Insurance Agent Forum

[jdeasy]

This is some info from an email I got today;


Background: CMS (Centers for Medicare and Medicaid Services) announced changes to the regulations affecting all who market Medicare Advantage products. Listed below are some highlights and recommended changes that need to be made to your activities in order to remain in this marketplace.
[COLOR=#000000]Call Center Activity:[/COLOR]
[COLOR=#ff0000]As of Thursday, September 18, 2008, you will no longer be able to call prospective members to set sales appointments unless you have the permission of the beneficiary to call. This permission may be by invitation or as a result of a business reply card. The wording from CMS is:[/COLOR]

[COLOR=#000000]Beginning September 18, 2008, the prohibition on door-to-door solicitation extends to other instances of unsolicited contact that may occur outside of advertised sales or educational events. Prohibited activities include, but are not limited to, the following: [/COLOR]

• Outbound marketing calls, unless the beneficiary requested the call. This includes contacting existing members to market other Medicare products, except as permitted below.
• Calls to former members who have disenrolled, or to current members that are in the process of voluntarily disenrolling, to market plans or products, except as permitted below.
• Calls to beneficiaries to confirm receipt of mailed information, except as permitted below.
• Calls to beneficiaries to confirm acceptance of appointments made by third parties or independent agents.
• Approaching beneficiaries in common areas (i.e. parking lots, hallways, lobbies, etc.)
• Calls or visits to beneficiaries who attended a sales event, unless the beneficiary gave express permission at the event for a follow-up call or visit.

[COLOR=#000000]This is what Call Centers may do:[/COLOR]
Organizations may do the following:

• Conduct outbound calls to existing members to conduct normal business related to enrollment in the plan, including calls to members who have been involuntarily disenrolled to resolve eligibility issues.
• Call former members after the disenrollment effective date to conduct disenrollment survey for quality improvement purposes. Disenrollment surveys may be done by phone or sent by mail, but neither calls nor mailings may include sales or marketing information.
• Under limited circumstances and subject to advance approval from the appropriate CMS Regional Office, call LIS-eligible members that a plan is prospectively losing due to reassignment to encourage them to remain enrolled in their current plan.
• Agents/brokers who enrolled a beneficiary in a plan may call that beneficiary while they are a member of that organization.
• Call beneficiaries who have expressly given permission for a plan or sales agent to contact them, for example by filling out a business reply card or asking a Customer Service Representative (CSR) to have an agent contact them. This permission applies only to the entity from whom the beneficiary requested contact, for the duration of that transaction, or as indicated by the beneficiary.

[COLOR=#000000]All outbound scripts must be submitted for review and approval prior to use in the marketplace. [/COLOR]When conducting outbound calls:

• Scripts must include a privacy statement clarifying that the beneficiary is not required to provide any information to the plan representative and that the information provided will in no way affect the beneficiary’s membership in the plan.
• Plans are prohibited from requesting beneficiary identification numbers (e.g., Social Security Numbers, bank account numbers, credit card numbers, HICN).
• Plans are allowed to say they are contracted with Medicare to provide prescription drug benefits or that they are Medicare-approved MA-PD/PDP.
• Plans cannot use language in outbound scripts that imply that they are endorsed by Medicare, calling on behalf of Medicare, or Medicare asked them to call the member.

All calls must be recorded!
[COLOR=#ff0000]This means that beginning this Thursday, you cannot do any cold calling to set appointments.[/COLOR]
There are several items of concern beyond the “no cold calling” that we are continuing to explore. For clarification on some, we need to hear back from the insurance carriers. These issues include new commission rates, chargeback rules and future commissions on replacements across carriers.
Please take note of these requirements so that no cold calls are made after this Wednesday! We will notify you as soon as we receive clarification on the other subjects covered

[xrac]

Originally Posted by jdeasy

This is some info from an email I got today;


Background: CMS (Centers for Medicare and Medicaid Services) announced changes to the regulations affecting all who market Medicare Advantage products. Listed below are some highlights and recommended changes that need to be made to your activities in order to remain in this marketplace.
[COLOR=#000000]Call Center Activity:[/COLOR]

[COLOR=#ff0000]As of Thursday, September 18, 2008, you will no longer be able to call prospective members to set sales appointments unless you have the permission of the beneficiary to call. This permission may be by invitation or as a result of a business reply card. The wording from CMS is:[/COLOR]

[COLOR=#000000]Beginning September 18, 2008, the prohibition on door-to-door solicitation extends to other instances of unsolicited contact that may occur outside of advertised sales or educational events. Prohibited activities include, but are not limited to, the following: [/COLOR]

• Outbound marketing calls, unless the beneficiary requested the call. This includes contacting existing members to market other Medicare products, except as permitted below.
• Calls to former members who have disenrolled, or to current members that are in the process of voluntarily disenrolling, to market plans or products, except as permitted below.
• Calls to beneficiaries to confirm receipt of mailed information, except as permitted below.
• Calls to beneficiaries to confirm acceptance of appointments made by third parties or independent agents.
• Approaching beneficiaries in common areas (i.e. parking lots, hallways, lobbies, etc.)
• Calls or visits to beneficiaries who attended a sales event, unless the beneficiary gave express permission at the event for a follow-up call or visit.

