Event Compliance Training

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Event Compliance Training
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Types of Events - Educational

• Informational presentation on Medicare topics
• Neither sales nor marketing are permitted to take
  place.

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Types of Events - Informal

• Marketing/Sales events, also referred to as lead
  generation activities
• Events are typically conducted in a less formal
  environment that allow a beneficiary to walk up
  to an agent learn more about product offerings
  with a less structured presentation
• These events sometimes utilize a table, kiosk or
  a recreational vehicle (RV) that is manned by a
  plan sponsor representative who can discuss the
  merits of a plans products

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Types of Events - Formal

• Marketing/Sales events are usually structured in
  an audience/presenter style
• Sales person or plan formally providing specific
  plan sponsor information via a presentation on
  the products being offered
• The presenter usually presents to an audience
  that may have been invited to attend

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Marketing/Sales Events

• Sales seminar or presentation that a broker hosts
  aimed at promoting specific benefits and/or
  services
• CAN accept perform enrollments at event
• These events must be submitted to compliance
  prior to advertising
• These events must be submitted to AGA for
  submission to a carrier at least 7 days prior to
  the event (preferably by the 10th of the month
  prior)

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Educational Events

• Events designed to inform beneficiaries about
  Medicare information and programs
• May not include any sales/marketing activities
  (e.g. giveaways, business cards, prize wheel)
• Must be advertised as Educational
• You have the option to submit these events to CMS

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Provider Marketing Events

• Marketing activities are permitted in common
  areas of health care settings
• Marketing activities are prohibited in any areas
  where patients receive health services (e.g.
  exam/waiting room)
• Appointments with beneficiaries residing in long
  term care facilities must only take place upon
  request of beneficiary

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Health Fairs

• Marketing
• Pre-enrollment materials are
• permitted
• You can accept enrollment forms
• Can collect lead information from attendees
• Can hand out business
• Cards or marketing with
• contact information

Educational No marketing materials
permitted Cannot accept enrollment forms Cannot
accept lead information Cannot hand out
business card or any marketing materials with
contact information
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Definitions/Permissible Activities Marketing/Sales Event Personal/Individual Sales Appointment Marketing in the Health Care Setting Educational Event Health Fair
Principle Purpose Selling Formal/Informal Selling Selling Education Educational/Selling
Reportable to CMS Yes No Yes Yes/optional Yes
Scope of Appointment (SOA) No(Unless they require a 1 on 1 following the presentation) Yes No(Unless they require a 1 on 1 following the presentation) No No(Unless they require a 1 on 1 following the presentation)
Ability to set up a future appointment Yes(Scope required prior to appt, unless walk-in to sales office) Yes(Scope required prior to appt, unless walk-in to sales office) Yes (Scope required prior to appt, unless walk-in to sales office) No Educational No Selling Yes (Secure SOA)
Future contact Permission to Contact (Lead Card) Yes, if prospect wants agent to contact them after a meeting No Yes No Educational-NoSelling-Yes
Attendance Sheet Formal-Yes (Cant be a requirement)Informal-No No Yes No No
Light Snacks and refreshments only Yes Yes Yes Yes(Meals are permitted) Educational-YesSelling-Yes
Informational guides, promotional items and banners Yes Yes Yes Yes Educational-YesSelling-Yes
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Definitions/Permissible Activities Marketing/Sales Event Personal/Individual Sales Appointment Marketing in the Health Care Setting Educational Event Health Fair
Principle Purpose Selling Formal/Informal Selling Selling Education Educational/Selling
Distribution of Business CardsPlease Note CMS clarified business cards may NOT be stapled to any marketing material. Stickers with agent contact information may NOT be applied to any approved materials, doing so is altering what was approved by CMS Yes Yes Yes Yes (Upon request by the beneficiary) Educational Yes (Upon request by the beneficiary)Selling Yes
Ability to conduct plan-specific sales presentation Formal - Yes(Full Presentation)Informal No Yes (Full Presentation) Yes No Educational NoSelling No
Marketing Materials approved by CMS Yes Yes Yes Yes Educational Yes Selling Yes
Distribution of Benefits at a Glance Yes Yes Yes No Educational-NoSelling-Yes
Distribution of Pre-Enrollment Kits(SBs and Apps) Yes(Complete Kit) Yes Yes No Educational No Selling Yes
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Definitions/Permissible Activities Marketing/Sales Event Personal/Individual Sales Appointment Marketing in the Health Care Setting Educational Event Health Fair
Principle Purpose Selling Formal/Informal Selling Selling Education Educational/Selling
Advertisement needs to include scope of product language and disclaimers Formal YesInformal No Yes Yes No Educational NoSelling - Yes
Advertisement needs to include educational event disclaimer No No No Yes Educational YesSelling - No
Advertisement needs to be approved by CMS Yes Yes Yes Yes Educational-YesSelling Yes
Compliant (e.g., non-steering) provider participation Guest Speaker Yes No Yes Yes Educational-YesSelling-Yes
Accept enrollments Yes Yes Yes No Educational-NoSelling-Yes
All producers are required to submit the
completed Scope of Appointment for with each
enrollment application (see page XX for an
example).
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Compliant Presentation Tips

• Always identify the types of plans you will be
  covering (Formal)
• Explain eligibility requirements (Formal,
  Informal, Educational)
• Explain enrollment/disenrollment periods (Formal,
  Informal, Educational)
• Explain premiums, co-insurance co-pays
  (Formal)
• If using a PowerPoint or flipbook to guide you,
  be sure to cover all slides within your
  presentation
• Benefits Information (Formal)
• Medicare tips/Information (Informal)

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Compliant Presentation Tips

• Show up early and be where you said youd be
• Do not make absolute statements (e.g. X plan is
  the best! or extraordinary)
• Do not use high pressure tactics
• Do not make inaccurate statements
• See guidebook for a more detailed listing of what
  to cover

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Basic Medicare Comprehension

• Part A Hospital coverage requires a monthly
  premium
• Part B Medical coverage does not cover expenses
  outside the US
• Part C Medicare plans must cover Part A B
  expenses
• Special Needs Plans (SNP) are only for
  beneficiaries with special healthcare needs and
  those with Medicare Medical
• There is financial assistance for Part B D
  Prescription Drug premiums for low income
  households

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Basic Medicare Comprehension

• The earliest one may be eligible to submit an
  enrollment for Medicare Advantage is 64 years, 9
  months old UNLESS they have ESRD or certain
  chronic illnesses
• Annual Enrollment Period is October 15 -
  December 7
• Understand how the Disenrollment Period
  works(January 1 February)

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Basic Medicare Comprehension

• A senior may choose to solely be covered by
  Medicare and does not need to enroll on another
  type of plan
• Make sure to check that the beneficiarys
  doctors/specialists accept the plan FIRST
• Not all Medicare Advantage plans cover
  prescription drugs
• Compare drug plan costs and find the plan with
  the least out of pocket expense

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Basic Medicare Comprehension

• Understand the donut hole and how it works
• Only RX amounts paid when in the hole apply
  towards TROOP (true out of pocket costs)
• Catastrophic Coverage begins when the
  beneficiaries TROOP 4,550
• When in the hole, beneficiary will only be
  responsible for 50 of the brand name drugs
  manufacturer cost plus a 2 dispensing fee

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Personal/Individual Appointments

• Typically take place in a beneficiaries home
• Face to face appointments are considered
  marketing/sales events by CMS
• Scope of Appointment is required for all personal
  appointments

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Questions