furthering your education as an insurance agent to stay compliant? Check out our training opportunities for webinars on the latest compliance issues and standards. You can also refer to the resources below for more detailed information on compliance.