How Did This Banker's Life Agent Do This?

[yogooglethis]

I have a long time client who has been on disability for years and turned 65 in March and wanted her to switch her MA plan which she was able to do using her IEP 2 election code.She called me 3 months later and said she will be making more money on her pension than she expected and wanted a Med Supp instead . I informed her she can't change until AEP since she wasn't eligible for any SEPs.I am pretty versed in the SEPs and couldn't see any she would have qualified for.She called me in June and said a Bankers Life agent had knocked on her door and promised her she could get her on a Med Supp/PDP and I told her i don't see how but if she knew how to get her on a PDP then I would be glad to write the AARP Plan F which is about 40.00 a month less than Bankers.

The interesting thing is that the client told me the agent had her sign a letter that was addressed to the MA carrier( UHC) as some type of cancellation notice.This is not necessary if this Bankers agent used a SEP to enroll her in a PDP because as we know this would automatically dis-enroll her from the MA plan.In fact based on what she told me on the phone from the rx plan premium ( there is no PDP plan in Fl that matches what she wrote the check for 40.00 even) , the co pays , the fact it didn't cover any brand names, the fact that Bankers Life doesn't even have a PDP but yet the " rx card" she received said Bankers Life on it. I think the agent sold her a Bankers life discount rx card for 40.00 and just somehow got her cancelled off the MA plan by having her sign the letter.The client was aware that the Bankers Life Plan F was 40.00 more than AARP but was assured by the agent that it was a much better plan F than AARP's plan F.

The client called me today and i will go an replace the Bankers's policy but just wondering how she could have got her off the MA plan without any apparent SEPS..Maybe it is actually a PDP and the agent put a fraudulent SEP.Anybody having any idea how this can be done.There areno 5 star plans in Fl.I assume it wasn't a complaint because i would have been notified by now.

I wish CMS would wholesale investigate Bankers Life T65 door knocking methods.
- - - - - - - - - - - - - - - - - -
I just called UHC and apparantly the client was enrolled in to another PDP plan so I am suspecting the agent used a fraudulant election code.I guess CMS doesn't verify them all the time.

 

[senior-advisor-indiana]

She has 12 months from her oep To switch back to OM and a med supp with no health questions. Easily done. Bankers probably has a deal with a pdp company and that's why bankers name is on it. There should also be the pdp company name on the card also.

 

[yogooglethis]

She has 12 months from her oep To switch back to OM and a med supp with no health questions. Easily done. Bankers probably has a deal with a pdp company and that's why bankers name is on it. There should also be the pdp company name on the card also.

This wasn't her first time on MA this was her third time.I used the IEP 2 to enroll her in MA for 3/1/12.What election code would you have used to enroll her in a PDP for a 7/1/12 effective date?

 

[senior-advisor-indiana]

It is my understanding that when someone turns 65 and gets part B it would start the ICEP regardless of whether they were in a MAPD before, they would still have the 12 month window to switch back to OM and a pdp. I would probably just code or as SEP if it were me doing it.

 

[yogooglethis]

It is my understanding that when someone turns 65 and gets part B it would start the ICEP regardless of whether they were in a MAPD before, they would still have the 12 month window to switch back to OM and a pdp. I would probably just code or as SEP if it were me doing it.

The SEP 65 applies to consumers who enroll in a MA plan ( for the first time) using their IEP at the time of their 65th birthday.for those

She had Part B for years before she turned 65 in march so I used IEP -2 for the enrollment in the MA plan. The election code for a PDP enrollment in the same situation is also IEP-2. I dont believe CMS gives you one of each.This code would be easy for the the carrier to verify but I know for a fact that CMS will accept the customers attestation for some SEP codes such as loss of credible coverage( Loss EGHP) and or having or losing a SPAP (state sponsored discount drug plans).i have seen unscrupulous agents fraudulently use these codes before because its not verified.

 

[senior-advisor-indiana]

You have me second guessing myself now so I will have to get out my bible and check the rules...

 

[jdeasy]

I have a long time client who has been on disability for years and turned 65 in March and wanted her to switch her MA plan which she was able to do using her IEP 2 election code.She called me 3 months later and said she will be making more money on her pension than she expected and wanted a Med Supp instead . I informed her she can't change until AEP since she wasn't eligible for any SEPs.I am pretty versed in the SEPs and couldn't see any she would have qualified for.She called me in June and said a Bankers Life agent had knocked on her door and promised her she could get her on a Med Supp/PDP and I told her i don't see how but if she knew how to get her on a PDP then I would be glad to write the AARP Plan F which is about 40.00 a month less than Bankers.

The interesting thing is that the client told me the agent had her sign a letter that was addressed to the MA carrier( UHC) as some type of cancellation notice.This is not necessary if this Bankers agent used a SEP to enroll her in a PDP because as we know this would automatically dis-enroll her from the MA plan.In fact based on what she told me on the phone from the rx plan premium ( there is no PDP plan in Fl that matches what she wrote the check for 40.00 even) , the co pays , the fact it didn't cover any brand names, the fact that Bankers Life doesn't even have a PDP but yet the " rx card" she received said Bankers Life on it. I think the agent sold her a Bankers life discount rx card for 40.00 and just somehow got her cancelled off the MA plan by having her sign the letter.The client was aware that the Bankers Life Plan F was 40.00 more than AARP but was assured by the agent that it was a much better plan F than AARP's plan F.

The client called me today and i will go an replace the Bankers's policy but just wondering how she could have got her off the MA plan without any apparent SEPS..Maybe it is actually a PDP and the agent put a fraudulent SEP.Anybody having any idea how this can be done.There areno 5 star plans in Fl.I assume it wasn't a complaint because i would have been notified by now.

I wish CMS would wholesale investigate Bankers Life T65 door knocking methods.
- - - - - - - - - - - - - - - - - -
I just called UHC and apparantly the client was enrolled in to another PDP plan so I am suspecting the agent used a fraudulant election code.I guess CMS doesn't verify them all the time.

Turning 65 would give the person a 6 month open enrollment to sign up for a med sup. Regardless of whatever plan they were in previously. It also gives them a 7 month window to get an MAPD, an MA or a PDP.

It is not an SEP. It is open enrollment and IEP.

 

[eharriett]

Most of the posts here have the correct answer. There is only one thing I can add:

CMS marketing regulations explicitly prohibit door knocking as a way of marketing any MA or PDP products. Supplement laws vary state-to-state, but PDP laws are clear. If that agent sold her a PDP with the supplement and it was an actual PDP not a discount card, he broke the law.

 

[Chazm]

Most of the posts here have the correct answer. There is only one thing I can add:

CMS marketing regulations explicitly prohibit door knocking as a way of marketing any MA or PDP products. Supplement laws vary state-to-state, but PDP laws are clear. If that agent sold her a PDP with the supplement and it was an actual PDP not a discount card, he broke the law.

I don't think so. You can door knock Med supps. If he went in and sold her a med supp and she brought up Part D then he can have her sign a scope.

 

[floridagirl]

So, if she switched to a new MA plan in March, this guy comes in in June (which is the 3 months later), she can still switch since she is still in open enrollment, correct? So in March, was this MA only plan? Or MAPD? I thought once you made a choice of a rx plan, either stand alone or MAPD, you were done with initial enrollment.