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Aetna | Countdown to AEP | Enhanced benefits! | Final Rule FAQs | New grocery stores in-network

Aetna | Countdown to AEP | Enhanced benefits! | Final Rule FAQs | New grocery stores in-network

Aetna | Countdown to AEP | Enhanced benefits! | Final Rule FAQs | New grocery stores in-network
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broker news

Your source for Aetna Medicare broker news and information

September 25, 2023

September is Healthy Aging Awareness Month:

Watch our podcast and learn about the sales opportunities ahead (15 min.)

New and noteworthy

Wow! Don’t miss enhanced benefits

Have you heard? We enhanced benefits on 591 plans during the rebate reallocation process. Visit the First Look website to see enhancements to 2024 MA/MAPD and D-SNP products in your market. Get pumped for AEP.

Exciting fitness reimbursement benefit included with many 2024 plans

In 2024, select plans in every market will offer a fitness reimbursement benefit. This benefit gives members a quarterly or annual allowance to use for fitness and activity fees and select supplies. This exciting benefit is in additionto SilverSneakers® fitness benefit available with all Aetna Medicare plans. To find out which plans offer this benefit in your market, talk to your Aetna Medicare Broker Manager or visit FirstLook.Aetna.com.

You now have more time to complete the health risk assessment (HRA)

You now have more time to work with your clients to complete the HRA. The new rule is you can submit HRAsthe same day you enroll your client or the next day(i.e., the day your client enrolls into a plan, plus one additional day). We use HRA information to better support new members as they transition onto their plan. And remember, when you assist your client with completing the HRA, you earn an additional service fee payment. Learn more about HRAs.

Answers to FAQs on the CMS Final Rule 

Review rules and requirements you need to know effective September 30. Our FAQ covers important topics including:

  • The new rule mandating that you obtain a completed Scope of Appointment 48 hours before having an enrollment discussion with clients
  • Communications vs. marketing
  • Educational vs. marketing events, and more

Great news: Members with an Extra Benefits Card now have more options for where they can buy healthy foods

Members with a 2023 Extra Benefits Card now have more locations to shop for healthy foods. New grocery store locations include Hannaford, Stop & Shop, Food Lion, Giant, Giant Food, Giant Heirloom Market, Giant to Go, and Martin’s Supermarket. Let your clients know about these new grocery options.

Updated COVID-19 vaccine now available at CVS Pharmacy locations

Learn more.

AEP readiness

Access 2024 sales presentations

2024 consumer sales presentations are now available to download from Producer World. You’re required to present the presentation, either the PowerPoint or the video version, when reviewing 2024 Aetna Medicare plans with your clients starting October 1. There is also a PDF version with speaker notes to assist you. NOTE: All of these versions are CMS-approved and cover all required topics. To remain compliant, you may not add to, remove, or alter anything in the presentations.

Learn details on 2024 plans and benefits

Remember, you need to attend a market-specific event for all the states where you plan to sell 2024 MA/MAPD and D-SNP plans. Attend an upcoming event in your area.

Learn how to order AEP marketing materials from our new portal, AMP

Get up to speed on the Aetna Marketing Portal (AMP), formerly called Aetna Medicare Marketing Studio, and learn how to order AEP materials. Join us for one of the training sessions below:

Introducing the Aetna Marketing Portal 

Just in time for AEP, we’re rebranding our marketing tool with a new name, the Aetna Marketing Portal (AMP), and a new URL, www.aetnahub.com/amp. We made some behind-the-scenes changes to enhance your experience this AEP. For those who used MMS in the past, there’s no impact to your login credentials; you’ll use your same username and password to login.

Order 2024 enrollment kits

If you still need to order enrollment kits and are ready to sell for 2024, go to Producer World to order MA/MAPD and PDP enrollment kits. Orders are shipped in a first-in/first-out manner. And remember, new this year, you need to take action to order enrollment kits for 2024 SilverScript PDPs, as they will no longer be mailed to you automatically. To order them, follow the same process you use for MA/MAPD kits.

Tools

What’s new in Think Agent? Lots! 

With the most recent Think Agent update, you can now;

  • Conduct video appointments
  • View if drugs are available for mail-order
  • Login with your fingerprint or face ID on a mobile device

Watch the Sales 101 training to get started with Think Agent, and watch Sales 102 training to take your knowledge to the next level.

