Agents, brokers, producers, and other Vibra Health Plan, Inc. (“VHP”) sales and other representatives may not engage in activities which have the potential to mislead, confuse or misrepresent VHP Medicare products. When selling or marketing VHP Medicare products, you must comply with all state licensure laws, as well as all applicable Medicare Advantage and Part D laws, Centers for Medicare & Medicaid (“CMS”) policies, including CMS Marketing Guidelines, and all federal healthcare laws (including civil monetary penalty laws). The list below highlights certain prohibited activities for agents, brokers, Vibra Health Plan, Inc. and VHP sales representatives. You acknowledge that you are aware of these prohibited activities and agree to refrain from engaging in them, unless all of the following are true: (1) the activity in question is done in connection with employer plans; (2) the activity in question is expressly allowed by applicable laws and regulations with respect to employer plans; and (3) VHP expressly approves the activity prior to the activity occurring. You also agree to otherwise comply with all applicable legal requirements.
Subject to the very limited exception noted above, agents, brokers, producers and Vibra Health Plan, Inc. sales or other representatives:
- May not claim recommendation or endorsement by CMS or that CMS recommends that Medicare beneficiaries enroll in the plan
- May not make any statement, claim, or promise that conflicts with, materially alters, or erroneously expands upon the information contained in CMS-approved materials
- May not use providers or provider groups to distribute printed information comparing benefits of different health plans, unless the materials have the concurrence of all Medicare Advantage Organizations’ (MAOs) involved and unless the materials have received prior approval from CMS
- May not accept enrollee applications in provider offices or other places where healthcare is delivered. Sales presentations may be conducted and enrollment applications may be distributed and collected only in common areas of a healthcare setting, away from where care is delivered
- May not conduct sales presentations, distribute or accept Medicare Advantage Plan applications, or enroll eligible Medicare beneficiary(s) at educational events
- May not distribute any marketing, enrollment or election forms not approved by CMS except for marketing materials for employer groups that are expressly exempt from approval by CMS if VHP has expressly approved the use of such materials
- May not engage in any discriminatory marketing practice, such as attempting to enroll Medicare beneficiaries from higher income areas, without a similar effort in lower income areas, or not allocating appropriate resources to the disabled Medicare population as well as beneficiaries 65 and over
- May not conduct door-to-door solicitation of Medicare beneficiaries
- May not engage in forgery, including manually assisting Eligible Medicare Beneficiary with the signing of the enrollment application
- May not engage in unauthorized language interpretation
- May not disseminate inaccurate or false enrollment materials
- May not make unsolicited home visits or engage in other unsolicited means of direct contact, other than as permitted through conventional mail
- May not conduct outbound telephone enrollment, which also includes transferring outbound calls to inbound lines for telephone enrollment
- May not place outbound calls to prospective or former members, unless the eligible Medicare beneficiary requested the call and their solicitation for information is documented
- May not use misrepresenting, intimidating, or high-pressure sales tactics. If eligible Medicare Beneficiary says he or she is not interested, the conversation must end
- May not misrepresent a product being marketed as an approved Medicare Advantage or Prescription (Part D) plan when it is actually a Medigap policy or non-Medicare drug plan
- May not state that you work for or are contracted with the Social Security Administration (SSA) or the Centers for Medicare & Medicaid Services (CMS)
- May not market or enroll in additional products that were not identified, agreed upon, and documented in the Scope of Appointment. Additional products cannot be discussed unless the eligible Medicare Beneficiary requests this information
- May not ask for personal information (i.e., Medicare number, bank account or credit card numbers) during sales presentations
- May not offer any rebates, gifts or other inducement for enrollment in a Medicare product unless such gifts are permitted as nominal in value by CMS (i.e., worth no more than $15 with a maximum aggregate of $50 per person per year), are not cash or monetary or cash equivalents, and are provided regardless of enrollment
- May not offer or market any non-health related products to prospective enrollees during any sales activity related to any Medicare sales activity
- Must comply with the National Do-Not-Call Registry, as well as applicable state telemarketing “Do Not Call” regulations, honor “do not call again” requests, and abide by Federal and State calling hours
- May not provide meals for potential Medicare Advantage or Medicare Part D enrollees
- May not solicit prospective Medicare Advantage beneficiaries for individual appointments under the premise that the appointment is for educational purposes, and may not conduct outbound calls to prospective beneficiaries to solicit educational appointments
- May not assist or be present during telephonic enrollments or provide online enrollment services for potential or actual Medicare Advantage beneficiaries
- May not engage in any other activity prohibited by CMS’s regulations, marketing guidelines, or any other federal or state laws or regulations
