As you are well aware, agents will juggle vast amounts of activity during this time. Unintended actions may be a pathway to making compliance mistakes, which may derail the AEP application process. Before we lift off into a new AEP season, let's consider a few significant points related to compliance in order to remain on the right trajectory for a successful launch.
SCOPE OF APPOINTMENTS
Scope of Appointments detail the exact topics beneficiaries would like to discuss with an agent. CMS requires agents to have beneficiaries sign an SOA prior to discussing Medicare Advantage or Part D Prescription drug plans. Every appointment with a beneficiary requires an SOA and these forms must be kept on file for 10 years, even if the appointment doesn't result in a sale. Also, starting this year, a new CMS ruling requires agents to read a disclaimer to all potential clients at the beginning of a sales call. Reading this during the SOA process is an optimal time for this disclosure. These calls must be recorded and stored for 10 years.
HEALTH CARE PROVIDERS
Before agents can help a client with a Medicare plan, they must know the physicians and the specialists a client sees for their healthcare services. Many beneficiaries are happy with their healthcare providers and don't want to change. Compare their current providers with the providers in the plan's network to ensure there isn't a disruption in services.
PRESCRIPTION DRUG FORMULARY
It's important to review a client's prescriptions in order to help them clearly understand the cost of drugs for a particular plan. An unexpected increase in drug prices can quickly turn an exceptional client experience into an unsatisfactory one. Make sure to review enrollment data with your clients, this way, if there is an error, you can fix it on the spot rather than having the application returned. Reviewing a client's prescriptions will ensure they are given options for the most comprehensive coverage for their individual needs.
SUMMARY OF BENEFITS
A Summary of Benefits must be provided to beneficiaries at the time of enrollment to provide clarity regarding coverage. Although beneficiaries will receive a hard copy of this document after enrollment, agents must summarize key features such as covered benefits and cost sharing. The Summary of Benefits needs to be thoroughly discussed prior to signature-collection and verification of intent-to enroll.
TIMELY APPLICATION SUBMISSIONS
Agents are certainly busy during AEP and sometimes put off submitting an application to a carrier. This can result in the application not being submitted in the required 24-48 hour time frame. An agent's primary responsibility is to ensure a clients' insurance needs are met. It's important to take the extra time and double check to make sure your clients' applications have been taken care of within this time frame.
So there you have it - you should be all set for a successful launch! Thanks for tuning in and good luck this season! As always, we thank you for your continued support and cooperation. Please do not hesitate to reach out with any questions or comments.