Marketing Through Unsolicited Contacts and Scope of Appointment

October 17, 2016

70.5 – Marketing through Unsolicited Contacts – 42 CFR 422.2268(d), 423.2268(d)

In general, Plans/Part D Sponsors may not market through unsolicited direct contact, including but not limited to:

• Door-to-door solicitation, including leaving information such as a leaflet or flyer at a residence or on a car;
• Approaching potential enrollees in common areas (e.g., parking lots, hallways, lobbies, sidewalks, etc.); and
• Telephonic or electronic solicitation, including leaving electronic voicemail messages or text messaging.

Note:

• Agents who have a pre-scheduled appointment with a beneficiary that becomes a “no-show” may leave information at the potential enrollee’s residence.
• The prohibition on marketing through unsolicited contacts does not extend to conventional mail and other print media (e.g., advertisements, direct mail).
• In addition, if a potential enrollee provides permission to be called or otherwise contacted, the contact must be event-specific, and may not be treated as open-ended permission for future contacts.

Scope of Appointment

When conducting marketing activities for Medicare Advantage (MA) and Medicare Prescription Drug Plans (PDP), a Sales Agent may not market health care related products beyond the scope that the beneficiary agreed upon prior to the meeting. The Sales Agent must document (and the beneficiary initial) the scope of the agreement before the appointment.

• Distinct lines of plan business include MA, PDP and Cost Plan products. If a beneficiary would like to discuss additional health-related products that they did not agree to discuss in advance, a second SOA form must be completed and the appointment can continue.
• If a prospect attends an informal or a formal event and subsequently schedules an in-home appointment, the agent must obtain an SOA from the prospect agreeing to the products that will be discussed.
• If additional sales prospects (includes a husband and/or wife) are present for a scheduled in-home appointment, the sales agent must request the additional prospects complete the SOA form. A 48-hour wait is not necessary; however, the agent must document as to why the SOA and the presentation occurred on the same day.
• DO NOT BACK DATE A SCOPE OF APPOINTMENT AND/OR THE ENROLLMENT APPLICATION.

“Walk-in” beneficiaries to an Agent/Broker Office

If a beneficiary visits an agent/broker office on his/her own accord, an SOA form must be completed prior to any MA or PDP presentation and document that the beneficiary was a “walk in”.

NO CROSS SELLING

Under no circumstances can you discuss and/or complete an application for a non-health product; e.g., life insurance or annuity at the time of a Medicare Advantage or Part D enrollment. Returning a minimum of 48 hours later allows the consumer to have a “fresh mind” and gives way to a better understanding of the new product you are discussing. Plus….CMS clearly states no cross-selling.

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