Every year CMS hires secret shoppers to gauge agent and agency compliance when selling Medicare Advantage (MA)/ Medicare Advantage-Prescription Drug (MA-PD) plans. It is important that CMS continues to monitor how agents are marketing and selling MA plans to seniors because it impacts their financial livelihoods. It is to ensure that as an agent you are taking care of your clients first, which you should be doing anyway. All agents selling MA/ MA-PD Plans can be subjected to a secret shopper at any time. Keep in mind this is not a comprehensive list, but if you are hosting an event or educational seminar, or simply having a one-on-one meeting, these are tips you need to keep in mind.
Face-to-Face Appointment Checklist
√ You must get permission to meet in person and must document the plan options you wish to discuss
√ You cannot come to clients’ homes without an appointment or Scope of Appointment
√ Once you are with client provide any pertinent plan materials
√ Be sure to tell your potential client how to access more plan information and additional materials
√ Tell your clients about the plan options you agreed to discuss
√ Give client an enrollment form
√ Collect the completed enrollment form
√ Leave your business cards for clients to contact you
Many agents get anxious when they think they are being secret shopped. DON’T! If you are a reputable agent, continue to educate the client as you normally would. As you continue to work in the senior community, many agents like yourself will decide to hold seminars. Marketing events are a great way to discuss a very important topic with a larger audience. Here are some compliance items to remember while hosting an event.
Marketing and Sales Event Checklist
√ Ideally arrive 30 minutes prior to the event starting and stay at venue for 30 minutes after the event start time even if no one arrives
√ Consumer friendly venue-handicap accessible doors, no cluttered walk ways, ramps, and way to isolate noise for guests
√ You must state your name, and the company that you represent, and product(s) you present at event—-You CANNOT say you represent Medicare or CMS
√ Provide light snacks and refreshments; however you may not pay for meals or provide a meal
√ An optional sign-in sheet for guests to register, but sign-in sheet should clearly state it is optional and not mandatory
√ You can’t require that attendees provide contact information or complete a registration form in order to attend the event receive information available, or promotional items offered
√ Provided all attendees a Pre-Enrollment Kit: Plan’s Star Rating Document, Summary of Benefits and Multi-Language Insert
√ All marketing materials were CMS approved and has CMS ID number located on marketing items
√ Plans/Part D Sponsors must submit all sales scripts and presentations for approval to CMS prior to their use during the marketing/sales event
√ Plans/Part D Sponsors 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
Again, this isn’t a comprehensive list. We encourage you to familiarize yourself with CMS’ Marketing Guidelines PDF by clicking HERE.
NCC provides all the tools for agents in the senior market to succeed and we want to stress the importance of staying compliant. Although being secret shopped can be frustrating and nerve-wracking just remember to continue to follow compliance protocol. As an insurance agent, you have to do what’s right by the clients and by the CMS book. If you ever have questions or concerns, please call your NCC Marketing Specialist. We are here to serve you and help you become the best possible version of yourself.
Did You Know?
- You cannot ask a non-member of a plan to be a referral. Once they are a client then they may refer people to you
- You may call former clients after disenrollment to conduct disenrollment surveys for quality improvement purposes only
- For events cancelled within 48 hours of the scheduled time, the plan must ensure a representative of the plan sponsor is present at the site of the cancelled sales event for at least 15 minutes beginning at the time the event was scheduled to occur, to inform attendees of the cancellation and distribute information about the plan sponsor.
- Cancellations due to inclement weather do not require a representative to be present at the site
- For events cancelled more than 48 hours prior to the scheduled time, a representative need not be present at the site of the event, but must notify the CMS Regional Account manager and must notify beneficiaries of the cancellation using the same means used to advertise the event (newspaper, phone, etc).