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]