SilverScript PDP portal will now link directly to Aetnamedicare.com for plan information

Starting, September 30, on the SilverScript Agent Portal, if you select “PDP Plan Offering” or “PDP Drug Prices” to look for plan and prescription drug information, you’ll be directed to AetnaMedicare.com. Going forward, you can find the information you need there, in a consistent format.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Aetna | Countdown to AEP | Enhanced benefits! | Final Rule FAQs | New grocery stores in-network

Aetna | CY2024 Final Rule Marketing and Communication Guidelines

Aetna | CY2024 Final Rule Marketing and Communication Guidelines
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Aetna Medicare FAQs

Below you will find Frequently Asked Questions relevant to the CY2024 Final Rule Marketing and Communication Guidelines. You may find additional CMS guidance by reviewing the CMS CY2024 Final Rule in its entirety.

Scope of Appointment (SOA) and 48-hour rule

When is a Scope of Appointment required?

The SOA must be documented for all personal marketing appointments, regardless of location, venue or mechanism (in-person, telephonic, or electronic). The following components must be documented at least 48 hours prior to the appointment:

  • Product Types to be discussed
  • Date of Appointment
  • Beneficiary and agent contact information
  • Statement stating, no obligation to enroll, current or future Medicare enrollment status will not be impacted, and automatic enrollment will not occur.  

Are there any exceptions to the SOA 48-hour rule?

At least 48 hours prior to the scheduled personal marketing, the MA plan (or agent or broker, as applicable) must agree upon and record the SOA with the beneficiary(ies), except for:

  • SOAs completed during the last four days of a valid election period for the beneficiary.
  • Unscheduled in-person meetings (walk-ins) initiated by the beneficiary.
  • Inbound calls.

Are call centers exempt from the SOA requirements because the calls are not considered personal meeting appointments?

Call centers are not exempt from the SOA 48-hour rule.

Does the SOA 48-hour rule apply to telephonic and electronic interactions?

Telephonic and electronic communications are not exempt from the SOA 48-hour rule; the rule applies to any personal marketing appointment, whether in person, telephonic, or virtual/electronic. In addition, to the exception outlined in the Final Rule, we have received clarification from CMS that the 48-hour rule is not applicable to inbound calls. TPMOs should still obtain an SOA for inbound sales/marketing calls and electronic communications, but the 48-hour guideline does not apply to these scenarios.

How does the SOA 48-hour rule work relative to outbound calls? 

The SOA 48-hour rule does apply to outbound calls even if the beneficiary has requested a call to discuss plans. The initial outbound call is to determine the type of plans the member would like information on and to schedule the sales call at least 48 hours after this contact.

Does the SOA 48-hour rule apply to telephonic and electronic interactions?

Telephonic and electronic communications are not exempt from the SOA 48-hour rule; the rule applies to any personal marketing appointment, whether in person, telephonic, or virtual/electronic.

Does the SOA 48-hour rule apply to contracted agents that receive Live Transfer calls?

CMS provided clarification that the 48-hour rule is not applicable to inbound calls. If the initial outreach to a beneficiary is conducted as an outbound call and then transferred to an agent, this is still considered an outbound call and the 48-hour rules apply. The agent should not discuss plans after this live transfer but rather schedule an appointment at least 48 hours after the SOA is agreed to by the beneficiary.

Is there an issue with agents taking calls and doing immediate enrollments without the 48-hour waiting period? 

As long as it is a member-initiated inbound call, the SOA 48-hour rule does not apply and agents may conduct marketing, sales, and enrollment activities during that inbound call (must be recorded).

Do you have to be licensed to take a SOA?

Based upon CMS guidelines, SOAs do not need to be completed by licensed agents (as long as the individual completing this function has completed all required Medicare training, i.e. required FDR compliance and FWA training). Third-Party Marketing Organizations (TPMOs) need to ensure no further State DOI licensure requirements apply to licensed and unlicensed prospect communication activities.

What can agents do in between the time they collect the SOA and the 48 hours?  Must they wait to complete the full consultation/needs assessment or is it solely the ENROLLMENT they cannot collect for 48 hours?

When the SOA 48-hour applies (i.e. outbound calls), the agent may not discuss any plan-level details with the beneficiary, and therefore no sales/marketing consultations regarding MA/MAPD/PDPs should be conducted until the scheduled appointment. 

Does the 48-hour rule and/or SOA, in general, apply to beneficiaries who enroll via a website?  Can they enroll same day or will there be restrictions on websites as well?

If no sales/marketing appointment takes place, (i.e. no direct interaction with an agent), then the SOA is not applicable.

