rules of engagement · 2020. 7. 13. · rules of engagement – 2021 handbook 6 › a managing...
TRANSCRIPT
909928 a 07/20
RULES OF ENGAGEMENT
2021 Agent and Agency Sales Handbook Effective: 7/1/2020
TABLE OF CONTENTSSECTION I: SalesDistributionManagement...............................................................................................................................................3
SECTION II: Contracting,LicensingandTraining.....................................................................................................................................5
SECTION Ill: SuspensionandTermination..................................................................................................................................................12
SECTION IV: Commissions..................................................................................................................................................................................14
SECTION V: Oversight........................................................................................................................................................................................16
SECTION VI: TelesalesRequirements............................................................................................................................................................18
SECTION VII: OperationalRequirements.....................................................................................................................................................22
This Rules of Engagement Handbook is a supplement to the Sales Agency Agreement for Cigna Medicare Advantage & Prescription Drug Plans (“Agreement”) between Cigna Medicare and Agent/Agency and shall be a part of the Agreement as if fully restated therein. In the event of any conflicting terms between the Rules of Engagement and the Agreement, this Rules of Engagement shall supersede and control, unless otherwise specified in the Agreement.
This overview is for Agencies and Agents who are contracted, certified, licensed and appointed to sell Cigna Medicare Advantage & Prescription Drug Plan products. Due to the high degree of compliance required, and that Medicare Advantage & Prescription Drug Plan products are governed by state and federal regulations, the Agencies and Agents must fully comply with all applicable Cigna Medicare policies and procedures, including, but not limited to, those set forth below. The Rules of Engagement may be amended by Cigna Medicare, at its sole discretion, upon thirty (30) days advance written notice to Agencies and Agents. Notwithstanding the foregoing, Cigna Medicare may make any changes to the Rules of Engagement without advanced written notice if changes are necessary to comply with any law, rule, regulation or Centers for Medicare and Medicaid Services (CMS) instructions.
Agencies and Agents agree to comply with all state and federal rules and regulations, as well as all Cigna Medicare policies and regulations as set forth, and shall require each individual subordinate Agent affiliated with the Agency to likewise comply.
AEP AnnualEnrollmentPeriod
AOC AssignmentofCommissions
AOR AgentofRecord
CMS CentersforMedicareandMedicaidServices
CSV CustomerServiceViolation
CTM MedicareComplaintsTrackingModule
DOB DateofBirth
Downlines Agenciesdownstreamfromdirectlycontractedagency
DSA DelegatedServicesAgreement
EFT ElectronicFundsTransfer
FDR FirstTier,DownstreamandRelatedEntities
FMO FieldMarketingOrganization
FTP FileTransferProtocol
GA GeneralAgency
GTS GrievanceTrackingSystem
CARL CignaAgentResourceLine
HPMS HealthPlanManagementSystem
MA/MAPD MedicareAdvantage/MedicareAdvantageandPrescriptionDrug
MIPPA MedicareImprovementsforPatientsandProvidersAct
MGA ManagingGeneralAgency
MLI Multi-languageInsert
MCMG MedicareCommunicationsandMarketingGuidelines
NPN NationalProducerNumber
PDP MedicarePartDPrescriptionDrugPlan
PHI ProtectedHealthInformation
RFI RequestforInformation
ROE RulesofEngagement
SDAP SalesDevelopmentActionProgram
SGA SupervisingGeneralAgency
SOA ScopeofAppointment
SSN SocialSecurityNumber
SSA SocialSecurityAdministration
TIN TaxIdentificationNumber
Toplines Directlycontractedagencies
Uplines UpstreamAgencies
KEY ACRONYMS AND TERMINOLOGY
CALENDAR YEAR AT A GLANCE
January
› OEPbegins
› AEPnewapplicationcommissionsdistributed
› Renewalsdistributed
March
› AgencyProducers’Universityattestationfinaldeadline3/31
› OEPends3/31
April
› AHIPreimbursementdistributedforagentswhomeetqualifications
July
› Annualcertificationrelease
September
› AHIPreimbursementeligibilitydeadline9/15
October
› AEPkick-off10/15
November
› Lastdayfor2020effectivesales11/30
December
› AEPends12/7
› 2021Agentcertificationsanduptodatelicensesandappointmentsdeadline12/31
› 2021AgencyProducers’Universityattestationsinitialdeadline12/31
– Updatebusinesslicensesandappointmentsby12/31orapplicableadministrativefeerenewalswillbeforfeited
AEPOEP
LOCK-IN
AEP READLINES
JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
4
SECTION I
SALES DISTRIBUTION MANAGEMENTLevels of Agencies
TherearefivedifferentlevelsofAgencieswithinthehierarchystructureatCigna-HealthSpring.
› FieldMarketingOrganization(FMO)
› SupervisingGeneralAgency(SGA)
› ManagingGeneralAgency(MGA)
› GeneralAgency(GA)
› Agent
– PersonalBusinessEntity
Field Marketing Organization (FMO)
FMOisaninsuranceAgencythatmayalsocontractwithIndependentAgents,GAs,MGAs,and/orSGAs,asdefined byCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestate(s)inwhichFMO,SGA,MGA,orGAisappointedandinwhichCignaMedicareoperates.FMOmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.
Supervising General Agency (SGA)
SGAisaninsuranceAgencythatmayalsocontractwithIndependentAgents,GAs,and/orMGAs,asdefinedbyCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestate(s)inwhichSGA,MGA,orGAisappointedandinwhichCignaMedicareoperates.SGAmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.
Managing General Agency (MGA)
MGAisaninsuranceAgencythatmayalsocontractwithIndependentAgentsand/orGAs,asdefined byCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestatesinwhichMGAorGAisappointedandinwhichCignaMedicareoperates.MGAmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.AgenciescontractingasanMGAmustcontractthroughanuplineagency.
General Agency (GA)
GAisaninsuranceAgencythatmayalsocontractwithIndependentAgentsasdefinedbyCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestatesinwhichGA/AgentisappointedandinwhichCignaMedicareoperates.GAmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.AgenciescontractingasaGAmustcontractthroughanuplineagency.
Independent Agent/Broker
IndividualsalesAgents/Brokersusingtheirpersonalcredentials(SSN,NPN,andlicenses)tocontractaswritingAgentsforCignaMedicareneedtocontractdirectlywithCignaMedicareorcontractthroughanuplineAgency.WithoutCignaMedicare’spriorapproval,CignaMedicare’sdirectlycontractedAgentsareprohibitedfromcontractingwithaGA,MGA,SGAorFMO.
Personal Business Entity
PersonalBusinessEntityisanentityanenrollingagentmaybepermittedtoassigntheircommissionstothatdoesnotqualifyasaGA,MGA,SGAorFMO.Thisentityoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestatesinwhichPersonalBusinessEntityisappointedandinwhichCignaMedicareoperates.Onlytheagentthatownsthepersonalbusinessentityandhis/herspouseorbusinesspartnermayassigncommissionstotheentity.Thisentitydoesnotqualifyforadministrativefees.PersonalBusinessEntitymustmeetallapplicablelaws,rulesandregulations.PersonalBusinessEntity’sarenotrequiredtocompleteannualagencyattestations.
Exclusive/Non-exclusive
Exclusive Agent/Agency–Agent/AgencythatislicensedandappointedwithCignaMedicareandrepresentsonlyCignaMedicare’sMedicareAdvantage/PrescriptionDrugPlanproductswithinaCignaMedicaregeographicservicearea.Agent/Agencyagreesnottorepresentorsellotherentities’MedicareAdvantage/PrescriptionDrugproductsincluding,butnotlimitedto,HMO,PPO,RegionalPPO,andPFFSplans.
RULES OF ENGAGEMENT – 2021 HANDBOOK 5
Engagement criteria for each Agency level
ToenterintoanAgencyAgreement,theAgencymusthaveaminimumnumberofactiveAgentsandannuallymeetorexceedthesalesproductionrequirementsasoutlinedinthetablebelow.ExpansionmarketAgencytargetsmayvarybasedonnetworkandotherfactorsatmarketlaunch.
Agency LevelMinimum number of active Agents
Minimum annual total of MA enrollment
applications
Number of states required to be
contracted
General Agency 3 150 –
Managing General Agency 5 300 –
Supervising General Agency 5 500 –
Field Marketing Organization 37 3,200 2
AgenciesmayonlyupgradetoahighercontractlevelaftersixmonthscontractedattheirexistingcontractlevelandifdownlineagentandproductionrequirementsfortheirdesiredcontractlevelaremetandCignaMedicareapprovalisgranted.
AgenciesshouldworkwiththeiruplineiftherearequestionsorconcernsrelatedtomeetingormaintainingtheminimumAgentrequirement.CignaMedicarereservestherighttoreviewallAgency-levelcontractstoensurethespecificrequirementsarebeingmet.CignaMedicareutilizesAccountabilityLetterssentquarterlyviaemailtoallAgenciestotrackAgencyprogresstowardmeetingdownlineAgentandannualproductionrequirementsfortheirAgencylevel.
IntheeventanAgencyisdowngradedorterminatedduetofailuretomeetengagementcriteria,CignaMedicarewillnotifyAgency’stopline.
