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.
EXPANDED DEFINITION OF “MARKETING”
On May 10, 2023, CMS issued a memo regarding their definition of “marketing.” To date, CMS has permitted the mentioning of widely available benefits (i.e. Dental, Vision, Hearing, Prescription Drugs, Premium Reduction, and Fitness) in materials or activities without those materials or activities being considered “marketing” and subject to the marketing regulations, including submission to CMS for approval.
This interpretation was predicated on the assumption that a beneficiary would be unlikely to make an enrollment decision based on widely offered benefits advertised without information on the associated costs for enrollees. CMS has found through monitoring that many beneficiaries do inquire and some enroll based on the original advertisement of these types of benefits. Beneficiaries have contacted agents, made calls to 1-800 numbers, and responded to flyers asking about the dental, vision, hearing, and cost-savings being marketed. Therefore, CMS is expanding its interpretation of the regulatory definition of “marketing” to include content that mentions any type of benefit covered by the plan and is intended to draw a beneficiary’s attention to plan or plans, influence a beneficiary’s decision-making process when selecting a plan, or influence a beneficiary’s decision to stay enrolled in a plan (that is, retention-based marketing) and thus subject to CMS submission and approval.
Beginning July 10, 2023, any material or activity that is distributed via any means (e.g., mailing, television, social media, website, radio, etc.) and mentions any Medicare Advantage Plan benefit will be considered “marketing” and must be submitted to carriers and CMS for approval.
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:
***UPDATED SEPTEMBER 22, 2023!***