AHIP-4

PRENTICE has many clients who are Medicare beneficiaries. He should review the Centers for Medicare and Medicaid Services’ Marketing guidelines to ensure he is compliant for which type of products?

MA and PDP

Another agent working for your agency claims that because you are not employed by the MA plans that you represent, you are not subject to the same requirements as the plans themselves.

Your coworker is NOT correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with ALL Medicare marketing rules.

You work for a company that has marketed Medigap products for many years. The company has added MA and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the difference in benefits, premiums and cost sharing for each of the products. What do you need to do with your materials before using them for marketing purposes?

You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate.

Which of the following is a correct statement about state laws as they pertain to marketing representatives?

Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative.

You are seeking to represent an individual MA plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation?

You will NOT be able to represent any MA or Part D plan until you compete the training and achieve an adequate score, although you will NOT have to take a test if you exclusively market employer/union group plans and the companies do not require testing.

Your colleague works at a third party marketing organization, TMO and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells.

You could tell her she is wrong, and that only agents selling Employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements.

During a sales presentation to Ms. Daley for MA plan that has a 5 star rating in customer service and care coordination, and received an overall plan performance rating of a 4 star, which of the following would be the correct statement to say to her?

The MA plan received a 5 star rating in customer service and care coordination with an overall performance rating of 4 stars.

During a sales presentation, you client ask you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare.

Tell her that the Medicare agency does not endorse or recommend any plan.

Medicare health plan establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor’s contract.

You have set up an appointment for an in-home sales presentation with Mrs. Fowler, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do?

Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along wit her interest in the specific products you will present.

LU is turning 65 in November and called to ask for your help deciding on a MA plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do?

You may provide her with the required enrollment material and take her completed enrollment application.

The scope of appointment forms must be retained for a period of ten years.

…

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the MA program. Before engaging in such a discussion, what should you do?

You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a “walk in. ” You may then proceed with the discussion.

You are meeting with Mrs. Hall in her home. On her scope of appointment form she asked to discuss MA plans. During the meeting, she asks to discuss a stand-alone Rx plan. She is leaving the next day to visit her family in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place?

Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new scope of appointment form first, indicating that she wants to discuss the Part D plan.

Third parties may NOT make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of MA or Part D plans.

…

You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing MA and Part D plans, what must you do about contact potential clients to market those plans?

You will have to AVOID calling any potential client, unless he or she initiates contact with you and specifically asks that you give him/her a call.

During a sales presentation for a PFFS plan, which of the following points should you explain?

That the beneficiary, NOT the plan, is responsible for the entire cost for services she obtains that are not medically necessary.

VALESQUEZ asked if the PFFS plan you have discussed is like Original Medicare or a Medigap supplement plan. What should you say about a PFFS plan to explain it to Mr. Valesquez?

It is NOT Original Medicare and it works differently than a Medicare supplement plan.

By contact plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

You must present comparative information that has been created and approved by the CMS, such as a print out from the Medicare plan comparison website.

One of your colleagues argues that face to face meetings with potential enrollees should be required because they can’t make an appropriate decision with the minimal information that can be provided over the phone or in small brochures.

This is INCORRECT. Brokers and agents CAN’T require face to face meetings in order to answer questions or enroll a Medicare beneficiary.

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

Clearly state that NO obligation exists to enroll if a gift or prize is being offered.

Ordinarily, you ask your clients for referrals to people they think would benefit from the products you offer. When selling MA or Part D products, how might you solicit referrals?

You may solicit referrals from current MA and Part D enrollees and offer one thank you gift per member per year of less than $15, based on retail purchase price of the item, although you may NOT inform enrollees of the availability of the gift in your letter soliciting referrals.

When soliciting referrals from current member of an MA or Part D plan, what may you do?

You MAY request names and mailing addresses.

You can give away more than one gift during a single event, but the aggregate retail value CAN’T exceed $15 each.

