1. Monthly Compliance Training
November 2016
AEP/OEP Best Practices

2. Exchange Federal Subsidies
Household Income (what is reported on Income Tax filing) must be used even if the customer does not want to use it.
Couples separated but filing taxes together the total income must be used for the subsidy calculation.
To qualify for either premium tax credits or cost sharing reductions, members of the household must not be eligible for health insurance from other sources
Including employer plans, Medicare, Medicaid or other government sponsored plans such as VA coverage.

3. Agent Responsibility Insurable Interests:
Agents have a responsibility to ensure all insurance transactions are compliant.
Compliant insurance transactions apply to all parties, agents, consumers and insurance companies.
Complete a level of due diligence to ensure:
Applicant for an insurance policy is the actual person.
Payment information for the policy belongs to the insured.
Intent for issuance of an insurance policy is to only benefit the insured not a third party.
For example: Several referrals are received from one person who is helping individuals get insurance. Why are they helping individuals and what is the benefit to the referee?

4. Agent Responsibilities
Departments of insurance expect agents to keep thorough records including:
Contact with a client including dates, times and location
Specifically why a client chose a particular plan/type of coverage, policy changes, etc.; for example:
Dental insurance was purchased because their daughter Stacy will need braces in about a year.
Client’s friend Jack had a stroke and wasn’t able to work for 6 months and it put a strain on paying bills. The client chose a critical illness plan because they didn’t want the strain should anything happen to them.
Client asks the agent to cancel their coverage. The agent sent an to the client stating the cancellation request would need to come from them and provided the carrier’s telephone number.
All names used in this example are fictitious characters.

5. Protecting Private Information
Customers trust HealthMarkets agents with private and secured information.
Agents must secure PHI and PII which includes encrypting any device you use to conduct HealthMarkets business.
Agents must report the theft of technology containing secured information to local police within 24 hours.
Agents are required to report any breach of secured information within 24 hours

6. Protecting Private Information
Did you know that the number 1 agent breach of customer information is responses?
Agents receive private information (i.e. social security numbers, banking information, health information etc.) from customers on a daily basis.
Agents not deleting private customer information or creating a new before sending a response (even if the information was not solicited by the agent) exposes the information and breaches PII/PHI.

7. Code of Ethics and Professional Conduct
HealthMarkets expects contracted agents to be ethical at all times.
Examples of ethical behavior include:
Ensuring clients know what coverages they purchased and the premium associated with each plan.
Ensuring the client is not paying for coverage that doesn’t fit their needs or budget.
Ensuring the client understands that supplemental coverage is optional and not required to get health insurance.
Speaking up when you see unethical behavior and not just looking the other way.
Ensuring applications for insurance are completed accurately and truthfully.

8. Code of Ethics and Professional Conduct
Other examples of professional behavior
Being respectful of other agent’s, carrier representative’s and HealthMarkets’ employee’s time.
Refraining from personal or inappropriate comments to other agents, carrier representatives or HealthMarkets’ employees.
Being respectful during training classes and not using the event to voice personal dissatisfactions or complaints towards other agents, insurance carriers or HealthMarkets.
Maintaining composure and refraining from yelling, name calling or being irate towards other agents, customers, carrier representatives or HealthMarkets’ employees.

9. Medicare Reminders
Allow 48 hours to pass from when the Scope of Appointment (SOA) was signed by the beneficiary before conducting a sales appointment.
Update the SOA if the beneficiary decides to discuss additional products not initially indicated.
The expectation around discussing additional products after initial completion of the SOA is that the act would be rare and not a normal occurrence.

10. Medicare Reminders Agents must
Provide a copy of the SOA to the carrier when submitting the application
Keep a copy for 10 years
Upload a copy to the Resource Center
Agents must follow carrier requirements when conducting Marketing/Sales Events.
Agents must be on time and remain at the venue for at least 30 minutes after formal events and the entire scheduled time for informal events.
When conducting Medicare Events agents must explain the sponsors’ Star Ratings.

11. Medicare Reminders- cont.
Agents are measured by carriers for:
Rapid Disenrollment (client cancels after enrollment but before effective date of coverage)
Cancellations (client cancels within 3 months of effective date)
Late Applications (applications must be sent to carrier within 24 hours of the date the agent signed the application)
Unauthorized Sales (agent was either not licensed, appointed or certified)
Complaints