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Event Compliance Training. Types of Events - Educational Informational presentation on Medicare topics Neither sales nor marketing are permitted to take.

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Presentation on theme: "Event Compliance Training. Types of Events - Educational Informational presentation on Medicare topics Neither sales nor marketing are permitted to take."— Presentation transcript:

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 plans 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 CAN accept & 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 10 th 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 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 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

9 Definitions/ Permissible Activities Marketing/Sales Event Personal/ Individual Sales Appointment Marketing in the Health Care Setting Educational Event Health Fair Principle Purpose Selling Formal/Informal Selling EducationEducational/Selling Reportable to CMSYesNoYesYes/optionalYes Scope of Appointment (SOA)* No (Unless they require a 1 on 1 following the presentation) Yes No (Unless they require a 1 on 1 following the presentation) No No (Unless they require a 1 on 1 following the presentation) Ability to set up a future appointment Yes (Scope required prior to appt, unless walk- in to sales office) No Educational – No Selling – Yes (Secure SOA) Future contact Permission to Contact (Lead Card) Yes, if prospect wants agent to contact them after a meeting NoYesNo Educational-No Selling-Yes Attendance Sheet Formal-Yes (Cant be a requirement) Informal-No NoYesNo Light Snacks and refreshments only Yes Yes (Meals are permitted) Educational-Yes Selling-Yes Informational guides, promotional items and banners Yes Educational-Yes Selling-Yes

10 Definitions/ Permissible Activities Marketing/Sales Event Personal/ Individual Sales Appointment Marketing in the Health Care Setting Educational Event Health Fair Principle Purpose Selling Formal/Informal Selling EducationEducational/Selling Distribution of Business Cards Please Note: CMS clarified business cards may NOT be stapled to any marketing material. Stickers with agent contact information may NOT be applied to any approved materials, doing so is altering what was approved by CMS. YesNoYes Yes (Upon request by the beneficiary) Educational – Yes (Upon request by the beneficiary) Selling – Yes Ability to conduct plan- specific sales presentation Formal - Yes (Full Presentation) Informal – No Yes (Full Presentation) YesNo Educational – No Selling – No Marketing Materials approved by CMS Yes Educational – Yes Selling – Yes Distribution of Benefits at a Glance Yes No Educational-No Selling-Yes Distribution of Pre- Enrollment Kits (SBs and Apps) Yes (Complete Kit) Yes NoEducational – No Selling – Yes

11 Definitions/ Permissible Activities Marketing/Sales Event Personal/ Individual Sales Appointment Marketing in the Health Care Setting Educational Event Health Fair Principle Purpose Selling Formal/Informal Selling EducationEducational/Selling Advertisement needs to include scope of product language and disclaimers Formal – Yes Informal – No Yes No Educational – No Selling - Yes Advertisement needs to include educational event disclaimer No Yes Educational – Yes Selling - No Advertisement needs to be approved by CMS Yes Educational-Yes Selling Yes Compliant (e.g., non- steering) provider participation – Guest Speaker YesNoYes Educational-Yes Selling-Yes Accept enrollmentsYes NoEducational-No Selling-Yes *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 youd 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 beneficiarys 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


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