Overview
You are expected to adhere to the Centers for Medicare & Medicaid Services (CMS) regulations, state and federal laws, guidelines, and UnitedHealthcare rules, policies, and procedures when receiving leads, setting appointments, and meeting with consumers to discuss the UnitedHealthcare Medicare Solutions portfolio of products. The agent must advise the consumer of the products that will be discussed at the future appointment, secure consumer agreement on a Scope of Appointment (SOA) form 48 hours prior to the appointment, and follow procedures for submitting and retaining the form.
You may not discuss or leave Enrollment Guide related to products not previously agreed upon with the consumer in the Scope of Appointment (SOA). Cross-selling of non-healthcare related products is strictly prohibited.
Guidelines for Direct Contact with Consumers
Unsolicited contact with a consumer is prohibited. Permission to Call (PTC) must be secured prior to making contact with the consumer and renewed in order to make on-going contact.
Unsolicited contact includes in-person (e.g. door-to-door marketing), telephonic (e.g. outbound telemarketing), email, leaving electronic voicemail messages on answering machines, and text messaging. Postal mail is not considered unsolicited contact.
Permission to Call (PTC):
∼ Is given by the consumer to be called or otherwise contacted – including in-person, telephonic, text message, leaving electronic voice messages and email contact.
∼ Is to be considered limited in scope, event-specific, and may not be treated as open-ended permission for future contacts.
∼ In the absence of renewed and documented PTC, previously provided permission expires 90 days after the date received if the consumer is on the federal Do-Not-Call-Registry or nine months after the date received.
∼ Must be documented (in bConnected, if available to the agent) and kept on file and available upon request for the remainder of the selling year plus ten additional years and should be updated with each contact with the consumer.
In the absence of document PTC, the following are examples of prohibited unsolicited contact:
∼ Approaching a consumer in a common area such as a parking lot, hallway, lobby, or sidewalk.
∼ Depositing marketing materials (e.g., flyer, door hanger, leaflet) outside a residence, under a door to a residence, on a vehicle, or similar.
∼ Telephoning or emailing a consumer whose contact information was gained from a consumer referral, or purchased lead list.
∼ Follow up contact via telephone or email with a consumer who attended a marketing/sales or educational activity/event or to whom a marketing item was mailed, even if the consumer requested the item.
∼ Contacting, for the purpose of marketing a product or plan a consumer identified in bConnected as a contact with whom you do not have a relationship, unless delegated PTC has been provided by UnitedHealthcare.
∼ Contacting, for the purpose of marketing a product or plan, any former member who disenrolled or current member in the process of voluntarily disenrolling.
PTC must be obtained and appropriately documented in order to contact the consumer in-person or by telephone, email, or text. Contact is always limited to the scope of products and timeframe contained within the documented permission.
When PTC is documented, acceptable forms of contact include:
Consumers who have initiated (solicited) contact by the following means may be contacted:
∼ The consumer made an inbound telephone call, gave permission for an agent to call, and the PTC was documented. Any subsequent discussion with the consumer must be limited to the product(s) identified in the PTC.
∼ The consumer returned a business reply card or submitted an online contact form granting PTC.
Any discussion with the consumer must be limited to the products advertised on the business reply card or in the contact form.
1.Telephonic contact is prohibited if the consumer did not provide a telephone number and/or the telephone number provided is invalid.
∼ The consumer submitted an online contact form. Any subsequent discussion with the consumer must be limited to the product(s) identified in the PTC.
∼ The consumer requested an Enrollment Guide either in-person at a sales event, online,
telephonically, or by business reply card; gave permission for an agent to call; or the permission has been documented. Any subsequent discussion with the consumer must be limited to the product(s) identified in the PTC.
Plan sponsors (UnitedHealthcare) may contact any existing UnitedHealthcare member, who meets the following criteria:
∼ A commercial member who is aging-in
∼ A Medicare Advantage (MA) or Part D member to discuss other MA or Part D products
∼ A Medicare Supplement plan member to discuss MA or Part D products
∼ Medicaid members enrolled in a UnitedHealthcare product.
If you are not the Agent of Record (AOR), only you are permitted to call an existing member under certain circumstance, if PTC has been delegated to the agent:
∼ Delegation of PTC occurs when the plan sponsor (UnitedHealthcare) provides the member’s contact information (e.g., a lead) to you.
∼ You are only permitted to use the member’s Protected Health Information and Personal
Identifying Information (PHI/PII) to the extent necessary to conduct business on behalf of the plan sponsor (UnitedHealthcare).
∼ Any other use of PHI/PII obtained through delegated PTC is prohibited.
You may contact their current clients with whom you have a current, active contract or business relationship in other products (Example: In-Force Life Policy, Homeowners, or Dental Insurance).
∼ If you are in the process of establishing a new relationship, PTC must be obtained and documented.
Prohibited telephonic activities include, but are not limited to the following:
∼ A commercial member who is aging-in
∼ A Medicare Advantage (MA) or Part D member to discuss other MA or Part D products.
∼ A Medicare Supplement plan member to discuss MA or Part D products.
∼ Medicaid members enrolled in a UnitedHealthcare product.
∼ Bait-and-switch strategies – making unsolicited calls about other business as a means of generating leads for Medicare plans.
∼ Calls based on referrals. If an individual would like to refer a friend or relative to an agent or plan sponsor, you or the plan sponsor may provide contact information such as a business card to the individual to give to the friend or family member. In all cases, a referred individual needs to contact the plan or agent/broker directly.
∼ Calls to former members who have disenrolled, or to current members who are in the process of voluntarily disenrolling, to market plans or products. Members who are voluntarily disenrolling from a plan should not be contacted for sales purposes or be asked to consent in any format to further sales contacts.
∼ Calls to members who attended a sales event, unless the member gave express permission at the event for a follow-up call (including documentation of permission to be contacted).
Lead Collection Stations
Lead boxes and/or collection stations must comply with all CMS regulations and UnitedHealthcare rules, policies, and procedures related to obtaining PTC, contacting consumers, use of marketing materials, and marketing/sales activities. The following guidelines apply to the use of lead collection boxes and/or collection stations:
The lead box or collection station must be secured in such a manner as to prevent the unauthorized access and use of any consumer’s contact information. The collection box must be locked and either integrated in a fixture or attached to a fixture in such a manner that prevents unauthorized removal of the box and/or its contents.
Permission from the venue must be obtained prior to placing a lead card box or collection station in any location.
Rules pertaining to marketing materials in provider locations apply (e.g., stations cannot be placed where consumer receive care or wait to receive care).
Only UnitedHealthcare and/or CMS approved lead cards and marketing materials are permitted.
Information provided on lead cards must be considered private and must only be used for the purpose intended.
Providers must not steer consumers to the lead box or collection station.
Providers must not handle in any manner the leads collected (e.g., empty lead box, forward leads to the agent).
Agent must check on and empty lead box or collection station no less than weekly.
Agent must immediately report to UnitedHealthcare any suspected or known breach or theft of the lead box, collection station, and/or individual lead cards.