› AnAgencydowngradetoPersonalBusinessEntitywillresultinforfeitureofadministrativefees.Alldownlineagents,asidefromthePersonalBusinessEntityownerandpartner/spouse(ifapplicable),willbemovedtothenextdirectupline.AgentcommissionswillcontinuetobepaidprovidedAgentsmeetallrequiredvalidations(contracted,certified,licensedandappointed),PersonalBusinessEntitymeetsallrequiredvalidations(contracted,licensedandappointed)andthecustomerremainsenrolled.
› AnAgencydowngradetoAgent-levelwillresultinforfeitureofadministrativefees.Alldownlineagentswillbemovedtothenextdirectupline,andagentcommissionswillcontinuetobepaidprovidedAgentsmeetallrequiredvalidations(contracted,certified,licensedandappointed)andthecustomerremainsenrolled.TerminationofaGeneralAgencyandalldownlineagentswillresultinforfeitureofanycommissionpayments.
Non-exclusive Agent/Agency–Agent/AgencythatislicensedandappointedwithCignaMedicarebutrepresentsotherMedicareAdvantage/PrescriptionDrughealthplansinadditiontoCignaMedicarewithinaCignaMedicaregeographicservicearea.
The Difference between an Agent/Broker and Agency
Agent/Broker–Anindividualwhoisusinghis/herpersonalcredentials(SSN,NPN,andLicenses)tocontractasawritingAgentforCignaMedicare.
Agency–Anorganization(PersonalBusinessEntity,GA,MGA,SGA,orFMO)thatisusingitsownuniquebusinesscredentials(TIN/EIN,NPN,License)tocontractasanAgencyforCignaMedicare.AgencieswillnotbeallowedtocontractwithCignaMedicareusinganindividualperson’s/Agent’scredentials.
RULES OF ENGAGEMENT – 2021 HANDBOOK 6
› AManagingGeneralAgencydowngradetoGeneralAgencywillresultinadministrativefeesbeingpaidaccordingtothedateofenrollment.EnrollmentscompletedatMGAlevelwillcontinuetobepaidattheMGAlevelwhileenrollmentscompletedafterthedowngradewillbepaidatthenewGAadministrativefeelevel.Alldownlineagencieswillbemovedtothenextdirectupline.DownlineAgentandAgencycommissionswillcontinuetobepaidprovidedAgentsandAgenciesmeetallrequiredvalidations(contracted,certified/attestationcompleted,licensedandappointed)andthecustomerremainsenrolled.TerminationofaManagingGeneralAgencyandalldownlineagentsandagencieswillresultinforfeitureofanycommissionpayments.
› ASupervisingGeneralAgencydowngradetoalowerAgencylevelwillresultinadministrativefeesbeingpaidaccordingtothedateofenrollment.EnrollmentscompletedatSGAlevelwillcontinuetobepaidattheSGAlevelwhileenrollmentscompletedafterthedowngradewillbepaidatthenewadministrativefeelevel(MGA/GA).Downlineagenciesmaybemovedtothenextdirectupline,asneededbasedonthenewagencylevel.DownlineAgentandAgencycommissionswillcontinuetobepaidprovidedAgentsandAgenciesmeetallrequiredvalidations(contracted,certified/attestationcompleted,licensedandappointed)andthecustomerremainsenrolled.TerminationofaSupervisingGeneralAgencyandalldownlineagentsandagencieswillresultinforfeitureofanycommissionpayments.
› AFieldMarketingOrganizationdowngradetoalowerAgencylevelwillresultinadministrativefeesbeingpaidaccordingtothedateofenrollment.EnrollmentscompletedatSGAlevelwillcontinuetobepaidattheSGAlevelwhileenrollmentscompletedafterthedowngradewillbepaidatthenewadministrativefeelevel(MGA/GA).Downlineagenciesmaybemovedtothenextdirectupline,asneededbasedonthenewagencylevel.DownlineAgentandAgencycommissionswillcontinuetobepaidprovidedAgentsandAgenciesmeetallrequiredvalidations(contracted,certified/attestationcompleted,licensedandappointed)andthecustomerremainsenrolled.TerminationofaSupervisingGeneralAgencyandalldownlineagentsandagencieswillresultinforfeitureofanycommissionpayments.
Individual leads
CignaMedicaremay,atitssolediscretion,supplyoverflowleadstoAgencyorSubordinateAgency,BrokerorAgent.However,CignaMedicareisnotresponsibleforsupportingtheAgencywithleadsorfinancialsupportintheirprospectingefforts.Duringavisitwiththeprospect,AgencyorSubordinateAgency,BrokerorAgentcanpresenttheCignaMedicareAdvantageproductswithfulldisclosureandenrolltheprospect.ReferralsmayonlybesoughtinaccordancewithCignaMedicarepolicyandCMSguidelines.AgencyorsubordinateAgency,BrokersorAgentsmustfollowallguidelinesandregulationsthatgoverntheproperprocedureforprospectingandsellingCignaMedicareproducts,includingallrequirementssetforthunderMIPPAandtheCMSMedicareCommunicationsandMarketingGuidelines(MCMG).
RULES OF ENGAGEMENT – 2021 HANDBOOK 7
SECTION II
CONTRACTING, LICENSING, AND TRAININGAgency qualificationsTobeanauthorizedCignaMedicareAgency,youmust:
› CompleteAgencycredentialingadministeredbyCignaMedicareoritsdesignee
› CompleteAgencyProducers’UniversityattestationadministeredbyCignaMedicareoritsdesigneeuponcontractingandannuallythereafter
› BealicensedhealthAgencyintheCignaMedicarestate(s)inwhichAgencyintendstosellandsubmitapplicationstoCignaMedicare,beingoodstanding,andsupplyCignaMedicarewithacopyofthelicenseuponrequest
› BeappointedbyCignaMedicareasanAgencyinthestatesAgencyintendstosellandsubmitapplicationstoCignaMedicare,perstateregulations
› HaveanexecutedagreementwithFMO,SGA,MGA,GAorCignaMedicare
› Complywithalllegal,complianceandregulatoryguidanceinaccordancewithapplicablestateandfederallawsandCignaMedicarepolicies
› ReceivecontinuingeducationrelativetothecurrentMedicareAdvantage/PrescriptionDrugPlanproductsandcomplywithanychangesthatoccurrelativetothisprogram
› ParticipateinintegrityoversightevaluationsandtheCignaMedicareSalesDevelopmentActionProgramasrequiredbyCMSandCignaMedicare
› Havereasonableaccessibilityforreceivingcommunicationsconcerningimmediateregulatoryornetworkchanges(i.e.,phone,email,fax,pager,voicemail,etc.)
› Maintainaproficiencyin,andknowledgeof,Cigna’sMedicareAdvantage/PrescriptionDrugPlanproductsaswellasallnecessarycompliancerequirements
› ComplywithCignaMedicare’ssalesperformanceanddisciplinarystandardsassetforthinCignaMedicare’spoliciesandprocedures,hereinincorporatedbyreference
› HaveanexecutedHIPAAAgreementforAgentsaffiliatedwithAgency
Agent qualificationsTobeanauthorizedCignaMedicareAgent/Broker,youmust:
› CompleteAgent/BrokercredentialingadministeredbyCignaMedicareoritsdesignee
› CompletetheCignaMedicareAgent/BrokercertificationtrainingandpasstherequiredcertificationexaminationsadministeredbyapprovedCignacertificationvendorsorCignauponcontracting(priortoselling)andannuallythereafter
› Completeanyinstructor-ledvirtualorin-persontrainingthatmayberequired
› BealicensedhealthAgentintheCignaMedicarestate(s)inwhichyouintendtosellandsubmitapplicationstoCignaMedicare,beingoodstanding,andsupplyCignaMedicarewithacopyofthelicenseuponrequest
› BeappointedbyCignaMedicareasanAgentinthestatesyouintendtosellandsubmitapplicationstoCignaMedicare,perstateregulations
› HaveanexecutedagreementwithFMO,SGA,MGA,GAorCignaMedicare
› Complywithalllegal,complianceandregulatoryguidanceinaccordancewithapplicablestateandfederallawsandCignaMedicarepolicies
› ReceivecontinuingeducationrelativetothecurrentMedicareAdvantage/PrescriptionDrugPlanproductsandcomplywithanychangesthatoccurrelativetothisprogram
› Attendanymeetingsrequiredtostayinformedofcomplianceandregulatory,proceduralandnetworkchanges
› ParticipateinintegrityoversightevaluationsandtheCignaMedicareSalesDevelopmentActionProgramasrequiredbyCMSandCignaMedicare
› Havereasonableaccessibilityforreceivingcommunicationsconcerningimmediateregulatoryornetworkchanges(i.e.,phone,email,fax,pager,voicemail,etc.)
