Prosperity | Contracting Terms Update

Prosperity | Contracting Terms Update

Prosperity | Contracting Terms Update
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In the past few years, there have been increasing lawsuits and threats of litigation against insurance carriers based on alleged violation of the Telephone Consumer Protection Act (“TCPA”) and other related laws by agents marketing their policies. All agents are required to comply with all applicable laws and regulations in the solicitation of our insurance products. This includes the TCPA, national and state Do-Not-Call (“DNC”) list prohibitions, the Truth in Caller ID Act, and other state and federal laws prohibiting or restricting telemarketing activities (collectively, the “TeleMarketing Laws”).

As an independent contractor, it is your responsibility to ensure that you and those who work with you (including lead generators) are in compliance with the Telemarketing Laws to the extent you or they engage in telemarketing activities in which a Prosperity Life Group company, service, or product might be mentioned or offered. A copy of Prosperity Life Group’s Policy Statement as to Telemarketing Law compliance may be found on the Agent Portal under General Information, Training & Regulations, “Compliance with the TCPA and Do Not Call List.”

As a condition of continuing to do business with us, we are now requiring your agreement to the terms of a TeleMarketing Compliance Agreement, which documents your agreement to the following understandings and expectations: (1) you will fully comply with the TeleMarketing Laws; (2) you are responsible for compliance by all employees, contractors or subagents working in your call center or whom you otherwise control, including any third-party lead generators (“representatives”); and (3) you will defend, indemnify, and hold the company and its affiliates harmless against any claim or demand arising from an alleged violation of the Telemarketing Laws by you or your representatives.

If you have not already signed this Agreement as part of the onboarding process, you will be directed to a link to review and consent to e-sign this agreement when you log in to the Agent Portal. You may also receive an e-mail with a link to the same. If we have not received your consent promptly after request, we reserve the right to suspend your credentials until this outstanding requirement is fulfilled. Failure to agree to the terms of the TeleMarketing Compliance Agreement may ultimately lead to termination of your contract or rejection of your pending appointment request with us.

You are responsible for familiarizing yourself with the requirements of the TeleMarketing Laws and how they impact your business. These laws cover all telemarketing activities (including calls, texts, call transfers, acceptance of call transfers, etc.). Compliance is required even when a solicitation is made in response to an incoming call stemming from a third-party-generated lead. You are responsible for ensuring that any lead generators you use are in compliance with all applicable Telemarketing Laws before using their leads to solicit our products.

The TCPA is the primary federal law that applies to such activities. It contains numerous restrictions on when, where, how, and to whom telemarketing calls may be placed. The TCPA is complex. If you are unfamiliar with its requirements, consult an attorney. You can also find general information on the Federal Communications Commission consumer website: https://www.fcc.gov/tags/telephone-consumer-protection-act-tcpa. Please be aware that some states have additional consumer protections as well as separate Do Not Call lists.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x6003 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

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

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Compliance Update November 2021

Compliance Update November 2021

Compliance Update November 2021
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GSA EXCLUSION SCREENING
PROCESS UPDATE

The Department of Health and Human Services Officer of Inspector General (OIG) and the General Services Administration (GSA) requires background screening of any non-licensed employees and contractors who support Medicare Advantage and Prescription Drug-related business activities.

Please be aware that the new GSA exclusion screening process has changed slightly.

Here are the instructions to help with the new GSA screening process.

 Pinnacle’s downline agencies are also required to review this information to adhere to the guidelines.

You can also reach out to the Pinnacle Financial Services compliance team at Compliance@pfsinsurance.com with any questions

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

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Wellcare | 2022 Wellcare Product Pointers – Pharmacy Benefits and Network Highlights

Wellcare | 2022 Wellcare Product Pointers – Pharmacy Benefits and Network Highlights

Wellcare | 2022 Wellcare Product Pointers – Pharmacy Benefits and Network Highlights
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Pharmacy Benefits and Network Highlights

Attention Valued Partner,

Our members trust us for coverage that goes beyond basic Medicare. Our Medicare Advantage Prescription Drug (MAPD) plans offer comprehensive coverage of the prescription medications members need to support their total well-being and help them live a better, healthier life. With this in mind, we would like to share exciting new pharmacy highlights that Wellcare members will be able to take advantage of when they enroll in our 2022 Medicare Advantage plans. 

Highlights:

Quality and Affordability:

  • NEW! $0 preventive vaccines copay option on all plans 
  • IMPROVED! Now included in all MAPD plans, supplemental tier 1 excluded drug coverage with increased quantity limits (from 4 to 6) 
  • $0 tier 1 and/or tier 6 copay on all plans
  • $0 deductible or tier-specific deductible (tiers 2-5, 3-5, or 4-5) on all MAPD plans
  • Gap coverage for select generic drugs for diabetes, high blood pressure, and high cholesterol on about half of Traditional Medicare Advantage (TMA) and Chronic Special Needs Plans (C-SNPs)
  • Insulin savings on all non-specialty formulary insulin products with Senior Savings Model on all C-SNP plans

Member Access:

NEW!

  • Independent Pharmacy Preferred Network (pilot) for Wellcare Community Assist (PPO) plans in LA, MI, MO, MS including many Independent Pharmacies as preferred

IMPROVED!