How does the 48-hour rule apply when a beneficiary requests a call? 

If a beneficiary completes permission to contact or a business reply card, contact can be made immediately. Since that contact is outbound to the beneficiary, the agent may not discuss any plan-level details with the beneficiary, therefore no sales/marketing consultations regarding MA/PDPs should be conducted until an SOA is completed and an appointment is scheduled at least 48 hours after.  No enrollment should be completed on the initial outbound response to the permission to contact, unless a CMS exception applies, i.e. last four days of a valid election period.

Are agents able to do a needs analysis first and then schedule a call with the beneficiary 48 hours later to complete enrollment, or are they not allowed to discuss any MA/PDP plans at all until 48 hours?

When the SOA 48-hour rule applies (i.e. outbound calls), the agent may not discuss any plan-level details with the beneficiary, therefore no sales/marketing consultations regarding MA/MAPD/PDPs should be conducted until the scheduled appointment. A need analysis is not permissible prior to the 48-hour wait period.  

If a TPMO collects the SOA from the customer when they complete the lead form, is it acceptable to tag the lead with the date and time the SOA was completed and then call the customer after 48 hours?

The lead form must include all required elements of the SOA. This includes the date of appointment as a required field. The customer should understand and agree to when (after 48 hours) the personal marketing appointment will take place. For example, Jane Doe completed and signed an SOA on October 15th, for a telephonic appointment with an Aetna Medicare licensed insurance agent for October 18th at 10:00 am ET. The outbound call should be made to Jane Doe on October 18th at 10:00 a.m. ET. The SOA must be completed with the date and time of the appointment and that appointment must be at least 48 hours after completion of the SOA.   

Does the “Agent Contact Information” on an SOA need to be agent specific or can it be general at a sales agency contact information, so the prospect/member knows they will be contacted by a licensed agent from XYZ agency or an Aetna Medicare licensed agent?

General contact information for the sales agent/broker or contracted entity may be permissible, but the beneficiary must be able to contact that entity for any questions regarding the appointment. If the SOA reflects that an agent from XYZ Company will contact Jane Doe on Thursday at 3:00 p.m., the agent that ultimately conducts this appointment must be a licensed agent at XYZ Company.

TPMO contacts their current client via an outbound call to check in on the current plan. During the conversation, the member wants to discuss a new plan because they may want a PPO instead of their HMO. Does the agent need to wait 48 hours to present plan details for a plan change for a current client?

The 48-hour rule DOES apply since it is applicable to outbound calls. The fact that the client is an existing member does not waive the 48-hour wait time.

TPMO contacts a beneficiary to discuss Medicare Supplement based upon a business reply card or some other permission to contact. During the conversation, the member wants to discuss a PDP in addition to their Medicare Supplement plan. Since the 48-hour and SOA rules do not apply to Medicare Supplement and the lead was generated based on those products but turned into a discussion about MA/PDP, does the agent need to wait 48 hours to present the plan details for the PDP?  

The 48-hour rule DOES apply.  

TPMO makes an outbound call based upon permission to contact. Beneficiary states let’s review the plans now, I have time. Agent should inform the beneficiary that, due to CMS guidelines, I must schedule a future appointment at least 48 hours from now. If the beneficiary continues to want to hear about MA/PDP can the agent have the beneficiary call them back on an inbound call to waive the 48-hour rule?

No, the 48-hour rule is only waived on UNSOLICITED inbound calls. An agent should never advise a beneficiary to call them back just to avoid the 48-hour rule.

Events

What’s the difference between an educational and a marketing event?

Educational events must be advertised as such and be designed to generally inform about Medicare, Medicare Advantage, Prescription Drug Plans, or any other Medicare program. There may be NO marketing of specific MA/PDP plans or benefits or any sales/marketing presentations. Scope of Appointments CANNOT be collected and applications may not be distributed or collected.

Marketing events, regardless of the forum, are group activities that meet the CMS definition of marketing. Discussion of specific MA/PDP plans, marketing materials, Scope of Appointments, and collecting applications can take place during marketing events.

Can I schedule a marketing event at the same location as an educational event?

No, marketing events are prohibited from taking place within 12 hours of an educational event, in the same location. The same location is defined as the entire building or adjacent buildings.

Can I request the completion of an SOA at an educational event?

No, at an educational event, an agent/broker may make available and receive beneficiary contact information (may not require the beneficiary to provide their contact information), including business reply cards, but not including Scope of Appointment forms.

