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Agent Compliance Resources

Emphasizing Compliance: A Key to Success

In the world of insurance, adhering to established rules and regulations is non-negotiable. Whether you’re engaging with existing clients or reaching out to potential new ones, it’s crucial to comply with Federal and State laws, as well as the guidelines set by carriers and marketing organizations you represent. To support this endeavor, Benavest offers comprehensive Agent Compliance Resources designed to help insurance professionals navigate their roles with excellence.

Important Update: 2024 AEP CMS Guidelines Now Available! 

 

The Centers for Medicare and Medicaid Services (CMS) has released its 2024 policy and technical amendments for the Medicare Advantage (MA) and Prescription Drug Programs (PDP). Here’s a brief rundown of key updates that could impact your operations:

Scope of Appointment (SOA):

A new requirement mandates obtaining an SOA at least 48 hours before any sales meeting with a beneficiary, with exceptions for in-person walk-ins and urgent meetings during the final days of an election period.

Medicare Branding:

Strict regulations govern the use of the Medicare name, CMS logo, or government-issued materials. Notably, images of the Medicare card now need CMS pre-approval.

Marketing Materials:

There are restrictions on promoting benefits not available in the service area and new rules requiring the inclusion of all represented MA and Part D organizations in marketing materials.

Call Recording:

CMS now specifies that recordings are necessary for all sales and enrollment calls, including those conducted via virtual platforms like Zoom or Skype.

Disclaimers:

Enhanced disclaimers are required, including information about alternative consultation options like SHIPs, and the range of plans offered by TPMOs.

Educational Events:

Tighter controls are now in place to prevent sales activities from occurring too close in time or location to educational events.

Door Knocking:

Agents must not use BRCs or PTCs as permissions for unscheduled visits to beneficiaries’ residences.

Expanded Definition of “Marketing”

As of May 10, 2023, CMS has widened its definition of “marketing.” This change means that any mention of common benefits like dental, vision, or prescription drug coverage in any material now falls under the umbrella of marketing and must comply with stringent submission and
approval processes.

 

Navigating Ambiguities

We recognize some new rules might be unclear. Our team, in collaboration with Integrity’s compliance experts, is dedicated to deciphering these regulations and providing you with clear guidance. Should you have any queries, your Agent Advisor is just a call away. Also, don’t forget to download the updated compliance resources available below.

Through these resources and ongoing support, we aim to ensure that you can continue your
marketing efforts confidently and compliantly.

ACA Final Rule Update as of June 18th, 2023

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New Consent and Review Documentation Requirements

 

Consent Documentation:

Benavest is required to adhere to CMS’s latest regulation updates that mandate comprehensive consent documentation. Agents, brokers, and web-brokers must secure documented consent from consumers or their authorized representatives, which includes:

● An active confirmation by the consumer or their representative to produce the documentation.

 

Documentation should minimally include:

● Details of the consent’s scope, purpose, and duration.

● The date on which consent was granted.

● Names of the consumer or their representative and the agent, broker, or web-broker.

● A method for the consumer to rescind consent if desired.

● Documentation must be maintained for at least 10 years.

Review Documentation

The new rules also require that eligibility application information is reviewed and confirmed for accuracy by the consumer or their authorized representative before submission:

The consumer or their representative must actively confirm the documentation’s creation.

Documentation must at least include:

● The name of the consumer or their authorized representative.

● A clear explanation of the eligibility application’s final attestations.

● The name of the assisting agent, broker, or web-broker.

● This documentation also must be retained for a minimum of 10 years.

Download the CMS Model Consent Form Here

How to Avoid Unqualified Sales:

 

Essential compliance tips include:

 

● Keeping State Appointments current with each Carrier.

● Completing all required product certifications, especially for Medicare products, before engaging in sales.

● Ensuring your state license and Continuing Education (CE) credits are up-to-date.

● For managers with downline agents, it’s crucial to ensure they are also compliant and well-trained in these regulations.

 

Educational and Sales Events During AEP:

 

During the Medicare Advantage Annual Enrollment Period (AEP), it’s vital to adhere to the compliance standards of CMS and the carriers represented. Organizing educational and sales events is a great opportunity to engage clients but must be done within regulatory guidelines.

Advertising and Website Compliance:

 

Promoting your services while complying with the legal and carrier requirements is essential. For any unapproved advertising materials (print, digital, radio, TV), consult your Agent Advisor or Compliance Officer for review procedures. When using online platforms:

● Avoid using carrier logos and specific plan details without permission.

● Choose titles that clearly state your licensing status and do not imply governmen affiliation.

● Ensure your website includes the required TPMO disclosure prominently.

● Consult with your Compliance Officer for any website compliance queries.

Benavest is committed to supporting you through these regulatory updates to ensure seamless and compliant business operations.