Aetna |  CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more
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brokernews

Your source for Aetna Medicare broker news and information

September 22, 2022

New and noteworthy

Earn a $110 administrative fee if your new D-SNP member completes the HRA 

New for 2023 AEP, you can earn a $110 administration fee for completing a health risk assessment (HRA) with eligible D-SNP enrollments through the Think Agent tool. Available for field sales agents only.

You can also earn a $70 administration fee for completing the HRA with MA/MAPD enrollments, which is the same as last year. Please note that HRAs will be paid on issued sales only. 

Remember, starting October 1, you must record calls with beneficiaries and incorporate a new disclaimer statement

As outlined in the 2023 CMS Final Rule released earlier this year, starting October 1, agents are required to record calls with beneficiaries related to Medicare Advantage (MA, MAPD, D-SNP) and Prescription Drug Plans, and incorporate a new disclaimer.

Sales info

Are you ready to sell for 2023?

Think Agent is your electronic enrollment tool and so much more for 2023 AEP

Think Agent is Aetna’s new electronic enrollment app that offers an optimized enrollment experience for you and your clients. There’s a website version and an app version that you can use on any mobile device, even your cell phone

Order and use the correct formularies with 2023 enrollment kits

When ordering 2023 enrollment kits, please order all formularies recommended with the selected enrollment kits at checkout.

Why is this important? In some cases, because of how the formularies are titled, it may seem like you’re ordering duplicates. For example, you may see two B2 formularies or two B4 formularies. In these cases, one of the formulary versions is for plans participating in the Insulin Savings Program and one is for those that aren’t. All formularies shown with your selected enrollment kits should be ordered.

How can you tell which formulary corresponds to plans participating in the Insulin Savings Program?

Marketing

Guidelines for assisting your clients prior to October 1

As you know, AEP runs from October 15 to December 7. The first day you can begin marketing 2023 plans is October 1. Before October 1, you’re prohibited from discussing 2023 plans or plan changes with your existing clients or with prospects. Additionally, you may not accept, collect or take possession of a completed AEP enrollment application prior to October 15.

Access 2023 sales presentations

This year, you have several options for presenting Aetna’s consumer-facing sales presentation at sales events and beneficiary meetings starting October 1. You can use a traditional PowerPoint presentation format or share the video version. There is also a PDF version with speaker notes.

NOTE: All of these versions are CMS-approved and cover all required topics. To remain compliant, it is very important you do not add to, remove, or alter anything in the presentations.

2023 MA/MAPD sales PowerPoint presentation (English version)

2023 MA/MAPD sales presentation VIDEO (13 mins)

Start marketing your business with social media

Want to use social media to grow your business, but not sure where to start? Get tips from the pros! Below, watch new episodes focused on social media from our video podcast series Successful Sales Solutions.

Compliance reminders

Sales and marketing tips to stay compliant with this AEP

Tip #1: Explain to prospects about the Part D formulary and drug coverage rules. Pharmacy terms are very confusing to consumers. 

To help them:

Tip #2: If you use a sign-in sheet for in-person meetings, be sure to use the one on Producer World. It is optional if a prospect or member provides their contact information. It is against CMS rules to verbally request any type of personal contact information and ask beneficiaries to sign in. CMS considers this pressuring for personal information.

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 |  CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | 2023 CMS Final Rule – Third-Party Marketing Organization (TPMO) Guidelines

Aetna | 2023 CMS Final Rule – Third-Party Marketing Organization (TPMO) Guidelines
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Medicare Advantage organizations, like Aetna, are responsible for ensuring that our Third-Party Marketing Organizations (TPMOs) adhere to all applicable laws, regulations and CMS guidelines, including the requirements for conducting lead generation, marketing, selling, and enrollment activities with Medicare beneficiaries as outlined within the 2023 CMS Final Rule released May 9, 2022.

Please review and implement the new requirements outlined below. These requirements will be incorporated into your 2023 producer contract. 

New TPMO disclaimer

The following new disclaimer needs to be on all third-party CY2023 materials, effective for marketing beginning October 1, 2022:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 

TPMOs must add this disclaimer to any previously approved material and resubmit. Previous versions must be marked as “no longer in use.” 

This disclaimer must be: 

  • Verbally conveyed within the first minute of a sales call.
  • Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
  • Prominently displayed on TPMO websites.
  • Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the TPMO.

Compliance oversight of all lead sources

TPMOs are responsible for compliance oversight including ensuring all lead sources used to solicit Medicare product enrollments are compliant with CMS guidelines, and all other state or federal laws, rules, and regulations.

This includes but is not limited to ensuring that the TPMO when conducting lead-generating activities, either directly or indirectly, for an MA organization, must:

  • Disclose to the beneficiary that his or her information will be provided to a licensed agent for future contact. This must be done:
    • Verbally when communicating with a beneficiary by phone.
    • In writing when communicating with a beneficiary through mail or other paper.
    • Electronically when communicating with a beneficiary through email, online chat, or another electronic messaging platform.
  • Disclose to the beneficiary that he or she is being transferred to a licensed agent who can enroll him or her into a new plan.