Does an agent need to collect an SOA for a future appointment (at least 48 hours after) at a marketing event?

Enrollment applications can be accepted at marketing events. If the beneficiary wants to schedule a separate personal marketing appointment after the marketing event, the SOA 48-hour rule would apply.    

Does an agent need to collect an SOA for a future appointment (at least 48 hours after) at a marketing event?

Enrollment applications can be accepted at marketing events. If the beneficiary wants to schedule a separate personal marketing appointment after the marketing event, the SOA 48-hour rule would apply.    

Marketing materials

What determines a material to be communication versus marketing?  Is the channel a consideration?  For example, email vs. direct mail?

The definition of marketing is determined by the intent and content of the material/activity, not necessarily the media type or distribution method (email versus direct mail). While evaluating the intent, the objective of the material must be considered as well, i.e. audience, other information contained in the communication, timing and other context. In addition, CMS recently clarified that content includes any reference to benefits, including general references to commonly offered benefits. Link to CMS definition of Marketing: https://www.ecfr.gov/on/2023-06-05/title-42/chapter-IV/subchapter-B/part-422/subpart-V#p-422.2260(Marketing)

In developing TV ads that will be used nationally, it seems virtually impossible to be able to advertise any kind of benefits or costs whatsoever, since any benefits/costs in the ad would need to be available in every service area nationwide by all carriers with whom we contract. Are there any exceptions?

There is no exception to these guidelines for national materials/communications, all materials must NOT be misleading. In order to advertise benefits at a national level, the benefits must be available from at least one plan sponsor in every service area that the TPMO represents. For example, if a marketing material/website describes plans with a $0 premium, there needs to be a plan available in all service areas that offer a $0 premium. If all plans in Montana have a premium, this material would be considered misleading to beneficiaries in Montana.  

Clarification on “medicare” being used in the URL.  

The use of the term Medicare and/or Medicare Advantage is not prohibited, but it cannot be used in a way that misleads beneficiaries.  A URL that is just “MyMedicare.com” would not be acceptable, as an individual has no way of knowing that this does not direct them to CMS/Medicare. The URL needs to be able to explicitly express that the URL will not go to a government entity. For example, “AetnaMedicareSolutions” is acceptable. Note: Additional state guidelines may also apply above and beyond the CMS requirements, TPMOs must ensure they are meeting any applicable State licensure requirements.  

If an agent creates a communication document but uses the wording Contact me for a Medicare Advantage Plan Review. Would that be compliant?

If their company name is apparent and the other verbiage makes it clear that they are not “Medicare”/ the government, the material may not be considered misleading, but the entire material and messaging should be considered, not just the statement “Medicare Advantage Plan Review”.

Can mailers, or similar types of materials use the term “Medicare Notice” or “Important Medicare Information”?

Without further explanation or description, a beneficiary may believe that these materials are from the Federal Medicare program, not a TPMO or agent/broker. Marketing materials should not mislead beneficiaries into believing the material is coming from the federal government. The term “Important Medicare Notice”, without any other information within the vicinity would be misleading.  

TPMO disclaimers

Does the disclaimer need to be on all materials or just the ones that meet the definition of “Marketing materials?”

Per regulatory rule CFR §422.2267, Required materials and content, Sec. (e)(41) (v) Third-party marketing organization disclaimer; TPMO’s must ensure disclaimers are “included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO”.

The new TPMO disclaimer requires the insertion of the number of organizations and total number of plans available to the beneficiary. How should a TPMO reflect the number of organizations/plans on the website and national marketing pieces?

For materials that will have a national audience, the TPMO disclaimer should include the number of organizations and plans contracted at the national level. For materials that are distributed in select service areas, the disclaimer should reflect the organization and plans for that specific service area.

If a TPMO is unable to operationalize the number of organizations/plans at a national level on materials such as their national TPMO website, TPMO may reflect the general (CY2023 version) TPMO disclaimer on the landing page, as long as the number of organizations and plans is displayed once the beneficiary enters their zip code to view available plans.

Do agent advertisements without content regarding MAPD/PDP plan premiums, cost sharing, or benefit information still need the TPMO disclaimer?

The TPMO disclaimer applies to all materials used that meet the definition of marketing. If the material does not include MAPD/PDP content or is not intended to be used for MAPD/PDP plan marketing, then the material does not require the TPMO disclaimer.

If a member makes an inbound call to set up an appointment, is the TPMO disclaimer required to be provided in the first minute of the call?

No, the disclaimer is not required for inbound calls to set up appointments.

