GoldenRule Colorado Update

Due to new Colorado rules for health insurance, GoldenRule will be suspending all Colorado health insurance products effective January 1, 2011. If your clients are outside of Colorado, you may still quote and turn in applications. If you have any questions, please contact Josh Youngs.

Medicare imposes marketing and enrollment suspension on three health and drug sponsors Plan violations range from marketing to risks to health and safety of members

The Centers for Medicare & Medicaid Services (CMS) today issued a notice to three Medicare health and drug plan sponsors imposing sanctions for violations of Medicare’s rules and regulations. This action ensures that beneficiaries continue to have access to the essential Medicare services to which they are entitled, and also protect Medicare beneficiaries from misleading marketing practices.

Under the notices issues today, Health Net of Woodland Hills, Calif., is required to immediately suspend marketing to and enrolling new beneficiaries into their prescription drug and Medicare Advantage plans.  Intermediate sanctions were also imposed on Medicare Advantage plans sponsored by Arcadian Management Services of Oakland, Calif., and Universal American Corporation of Houston, Texas.  The marketing and enrollment suspension for Arcadian and Universal American will be effective on December 5.  These sanctions will remain in effect until each of the three plans demonstrate to CMS that they have corrected the related deficiencies and that those deficiencies are not likely to recur.  CMS’ actions will not impact the one million Medicare beneficiaries currently enrolled in these three health and drug plans across the country.

“Current members in Health Net, Arcadian and Universal American health and drug plans who are having difficulty getting their prescriptions filled or accessing needed medical services should contact 1-800-MEDICARE or their local state health insurance assistance program for help,” said Jonathan Blum, deputy administrator of CMS’ Center for Medicare.  “Beneficiaries who may have already enrolled in one of these plans as part of the annual enrollment period should call 1-800-MEDICARE if they have any additional questions about that enrollment.”

Health Net’s violations were identified during a CMS audit of the plan.  The Universal American and Arcadian issues were identified by CMS monitoring and were raised to CMS by both plan members and CMS’ partners. The immediate sanctions were imposed on Health Net because it has continued to improperly administer the Medicare drug benefit in its national prescription drug plan (PDP) and local Medicare Advantage prescription drug plan (MA-PD) contracts.  Approximately 660,000 Medicare beneficiaries are enrolled in the organization’s national and local plans.  Health Net operates MA-PD plans in California, Oregon, Washington and Arizona. 

Universal American currently has 300,000 enrollees in its MA-PDs in all 50 states and the District of Columbia. Sanctions were not imposed on its national stand-alone PDPs.  The sanctions apply to the sponsor’s Medicare Advantage plans because it did not provide proper oversight of sales agents who misled beneficiaries about network providers who were not actually part of the network or drugs that were not part of the plan’s formulary.  These marketing violations resulted in delays in treatment and may have resulted in risks to patient health.

Arcadian was served with intermediate sanctions for similar marketing violations. Sales agents were misleading beneficiaries about network providers and/or drug plan formularies.  Arcadian has 66,000 enrollees in Medicare Advantage plans, including a number of Special Needs Plans, in 15 states with the vast majority of members in Texas and Arkansas. 

CMS will closely monitor the plans until the determination is made that corrective actions have been taken and to ensure that these deficiencies are not likely to recur.  If the sponsors do not come into compliance with Medicare requirements, penalties that could be imposed range from fines to the possibility of termination of the sponsors’ contracts with Medicare.

CMS Update - CMS is handing out fines to companies. View the letters and the fines below.

CMS is handing out fines to companies for various infractions. Most of the infractions are due to printed consumer materials.

• Enforcment Chart
• CMS letters to the companies

IMPORTANT NOTICE!! - To Our Sales Partners

A number of the companies we work with on health insurance, have began to make adjustments to their commission programs, as they attempt to comply with the changes required by health care reform. Links to both the Assurant and Golden Rule announcements will let you read their notice, if you have not already.

Although the healthcare bill was 2,700 pages, the devil is in the details, and unfortunately many of the details are yet to be defined. What has been decided, is that advances are being reduced.

Please read carefully both the Assurant and Golden Rule announcement.  I expect most, if not all companies, to issue similar announcements.

We are working to get you current information as it becomes available. As we move forward together, the value of Ancillary, Critical Illness and accident plans, packaged with the health sale, become increasingly more important. 

Rudy Deutschmann

CMS Issues Revised Version of Marketing Guidelines

CMS, in their August 10 Memo to MA & PDP Organizations, has released a new version of their Marketing Guidelines.  This takes the place of the previous edition which was first published in 2006.  This newest version of the CMS Marketing Guidelines goes over a wide range of topics, including but not limited to:  Sales & Educational Events, Broker Compensation, Marketing Pieces, Nominal Gift Rules, and Scope of Appointment Guidelines.

New Guaranteed issue plan from Assurant

Assurant has come out with a new limited benefit plan for consumers. This plan is a guaranteed issue plan. While it is not a full Major Medical product, it could be extremely useful for struggling families. For more information and state availability, please take a look at the MS PowerPoint below. NOTE: Coming to Colorado beginning Sept. 1st, 2009.

• Access PowerPoint
• Access PowerPoint (States: OK & MO only)
• Free PowerPoint viewer from Microsoft

New Rules for Marketing MA and Part D Plans

You have registered for AHIP's course, "Marketing Medicare Advantage and Part D Prescription Drug Plans: Understanding Medicare Basics, Plan Options, and Marketing and Enrollment Requirements."  You need to comply with new rules from the Centers for Medicare & Medicaid Services (CMS) that apply to sales of all 2009 Medicare Advantage and Part D plans.  CMS and plan sponsors will be overseeing marketing activities to ensure compliance with the new requirements.  Please follow this Web link to review the slides in Part 4 that highlight the new requirements in yellow font.  To ensure that plans can fulfill their obligation to appropriately train marketing agents, we will track whether you have clicked on the web link and reviewed the revised slides.
If you have not yet taken the exam for the course, you will be expected to know the new information when you take the test.  We encourage you to review all slides thoroughly to ensure your readiness for the exam.