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Here is a link to the memo:  MMG Corrected 8 14 14.

Here is a summary of some of the important clarifications:

1.  Section 70.6 Telephonic contact – I will probably need more clarification on this clarification.  MMG currently reads, “Agents may contact their own clients and Plans/Part D Sponsors may contact current enrollees at any time to discuss plan business.”  CMS clarifies that “Plan business” means their CURRENT PLAN and that “agent’s may not contact members, via the telephone, to discuss other plan options.  This is considered an unsolicited contact.”  Not sure if CMS is saying that agents cannot contact their own clients to discuss other options or that agents cannot contact plan members (not their clients) to discuss other options (like if a plan non-renews).

2.  Referral fees (Page 2) – Limits referral fees on PDP to $25.

3.  Payment of Compensation – Plans MUST wait until January 1st, 2015 to pay commissions on 1/1/15 effectives.

4.  Renewal Compensation – Starting with January 2015 renewals, renewal commissions on ALL MA/PDP business must be paid according to the 2015 Fair market value (FMV), regardless of the renewal commission in place at the time the policy was written.

5.  Admin Fees – Plans are allowed to pay admin fees to downstream entities such as FMO’s prior to January 1st, 2015.  (This seems like it would be difficult to administer as the agent commission and override would be paid at two different times, if the plans choose to do this.)

6.  Clarification on Initial payments – Clarifies that plans CAN pay either (1) the full initial commission for mid year entry OR (2) pro-rated compensation as long as there is no prior plan history, however, if the member disenrolls during the initial calendar plan year, the plan must charge back for ALL months the member was not enrolled (including months prior to enrollment).  If a plan enrolls an initial member (cycle year 1) with prior history of MA enrollment, they may only pay for the remaining months in the year.  Here is CMS’ example:

For example, a member ages into Medicare and elects an MA-PD plan (Plan A), effective April 1. The member moves and is eligible for a special enrollment period. The member elects a new MA-PD (Plan B), effective November 1. Plan A must recoup 5/12ths of the initial compensation (January through March and November through December) to account for the months the member was not enrolled in Plan A. Since the member had prior plan history when the member enrolled in Plan B, Plan B many only pay a pro-rated initial compensation equal to 2/12ths (November through December).

Must admit that this one was confusing for me!  WellPoint is the parent company of Anthem.  Consumers, for the most part, are more familiar with the Anthem brand.  Pending shareholder approval, the company will be known as Anthem, Inc. to provide consumers with a single brand to recognize.

Here is the story from ABC News.

NAHU had been asking for this for many months and here is the inaugural issue of CMS newsletter for Agents and Brokers who participate in the Federally Facilitated Exchanges of the ACA.

Since HIV drugs are in a protected class, PDP companies can’t put any controls around them.  Here is a link to a story from the Washington Post which talks about an inspector general report which identified $30 million in questionable HIV prescription fills.

CMS published the final Regional Prescription Drug Benchmarks about 9 days ago.  Here is a link to the press release.

Here is a link to the bid information and other details on the bid.

Here is a link to the final RPPO regional capitation rates and also to the prescription drug benchmarks BY REGION.  If agents want to see how much Part D prescription drug premium will be subsidized for Low Income Subsidy eligible individuals, they can find this on the second page of the third link.  (Also, I reprinted it below!)

2015 Low Income Premium Subsidy Amounts

Region

State(s)

Subsidy

1

NH, ME

$     29.60

2

CT, MA, RI, VT

$     29.65

3

NY

$     36.94

4

NJ

$     37.64

5

DE, DC, MD

$     30.61

6

PA, WV

$     33.91

7

VA

$     29.47

8

NC

$     29.34

9

SC

$     28.78

10

GA

$     26.47

11

FL

$     25.83

12

AL, TN

$     30.20

13

MI

$     31.46

14

OH

$     28.64

15

IN, KY

$     31.79

16

WI

$     35.32

17

IL

$     28.23

18

MO

$     28.28

19

AR

$     24.76

20

MS

$     29.33

21

LA

$     31.28

22

TX

$     27.31

23

OK

$     29.97

24

KS

$     30.32

25

IA, MN, MT, ND, NE, SD, WY

$     30.00

26

NM

$     21.19

27

CO

$     28.93

28

AZ

$     32.89

29

NV

$     24.25

30

OR, WA

$     33.81

31

ID, UT

$     39.74

32

CA

$     28.84

33

HI

$     27.91

34

AK

$     32.86

Yesterday, Universal American announced that they are selling their Oklahoma Medicare HMO (Generations HMO) to GlobalHealth, Inc.  The transaction is expected to close in 60 to 90 days and terms were not announced.  Agent training, certification and licensing of those agents who are marketing for Generations HMO are instructed to proceed as normal through Universal American.

According to CMS enrollment data, Generations Classic had about 4,700 members in 9 Oklahoma counties, however, the majority of members are in Oklahoma county, Oklahoma.

Congrats to Clara in PA for a $2,500 bonus as the first place winner in Q2 of the Ritter $100,000 Med Supp bonus!  That’s a nice bonus for 3 months of selling!  Clara’s production in Q2 was just over $90k of Med Supp NAP.  In 50th place was Ron B. of NJ with a $250 bonus for just under $20k in Med Supp NAP.

Would you like to collect big bonuses for big production?  Click here to see all the winners!

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