Is This Legal

[steveadlman]

Can you call a prospect turning age 65 with the intent of making an appointment to present a Medicare supplement. Once you are into your presentation the prospect ask you about Medicare Advantage Plans. Can you then get a SOA signed then proceed to go over the benefits of a MA plan. Could you sell the MA plan if that is what the prospect truly wants without violating CMS rules?

 

[Josh]

Yes/no.

In theory yes, but this is a witch hunt. They'll take a look at how many presentations your making vs number of MA sales and compare that to MS sales and convict you on that ratio.

Rome Insurance Agancy And Its President Fined $120,000 For Pressuring Senior Citizens To Buy Insurance Policies

That was a little while ago, but it underscores the importance. I talked to the insurance department about it and that's exactly how it happened.

If it happens 1/10, you're probably fine. If it happens more often than not, I'd find another way of doing it.

 

[Guest]

I'm still, 4 years later, trying to wrap my head around this scope stuff.
I have never mailed a customer a scope to sign before the initial appointment.
The directions from cms state to have the scope signed before the appt.
I go into the home, pull out the scope, have it initialed and signed then move on to the presentation, I have faxed in every scope and they all say, same day appt. I have never had any one call me on this.

 

[rousemark]

Best advice I can give is if you have to ask "is this legal", it is best to leave it alone.

 

[Blue]

We sold a bunch of Medicare Advantage this year. Lots of agents asking to get in trouble out there. Must have scope 48 hours before appointment. Exception is a true walk in. If you are prospecting for supps and the client really turns the conversation you are okay. But let's be real, the agent lots of times will guide the call the way they want. Plus, they are always going to want to talk about Rx. Play by the rules.

 

[TwiLight]

Can not talk about it on the same appointment. Must wait at least 24 hours after the signing of the SOA and after wait time set a new appointment.

Bunch of BS if you ask me.

 

[ksigmtsu]

Guys. New guideline was released on this last year.

Bad information you're all giving here.

If initial contact method is by unsolicited contact, be that cold call, door knock, or even a mail card if that particular BRC mail card has not been carrier AND cms approved, the customer can NEVER be sold an MAPD or Part D plan by the current rule for medicare managed care marketing guidelines.

It is a violation under any circumstance, even if the customer asks you about MAPD plans, if your initial method of contact was unsolicited.

This also applies to any Medicare supplement sold in the state of Ohio.

Because it is a CMS violation does not make it against the law, but it is a CMS violation, and you can have your right to market those plans revoked, license revoked, etc, just as with any other CMS violation.

The only methods which are valid by CMS guidlines are if the consumer requests contact via lead form, email, phone, or carrier approved BRC card, or is a walk in.

The way the guideline is written in the managed care marketing guidelines, I would believe it could be a CMS violation if you sold one of your current medicare supplement customers a MAPD plan 1 year later after the medsupp, if your initial contact was via cold call or any other unsolicited contact.

You're all repeating a rule that has been changed for almost a year.

 

[ctg]

I've been cold calling for Med Supps and at the appointment (usually in their home) if they ask about Medicare Advantage I will say somthing along the lines of "I would love to talk to you about the companies I represent. However, the government has very strict rules regarding this. I would need you to sign this(SOA) and I will come back in a couple of days. In the meantime, I will get to work on what we've talked about so far."
I may take "Cover Your A--" too far but...
Am I way off kilter?

 

[ksigmtsu]