Are agents still required to provide beneficiaries with information for consenting to transfer?

Yes, per existing guidance in CFR and MCMG General Communications materials and Activities Requirements (42 CFR §§ 422.2262, 423.2262). Language for beneficiaries consenting to transfer is required as part of call center and agent scripts.

TPMO call recording

Who needs to follow call recording guidelines? For example, is an agent who has  ‘feet on the street’ and happens to make a sale telephonically required to follow the guidelines?

Yes, the agent is required to follow the guidelines. The regulatory requirement applies to all TPMOs, including agents/brokers or organizations that are providing TPMO services. TPMOs are defined as organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment-related functions as a part of the chain of enrollment. TPMOs may be first-tier, downstream, or related entities (FDRs), as defined under § 422.2, but may also be entities that are not FDRs but provide services to an MA plan or an MA plan’s FDR.

Do all calls need to be recorded?

TPMOs must record all marketing, sales, and enrollment calls, including the audio portion of calls via web-based technology, in their entirety.

How will individual agents know to start the recording process? (E.g., Individual agents who sell plans on their cellphones)

When the telephonic conversation or the intent of the conversation includes marketing, sales, and enrollment for Medicare Advantage and/or Prescription Drug Plans, the call recording should begin.

Do Zoom and WebEx marketing, sales, and enrollment calls need to be recorded?

Yes, the audio portion of the call needs to be recorded and retained for a minimum of 10 years.

Do we have a standard request process to obtain recordings from individual field agents as well as larger brokerages? What happens if the agents retire or pass away?

Per our Producer Agreement, we reserve the right to monitor, audit, and request documentation to support compliance. Call recordings may be requested by Aetna as part of the standard investigative process of inquiries, and complaints, as well as through routine monitoring and auditing. Upon a request for a call recording, the TPMOs should respond using HIPAA-compliant transfer methods, including secure email encryption and/or the use of a secure file transfer protocol (sftp). In cases where the agent may no longer be able to respond to the request, it is the expectation that the upline maintains these records to ensure compliance with the 10-year record retention requirements.

Oversight and reporting

How does Aetna monitor agent/broker/TPMO marketing, sales, and enrollment activities?

Aetna has a robust agent oversight program that includes monitoring, auditing, and reviewing TPMO marketing, sales, and enrollment activities to ensure compliance with CMS guidelines. These activities include but are not limited to investigation of inquiries and complaints, call monitoring, secret shopping, and review of agent performance, i.e. Aetna Watch List, etc. Failure to comply with Aetna and/or CMS requirements may result in corrective actions up to and including termination.

Are there specific questions and topics that must be discussed prior to enrollment?

Yes, as outlined in the CY2024 CMS Final Rule, MA organizations, must ensure that, prior to an enrollment, CMS’ required questions and topics regarding beneficiary needs and health plan choices are fully discussed. Examples of these topics include but are not limited to information regarding primary care providers and specialists, pharmacies, prescription drug coverage, and costs, costs of health care services, premiums, benefits, and specific health care needs.

For a full list of questions and topics that must be discussed, please review CMS’ 2024 Agent and Broker Training and Testing Guidelines, specifically the new #4.

What is the Pre-Enrollment Check List (PECL) and where do I find it?

The PECL is a standardized communication material that must be provided to prospective enrollees so that the enrollees understand important plan benefits and rules. For telephonic enrollments, the contents of the PECL must be reviewed with the prospective enrollee prior to the completion of the enrollment. In addition to covering information about the Evidence of Coverage (EOC), Provider/Pharmacy Directory, Formulary, Premiums/copayments/coinsurance, Emergency/urgent coverage, and Plan-type rules, CMS added a NEW section outlining the Effect on Current Coverage.

The PECL is incorporated with the Summary of Benefits as part of the Aetna Enrollment Kit and must be included in sales and enrollment scripts.  

How do I submit marketing materials to Aetna for review prior to use and/or submission in CMS’ HPMS?

Marketing materials, both Aetna branded and Multi-Plan, must be reviewed by Aetna prior to use. Please work with your Aetna Account/Broker Manager for a review of Aetna branded/specific materials. Multi-plan materials should be sent to AgentOversight@aetna.com for pre-review. Please include the Standardized Material Identification (SMID) within the subject line and in the body of the email describe the material you are submitting as well as contact information for any concerns/questions. Materials must be submitted by approved Multi-Plan Marketing Consultants. If you are unsure whether your organization is a Multi-Plan Marketing Consultant access, please contact AgentOversight@aetna.com for assistance.   

