Insurance Agent Forum

[GreenSky]

Just returned from Vegas a little poorer financially, but a little richer in knowledge.

Had a conversation with the trainer for Today's Options. I asked him if presentations and enrollments had to be done in person. His answer was that CMS did not require this. He basically told me that "CMS may not require a face to face." This question is specifically covered as part of his seminar training for agents.

He does not know if online enrollment will still be available but will let me know when he finds out.

I know that other carriers say we must do this in person but this must be a carrier requirement, not CMS.

So the bottom line is "I'm still in business!"

Rick

[salpro22]

Originally Posted by GreenSky

Just returned from Vegas a little poorer financially, but a little richer in knowledge.

Had a conversation with the trainer for Today's Options. I asked him if presentations and enrollments had to be done in person. His answer was that CMS did not require this. He basically told me that "CMS may not require a face to face." This question is specifically covered as part of his seminar training for agents.

He does not know if online enrollment will still be available but will let me know when he finds out.

I know that other carriers say we must do this in person but this must be a carrier requirement, not CMS.


So the bottom line is "I'm still in business!"

Rick

How was the Ranch????

[craig_ritter]

Originally Posted by GreenSky

Just returned from Vegas a little poorer financially, but a little richer in knowledge.

Had a conversation with the trainer for Today's Options. I asked him if presentations and enrollments had to be done in person. His answer was that CMS did not require this. He basically told me that "CMS may not require a face to face." This question is specifically covered as part of his seminar training for agents.

He does not know if online enrollment will still be available but will let me know when he finds out.

I know that other carriers say we must do this in person but this must be a carrier requirement, not CMS.

So the bottom line is "I'm still in business!"

Rick

Rick: I agree that there is no CMS mandate for a F2F or personally witnessed sig. FWIW!

Craig

[policy doctor]

I can't believe I missed this entire thread. Now I see why some were so upset with me. SORRY

[retread]

I think some people have been misunderstood by the enquirer not making clear their question. A face-to-face presentation of RE-CERTIFICATION is required for at least some MA carriers. I don't propose to speak for them all, but I do know that Today's Options was one of them. Only two states had that requirement, and they were Kansas and Oregon. They were singled out by CMS as having some issues. All other states could re-certify online.
When speaking of ENROLLMENTS, MA plans CANNOT be taken over the telephone. You are to call for an appointment, because you CANNOT show up uninvited. As far as the "face-to-face" is concerned, there is nothing wrong with taking an enrollment over the phone for a Medigap policy, but it is forbidden with MA plans. NO OUTBOUND ENROLLMENTS, i.e. no telemarketing for the purpose of enrollment, only appointments. Read the regulations for yourself:

Medicare Marketing Guidelines for MAs, ch 2, p. 136. Look here: http://www.cms.hhs.gov/PrescriptionD...Guidelines.pdf

INBOUND enrollments can be set up by IVR, and ONLINE enrollments via the web, but are strictly regulated. All scripts must be submitted for review by CMS.

This issue has been stressed at my recertification classes for both HMO/PPO and PFFS carriers. This is a big thing with CMS! Apparently, either not enough of you guys have paid attention in class or for some reason did not get the word. Both door-to-door and telemarketing sales have come into close scrutiny. Listen up, or you are gonna get your license spanked! It is very simple: No door-to-door (unexpected visits) or pushy telephone calls (outbound enrollment attempts). Call, using FTC guidelines (scrub DNC list, during acceptable hours -8a.m. to 9p.m.) and offer your services. Additionally, there is a laundry list of things you must say, and things you can't say. Read up on it.

[James]

Inbound Call Rules:

Plans are not permitted to:

Conduct outbound telephone enrollment.

• Transfer outbound calls to inbound lines for telephonic enrollment.

•

Market or enroll other lines of business as part of the telephonic enrollment
Script.

Request or collect credit card numbers or bank account information for any

Purpose during the telephonic enrollment call.

Outbound Call Rules:

To this end, the MMA allows plans to conduct outbound telemarketing within the scope
Of the following guidelines.

