Event Compliance Training

1. Event Compliance Training

2. Types of Events - Educational • Informational presentation on Medicare topics • Neither sales nor marketing are permitted to take place.

3. Types of Events - Informal • Marketing/Sales events, also referred to as “lead generation” activities • Events are typically conducted in a less formal environment that allow a beneficiary to walk up to an agent & learn more about product offerings with a less structured presentation • These events sometimes utilize a table, kiosk or a recreational vehicle (RV) that is manned by a plan sponsor representative who can discuss the merits of a plan’s products

4. Types of Events - Formal • Marketing/Sales events are usually structured in an audience/presenter style • Sales person or plan formally providing specific plan sponsor information via a presentation on the products being offered • The presenter usually presents to an audience that may have been invited to attend

5. Marketing/Sales Events • Sales seminar or presentation that a broker hosts aimed at promoting specific benefits and/or services • CANaccept & perform enrollments at event • These events must be submitted to compliance prior to advertising • These events must be submitted to AGA for submission to a carrier at least 7 days prior to the event (preferably by the 10th of the month prior)

6. Educational Events • Events designed to inform beneficiaries about Medicare information and programs • May not include any sales/marketing activities (e.g. giveaways, business cards, prize wheel) • Must be advertised as “Educational” • You have the option to submit these events to CMS

7. Provider Marketing Events • Marketing activities are permitted in common areas of health care settings • Marketing activities are prohibited in any areas where patients receive health services (e.g. exam/waiting room) • Appointments with beneficiaries residing in long term care facilities must only take place upon request of beneficiary

8. Health Fairs Educational No marketing materials permitted Cannot accept enrollment forms Cannot accept lead information Cannot hand out business card or any marketing materials with contact information Marketing Pre-enrollment materials are permitted You can accept enrollment forms Can collect lead information from attendees Can hand out business Cards or marketing with contact information

11. *All producers are required to submit the completed Scope of Appointment for with each enrollment application (see page XX for an example).

12. Compliant Presentation Tips • Always identify the types of plans you will be covering (Formal) • Explain eligibility requirements (Formal, Informal, *Educational) • Explain enrollment/disenrollment periods (Formal, Informal, Educational) • Explain premiums, co-insurance & co-pays (Formal) • If using a PowerPoint or flipbook to guide you, be sure to cover all slides within your presentation • Benefits Information (Formal) • Medicare tips/Information (Informal)

13. Compliant Presentation Tips • Show up early and be where you said you’d be • Do not make absolute statements (e.g. “X plan is the best!” or “extraordinary”) • Do not use high pressure tactics • Do not make inaccurate statements • See guidebook for a more detailed listing of what to cover

14. Basic Medicare Comprehension • Part A [Hospital] coverage requires a monthly premium • Part B [Medical] coverage does not cover expenses outside the US • Part C [Medicare] plans must cover Part A & B expenses • Special Needs Plans (SNP) are only for beneficiaries with special healthcare needs and those with Medicare & Medical • There is financial assistance for Part B & D [Prescription Drug] premiums for low income households

15. Basic Medicare Comprehension • The earliest one may be eligible to submit an enrollment for Medicare Advantage is 64 years, 9 months old UNLESS they have ESRD or certain chronic illnesses • Annual Enrollment Period is October 15 - December 7 • Understand how the Disenrollment Period works(January 1 – February)

16. Basic Medicare Comprehension • A senior may choose to solely be covered by Medicare and does not need to enroll on another type of plan • Make sure to check that the beneficiary’s doctors/specialists accept the plan FIRST • Not all Medicare Advantage plans cover prescription drugs • Compare drug plan costs and find the plan with the least out of pocket expense

17. Basic Medicare Comprehension • Understand the “donut hole”and how it works • Only RX amounts paid when in the hole apply towards TROOP (true out of pocket costs) • Catastrophic Coverage begins when the beneficiaries TROOP = $4,550 • When in the hole, beneficiary will only be responsible for 50% of the brand name drugs’ manufacturer cost plus a $2 dispensing fee

18. Personal/Individual Appointments • Typically take place in a beneficiaries home • Face to face appointments are considered marketing/sales events by CMS • Scope of Appointment is required for all personal appointments

19. Questions