70.4 - Marketing through Unsolicited Contacts
(Rev. 96, Issued: - 5-17-11, Effective: 5-17-11, Implementation: 5-17-11)
42 CFR 422.2268(d), 423.2268(d)
As reflected in 42 CFR 422.2268(d) and 42 CFR 423.2268(d), there is a general prohibition on
marketing through unsolicited contacts. In general this prohibition includes the following and
may extend to other instances of unsolicited contact that may occur outside of advertised sales or
educational events. Some examples include:
• Door –to- door solicitation including leaving information such as a leaflet, flyer, or
door hanger at a residence, or leaving information such as a leaflet or flyer on
someone’s car.
• Approaching beneficiaries in common areas (e.g., parking lots, hallways, lobbies,
sidewalks, etc.)
• Telephonic or electronic solicitation including leaving electronic voicemail
messages, text messaging, or sending unsolicited e-mail messages.
NOTE: Agents/brokers who have a pre-scheduled appointment which becomes a “no-
show” may leave information at the no-show beneficiary’s residence.
The prohibition on marketing through unsolicited contacts does not extend to mail and
other print media (e.g., advertisements, direct mail) provided they are constructed and
approved in accordance with the information set forth in these Medicare Marketing
Guidelines. Leads may still be generated through mailings, websites, advertising and public
sales events. Refer to § 70.3 regarding email policy.
Plan sponsors will be held accountable for all actions of agents/brokers selling their products,
and plans/agents/brokers should be wary of any company selling beneficiary contacts that claims
to be permissible under our guidance. Plan sponsors should also note that Medicare Marketing
Guidelines and regulations apply to Medicare age-ins as well as existing beneficiaries.
In addition, permission given by a beneficiary to be called or otherwise contacted is to be
considered short-term, event-specific, and may not be treated as open-ended permission for
future contacts. All business reply cards (BRC) used for documenting beneficiary agreement for
a contact must be submitted to CMS for review/approval. Additionally, plan sponsors that
develop a BRC should include a statement on the BRC that by replying to this card, a sales
person may call you.
70.5 - Specific Guidance on Telephonic Contact
(Rev. 96, Issued: - 5-17-11, Effective: 5-17-11, Implementation: 5-17-11)
42 CFR 422.2268(d), 423.2268(d)
Because telephonic contact with Medicare beneficiaries is performed for a variety of reasons, the
following guidance has been developed to further clarify the scope of the restriction on
unsolicited contact. CMS makes a distinction between contact with beneficiaries to establish a
new relationship with a plan sponsor or independent sales agent, and contact that is with a plan
member or a beneficiary where a business relationship already exists (e.g., the agent has sold
the beneficiary non-Medicare products in the past).
When contacting beneficiaries to establish new relationships, a consent for future contact must
be limited in scope, short-term, and event-specific. The consent to contact may not be treated as
open-ended permission for future contacts. However, for agents contacting their own clients, or
plan sponsors (or contracted agents) contacting their current members, consent for each specific
contact is not required to discuss plan business.
NOTE: All plans sponsors must comply with § 170 regarding the use of beneficiary data as
related to telephonic contact. Also refer to § 80.1.9 for information about telephonic
script review and approval.
Prohibited telephonic activities include, but are not limited to, the following:
• Making unsolicited outbound calls to beneficiaries about other business as a means of
generating leads for Medicare plans (Examples of other lines of business include, but are
not limited to: a discount prescription drug card, a Medigap plan, a needs assessment, an
educational event, or a review of Medicare coverage options, or any other service or
product that is not an MA plan or PDP.)
• Calls to beneficiaries based on referrals resulting in an unsolicited contact. (e.g.,
referrals from friends, relatives, neighbors, or companies that collect, buy, or sell contact
information). If an individual would like to refer a friend or relative to an agent or plan
sponsor, the agent or plan sponsor may provide contact information such as a business
card that the individual may give to the friend or family member. In all cases, a referred
beneficiary needs to contact the plan or agent/broker directly. A call from an agent or
plan sponsor to a beneficiary who was referred would be considered an unsolicited
contact.
• Calls to former members who have disenrolled, or to current members who are in the
process of voluntarily disenrolling, to market plans or products, except as permitted
below. Members who are voluntarily disenrolling from a plan should not be contacted for
sales purposes or be asked to consent in any format to further sales contacts.
• Calls to beneficiaries who attended a sales event, unless the beneficiary gave express
permission at the event for a follow-up call (including a completed scope of appointment
form).
• Calls to beneficiaries to confirm receipt of mailed information, except as permitted
below.
Plan sponsors may do the following:
• Contact beneficiaries who submit enrollment applications to conduct quality control and
agent/broker oversight activities. Scripts for this purpose, like all other call scripts, must
be submitted to CMS for review and approval.
• Contact their members or use third-parties to contact their current members. Examples of
allowed contacts include, but are not limited to, calls to members aging-in to Medicare
from commercial products offered by the same sponsoring organization and calls to an
organization’s existing Medicaid plan members to talk about its Medicare products.
However, plan sponsors may not conduct unsolicited calls to their Medigap enrollees
regarding their, MA, Part D or section 1876 cost plan products.
• Contact members to promote other plan types (i.e., plans may contact their PDP
members to promote their MAPD offerings) and discuss plan benefits.
• Contact their members to discuss educational events.
• Contact their 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
surveys 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.
• Call beneficiaries who have expressly given permission for a plan or sales agent to
contact them, for example by filling out a BRC or asking a customer service
representative (CSR) to have an agent contact them. This permission applies only to the
entity from which the beneficiary requested contact, for the duration of that transaction,
for the scope of product (e.g., MA-PD plan or PDP) previously discussed or indicated in
the reply card.
• Return beneficiary phone calls or messages, as these are not unsolicited.
• Contact their members via an automated telephone notification to inform them about
general information such as the AEP dates, availability of flu shots, upcoming plan
changes and other important information.
Plan sponsors may not accept an MA plan or PDP appointment that resulted from an unsolicited
contact with a beneficiary (including if the call started based on a non-MA or non-PDP product).
We reiterate that any agent/broker representing a Medicare health plan is subject to the CMS
marketing requirements at any point in which a discussion with a beneficiary turns to Medicare
health plans, even if during the sale of an unrelated product, such as long-term care insurance.
(See scope of appointment guidance in § 70.9.1)
Finally, for those outbound calls (refer to § 70.4, 70.6, and 80) that are allowable under these
Medicare Marketing Guidelines, plan sponsors must comply to the extent applicable with the
following:
• Federal Trade Commission’s Requirements for Sellers and Telemarketers
• Federal Communications Commission rules and applicable State law
• National-Do-Not-Call Registry
• Honor “Do not call again” requests, and
• Abide by Federal and State calling hours
All outbound scripts utilized by the plan sponsor or its contractors must be submitted for review
and approval prior to being used in the marketplace. Please refer to § 80-Special Guidance on
Telephonic Activities and Scripts for additional guidance on outbound calls.
- - - - - - - - - - - - - - - - - -
https://www.cms.gov/ManagedCareMarketing/downloads/2012MMG.zip