How do I submit marketing materials to Aetna for review prior to use and/or submission in CMS’ HPMS?

Marketing materials, both Aetna branded and Multi-Plan, must be reviewed by Aetna prior to use. Please work with your Aetna Account/Broker Manager for a review of Aetna branded/specific materials. Multi-plan materials should be sent to AgentOversight@aetna.com for pre-review. Please include the Standardized Material Identification (SMID) within the subject line and in the body of the email describe the material you are submitting as well as contact information for any concerns/questions. Materials must be submitted by approved Multi-Plan Marketing Consultants. If you are unsure whether your organization is a Multi-Plan Marketing Consultant access, please contact AgentOversight@aetna.com for assistance.   

Do we have SLAs in place regarding the response time to CMS or to Aetna for requests for call recordings at the individual agent level?

Medicare guidelines state to provide to CMS timely and upon request. Section 4(B) of the Producer Agreement states, “Producer shall provide Company with copies of recorded calls within forty-eight (48) hours of Company’s request.”

If the agent does not have a recording what is the process to notify that they failed to maintain a copy of a recording? (e.g., if an agent keeps the recording on their phone and it is stolen?)

Agents should report issues of non-compliance using the Aetna reporting mechanisms (as outlined within the CVS Health Code of Conduct) including the AgentOversight@aetna.com mailbox. Call recordings may include PHI/PII or other sensitive information and, therefore should be maintained securely. Any breach or potential breach of PHI/PII must be reported to Aetna.

Do I have to report disciplinary actions to Aetna?

Effective October 1, 2022 (CY2023 Final Rule, CMS guidance § 423.2274(g)), TPMOs must submit a report to Aetna of any agent/staff disciplinary actions or violations of any requirements that apply to Aetna associated with Medicare beneficiary interaction on a monthly basis. This requirement is outlined in your Aetna Producer Agreement – Medicare Addendum with instructions for reporting found here.

Do I have to report any TPMO entities to Aetna?

Effective October 1, 2022 (CY2023 Final Rule, CMS guidance § 423.2274(i)), TPMOs must submit a report to Aetna disclosing any new, existing, or discontinued subcontracted relationships used for Medicare Advantage and Part D marketing, lead generation, and enrollment activities. This includes and is not limited to any entities that are compensated to provide these functions for their organizations and downlines, such as lead generation vendors. 

This requirement is outlined in your Aetna Producer Agreement – Medicare Addendum with instructions for reporting found here.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Aetna | Coming Soon: Take a Second Look at 2024 Plans!

Aetna | Coming Soon: Take a Second Look at 2024 Plans!

Aetna | Coming Soon: Take a Second Look at 2024 Plans!
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Can 2024 AEP Get Even Better?

Great news! We enhanced a number of benefits on our 2024 Aetna MA/MAPD and D-SNP plans during the rebate reallocation process. You’re going to like what you see, including:

  • 428 plans with an increased or added fitness reimbursement benefit
  • 286 plans with an increased eyewear allowance
  • 227 plans with an increased dental allowance
  • 140 plans with premium reductions
  • 114 plans with an increased over-the-counter (OTC) allowance

We’re working fast and furiously to update our First Look website to show off these benefit upgrades. Plan to revisit www.firstlook.aetna.com for a 2nd look at 2024 plans and many enhanced benefits – the week of August 28.

In the meantime, make sure you’re ready to sell for 2024, by completing your 2024 certification and attending a market-specific product training for all the states/markets where you plan to sell.

Reach out to your local Aetna Medicare Broker Manager for an inside scoop and special insights on how we can work even better together. We look forward to working with you this AEP!

Complete 2024 producer certification

Sign up for market-specific product training

Connect with a local representative

For producer use only. Confidential and proprietary. Not to be shared with Medicare beneficiaries. Distribution to consumers, other insurers, or any other person or company is strictly prohibited and may be grounds for termination of your agreement with Aetna and its affiliates.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance and its affiliates (Aetna).

Prior to engaging in the sale of Aetna Medicare products, producers must be ready to sell, which means certified, contracted, licensed in the applicable states, and appointed by Aetna in accordance with state law. As permitted in certain states, Aetna will order appointments after the first sale.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Aetna | Countdown to AEP | Enhanced benefits! | Final Rule FAQs | New grocery stores in-network

Aetna | Accendo Medicare Supplement discontinuation in five states effective July 28

Aetna | Accendo Medicare Supplement discontinuation in five states effective July 28
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Effective July 28, we will be discontinuing ourAccendo Medicare Supplement offering in the following states:

  • North Dakota
  • New Jersey
  • Ohio
  • Oregon
  • Pennsylvania

Sales materials for Accendo Medicare Supplement plans in these states will be available until July 14

This change does not affect the availability of our other Aetna Medicare Supplement insurance plans.

