Compliance. Honesty, Ethics and Integrity. Conduct and Ethical Behavior. You will clearly identify yourself and your relationship with the carrier . Disclose you are a licensed insurance agent . Never suggest you are an employee of the U.S. government or any carrier. Who you are.
Honesty, Ethics and Integrity
You will clearly identify yourself and your relationship with the carrier.
You will not make any statement concerning any insurance product or plan that is untrue, deceptive, confusing or misleading.
You will not make a false or misleading statement as to the financial condition of any carrier.
You will not engage in activities that could confuse clients or potential clients.
You will not misrepresent carrier partners or their products or plans.
You will not submit to a carrier, on behalf of a client, an application or policy-related document bearing a false or fraudulent signature or initials.
This conduct is illegal, unethical and grounds for immediate termination.
Violations are reported to the appropriate law enforcement authority.
Except as expressly provided by law, you will not give or provide anything of value to a client whether it’s directly or indirectly.
In addition to tangible items having value, inducements include:
Special favors and offers to pay or rebate any portion of premiums or charges; or,
Sharing of commissions or bonuses.
You will not use scare tactics, coercion, deception, sympathy appeal, false sense of urgency or other high pressure tactic to cause a client or potential client to enter into any transaction.
You will conduct yourself with courtesy, dignity and with respect for the rights and reasonable requests of clients and potential clients at all times.
You will ensure that all information on any application is completely filled in by the client or their legal representative, or you at the direction of the client or their legal representative.
Prior to recommending any product, you will first make reasonable efforts to obtain information concerning the client’s objectives, needs, financial and/or health status, as applicable, to evaluate the suitability of the recommendation.
If you believe that the consumer does not have the mental capacity to understand the information you are presenting, probe to determine if there is someone that assists with their healthcare decisions.
If there is an “active” power of attorney for healthcare, ask to see the document and include with the carrier application, if possible. The designee must sign all of the enrollment paperwork.
Unsolicited contact of Medicare beneficiaries for the purpose of marketing a Medicare Advantage product is strictly prohibited.
You will not engage in any door-to-door marketing or sales activity relating to all types of Medicare Advantage Plans.
Enrollments in a Medicare Advantage plan will not be predicated on age or medical condition, except as provided by federal rules pertaining to access in Medicare.
While marketing Medicare Advantage products, you will ensure that all CMS and carrier regulations regarding the scope of appointment are strictly followed, including the mandatory 48-hour wait period prior to discussion and recommendation of a specific plan.
You will be mindful and understand CMS’ marketing guidelines relating to the use of prohibited words and phrases.
During every Medicare Advantage presentation, you will take steps to fully explain the plan’s summary of benefits and the carrier’s plan rating.
And you must provide the beneficiary with a copy of the summary of benefits, plan ratings and the multi-language insert.
In connection with Medicare Advantage products, you will not make direct initial contact with any person referred to you by a client.
You may ask the client to provide your contact information (business card) to that person and have him/her initiate the contact.
The purpose of business entertainment and gifts in a commercial setting is to create goodwill and sound working relationships, not to gain unfair advantage with customers.
We all must maintain the confidentiality of information entrusted to us, except when disclosure is authorized by the Company’s Legal Department or required by laws or regulations.
Confidential information includes all non-public or proprietaryinformation that might be of use to competitors or harmful to the company or our customers, if disclosed.
It also includes information that suppliers and customers have entrusted to us.Maintaining Confidentiality
With respect to health insurance business, including Medicare Supplement insurance, Medicare Advantage and hospital indemnity business, the federal Health Insurance Portability and Accountability Act (“HIPAA”), along with its amendments and related regulations, govern our use and disclosure of client information.
HIPAA-protected data includes Protected Health Information (“PHI”) relating to our clients.
HIPAAincludes a broad definition of PHI.
A photocopy of a completed application for insurance (Medicare Advantage application, Medicare Supplement, Hospital Indemnity Plan, etc.) is considered PHI.
PHI does not only refer just to information on specific health conditions or treatment records.
Any identifying data that is associated with a client can be considered PHI.Protected Health Information (PHI)
Protected Health Information may only be used or disclosed for permitted purposes to serve the client’s interests, and only in accordance with applicable privacy policies, carrier agreements, the provisions of HIPAA, and any other state or federal law.Protected Health Information (PHI)
You are required:
To not use or disclose the Protected Information other than as permitted or required in connection with your job duties or as otherwise required by law, and
To use appropriate safeguards to prevent use or disclosure of the Protected Information by unauthorized persons
In the health care and financial services industry, when sensitive information must be sent via email, the email must be encrypted.
You may have encountered a secure, encrypted email before if you ever received an email where you were required to enter a user ID and password before being able to view the email.
When it is absolutely necessary for you to transmit sensitive data, you have several options:
If you use a mobile device or tablet to access and view confidential or sensitive information or PHI, you must use safeguards to ensure confidentiality of data.
Anonymous reporting may be made through the Toll-Free Hotline provided by the Company’s Third Party Hotline Service:
Taylor White Accounting and Finance
For agent use only. Not for use with consumers. Certain exclusions and limitations may apply. Not affiliated with the United States government or the federal Medicare program. The content of this presentation reflects the opinion of the presenter and not necessarily the opinion of any entity with which the presenter has a business relationship. This information is provided for educational purposes. The ongoing implementation of laws, rules, and regulations may call for information in this presentation to be revised. Neither the presenter, nor any entity with which the presenter may be affiliated, contracted, or employed, provide tax, investment, or legal advice.