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I'm thinking maybe the last one on page 23, "You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you."
Whadda you think?
Poor Performing Plan SEP
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- Start date
I'm thinking maybe the last one on page 23, "You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you."
Whadda you think?
Every company is different. I just left a house where I did two switches. WellCare will cross reference the AVL (scope) to enrollments. Other companies make you send the clients info to them after they call Medicare.
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Low performing plans do not give him GI. The plan is still there just not up to snuff
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Is this a new requirement that they must call Medicare for this? Couldn't we do a paper app last year using a special SEP?
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It's not in there because it's a new SEP announced in Oct. 2012 at the start of AEP. Their current plan has to have 2.5 star or below three straight years. PlanFinder has a warning icon next to the affected plans. They get a one-time SEP to move to a three-star or better plan outside of AEP (in addition to any other SEP they may qualify for).. The letter members of these plans received gives only one way to use this SEP: call 800 MEDICARE. The letter does not offer them the option to return to Original Medicare and get a PDP so GI for a med supp appears ruled out; they're still locked in to an MA, but free to leave the one they're in.
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He has a PDP separate so that's not an issue. He can't just return to Medicare with this SEP?
Even if he has to go to another MA plan he would be better off than this PFFS plan that he's paying $80/mo for.
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The beneficiary letter does not offer option to leave an MA for Medicare, just pick a higher rated plan or stay with current. Using this new SEP to dump the PFFS seems like a wise plan. Just a few days left for an April 1 start date. The PDP mention was in reference to an earlier raised GI for med supp question.
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According to my carriers, UHC and Humana and Coventry, first the client has to send you back an SOA. You fax this to the carrier 48 hrs (at least) prior to appt. You then do a F2F presentation.
Then if client agrees to change, they have to call medicare but you must be absent. They tell CMS which plan they want with which co. Within 30 days you submit your request for commission of the effective date to the carrier with the clients info like HICN, address, Birth date, usual stuff. and the copy of the soa you faxed in,
After CMS has processed the enrollment, the carrier matches the soa and your request form to the enrollment request they receive from CMS. Capisz?
So you won't make it for April, but you can shoot for May 1.
Then if client agrees to change, they have to call medicare but you must be absent. They tell CMS which plan they want with which co. Within 30 days you submit your request for commission of the effective date to the carrier with the clients info like HICN, address, Birth date, usual stuff. and the copy of the soa you faxed in,
After CMS has processed the enrollment, the carrier matches the soa and your request form to the enrollment request they receive from CMS. Capisz?
So you won't make it for April, but you can shoot for May 1.
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The poor performing plans include those in bk proceedings, for example... Universal Health Care of Florida, but it was United Healthcare that sent out letters to their agents announcing the new SEP for poor performing plans last week that covers other carriers across the nation. I also got a letter from Coventry this week....
"Commissions information in response to
CMS "Poor Performing" plan letters
UnitedHealthcare is pleased to announce that after receiving guidance from the Centers for
Medicare & Medicaid Services (CMS) late last week UnitedHealthcare may now pay
commissions on enrollments of beneficiaries who received a CMS letter designating
their current plan as "Poor Performing" and allow them to change plans via 800-
Medicare. This change is effective immediately and opens up opportunities for you to assist
existing clients where enrollment into a UnitedHealthcare Medicare Solutions product might
be beneficial to them.
If your client is interested in switching to one of our plans, you must do the following for
commission credit:
1. Obtain a Scope of Appointment (SOA) and fax it to UnitedHealthcare at 1-866-
994-9659. This should be 48 hours prior to the appointment.
2. Conduct a complete, compliant presentation. NOTE: You will not be conducting
an enrollment; only notifying them of plan information and next steps.
3. If your client is interested in changing, refer them to CMS at 1-800-Medicare.
Have them tell CMS that they want to enroll in UnitedHealthcare and the product plan
they choose. This will be based on the product discussed in the sales presentation.
This call is between the beneficiary and CMS only. You MUST not be present
during this call. You are not providing any information to CMS.
4. Submit your request for commission within 30 days of the effective date
through the Producer Help Desk (PHD) at [email protected]. You will need to
provide the members HICN #, name, address, effective date, agent name and agent
ID and a copy of the SOA you faxed.
5. Once CMS has processed the enrollment, UnitedHealthcare Medicare
Solutions will match the SOA and your request form to the enrollments
received from CMS, and will advise you if there is a match. "
"Commissions information in response to
CMS "Poor Performing" plan letters
UnitedHealthcare is pleased to announce that after receiving guidance from the Centers for
Medicare & Medicaid Services (CMS) late last week UnitedHealthcare may now pay
commissions on enrollments of beneficiaries who received a CMS letter designating
their current plan as "Poor Performing" and allow them to change plans via 800-
Medicare. This change is effective immediately and opens up opportunities for you to assist
existing clients where enrollment into a UnitedHealthcare Medicare Solutions product might
be beneficial to them.
If your client is interested in switching to one of our plans, you must do the following for
commission credit:
1. Obtain a Scope of Appointment (SOA) and fax it to UnitedHealthcare at 1-866-
994-9659. This should be 48 hours prior to the appointment.
2. Conduct a complete, compliant presentation. NOTE: You will not be conducting
an enrollment; only notifying them of plan information and next steps.
3. If your client is interested in changing, refer them to CMS at 1-800-Medicare.
Have them tell CMS that they want to enroll in UnitedHealthcare and the product plan
they choose. This will be based on the product discussed in the sales presentation.
This call is between the beneficiary and CMS only. You MUST not be present
during this call. You are not providing any information to CMS.
4. Submit your request for commission within 30 days of the effective date
through the Producer Help Desk (PHD) at [email protected]. You will need to
provide the members HICN #, name, address, effective date, agent name and agent
ID and a copy of the SOA you faxed.
5. Once CMS has processed the enrollment, UnitedHealthcare Medicare
Solutions will match the SOA and your request form to the enrollments
received from CMS, and will advise you if there is a match. "
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I think most agents abandoned this process for the SEP.terminate re. Universal. I don't know of any other carriers at 2.5 stars....especially 3 years running.