› Maintainaproficiencyin,andknowledgeof,Cigna’sMedicareAdvantage/PrescriptionDrugPlanproductsaswellasallnecessarycompliancerequirements
› ComplywithCignaMedicaresalesperformanceanddisciplinarystandardsassetforthinCignaMedicarepoliciesandprocedures,hereinincorporatedbyreference
› HaveanexecutedHIPAAAgreementforAgentsaffiliatedwithanAgency,orhaveaBusinessAssociateAgreementforAgentsdirectlycontractedwithCignaMedicare
RULES OF ENGAGEMENT – 2021 HANDBOOK 8
Agent/Broker credentialing
Agents/Brokersmustbeproperlylicensed,contractedwithCignaMedicareafterasuccessfulbackgroundcheck,appointedbyCignaMedicare,andcertifiedviacompletionoftheannualcertificationprocessbeforebeingabletosellanyCignaMedicareproducts.
Maintainingproperlicensure,contracting,appointment,andcertificationensuresanAgentremainsingoodstandingwithCignaMedicareinordertoservicecustomersandmaintainrenewalcommissions.
Licensing
AnAgentmustbelicensedandappointedintheirprimarystateofresidenceandallotherstatestheAgentwillmarketandsellCignaMedicareproducts.TheAgentisresponsibleforobtainingandkeepingtheappropriatelicensure.Licensingrulesvarybystate.
TheAgentmustcontacttheirToplineorLocalMarketManagerforfurtherdetails.
AgenciesmustbelicensedandappointedinallstatestheyandtheirAgentssellandmarketproductsforCignaMedicare.TheAgencyisresponsibleforobtainingandkeepingtheappropriatelicensure.
Licensingrulesvarybystate.Agenciesmustcontinuetobelicensedandappointedtoservicecustomersinordertocontinuereceivingrenewalcommissions.
ThefailureofanAgent/Agencytomaintaintheappropriatelicensure,appointments,andcertification,willresultintheAgent/AgencybeingterminatedfromsellingCignaMedicareproductsandwillceaseanyrenewalcommissions/administrativefees.
Contracting
Sales Agency Agreement
TheSalesAgencyAgreementisforAgenciesandAgentswhoaredirectlycontractedwithCignaMedicare.TheagreementestablishesthetermsandconditionsunderwhichtheSalesAgencyanditsdownlineAgenciesandAgentsareauthorizedtosellMedicareAdvantageandPrescriptionDrugPlansofferedbyCignaMedicare,includingthecompensationCignaMedicarewillpaytheSalesAgencyanditsdownlineAgenciesandAgentsforsellingsuchhealthplans.
Subordinate Agent Agreement
ThisSubordinateAgentAgreementisexecutedbyandbetweenCignaMedicareandaSubordinateAgentorAgency.ThisagreementstatestheSubordinateAgent/AgencyagreestobelegallyboundbythetermsandconditionsoftheSalesAgencyAgreement.
Contracting process
AnAgentmusthaveanexecutedagreementwithanFMO,SGA,MGA,GA,orwithCignaMedicare,asapplicable.ExternalToplineAgenciesareresponsibleforinitiatingonboardingandmaintenancerequestsfortheirdownlineAgenciesandAgentsthroughtheeContractingsystem(ProducerExpress).TheCignaMedicareContractingDepartmentisresponsibleforreviewingandprocessingonboardingandmaintenancerequests,communicatingtorecruitersinregardtocurrentstatus,activatingAgents,andarchivingcontractingdocumentation.
AnAgent’sfirststepintheonboardingprocessistocompletethedataentryassociatedwiththeonboardingeviteandelectronicallysignalldocumentsforsubmissiontoCignaMedicare.
Bulk Onboarding
Agenciesmustmeetminimumonboardingrequirements,meetorexceedCignaMedicarebackgroundcheckstandardrequirements,andbeapprovedbyCignaMedicareinordertoutilizebulkonboardingfordownlineAgents.ShouldAgencybeapprovedforbulkonboarding,CignaMedicaremayperformongoingcriminalbackgroundchecksonanyorallappointedAgents.
Recruitment ethics
WhenrecruitingnewAgentsasyoubuildyourAgency,itisoftencommontocomeacrossexistingCignaMedicareAgentsandAgencies.Asarule,youcannotcontractwithanycurrentCignaMedicaredirectlycontractedoremployedAgentswithoutwrittenconsentfromCignaMedicare.ThedirectlycontractedoremployedAgentcanrequestreleasefromtheirLocalSalesManager.
Asageneralguideline,werequestyourespectfullywalkawayfromanycurrentCignaMedicareAgentorAgencywritingunderanexistinghierarchy.
InanefforttominimizerunningintoexistingCignaMedicareAgents,eachlocalmarketcanscrubyourrecruitinglistsagainstactiveCignaMedicareAgents.Pleasesubmittoyourlocalsalesrepresentativebeforestartingyourmailorcallcampaign.
CignaMedicarelooksforwardtoworkingwithyouasyougrowyourorganization.WeencourageallofoursellingAgents/Agenciestomaintainthehighestlevelsofprofessionalism,courtesyandrespecttowardothers.
RULES OF ENGAGEMENT – 2021 HANDBOOK 9
Contracting platform
ProducerExpressistheCignaMedicaredatasourceforlicenseandappointmentinformation.Appointmentsareprocessedaccordingtostatelicensureandappointmentlawsviatheautomatedonboardingandappointmentprocessingsystem.
New Agent onboarding processDownline Agent contracting packet
ThefollowingitemsarerequiredandareincludedintheAgentonboardingevite:
› AgentApplication
› AuthorizationtoConductaBackgroundInvestigation/Questionnaire
› SubordinateAgentAgreement–referencedabove
› AssignmentofCommissionsAgreementForm(applicableifAgentisassigningcommissionstotheiruplineAgency)–authorizesandempowerstheCompanytopayAssigneeAgencyallcompensation
› Hierarchyform
› W9(applicableifagentispaidcommissionsdirectly)
› EFTform(accompaniedbyvoidedcheck)–completethisformifDirectDepositisdesired;ifnotcompleted,checkswillbemailed.Note,thisformmustbesubmittedseparatelyfromthepacket,followingtheinstructionswithintheform.
Step one
NewAgentsareonboardedviaProducerExpress.
› ExternalAgentsareonboardedbytheirrespectiveToplineAgencyrecruiter(s).
› DirectlycontractedAgentsareonboardedbytheCignaMedicareContractingDepartment.
Step two
OnceonboardingiscompletedandsubmittedtotheCignaMedicareContractingDepartment:
› AbackgroundcheckwillbeautomaticallyinitiatedandtheautomatedappointmentprocessingwiththeNationalInsuranceProducerRegistry(NIPR)databasewillbeginforstatesselectedbytherecruiterduringonboarding.
– Backgroundcheck:IfanAgentpassesthebackgroundcheck,thecontractingprocesswillcontinue.IfanAgentfails,theywillreceiveanemailwithadditionalinformationregardingtheappealsprocess.Backgroundcheckscantakeanywherefromtwoto14businessdays,dependingontheAgent’sresidentstate.
Step three
Oncethebackgroundcheckiscompletedandatleastoneappointmentisinplace,arecordfortheAgentisestablished.
› ThenewAgentprofiledictatestheappropriatecertificationmodulesassignedinCignaMedicareProducers’University.
› RequeststoswitchagentstoaCommissionedTelesalesprofiletype,whichmaymodifythecertificationmodulesassignedinCignaMedicareProducers’University,mustbereviewedandapprovedbyCignaMedicare.
Step four
AnAgentisnotactivatedtomarketandsellCignaMedicareplansuntilthefollowinghavebeenvalidated.
› Thereisatleastoneactivelicenseandappointmentinplace.
› Thebackgroundcheckwassuccessfullypassed.
› Successfulcompletionofcertificationrequirements.
Oncecertificationiscomplete,the“Ready-to-Sell”emailissenttotheAgentadvisingthathe/sheisreadytobeginmarketingandsellingforCignaMedicare.Theemailidentifiesthestate(s)inwhichtheAgentisappointedandtheAgent’swritingnumber.AnAgentisonlyapprovedtosellinthestate(s)inwhichtheAgenthasbeenappointedandnoothers.IftheAgentintendstosellCignaMedicareproductsinadditionalstate(s),theymusteithersendanemailrequesttotheCignaMedicareContractingDepartmentorinformtheirrecruiterwhowillinitiatetherequest.TheAgentorrecruitercancontactContractingbyemailingContractingMailbox@Cigna.comwiththeAgentIDandarequesttobeappointed.AnAgentisnotapprovedtobeginsellinginadditionalstate(s)untiltheyreceiveconfirmationoftheirstateappointment(s)fromCignaMedicare.
IfanAgenthasanyquestionsorneedsassistancewithanypartoftheonboardingprocess,pleasecontactCignaMedicareContractingatContractingMailbox@Cigna.com.
RULES OF ENGAGEMENT – 2021 HANDBOOK 10
New Agency onboarding process
Downline Agency contracting packet
ThefollowingitemsarerequiredandareincludedintheAgencyonboardingevite:
› AgencyApplication
› SubordinateAgentAgreement–referencedabove
› Hierarchyform
› PrincipalDesignationform
› W9
› EFTform(accompaniedbyvoidedcheck)–completethisformifDirectDepositisdesired;ifnotcompleted,checkswillbemailed.Note,thisformmustbesubmittedseparatelyfromthepacket,followingtheinstructionswithintheform.
Step one
NewAgenciesareonboardedviaProducerExpress.
