When is the best time to switch someone

[Medicare bro]

Caveat, not an agent.

After doing a bit of reading, I believe you have given a great example of committing Insurance Fraud by using Material Misrepresentation on an application for insurance coverage.

I didn't do it. I'm gonna wait for AEP. I still think you're wrong. If that is true every call center in the entire country would be shut down.

 

[Medicare bro]

Caveat, not an agent.

After doing a bit of reading, I believe you have given a great example of committing Insurance Fraud by using Material Misrepresentation on an application for insurance coverage.

Well I need to eat some crow here and apologize. According to this document they would have needed to miss the election period because the disaster had direct impact on them. I find it odd CMS hasn't cracked down on this as they will go to extremes to make an agents life a nightmare. If I was to guess 90% or more of agents do this. So either CMS says this and really doesn't care of they look at it like a non moving violation. You were right though. This has me curious.

https://www.cms.gov/about-cms/agency-information/emergency/downloads/medicarebeneficiarydisasterenrollmentqsandas.pdf

 

[straightnochaser]

Well I need to eat some crow here and apologize. According to this document they would have needed to miss the election period because the disaster had direct impact on them. I find it odd CMS hasn't cracked down on this as they will go to extremes to make an agents life a nightmare. If I was to guess 90% or more of agents do this. So either CMS says this and really doesn't care of they look at it like a non moving violation. You were right though. This has me curious.

https://www.cms.gov/about-cms/agency-information/emergency/downloads/medicarebeneficiarydisasterenrollmentqsandas.pdf

CMS sets the rules, carriers "enforce" them.

 

[LostDollar]

CMS sets the rules, carriers "enforce" them.

Would it be better to say: "carriers administer the rules; CMS (and possibly the state insurance department) enforces them"?

 

[straightnochaser]

Would it be better to say: "carriers administer the rules; CMS (and possibly the state insurance department) enforces them"?

Nope.

 

[MedicareWAA]

I am a newer agent and I am well aware of the difference between TROOP and MOOP. I was simply asking if MOOP followed similar rules as TROOP. Thank you for the clarification.

Good on you for asking and learning.

Walter

 

[MedicareWAA]

Caveat, not an agent.

Bro, once again, we know this. And you're not here giving insurance advice. If you're going to keep posting so often, maybe put it at the end of your posts.

Better yet, put it in your one sentence user description.

 

[MedicareWAA]

Caveat, not an agent.

After doing a bit of reading, I believe you have given a great example of committing Insurance Fraud by using Material Misrepresentation on an application for insurance coverage.

Agents know there are specific rules as to how SEPs work and when you may use them. If you misuse them, you're a piece of crap but not necessarily guilty of fraud. There's fraud, there's waste, and there's abuse. Carriers should hold agents accountable in all cases.

These things are covered in the training that comes along with getting an insurance license, along with annual carrier certifications and continuing education courses.

Here is an example of fraud: The agent asks the applicant if they missed an applicable enrollment period because of, say, a disaster. The applicant says no. The applicant elaborates and the agent clearly understands the applicant is not entitled to the SEP. The agent falsely tells the applicant that there's another way to join the plan. The agent then submits the application under the disaster SEP . The agent does this on purpose, with bad intent, and those things can be proven.

Not insurance fraud: Same scenario but you tell the applicant that there's no way the government can know if the applicant is being truthful. Whatever the applicant tells the agent is what the agent is going to put the application. The applicant says yes a drought caused them to miss a previous enrollment period. He does not elaborate. The insurance agent finds that hard to believe but does not question the applicant. The agent submit the application and it's approved.

Walter

 

[LostDollar]

Here is an example of fraud: The agent asks the applicant if they missed an applicable enrollment period because of, say, a disaster. The applicant says no. The applicant elaborates and the agent clearly understands the applicant is not entitled to the SEP. The agent falsely tells the applicant that there's another way to join the plan. The agent then submits the application under the disaster SEP . The agent does this on purpose, with bad intent, and those things can be proven.

Not insurance fraud: Same scenario but you tell the applicant that there's no way the government can know if the applicant is being truthful. Whatever the applicant tells the agent is what the agent is going to put the application. The applicant says yes a drought caused them to miss a previous enrollment period. He does not elaborate. The insurance agent finds that hard to believe but does not question the applicant. The agent submit the application and it's approved.

Walter

Caveat, not an agent.

Sorry to disappoint. Both your scenarios are examples of Insurance Fraud caused by Material Misrepresentation on the application.

 

[straightnochaser]

Caveat, not an agent.

Sorry to disappoint. Both your scenarios are examples of Insurance Fraud caused by Material Misrepresentation on the application.

I always love it when layman tell me how to do my job.