No impact on existing policyholders or renewal commissions

The closure of the Accendo Medicare Supplement product in the above states will not impact your existing policyholders. Commission renewals will continue to be paid on your existing Accendo Medicare Supplement policies.

You can submit applications through July 28

The last application submission and signature date for Accendo Medicare Supplement plans in these states will be July 28, 2023. This applies to both electronic and paper applications. We will no longer accept new applications for Accendo Medicare Supplement policies in these states after July 28.

You have other Aetna Medicare Supplement options available

We’re committed to maintaining competitive Medicare Supplement offerings in these states. Here are the plans we will continue to offer:

  • North Dakota
    (ACI)
  • New Jersey
    (AHIC 7% household discount)
  • Ohio
    (CLI 7% household discount)
  • Oregon
    (CLI 5% household discount)
  • Pennsylvania
    (AHIC 7% household discount)

Thank you for your continued business.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Aetna | Coming Soon: Take a Second Look at 2024 Plans!

Aetna | Coming soon! 2024 Producer Certification

Aetna | Coming soon! 2024 Producer Certification
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Aetna Medicare Producer Certification kicks off on June 28 

Planning to sell Aetna Individual MA/MAPD/PDP or SNP this AEP? Aetna Medicare will have two certification options to choose from: AHIP Medicare Training and Aetna Medicare Compliance Training (no-cost certification option). 

A friendly reminder that certification is an annual requirement, so plan to certify with us on June 28 at AetnaMedicareProducerCertification.com. We look forward to working with you!

Producer certification options

AHIP Medicare TrainingCertifies producers to sell for multiple carriers, including Aetna  

  • Producers complete 8 CMS general courses and apply it toward certification for Aetna and other carriers you are appointed with
  • Producers have three (3) attempts to achieve a passing score of 90% or higher 
  • Includes knowledge checks and required test completion 
  • Available in English and Spanish
  • CE credit offered: Yes
  • Cost: $175 ($125 discounted rate if taken directly through AetnaMedicareProducerCertification.com starting June 28)

Aetna Medicare Compliance Training*Certifies producers to sell Aetna only (AHIP alternative)  

  • Producers complete the 8 CMS general courses and apply it toward certification for Aetna
  • Producers have three (3) attempts to achieve a passing score of 90 % or higher 
  • Includes knowledge checks and required test completion
  • Available in English and Spanish
  • CE credit offered: No  
  • Cost: $0 

*This no-cost certification option is specific to Aetna, is non-transferable to other carriers, and is recommended for those agents who wish to sell Aetna MA/MAPD/PDP or SNP products, exclusively. Visit AetnaMedicareProducerCertification.com.

New! Enhanced course design

You spoke – we listened! Based on your feedback, we’ve redesigned the Aetna Medicare Compliance Training to help provide an improved producer experience. Here’s an example of the changes you’ll see:

  • The Aetna Medicare Advantage and D-SNP courses have been combined into a single course.
  • The Aetna PDP course is now shorter, with a specific focus on Aetna product information, including how to use the Aetna PDP enrollment kit.
For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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Aetna | Coming Soon: Take a Second Look at 2024 Plans!

Aetna | CMS Final Rule requirements you need to know

Aetna | CMS Final Rule requirements you need to know
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Important new requirements and clarifications from CMS for Aetna third-party marketing organizations (TPMOs)

In this email, we provide information on:

  1. The CMS CY2024 Final Rule impacts marketing, communications, and sales
  2. CMS’s definition of “marketing”
  3. The modifications to the marketing module in HPMS

Notice: Do not rely only on Aetna’s key points and summaries to educate your organization on the new requirements. Please review the regulation and guidance to gain a full understanding of each requirement and the changes that your organization may need to make.

When reviewing these communications keep in mind that the term “MA organization” generally also applies to third-party marketing organizations (TPMOs), including agents and brokers.

CY2024 Final Rule – Marketing, communications, and sales

What you will find in this section:

  • A summary of key points in the Final Rule that pertain to marketing materials and sales and marketing activities.
  • The pertinent regulations from the Final Rule along with Aetna’s commentary regarding relevance to TPMOs.
  • The full Final Rule as it appears in the Federal Register, which includes CMS commentary.