 

[rousemark]

70.4 - Marketing through Unsolicited Contacts
(Rev. 96, Issued: - 5-17-11, Effective: 5-17-11, Implementation: 5-17-11)
42 CFR 422.2268(d), 423.2268(d)
As reflected in 42 CFR 422.2268(d) and 42 CFR 423.2268(d), there is a general prohibition on
marketing through unsolicited contacts. In general this prohibition includes the following and
may extend to other instances of unsolicited contact that may occur outside of advertised sales or
educational events. Some examples include:
• Door –to- door solicitation including leaving information such as a leaflet, flyer, or
door hanger at a residence, or leaving information such as a leaflet or flyer on
someone’s car.
• Approaching beneficiaries in common areas (e.g., parking lots, hallways, lobbies,
sidewalks, etc.)
• Telephonic or electronic solicitation including leaving electronic voicemail
messages, text messaging, or sending unsolicited e-mail messages.
NOTE: Agents/brokers who have a pre-scheduled appointment which becomes a “no-
show” may leave information at the no-show beneficiary’s residence.
The prohibition on marketing through unsolicited contacts does not extend to mail and
other print media (e.g., advertisements, direct mail) provided they are constructed and
approved in accordance with the information set forth in these Medicare Marketing
Guidelines. Leads may still be generated through mailings, websites, advertising and public
sales events. Refer to § 70.3 regarding email policy.
Plan sponsors will be held accountable for all actions of agents/brokers selling their products,
and plans/agents/brokers should be wary of any company selling beneficiary contacts that claims
to be permissible under our guidance. Plan sponsors should also note that Medicare Marketing
Guidelines and regulations apply to Medicare age-ins as well as existing beneficiaries.
In addition, permission given by a beneficiary to be called or otherwise contacted is to be
considered short-term, event-specific, and may not be treated as open-ended permission for
future contacts. All business reply cards (BRC) used for documenting beneficiary agreement for
a contact must be submitted to CMS for review/approval. Additionally, plan sponsors that
develop a BRC should include a statement on the BRC that by replying to this card, a sales
person may call you.
70.5 - Specific Guidance on Telephonic Contact
(Rev. 96, Issued: - 5-17-11, Effective: 5-17-11, Implementation: 5-17-11)
42 CFR 422.2268(d), 423.2268(d)
Because telephonic contact with Medicare beneficiaries is performed for a variety of reasons, the
following guidance has been developed to further clarify the scope of the restriction on
unsolicited contact. CMS makes a distinction between contact with beneficiaries to establish a
new relationship with a plan sponsor or independent sales agent, and contact that is with a plan
member or a beneficiary where a business relationship already exists (e.g., the agent has sold
the beneficiary non-Medicare products in the past).
When contacting beneficiaries to establish new relationships, a consent for future contact must
be limited in scope, short-term, and event-specific. The consent to contact may not be treated as
open-ended permission for future contacts. However, for agents contacting their own clients, or
plan sponsors (or contracted agents) contacting their current members, consent for each specific
contact is not required to discuss plan business.
NOTE: All plans sponsors must comply with § 170 regarding the use of beneficiary data as
related to telephonic contact. Also refer to § 80.1.9 for information about telephonic
script review and approval.
Prohibited telephonic activities include, but are not limited to, the following:
• Making unsolicited outbound calls to beneficiaries about other business as a means of
generating leads for Medicare plans (Examples of other lines of business include, but are
not limited to: a discount prescription drug card, a Medigap plan, a needs assessment, an
educational event, or a review of Medicare coverage options, or any other service or
product that is not an MA plan or PDP.)
• Calls to beneficiaries based on referrals resulting in an unsolicited contact. (e.g.,
referrals from friends, relatives, neighbors, or companies that collect, buy, or sell contact
information). If an individual would like to refer a friend or relative to an agent or plan