› ExternalAgenciesareonboardedbytheirrespectiveToplineAgencyrecruiter(s).
› DirectlycontractedAgenciesareonboardedbytheCignaMedicareContractingDepartmentfollowingsuccessfulcompletionoftheFDRIntakeprocess.
Step two
Onceatleastoneappointmentisinplace,arecordfortheAgencyisestablished.
Step three
AnAgent/AgencyisnotactivatedtomarketandsellCignaMedicareplansuntilthefollowinghavebeenvalidated.
› Thereisatleastoneactivelicenseandappointmentinplace.
› Successfulcompletionofattestationrequirements.AgenciesarerequiredtologintoCignaMedicareProducers’UniversityandattesttothePoliciesandProceduresandRulesofEngagement.
Onceonboardingiscomplete,the“Ready-to-Sell”emailissenttotheAgencyadvisingthatAgencyisreadytobeginonboardingdownlineAgents.Theemailidentifiesthestate(s)inwhichtheAgencyisappointedandtheAgency’swritingnumber.AnAgencyisonlyapprovedtosellinthestate(s)inwhichtheAgencyisappointed.
IftheAgencyintendstosellCignaMedicareproductsinadditionalstate(s),theymusteithersendanemailrequesttotheCignaMedicareContractingDepartmentorinformtheirrecruiterwhowillinitiatetherequest.TheAgencyorrecruitercancontactContractingbyemailingContractingMailbox@Cigna.comwiththeAgencyIDandarequesttobeappointed.AnAgencyisnotapprovedtobeginsellinginadditionalstate(s)untiltheyreceiveconfirmationoftheirstateappointment(s)fromCignaMedicare.
Note,ifAgencyprincipalisasellingprincipal,he/shemustalsocompleteaseparateDownlineAgentcontractingpackettocontractasanindividualsellingagent.
IfanAgencyhasanyquestionsorneedsassistancewithanypartoftheonboardingprocess,pleasecontactCignaMedicareContractingatContractingMailbox@Cigna.com.
Contracting and changing hierarchies
MostcontractedAgentswhoareappointedtosellforCignaMedicarealignunderacompany-approvedandcontractedTopline.WhenanAgency/Agentchangeshierarchies,residualoverridecommissionsareretainedbythehierarchystructureandaresubjecttothecontracttermsinplaceatthetimeoftheoriginalsale.
IfanAgent/Agencywishestochangehierarchiestheymustfollowthestepsbelow.
Agent/Agency Request to change hierarchies with a new Topline
TheAgent/AgencymustbeingoodstandingwithCignaMedicare.TheAgent/Agencycannotbeunderinvestigationinternallyorexternally,musthaveacceptablecompliancemetrics,sufficientsales,notbeindebttoCignaMedicare,nothavethird-partypaperprohibitingamoveinhierarchy,andmustpossessanactivewritingnumberwithCignaMedicare.
AnAgent/AgencymusttransfertothesameorlowercontractlevelwiththenewToplineAgency.TheAgent/AgencymayonlyupgradetoahighercontractlevelaftersixmonthsfromthechangedateandifdownlineagentandproductionrequirementsaremetandCignaMedicareapprovalisgranted.
RULES OF ENGAGEMENT – 2021 HANDBOOK 11
TheAgent/AgencymustbesuccessfullyreleasedfromthecurrentToplineAgencybeforeanymovecanbemadetoanewToplineAgency.Asuccessfulreleasecanbeaccomplishedinoneofthreeways.
1. ObtainareleaselettersignedbythecurrentToplineAgency.
2. IftheAgenthasbeencontinuouslyactiveunderthesameToplineAgencyforatleastthepreviousninety(90)calendardaysbuthasnotproducedanybusinessduringthattime,noreleaseisrequiredtochangehierarchies.
3. IftheToplineAgencyisunwillingtograntarelease,andtheAgent/Agencyhasproducedbusinessinthatpreviousninety(90)calendardays,theAgent/Agencycansubmitasignedanddated“Request for Release from Topline Form”totheContractingDepartmentviaemail([email protected]).ThiswillserveastheAgent’s/Agency’snoticeofintenttochangetoanewsaleshierarchyandwillstartaninety(90)calendardaywaitingperiodtobeeligibletoswitchhierarchieswithoutarelease.Theninety(90)calendardaytimeframeforareleaseofficiallybeginsonthedaytheContractingemailboxreceivesthereleaseform.
Aftertheinitialacknowledgmentofthechangerequest,noadditionalnoticesorreminderswillbesentfromCignaMedicareregardingtheeligibilitydate.Attheendoftheninety(90)calendardaywaitingperiodtheAgent/AgencywillbefreetoonboardwiththeAgencyoftheirchoosing.Agentsmaycontinuetosellduringtheninety(90)calendardays,butthebusinesssoldinthatninety(90)calendardaytimeframeremainsunderthehierarchyinplaceatthetimethebusinessiswritten.TheacceptingToplineAgencyisresponsibleforinitiatinganonboardingevitefortheAgent/AgencyinProducerExpress(Sircon).
AgentsandotherentitiesintheToplinehierarchyarepermittedtochangesaleshierarchiesnomorethanoncepercalendaryearundertheninety(90)calendardaynoticescenario(Option3above).
WhenanAgencyisreleased,thecontracteddownlineAgencies/Agentsareconsideredtobeincludedinthatrelease,unlessotherarrangementsarerequestedbytheToplineAgencyandapprovedbyCignaMedicare.TheacceptingToplineAgencyisresponsibleforinitiatingonboardingevitesforany/alldownlineAgencies/AgentsinProducerExpress(Sircon).
Agent/Agency request to change hierarchies within the same Topline Agency
TheToplineAgencyhasdiscretiontomoveandchangethelevelofAgentsandsolicitorswithintheirhierarchystructureatareasonablefrequency.
TheToplineAgencydoesnotneedtheconsentoftheAgentorAgencytocompleteamoveordowngradewithinitsownhierarchy.TheToplinedoes,however,needtonotifytheAgent/Agencyofthemoveordowngrade.TheToplineAgencywillinitiateanagreementmaintenanceeviteforanymoveordowngraderequests,whichwillbecompletedbytheAgent/AgencyandsubmittedtoCignaMedicareContracting.Residualoverridecommissionsareretainedbythehierarchystructureandaresubjecttothecontracttermsinplaceatthetimeoftheoriginalsale.
TheToplineAgencyisresponsibleforinitiatingagreementmaintenanceevitesforanydownlineAgencies/AgentsinProducerExpress(Sircon).
Agent/Agency training and certification at Cigna Medicare
CignaMedicareapproachestrainingasatooltohelpourAgentsandAgenciesbecomesuccessful.Tothisend,weofferavarietyofperformance-focusedtrainingandongoinglearningopportunitiesforallournewandexistingAgentsandAgencies.
TrainingandcertificationcanbeaccessedthroughtheCignaMedicareProducers’UniversityatCignaHealthSpringProducers.com.
Accessing training
Mostcoursesareofferedasself-pacedeLearningontheCignaMedicareProducers’University.CoursesareavailableatCignaHealthSpringProducers.com.ThissystemallowsAgentsandAgenciestohaveeasyaccesstotrainingandlearnattheirownpace.Afewothercoursesareinstructor-led(face-to-face)orvirtualinstructor-led(webinars).Somemayalsobeofferedasblendedlearning–incorporatingbotheLearningandinstructor-ledcontent.
› InordertoaccesstheProducers’UniversityandanyofoureLearningcontent,includingcertificationandothercourses,AgentsandAgencieswillneedtocompleteregistrationonthesite,firstasanewAgentandAgencyandthenannually.OnlyAgentsandAgencieswhohavebeenfullyonboardedinProducerExpressandsetupinourSalesforcesystemmay
RULES OF ENGAGEMENT – 2021 HANDBOOK 12
registerandaccesstheProducers’University.ThesesystemsfeeduserinformationtotheProducers’UniversitytoenableanAgentorAgencytoregisterandpreventanyunauthorizedaccess.AnAgent’sorAgency’susernameonProducers’UniversityisusuallytheNationalProducerNumber(NPN).AgentsandAgencieswillneedtocreateasecurepasswordtogowiththeusername.AgentsandAgenciescanaccesstheirlearningortrainingtrackuponloggingintoProducers’University.Agentscanalsoregisterforinstructor-ledtrainingusingtheInstructorLed-Trainingscheduleavailableonthesite.
› TheResourceLibrarypageoftheProducers’UniversitycontainsseveraldownloadablejobaidsandreferencematerialsonanabundanceoftopicsthatAgentsandAgenciescanfindusefulbefore,during,andafterthesale.
Inactive Agents/Agencies
AgentsorAgencieswhonolongerhaveanactiveagreementwithCignaMedicarearenotallowedtoaccessanyofourtraining.InactiveAgentsorAgencieswillneedtocompletetherecontractingprocessinordertoaccesstraining.
Agent training requirements
› CertificationisrequireduponcontractingasanAgent/BrokerandannuallythereafterbythedatespecifiedannuallybyCignaMedicare.
› Agentsarerequiredto:
– Completecertificationpriortosellinganyofourproducts.
