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Medicare Advantage/Part D Marketing Guidelines

Medicare Advantage/Part D Marketing Guidelines. Marketing Provisions. All beneficiary communication materials require CMS review/approval prior to distribution.

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Medicare Advantage/Part D Marketing Guidelines

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  1. Medicare Advantage/Part D Marketing Guidelines

  2. Marketing Provisions • All beneficiary communication materials require CMS review/approval prior to distribution. • All plan specific materials must show the Marketing Material ID and approval date, Federal Contracting Statement and the Standard Plan Type. • Disclaimers may be required. • CMS generated materials do not require review

  3. Enrollment Kit • Required Materials in Enrollment Kit: • Enrollment Form with Instructions • Grievance /Appeals Information • Plan Ratings • Summary of Benefits • Distributed by Plan within 10 days following CMS confirmation or last day of 1st month of enrollment: • Provider/Pharmacy directory • Comprehensive/Abridged formulary • Evidence of Coverage • ID Card

  4. Marketing/Sales Events Events designed to steer or attempt to steer potential enrollees toward a plan or set of plans. May discuss plan benefits, premium, cost-sharing Distribute or collect applications All Sales Events scheduled or cancelled must be reported to the Plan

  5. Promotional Activity Reminders Promotional Nominal Gifts • Can can offer gifts to potential enrollees • Must be worth $15 or less, based on retail value of the item • Non-conditional - must be given whetherbeneficiary enrolls or not • Cash gifts are prohibited

  6. Promotional Activity Reminders Prohibition of Meals Plan sponsors may not provide meals or have meals provided to prospective enrollees at sales/marketing events (any events where marketing materials are distributed or enrollment forms gathered. Light snacks and refreshments are permitted – (<$15 nominal value)

  7. Promotional Activity Reminders Prohibited Telephone Contact • Unsolicited outbound calls about other business as a means to generate leads • Calls based on referrals (friends, family, purchased lists) • Calls to sales event attendees, unless scope of appointment was given • Calls to confirm receipt of mailed info

  8. Promotional Activity Reminders • Unsolicited contact prohibited • Door-to-door • Flyers on cars or doorways • Outbound calls, voicemail, texts • Approaching beneficiaries in common areas (lobby, parking lot, hallways) • Outbound calls/visits after attending sales event unless Scope of Appt given • Unsolicited emails

  9. Promotional Activity Reminders • Cross Selling • Prohibited during any sales activity • Cannot market non-health related products • Annuities • Life insurance • Other products • *Allowed on inbound calls if requested

  10. Promotional Activity Reminders • In-home / Personal Appointments • Scope of Appointment Required • Must secure prior to in-home appointment • Must specify product type of interest • Cannot secure over phone unless call is recorded and scripted. • Beneficiary may sign at Sales Event for future personal appointment • Can call to confirm appointment.

  11. Promotional Activity Reminder Health Care Settings • Marketing allowed in common areas • Hospital or nursing home cafeterias • Community or recreational rooms • Conference rooms • No marketing in health care settings • Waiting rooms • Exam rooms or hospital patient rooms • Dialysis center • Pharmacy counter areas • Any other area where patients receive health care services

  12. Promotional Activity Reminders Educational Events • No marketing activities at educational events • Health information fairs • Conference expositions • State- or community-sponsored events • Plans may distribute • General Medicare information • Health education materials • Agent/broker business cards • Containing no marketing information

  13. State Licensure of Agents • All agents/brokers representing a Medicare Advantage plan must: • Be state-licensed, certified, or registered per state requirements • Provide a copy of licensure to the Plan • The Plan must report a termination and reason of termination to the state

  14. Agent/Broker Training and Testing • Agents/brokers must be trained/tested annually • Medicare rules and regulations • Plan details specific to plan products • Both contracted and employed agents • Completed prior to start of marketing season • Must have a passing grade of 85%

  15. CMS Marketing Surveillance • Surveillance strategy • Clipping Service (newspaper ads) • “Real-time” observations and responses • Secret shoppers • Complaints of misrepresentation

  16. Medicare Compliance Oversight • Detect, prevent and respond to allegations of misconduct • Secret shopping • Ride-along with employed agents • Investigate allegations Oversight of marketing activity

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