11/14/2008
New MIPPA guidelines summarized
It was great to see so many of you at our recent Medicare certification courses. We are thankful for our continued partnership. As a follow-up we thought it would be helpful to provide a summary of the new MIPPA guidelines that were covered in class.
Nominal gifts
Gifts must be less than $15 based on retail value (not actual cost). The gifts must not be readily convertible to cash and must be provided to every individual regardless of whether they enroll in the plan.
Meals
Plans and agents representing Plans may not offer or subsidize meals at any marketing event. This prohibition includes holding marketing events at a location where meals are already provided as a normal activity of that location (e.g., soup kitchens, senior centers, etc.). Plans may offer light snacks or refreshments, but they may not be bundled and provided as if they were a meal. Acceptable light snacks include:
- Fruit
- Raw vegetables
- Pastries
- Cookies or other small dessert items
- Crackers
- Muffins
- Cheese
- Chips
- Yogurt
- Nuts
Meals are permitted at educational events.
Marketing through unsolicited contacts
The prohibition on door-to-door solicitation now extends to other instances of unsolicited contact that may occur outside advertised sales, marketing or educational events.
Plans and Agents may:
- Call current members to discuss normal business, including discussions about other products offered by the Plan
- Call beneficiaries who have expressly given permission for the Plan or sales agent to contact them by filling out a business reply card (BRC) or similar document, or by asking a customer service representative to have an agent contact them (BRCs and other documents securing permission to contact beneficiaries must be filed with CMS.)
- Conduct follow-up calls on appointments already made to remind the beneficiary of an appointment or sales/educational event
- Conduct certain customer service and quality calls, such as disenrollment surveys, LIS reassignment calls, quality control and agent/broker oversight calls (Scripts for these calls must be submitted to CMS for review and approval.)
Plans and agents may NOT:
- Conduct any outbound marketing calls not expressly permitted above, including calling former members who have disenrolled or current members who are in the process of disenrolling to market other plans or products
- Call beneficiaries to confirm receipt of mailed information
- Approach beneficiaries in common areas (e.g., parking lots, hallways, lobbies, etc.)
- Conduct outbound calls to beneficiaries based on referrals, including referrals from family members, friends and other third parties (For referrals please ask that the third party call you.)
- Use any documents that do not have CMS approval (Permission given by a beneficiary is considered short-term and event-specific, and Plans may not treat this permission as open-ended. If a BRC is attached to an advertisement, Plans may discuss only those products mentioned in that advertisement during the follow-up call, unless the beneficiary clearly indicated a desire to discuss other products.)
Cross-selling
Plans and agents representing Plans may not market any non-health related products (e.g., long term care insurance, life insurance and annuities) to prospective enrollees during any Medicare sales activity or presentation. Agents may sell non-health related products on inbound calls when a beneficiary requests information on other non-health related products.
Dental coverage is considered health-related and therefore may be marketing during Medicare sales activities.
Scope of appointments
Prior to any marketing appointment, agents must document the scope of appointment agreed upon by the beneficiary. The Scope of Appointment form is currently being revised by CMS. When the form is available, we will send you a link you can use to view the form and download copies.
Agents can document this in two ways: (1) record the phone call during which the appointment is set up; or (2) have the beneficiary sign a paper Scope of Appointment form. Scope of Appointment documentation must be secured before the marketing appointment; having the beneficiary sign a Scope of Appointment form "at the doorstep" is not permitted. Plans and agents representing Plans may have beneficiaries return signed Scope of Appointment forms before marketing appointments via mail, email or fax. A beneficiary may sign a Scope of Appointment form at a marketing presentation for a follow-up appointment.
Additional lines of business that are not identified and documented prior to an in-home appointment require a separate appointment. This separate appointment may not be scheduled until 48 hours after the initial appointment. The separate appointment must also be appropriately documented by the agent.
Beneficiary walk-ins and similar beneficiary-initiated face-to-face sales events also require Scope of Appointment documentation. Plans should have the beneficiary fill out and sign the Scope of Appointment form and note that the beneficiary was a "walk-in." Similarly, when agents find other beneficiaries present at a properly documented sales event, the agent should have the additional beneficiaries fill out and sign a Scope of Appointment form prior to beginning the sales presentation.
For advertised group sales presentations, CMS views the presentation advertisement as the scope of appointment. Agents should discuss only products that are mentioned in the presentation advertisement.
Sales/marketing in health care settings
Agents may conduct sales activities only in common areas of health care settings (e.g., cafeterias, community/recreational rooms, conference rooms, etc.). Agents are prohibited from conducting sales presentations and distributing and/or accepting enrollment applications in areas where patients primarily intend to receive health care services (e.g., waiting rooms, exam rooms, hospital patient rooms, dialysis centers, pharmacy counters, etc.). Agents are allowed to schedule appointments with a beneficiary residing in long-term care facilities only at the beneficiary's request.
Sales/marketing at educational events
Agents may not conduct sales activities at educational events. This prohibition includes distributing marketing materials and the distribution or collection of enrollment applications. An event is educational if it is advertised as such. If the event is not advertised as educational Plans may conduct sales activities.
Plans and agents may:
- Distribute educational materials (Materials must be free of Plan-specific information and any bias towards one plan type over another.)
- Display a banner with the Plan name and/or logo
- Distribute promotional items, including those with Plan name, logo and toll-free customer service number and/or Web site (Promotional items must be free of benefit information.)
- Distribute a business card if the beneficiary requests information on how to contact the agent (The business card must be free of plan marketing or benefit information.)
Plans and agents may NOT:
- Discuss Plan-specific premiums and/or benefits
- Distribute or display BRCs, Scope of Appointment forms, or sign-up sheets
- Set up personal sales appointments or get permission for an outbound call to the beneficiary
- Attach business cards or Plan/agent contact information to educational materials
Plans and agents representing Plans that organize, sponsor or promote an educational event must include the following disclosure:
"This event is only for educational purposes and no plan specific benefits or details will be shared."
If the Plan wishes to market at an event they should not advertise it as educational.
If you need additional information, CMS has provided the following reference guides:
If you have questions, please talk to your Asuris Sales contact.
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