AHIP Marketing, Sales Compliance, and Ethics 1 — Questions and Answers
Question 1: Under CMS marketing guidelines, when can an agent conduct a marketing/sales event at a healthcare facility such as a hospital or skilled nursing facility?
- Anytime with facility management permission
- Never — CMS prohibits marketing events at healthcare facilities (Correct answer)
- Only in common areas with prior facility consent and CMS-approved materials
- Only for current plan members during annual renewal
Correct answer: Never — CMS prohibits marketing events at healthcare facilities
CMS prohibits marketing and sales activities at healthcare facilities such as hospitals, physician offices, and skilled nursing facilities because beneficiaries in these settings are considered vulnerable.
Question 2: Which of the following agent activities is PROHIBITED under CMS marketing rules?
- Providing CMS-approved plan comparison materials
- Conducting a sales presentation during a community education event
- Offering gifts or meals of more than nominal value to influence enrollment (Correct answer)
- Answering a beneficiary's question about plan benefits
Correct answer: Offering gifts or meals of more than nominal value to influence enrollment
Agents may not offer gifts, meals, or items of more than nominal value (currently $15 per item, $75 aggregate) to influence a beneficiary's enrollment decision.
Question 3: An agent who sells Medicare Advantage or Part D plans must be licensed in the state where the beneficiary:
- Was born
- Works
- Resides (Correct answer)
- Receives medical care
Correct answer: Resides
Agents must hold a valid health insurance license in the state where the beneficiary resides in order to sell Medicare plans in that state.
Question 4: Before conducting a Medicare sales presentation, an agent must:
- File a pre-sales report with CMS
- Provide the beneficiary with a Scope of Appointment (SOA) form and have it signed (Correct answer)
- Obtain a referral from the beneficiary's physician
- Complete a needs assessment approved by the plan
Correct answer: Provide the beneficiary with a Scope of Appointment (SOA) form and have it signed
The Scope of Appointment (SOA) form documents which plan types the beneficiary agreed to discuss, and must be completed before the sales meeting.
Question 5: What is the 'cooling-off period' related to Medicare marketing?
- A 30-day period after enrollment during which the plan cannot charge a premium
- The 48-hour period after a sales event during which the agent cannot call the beneficiary back (Correct answer)
- A 60-day window for rescinding a prior authorization denial
- The period between AEP close and coverage effective date
Correct answer: The 48-hour period after a sales event during which the agent cannot call the beneficiary back
After a marketing/sales event, agents must wait 48 hours before following up with a beneficiary who attended, to avoid high-pressure tactics.
Question 6: CMS requires that all marketing materials used by Medicare Advantage and Part D plans be:
- Approved by the state insurance department before use
- Submitted to CMS for review and approval before distribution (Correct answer)
- Pre-approved by a third-party compliance vendor
- Submitted to CMS within 90 days after first use
Correct answer: Submitted to CMS for review and approval before distribution
CMS requires plan sponsors to submit marketing materials for review and approval through the Health Plan Management System (HPMS) before distributing them.
AHIP Marketing, Sales Compliance, and Ethics 1
Under CMS marketing guidelines, when can an agent conduct a marketing/sales event at a healthcare facility such as a hospital or skilled nursing facility?