Plan Advisors Blog

Have a Compliant AEP

Posted by Lance Hoeltke on Fri, Oct 23, 2020 @ 09:28 AM

AEP looks different this year thanks to COVID-19, so it’s more important than ever to make sure your Medicare marketing and sales comply with rules, regulations, and best practices. 

The Centers for Medicare and Medicaid Services (CMS) has specific guidelines for every kind of interaction you will have with potential clients. Not sure where to start? Plan Advisors has your back.

Here are a few best practices according to CMS guidelines:

Marketing Compliance

Materials are either considered "communications" or "marketing." Communications materials are usually more general, with non-specific information for prospective clients. 

The goal of marketing materials, on the other hand, is to tell prospective clients about specific plan benefits in the hopes that they might choose that plan. Marketing materials are subject to review while communication materials are not.

If you're not sure whether something counts as marketing or communication, our team is happy to help!

Whenever you are marketing certain plans, either digitally, on paper, or in person, it’s important to provide beneficiaries with helpful, accurate, and transparent information. Do not mislead them in any way. Avoid using absolutes, superlatives, and the word "free."

Sales Compliance

Every face-to-face meeting and one-on-one phone conversation requires a Scope of Appointment. As of 2018, same-day SOAs are compliant.

If your client requests Medicare information not included in the original Scope, a second SOA will be required. And if they would like information on something other than health-related products, a second appointment will be necessary.

Don’t forget to cover all your bases with your telephonic meetings, too. Here is a blog post on ways to avoid telephonic sales allegations.

Event Compliance

Education events are a great way to inform beneficiaries about healthcare programs, but it’s important not to steer potential enrollees in a certain direction. If you’re hosting an education event, it needs to remain just that, and it should clearly state that this is an educational event in any advertising and marketing. Answer questions, participate in health fairs, and distribute materials or information, but don’t discuss plan specifics. These events cannot be held in-home or in one-on-one settings.

Sales and marketing events, on the other hand, can include plan-specific information. These events are less formal and without a structured presentation, but they should also be focused on health-related products. Providing your potential enrollees with promotional materials is a great way for them to remember you, but don’t exceed a $15 value per attendee.

You can promote these events in a variety of ways. Use social media and local media to your advantage. Remember, though, for marketing and sales events, you can’t require people to submit their personal information to RSVP. 

Finally, be sure to leave your attendees with your contact information and details about how you can help them. 

Here's some specific guidance on presentation compliance.

Digital Tool Compliance

Unsolicited contact is generally forbidden, but an update to the CMS guidelines allows for unsolicited contact via email, as long as there is an option to unsubscribe or opt-out of emails. The emails should not be plan-specific, however, and should focus on the services you offer. Unsolicited phone calls and approaching potential enrollees directly in common areas is not compliant.

To begin conversations with potential enrollees, permission to contact (PTC) forms will be needed. A new update to the CMS guidelines, however, states that you can use the same PTCs during different periods.

Social media is a great tool to use to promote you and your services. Carrier or plan-specific information, however, should not be shared on social media. Likes and shares also do not count as PTCs.

Website content should be submitted for evaluation in advance. Don’t forget, though, to review the carrier-specific information, as different carriers may have different requirements.

We know following the guidance to the letter can seem complicated, but being aware of the rules is a great first step. Researching the regulations and planning your messaging, meetings, and more around those regulations will ensure you are being compliant every step of the way. Not being compliant can lead to some pretty hefty consequences, like administrative penalties or even license suspension. It’s always better safe than sorry when it comes to compliance, even if that means taking a few extra steps.

Everyone is responsible for following CMS guidelines. Compliance doesn’t have to be difficult, but it does require forethought and preparations. When in doubt, contact Plan Advisors for help!