Medicare Advantage Communications, Marketing and Training Rules 

2 comments on “Marketing Rules – Best Plan – SOC Scope of Appointment”

1. 17 comments on “Scope of Appointment – Telephone & Face to Face Meetings”

   1. Hello Steve, thanks for getting into the weeds of this. It can be confusing even after AHIP.

      My question is:

      are communications with the prospect still considered ‘marketing’ even after the SOA has been signed?

      If so, the rules requiring plan benefits information to only be communicated through specific CMS-approved formats would seem to prevent an agent from discussing any plan benefits via email, or even over the phone if not following an official CMS-approved script.

      For instance, if a prospect sends me an email requesting that I share information about $0 premium MA plans and I have them fill out an SOA, I might then send an email saying ‘Company X and Y both have zero-premium plans in your area, let’s schedule a call to talk more…’

      In effect, by typing out that email I’ve just shared plan benefits information in a non-cms approved format. This interpretation of the rules seems prohibitively burdensome. My upline tells me that marketing rules don’t apply the same way after the SOA, but I’ve never seen that stated as such in any compliance training I’ve taken. What am I missing?

      Thank you,

      – Evan

      Reply

      • My biggest grip with AHIP and company training, is that they don’t show the actual law, brochure or Medicare Official Information, but use power point and then forbid agents to show it to anyone. IMHO it’s worthless!!!

        See above, where I cut and pasted the definition of marketing

        Definition Marketing Activities

        20 – Communications and Marketing Definitions 42 CFR §§ 422.2260, 423.2260

        Communications means activities and use of materials to provide information to current and prospective enrollees. This means that all activities and materials aimed at prospective and current enrollees, including their caregivers and other decision makers associated with a prospective or current enrollee, are “communications” within the scope of the regulations at 42 C.F.R. Parts 422, 423 and 417.

        Marketing is a subset of communications and includes activities and use of materials that are conducted by the Plan/Part D sponsor with the intent to draw a beneficiary’s attention to a MA plan or plans and to influence a beneficiary’s decision-making process when selecting a MA plan for enrollment or deciding to stay enrolled in a plan (that is, retention-based marketing). Additionally, marketing contains information about the plan’s benefit structure, cost sharing, and measuring or ranking standards.

        These rules change… here’s the draft for 2019 See page 6, it looks like the same defintion

        So, IMHO it’s marketing. I think your question is, do you need a new scope of appointment each time you contact a prospect?

        Reply

      • https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/Draft_2020_MCMG.pdf#page=55
        

        This is “crazy!” do we need an SOC to respond to an email?

        Let’s check the Code of Federal Regulations CFR

        https://www.law.cornell.edu/cfr/text/42/part-422
        Definitions
        https://www.law.cornell.edu/cfr/text/42/422.2260

        Reply

        • 70.4.3 – Scope of Appointment

          42 CFR 422.2262, 422.2268(g) and (h), 423.2262, 423.2268 (g) and (h)

          When conducting marketing activities, in-person or telephonically, a Plan/Part D Sponsor may not market any health care related product during a marketing appointment beyond the scope that the beneficiary agreed to before the meeting. The Plan/Part D Sponsor must document the scope of the appointment prior to the appointment. Distinct lines of plan business include MA, PDP and Cost Plan products. If a Plan/Part D Sponsor would like to discuss additional products during the appointment in which the beneficiary indicated interest, but did not agree to discuss in advance, the Plan/Part D Sponsor must document a second scope of appointment (SOA) for the additional product type to continue the appointment.

          SOA documentation is subject to the following requirements:

           The documentation may be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement. Any technology (e.g., conference calls, fax machines, designated recording line, pre-paid envelopes, and email) can be used to document the scope of appointment.
           Date of appointment
           Beneficiary contact information (e.g., name, address, telephone number)
           Written or verbal documentation of beneficiary or appointed/authorized representative agreement
           The product type(s) (e.g., MA, PDP, MMP) the beneficiary has agreed to discuss during the scheduled appointment
           Agent information (e.g., name and contact information)
           A statement clarifying that:
          – beneficiaries are not obligated to enroll in a plan
          – current or future Medicare enrollment status will not be impacted
          – that the beneficiary is not automatically enrolled in the plan(s) discussed

          A beneficiary may sign an SOA at a marketing/sales event for a future appointment. Marketing/sales events, as defined in section 70.5, do not require documentation of beneficiary agreement.

