AETNA 2014 SCOPE OF APPPOINTMENT

Transcription

1 AETNA 2014 SCOPE OF APPPOINTMENT When conducting marketing activities, producers may not market any health care related product during a marketing appointment beyond the scope agreed upon by the beneficiary before the face-to-face individual meeting. Producers are required to collect a Scope of Appointment before meeting with a beneficiary for a face-to-face individual meeting to discuss MA/PDP products. A Scope of Appointment is a documented agreement between a beneficiary and a plan sponsor or producer, detailing which products may be discussed during a marketing appointment. The Scope of Appointment documentation must be in writing, in the form of a signed agreement by the beneficiary. Aetna s Scope of Appointment form is available on Producer World (and we have included it at the end of this document). Note that a beneficiary cannot agree to the scope over the phone, unless it is recorded through a Plan Sponsor with an approved system such as Voice Vault. In conducting marketing activities for MA or Part D products, plan sponsors or an individual or organization on a plan sponsor s behalf, may not market any health care related product during a marketing appointment beyond the scope agreed upon by the beneficiary and documented by the plan or representatives of the plan, prior to the appointment (48 hours in advance when practicable) If the beneficiary chooses to enroll in an MA/PDP plan, the producer must submit the Scope of Appointment to Aetna along with the application. See below for instructions on submitting the Scope of Appointment for online enrollments to Aetna. When is a Scope of Appointment form required? A Scope of Appointment is required before meeting with a beneficiary for a face-toface individual meeting to discuss MA/PDP products. If a producer would like to discuss additional products during the appointment that the beneficiary did not agree to discuss in advance, they must document it 48 hours in advance, when practicable. If it is not practicable and the beneficiary requests to discuss other products, the producer must document a second scope of appointment for the additional product type to continue the marketing appointment. Producers do not need to collect a Scope of Appointment to speak with or enroll beneficiaries in a formal group setting, like an advertised meeting, or to discuss or enroll beneficiaries in a Medicare Supplement plan. A beneficiary may complete and sign a Scope of Appointment at a marketing/sales event for a future appointment. In instances where a beneficiary visits a producer s office on his/her own accord, the producer must document the Scope of Appointment prior to discussing MA or PDP products.

2 Producers should note on the Scope of Appointment form that the beneficiary was a walk-in. Other Scope of Appointment guidance Producers cannot agree to the Scope of Appointment on behalf of the beneficiary but can confirm the appointment Securing a completed Scope of Appointment form from a beneficiary may not be treated as open-ended permission for future contact with the beneficiary, and is only valid for the duration of that transaction. Scope of appointment form must be completed by the beneficiary and returned prior to the appointment. If it is not feasible for the Scope of Appointment form to be executed prior to the appointment, a producer may have the beneficiary sign the form at the beginning of the marketing appointment. How to submit the Scope of Appointment form to Aetna As mentioned above, if a producer meets with a beneficiary one-on-one or during personal/individual appointment (i.e., not in a formal group setting such as an advertised meeting), the producer must capture a Scope of Appointment prior to the appointment. If the beneficiary chooses to enroll, the producer must submit the Scope of Appointment to Aetna along with the application as per the directions below. (Exception: If WEST captures a Scope of Appointment for a personal/individual appointment, the producer does not need to obtain another Scope of Appointment prior to the appointment or submit the Scope of Appointment to Aetna with the application.) When using paper applications: Write the HICN in the Plan Use Only field of the Scope of Appointment prior to submitting the enrollment and Scope of Appointment to Aetna. Beneficiaries are not permitted to fill in the HICN on their own. If using Voice Vault: Obtain the Voice Vault Transaction ID (9-digit number) from the Scope of Appointment confirmation and write that Transaction ID number next to the Broker/Agent Use Name on the paper enrollment application. When using the ipad mobile enrollment app or POET: Obtain a paper Scope of Appointment. Write the HICN in the Plan Use Only field of the Scope of Appointment before submitting the Scope of Appointment to Aetna. Beneficiaries are not permitted to fill in the HICN on their own. Fax the Scope of Appointment directly to Aetna at (If using Voice Vault: Obtain the Voice Vault Transaction ID and enter it in the Voice Vault ID field in the ipad app or in POET. This will automatically tie the telephonic Scope of Appointment captured in Voice Vault with the enrollment.) Permission-to-Contact Form The Permission-to-Contact Form is used by Aetna sales representatives and external producers to contact

3 beneficiaries. The Permission-to-Contact Form must be completed prior to conducting an outbound call to a prospect. It is a separate and distinct tool from the Scope of Appointment form and is required by CMS: If a prospect calls in to RSVP for a meeting, a Permission-to-Contact Form is not required for that meeting, but would be required for a rep to place a follow-up call to a meeting attendee Requests for identification numbers, bank or credit card information are prohibited Calls or visits to beneficiaries who attended a sales event are prohibited, unless the beneficiary has given express permission at the event for a follow-up call (completed Permission-to-Contact Form) or visit (completed Scope of Appointment form). CMS views beneficiary consent as limited in scope, and short-term, event-specific consent may not be treated as open-ended permission for future contacts. Aetna s policy for short term and using good judgment is considered to be 90 days. The exception would be for leads received immediately prior to the beginning of the 10/15 OEP. In this case, producers could contact a prospect during the 10/15 12/7 OEP time frame. Learn more Producers can access Aetna s Permission-to-Contact Form on the Individual Medicare page of Producer World under Marketing Materials.