sponsor, the agent or plan sponsor may provide contact information such as a business
card that the individual may give to the friend or family member. In all cases, a referred
beneficiary needs to contact the plan or agent/broker directly. A call from an agent or
plan sponsor to a beneficiary who was referred would be considered an unsolicited
contact.
• Calls to former members who have disenrolled, or to current members who are in the
process of voluntarily disenrolling, to market plans or products, except as permitted
below. Members who are voluntarily disenrolling from a plan should not be contacted for
sales purposes or be asked to consent in any format to further sales contacts.
• Calls to beneficiaries who attended a sales event, unless the beneficiary gave express
permission at the event for a follow-up call (including a completed scope of appointment
form).
• Calls to beneficiaries to confirm receipt of mailed information, except as permitted
below.
Plan sponsors may do the following:
• Contact beneficiaries who submit enrollment applications to conduct quality control and
agent/broker oversight activities. Scripts for this purpose, like all other call scripts, must
be submitted to CMS for review and approval.
• Contact their members or use third-parties to contact their current members. Examples of
allowed contacts include, but are not limited to, calls to members aging-in to Medicare
from commercial products offered by the same sponsoring organization and calls to an
organization’s existing Medicaid plan members to talk about its Medicare products.
However, plan sponsors may not conduct unsolicited calls to their Medigap enrollees
regarding their, MA, Part D or section 1876 cost plan products.
• Contact members to promote other plan types (i.e., plans may contact their PDP
members to promote their MAPD offerings) and discuss plan benefits.
• Contact their members to discuss educational events.
• Contact their 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
surveys 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.
• Call beneficiaries who have expressly given permission for a plan or sales agent to
contact them, for example by filling out a BRC or asking a customer service
representative (CSR) to have an agent contact them. This permission applies only to the
entity from which the beneficiary requested contact, for the duration of that transaction,
for the scope of product (e.g., MA-PD plan or PDP) previously discussed or indicated in
the reply card.
• Return beneficiary phone calls or messages, as these are not unsolicited.
• Contact their members via an automated telephone notification to inform them about
general information such as the AEP dates, availability of flu shots, upcoming plan
changes and other important information.
Plan sponsors may not accept an MA plan or PDP appointment that resulted from an unsolicited
contact with a beneficiary (including if the call started based on a non-MA or non-PDP product).
We reiterate that any agent/broker representing a Medicare health plan is subject to the CMS
marketing requirements at any point in which a discussion with a beneficiary turns to Medicare
health plans, even if during the sale of an unrelated product, such as long-term care insurance.
(See scope of appointment guidance in § 70.9.1)
Finally, for those outbound calls (refer to § 70.4, 70.6, and 80) that are allowable under these
Medicare Marketing Guidelines, plan sponsors must comply to the extent applicable with the
following:
• Federal Trade Commission’s Requirements for Sellers and Telemarketers
• Federal Communications Commission rules and applicable State law
• National-Do-Not-Call Registry
• Honor “Do not call again” requests, and
• Abide by Federal and State calling hours
All outbound scripts utilized by the plan sponsor or its contractors must be submitted for review
and approval prior to being used in the marketplace. Please refer to § 80-Special Guidance on
Telephonic Activities and Scripts for additional guidance on outbound calls.
- - - - - - - - - - - - - - - - - -
https://www.cms.gov/ManagedCareMarketing/downloads/2012MMG.zip

This post is a perfect example of why I no longer sell Med Supp and will leave that to the rest of you fellows.. I do not need all the hassle involved with this line business at this stage in my life.