This year you have decided to focus your efforts on marketing to employer group plans. One
employer provides you with a list of their retirees and asks you to contact them to explain the
characteristics of the plan they have selected. What should you do?
Question 1
Answer
a.
You may call them but must not engage in cross-selling other products.
b.
You may go ahead and call them.
c.
You may only contact the retirees after the employer has notified them that they will be receiving a
call.
Incorrect: There is no need for the employer to first notify the retirees that you will call them. When
marketing to employer group health plans, marketing representatives must follow all marketing
rules with many exceptions including the prohibition against unsolicited contracts.
d.
You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to
tell its retirees to call you.
Agent Mendez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her?
Question 2
Answer
a.
Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is
opened marketing representatives may also follow-up with unsolicited telephone calls.
b.
Marketing representatives may only use internet pop-up ads providing plan-specific information
that have been approved by CMS when soliciting prospects through electronic means of
communication.
c.
While unsolicited contacts may be made through print media such as direct mail, marketing
representatives may not initiate electronic contact.
, d.
Marketing representatives may initiate electronic contact through e-mail but an opt-out process
must be provided.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health
plan who markets for multiple plans and sponsors. Carl is a captive agent who markets for only one
plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is
an independent agent who markets only to employer and union groups. CMS marketing
representative compensation rules generally apply to:
Question 3
Answer
a.
Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply).
b.
Denise and Edward (the independent agents), but not Alice (the employee) or Betty or Carl (the
captive agents).
c.
All of these people.
d.
All of these people except Alice, the employee.
Stephanie King becomes eligible for Medicare for the first time in July. With the help of Agent James
Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which
statement best describes how Agent Chan may be compensated under CMS rules?
Question 4
Answer
a.
FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July.
Renewal amount will be paid thereafter if Ms. King remains enrolled. Agent Chan's plan has
chosen not to apply an exception to the pro rata rule.
, Incorrect: Compensation is paid on a calendar year basis, not on an enrollment anniversary date
basis. Agent Chan will therefore be paid initial year compensation for July through December and
renewal compensation starting in January of the following year if Ms. King remains enrolled.
b.
FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he
has successfully enrolled Ms. King in a MA plan when she is both first eligible and a younger, and
likely healthier, enrollee.
c.
FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October
15th (the date open enrollment begins). If Ms. King remains enrolled in the plan, renewal amounts
will be paid.
d.
FeelBetter will pay Agent Chan initial year compensation for July through December. The renewal
amounts will be paid starting in January if Ms. King remains enrolled the following year.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual?
Question 5
Answer
a.
Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such
individuals for each violation.
b.
The plan may withhold commission, require retraining, report the misconduct to a state department
of insurance or terminate the contract.
Correct: Plans must take corrective action in the event of verified misconduct by a marketing
representative. Such disciplinary action might include withholding or withdrawing commissions,
retraining, termination, and reporting agent termination to a state department of insurance.
c.
Plans must immediately terminate their contracts with such individuals.
d.
Her name will be reported to a publicly accessible database and could be advertised in local
newspapers.
, Steban Marsh is a newly appointed agent. Steban intends to conduct an educational session on
Medicare at a senior citizens center near his home. He has advertised the session as an educational
event. Steban asks you what is permissible at such an event. What should you say?
Question 6
Answer
a.
Steban may provide a meal regardless of its value because this is an educational event, not a
marketing event.
b.
Steban may distribute business cards and scope of appointment (SOA) forms.
c.
Steban may provide a meal as long as its value is $15 or less per attendee and he may make
available business reply cards (BRCs).
Correct: At educational events, marketing representatives may provide meals as long as they
comply with the gift/promotional item requirements which limit individual gifts to $15. In addition,
marketing representatives may make business reply cards (BRCs) available as a way to receive
beneficiary contact information.
d.
Steban may distribute benefit information about the plan(s) he represents and set up marketing
appointments at the event.
You are working with several plans and community organizations to sponsor an educational event.
When putting together advertisements for this event, what should you do?
Question 7
Answer
a.
You must ensure that the advertisements indicate it is an educational event, otherwise it will be
considered a marketing event.
Correct. Educational events must be explicitly advertised as educational
b.