Aetna’s summary of key points in CY2024 Final Rule

Marketing materials (changes effective 9/30/23)

  • Authorized TPMOs must submit multi-plan materials to HPMS after pre-review by MA organizations.
  • Superlatives may not be used in communications unless new requirements regarding supporting documentation are met. Examples include, but are not limited to, words like “best” or “most”.
  • Do not use the Medicare name and CMS logo in a misleading way. Use of the Medicare ID card image must be authorized for use by CMS.
  • Do not advertise plan benefits outside the service area.
  • The MA organization name or marketing name(s) as listed in HPMS must be identified in the marketing of any products, plans, benefits, or costs.
  • Marketing communications may not include information regarding potential savings that are based on a comparison of typical expenses borne by uninsured individuals, unpaid costs of dually eligible beneficiaries, or other unrealized costs of a Medicare beneficiary.

Sales and marketing activities

  • Visiting a beneficiary without an appointment is always prohibited, even when the beneficiary has expressed an interest in MA products.
  • MA organizations need to provide members with an annual opportunity for members to opt-out of plan calls. Aetna will provide future clarification on this matter to TPMOs.
  • MA organizations holding education events may no longer set up future personal marketing appointments or have beneficiaries complete Scope of Appointment forms at these events.
  • Marketing events are prohibited from taking place within 12 hours of an educational event in the same location. The same location is defined as the entire building or adjacent buildings.
  • MA organizations must wait 48 hours between the completion of the Scope of Appointment and the start of the personal marketing appointment. (See the next section for Aetna’s notes on this topic.)
  • A Scope of Appointment, business reply card, or request to receive additional information is valid for 12 months following the date of the beneficiary’s signature date or the date of the beneficiary’s initial request for information.
  • The pre-enrollment checklist (PECL) must be provided prior to enrollment, including telephonic enrollment. “Effect of current coverage” has been added to the PECL.
  • TPMOs must provide the number of plans and products it offers, as well as SHIP contact information in their disclaimer. TPMOs who offer all plans and products must also provide a version of this disclaimer.
  • Beneficiary health plan needs must be reviewed prior to enrollment.
  • TPMOs must record all marketing, sales, and enrollment calls, including the audio portion of calls via web-based technology, in their entirety. Other types of calls have been excluded.

Pertinent regulations from the Final Rule including Aetna’s notes regarding relevance to TPMOs

Click here for CMS’s actual regulatory verbiage along with Aetna’s commentary. Please review this section in its entirety. You’ll find answers to some common industry questions.

CMS’s Final Rule as it appears in the Federal Register

You can review CMS’s CY2024 Final Rule, which includes the marketing, communication and sales changes summarized above and CMS’s own commentary. On May 31, 2023, CMS issued some revisions to the Final Rule to correct typographical and technical errors in the regulations; CMS indicated that they didn’t make substantive changes.

The 2023 clarification of the definition of “marketing”

This change is effective July 10, 2023. CMS has significantly broadened the content portion of the definition of “marketing” to include materials that mention any type of plan benefits. This requirement applies to all new materials, as well as existing materials that were previously reviewed, which will be in use on or after July 10, 2023.

In its May 10, 2023 memorandum, CMS stated that “any material or activity that is distributed via any means (e.g., mailing, television, social media, etc.) that mentions any benefit will be considered marketing and must be submitted into HPMS.”

Therefore, TPMOs, including agents and brokers, must:

  • Determine if their communications meet the new definition of marketing and then submit materials for marketing review as appropriate.
  • Ensure that all multi-plan materials that include “intent” and mention any benefit are provided to Aetna for pre-review and then submitted to HPMS.

Organizations must submit their materials timely so that they are approved prior to July 10. Please direct any questions regarding the multi-plan marketing material submission and review process to AgentOversight@aetna.com or your Aetna Medicare Broker Manager or Sales Director.

Modifications to the marketing module in HPMS

Aetna released a summary of these changes on May 9, 2023, which we are providing again here. Given the changes to this module, make sure you are appropriately planning for pre-review and HPMS submission timelines. For example, you will need to be ready to submit online videos for a 45-day review.

Questions? We’re here to help

We expect that CMS will provide guidance regarding specific regulations in the coming months and we’ll provide additional details and clarifications at that time.

If you have any questions, please contact your local Aetna Medicare Broker Manager for assistance.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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