[COLOR=#000000]This is what Call Centers may do:[/COLOR]
Organizations may do the following:

• Conduct outbound calls to existing members to conduct normal business related to enrollment in the plan, including calls to members who have been involuntarily disenrolled to resolve eligibility issues.
• Call former members after the disenrollment effective date to conduct disenrollment survey for quality improvement purposes. Disenrollment surveys may be done by phone or sent by mail, but neither calls nor mailings may include sales or marketing information.
• Under limited circumstances and subject to advance approval from the appropriate CMS Regional Office, call LIS-eligible members that a plan is prospectively losing due to reassignment to encourage them to remain enrolled in their current plan.
• Agents/brokers who enrolled a beneficiary in a plan may call that beneficiary while they are a member of that organization.
• Call beneficiaries who have expressly given permission for a plan or sales agent to contact them, for example by filling out a business reply card or asking a Customer Service Representative (CSR) to have an agent contact them. This permission applies only to the entity from whom the beneficiary requested contact, for the duration of that transaction, or as indicated by the beneficiary.

[COLOR=#000000]All outbound scripts must be submitted for review and approval prior to use in the marketplace. [/COLOR]When conducting outbound calls:

• Scripts must include a privacy statement clarifying that the beneficiary is not required to provide any information to the plan representative and that the information provided will in no way affect the beneficiary’s membership in the plan.
• Plans are prohibited from requesting beneficiary identification numbers (e.g., Social Security Numbers, bank account numbers, credit card numbers, HICN).
• Plans are allowed to say they are contracted with Medicare to provide prescription drug benefits or that they are Medicare-approved MA-PD/PDP.
• Plans cannot use language in outbound scripts that imply that they are endorsed by Medicare, calling on behalf of Medicare, or Medicare asked them to call the member.

All calls must be recorded!
[COLOR=#ff0000]This means that beginning this Thursday, you cannot do any cold calling to set appointments.[/COLOR]
There are several items of concern beyond the “no cold calling” that we are continuing to explore. For clarification on some, we need to hear back from the insurance carriers. These issues include new commission rates, chargeback rules and future commissions on replacements across carriers.
Please take note of these requirements so that no cold calls are made after this Wednesday! We will notify you as soon as we receive clarification on the other subjects covered

I do not work the senior market so my response is that we are no longer a free country are we? Are our seniors so incapable that they need this much protection?

[policy doctor]

No we're not a free country and these new rules are anti-competitive, anti- free market(or capitalistic) and interferes with commerce.

And this may be the spread of further regulation into other business arenas.

Make everyone a wage slave instead of commission so taxes can be collected immediately and full control over their economic life.

AHHHH...don't get me started.

But i've stated before on some past posts, that we agents are being used in this MA arena, then we will be trashed.

[midwestbroker]

These rules are not new. Humana got in trouble in Wal Mart (when they had booths there). Agents were walking around the store approaching seniors. As of early 2007, CMS said no more, that you have to be approached by a senior.

No cold calling? Have you talked to a senior that was not on the DNC list? They are getting slammed by telemarketers.

As far as I know, this does only apply to MA and Part D. Supplements, final expense, and other plans are still a free for all, and there is the loop hole.

[Cheech]

I thought the "cold calling/telemarketing" rules weren't going to be in effect till Jan. 1 2009?

Wondering where this e-mail you received was orginally generated?

I do work in the senior market and do "cold call"

[jdeasy]

Originally Posted by Cheech

I thought the "cold calling/telemarketing" rules weren't going to be in effect till Jan. 1 2009?

Wondering where this e-mail you received was orginally generated?

I do work in the senior market and do "cold call"

That particular email came from a FMO that I am contracted with. It quotes CMS. I spoke to another FMO by phone this morning and was told that they got the same info yesterday from CMS. I talked to another GA and he said that he was told that the restrictions start Oct. 1.

I'm just passing the info along. How accurate it turns out to be, I don't know.I personally do not cold call, but, I do buy preset appointments and those are generated by cold calling I'm sure.

