Can They Do That??? SMP Resource Center Webinar February 24, 2009 Hilary Dalin, My Medicare Matters, NCOA Vicki Gottl

1. Can They Do That???SMP Resource Center WebinarFebruary 24, 2009 Hilary Dalin, My Medicare Matters, NCOA Vicki Gottlich, Center for Medicare Advocacy

2. What We’ll Cover Introduction and background Distinguishing between marketing and education Marketing rules – the highlights Unsolicited contacts Scope of sales appointments Nominal gift limitation Meals prohibition Co-branding limitations Agent/broker requirements Remedies and Enforcement Ok or Not OK – let’s learn together

3. Marketing vs. Education • Marketing is • Any promotion of a specific plan • Any steering towards one plan over other plans in same line of business • Line of business: Medicare Advantage, Part D, Medigap • Education is: • General or specific information about Medicare, prescription drug coverage, and/or Medicare Advantage

4. Unsolicited marketing contacts No door-to-door “cold” contacts No outbound calls, not even to confirm receipt of mailed information Very few exceptions: Permissible un-requested outbound calls: To Extra Help members being reassigned, subject to prior approval by CMS of call scripts To conduct “normal business” of the plan, including informing members of additional products available through the plan sponsor By express permission of the beneficiary, or by the agent/broker who enrolled the member

5. Unsolicited marketing contacts No post-event solicitations in lobbies, or parking lots No marketing at educational events Can’t do back-to-back education and sales events Can’t say “come out to my car; I’ve got enrollment forms there”

6. Scope of sales appointments Line of business to be discussed must be identified in advance, and Documented by the plan in writing or via recording phone calls To market additional lines of business beyond what was agreed to in advance, the beneficiary must: request in advance again, with at least a 48 hour cooling off period, and a new appointment must be arranged These requirements have not been waived by CMS If neighbors just happen to be present, they must sign a scope of appointment, but the waiting period is waived Line of business is PDP, Medicare Advantage or Medigap

7. Nominal gifts limitation Plans may give gifts to those attending marketing events Only for attending, must be clear the gift is not conditional upon enrolling Limited in value to $15 retail May not be convertible into cash – no gift certificates

8. Meals prohibition No meals may be served or subsidized at marketing events Where plans are discussed Where plan materials are handed out or are made available Snacks are ok, but may not be “bundled” into meals

9. Co-branding limitations Name and logo of co-branded providers may not be on plan membership card Name and/or logo of co-branded providers may be on other marketing materials only if: Accompanied by a disclaimer that other providers are in-network If a provider is the exclusive provider, such as if there is only one hospital in the network If the member has selected a provider, such as a primary care provider (PCP)

10. Agents/Brokers requirements Training and Testing All plan contracted and staff agents/brokers must be trained on: Medicare rules and regulations Plan-specific coverage and procedures All agents/brokers must pass a test with a score of at least 85 percent by the end of calendar year 2009

11. Agents/Brokers requirements State appointment rules must be obeyed All agents and brokers marketing Medicare plans must be state-licensed They must obey state appointment rules, including paying any state appointment fees, unless plan pays on their behalf Customer service representatives do not need to be state-licensed, as long as the scope of their activities is limited to: Answering questions with factual information Arranging for delivery of plan materials Completing enrollments at the request of your client on an inbound call

12. Agents/Brokers requirements Termination of agents/brokers must be reported to state licensure agency Reporting must comply with state appointment laws Must include the reason for the termination

13. Agents/Brokers requirements Agent/broker compensation Designed to reduce “churning”, “cherry-picking” and “lemon-dropping” Effective 2009, agent/broker compensation for sales must be structured over a 6 year period Generally $400 for new enrollment and $200 for a renewal Compensation is adjusted for “early” switches to different “lines of business” - Examples: PDP to MA plan MA plan to Original Medicare with Medigap

14. Agents/brokers selling Part D and Medicare Advantage plans may not Represent they come from or were sent by Medicare, Social Security, or Medicaid Request Social Security numbers, bank or credit card info Transfer outbound calls to inbound call centers Require a face-to-face meeting to provide plan details

15. Remedies and Enforcement Two essential and inter-related components to resolving any marketing issue: Individual remedies for your client Retroactive disenrollment/Special Enrollment Period options Plan Make sure the plan knows at the highest level CEO Government Relations Compliance MEDIC CMS Regional Office Systemic enforcement to prevent recurrence of the problem

16. OK or Not OK Now it’s time to learn together Let’s talk about some of the scenarios that have frequently occurred Remember to put your phones on mute if you aren’t talking DON’T put us on hold!

17. Ok or Not Ok? Your client calls the plan “800” number, asks to enroll and enrollment is completed Plan broker books a seminar at the local Applebee’s and caters lunch for attendees Plan agent puts an attendance sign-in sheet at the door of an educational event Mrs. Jones, a dual, was enrolled by an agent in a PFFS plan on September 3, 2008 during the agent’s visit to her senior housing complex

18. Ok or Not Ok? A PDP places robo-calls within zip codes in a major metropolitan area that contain the highest percentages of older residents Four agents, each representing a different Medicare Advantage plan (two SNPs, a PFFS, and a national PPO) set up a booth in the parking lot outside the Medicaid office Mrs. Jones gets a call from Mr. Smith who says he is from a large MA plan sponsor and wants to tell her about all the great features she’s missing out on that are really valuable and cheap

19. Ok or Not Ok? A physicians practice promotes free flu shots at their educational session “All About Medicare” open to “Medicare eligible seniors”. Would it make a difference if this practice only accepts new patients who belong to certain Medicare Advantage plans? A Medicare Advantage plan opens a Care Center in the local mall. They offer ice cream socials, pizza socials, and blood pressure screening (guess folks will need those after all that high fat food!), along with meeting “leading physicians” An insurance salesman volunteers to call bingo at the largest senior center in the area. What if he gives all attendees a gift package that includes his card?

20. Ok or Not Ok? The local senior and disabled housing complex program director declines an agent’s offer of a free forum on Medicare, and the agent accuses the director of depriving him of his First Amendment rights and suggests he might sue the management company that runs the complex And what are YOU encountering?

21. Contact Info Hilary Dalin Associate Director My Medicare Matters, National Council on Aging (202) 479-6626 hilary.dalin@ncoa.org Vicki Gottlich Senior Policy Attorney Center for Medicare Advocacy (202) 293-5760 Ext 103 vgottlich@medicareadvocacy.org Resources can be found on www.MyMedicareCommunity.org: http://www.mymedicarecommunity.org/library/advantage/Articles/marketing.php