SEP Type for Sanction

Feb 17, 2016

  1. melmadhav
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    melmadhav Expert

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    Hello,

    Does anyone know what SEP type to use when doing a switch from a carrier that is in sanctions (PDP to PDP)

    Thanks!
    Mel
     
  2. TN_agent
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    I think they have to call Medicare directly and plead their case, to my knowledge there isn't a way to do it with an agent.
     
    TN_agent, Feb 17, 2016
    #2
  3. yorkriver1
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    yorkriver1 Guru

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    UHC is having a tutorial. Client enrolls at Medicare, agent notifies carrier, they do the rest.
     
  4. melmadhav
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    melmadhav Expert

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    Wanted to do an Aetna, I'll just have her call CMS.

    Thanks for yalls help!
     
  5. agentjhc
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    As you may be aware, the Centers for Medicare & Medicaid Services (CMS) imposed intermediate sanctions against Cigna-HealthSpring. CMS did not create a Special Election Period (SEP) for members, but it is considering requests for an SEP on a case-by-case basis. If Cigna members want to choose another plan, they must call CMS. So, what happens if Cigna members move to another carrier through 1-800-MEDICARE? Are agents eligible for commission payments if they assist a Cigna enrollee in moving to a UnitedHealthcare plan? Yes! Find the details below.

    What you need to do to earn commission
    You can earn commission if you conduct a needs assessment for a Cigna enrollee interested in changing plans and that individual enrolls in a UnitedHealthcare plan for which you are appropriately licensed, appointed and certified. Please ensure that your contact with Cigna enrollees and the following required actions are compliant with CMS's regulations and guidelines.
    Obtain a Scope of Appointment (SOA) at least 48 hours prior to the appointment with the beneficiary. You can find the SOA document in the Resources section on the Agent Portal.

    Conduct a complete, compliant needs assessment. NOTE: You cannot directly enroll beneficiaries; you can only conduct a needs assessment and help them find plans that best fit their lifestyles. Any UnitedHealthcare Medicare materials you need can be found on the Agent Portal.

    If beneficiaries want to change plans, refer them to CMS at 1-800-Medicare. Cigna members can tell CMS which plans they want to enroll in. This call is between the beneficiary and CMS only. You cannot be present during the call.

    Next, submit a request for commission within 30 days of the effective date to [email protected]. Please include:
    The plan number(s) that were presented, along with the beneficiary's name, address, birth date, HICN number and effective date
    The agent name and agent ID
    A copy of the SOA

    Once CMS processes the enrollment, we will match it to the information you provided to PHD and process the commission as long as you meet the license, appointment and credential requirements per your agent contract.
    Thank you for your business! We look forward to being your strong, stable partner for 2016 and beyond.
     
    agentjhc, Feb 17, 2016
    #5
  6. BeeSelective
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    BeeSelective Guru

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    Spend 5 hours for 32$.
    I rather fish.
     
  7. SirLurkAlot
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    $32! You have the big contract!!!! :twitchy:
     
  8. yogooglethis
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    more like 17.00- but that's each month for for the rest of your life ! ( or until they die or change plans)
    You would be surprised how these 17.00 can add up after a while
     
  9. Chazm
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    Chazm Guru

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    Yeah but the OP was referring to PDP lol
     
    Chazm, Feb 18, 2016
    #9
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