Plans may not participate in advertising such an event. All advertising must be done by community
organizations.
c.
employer provides you with a list of their retirees and asks you to contact them to explain the
characteristics of the plan they have selected. What should you do?
Question 1
Answer
a.
You may call them but must not engage in cross-selling other products.
b.
You may go ahead and call them.
c.
You may only contact the retirees after the employer has notified them that they will be receiving a
call.
Incorrect: There is no need for the employer to first notify the retirees that you will call them. When
marketing to employer group health plans, marketing representatives must follow all marketing
rules with many exceptions including the prohibition against unsolicited contracts.
d.
You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to
tell its retirees to call you.
Agent Mendez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her?
Question 2
Answer
a.
Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is
opened marketing representatives may also follow-up with unsolicited telephone calls.
b.
Marketing representatives may only use internet pop-up ads providing plan-specific information
that have been approved by CMS when soliciting prospects through electronic means of
communication.
c.
While unsolicited contacts may be made through print media such as direct mail, marketing
representatives may not initiate electronic contact.
, d.
Marketing representatives may initiate electronic contact through e-mail but an opt-out process
must be provided.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health
plan who markets for multiple plans and sponsors. Carl is a captive agent who markets for only one
plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is
an independent agent who markets only to employer and union groups. CMS marketing
representative compensation rules generally apply to:
Question 3
Answer
a.
Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply).
b.
Denise and Edward (the independent agents), but not Alice (the employee) or Betty or Carl (the
captive agents).
c.
All of these people.
d.
All of these people except Alice, the employee.
Stephanie King becomes eligible for Medicare for the first time in July. With the help of Agent James
Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which
statement best describes how Agent Chan may be compensated under CMS rules?
Question 4
Answer
a.
FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July.
Renewal amount will be paid thereafter if Ms. King remains enrolled. Agent Chan's plan has
chosen not to apply an exception to the pro rata rule.
, Incorrect: Compensation is paid on a calendar year basis, not on an enrollment anniversary date
basis. Agent Chan will therefore be paid initial year compensation for July through December and
renewal compensation starting in January of the following year if Ms. King remains enrolled.
b.
FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he
has successfully enrolled Ms. King in a MA plan when she is both first eligible and a younger, and
likely healthier, enrollee.
c.
FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October
15th (the date open enrollment begins). If Ms. King remains enrolled in the plan, renewal amounts
will be paid.
d.
FeelBetter will pay Agent Chan initial year compensation for July through December. The renewal
amounts will be paid starting in January if Ms. King remains enrolled the following year.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual?
Question 5
Answer
a.
Plans do not impose penalties. Instead, the Medicare agency has specific authority to fine such
individuals for each violation.
b.
The plan may withhold commission, require retraining, report the misconduct to a state department
of insurance or terminate the contract.
Correct: Plans must take corrective action in the event of verified misconduct by a marketing
representative. Such disciplinary action might include withholding or withdrawing commissions,
retraining, termination, and reporting agent termination to a state department of insurance.
c.
Plans must immediately terminate their contracts with such individuals.
d.
Her name will be reported to a publicly accessible database and could be advertised in local
newspapers.
, Steban Marsh is a newly appointed agent. Steban intends to conduct an educational session on
Medicare at a senior citizens center near his home. He has advertised the session as an educational
event. Steban asks you what is permissible at such an event. What should you say?
Question 6
Answer
a.
Steban may provide a meal regardless of its value because this is an educational event, not a
marketing event.
b.
Steban may distribute business cards and scope of appointment (SOA) forms.
c.
Steban may provide a meal as long as its value is $15 or less per attendee and he may make
available business reply cards (BRCs).
Correct: At educational events, marketing representatives may provide meals as long as they
comply with the gift/promotional item requirements which limit individual gifts to $15. In addition,
marketing representatives may make business reply cards (BRCs) available as a way to receive
beneficiary contact information.
d.
Steban may distribute benefit information about the plan(s) he represents and set up marketing
appointments at the event.
You are working with several plans and community organizations to sponsor an educational event.
When putting together advertisements for this event, what should you do?
Question 7
Answer
a.
You must ensure that the advertisements indicate it is an educational event, otherwise it will be
considered a marketing event.
Correct. Educational events must be explicitly advertised as educational
b.
Plans may not participate in advertising such an event. All advertising must be done by community
organizations.
c.
