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Now that the rush of AEP is in full swing, compliance may not be at the top of your list but it’s still important to remain compliant. Since the vast majority of applications are written during these 7 weeks, it also means that carriers are increasing their focus on compliance as well. For instance, when do you think the majority of secret shops take place? That’s right, AEP! So it’s a good idea to keep compliance front of mind. |
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Here are some quick tips that should help you stay compliant this AEP: |
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UNSOLICITED CONTACT: |
Marketing through unsolicited contact is prohibited per CMS regulations. The following are some examples of unsolicited contact so should not be used to contact consumers: |
- Door-to-Door Solicitation (Door Knocking)
- Leaving Flyers, Leaflets, etc. at residences or on cars
- Approaching potential enrollees in common areas such as parking lots, lobbies, sidewalks, retail stores, etc.
- Telephonic or electronic (cold-calling, texting, etc.)
- Calling attendees of a Sales Event (unless express permission is given for a follow-up call)
- Calling a “referral” from a current client
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AVOIDING MEMBER COMPLAINTS |
During the Sale |
- Thoroughly and Accurately cover the following areas in your presentation as they are continually the top reasons for Member Complaints:
- Benefit/Coverage information – Explain all coverage and what other benefits the plan has.
- Copay/Coinsurance information – thoroughly explain all costs associated with the plan; people like money and if they’re spending more than they thought they were supposed to they’ll most likely file a complaint.
- Provider Network – make sure your client’s Providers are in Network
- Drug Formulary – make sure your client knows any and all costs associated with any prescriptions they might have.
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*The importance of thoroughly covering these areas cannot be stressed enough. The vast majority of all complaints stem from these areas!!! |
After the Sale |
- Leave your contact information for the client and advise them to call you with any questions
- Re-Hash the main benefits of the plan, the Provider information, Specialist process (if applicable), any Rx information, double-check if they understand all the benefits that have been discussed
- Follow-Up with your clients to verify they have received the plan information, insurance cards, and alleviate any concerns or questions they may have
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SALES AND EDUCATIONAL EVENTS |
- Report them correctly to the applicable Carriers – each Carrier has their own timeframes and methods so it’s important to know each one.
- Do not present Plan Material at Educational Events – If you want to share any type of plan material whatsoever (even if it’s only premiums) it needs to be filed as a Sales Event.
- Remember under NEW guidance you can now distribute business cards, schedule future appointments, and collect Scope of Appointment forms at Educational Events.
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Show up to all scheduled events and arrive 15 min early to your event! |
For further guidance, please reference the following guides: |
Agent Compliance Guide – Best practices in overall Medicare Compliance
Agent Marketing Guide – Best practices in Medicare Advertising |
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Please pass this information on to
your downline agents (if you have any) |
Contact us with any questions or for more
information regarding compliance.
We are here to support YOU! |
| 800-365-8208 |
compliance@premiersmi.com |
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