Organizations may conduct outbound telemarketing activities for health related
Products to the extent permitted to do so under the HIPAA Privacy Rule.

Organizations may not conduct outbound telemarketing activities for non-health
Related items unless beneficiaries have provided prior written authorization.
This rule is intended to protect each beneficiary’s privacy rights under HIPAA.
In order to further protect the privacy of potential plan enrollees and to ensure that
Outbound telemarketing activities present clear, concise, and accurate information that
Enables potential plan enrollees to make an informed choice, all telemarketing activities
Must adhere to the Federal Trade Commissions Requirements for Sellers and
Telemarketers, the Federal Communications Commission and applicable state law.
In addition, organizations must:

Comply with the National-Do-Not-Call Registry,

•

Honor “do not call again” requests, and

•

Abide by Federal and State calling hours.
In addition, because of the complex nature of offerings, enrollment by outbound
Telemarketers is not allowed. Rather, outbound telemarketing may be used solely to

Solicit requests for pre-enrollment information,

If these rules are followed I would imagine most plans be difficult to do over the telephone.

[Slick]

The Coventry re-cert made it very clear that you must be face to face for telephonic and online enrollment. You may take a paper app. and fax it in later that day.

[retread]

Thank you, James, and also Slick.... you restore some faith in the credibility of my fellow forum members. At least some are up on the rules.

What bothers me is Greensky's report that a Today's Option "trainer" could not answer his question. It is absolutely clear in Today's Option compliance manual. All company representatives should know those rules. Additionally, any agent contracted with them should have access to the compliance manual. (I am not going to copy it here due to privacy policy)

[GreenSky]

Originally Posted by retread

Thank you, James, and also Slick.... you restore some faith in the credibility of my fellow forum members. At least some are up on the rules.

What bothers me is Greensky's report that a Today's Option "trainer" could not answer his question. It is absolutely clear in Today's Option compliance manual. All company representatives should know those rules. Additionally, any agent contracted with them should have access to the compliance manual. (I am not going to copy it here due to privacy policy)

Please re-read my post. The trainer was absolutely certain (and even documentation proves him correct) that face to face is NOT required by CMS. Carriers may impose this just as Coventry has, but it is not a CMS requirement.

He was not certain how we could move forward on electronic enrollments.

I don't know why my report bother you and I really don't understand your comment about compliance, etc. The question on enrolling on-line has nothing to do with compliance.

There is another thread that discusses Today's Options at nauseum. I suggest you search for it and read it. I believe your concerns will be answered.

Rick

[James]

Originally Posted by GreenSky

Please re-read my post. The trainer was absolutely certain (and even documentation proves him correct) that face to face is NOT required by CMS. Carriers may impose this just as Coventry has, but it is not a CMS requirement.

He was not certain how we could move forward on electronic enrollments.

I don't know why my report bother you and I really don't understand your comment about compliance, etc. The question on enrolling on-line has nothing to do with compliance.

There is another thread that discusses Today's Options at nauseum. I suggest you search for it and read it. I believe your concerns will be answered.

Rick

Let me ask this, are you saying that I can do enrollment for MA's with outgoing calls or calling clients?

[Frank Stastny]

Copied and pasted from another thread. My comments are in RED

How much clearer does this have to be??????????????????????

The word "PHONE" is mentioned three (3) times!

The word "ENROLLMENT" is mentioned five, count them, 5 times.

Today’s Options Phone Enrollment Instructions

In order to process an enrollment via phone, please follow these easy steps:
1. Make sure the enrollee is present. (Present, as on the phone with you.)

2. Call

1-800-695-5640.

3. Choose Option 1.

4. Provide the call center representative with your agent number.

NOTE: If you do not provide the call center representative with your agent number, you will not receive commissions for the enrollment.

5. Have the enrollee speak to the call center representative to complete the phone application process.

NOTE: You may speak to the call center representative on behalf of the enrollee as long as the enrollee is present.

6. At the end of the enrollment call, you will be provided a confirmation number. Write down the confirmation number, provide it to the enrollee and keep it for your records.

