Agent Compliance Resources
Stay compliant with ACA rules using InsureUniversity resources. Access consent forms, scripts, and compliance guides for agents.
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.
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 Sept. 30, 2025
- Consent must be explicit and involve an action by the consumer or authorized representative that produces a record, such as a wet or electronic signature, consent email, or a recorded verbal authorization.
- Consent documentation must state the scope, purpose, and duration of the consent granted.
- There must be a process for the consumer to rescind consent at any time.
- Agents, brokers, or web-brokers are required to keep this documentation for a minimum of ten years and present it to CMS upon request for compliance audits.
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:
- Documentation is required that the consumer has reviewed and confirmed the accuracy of the information in their eligibility application prior to submission.
- At a minimum, documents must include the date of review, the consumer’s or representative’s name, an explanation of the application attestations, and the name of the assisting agent or broker.
- The consumer must take an action to indicate this review (e.g., signature , email confirmation, or recorded phone line).
How to Avoid Unqualified Sales:
Essential compliance tips include:
- New CMS rules require pre-enrollment eligibility verification for at least 75% of new special enrollment period (SEP) enrollments, aiming to reduce improper and fraudulent enrollments and ensure only qualified individuals access coverage.
- Agents and brokers are subject to stricter monitoring. Failure to comply with rules (such as not securing proper consent or neglecting eligibility verification) can result in termination of agreements with Marketplaces.
- It is essential to follow the outlined consent and review procedures precisely, maintain clear records, and report any suspicious activity to avoid compliance failures and the risk of enabling unqualified sales.
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.