Medicare Advantage/Part D Marketing Guidelines

1

• Medicare Advantage/Part D Marketing Guidelines

2
Marketing Provisions

• All beneficiary communication materials require
  CMS review/approval prior to distribution.
• All plan specific materials must show the
  Marketing Material ID and approval date, Federal
  Contracting Statement and the Standard Plan Type.
• Disclaimers may be required.
• CMS generated materials do not require review

3
Enrollment Kit

• Required Materials in Enrollment Kit
• Enrollment Form with Instructions
• Grievance /Appeals Information
• Plan Ratings
• Summary of Benefits
• Distributed by Plan within 10 days following CMS
  confirmation or last day of 1st month of
  enrollment
• Provider/Pharmacy directory
• Comprehensive/Abridged formulary
• Evidence of Coverage
• ID Card

4
Marketing/Sales Events

• Events designed to steer or attempt to steer
  potential enrollees toward a plan or set of
  plans.
• May discuss plan benefits, premium, cost-sharing
• Distribute or collect applications
• All Sales Events scheduled or cancelled must be
  reported to the Plan

5
Promotional Activity Reminders

• Promotional Nominal Gifts
• Can can offer gifts to potential enrollees
• Must be worth 15 or less, based on retail value
  of the item
• Non-conditional - must be given whether
  beneficiary enrolls or not
• Cash gifts are prohibited

6
Promotional Activity Reminders

• Prohibition of Meals
• Plan sponsors may not provide meals or have
  meals provided to prospective enrollees at
  sales/marketing events (any events where
  marketing materials are distributed or enrollment
  forms gathered.
• Light snacks and refreshments are permitted
  (lt15 nominal value)

7
Promotional Activity Reminders

• Prohibited Telephone Contact
• Unsolicited outbound calls about other business
  as a means to generate leads
• Calls based on referrals (friends, family,
  purchased lists)
• Calls to sales event attendees, unless scope of
  appointment was given
• Calls to confirm receipt of mailed info

8
Promotional Activity Reminders

• Unsolicited contact prohibited
• Door-to-door
• Flyers on cars or doorways
• Outbound calls, voicemail, texts
• Approaching beneficiaries in common areas (lobby,
  parking lot, hallways)
• Outbound calls/visits after attending sales event
  unless Scope of Appt given
• Unsolicited emails

9
Promotional Activity Reminders

• Cross Selling
• Prohibited during any sales activity
• Cannot market non-health related products
• Annuities
• Life insurance
• Other products
• Allowed on inbound calls if requested

10
Promotional Activity Reminders

• In-home / Personal Appointments
• Scope of Appointment Required
• Must secure prior to in-home appointment
• Must specify product type of interest
• Cannot secure over phone unless call is recorded
  and scripted.
• Beneficiary may sign at Sales Event for future
  personal appointment
• Can call to confirm appointment.

11
Promotional Activity Reminder

• Health Care Settings
• Marketing allowed in common areas
• Hospital or nursing home cafeterias
• Community or recreational rooms
• Conference rooms
• No marketing in health care settings
• Waiting rooms
• Exam rooms or hospital patient rooms
• Dialysis center
• Pharmacy counter areas
• Any other area where patients receive health care
  services

12
Promotional Activity Reminders

• Educational Events
• No marketing activities at educational events
• Health information fairs
• Conference expositions
• State- or community-sponsored events
• Plans may distribute
• General Medicare information
• Health education materials
• Agent/broker business cards
• Containing no marketing information

13
State Licensure of Agents

• All agents/brokers representing a Medicare
  Advantage plan must
• Be state-licensed, certified, or registered per
  state requirements
• Provide a copy of licensure to the Plan
• The Plan must report a termination and reason of
  termination to the state

14
Agent/Broker Training and Testing

• Agents/brokers must be trained/tested annually
• Medicare rules and regulations
• Plan details specific to plan products
• Both contracted and employed agents
• Completed prior to start of marketing season
• Must have a passing grade of 85

15
CMS Marketing Surveillance

• Surveillance strategy
• Clipping Service (newspaper ads)
• Real-time observations and responses
• Secret shoppers
• Complaints of misrepresentation

16
Medicare Compliance Oversight

• Oversight of marketing activity

• Detect, prevent and respond to allegations of
  misconduct
• Secret shopping
• Ride-along with employed agents
• Investigate allegations