Phone Enrollment Hours of Operation

1-800-695-5640
Monday thru Sunday: 8:00 AM – 11:00 PM ET

Spanish Speaking Representatives will be available: 9:00 AM – 7:00 PM ET

[James]

I'm not too worried about it, yet my understanding was that the word "Present" was used in the physical sense. Maybe I'm wrong, yet that would follow the rule of "Plans are not permitted to: Conduct outbound telephone enrollment." Plus I'm under the understanding that you can not use the transfer as to make a outbound call into a inbound call.

Other words I'm under the impression that the client has to call in to enroll, that is what I'm asking. So let me ask again, can I call a person an enroll them? Or does the person have to call back before I go into the enrollment call?

[GreenSky]

Originally Posted by James

I'm not too worried about it, yet my understanding was that the word "Present" was used in the physical sense. Maybe I'm wrong, yet that would follow the rule of "Plans are not permitted to: Conduct outbound telephone enrollment." Plus I'm under the understanding that you can not use the transfer as to make a outbound call into a inbound call.

Other words I'm under the impression that the client has to call in to enroll, that is what I'm asking. So let me ask again, can I call a person an enroll them? Or does the person have to call back before I go into the enrollment call?

Okay, here's the deal...

1. Application is completed and in agent's hands. (Eventually I would hope this can be an on-line application.)

2. Agent and client on a conference call to Today's Options.

3. Today's Options asks client when he/she can be called back for verification.

4. Today's Option gives a code number to agent and client. This is included with paperwork faxed or mailed to carrier.

5. Everyone hangs up phone and agent then hopes that everything goes smoothly on the verification call.

6. Commission gets paid and everyone is happy.

Hope that clarifies things. Disclaimer - this is obviously NOT exactly what happens (especially the "everyone is happy" part.)

Rick

[James]

Originally Posted by GreenSky

Okay, here's the deal...

1. Application is completed and in agent's hands. (Eventually I would hope this can be an on-line application.)

2. Agent and client on a conference call to Today's Options.

3. Today's Options asks client when he/she can be called back for verification.

4. Today's Option gives a code number to agent and client. This is included with paperwork faxed or mailed to carrier.

5. Everyone hangs up phone and agent then hopes that everything goes smoothly on the verification call.

6. Commission gets paid and everyone is happy.

Hope that clarifies things. Disclaimer - this is obviously NOT exactly what happens (especially the "everyone is happy" part.)

Rick

Telephone enrollment is not new but the question is this, can I go into the enrollment telephone call with the carrier if I called the person? Or does that person have to call me before I go into the phone enrollment with the carrier?

Today’s Options Phone Enrollment Instructions

In order to process an enrollment via phone, please follow these easy steps:
1. Make sure the enrollee is present.
2. Call
1-800-695-5640.

3. Choose Option 1.

4. Provide the call center representative with your agent number.
NOTE: If you do not provide the call center representative with your agent number, you will not receive commissions for the enrollment.

5. Have the enrollee speak to the call center representative to complete the phone application process.
NOTE: You may speak to the call center representative on behalf of the enrollee as long as the enrollee is present.

6. At the end of the enrollment call, you will be provided a confirmation number. Write down the confirmation number, provide it to the enrollee and keep it for your records.

Phone Enrollment Hours of Operation

Sorry Frank but I removed your red part, it wasn't CMS compliant!

[Frank Stastny]

Originally Posted by James

Telephone enrollment is not new but the question is this, can I go into the enrollment telephone call with the carrier if I called the person? Or does that person have to call me before I go into the phone enrollment with the carrier?

Sorry Frank but I removed your red part, it wasn't CMS compliant!

That is why it was specifically made red along with my comment stating that it was my comment.

That part was added as a result of my phone conversation with them.

[Frank Stastny]

Originally Posted by GreenSky

Okay, here's the deal...

1. Application is completed and in agent's hands. (Eventually I would hope this can be an on-line application.)

2. Agent and client on a conference call to Today's Options.

3. Today's Options asks client when he/she can be called back for verification.

4. Today's Option gives a code number to agent and client. This is included with paperwork faxed or mailed to carrier.

5. Everyone hangs up phone and agent then hopes that everything goes smoothly on the verification call.

6. Commission gets paid and everyone is happy.

Hope that clarifies things. Disclaimer - this is obviously NOT exactly what happens (especially the "everyone is happy" part.)