4 Scope of Sales Appointment Confirmation Form The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative. Agents must be licensed, contracted and certified, where applicable, to sell each of the plans listed below. Please initial below beside the type of product(s) you want the agent to discuss. (Refer to page 2 for product type descriptions.) Stand-alone Medicare Prescription Drug Plans (Part D) Medicare Advantage Plans (Part C) and Cost Plans Dental/Vision/Hearing Products Hospital Indemnity Products Medicare Supplement (Medigap) Products By signing this form, you agree to a meeting with a sales agent to discuss the types of products you initialed above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan. Signing this form does NOT obligate you to enroll in or apply for a plan or affect your current enrollment. Beneficiary or Authorized Representative Signature and Signature Date: Signature Signature Date: If you are the authorized representative, please sign above and print below: Representative s Name: Your Relationship to the Beneficiary: To be completed by Agent: Agent Name: Beneficiary Address (Optional): Agent Phone: Beneficiary Phone (Optional): Initial Method of Contact: (Indicate here if beneficiary was a walk-in.) Agent s Signature: Plan(s) the agent represented during this meeting: Date Appointment Completed [Plan Use Only:] Agent, if the form was signed by the beneficiary at time of appointment, provide explanation why SOA was not documented prior to meeting: *Scope of Appointment documentation is subject to CMS record retention requirements* Agents are required to submit a Scope of Appointment form with each enrollment Medicare Advantage Plan or Medicare Prescription Drug Plan application. Y0001_M_LG_FM_ Aetna Inc B (09/13)

5 Stand-alone Medicare Prescription Drug Plans (Part D) Medicare Prescription Drug Plan (PDP) A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Medicare Advantage Plans (Part C) and Cost Plans Medicare Health Maintenance Organization (HMO) A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan s network (except in emergencies). Medicare Preferred Provider Organization (PPO) Plan A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. PPOs have network doctors and hospitals but you can also use out-of-network providers, usually at a higher cost. Medicare Private Fee-For-Service (PFFS) Plan A Medicare Advantage Plan in which you may go to any Medicare-approved doctor, hospital and provider that accepts the plan s payment, terms and conditions and agrees to treat you not all providers will. If you join a PFFS Plan that has a network, you can see any of the network providers who have agreed to always treat plan members. You will usually pay more to see out-of-network providers. Medicare Point of Service (POS) Plan A type of Medicare Advantage Plan available in a local or regional area which combines the best feature of an HMO with an out-of-network benefit. Like the HMO, members are required to designate an in-network physician to be the primary health care provider. You can use doctors, hospitals, and providers outside of the network for an additional cost. Medicare Special Needs Plan (SNP) A Medicare Advantage Plan that has a benefit package designed for people with special health care needs. Examples of the specific groups served include people who have both Medicare and Medicaid, people who reside in nursing homes, and people who have certain chronic medical conditions. Medicare Medical Savings Account (MSA) Plan MSA Plans combine a high deductible health insurance plan with a bank account. The plan deposits money from Medicare into the account. You can use it to pay your medical expenses until your deductible is met. Medicare Cost Plan In a Medicare Cost Plan, you can go to providers both in and out of network. If you get services outside of the plan s network, your Medicare-covered services will be paid for under Original Medicare but you will be responsible for Medicare coinsurance and deductibles. Dental/Vision/Hearing Products Health insurance plans offering additional benefits for consumers who are looking to cover needs for dental, vision or hearing. These plans are not affiliated or connected to Medicare. Hospital Indemnity Products Health insurance plans offering additional benefits; payable to consumers based upon their medical utilization; sometimes used to defray copays/coinsurance. These plans are not affiliated or connected to Medicare. Medicare Supplement (Medigap) Products Health insurance plans offering a supplemental policy to fill gaps in Original Medicare coverage. A Medigap policy typically pays some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare, such as care outside of the country. These plans are not affiliated or connected to Medicare. Aetna Medicare is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Aetna Medicare depends on contract renewal. Plans are offered by Aetna Life Insurance Company and its affiliates Y0001_M_LG_FM_ Aetna Inc B (09/13)