Prospecting Compliancy Questions - MA Plans

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Hi All,

I'm hoping that you can help me determine whether this is a compliant way to meet with Medicare Advantage clients. As you all know PFFS plans are coming to an end in counties that have at least 2 HMO or PPO plans available. So there are many enrollees who are currently on PFFS plans who need to be rolled over to HMO or PPO plans, or just lose coverage.

I took a part-time gig during the down season and have been working nights. A company needed licensed insurance agents to process claims, the work sucks, but its extra income with a decent hourly wage. There are about 50 licensed agents who've taken jobs at this place.

There is a lady I work with who, for the last 3 years, was an agent selling MA plans. She got fed up with the rules and regulations and decided to retire. She has several clients who are about to lose their PFFS plans due to the changes in CMS rules and she doesn't want to mess with getting certified and she doesn't want any more customer service calls on weekends. She calls most of these people her "Hell Clients." She offered to give me her clients who are losing their plans if I agree to take all customer service calls and make them solely my clients.

If she calls her clients and tells them that she has retired and refers them to me is that a compliant way for me to go and sign them under a new HMO or PPO plan? I can't find anything in the regs about this. I obviously do not want to do anything unethical. But she is the agent of record, I'm just not sure if I can approach without them coming to me or without the prospect initiating the contact between us.

Please let me know your thoughts.
 
So there are many enrollees who are currently on PFFS plans who need to be rolled over to HMO or PPO plans, or just lose coverage.

I believe they will have another option besides taking either an HMO or PPO.

All of those people who are losing their PFFS plan will have GI to take a Med Supp.
 
You cannot contact them for Medicare Advantage because they are not your clients. She could call them and have them contact you, or you could send out a letter to them (which will probably get discarded with the rest of the mail pieces seniors are receiving right now).

They must initiate the contact.
 
Hi All,

I'm hoping that you can help me determine whether this is a compliant way to meet with Medicare Advantage clients. As you all know PFFS plans are coming to an end in counties that have at least 2 HMO or PPO plans available. So there are many enrollees who are currently on PFFS plans who need to be rolled over to HMO or PPO plans, or just lose coverage.

I took a part-time gig during the down season and have been working nights. A company needed licensed insurance agents to process claims, the work sucks, but its extra income with a decent hourly wage. There are about 50 licensed agents who've taken jobs at this place.

There is a lady I work with who, for the last 3 years, was an agent selling MA plans. She got fed up with the rules and regulations and decided to retire. She has several clients who are about to lose their PFFS plans due to the changes in CMS rules and she doesn't want to mess with getting certified and she doesn't want any more customer service calls on weekends. She calls most of these people her "Hell Clients." She offered to give me her clients who are losing their plans if I agree to take all customer service calls and make them solely my clients.

If she calls her clients and tells them that she has retired and refers them to me is that a compliant way for me to go and sign them under a new HMO or PPO plan? I can't find anything in the regs about this. I obviously do not want to do anything unethical. But she is the agent of record, I'm just not sure if I can approach without them coming to me or without the prospect initiating the contact between us.

Please let me know your thoughts.

Just call them and tell them that "so & so" has retired and you are now servicing her clients if they need anything.
Thats it, sell them a med supp and be done with it. The disenrollment is a get a "jail free card" for them (GI to med supp).
 
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Just call them and tell them that "so & so" has retired and you are now servicing her clients if they need anything.
Thats it, sell them a med supp and be done with it. The disenrollment is a get a "jail free card" for them (GI to med supp).

These are lower income folks who were on no premium MA plans. The agent that I'm working with said she doesn't think any of them would be willing to pay a monthly premium, that's why I was going to keep them with another MA plan. The AARP HMO is a $0 premium plan.
 
These are lower income folks who were on no premium MA plans. The agent that I'm working with said she doesn't think any of them would be willing to pay a monthly premium, that's why I was going to keep them with another MA plan. The AARP HMO is a $0 premium plan.

I'll try to help.

I see no reason you can't design a simple letter explaining your friend has retired, and as a courtesy she requests her clients needing help to feel free to contact you regarding their enrollment options and questions. Have her sign it, run signed copies mailed to their home from her address- that should get their attention and be sure to incude your card & contact info.
If I'm out of line- someone will jump in here- just don't cold call them first.
 
Sounds like you're going to have a busy AEP and a nice boost to your book and potential additional referrals, after the sale of course, not during or while in the home on the appt. The best scenario is to have her call each of them even if she leaves a message with your contact info urging them to call you for the "transition".

Congrats!

BTW, here in PA, PFFS plans are not necessarily going away as originally thought, it's a wait and see at the moment. So, Humana, and Today's Options may still offer PFFS in 2012.
 
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