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  • Most Common Compliance Issues

    We know you all want to steer clear of any compliance issues, so here are a few of the most common mistakes you need to avoid.

    Agent Phone Number Disclaimer – Anything other than business cards that includes an agent’s phone number must note that calling that number will connect someone to a licensed agent.

    Network Restrictions – When enrolling clients in an HMO, make sure any network limitations or referral requirements are clearly and completely explained. It’s also important to make certain that clients are aware that providers can leave networks if they choose. This is probably the single most common reason for sales allegations.

    Font Size – All text on any marketing or plan materials must be at least Times New Roman 12 point (or equivalent). This does not apply to television ads, internal tracking numbers, taglines as part of logos, or announcements placed in the Public Notices section of a newspaper.

    Promising Formulary Exceptions – Agents cannot promise that a carrier will grant a formulary exception to cover a member’s prescription drug. You can explain that the client can request an exception, but you must inform them that the decision rests entirely with the plan.

    Misrepresenting Plan Availability – If there are plans available to a client that you as an agent do not offer, you still must inform the client that there are other options that they can consider.

    Using “Best”, “Highest Ranked”, or Other Superlatives – Any absolute superlatives (best, highest ranked, most popular, etc.) cannot be used unless they are backed up by data that is provided to CMS for review. This *includes* qualified superlatives like “one of the best” or “among the most popular.”

    Cross-selling – If you uncover additional client needs that you could help meet with other types of products, you can certainly offer those, but it must be at a separate appointment from Medicare products. What’s on the Scope of Appointment is all that can be discussed that day.

    Advertising Sales Events – Sales events cannot be advertised before they are submitted and approved by carriers and CMS. Events must registered as “advertised” if any form of advertisement (including flyers on bulletin boards or similar) is going to be used.

    And remember, we’re here to help if you have any questions or concerns about compliance, so don’t be afraid to reach out!