Compliance Information

Compliance Frequently Asked Questions

Can I still sell if I receive an allegation?

Yes! Unless otherwise advised that your contract with a carrier is suspended, you are still able to sell plans by the carrier that issued the allegation.

What are the most common reasons an agent receives an allegation?

Member complaints due to plan coverage and costs:

  1. Always check your client’s prescriptions and verify them with Broker Support to ensure you’re noting the correct associated cost.
  2. Ensure that your client understands the cost of the plan for which they are signing up.

Member complaints due to loss of primary care provider:

  1. Check the printed provider directory as well as the carrier’s online directory to verify if your client’s PCP is an option.
  2. If you have any insecurity about this information, always contact the carrier’s Broker Support line to verify the information so your client is satisfied with their PCP and plan choices.
Do I need an SOA if I conduct a phone appointment?

Per CMS, no. But, some carriers require an SOA regardless of the nature of your appointment. AGA recommends always capturing an SOA to illustrate that both your client and you understand what was discussed during your appointment and what was covered. It’s better to be safe than sorry.

Why should I report an event if I’m just going to be secret shopped?

Two reasons:

  1. In order to remain compliant with the regulations listed in the Medicare Marketing Guidelines, you must report an event where there is sales activity. Reporting your events grants you access to your literal sales tools; lead cards, scope of appointments, appointments and hopefully, applications!
  2. There’s no reason to fear a secret shopper! Think of a secret shopper’s feedback like getting a pop quiz. Just because you might not “pass” with flying colors, doesn’t mean you fail the class. You study a little bit more for the next quiz and ultimately, you become a better student. Welcome the feedback and knowledge so that you grow into a more knowledgeable and better-equipped agent.
I can still accept leads at when I host events that I don’t report to CMS, right?

False. You cannot conduct any sales activity unless it is reported as either an Informal Sales Event or a Formal Sales Event.

How do you know so much about compliance?

We review the Medicare Marketing Guidelines (MMG) annually and multiple times a year. All of the regulations shared by the carriers are derived from the MMG. In addition to the MMG, we review all of the carrier tools shared as soon as they are released and also have years of experience working with our carrier partners’ oversight teams when allegations and complaints are released. All of these tools and experience we aim to share with you, the agent.

We have this as a tool for reference in the agent portal for ease of access at any time.

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