WASHINGTON, May 16 /PRNewswire-USNewswire/ -- The Board of Directors of
America's Health Insurance Plans (AHIP) today announced a new initiative to
protect beneficiaries as they consider enrolling in the Medicare Advantage
and Part D programs and ensure that brokers, agents and plan marketing
staff meet new qualifications and requirements.
(Logo: http://www.newscom.com/cgi-bin/prnh/20040830/AHIPLOGO )
The new initiative sets out responsibilities that go beyond existing
guidelines and make clear that health plans are committed to giving
Medicare beneficiaries peace of mind. AHIP plans will work with the Centers
for Medicare & Medicaid Services (CMS) to implement new steps on training,
retraining and monitoring to ensure compliance, including requiring
beneficiary attestation on enrollment applications and other steps to
confirm that beneficiaries understand the plan they have chosen.
In addition, plans will strengthen mechanisms to promptly and
effectively address non-compliance, including working with the National
Association of Insurance Commissioners (NAIC), CMS, beneficiary groups and
broker organizations to urge that new uniform processes and criteria be
adopted to report serious broker, agent or plan employee misconduct in
these areas.
Karen Ignagni, President and CEO of AHIP, said that while the vast
majority of brokers, agents and plan marketing staff adhere to the highest
ethical standards, these principles build on the current protections to
ensure beneficiaries have greater peace of mind when considering Medicare
coverage choices.
"When considering choices regarding their personal health care, seniors
and individuals with disabilities deserve to know that they can trust the
information they receive," said Ignagni. "The principles coupled with tough
enforcement are designed to allow beneficiaries to focus on their Medicare
choices without worrying about the integrity of the information provided."
The principles state that plan sponsors should specify the
qualifications that brokers and agents and plan marketing staff must meet
to market Medicare Advantage plans, clearly communicate these
qualifications and consistently apply them, including:
-- Performing background checks, including verification of required state
licensure;
-- Checking applicable databases for documentation of prior serious
misconduct;
-- Requiring brokers and agents and plan marketing staff to obtain
threshold test scores on plan-specific training that provides detailed
information about the plan types and benefits offered by the plan
sponsor; and
-- Obtaining documentation substantiating that threshold test scores have
been achieved on core training that meets CMS standards.
The principles further state that MA plans will:
-- Verify beneficiaries' intent to enroll and understanding of the plans
they are electing, including conducting oversight such as post-
enrollment outbound calls from the plan sponsor to the beneficiary or
his/her legal representative for face-to-face enrollments or systematic
monitoring of recorded telephonic enrollments;
-- Track and analyze individual broker and agent and plan marketing staff
performance with respect to beneficiary satisfaction, rapid
disenrollments and complaints;
-- Rapidly investigate complaints and take immediate and decisive action
when complaints are verified;
-- Adopt compensation arrangements that comply with the CMS Marketing
Guidelines, including withholding or withdrawing payment for rapid
disenrollments; and
-- Make available to physicians, hospitals and other providers detailed
information about plan structure, benefits, rules and payment terms.
The entire set of AHIP principles is available at
http://www.ahip.org/content/fileviewer.aspx?docid=19761&linkid=170189
America's Health Insurance Plans - Providing Health Benefits to More
Than 200
Million Americans
SOURCE America's Health Insurance Plans
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Related links:
http://www.ahip.org
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AP Archive: http://photoarchive.ap.org PRN Photo Desk
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CONTACT:
Mohit Ghose of AHIP, +1-202-778-8494
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