I have contacted AMAC—the new competitor to AARP
Association of Mature American Citizens- you can market life/health, medicareadvantage and supplements to their members if you have a license in good standing–

I would like to talk to you about working with Ritter IM
on this national account

Duncan J Blankinship,ChFC,CLU,CEBS,MSFS
djblankinship@gmail.com
804-787-3520

I am in Richmond,Va and would be very happy to
come up to your office to discuss this prospect with you
further. Please give me a call anytime.

I met with a person who has a group MA PPO with Aetna. This MA PPO had the same co-payments for both in and out of network providers. This was very important to this person since Aetna does not have a network in the area. Would it be possible for PFFS plans to do this next year?

I think we’re on the same page. There is no law or regulation that says “PFFS will go away” other than the fact that it will be more burdensome to offer it in 2011 in “non-rural” counties.

It’s tough for me to speak for Cigna, but I imagine that they will look at their book of business and determine where the benefits of networking a county would outweigh the cost. Most other carriers are not taking this approach, instead, they are looking to migrate PFFS business to a PPO or HMO product based on the density of their business (Humana and Universal American are good examples). Obviously, network building as an expense associated with it. Some carriers like Coventry, Wellcare and Aetna decided it wasn’t worth the expense and exited in 2010. I agree that Cigna’s position is that they will network PFFS in 2011. It is my understanding that they will need to meet CMS requirements for adequacy of network (similar to HMO and PPO).

I’d say a networked PFFS would resemble an HMO more than a PPO. PPO specifically gives the freedom to go out of network. Honestly, at this point, I’m not sure if a member of a Networked PFFS would be able to go to a “willing” provider out of network or not at this point, but it’s a good question!

Thanks for your research and quick reply. I’ve been getting all kinds of information about this from carriers, but most of it does not appear to be totally accurate. For example, I was told that all PFFS plans for 2011 forward have to have a network. And I was told that PFFS plans would only be available in rural areas where network-based plans were not offered. From your reply, it appears that PFFS plans will be able to be offered in non-rural areas as long as they have a network. Cigna is claiming that their PFFS plan will not disappear in 2011. I know that carriers can choose the counties in which to offer these plans, so they can certainly add or delete them in different counties. But does it sound to you like they are going to build networks and continue to offer them around the country? Also, would a network-based PFFS be like an EPO where a member can only access providers within the network (vs a PPO)?

This comes from the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, for short). Not sure if this link will work, but here is where I found the bill: http://thomas.loc.gov/cgi-bin/query/D?c110:4:./temp/~c110Q9QJWh::

The section on the changes to PFFS is 161. MIPPA requires that PFFS plans use a network in counties where there are 2 or more existing Networked plans (HMO or PPO). This covers all the Metro counties and most of the rural counties, but there are places where 2 Network plans do not exist. In 2010, there were more HMO and PPO plans filed versus PFFS, so the number of counties with less than 2 options is probably shrinking.

I have the link to the CMS site on my Geisinger Certification page. Go here: https://ritterim.pbworks.com/Geisinger+Health+Plan and click on “Get Certified”. However, you will not be able to print your certificate (don’t ask). We have a contact person within CMS who is helping us with this. Call our office, ask for Lina and she will help you get it!

Craig

Larry

There are 3 things you need to do:
1. Be licensed in the state where you are selling (resident or non-resident license)
2. Be appointed with the insurance company in that state.
3. Be certified to sell the product.

1, 2, and 3 make you an agent “in good standing” and able to receive CMS approved commissions from the insurance company. There is no quick way to sell “Nationwide”, you’d have to be licensed and appointed in 50 states and certified to do that.