Rick

Rick,

I suggest we go on to another topic and stop "fighting" to help the agents who are still in doubt and let them sell PFFS plans anyway they choose.

I have stated many times on this board that it is incumbent on everyone to do their own research. You and I have done ours and I believe we are comfortable with the words we received direct from the "horses mouth".

Frankly, that would be me, I'm tired of saying the same thing over and over again and having people tell me I don't know what I'm talking about when I have documentation to back up what I have said. If I get sent to jail and gassed then so be it. This is not rocket science guys.

I think they are a very poor substitute for a Med Supp policy anyway. I sure as hell wouldn't take one if I was on Medicare!

So, how's your golf game. Did the lessons help you keep your balls in the short grass?

[James]

Originally Posted by Frank Stastny

That is why it was specifically made red along with my comment stating that it was my comment.

That part was added as a result of my phone conversation with them.

Sorry, but you still have not answer the question, does it have to be an inbound call directly by the client or can I enroll during an outbound call to the client? The question is quite straight forward yet no one has given me a straight answer? Plus is the carrier (like I never been steered wrong by a carrier????) or is it CMS that is the real horses mouth?

Oh well, I know the answer it is all over the CMS site if one looks, it has to be a inbound call by the client, it can't be a outbound call and you can not redirect the call too make it look like an inbound call, like a transfer to the telephone enrollment number.

Now was that so hard to answer?

[Frank Stastny]

Originally Posted by James

Sorry, but you still have not answer the question, does it have to be an inbound call directly by the client or can I enroll during an outbound call to the client? The question is quite straight forward yet no one has given me a straight answer? Plus is the carrier (like I never been steered wrong by a carrier????) or is it CMS that is the real horses mouth?

Oh well, I know the answer it is all over the CMS site if one looks, it has to be a inbound call by the client, it can't be a outbound call and you can not redirect the call too make it look like an inbound call, like a transfer to the telephone enrollment number.

Now was that so hard to answer?

If you think you knew the answer, why did you ask the question?

Are you here to play games or to provide factual information substantiated by documentation? I don't see any documentation. Never mind, I already have all the information I need.

Why would a client call anyway. I'm more interested in selling to prospects. My clients already have what they need.

[James]

Originally Posted by Frank Stastny

If you think you knew the answer, why did you ask the question?

Are you here to play games or to provide factual information substantiated by documentation? I don't see any documentation. Never mind, I already have all the information I need.

Why would a client call anyway. I'm more interested in selling to prospects. My clients already have what they need.

Oh my, this question has been documented on both threads, yet for some odd reason some decided that the carrier and not CMS is the horses mouth? Oh well, its not all that much of a money maker and hopefully any thinking person should take from this, if nothing else, that there should be no way these bozoos should ever get their hands on everyones health care coverage!

[GreenSky]

Originally Posted by James

Sorry, but you still have not answer the question, does it have to be an inbound call directly by the client or can I enroll during an outbound call to the client? The question is quite straight forward yet no one has given me a straight answer? Plus is the carrier (like I never been steered wrong by a carrier????) or is it CMS that is the real horses mouth?

Oh well, I know the answer it is all over the CMS site if one looks, it has to be a inbound call by the client, it can't be a outbound call and you can not redirect the call too make it look like an inbound call, like a transfer to the telephone enrollment number.

Now was that so hard to answer?

You are confusing the verification call with the enrollment application. CMS requirements apply to this, not to taking the application.

Pyramid allows that agent and client to be on a conference call to SET UP the verification phone call. The agent may not be on a conference call with the client during this call.

Do what ever you would like to do. Some of us understand this and are not looking to interpret anything. I intend to follow the guideline that and IN WRITING from Today's Options instead of trying to decide for myself what I am allowed to do.

At this point, I give up trying to convince people what is right and wrong. I'll do it the way I have been instructed by various carriers and you do it the way you think is right.

Rick