…

Your friend’s mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-Pd plans you market. What could you tell him?

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.

Plan sponsors may undertake the following marketing activities with current MA members?

Market non-Medicare health related products, such a dental insurance, to current members as permitted by HIPPA Privacy Rules

This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected.

You MAY go ahead and call them.

Next week you will be participating in your First educational event. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage?

You should plan to ensure that the educational event is a social event, and must NOT conduct a sales presentation or distribute or accept enrollment forms at the event.

If you are to be in compliance with Medicare’s guidelines regarding educational events, which of the following would be acceptable activities?

You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent.

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare health plans you market, and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague’s suggestion?

You should tell your colleague NO because participation in an educational event may NOT include a sales presentation.

Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual?

The plan may withhold commission, require retraining, report the misconduct to the state dept. of insurance or terminate the contract.

The Medicare agency has requested a list of contracted representatives from a PFFS plan that you represent. In this situation, what will the plan do?

Plans will provide to the Medicare agency a complete list of all of their contracted representatives who are marketing PFFS products, and will authorize the agency to provide those names to state departments of insurance when they request it.

With regard to the training you are currently taking, what involvement will CMS have in ensuring that it takes place?

CMS will conduct oversight of plan training programs and plans must provide the agency with any information necessary for the agency to conduct such oversight.

The Medicare agency requires ALL Medicare health plans that contract with marketing representatives to ensure that contracts address which of the following?

Medicare health plans MUST include in ALL marketing representatives contracts requirements to abide by all guidance from the Federal agency overseeing Medicare and all applicable state laws.

Medicare health plans establish provisions in marketing representative contracts to ensure compliance with applicable laws and policies. If non-compliance occurs, CMS can penalize a plan in which of the following ways?

CMS requires plan sponsors to create and complete a corrective action plan and may terminate a sponsor’s contract.

QUINN is a marketing representative who markets an MA plan. He is a very good speaker and was asked to make a presentation at a local event that was advertised as education. He accepted the invitation and the MA plan reported the event to CMS. CMS’s secret shopper attended the event and heard Mr. Quinn’s sales presentation. Which of the following could CMS do?

Require the MA plan to suspend marketing and enrollment for a period of time.

LYNN, an agent for ACME ins. Inc., thinks that, since state laws are preempted with regard to the marketing of Medicare health plans, he doesn’t have much to worry about. What might you, as his colleague, advise him concerning the type of scrutiny he will be under?

Organizations sponsoring Medicare health plans are responsible for the behavior of their contracted representatives and will be conducting monitoring activities to ensure compliance with all applicable Federal laws and guidance and plan policies. Furthermore, state agent licensure laws are NOT preempted and he must abide by their requirements.

Can marketing representatives request information from providers regarding Medicare beneficiaries with specific health conditions for marketing purposes?

NO, providers are legally prohibited from sharing such information.

When soliciting referrals from current members of an MA or Part D plan, what may you do?

You may request names and mailing addresses.

Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing MA and Part D plans apply to this practice?

Third parties may NOT make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of MA or Part D plans.

Your colleague works at a third party marketing organization TMO and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells.

You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements.

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

You may present comparative information that has been created and approved by the Medicare agency CMS, such as a print out from the Medicare plan comparison website.

WEISS is entitled to Part A and has medical coverage w/o drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover Rx’s, she wants to enroll in a Medicare Rx plan. Will she be able to?

YES, Mrs. Weiss must be entitled to Part A OR enrolled in Part B to be eligible for coverage under the Medicare Rx plan.

SAUNDERS is entitled to Part A, but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a MA plan, what will he has to do?

He will have to enroll in Part B.

KELLY wants to know whether he is eligible to sign up for a PFFS plan. What questions would you need to ask to determine his eligibility?

You would need to ask Mr. Kelly if he is enrolled in Part A and B and if he lives in the PFFS plan’s service area.

