Cold calling rules

[allhealthandlife]

I have not verified with other sources but email i received
was from management of large ( very large ) carrier that cold calling for 2008 plans is OK according to compliance dept. and i don't think it is specific to this carrier. I would have thought other carriers would be disiminating information by now as well.

Cold calling for 2009 plan rules did go into effect 9/18/08

 

[hwmassoc]

I heard today that cold calling rules do not effect the 2008 MA and PDP plans so you can still cold call these prospects through November for 12/1/08 effective.

The new CMS rules were effective 9/18/08 and apply to all marketing activities in connection with Medicare 2009 plans.

These plans can be marketed starting 10/01/08 and the new rules must be used from October 1 forward.

 

[jdeasy]

The new CMS rules were effective 9/18/08 and apply to all marketing activities in connection with Medicare 2009 plans.

These plans can be marketed starting 10/01/08 and the new rules must be used from October 1 forward.

From what I've read of the rules, I think that's what they say, too. However, the companies I had conversation with about so far, Coventry, Pyramid, UHC and Wellcare, all say that the rules are in effect now even for '08 enrollees either T65 or SEP.

Now, here's another nugget that Pyramid threw out there on their national call yesterday; They say you can't call up the AEP file that you have been building since OEP ended. For example, I have a huge file of people that I meet on final expense appointments. They wish to talk about an MA plan or a PDP. I tell them I'll call them for the AEP. Or, I get calls for the same and I tell someone that I can't do anything until AEP. These all go into my "Nov" file. Most MA agents that I've met have a similar file. Pyramid says that it is now unlawful for me to call those folks unless the request was made within 90 days of the AEP.

I disagree strongly with that position and feel it's just Pyramid's take, but, that's the only info I have right now. I sent an email to Wellcare about this issue. They responded that they would have to take it up with compliance and get back to me.

 

[MedSuppPro]

Pyramid threw out there on their national call yesterday; They say you can't call up the AEP file that you have been building since OEP ended. For example, I have a huge file of people that I meet on final expense appointments. They wish to talk about an MA plan or a PDP. I tell them I'll call them for the AEP. Or, I get calls for the same and I tell someone that I can't do anything until AEP. These all go into my "Nov" file. Most MA agents that I've met have a similar file. Pyramid says that it is now unlawful for me to call those folks unless the request was made within 90 days of the AEP.

Let us know were they have pulled this rule out of!

F. Scope of Appointments
42 CFR 422.2268(g) and (h); 423.2268(g) and (h) -- CMS 4138-IFC

Effective date: September 18, 2008

Under current Medicare Marketing Guidelines, marketing representatives are to clearly identify the types of products that will be discussed before marketing to a potential enrollee. To ensure beneficiaries have accurate information to make an informed choice about their Medicare benefits without being pressured, marketing representatives that initially meet with a beneficiary to discuss specific lines of plan business (Examples of separate lines of business include Medigap, MA, and PDP) must inform the beneficiary of all products that will be discussed prior to the in-home appointment.

Effective September 18, 2008, prior to any marketing appointment, the beneficiary must agree to the scope of the appointment and that agreement must be documented by the plan. ...

Additional products may not be discussed unless the beneficiary requests the information.​

​

 

[jdeasy]

Let us know were they have pulled this rule out of!

F. Scope of Appointments​

42 CFR 422.2268(g) and (h); 423.2268(g) and (h) -- CMS 4138-IFC​

Effective date: September 18, 2008​

Under current Medicare Marketing Guidelines, marketing representatives are to clearly identify the types of products that will be discussed before marketing to a potential enrollee. To ensure beneficiaries have accurate information to make an informed choice about their Medicare benefits without being pressured, marketing representatives that initially meet with a beneficiary to discuss specific lines of plan business (Examples of separate lines of business include Medigap, MA, and PDP) must inform the beneficiary of all products that will be discussed prior to the in-home appointment.​

Effective September 18, 2008, prior to any marketing appointment, the beneficiary must agree to the scope of the appointment and that agreement must be documented by the plan. ...​

Additional products may not be discussed unless the beneficiary requests the information.​

​

They can't tell you where they get it. I spoke to a Pyramid manager today. He insists that it's CMS rules even though he can't give the rule or regulation.

Coventry sent out their version today, it seems to mirror Pyramid's take.

I haven't heard back from Wellcare yet.
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This is the response I got from a Wellcare rep in regards to my question of being able to call the people in my callback file;


Hey, JD! The regs are still being evaluated for the specifics. Let's wait until they give us more details and then we'll be able to go from there. We want to be compliant, and right now, we need more specifics from CMS. We should get those soon...

 

[Daytona_Guy]

Gotta love it...


Stricter rules, 'secret shoppers' greet Medicare sales season | Ocala.com | Star-Banner | Ocala, FL

Stricter rules, 'secret shoppers' greet Medicare sales season


Carol Gentry
Florida Health News


Published: Thursday, September 25, 2008 at 1:01 p.m.
Last Modified: Thursday, September 25, 2008 at 1:04 p.m.
Insurance agents that enroll Medicare beneficiaries into drug and HMO-style plans are being warned that the rules have changed to protect against marketing abuses and that government agents – "secret shoppers" -- will be watching.

The Centers for Medicare and Medicaid Services is tripling the number of undercover agents it will send to sales events this season, a CMS advisory warns. Last year CMS had 300 secret-shopper events -- many of them in Florida -- and took action on four companies, the agency says.
The new rules, released Sept. 15, apply to the marketing for 2009 enrollment in Medicare drug plans and all-inclusive Medicare Advantage plans, such as HMOs. Plans may begin marketing Oct. 1, with sign-ups allowed beginning Nov. 15.
"It's unfortunate that a few scurrilous salespeople and overzealous regulators are making life more difficult for the rest of us," says The Complete Advisor, a newsletter to agents from North American Life Plans. It urges agents to be "diligent about protecting yourself by staying informed, documenting everything and erring on the side of caution in all of your sales and marketing efforts."
A news release at the CMS Web site explains that the regulations are intended to "protect Medicare beneficiaries from deceptive or high-pressure marketing tactics…"
Another change that CMS is proposing would also have a major effect on agents. It would not allow plans to give agents big up-front commissions each time they enroll a new member, but would require that the payment be structured so that the agent wins if the member stays in the plan. CMS says this is aimed at removing the incentive to switch a beneficiary from one plan to another – a process known as "churning."
Florida has been the site of some of the most flagrant examples of churning and deceptive sales practices to Medicare beneficiaries, as described in press accounts and Congressional hearings.
While most beneficiaries have not been subjected to abuses and are pleased with their drug and Medicare Advantage plans, CMS says in its releases, "we will monitor activities throughout this year's enrollment period to ensure that beneficiaries are protected from aggressive marketing behavior from agents and brokers."
In addition to the change in commissions, the new regulations say:
--No more cold-calling or telemarketing. An agent may not call a Medicare beneficiary unless that person has contacted the agent first, according to an e-mail from Universal American. "Even then, the agent must set up an appointment with the individual before visiting the person's home," it says.
-- No more meals at sales seminars. Light snacks are OK, but it's the end of the Red Lobster sales talks.
-- No cross-selling. When agents are making presentations on one product, such as a drug plan, they may not push other products, such as an HMO. If the beneficiary wants information on the HMO, the agent must schedule another appointment to allow "a 48-hour cooling-off period."
-- No selling materials in certain areas, such as clinic waiting rooms, dialysis centers, pharmacy counters, or educational seminars.
CMS has told plans it will check on their ads in print and broadcasts and review recordings of enrollment calls to make sure companies are complying with the new regulations.