Medicare Module 4

payment of fees for laws, training, cert,etc., marketing budget provision, reimbursement for mileage

compensation does not include

fair market value cut off

compensation for initial year enrollments cannot exceed a fair market value published annually by the CMS

50 percent

compensation for renewal year enrollments cannot exceed ___ of the FMV cut off - can be less or not paid at all

commissions, bonuses, gifts, prizes or awards, referral or finder fees paid to agents/brokers

compensation includes

calendar year, jan 1, anniversary

compensation is paid on a ___ basis - thus regardless of the month of a beneficiary's initial year enrollment, the renewal year begins on ____ of the subsequent year, not on their __ date

is enrolled

compensation may only be paid for the months the beneficiary ___ in the plan

disclaimers

CMS may require that certain ___ or other information be included in marking materials

health care providers

CMS places strict limits on marketing by ___

setting, who may market, timing, contact, content

CMS regulates marketing activities in a variety of ways including:

approval, review

CMS requires that all marketing materials be submitted to CMS for ___ and/or ___

marketing, communications

cms regulates activities and materials based on whether they are __ or ___

marketing, communications

___ activies and materials are generally subject to a higher degree of regulation and oversight than ___

communication only

activites and material that provide information to current and prospective enrollees -contains no marketing content -does not have marketing intent (may contain content but deemed okay by cms)

rapid disenrollment

applies when an enrollee moves from one parent organization to another parent organization, or when an enrollee moves form one plan to another plan within the same parent organization

contact information, health screenings, meal, raffles, drawings

at marketing events agents may not: -require beneficiaries to provide ___ as a prerequisite for attending the event -conduct ___ or other activities that could give the impression of ____ -provide meals or multiple snacks/refreshments bundles and provided as if a ___, regardless of value -use information collected for __ and __ for other purposes

scope of appointment

before the personal marketing appointment begins, the agent and the beneficiary must complete a ___

enrollment, marketing, educational, presentations, enrollment

during individual appointments, marketing representatives may: -distribute plan materials such as an ___ kit or __ materials -provide __ information -conduct marketing __ -provide and collect __ forms

turning 65, 5-star, dual eligible, LIS, proactive request, one on one meetings, call center

during open enrollment period marketing representatives may conduct marketing activities that focus on other enrollment opportunities such as: -marketing to individuals ____ -marketing by ___ regarding their continuous enrollment SEP -marketing to ___ and ___ beneficiaries who in general may make changes once per calendar quarter during the first nine months of the year -send marketing materials when a beneficiary makes a __ __ -at the beneficiary's request have ___ with a sales agent -at the beneficiary's request, provide information on the OEP through the plans __ __

educational events

events designed to inform potential enrollees about medicare, including MA, Part D, or other medicare programs and do not include marketing activities

marketing sales event

events designed to steer potential enrollees toward a plan or limited set of plans or remain in their plans

independently, dual plan enrollment

for enrollments in two plans at once, the compensation rules apply ___ to each plan - this is known as ____

$15 or less

gifts are of nominal value if an individual item is worth __ or less based on the retail purchase price of the item

Cash or cash equivalents

gifts or prizes must not be in the form of ___ or other monetary reward or rebate even if their worth is less than $15

scope of appointment

identifying the types of products that will be discussed, obtain agreement form the beneficiary, and document that agreement - known as the _____

3, recouped

if a beneficiary disenrolls within the first __ months of enrollment, the entire compensation amount paid for the enrollment must be __, except under certain circumstances (page 92)

general audience marketing

includes direct mail, newspapers, magazines, television, radio, yellow pages, and the internet

benefits, premiums, cost sharing, comparisons, rankings, star ratings

marketing content: -information about __ or the structure -information about __ and ___ -___ to other plans Part D sponsors -___ or measurements about other plans/sponsers -information about ____

60-65

marketing representative must not pages ?

door to door, common areas, telephone calls, texts

marketing representatives are prohibied from making unsolicited contact with beneficiaries through: -____ solicitation -approaching beneficiaries in ___ such as parkign lots, hallways, etc. -_____ -___ and other forms of electronic direct message

health care services (exam room, pharmacy counter), common areas (cafeteria, recreational room, waiting room, retail pharmacy away from counter), communication

marketing representatives must not engage in marketing activities in areas where patients receive ____ but they may engage in activities in __ __ of health care settings and provide ___ mateiral to be distributed and displayed in the healthcare setting

marketing materials, talking points, presentations

marketing representatives must: provide to prospective enrollees only CMS-approved/submitted or created __ ___ and use only CMS approved ___ and ___ they are marketing

communications

materials and activities that promote and/or provide information to current and prospective enrollees on medicare health plans and part d plans

Ma, MAPD, PDP, section 1876 cost, medicare-medicaid

medicare marketing and communications rules apply to the following health plans

$75

multiple gifts given to a beneficiary on different occasions may not exceed __ aggregate, per person, per year

individuals, contract

plan marketing representatives include: ____ employed by a plan -individuals or entities under ___ to the plan through a direct or downstream contract

service area

plan sponsors and their marketing representatives may only market the star ratings in the ____ in which the star rating is applicable

commissions, retraining, suspension, termination, reporting

plan sponsors are repsonsible for ensuring compliance with CMS marketing regulation and guidance - if they see prohibited tactics occuring they must take corrective action such as: -withholding or withdrawing ___ -___ the representative -___ of marketing -____ of the representative -___ agent terminations to state departments of insurance and CMS

trained, tested, state licensure/appointment

plan sponsors may not pay agents when -they are not been __ and __ -they do not meet ____ requirements

mislead, income levels, health status, seniors

plans and their marketing representatives may not: -___, confuse, or provide materially inaccurate information to beneficiaries -target enrollees based on __ __ or __ __ -state or imply that the plans re only available to ___, rather than all eligible medicare beneficiaries

product type, date, contact information, written, verbal, not obligated, automatically

plans/part d sponsors are expected to include the following when documenting the SOA: - __ __ that the beneficiary has agreed to discuss during the appointment -__ of appointment -beneficiary __ ___ -__ or ___ documentation of beneficiary or appointed/authorized representative agreement - a statement that beneficiaries are __ ___ to enroll in a plan; their status wont be affect and explain that the beneficiary is not ___ enrolled in plans discussed

HIPAA compliant authorization, accident only, life, annuities

plans/part d sponsors must obtain ____ from an enrollee before the plan or part d sponsor may use information about the enrollee to market non-health related items or services such as ___ policies, __ policies or ___

25, 100

referral or finder's fees paid to the independent, captive, or employed agents may not exceed $__ for PDPs or $__ for all other types of plans

like plans

renewal year enrollments include plan changes between ___

marketing event, educational event

sales representatives may conduct a ___ immediately following an ___ in the same general location

contact, say

the CMS regulates how marketing representatives can __ potential enrollees and what they may __

star ratings information

this document must also be prominently posted on each plan's website

schedule an appointment at their request, use staff operating in social worker capacity to provide info, set up in common areas and allow residents to approach

what can you do at a long term care facility

evidence of coverage, summary of benefits, annual notice of change, provider directory, pharmacy directory, formulary

what documents are plans required to post on their website in a downloadable format

plan ratings information, summary of benefits, pre-enrollment checklist

when a beneficiary is provided with enrollment instructions/form, they must also receive

sales presentations, plan specific premiums, benefits, marketing, enrollment

when an event has been advertised as "educational", marketing representatives may not -conduct __ ___ -discuss, display, or distribute ___ __ __, ___ or marketing materials -engage in __ activities -distribute or collect ___ applications

combined

when more than one gift is offered on one occasion the __ value must not exceed $15