GONZALEZ is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a PFFS plan, what will he have to do?

He will have to enroll in Part B prior to enrolling in the PFFS plan.

BROWN wants to enroll in a MA plan that does NOT include drug coverage and also enroll in a stand-alone Medicare Rx plan. Under what circumstances can she do this?

If the MA plan is a PFFS plan that does not offer drug coverage or a MSA, Mrs. Brown can do this.

ROBERTS has Original Medicare and would like to enroll in a PFFS plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan?

A MA-PD PFFS plan that combines medical benefits and Part D Rx coverage.
A PFFS plan offering only medical benefits, OR
A PFFS plan in combination with a stand-alone Rx plan.

PRENTICE has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services’ Marketing guidelines to ensure he is compliant for which type of products?

MA and PDP plans.

Another agent working for your agency claims that because you are not employed by the MA plan that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement?

Your coworker is NOT correct. Marketing on behalf of a plan is considered marketing by the plan and requires that ALL contracted and employed agents comply with all Medicare marketing rules.

You work for a company that has marketed Medigap products for many years. The company has added MA and Part D plans and you will begin marketing those plans this fall. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing of each of the products. What do you need to do with your materials before using them for marketing purposes?

You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate.

Which of the following is a correct statement about state laws as they pertain to marketing representatives?

Medicare health plans MUST comply with requests for information from state ins. departments investigating complains about a marketing representative.

You will NOT be able to represent any MA or Part D plan until you complete the training and achieve an adequate score, although you will NOT have to take a test if you exclusively market employer/union group plans and the companies do NOT require testing.

Prior to conducting the presentation, obtain, and document having obtained her permission to visit, along with her interest in the specific products you will present.

LU is turning 65 in November and called to ask you for help deciding on a MA plan. She agreed to sign a scope of appointment form and meet with you October 15. During the appointment, what are you permitted to do?

You may provide her with the required enrollment materials and take her completed enrollment application.

While marketing MA and Part D plans, you collected a large number of scope of appointment forms from you clients, wherein they indicated their interest in specific products and this wish for you to provide information on those products in their homes. What should you do with those forms?

The scope of appointment forms MUST be retained for a period of ten years.

You are meeting with Mrs. Hall in her home. On her SOA form she asked to discuss MA plans. During the meeting, she asks to discuss a stand-alone Rx plan. She is leaving the next day to visit her family for a week in another state, so it is important to her to make a decision before she leaves. What must happen before that additional discussion can take place?

You will have to avoid calling any potential client, unless he/she initiates contact with you and specifically asks that you give him/her a call.

During a sales presentation for a PFFS plan, which of the following points should you explain?

That the beneficiary, NOT the plan, is responsible for the entire cost for services she obtains that are NOT medically necessary.

Ordinarily, you provide clients who purchase various types of insurance products from you with a gift when they enroll and you let them know that they will receive it their enrollment is complete. When you market MA and Part D plans, what may you offer as a gift to induce enrollment in a plan?

You may NOT provide any gift or prize as an inducement to enroll.

This is INCORRECT. Brokers and agents CAN’T require face to face meetings in order to answer questions or enroll a Medicare beneficiary.

EDWARDS, a marketing representative of the ACME Ins. Co. scheduled a marketing event and expects about 40 people to attend. He has fired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency?

He can do this, because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15.

You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Under the guidelines from the Medicare agency, what types of gifts or prizes would NOT be allowed in this situation?

Gifts cards or gift certificates of $15 or less that can be readily converted to cash.

You are scheduled to give a sales presentation at a local senior center. At the beginning of the presentation, which of the following must you do?

Clearly state that NO obligation exists to enroll if a gift or prize is being offered.

Your friend’s mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PA plans you market.

You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request.

Plan sponsors may undertake the following marketing activities with current MA plan members?

Market non-Medicare health related products, such as dental insurance, to current members as permitted by HIPPA privacy rules.

You may go ahead and call them.