– CompletecertificationbythedeadlinescommunicatedbyCignaMedicaretoremainactive,qualifyforrenewalsandserviceexistingcustomers.
– PasseachcoursebythedeadlinescommunicatedbyCignaMedicare,withaminimumscoreof85%.
– Passeachcourseinnomorethanthreeattempts.AgentsshouldcontacttheirBrokerSalesRepresentativeintheeventacourseisfailed3timesandlocked.
› CertificationincludesstandardMedicaretraining,referredtoas“universal”trainingandCignaMedicarespecificcourses.
› AgentsarerequiredtocompleteuniversaltraininginadditiontotheCignaMedicarecorecertificationcourses.Agentsmaychoosetocompletetherequiredexternal(universal)MedicareandFraud
WasteandAbusetrainingprovidedbyanyofthecompaniesbelow.
CignaMedicarewillreimbursecertificationcostsfor2021MedicareAdvantageagentcertificationwhereeligibilityrequirementsaremet.Tobeeligibleforreimbursementagentsmustcomplete2021certificationbySeptember1,2020andsellfive(5)January1,2021effectiveapplicationsthatareingoodorder.Aftermeetingtheserequirements,agentswillbeeligibleforreimbursementasoutlinedbelow:
– AHIP($125reimbursement)www.AHIPMedicareTraining.com
– GormanHealth($99reimbursement)http://www.medicaresalestraining.com
– PinpointGlobal($89.95reimbursement)https://medicareonlinecertification.com
BothAHIPandPinpointGlobalcertificationscanbeaccesseddirectlyfromtheProducers’University.
› Forreasonsofemphasis,clarityorCMSdirectives,Cigna-Medicare’scertificationcoursesmayrepeatcertaintopicsthatAgentsmayhavecoveredintheexternalcertificationadministeredbyAHIP,PinpointorGorman.
Training Steps
1. GotoProducers’University
2. LoginwiththeNPNandpassword
3. Click“MyLearning”toseetracks
4. Selectanycoursetostart.Agentshavethreeattemptstopasseachcourse
5. LaunchandcompleteAHIPorPinpointMedicareTraining,oruploadavalidcertificatefromAHIP,PinpointorGormanHealth
CignaMedicare’strainingandtestingprogramsaredesignedandimplementedinawaythatmaintainstheintegrityofthetrainingandtesting,andensuresthateachindividualistakingthetestindependently.
Agents/brokersmaynotallowsomeoneelsetocompletetrainingontheirbehalforsharetheirloginstotheCignaMedicareProducers’Universitywithanyoneelse.DoingsowillviolatetheintegrityofthetrainingprocessandCMSAgentandTestingGuidelines.
CignaMedicaremaintainsevidenceofthetrainingtools,trainingexamsanddocumentationdemonstratingevidenceofcompletionandcanprovidethisinformationtoCMSuponrequest.
RULES OF ENGAGEMENT – 2021 HANDBOOK 13
Annual attestation
AgentsandAgenciesarerequiredtoreviewandabidebytheCignaMedicarePoliciesandProcedures,RulesofEngagement,andSocialMediaPolicyandconsentthroughelectronicattestationpriortomarketingorsellinganyofourproductsandannuallythereafterbythedeadlinescommunicatedbyCignaMedicare.Note,sellingprincipalsmustcompleteboththeirindividualAgentattestationaswellastheirAgencyattestationseparately.AttestationscanbechangedatthediscretionofCignaMedicare.FailuretocompleterequiredattestationsbythedeadlinescommunicatedbyCignaMedicarewillresultinforfeitureofAgent-levelcommissionsand/orAgencyadministrativefeerenewals.
Product knowledge
AgentsmustmaintainaproficiencyinandknowledgeofCigna’sMedicareAdvantage/PrescriptionDrugplansaswellasallnecessarycompliancerequirements.
Policies and Procedures
AgentsmustcomplywithallapplicableCignaMedicare’ssalesperformanceanddisciplinarystandardsassetforthinstateandfederalregulations,andCignaMedicare’sPoliciesandProcedures.
Welcome email and call
OnceanewAgentisfullycontractedandsuccessfullycertifiedandtrained,heorshewillreceiveawelcomeemailcontaininganAgentwritingnumber.AgentsshouldnotbeginmarketingCignaMedicareplansuntiltheyhavereceivedaWelcome/Ready-to-Sellnotificationemail.ThisemailwillcontaintheAgentwritingnumberandlistofapprovedstatesinwhichtheAgentcansellCignaMedicareproducts.
AgentswillalsoreceiveawelcomecallfromCigna’sAgentResourceLinetoansweranyquestionsandassistwithinitialsaleskitorders.
RULES OF ENGAGEMENT – 2021 HANDBOOK 14
Cigna-HealthSpring Certification Curriculum*
Course name Key focus
Selling with Integrity** Oursellingprocess
Howtosellconsultativelyandcompliantlyinone-on-onesettingandtelephonically
Ourvalueproposition
Products and Benefits Overview Lineofproductsandfeatures
Modelofcare
Eligibility
Snapshotofallplansandthekeybenefits
Our Compliance Program KeyrequirementsofourComplianceProgram
HIPAAandComplianceculture
Agent’sroleinourComplianceProgram
Reportingviolations
New Agent Training*** DoingbusinesswithCigna-HealthSpring:tools,processes,keyrequirementsandourvalueproposition
Attestations ReviewandattestationofRulesofEngagement,Policies&Procedures,SocialMediaandPrivacy
Cigna-HealthSpring Rx (PDP) Ourstand-alonePartDproduct
*The curriculum and content may change slightly from year to year.
**Selling with Integrity is offered in three different versions: Field, Telesales and Combined Field and Telesales. Agents will be assigned one based on their contract or their upline’s contract with us. If an Agent switches channels (i.e., Field to Telesales), the agent will be required to complete the appropriate Selling with Integrity course in order to fulfill training requirements for the new channel.
***New Agent Training is recommended for all newly contracted Field Agents and may be online, instructor-led (face-to-face), or virtual instructor-led.
Remediation training
ThistrainingisfocusedonhelpingAgentsimprovecomplianceperformanceandsatisfyviolationrequirements.
› Remediationcoursesareassignedasneededandmayrequireagentstoretakeapreviouslycompletedcourse
› AgentsarerequiredtocompletetimelytocontinuetobeingoodstandingwithCignaMedicare
› AcoachingsessionwithaCignaMedicareemployeemaybearequiredcomponentoftheremediationtraining
Invitation only
Certaintrainingcoursesandeventsareinvitationonly.Whenapplicable,Agentswillbeinvitedtoregisterforthetrainingandattendonlineorinperson.AnexampleofthisisourSalesEventTrainingforAgentswhohavebeenhandpickedtoconductsaleseventsonbehalfofCignaMedicare.
RULES OF ENGAGEMENT – 2021 HANDBOOK 15
SECTION III
SUSPENSION AND TERMINATIONSuspension of sales and marketing
CignaMedicareexpectsyoutocomplywithallCentersforMedicare&MedicaidServices(CMS)regulations,stateandfederallaws,guidelines,andCignaMedicarerules,policies,andprocedures.
› IfatanytimeyourperformanceoractiondamagesorthreatenstodamageanyMedicarebeneficiariesorthereputationofCignaMedicareordoesnotmeettheCignaMedicare’sstandards,CignaMedicarecan,atitsdiscretion,initiatesuspensionofyoursalesandmarketingactivities.
› Adeterminationtosuspendcanalsobebasedontheseverityofanallegation(s),thenumberofpendingcomplaintsorinvestigations,thenatureandcredibilityofinformationinitiallyprovided,and/orthenumberofcustomersorbeneficiariesaffected,andcanbebasedonotheroversightcriteria.Insuchcases,suspensionisineffectuntiltheinvestigationiscompleted,afinaldisciplinaryrecommendationhasbeenmadeandanyrequiredremediationhasbeencompleted.
› CignaMedicaremayberequiredtoreportthesuspensiontotheapplicablestateorgovernmentAgency.
Suspension process
› Whenadeterminationtosuspendyoursalesandmarketingactivitiesismade,youwillbesentasuspensionnotificationfromCignaMedicareContracting,withacopysenttoyourTopline.
› YouarenottosolicitorsellCignaMedicareproductswhileonasuspensionstatus.
› Agentscannotwritenewbusinesswhileundersuspension.Ifnewbusinessiswrittenduringthesuspensionperiod,agentswillnotbeeligibleforcommissionsand/orrenewals.Furtherdisciplinaryactionmaybelevied.
› CignaMedicarewillsatisfysuspensionreportingrequirementswithnotificationtotheappropriatestateAgencies.
› Wearenotobligatedtoreportyourstatustoagovernmentagencyunlessfurtheractionisrequired.
Temporary hold status
Dependingonthecircumstances,anAgentmaybeplacedon“temporaryhold.”Whenarecommendationtoplaceyoursalesandmarketingstatusontemporaryholdismade,youwillbesentatemporaryholdnotificationfromCignaMedicareContracting,withacopysenttoyourTopline.Thestatusof“temporaryhold”means:
› YouarenottosolicitorsellCignaMedicareproductswhileonatemporaryholdstatus.