          Note: Business reply cards (BRC) separate and independent from a marketing piece, must be submitted in HPMS if benefits and/or costs information is mentioned or the BRC is used as an agreement to be contacted, confirmation of attendance to a sales/marketing event, or request for additional information. Plans/Part D Sponsors should
          include a statement on the BRC informing the beneficiary that a sales person may call as a result of their returning a BRC. See section 90.2 for information on the material submission process.

          https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY-2018-Medicare-Marketing-Guidelines_Final072017.pdf#page=45

          I don’t find this in the current version…

          So, it appears that one only needs an SOC for appointments, not answering questions via email.

          Reply

      • I myself love Zoom meetings with screen sharing, as I can show the benefits using the approved summary of benefits for the respective company. That way, I’m not saying anything, the prospect and I are simply reviewing approved material. So, I wouldn’t say Company X & Y have Zero premiums, I’d send the Summary of Benefits and let the client look.

        While not required and I don’t represent Humana… I’ve taken their advise to heart, in all my sales endevors. That way no one can say I said something that wasn’t correct. I insist they go by the law or actual brochure, not what they think I said or may have said in error.

        I don’t see any difference in emailing before or after a SOC

        

        Reply

   2. Is a scope of appointment required if benefits are going to be discussed prior to a beneficiary enrolling on their own via the PURL?

      Personalized URL (PURL): Receive commissions when Medicare beneficiaries use your personalized URL (non-agent-assisted) to enroll online in a WellCare plan.

      Reply

      • I don’t see any way around the mandate to get a scope of appointment. Check with your agency manager.

        https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY2019-Medicare-Communications-and-Marketing-Guidelines_Updated-090518.pdf

        Scope of Appointment Must be documented for all marketing activities, in-person, telephonically, including walk-ins to Plan/Part D sponsor or agent offices

        The term “marketing” is referenced at Section 1851(h) and 1860 D-4 of the Social Security Act (the Act), as well as in CMS regulations. The scope of the definition of “marketing materials” extends beyond the public’s general concept of advertising materials.

        70.4.2 – Personal/Individual Marketing Appointments 42 CFR 422.2268(f)-(h), 423.2268(f)-(h)
        All Plans/Part D Sponsors conducting one-on-one appointments with beneficiaries, regardless of the venue (e.g., in home, telephonic, or library), must follow the scope of appointment (SOA) guidance (see section 70.5.3).

        Reply

        • If a person registers for a marketing seminar for a specific plan/carrier and wants to sign up, is A scope of appointment still required since they obviously registered for the event.

          Reply

          • Yes! One of the things I hate about all these rules, is the AHIP and Company training that we are not allowed to share and is secret.

            Here’s excerpts from something I found it google to answer your question:

            https://www11.anthem.com/agent/noapplication/f1/s0/t0/pw_e235866.pdf?refer=ahpagent&state=va

            There are two types of sales events, formal and informal. At a marketing/sales event, plan representatives may discuss plan specific information like premium, cost-sharing, and/or benefits, as well as, distribute and/or collect enrollment applications.”

             Formal marketing/sales events are structured events of an audience/presenter style with a sales person providing specific plan information via a specific CMS approved sales presentation.

            Don’ts

            Require or otherwise use personal contact information, collected for purposes of a raffle or other event giveaway, as means of permission for future contact.

            Require the completion of or pressure event attendees to fill out a sign in sheet or business reply card (‘thank you’ card).

            ***Thus, there is NO Registration!

            SCOPE OF APPOINTMENTS (SOA) and Individual Appointments Practices

            Don’t

            Begin discussing MA or PDP plans prior to the beneficiary signing the SOA Form.

            https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY2019-Medicare-Communications-and-Marketing-Guidelines_Updated-090518.pdf

            50.2 – Marketing/Sales Events
            42 CFR §§ 422.2268(b)(1-5), 423.2268(b)(1-5)
            Marketing/Sales Events are designed to steer or attempt to steer potential enrollees, or the retention of current enrollees, toward a plan or limited set of plans. The following requirements apply to all marketing/sales events:

             Plans/Part D sponsors must submit scripts and presentations to CMS prior to use, including those to be used by agents/brokers;
             Sign in sheets must clearly be labeled as optional;
             Health screenings or other activities that may be perceived as, or used for, “cherry picking” are not permitted;
             Plans/Part D sponsors may not require attendees to provide contact information as a prerequisite for attending an event; and
             Contact information provided for raffles or drawings may only be used for that purpose.

            Scope of Appointment (Communications)

            Must be documented for all marketing activities, in-person, telephonically, including walk-ins to Plan/Part D sponsor or agent offices

            Reply

   Reply

2. CA Insurance Code 787 (i) All advertisements used by agents, producers, brokers, solicitors, or other persons for a policy of an insurer shall have written approval of the insurer before they may be used.

   Reply