[yeager]

[COLOR=#003366]CMS Releases Updated Rules and Regulations for 2009 Selling Season [/COLOR]

[COLOR=black]On September 15, 2008 the Centers for Medicare & Medicaid Services (CMS) released its updated rules and regulations for marketing Medicare Advantage and Medicare Prescription Drug Plans with 2009 effective dates. These plans may be sold beginning with the Annual Enrollment Period (AEP) starting November 15, 2008. [/COLOR]
[COLOR=black]The new requirements listed below are in addition to current rules, which remain in effect. [/COLOR]
[COLOR=#003366]New Regulations for 2009 Enrollment Periods [/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]No cold calling/telemarketing[/COLOR][COLOR=black] - Agents may no longer purchase a list, scrub it against Do Not Call (DNC) and call prospects. The agent also may not call a referral, unless the individual has contacted the agent first. The potential client must have solicited us for information (meaning they must have responded to a mailer or contacted us requesting information in some other documented way).[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]No more meals at sales seminars[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]No cross-selling at MA / PDP appointments [/COLOR][COLOR=black]- Agents must make an appointment prior to going to the house and must stipulate what they will be presenting. Sales presentations can be grouped as follows: [/COLOR]
[COLOR=black]1) MA/PDP - Medicare Advantage (PFFS, PPO, HMO, SNP), and Medicare Prescription Drug Plans. Medicare Supplement may be discussed here.[/COLOR]
[COLOR=black]2) Traditional products (i.e. life, cancer, dental), Medicare Supplement may also be discussed at a traditional products appointment. If during the traditional product(s) appointment, the prospect expresses interest in Medicare Advantage or Medicare Prescription Drug Plans, a 48-hour cooling-off period is in place. The agent must schedule an appointment at least 48 hours later to discuss MA/ PDP products. This rule goes both ways (that is, MA/PDP may not be discussed at a traditional appointment and traditional products may not be discussed at a MA/PDP appointment).[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]No sales presentations, distribution or acceptance of applications in provider offices or anywhere health care is delivered[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]No sales activities, distribution or acceptance of applications at educational events or seminar setting[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]Agents must be both licensed and appointed in accordance with state laws in all states where they will solicit and sell MA/PDP Plans.[/COLOR]
[COLOR=#003366]In addition, CMS will be doing the following:[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]Tripling the number of "secret shopper" activities[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]Reviewing plans' local print and broadcast advertisements[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]Reviewing recordings of enrollment calls to ensure compliance with new regulations[/COLOR]
[COLOR=black]• [/COLOR][COLOR=black]Ensuring that plans properly enforce regulations and report agent/broker misrepresentation. [/COLOR]
[COLOR=black]The 2009 Enrollment Periods can be enormously successful for you if you take the time to review and then follow these new regulations.[/COLOR][COLOR=black]Stay compliant and have a successful AEP! [/COLOR]

[MedSuppPro]

I don't do cold calling or do I? When I call an existing client about a new plan for 2009 that I believe is in their best interest -- it may be a cold call by CMS definition.

I have heard that we Rent-A-Agents will also need to complete yet another form explaining how we made contact with our applicant. Keep in mind that your subjecting yourself to other federal rules that extend beyond CMS.

This reaches a point of diminishing returns. My cost of acquiring a new client and servicing that new client will most likely fall short of a decent living. I also risk my way of making a living if one of these rules trip me up.

I’m for levelized commissions and not for the Rent-A-Agent crap. I may downsize my operation back to a "Frank" level of offering MedSupp's only. Less governMENTAL crap and a return to 45 days of my life.

MA and PDP's will become an "Oh, by the way -- sale"! Or if I can't place them into a MedSupp due to their health I'll reach into my tool bag and pull out an MA plan -- after a 48 hour cooling off period!

[Cheech]

I got word from my FMO we have until- Fri.

On Sat- no more cold calling/telemarketing

I

[Cheech]

I got word from my FMO we have until- Fri.

On Sat- no more cold calling/telemarketing

I think we'll see alot of companies falling off

[theinuranceguy]

What your going to see are these fly by night Medicare Advantage agencies (yes some insurance agencies ONLY sell these) fall off the books really quick. I know some FMO's that have already begun to downsize, because they put alot of stock in these MA's.

Ill have to see what the commissions look like, but for less competition Ill take a cut in commission, no doubt Ill close more deals and make more money over all.

Now at $10 per month per app... thats iffy, That may take some time to make a decent income. By time I mean Years

[scottfree]

Originally Posted by midwestbroker

These rules are not new. Humana got in trouble in Wal Mart (when they had booths there). Agents were walking around the store approaching seniors. As of early 2007, CMS said no more, that you have to be approached by a senior.

No cold calling? Have you talked to a senior that was not on the DNC list? They are getting slammed by telemarketers.

As far as I know, this does only apply to MA and Part D. Supplements, final expense, and other plans are still a free for all, and there is the loop hole.