› Anyoutstandingcommissionswillcontinuetobepaidduringthisperiod.
› Wearenotobligatedtoreportyourstatustoagovernmentagencyunlessfurtheractionisrequired.
Agent termination: not-for-cause and for-cause
Allcontractandappointmentterminationsareclassifiednot-for-causeorfor-cause.TerminationofappointmentmayberecommendedbyCignaMedicare,theToplineorimmediateupline,aregulatoryAgency,orstateDepartmentofInsurance,oranAgentmayrequestavoluntaryterminationoranalterationtotheToplinehierarchy.
Not-for-cause termination (Agent/Agency)
Anot-for-causeterminationcanbeinitiatedbyyourToplineorimmediateupline,CignaMedicare,oryou,foranyreasonincluding,butnotlimitedto,relocation,expiredlicense,expiredErrorsandOmissionsinsurancecoverage.Thefollowingprocessisfollowedwhenanot-for-causeterminationisrequested.
› Terminationrequestsmustbesubmittedinwritingviaemailoraterminationformoutliningthereasonfortermination.Thetermination formmaybeobtainedbyContractingatContractingMailbox@Cigna.com.TheterminationrequestmustbesubmittedtoContractingatContractingMailbox@Cigna.com.
› TheterminatedAgent/Agencywillbesentaterminationnotification,whichwillidentifytheeffectiveterminationdate.
› State-levelappointmentswillbeterminatedinconjunctionwiththedatetheagreementisterminated.
RULES OF ENGAGEMENT – 2021 HANDBOOK 16
› WhenanAgencyisterminated:AnydownlineAgents/Agencieswillbemovedunderthenexthighestentityinthehierarchy.
› Terminationwillceasepaymentofcommissions.
Agent
IfyouareterminatedbyyourToplineAgencyorfallunderaToplineAgencythatwillnolongerholdacontractwithCignaMedicarebutareingoodstandingwithCignaMedicare,(i.e.,notunderinvestigationinternallyorexternally,haveacceptablecompliancemetrics,sufficientsales,notindebttoCignaMedicareand/orcurrentupline,donothavethird-partypaperprohibitingamoveinhierarchy),youmayre-contractunderanewhierarchyordirecttoCignaMedicare.Ifrecontracting,onboarding,certification,andactivationarecompletewithinthirty(30)calendardaysoftheterminationdate,commissionsandrenewalsmayberestored.
Agency
IfanAgencyisterminatedbyitsToplineorfallsunderaToplineAgencythatwillnolongerholdacontractwithCignaMedicareandisingoodstandingwithCignaMedicare,theAgencymayrecontractunderanewhierarchyordirecttoCignaMedicare.
For-cause termination
Afor-causeterminationcanbeinitiatedbyCignaMedicareorbyanexternalregulatoryAgency.
› Afor-causeterminationnotificationletter,detailingtheoffense,terminationeffectivedate,andtheappealprocess,issenttoyouviacertifiedU.S.mail.
› YourToplineoruplineisemailedacopyofyournotificationletter.
› State-levelappointmentswillbeterminatedinconjunctionwithfederalandstaterequirements.CommunicationtoanystateinwhichtheAgent/Agencyisappointedwillbemadeinaccordancewithallfederalandstaterequirements.
› WhenanAgencyisterminated,anyactivedownlineAgents/Agencieswillbemovedunderthenexthighestentityinthehierarchy.
› TerminationwillresultintheAgent/Agencybeingineligibletoreceiveanyfurthercommissionpayments.
› Insomecases,asdirectedbytheCignaMedicareSalesDevelopmentActionProgram,yourprofileinthecontractingsystemscouldalsobemarkedas“DoNotRecontract.”
› Ifyouareterminated“for-cause”or“notfor-cause”duetocomplianceand/orotherdisciplinaryreason,perourpolicy,youmustwaitatleastoneyearbeforeapplyingforreinstatement.
“Do Not Recontract” reinstatement process
Ifyouareflagged“DoNotRecontract,”youmaynotcontractwithanyCignacompanyoritsaffiliates,including,butnotlimitedto,allCignaMedicareandcommercialproducts.
Thefollowingistheprocesstorequestreconsiderationofyour“DoNotRecontract”status.
› Whenyoureceiveyourterminationletter,youhaveten(10)businessdaystoappealbysubmittingtheRequestforReinstatementofAppointmenttotheContractinginbox.PleasesenditviaemailtoContractingMailbox@Cigna.com.
› Iftherearenoopenviolationsagainstyou,therequestwillbeconsideredattheSalesDevelopmentActionProgram(SDAP)meeting.Ifthereareopenviolations,youandtheappropriatesalesleaderwillbenotifiedviaemailortelephonethatthereinstatementrequestwillnotgotothecommitteeuntiltheopenviolationshavebeenclosed.
› Thereinstatementrequest,alongwithanypertinentnewinformation,isreviewedbytheSDAP.Whenthecommitteehasmadeadetermination,theoutcomewillbedocumentedinyourAgentfileandyouwillbenotifiedinwritingviaemailwithanelectroniccopytoyourTopline.
› Ifyouareapprovedforreinstatement,youwillberequiredtorecontractbysubmittinganewcontractingpacket.
› Ifyouarenotapprovedforreinstatement,youmustwaitatleastoneyearbeforesubmittinganyadditionalrequestsforreconsideration..
RULES OF ENGAGEMENT – 2021 HANDBOOK 17
TheinformationcontainedinthissectionprovidesageneralsummaryoftheCompensationRulesofEngagementandtheMedicareAdvantagePrescriptionDrugCompensationSchedule.Pleaserefertoeachrespectivedocumentforadditionaldetails.TheMedicareAdvantagePrescriptionDrugCompensationScheduleandtheCompensationRulesofEngagementshallsupersedeintheeventofaconflictwiththisSectionIII.
Compensation overview
CignaMedicareannuallypublishestheMedicareAdvantagePrescriptionDrugCompensationScheduleandRulesofEngagement,whichprovidesadditionaldetailspertainingtoourcommissionprocessing.TheCompensationRulesofEngagementcanbefoundonCignaMedicareProducers’University.
PerCMSguidelines,CignaMedicaredefinesacompensationyearasJanuary–December(anormalcalendaryear).CignaMedicareisrequiredtopayAgentsatthecompensationrateswithinrangesfiledandattestedannuallywithCMS.AgentswithanAssignmentofCommissions(AOC)mustsimilarlybepaidbytheAssigneeunlessacompliantcompensationplanissubmittedwithdocumentedapprovalfromCignaMedicare.MorespecificcompensationinformationcanbefoundintheCignaMedicareCompensationRulesofEngagement.
Commissions – individual sales
EnrollmentsmustbearesultofthedirectcontactbetweentheAgent/Brokerandtheindividualprospect.CignaMedicarewillpayacommissionforeachindividualwhotheAgencyorSubordinateAgency,BrokersorAgentsenrollinaCignaMA/MAPDplan.Agent-levelcommissionsandAgencyadministrativefeesfornewapplicationsarepaidperthecurrentCignaMedicareCompensationRateSchedulesetforthannuallylocatedonCignaMedicareProducers’University.
PaymentswillbemadeduringthenormalcommissionpaymentscheduleassetforthbyCignaMedicarepolicyunlessotherwiseagreedbetweentheparties.
New application commission payments
InordertobeeligibletoreceiveAgent-levelcommissionpayments/AgencyadministrativefeesfromCignaMedicare,boththeAgentandAgencymustbeproperlycontracted,licensed,andappointed(basedoneachstate’sregulations)priortomakingasale.WritingAgentsarealsorequiredtocompleteannualtraining/certificationrequirementspriortomakingasale,perCMS.IfthewritingAgentisnoncompliant,paymentwillnotbeadministeredtoanyparty,includinghierarchy,fortheapplicableenrollment.IntheeventanAgencyisnoncompliant(i.e.isnotproperlycontracted,licensedandappointed,and/orhasnotcompletedrequiredattestation),thespecified.Agencywillnotreceivepayment,butallothercompliantentitiesinthehierarchymayreceivepayment.CignaMedicarepaymentsonnewapplicationsaremadepertheschedulesetforthintheCignaMedicareCompensationRateScheduleandalsolocatedonCignaMedicareProducers’University.Paymentschedulesmaybechangedannuallyand/oratthediscretionofCignaMedicare.
Commission Department services
TheCommissionDepartmentexiststoprocessnewapplications,chargeback,CMSreconciliationandrenewalcommissionpayments,aswellastoprovideservicetotheAgentandAgencypartnerssurroundingthesepayments.AnyinquiriestotheCommissionDepartmentshouldbesentfromtheBrokerpartnerthroughsecuremessagingviaCignaMedicare’ssecurewebportaloranothersecureportalutilizedbytheBrokerpartner.InquiriesareveryimportanttotheCommissionDepartmentandallinquirieswillreceivearesponsewithin72hoursofreceipt,exceptduringhigh-volumeperiods,suchasfollowingtheJanuaryrenewalpaymentandtheJanuary1newsalescycles.AllcommissioninquiriesshouldbemadetoCommissions@CignaMedicare.com.
