Guidance for Formal/Informal Event Participation

July 6, 2016

Many carriers are in the process of setting up events for the upcoming AEP. Remember, during marketing/sales events, plan representatives may discuss plan-specific information (e.g., premiums, cost-sharing and benefits), distribute health plan brochures, enrollment material and accept enrollments.

That being said, remember…. presentations/enrollments must consist of the entire enrollment process and the meeting location should be in a private area where the beneficiary’s personal information cannot be overheard by a passerby.

There two main types of marketing/sales events and both must be reported to CMS by the carrier. And, both have the same CMS marketing guidelines:

Formal Event: Typically in an audience/presenter format with an agent, broker or producer formally providing specific health plan or product information via a presentation.

Informal Event: Conducted with a less structured presentation or in a less formal environment. Typically, there is a table or kiosk staffed by a plan representative who can discuss the merits of a plan’s products. Remember, beneficiaries must approach you.

Event Scheduling

If you plan on scheduling an informal or formal event, you must inform the carrier you are representing at least 21 days in advance so the carrier can make sure that there are no conflicts, and the carrier’s representative can enter your event in the Health Plan Management System (HPMS).

Carriers must notify CMS of all formal and informal marketing/sales events via HPMS prior to advertising the event or seven (7) calendar days prior to the event’s scheduled date, whichever is earlier. Changes to marketing/sales events, (e.g., cancellations and room changes), should be updated in HPMS at least forty-eight (48) hours prior to the scheduled event.

This is a very busy time for all carriers, so please be considerate and provide as much prior notice that you can. It will be very much appreciated.

Cancellations

• Notification of cancelled sales events should be made at least forty-eight (48) hours prior to the originally scheduled date and time of the event.
• If you are unable to attend a scheduled event, it is up to the agent/up-line to find a suitable replacement, per the carrier’s guidelines.

Note: If the carrier has stricter event guidelines relating to event submission and/or cancellation, the carrier rules supersede the above-described guidelines.

As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@NSGACommunications.com or you may call the toll-free number listed below.

FOR AGENT USE ONLY. NOT FOR USE WITH CONSUMERS.

Compliance Updates | 2650 McCormick Drive | Clearwater, FL 33759 | 844.206.2927