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Clover Health: Compliance is everyone’s responsibility

October 26, 2022

The Medicare Annual Enrollment Period is a busy time of year for agents/brokers. But it cannot be a time where you cut corners for any reason! It is important that you always do a full and thorough sales presentation and enrollment with your clients. Compliance is everyone’s responsibility.

Through secret shopping CMS has identified areas of concern related to the marketing and sales activities that occur with Medicare beneficiaries. A primary concern is that information being provided is confusing, misleading and/or inaccurate. And this concern is not just around marketing materials but also around beneficiary experience in making enrollment decisions for a plan that best fits their needs.

CMS has advised of the following immediate actions they will take during the 2023 AEP to address these concerns:

  • Reviewing all marketing complaints received during the AEP and targeting oversight and review on MA organizations and Part D sponsors with high or increasing rates of complaints
  • Reviewing recordings of agent and broker calls with potential beneficiaries (see Clover's Guidance on Recording sales Appointments)
  • Secretly shopping marketing events

Additionally, CMS advised of some best practices and agents should expect additional oversight around the following:

  • Ensuring beneficiaries know how to file a marketing complaint (1-800-MEDICARE or through the plan directly)
  • Tracking and immediate review of all allegations raised against an agent/broker; action to address inappropriate agent/broker behavior
  • Ensuring agents/brokers obtain and retain required Scope of Appointment in advance of any sales or enrollment discussions
  • Ensuring agents/brokers review the Pre-Enrollment Checklist with beneficiaries prior to enrollment

Clover offers tools and resources in addition to CMS’ best practices that can help ensure agent/brokers’ engagement with beneficiaries is compliant, clear and a positive experience. Please be sure to download Clover's market-specific sales presentation from the Marketing Portal. As well, download and utilize Clover’s Medicare Beneficiary Needs Assessment form to help document the process by which you determine the plan that best fits a beneficiary’s needs.

Questions about Compliance, sales best practices or Clover’s tools and resources for agents/brokers, please contact your Sales Manager or Broker Support. Also, as a reminder, please respond promptly if contacted by Clover Compliance.

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Questions? Call us at 855-888-8326.

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