  • Preferred Pharmacy Network on all TMA & C-SNP plans (except AR & LA), including Walgreens, CVS, and most large grocers as preferred pharmacies 
  • $0 tier 1, 2, & 6 copays for a 90-day supply at CVS preferred mail order pharmacy on 99% of all MAPD plans; select C-SNP plans in AZ, FL, GA, IL, MI, and TX offer tier 6 at two times the preferred retail copay 

Product Resources:

For easy access to Wellcare product and benefit information, please review the resources below to see what benefits your members can take advantage of, and why Wellcare should be their healthcare provider of choice.

You can also access this information by searching “2022 AEP Readiness Resources” in the Ascend Mobile App.

We hope you find these resources helpful. As always, thank you for your partnership.

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

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Wellcare | 2022 Wellcare: Product Pointers – SSBCI

Wellcare | 2022 Wellcare: Product Pointers – SSBCI

Wellcare | 2022 Wellcare: Product Pointers – SSBCI
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Special Supplemental Benefits for Chronically Ill (SSBCI)

Attention Valued Partner,

Making sure you have the tools and resources needed to be successful in this AEP is important to us at Wellcare. This week we are going to focus on highlighting exciting information on our Special Supplemental Benefits for Chronically Ill (SSBCI)

Special Supplemental Benefits for the Chronically Ill (SSBCI) help qualified members with chronic illnesses improve health outcomes. *Members who are clinically eligible for high-risk care management for one or more CMS-listed chronic condition(s) are eligible to receive our SSBCI benefit(s).

  • Autoimmune disorders
  • Cancer
  • Cardiovascular disorders
  • Chronic alcohol and other drug dependence
  • Chronic heart failure
  • Chronic and disabling mental health conditions
  • Chronic lung disorders
  • Dementia
  • Diabetes
  • End-stage liver disease
  • End-stage renal disease (ESRD)
  • HIV/AIDS
  • Neurologic disorders
  • Severe hematologic disorders
  • Stroke

*See SSBCI FAQ document for more details on how to qualify

Our SSBCI offerings include:

  • Autoimmune disorders
  • Cancer
  • Cardiovascular disorders
  • Chronic alcohol and other drug dependence
  • Chronic heart failure
  • Chronic and disabling mental health conditions
  • Chronic lung disorders
  • Dementia
  • Assistive Devices
  • Helper Bees Care, Concierge,
  • Robotic Companion Pet
  • Social Needs Benefit (Applicable for Ascension Complete plans only)

Please note, our SSBCI offerings vary across plans/markets. Be sure to check specific plan benefits before discussing them with beneficiaries. Also, all of our markets except Hawai’i offer at least one SSBCI benefit.

Product Resources:

For easy access to Wellcare product and benefit information, please review the resources below to see what benefits your members can take advantage of, and why Wellcare should be their healthcare provider of choice.

You can also access this information from the 2022 AEP Readiness Resources page, or by searching “2022 AEP Readiness Resources” in the Ascend Mobile App.

We hope you find these resources helpful. As always, thank you for your partnership!

Centene ranks #24 on the Fortune 500 List

Our company provides programs and services to government healthcare programs. We are the country’s largest Medicaid managed care organization. See our current standing:https://fortune.com/company/centene/fortune500/

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

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Nationwide | Peak 10 Monthly Newsletter

Nationwide | Peak 10 Monthly Newsletter

Nationwide | Peak 10 Monthly Newsletter
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Coming Soon – e-App for Nationwide Peak® 10

We’re excited to announce that e-app capabilities through FireLight® will soon be available for Nationwide Peak 10.

Be on the lookout for more information, including webinar training, regarding this exciting opportunity to submit business more efficiently and with fewer not-in-good-order issues.

Current Participation Rates and Caps

For agents who are contracted to sell in AK, CT, IA, MN, MS, MO, NH, NJ, NV, OH, OK, PA, RI, SC, TX, UT, WA, and WY.

For agents who are contracted to sell in AL, AZ, AR, CO, DC, FL, GA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MT, NE, ND, NM, SD, TN, VT, WV, and WI.

This frequently updated blog from Nationwide offers economic insights and inspired, informed guidance for your clients and advice for building your practice. It’s your resource for timely, relevant expertise on the topics that matter most to financial professionals and their clients. Subscribe to receive new blog posts via email.

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

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Alignment Health plan | AHP News | AVA PPO Part B Rebate / Commission True Up

Alignment Health plan | AHP News | AVA PPO Part B Rebate / Commission True Up

Alignment Health plan | AHP News | AVA PPO Part B Rebate / Commission True Up
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AVA® PPO (007) available in Los Angeles, Orange, and San Diego counties just got BETTER!!

With the addition of a $50 PART B REBATE, AVA® PPO (007) has become an even better option for your clients! 

HOW DOES THE $50 PART B REBATE WORK? 
Members will be billed $22.50 and at the same time see a $50 Part B Rebate on their Social Security benefit check. 

AVA® PPO also offers the flexibility and convenience to see a doctor out of network or a specialist without a referral.

We’ve partnered with some exciting networks in Southern California including Cedars Sinai, Memorial Care, Scripps Health, PIH Health, and more! 

We’re excited to share with you that we are going to true-up your commissions for the past 2 YEARS to current 2022 CMS Fair Market Value Rates.

As always, if you have any questions, please email us at:
PartnerExperience@ahcusa.com

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

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Contact a Pinnacle Financial Service representative today for assistance.

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