Recording calls with beneficiaries

TPMOs, including lead generation vendors and downstream related entities, must record all calls with beneficiaries in their entirety. In addition, TPMOs must retain and make the recordings available upon request for a minimum of 10 years. This includes calls that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision), as well as post-enrollment telephonic discussions.

This rule applies to telephonic conversations only, not face-to-face meetings. 

Aetna does not dictate the technology to be used for these recordings. However, we will be providing recording capabilities to our sales partners through the Think Agent tool. More information will be provided as this tool is updated. 

Reporting of disciplinary actions or violations

TPMOs must report, on a monthly basis, any staff disciplinary actions or violations of any requirements that apply to Aetna associated with beneficiary interactions. Additional instructions will be provided in the future for the monthly reporting process.

Disclosing subcontracted relationships

TPMOs must disclose any subcontracted relationships used for marketing, lead generation, and enrollment to Aetna. Additional instructions will be provided in the future for disclosing these relationships.

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 |  CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | AEP Readiness! Get Certified to Sell Aetna before October 15

Aetna | AEP Readiness! Get Certified to Sell Aetna before October 15
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Certification is the first step to sell 2023 Aetna products this AEP – let’s get you prepared!

Planning to sell individual Aetna MA/MAPD or SilverScript PDP products this AEP? You’ll need to get certified before the October 15 deadline.

New this year! As an alternative to AHIP training, Aetna now offers a no-cost, Aetna/SilverScript-only certification option for agents who want to sell only Aetna MA/MAPD or SilverScript PDP products, exclusively!

Certification Options

This year, there are two certification options to choose from.

AHIP Medicare Training
Certification option #1

  • This option includes AHIP Medicare training, along with several Aetna-specific training courses (available in English and Spanish).
  • AHIP Medicare training is discounted if taken directly through AetnaMedicareProducerCertification.com.
  • Cost: $125.

Aetna/SilverScript-Only Training
(NEW! No-cost Option) Certification option #2

  • This new option allows you to bypass the AHIP Medicare training component and complete an alternative Aetna/SilverScript-only training instead, along with several Aetna-specific training courses (available in English and Spanish).
  • This no-cost certification option is for agents who want to sell only Aetna MA/MAPD or SilverScript PDP products, exclusively.
  • Cost: $0.

We’re Here to Help

Have questions? Contact Aetna Medicare Broker Services at 1 (866) 714-9301 or BrokerSupport@aetna.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

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

CallEmail

Aetna |  CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | Bonus Programs

Aetna | Bonus Programs
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Submit qualifying applications for Medicare Supplement and ancillary products July 1 through September 30, 2022, to earn a bonus. The more qualifying applications submitted and policies issued, the more bonus dollars you can earn.

You can earn a $100 bonus per underwritten Medicare Supplement electronic application. And for qualifying ancillary products, you can receive a $25 bonus per application.

Want more?

If you submit a qualifying Medicare Supplement application with a qualifying ancillary product, you can receive an additional $25 bonus per application.

How to qualify for a Medicare Supplement bonus

Submit qualifying Medicare Supplement applications and receive the following bonuses:

  • Electronic applications
    $100 bonus per underwritten application
    $25 bonus per open enrollment application
  • Paper applications 
    $25 bonus per underwritten application; 
    $10 bonus per open enrollment application

To receive a payout, you must submit a minimum of 5 signed applications monthly(underwritten, guaranteed issue, or open enrollment) and policies must be issued by the dates indicated below.

How to qualify for an ancillary bonus

Submit qualifying applications of any of the qualifying ancillary products and receive a $25 bonus per application (electronic and paper):

  • Dental, Vision, and Hearing Plus
  • Dental, Vision, and Hearing
  • Cancer and Heart Attack or Stroke/Plus
  • Hospital Indemnity/Flex
  • Recovery Care/Nursing Facility Care/Home Recovery Care
  • Home Care/Plus
  • Protection Series Final Expense

Policies must be issued by dates indicated below, with a $180 minimum annual premium

 

Application dates

Effective dates

Issued by

Payout by

July 1 – 31, 2022

By December 31, 2022

August 15, 2022

September 1, 2022

August 1 – 31, 2022

By December 31, 2022

September 15, 2022

October 1, 2022

September 1 – 30, 2022

By December 31, 2022

October 15, 2022

November 1, 2022

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.

CallEmail

Aetna |  CMS final rule requirements | New D-SNP HRA amount | Video podcasts and more

Aetna | CMS memo clarifies disaster SEP

Aetna | CMS memo clarifies disaster SEP
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Update: CMS memo clarifies that the COVID-19 pandemic does not qualify for the disaster SEP 

On June 22, 2022, CMS issued a memo titled “Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency.” 

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP.

What you need to know:

  • As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. 
  • Going forward, any new enrollments submitted for this reason will be declined.

How you can assist those impacted by COVID-19

Individuals impacted by COVID-19 — who were unable to change plans while they were eligible for an election period — currently have access, on a case-by-case basis, to the SEP for Exceptional Circumstances

Sales agents/brokers are to advise these beneficiaries to contact 1-800-MEDICARE to request an Exceptional Circumstances SEP from CMS.

Questions? 

Thanks for your attention and cooperation with this updated guidance. If you have any questions, please reach out to your Aetna Medicare Broker Manager.

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.

CallEmail