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AHIP MODULE 4
Marketing
| Term | Definition |
|---|---|
| Marketing is distinguished from communication by these two concepts: | 1) Intent 2) Content |
| What is marketing intent? | draw prospect/current enrollees attention to a plan or group of plans to influence a bene decision |
| What is marketing content? Some examples: | marketing activities and materials like info on benefits or premiums/cost sharing, comparisons to other plans, rankings, Star ratings etc. |
| How are marketing activities regulated? 5 main ways | Setting, Who may market, timing, contact, content |
| Provide just 2 examples of marketing activities | plan presentation, events, meeting in person with bene, health fairs, accepting enrollment forms at marketing/sales events |
| Explain the regulation of marketing materials in terms of content and the review/approval process | content - may require certain disclaimers and prohibits some language review + approval - all marketing materials be submitted to CMS for approval and review |
| What is the one exception to the review/approve process? | if the materials are developed for us with employer/union group members |
| What are the 5 types of medicare health plans and Part D plans that the CMS rules apply to? | MA, MA-PD, PDPs. 1876 Cost Plans, MMPs |
| Which type of Medicare health plan may have different rules for marketing based on the state? | MMP |
| True or False: Marketing Representatives from third party marketing firms are exempt from CMS regulations | False, same rules apply up and down stream from plan |
| True or False: Plan sponsors who wish to market in a specific state must contract with or employ marketing representatives who are licensed by the state in question | True |
| What continuing education criteria do marketing reps employed (or contracted) need to meet? What is the exception? | pass a written test each year, unless they ONLY sell union/employer group coverage |
| What unsolicited activities are marketing reps prohibited from doing? | door to door, approaching in-person, telephone, text messages (on all platforms), referrals |
| What unsolicited activities are marketing reps not prohibited from doing? | email, conventional mail, print media adverts, return calls from prospects who initiate, call benes to confirm appt, call benes who submit enrollment apps to discuss said apps |
| True or False: if a marketing rep meets a potential bene at an event, he/she can call anytime with no additional steps. | False, there must be documented express permission at the event in question in order to call |
| True or False: it is fine if a life insurance agent calls a (legal) life insurance lead and at the end of the call asks if the client would like to learn more about MA | False, that is unsolicited and a sales rep is considered a marketing rep |
| What are some reasons a marketing rep would call current benes ? | aging into medicare, talking about MA with someone in Medicaid or Medigap, promote other plans, call to inform of AEP dates, plan changes, events, etc |
| What are some characteristics of Marketing Events? | - held in public, hosted by plan/part D sponsor or outside entity - put on by providers or other groups and sponsored by one ore more health plans - immediately following an education event (in the same general location) ok to start marketing event |
| What can a sales agent do at an ed event if approved by CMS? | discuss plan specific info, merits of plan, distribute and collect apps, distribute adverts for plan and related marketing information, provide refreshments and light snacks of a nominal value (not bundled with meal) |
| What can't a sales agent do at an ed event? | require contact info, RSVP conditions, conduct health screenings or like activities, provide meals or multiple snacks/refreshments bundled and provided as if a meal, regardless of value |
| What can a marketing agent do at an ed event? | answer bene-limited questions, set up marketing appts, distribute business cards, provide nominal meals/refreshments/snacks |
| What can't a marketing agent do at an ed event? | conduct sales presentations, discuss/display/distribute plan specific info, engage in marketing activities, distribute/collect enrollment apps |
| What is considered a "gift of a nominal value"? What is the limit for gifts to the same bene per year on different occassions? | $15 or less (combined not per item) and not in cash or cash equivalents multiple gifts - $75 or less |
| What may marketing reps do during individual appointments? | distribute plan materials (kits, marketing materials), provide educational info, provide and collect enrollment forms |
| What can't marketing reps do during individual appointments? | discuss plan options not agreed to in scope of appt (unless bene asks during appt unprompted), market non-health care related products, solicit/accept enrollment request for 01/01 effective date prior to start of AEP unless bene has SEP |
| True or False: for appts made over phone, if the call that went over scope of meeting was not recorded, the rep MUST obtain written agreement signed by bene and authorized by rep before appt | True |
| What must be included when documenting the SOA for Plans/Part D sponsors? | product type, date of appt, bene contact info, written/verbal auth bene accepted this meeting, statement (bene no obligated to enroll, no risk) |
| What two terms are important to know when it comes to confidentiality and sensitive information? | PHI and HIPAA |
| True or False: HIPAA authorization from enrollee in question if firm wishes to use his/her personal data to market non-health related items/services | True |
| What items are required to be available anytime through the Plans website? What questions can they help answer? | evidence of coverage, summary of benefits, annual notice of change, provider directory, pharmacy directory, formulary q's: whether bene providers are in network, whether drugs a bene takes are on plans formulary, whether the plan matches bene needs |
| What three items must be received by the bene is provided with enrollment instructions/form? What about for D-SNPs? | plan ratings info, summary of benefits, pre-enrollment checklist if D-SNP - must include medicaid benefits too |
| True or False: when a bene enrolls online, the plan sponsor is not required to provide plan ratings info, summary of benefits, pre-enrollment checklist because that info will be online | False, the bene must receive plan ratings info, summary of benefits, pre-enrollment checklist BEFORE the completion and submission |
| For the CMS Star ratings, what topics do they generally include? | getting appts/care quickly, whether members got various screening tests, vaccines and other check-ups to help them stay healthy, how members rate the plan, and customer service |
| True or False: the Star ratings information does not have to be prominently posted on each plans website because not all plans are 5 stars | False, no matter what, that info must be clear as day |
| Why is it important to always check the star ratings in the callers area and not keep them on a notepad somewhere? | the ratings change and we are not allowed to provide ratings 21 days older than the release of the new rating |
| True or False: the rep must avoid using the word "Free" when talking about zero dollar premium plans | True |
| True or False: marketing reps cannot use an enrollment period to create a sense of urgency | True |
| True or False: an agent asks a family member to give their cards to patients at the hospital where they work, that is not a violation because the family member is the one giving it out, not the agent | False |
Created by:
cmazzariti
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