SECTION IV
COMMISSIONS
RULES OF ENGAGEMENT – 2021 HANDBOOK 18
Commission statements
DuringpayperiodsinwhichanAgentorAgencyhastransactions(newapplication,chargeback,CMSreconciliationorrenewalrecords),acommissionstatementwillbegenerated.CignaMedicarestatementsareemailedtoallproducersviasecureemailfromtheCommissionDepartment.ArizonaAgents/AgenciescanaccesscommissionstatementsforbusinesswrittenunderaCignaLegacyArizonacontractwithintheEvolveNXTBrokerportal.ThesestatementsarenotemailedunlessrequestedfromCignaProducerCommissions:[email protected].
Currently,CignaMedicareusesProofpointasthesecureemailsite.Registrationtothissite(loginandpassword)isrequiredtoaccessCignaMedicarestatements.AgentsorAgencieswhohavetroubleopeningtheirstatementsthroughthesecuredProofpointsystemshouldcalltheCignaAgentResourceLine(CARL)[email protected].
Allcommissionstatementsoutlinetheactivitywhichhasoccurredwithinthegivenpayperiodforeachproducer.
Cigna Agent Resource Line (CARL)
CARLisCignaMedicare’sHelpCenterstaffedbyemployeestrainedtoprovidevaluablesupporttoactiveInternalandExternalAgents.
CARL’shoursofoperationare:
› October1–December7(AEP):Monday–Saturday7:00am–9:00pmCSTandSunday9:30am–6:00pmCST
› December8–December31(Post-AEP):Monday–Friday7:00am–6:00pmCST
› January1-March31(OEP):Monday–Saturday7:00am–7:00pmCST
› April1–September30(Lock-In):Monday–Friday7:00am–6:00pmCST
Selling or Transferring an active commissionable book of business
SubjecttoCMSrulesandregulations,asamendedfromtimetotime,andwhenapprovedbyCignaMedicareProducerCommissionsmanagement,AgentsandAgenciesmaybepermittedtotransfertheiractivecommissionablebookofbusinesstoanotherAgentorAgencyingoodstandingwithCignaMedicare.Thetransfermustbetheresultofanacquisition,merger,sale,consolidation,deathofanagent,orotherlegaltransaction,andthetransferringAgent/AgencymustbeterminatingtheircontractwithCignaasaresultofthesale/transfer.DetailedrulesandrequirementsforaBookofBusinesssaleortransfercanbefoundintheCignaMedicareCompensationRulesofEngagement.
RULES OF ENGAGEMENT – 2021 HANDBOOK 19
Compliance/oversight responsibility
ToplineAgencies,pleaserefertoCignaMedicareFDRIntegrityOversightGuide.Furthermore,theDelegatedServicesAgreementcontainsadditionalobligationsforcomplianceandoversightactivitiesbyToplineAgencies.TheFDROversightGuideandDelegatedServicesAgreementshallcontrolintheeventofaconflictwiththisSectionV.
TheToplineAgencywillregularlyreviewtheperformanceofitsdata,aswellastheperformanceofallitsdownstreamdata.TheAgentisresponsibleforreviewinghisorherdataonaregularbasis.Thisincludesanydownstreamdataasapplicable.CignaMedicareAgentsandAgenciesmustreviewandinvestigatecomplaintsinatimelymanner.FailuretocooperatewithaCignaMedicareinvestigationmayresultinterminationoftheAgencyorAgentcontract.
AgentsmustactivelyparticipateintheCignaMedicareoversightprogram,standardsofwhichmaybechangedorenforcedinthesolediscretionofCignaMedicare,andwhichmayinclude,butarenotlimitedto:
a. PeriodicreviewofAgent’scontractualobligationstoensureAgentismeetingrequirements
b. ParticipationinCignaMedicare’sevaluationprograms(e.g.,ridealongs,telephonicreviews,secretshops).Evaluationsmustreceiveapassingscore.AllfailureswillbeprocessedthroughtheSalesDevelopmentActionProgram(SDAP).
c. ReviewofapplicationstoensuretheyarecompletedperCignaMedicareandCMSstandards.
d. ReviewofScopeofAppointments(SOA)toensuretheyareobtainedandcompletedperCignaMedicareandCMSstandards.
e. Asapplicable,ensuresaleseventsareapprovedbyCignaMedicarepriortoeventsandwithintheCMStimeframeforsubmission.
f. EnsureapplicationsaresubmittedtimelyperCignaMedicareandCMSpolicy.
g. Agentsmustregularlyreviewcomplaintrates,voidratesandrapiddisenrollmentrates.
h. PeriodicreviewofotherCignaMedicarepoliciesandprocedurestoensurecompliance.
SECTION V
OVERSIGHT
RULES OF ENGAGEMENT – 2021 HANDBOOK 20
Sales Development Action Program
CignaMedicarehasimplementedadevelopmentactionprogramwhichismanagedbytheSalesDevelopmentActionProgram(SDAP).TheSDAPiscomprisedofseniorleadershipwithinCignaMedicareandmeetsregularlytoreviewpotentialCignaMedicareandCMSpolicyviolationsbyanAgentorAgency.Policyviolationsmaytriggeraremediation/correctiveactionplanwhichtheAgentorAgencymustcomplete.
Agentremediation/correctiveactionplansmayinclude,butarenotlimitedto:
a. Retraining.
b. MeetingwithaCignaMedicarerepresentativetoreviewtheviolation(s)anddiscusspolicyrequirements.
c. Ride-alongs.
d. Secretshops.
i. Aformalaudit.
j. Financialpenalties.
k. Suspensionofsellingactivity,whichmustbereportedtostateandfederalAgencies.
l. Temporaryholdofsellingactivities.
m.Terminationofcontract.
Agencyremediation/correctiveactionplansmayinclude,butarenotlimitedto:
a. MeetingwithaCignaMedicarerepresentativetoreviewtheviolation(s)anddiscusspolicyrequirements.
b. Aformalaudit.
c. Financialpenalties.
d. Temporaryholdofsellingactivities.
e. Terminationofcontract.
Sales Complaints
AsalescomplaintisanallegationthatanAgentmisrepresentstheplanorplanbenefitsbyviolatingCMSguidelinesorregulationsand/orCignaMedicarepoliciesandprocedures.Salescomplaintsarereceivedfrommultiplesources:MedicareComplaintsTrackingModule(CTM),GrievanceTrackingSystem(GTS)orothersource.Salescomplaintsaretypicallyfiledbyacustomer,acustomer’srepresentative,aprovider,oraregulatoryAgency(SSA,congressionaloffice,etc.)onbehalfofacustomer.AllsalescomplaintsareinvestigatedandSDAPisengagedregardlessoftheoutcomeoftheinvestigation.
CTM Sales Complaints
ACTMisasalescomplaintthatisreceivedfromtheCentersforMedicare&MedicaidServices(CMS)directlyfromtheCMS’sHealthPlanManagementSystem(HPMS)ComplaintsTrackingModule(CTM),adatabasethatassistsCMSanditscontractedplansintrackingandresolvingcomplaints.Eachcomplaintreceivedwithinthedatabaseisconsidereda“CTM”orCTMcase.ACTMcanbefiledagainstanyCignaMedicareplancontracts(PDPandMAPD)andcanbeforanytypeofissue,suchascustomerservice,enrollment/disenrollment,copay/coinsurance,pricing/premium,claims,benefitcoveragedeterminations,organizationdeterminations,orappeals.ACTMconcerningtheactionsofanyAgentcanalsobealleged.EachCTMisassignedanissuelevelbyCMS,whichdeterminestheduedateoftheCTMcase.OurinternalguidelinesfollowtheCMSissuelevels.
› ImmediateNeedCTM–one-dayturnaroundtime
› UrgentCTM–seven-dayturnaroundtime(internalgoalthreedays)
› RegularCTM–30-dayturnaroundtime(internalgoal15days)
Customer Service Violation (CSV) Sales Complaints
ACSVisasalescomplaintthatisreceivedfromanyothersourceotherthanthatdescribedinCTMSalesComplaints.Thosesourcesinclude,butarenotlimitedto,theGrievanceTrackingSystem(GTS),aCignaMedicareinternaldatabasethattracksgrievancesinitiatedbycustomercommunications(verbalorwritten)withCignaMedicareCustomerService;theComplianceorEthicsHotline;DepartmentsofInsuranceofotherregulatoryauthorities;orothersourcedeemedapplicablebyCompliance.ACSVcanbefiledagainstanyAgentallegingtheactionsoftheAgentdirectlyorindirectlyledtothegrievance.ACSVistypicallyassignedaregularissueleveldeterminingtheduedatewitha30-dayturnaroundtime(internalgoal25days).
Reporting of identified compliance issues
AgencieswillreportpotentialissueswhichmaybeviolationsofCMS,state,federalorplan-specificpolicy,requirementsaffectingsellingprivilegestoCignaMedicareupondiscovery.PartiesagreetocooperatewithCignaMedicarebyprovidinganyandalldocumentationrequiredtoevaluate,correctandmonitortheidentifiedissueasapplicable.
AgenciesshouldrefertotheirCignaMedicareSalesIntegrityFDRoversightguidefordeadlinesforreportingschedulesandadditionalinformation.
