Are you in compliance with Medicare marketing guidelines?
Agents and brokers for AmeriHealth are responsible for performing marketing activities that comply with Medicare marketing guidelines. The Centers for Medicare and Medicaid Services (CMS) releases regulations that Medicare Advantage organizations and Medicare prescription drug plan sponsors must follow in order to remain CMS-complaint. These marketing guidelines are in place to protect Medicare beneficiaries. The table below offers a reference to some marketing dos and don'ts.
Dos |
Don'ts |
|
|---|---|---|
Nominal gifts |
- It is permissible to offer gifts to prospective enrollees as long as the gifts are less than the nominal retail value ($15), are not readily convertible to cash and are available to all participants regardless of enrollment. |
- Don’t offer cash or monetary rebates. - Don’t offer gifts or prizes that exceed nominal retail value of $15. |
Marketing through unsolicited contacts |
- Call beneficiaries that you have enrolled into a plan while the beneficiary is a member of that organization. - Call beneficiaries who have expressly given permission for an agent to contact them, for example, by filling out an approved business reply card. |
- Don’t conduct door-to-door marketing. - Don’t conduct outbound marketing calls. - Don’t approach individuals in common areas ( i.e., parking lots, hallways, lobbies). |
Cross-selling |
- Sell non-health-related products on inbound calls when the beneficiary requests the information on other non-health-related products. |
- Don’t sell non-health-related products during marketing of Medicare Advantage or Part D plans. |
Scope of appointments |
- Obtain scope-of-appointment agreement from beneficiary via recorded telephone call or completed scope-of-appointment form. - Clearly identify the types of products that will be discussed. |
- Don’t conduct a personal/individual appointment with a beneficiary without a documented scope-of- appointment agreement. |
Sales/Marketing in health care settings |
- Conduct sales activities in common areas such as hospital or nursing home cafeterias, community or recreational rooms, and conference rooms. |
- Don’t conduct sales activities where patients primarily intend to receive health care services (i.e., waiting rooms, exam rooms, dialysis centers, pharmacy counter areas). |
Sales/Marketing at educational events |
- Refrain from conducting any sales activity at educational events (e.g., having plan materials or enrollment forms available). - Include disclaimer when sponsoring or participating in educations events. |
- Don’t perform any sales activity at educational events.
|
Prohibition on the provision of meals |
- Provide light refreshments and light snacks to prospective enrollees (i.e., fruit, raw vegetables, pastries, crackers, nuts). |
- Don’t provide or subsidize meals of any value at promotional or sales activities. - Don’t bundle items that are considered refreshments or snacks together and provide as if a meal. |
State appointment of agents/brokers |
- Ensure that you are licensed and appointed as an agent for AmeriHealth under state law. |
- Don’t perform any sales activity if you are not appointed with the state as an agent for AmeriHealth. |
Plan reporting of terminated agents |
- Inform the plan of your termination as an agent of the plan and the reason for termination for reporting to the state. |
- Don’t neglect to inform the plan of a termination date when you will no longer act as an agent for the plan. |
Broker/Agent training and testing |
- Complete required Medicare training and testing prior to marketing or selling any Medicare Advantage or Part D plan. |
- Don’t market or sell any Medicare Advantage or Part D plan prior to completing the required training and testing. |
Broker/Agent use
of marketing materials |
- Submit marketing materials to the plan for submission to CMS for review and approval. |
- Don’t use marketing material that has not been CMS-approved. - Don’t submit marketing material directly to CMS. |
If you have any questions, please contact your AmeriHealth broker representative.