Midwest, There is that loophole like you suggest but if you set an appointment for supplements and you tell them their options and they want info on MA's you have to come back in 48 hours.

At out AR BCBS meeting they seemed to say that if you set an appointment to cover all their options with Medicare you could talk about MA's, PDP's and Supps without having to set another appointment. As long as they know up front of what you are going to talk about. This meeting was last week and before this BS was released. I don't know one senior that wouldn't want you talk about all their options at one time.

What the hell is CMS thinking? Sorry Mr. Client I can't tell you about these plans, I will come back in 2 days and since it is 8:00 now, lets make the appointment for 8:01.

[allhealthandlife]

I wonder if there is compliant literature that we are suppose to show the prospect to prove to them that we really do have to come back in 48 hours to give them the whole story.

Prospects are going to think that either we are loopy or that it is some type of standing room only close when we tell them about the " 48 hour rule "

[Winter]

What a frigging mess. I am still deciding whether to get involved with the whole MA thing this season. Right now I am thinking I will just take a pass but may change my mind. It is not just the marketing regs thing. It is also the problems with PFFs plans current and future which, in my area, cannot be gotten around by going with PPO's that have skimpy networks. I understand that is not true in all areas and I accept that.

This whole MA thing is a timebomb. Congress will keep cutting the subsidy to them so the premiums will keep going up over time to to the point where you have some crappo plan with a 5000 MOOP and you are paying 90 per month for it. Meanwhile, all these clients will have been in MA's for a couple years so will have lost the right of return to a supp which would be a better deal for a few extra dollars after MA premiums go up and up. What a mess.

Then to top it off you lose your license because you go blind reading the regs trying to figure out if you can talk about medicare options when you make an appointment to talk about medicare options. Oy!

Winter

[Frank Stastny]

Originally Posted by Winter

What a frigging mess. I am still deciding whether to get involved with the whole MA thing this season. Right now I am thinking I will just take a pass but may change my mind. It is not just the marketing regs thing. It is also the problems with PFFs plans current and future which, in my area, cannot be gotten around by going with PPO's that have skimpy networks. I understand that is not true in all areas and I accept that.

This whole MA thing is a timebomb. Congress will keep cutting the subsidy to them so the premiums will keep going up over time to to the point where you have some crappo plan with a 5000 MOOP and you are paying 90 per month for it. Meanwhile, all these clients will have been in MA's for a couple years so will have lost the right of return to a supp which would be a better deal for a few extra dollars after MA premiums go up and up. What a mess.

Then to top it off you lose your license because you go blind reading the regs trying to figure out if you can talk about medicare options when you make an appointment to talk about medicare options. Oy!

Winter

I saw the handwriting on the wall when PFFS plans first came out. I have never gotten involved in them and don't plan to. (I do not have the option of selling HMO's or PPO's in rural Missouri.)

If a prospect wants a PFFS plan then I recommend that they contact another agent.

Med Supps are still alive and well in Missouri. So am I.

[Cheech]

It appears that CMS is stating that all calls must be recorded.

So if you meet with a client regarding another product (final expense, Med supp) for them to meet w you again in 48hrs for MA you would have to record the conversation with the client.

Correct me if I am wrong?

[MedSuppPro]

Originally Posted by Cheech

It appears that CMS is stating that all calls must be recorded.

Yesterday, I heard this at a meeting...
Where did this "appear"? Maybe you were at the same freeking meeting!

[GreenSky]

Originally Posted by Cheech

It appears that CMS is stating that all calls must be recorded.

So if you meet with a client regarding another product (final expense, Med supp) for them to meet w you again in 48hrs for MA you would have to record the conversation with the client.

Correct me if I am wrong?

You must be able to prove to CMS that the meeting was set up in advance and the items to be covered. You can either record the call or send out a letter that must be received prior to the meeting.

By the way, we've only talked about MA plans. You need to do the same for PDP. In 2010, when you replace a PDP you only get a renewal commission. How hard are you going to work to help your client find the plan that covers his medications for $6?

The only thing worse than Congress is CMS.

Rick

[Frank Stastny]

Originally Posted by GreenSky

How hard are you going to work to help your client find the plan that covers his medications for $6?

The only thing worse than Congress is CMS.

Rick

I don't do it now for $50.

I suggest that they either go on line or to their local pharmacy. If they start taking a new drug that isn't covered by the plan I recommend then I am an SOB. That could jeopardize my credibility with them and cause me to lose their Med Supp business.

It isn't worth the $50.00 especially when I have spent as much as two hours on the phone with them answering all their questions and looking up their meds.

Let the pharmacist take that heat.

[OkWhy]

Heck, I sure picked a fine time to start out in the insurance business. Sigh! (Well, it was either this or real estate.)