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Compliance

In an industry of rules and guidelines that are constantly changing from different regulatory bodies, compliance can be a very scary thing for agents and agencies selling and marketing Medicare products. It doesn't have to be, we're here to help; in fact it's part of our job!

Our staff, leadership team, and full-time compliance officer all have an in-depth understanding of what you can and can't do when selling Medicare products. We'll ensure that whether you're selling over the phone or in person you know what you can and cannot do.

Here are some of the most common trends in agent compliance infractions, and items that CMS is very focused on at the moment

Agent who fail to review or read aloud the proper disclaimers or statement of understanding. When conducting a sale in person, it is on the last page of the paper application before the beneficiary signs. If it's a telephonic enrollment over the phone, it will be in the disclaimers at the end and you are required to read them aloud on a recorded line and have the consumer say "yes" or agree. No consent to enroll provided. This infraction occurs when a beneficiary tells an insurance carrier that they never gave the agent permission to enroll them in a plan or they did not understand that they were actually changing their insurance benefits. Agents need to be very transparent in plan and benefit presentation so consumers understand they are altering or changing their insurance coverage by completing an enrollment. It cannot be under the guise of simply performing a small update or enhancing benefits without disclosing that their plan coverage is changing.

Agents fail to do a proper needs analysis during the sales encounter process and have rapid disenrollments. Most commonly, we see that agents review copays or coinsurance, but don't properly review all the prescription drugs, doctors, facilities and providers that the beneficiary may be utilizing. Within a very short period of time the consumer suddenly has a plan that does not fit their health care needs and they cancel the plan due to poor needs analysis and recommendation by the agent. An agent sends out marketing pieces or conducts activities that are not compliant or approved. Generic marketing pieces such as direct mail, trifolds, websites, radio ads, call scripts and any other form of advertisement we can now file on your behalf with CMS and get a CMS approval number on your piece, prior to your advertising. Contact us today to help you with this process.

Specific questions or concerns regarding compliance? Send an email to [email protected]. We'll respond within 24 hours to your request.