2 Types of Events - Educational Informational presentation on Medicare topicsNeither sales nor marketing are permitted to take place.
3 Types of Events - Informal Marketing/Sales events, also referred to as “lead generation” activitiesEvents 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 presentationThese 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 styleSales person or plan formally providing specific plan sponsor information via a presentation on the products being offeredThe 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 servicesCAN accept & perform enrollments at eventThese events must be submitted to compliance prior to advertisingThese 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 EventsEvents designed to inform beneficiaries about Medicare information and programsMay 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 settingsMarketing 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 Educational Pre-enrollment materials are permittedYou can accept enrollment formsCan collect lead information from attendeesCan hand out businessCards or marketing withcontact informationEducationalNo marketing materials permittedCannot accept enrollment formsCannot accept lead informationCannot hand out business card or any marketing materials with contact information
9 Definitions/ Permissible Activities Marketing/Sales Event Personal/ Individual Sales AppointmentMarketing in the Health Care SettingEducational EventHealth FairPrinciple PurposeSelling Formal/InformalSellingEducationEducational/SellingReportable to CMSYesNoYes/optionalScope of Appointment (SOA)*No (Unless they require a 1 on 1 following the presentation)Ability to set up a future appointmentYes (Scope required prior to appt, unless walk-in to sales office)Yes (Scope required prior to appt, unless walk-in to sales office)Educational – No Selling – Yes (Secure SOA)“Future contact” Permission to Contact (Lead Card)Yes, if prospect wants agent to contact them after a meetingEducational-No Selling-YesAttendance SheetFormal-Yes (Can’t be a requirement) Informal-NoLight Snacks and refreshments onlyYes (Meals are permitted)Educational-Yes Selling-YesInformational guides, promotional items and banners
10 Definitions/ Permissible Activities Marketing/Sales Event Personal/ Individual Sales AppointmentMarketing in the Health Care SettingEducational EventHealth FairPrinciple PurposeSelling Formal/InformalSellingEducationEducational/SellingDistribution 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 (Upon request by the beneficiary)Educational – Yes (Upon request by the beneficiary) Selling – YesAbility to conduct plan-specific sales presentationFormal - Yes (Full Presentation) Informal – NoYes (Full Presentation)Educational – No Selling – NoMarketing Materials approved by CMSEducational – Yes Selling – YesDistribution of Benefits at a GlanceEducational-No Selling-YesDistribution of Pre-Enrollment Kits (SBs and Apps)Yes (Complete Kit)Educational – No Selling – Yes
11 Definitions/ Permissible Activities Marketing/Sales Event Personal/ Individual Sales AppointmentMarketing in the Health Care SettingEducational EventHealth FairPrinciple PurposeSelling Formal/InformalSellingEducationEducational/SellingAdvertisement needs to include scope of product language and disclaimersFormal – Yes Informal – NoYesNoEducational – No Selling - YesAdvertisement needs to include educational event disclaimerEducational – Yes Selling - NoAdvertisement needs to be approved by CMSEducational-Yes Selling YesCompliant (e.g., non-steering) provider participation – Guest SpeakerEducational-Yes Selling-YesAccept enrollmentsEducational-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 presentationBenefits Information (Formal)Medicare tips/Information (Informal)
13 Compliant Presentation Tips Show up early and be where you said you’d beDo not make absolute statements (e.g. “X plan is the best!” or “extraordinary”)Do not use high pressure tacticsDo not make inaccurate statementsSee guidebook for a more detailed listing of what to cover
14 Basic Medicare Comprehension Part A [Hospital] coverage requires a monthly premiumPart B [Medical] coverage does not cover expenses outside the USPart C [Medicare] plans must cover Part A & B expensesSpecial Needs Plans (SNP) are only for beneficiaries with special healthcare needs and those with Medicare & MedicalThere 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 illnessesAnnual Enrollment Period is October 15 - December 7Understand 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 planMake sure to check that the beneficiary’s doctors/specialists accept the plan FIRSTNot all Medicare Advantage plans cover prescription drugsCompare 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 worksOnly RX amounts paid when in the hole apply towards TROOP (true out of pocket costs)Catastrophic Coverage begins when the beneficiaries TROOP = $4,550When 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 homeFace to face appointments are considered marketing/sales events by CMSScope of Appointment is required for all personal appointmentsRemove this slide and add to events for “Lead Follow Up”
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