Ensuring Beneficiary Protection Marketing Do’s and Don’ts Camille J. Brown Marketing Policy Lead Division of Surveillance, Compliance & Marketing Medicare Drug & Health Plan Contract Administration Group

Ensuring Beneficiary Protection CMS uses several mechanisms to ensure beneficiary protection and that plans are compliant with the Marketing Guideline requirements Prospective and retrospective review of marketing materials Marketplace surveillance Partnership with states and beneficiary advocates 2

Unsolicited Contact and Outbound Telemarketing Plan Sponsors may not: – Solicit Medicare beneficiaries door-to-door – Leave leaflets, door hangers or flyers at a prospect’s home – Conduct unsolicited calls to their Medigap enrollees regarding their MA, PDP or 1876 cost plan products – Send unsolicited s, text messages or voic s to a beneficiary – Require an address or other contact information as a condition of enrollment – Contact beneficiaries to ensure receipt of mailed information 3

Unsolicited Contact and Outbound Telemarketing (cont.) Plan Sponsors may not: – Make calls to beneficiaries that resulted from a referral – Make calls to former members that have disenrolled or to current members that are in the process of disenrolling – Make calls to beneficiaries that attended a sales event unless permission given 4

Unsolicited Contact and Outbound Telemarketing (cont.) Plan Sponsors may not: – Make calls to beneficiaries about other lines of business o Example-Medigap plan, or discount drug card – Make calls to beneficiaries that resulted from a referral – Make calls to former members who have disenrolled or to current members who are in the process of disenrolling – Make calls to beneficiaries who attended a sales event unless permission given 5

Unsolicited Contact and Outbound Telemarketing (cont.) Plan Sponsors may: – Contact beneficiaries who have expressly given permission – Contact their own clients to discuss new plan options – Initiate a phone call to confirm an appointment – Contact their members to discuss educational events – Contact former members after the disenrollment date to conduct disenrollment survey – Return beneficiary phone calls 6

Marketing and Promotional Activities 7 CITY HEALTH Small Town NY Plan Sponsors may not: State that the agent represents Medicare or the Federal Government Send communications to beneficiaries that resemble government mailings Use marketing material that was not approved by CMS through a contracted Plan or sponsor

Marketing and Promotional Activities (cont.) Plan Sponsors may not: – Request beneficiary identification numbers – Misrepresent a product being marketed as an approved Part D, MA or MA-PD Plan when it is actually a Medigap policy or non-Medicare drug plan – Market non-health related products (such as annuities and life insurance) to potential enrollees during a MA or PDP sales activity or presentation – Offer gifts of more than $15 to potential enrollees – Provide meals at promotional activities or sales events 8

Marketing and Promotional Activities (cont.) Plan Sponsors may not: – Require a face-to-face appointment to provide plan information – Return uninvited to an earlier “no show” – Use high pressure sales tactics – Encourage beneficiaries to enroll or not enroll based on their current health status – Distribute marketing materials during an educational event 9

Marketing and Promotional Activities (cont.) Plan Sponsors may: – Provide light refreshments and snacks to potential enrollees – Offer promotional gifts to potential enrollees as long as gifts are of nominal value and provided whether or not the individual enrolls in the plan – Leave information at the beneficiary’s residence if the pre-scheduled appointment was a “no show” – Leave cards behind for clients to give their friend or family – Distribute marketing materials including enrollment forms during a sales event or individual appointment 10

Ensuring Beneficiary Protection in Healthcare Settings Plan Sponsors may not: – Conduct sales presentations, distribute and accept enrollment applications where patients receive care – Restricted areas include: o Waiting rooms o Pharmacy counter areas o Exam rooms o Hospital patient rooms 11

Ensuring Beneficiary Protection in Healthcare Settings (cont.) Plan Sponsors may: – Conduct sales presentations, distribute and accept enrollment applications based on the following: o Activity takes place in a common area o Common areas are: hospital or nursing home cafeterias, community or recreational rooms and conference rooms o Patients are not mislead or pressured into participating 12

Ensuring Beneficiary Protection in Healthcare Settings (cont.) Plan Sponsors may: – Conduct the following in LTC facilities o Display posters o Include materials in admission packets o Provide residents that meet I-SNP criteria a brochure for each I-SNP with which the facility contracts 13

Resources Subpart C Benefits and Beneficiary Protections (42 CFR and ) Subpart V Medicare Advantage Marketing Requirements and Subpart V Part D Marketing Requirements( 42 CFR 422 and 423 ) CMS Marketing Webpage: Health Plans-General Information: / / 14

Conclusion Q & A Additional questions may be sent to Any important links/references 15