Important Compliance Update: CMS Disclaimer Requirement FAQ + Compliance Review Process

CMS Required Disclaimer FAQ + Lead Time to Approve Materials for use on/after 10/1/22

 

The marketing guidelines for Medicare Advantage and Prescription Drug Plans were recently updated and among the provisions that apply directly to agents is a required disclaimer to be in use by October 1, 2022, for Plan Year 2023.

Important: Marketing materials (as defined further below) require CMS approval and must follow a compliance process that includes carrier review and filing through HPMS which can take up to 75 days to complete. If you have materials that meet the definition of marketing and want to use these materials on/after 10/1/22, NOW is the time to submit these pieces for review.

 

Send materials via email to: [email protected]

 

Disclaimer Language To Use:

 “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

 

Who must use this disclaimer?

 Any third-party marketing organization (which includes agents and brokers) must include this disclaimer.

 

When/where is the disclaimer used?

  • On all marketing* materials: print, electronically, television, and radio
  • Within the first minute of all sales calls
  • Prominently displayed on TPMO websites
  • Verbally, electronically, or in writing, during any sales meeting with a beneficiary

 

veGeneric Marketing and Communications

 We generally refer to advertising pieces – print, radio, tv, website, etc., as marketing however, CMS uses the terms ‘marketing’ and ‘communication’ to make a distinction  between generic advertising.  

 

Communications are all activities and materials used to provide information that is targeted to current and prospective enrollees, including their caregivers and other decision makers.  

Generic mailers and advertising materials you create to promote your business and generate leads fall under the definition of “communication” materials (given they are free of carrier names and specific plan informaiton, and do not list benefits, premiums, copays, and cost sharing).

 

Marketing is a subset of communications and is determined based on both the content and intent of activity or materials.

Marketing includes activities and materials with the intent to draw a beneficiary’s attention to a specific plan or plans and to influence a beneficiary’s decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan (retention-based marketing). Additionally, marketing has content with information about the plan’s benefits, cost sharing, measuring, or ranking standards.

Materials that meet the definition of marketing wil require submission to CMS through HPMS filing.  The term ‘marketing’ takes on new meaning when we talk compliance. Its CMS definition is used to distinguish materials that require review and approval vs. materials that fall under the ‘communication’ definition, which can be used without CMS review/approval.

 

We’re here to help.  Call if you have questions (614-763-2255), and click below to review the 2022 Agent Medicare Compliance Guide. This publication provides many examples of advertising content that is deemed marketing, and requires CMS approval, and includes details around generic communications where filing with CMS is not necessary.

 

Note: Updates to this guide to include the most recent CMS requirements (disclaimer and call recording) are in process so, please keep this in mind when reviewing the current content.  Cornerstone Senior Marketing will make the updated version of this guide available to all our broker partners as soon as it becomes available.

 

 DOWNLOAD THE 2022 AGENT MEDICARE COMPLIANCE GUIDE HERE

 

Worth repeating: If you have marketing materials that require filing with CMS for approval or have marketing or communication materials you want reviewed for compliance, please send them via email to: [email protected]

June 2022 Compliance Corner: 2023 Certification Season – Are you Ready-To-Sell?

Becoming Ready to Sell for 2023

In order to be eligible to sell Medicare Advantage and Prescription Drug Plans each year, agents are required to go through annual certification!

These educational requirements are just starting with many carriers set to release their certifications these coming weeks!

  1. First thing you need to do is make sure you are Health Insurance licensed in the state in which you intend to sell.
    1. For more information on becoming licensed, please visit your resident’s state department of insurance
  2. Second thing you need to do is make sure you are appointed with the carriers you wish to represent
    1. Cornerstone Senior Marketing offers a wide variety of carriers in multiple markets. A full list can be found on our website www.cornerstoneseniormarketing.com
    2. Be sure to reach out your local sales rep or email us at [email protected] to request a new carrier appointment
  3. Next you will need to complete the 2023 Medicare and Fraud, Waste, and Abuse training.
    1. There are multiple ways to complete this training:
      1. The most popular is America’s Health Insurance Plans (AHIP)
      2. National Association of Health Underwriters (NAHU) also offers a way to complete this annual training
      3. You only have to do this once and Cornerstone Senior Marketing recommends checking with the carriers you are appointed with to determine which training will meet their requirements.

IMPORTANT!: If you are completing your training through AHIP, we recommend you access this training through a carrier’s certification. Most carriers will offer a $50 AHIP discount by certifying through their portals.

 

4. Next you will need to complete all of your carrier MA/MAPD/PDP specific 2023 trainings

  • Each carrier has their own certification process
  • Links to carrier certifications, guides, and tips can all be found on our website. Simply go to www.cornerstoneseniormarketing.com click on resources then click on 2023 Medicare Certification

 

After you complete your carrier certifications, keep an eye out for communication from the carrier letting you know that you are 2023 Ready to Sell!

If you become RTS early, most carriers will also open a pre-ordering window for you to obtain Plan Year 2023 supplies sent to your place of business!

 

Accessing Resources

January 2022 Compliance Corner: OEP Marketing Do’s & Don’ts

Information sourced from Cornerstone Senior Marketing’s Medicare Agent Marketing Guidelines & our Agent Compliance Guide

 

OPEN ENROLLMENT PERIOD

During the Medicare Open Enrollment Period (OEP) which runs from January 1 to March
31 each year, beneficiaries can switch from one Medicare Advantage plan to another or go
back to Original Medicare. However, during OEP agents may not knowingly target or send
unsolicited marketing materials to any MA or Part D enrollee. “Knowingly” takes into account
the intended recipient as well as the content of the message.

During OEP, agents may:
• Conduct marketing activities based on other enrollment opportunities, such as:
○ Marketing to age-ins (who have not yet made an enrollment decision),
○ Marketing for a 5-star plan, and
○ Marketing to dual-eligible and LIS beneficiaries who, in general, may make changes once per
calendar quarter during the first nine months of the year.

• Send marketing materials when a beneficiary makes a proactive request; and

• Have one-on-one meetings at the beneficiary’s request

 

During OEP, agents may not:
• Conduct activities or send unsolicited materials advertising the ability/opportunity to
make an additional enrollment change or referencing the OEP;

• Specifically target individuals who are in the OEP because they made a choice during
Annual Enrollment Period (AEP) by purchase of mailing lists or other means of
identification;

• Call or otherwise contact former enrollees who have selected a new plan during the AEP.

 

MARKETING TIP: OEP is a great time to shift to Age-In or other SEP activities. We also
suggest using this time to reach out to your clients who enrolled in a plan during AEP to
check in to confirm they know how to use their benefits or if they have any question. Doing
so will go a long way with customer retention and satisfaction, will help reduce member
complaints, and can spark a request for permissible marketing information.