Welcome to our Frequently Asked Questions page
What does Compliance mean?
Compliance, by definition, is the act or process of doing what you have been asked or ordered to do.
Compliance is everyone’s responsibility!
What does FDR mean?
FDR means First tier, Downstream, and Related entity. CMS looks at the Broker community as an FDR and requires us to follow the same regulations as the carriers.
What is HIPAA?
Health Insurance Portability and Accountability Act, signed into law August 21, 1996. The HIPAA Privacy Rule governs the privacy and security of Protected Health Information records and transactions. The HIPAA Security Rule applies to individual identifiable health information in electronic form or electronic protected health information (ePHI). It is intended to protect the confidentiality, integrity, and availability of ePHI when it is stored, maintained, or transmitted.
What is Encryption?
Encryption is the conversion of electronic data into another form, called ciphertext, which cannot be easily understood by anyone except authorized parties. When transferring a beneficiary’s information electronically, you are required to encrypt your email to be compliant with HIPAA (Health Insurance Portability and Accountability Act) laws.
Are Encryption services MANDATORY for all agents?
If you are contracted with any carriers, you usually will have to sign a “Business Associate Agreement” (BAA) in addition to your regular contract. By signing this agreement you state that you will adhere to the requirements to protect the privacy of applicants and follow HIPAA laws. This would include obtaining encryption services. Western Asset Protection does not endorse any one encryption product, however we are happy to assist you in locating a service that may interest you, for questions regarding available encryption services, email our compliance officer at email@example.com
For an example of what a BAA indicates, please click the link below.
What are the penalties for HIPAA violations?
- For violations where a covered entity did not know and, by exercising reasonable diligence, would not have known that the covered entity violated a provision, a penalty of not less than $100 or more than $50,000 for each violation
- For a violation due to reasonable cause and not to willful neglect, a penalty of not less than $1,000 or more than $50,000 for each violation
- For a violation due to willful neglect that was timely corrected, a penalty of not less than $10,000 or more than $50,000 for each violation
- For a violation due to willful neglect that was not timely corrected, a penalty of not less than $50,000 for each violation; the penalty for violations of the same requirement or prohibition under any of these categories may not exceed $1.5 million in a calendar year.
As an agent, what do I do if I see another agent that is doing something that may be against the rules?
Contact our compliance officer immediately, 602-955-5353 extension 295. Please do not approach the agent, or try to submit to the plan, or to CMS. This may be inviting an audit to your services as well. Our compliance officer will document, research and obtain all of the facts surrounding each case. Each case will be discussed with our compliance committee to determine the appropriate action to be taken. We are here to promote compliance, and we choose to maintain a high level of conduct in these situations. We absolutely appreciate your commitment to compliance however, we know that you are too busy, or may not have the ability to obtain all of the facts.
Can I give my presentation by phone to a member, then mail the application?
Many plans are not fond of telephonic presentations. While there are no written “regulations” surrounding this practice, many plans do have policies in place regarding this type of sales activity. It is not considered a “best” practice, and to some plans it may be identified as part of the plan’s”risk” management policies. Some plans may prohibit it altogether, while others may require the presentation to be recorded. It is always best to check with your broker manager of the plan that you intend to present before the telephonic appointment with your client.
If I am presenting at an informal sales event, can another agent join me to assist in enrollments?
At the time you plan to submit an informal event request, notify the plan that you are going to be bringing another licensed agent to assist you in “maximizing” the enrollment possibilities at your venue. Some plans may require some additional information, and some may even be willing to provide some additional promotional assistance in your event. Always be upfront with your broker manager, they will steer you in the right direction, and confirm if your activity is acceptable to the plan.
Can I file an informal event and present several different carriers at one venue?
This is considered “multi-plan” marketing, and several of the carriers have strict policies in place that will not allow this type of sales activity. When filing this type of event, you must inform each plan of your intention to multi-plan market, and they will educate you on their policies. Make sure that you have obtained permission in writing in case you may need to present it with an allegation response, or to a secret shopper. Always save the documentation as part of the event record for a period of 10 years.
CMS sends several pieces of correspondence to our members. Is there a list of what the member’s receive and when?
CMS distributes a guide to mailings and key events for open enrollment each year. Below is the 2016/2017 guide for your review to understand what correspondence your client may be receiving and when.
Can a beneficiary with End-Stage Renal Disease (ESRD) enroll in a Medicare Advantage Plan?
A beneficiary can only join a Medicare Advantage Plan (Part C) in certain situations:
- If the beneficiary is already in a Medicare Advantage Plan when they develop ESRD, they may be able to stay in their plan or join another plan offered by the same company.
- If the beneficiary is already getting your health benefits (for example, through an employer health plan) through the same organization that offers the Medicare Advantage Plan.
- If the beneficiary already had ESRD, but have had a successful kidney transplant, and still qualify for Medicare benefits (based on age or disability), the beneficiary can stay in Original Medicare, or join a Medicare Advantage Plan.
- The beneficiary may be able to join a Medicare Special Needs Plan (SNP) for people with ESRD if one is available in their area.