RULES OF ENGAGEMENT – 2021 HANDBOOK 21
SECTION VI
TELESALES REQUIREMENTS Establishing a Telesales Agency with Cigna Medicare
AtCignaMedicare,webelieveinprovidingqualitycareandresponsiveservicetoourcustomerswhenandwheretheyneedit.WearefocusedonputtingourcustomersatthecenterofallwedoandwelcomeAgencieswhosharethisfocus.Theseguidelinesprovideadditionaldetailsonhowtoestablishacompliantandcustomer-focusedtelesalesAgencyonbehalfofCignaMedicare.
Telesales Agency criteria
Allstate/federalandCignaMedicarerequirementsmustbefollowedbyanyorganizationthatwillperformtelephonicenrollmentfunctions(telesales).ThefollowingminimumrequirementsoutlinewhatisnecessarytoimplementandmaintaintelesalesfunctionsonbehalfofCignaMedicare.
Compliance requirements
› TelesalesAgenciesarerequiredtoadheretothetelesalessetupcriteria,theTelesalesAddendumintheDelegatedServicesAgreement,andtelesalespoliciesandprocedures.
› Iftheorganizationdoesnotadheretothetelesalesrequirements,andifappropriateremediationactionisnottakenwithin72hoursofwrittennotice,theorganizationmaybesubjecttoimmediatetermination.
› ThetelesalesfunctionwillbeevaluatedonanannualbasistoensurecompliancewithCMSguidelines,CignaMedicarepoliciesandcontractadherencewithregardtotelesalesproduction.
› TheAgencymustcreateandmaintainallapplicablepoliciesandprocedurestosupportthetelesalesfunctions,whichincludebothtechnicalandadministrativesafeguards.
› CallerIDSpoofingisprohibited.“CallerIDSpoofing”or“Spoofing”isapracticewhereacaller(e.g.,anagentorbroker)makesatelephonecalltoapotentialcustomerusingatechnologythathelpsmaskthecaller’sidentitybyshowingtherecipientacallerIDtelephonenumberthatisdifferentfromthecaller’sactualtelephonenumber.Thisoftenoccurswhenrobocalltechnologyisutilized.Spoofingisillegal
undertheTruthinCallerIDActwhichmakesillegalthetransmissionofmisleadingorinaccuratecallerIDinformationwiththeintenttodefraud,causeharm,orwronglyobtainanythingofvalue.Anyonewhoengagesinillegalspoofingcanfacepenaltiesofupto$10,000foreachviolation.Cignarequiresthatbrokersandagentscomplywithallapplicablefederalandstatelaws.CignadoesnotapproveoftheuseofcallerIDspoofingtechnologyandwillterminateitsrelationshipwithanyproducerwhoisfoundtobeusingthetechnologytomisleadpotentialcustomers.WeencourageallagentsandbrokerstoreviewtheFederalCommunicationsCommissionwebsitetolearnmoreabouttheTruthinCallerIDActandconsumerissuesassociatedwithrobocalling:https://www.fcc.gov/consumers/guides/stop-unwanted-robocalls-and-texts
AnyviolationofCignaMedicareorstate/federalrequirementsmayresultindisciplinaryactionuptoandincludingterminationoftheCignaMedicarecontract.
Organizational structure
› Priortostartup,theAgencywilldetermineiftheywilloperateyear-roundoronlyduringtheAnnualElectionPeriod(AEP).
› AgencyshouldnotifytheirAccountManagerinwriting30dayspriortomakingchangestotheiroperatingduration(daysofoperation,operationhoursorclosingoftelesalesoperations).ChangescannotbemadeuntilwrittenapprovalisreceivedfromCignaMedicare.
› ThetelesalesAgencyshouldhaveapointofcontactfordailymanagementaswellasescalationissues.
Production requirements
› Thereisa12-monthramp-upperiodfornewtelesalesAgenciestomeetproductionrequirements.
› ProductionrequirementsmustbemetattheAgencycontractlevel.
› Failuretomeetproductiontargetsfollowingtwoconsecutivemonthsafterthe12-monthramp-upperiodmayresultinterminationofthetelesalesportionofthecontractwith30-daynotice.
RULES OF ENGAGEMENT – 2021 HANDBOOK 22
Licensure
› AllAgentsandAgenciesarerequiredtocompletetheappropriatelicensing,appointmentandstatespecificrequirementsinallstatestheAgencyorAgentsellstheCignaMedicareproduct.ThisincludesexternalcertificationtrainingadministeredbyAHIP,PinpointorGorman,aswellasadditionalrequiredtrainingmodules.
› Oncealltrainingiscomplete,theAgentwillbemade“active.”TheAgentwillthenbeassignedawritingnumberandAgentIDtoaccesstheCignaMedicareenrollmentplatform.AgentswillonlybereadytosellaftertheyreceivetheirCignaMedicare“WelcomeLetter,”listingthestatesandappointmentsinwhichtheyarepermittedtosell.
› CignaMedicarewillappointand/orterminateallAgentsprocessingtelephonicenrollments.
› AllAgentsmustcomplywithanyadditionaltrainingrequirementsidentifiedduringthetermoftheagreementwithCignaMedicare.
› TelesalestrainingwilloccurbetweenSeptember1andOctober15eachyear.Onsiteand/orwebinartrainingmaybeprovidedbyCignaMedicareatthetimeofinitialsetup,andannuallythereafter.
Initial setup of new Telesales Agency
› AnAgencysitevisitmustoccurpriortoproceedingwithimplementation.
› Sitevisitswillinvolveacompleteassessment,whichmayinclude,butisnotlimitedto,telesalesoperations,technicalcapabilitiesandcomplianceoversight.
› Anydeficienciesidentified duringthesitevisitwillbecommunicatedtotheAgencywithrequiredremediation.TimeframesforcompletingremediationworkwillbeagreeduponbyboththeAgencyandCignaMedicare.Ifremediationdeadlinesarenotmet,telephonicenrollmentcapabilitywillnotbegranted.
› TheAgencywillbeprovidedwithcopiesofallapplicableguidance(marketing,sales,etc.)thatwillneedtobecapturedinpoliciesandprocedures.
› AgencywillhavetocompleteaCignaMedicareITreview.IfAgencyanduplinehierarchyconfirmstheydonotexpecttoreceiveleadsfromCigna,ashortenedITreviewwillbeconducted.However,shouldanythingchangeinthefutureinthatAgencyorhierarchywishestoreceiveoverflowleadsfromCigna,amoreindepthITreviewwillberequiredbeforeleadscanbereceived,shouldtheybeavailable.
Telephonic systems
› AnAgencymusthaveatelephonesystemthatcanaccuratelyrouteprospectivecustomerstotrainedandqualifiedindividualemployeeswhocanappropriatelyhandletheircall.
› ThetelephonesystemmustbeabletotransfercallstoaparticularAgentasrequestedorneeded.Livedemonstrationmayberequiredduringsitevisit.
› Thetelephonesystemshouldhavethecapabilitytodoeithersilentorside-by-sidemonitoringoflivecalls.Livedemonstrationmayberequiredduringsitevisit.
› AgencywillhavetocompleteaCignaMedicareITreview.
› ThetelephonesystemmustalsohavevoicemailcapabilityoradministrativesupporttoanswercallswhenalicensedAgentisnotavailable.Agencymustreturnthecallwithinonebusinessday.Livedemonstrationmayberequiredduringsitevisit.
› AnAgencymustbeabletorecordalltelephonicneedsassessments,discussions,salespresentationsandenrollmentsforthedurationofthecall,includinginternaltransfers.
› AnAgencymustsuccessfullycompletetestingpriortogoinglive.Testingwouldincluderecordingcallsandsuccessfullyretrievingthestoreddata.Livedemonstrationmayberequiredduringsitevisit
› AnAgencymustbeabletosaverecordingsina.WAVor.MP3fileusingthefollowingnamingconvention(livedemonstrationmayberequiredduringsitevisit).
– Applicationcallsshouldbesavedas:
· Customer’sname_Agent’sname_YYYYMMDD_carriername
– Fact-findingcalls(includesneedsassessmentand/orpresalecall)shouldbesavedas:
· Customer’sname_Agent’sname_YYYYMMDD_carriername_FFPart1
· Customer’sname_Agent’sname_YYYYMMDD_carriername_FFPart2
· Customer’sname_Agent’sname_YYYYMMDD_carriername_FFPart3
– RewrittenApplicationcallsshouldbesavedas:
· Customer’sname_Agent’sname_YYYYMMDD_carriername_re-enroll
RULES OF ENGAGEMENT – 2021 HANDBOOK 23
Telesales recording transfer and storage requirements
CignaMedicarehastwooptionsavailableforprovidingrecordedtelesalescalls.Thetelesalescallrecording(“Recording”)istoincludetheneedsassessment,presale/salespresentationandtheenrollmentprocess.Failuretomeettheoutlinedrequirementsmayresultindisciplinaryorremediationactions.
Fornewlyonboardedcallcenters,Optiononewillberequiredforaprobationaryperiodofsixmonthstoensuretransfertimelineexpectationsand100%callreconciliationcanbemetpriortoallowingelectionofOptiontwo.
Option one (standard):
› 100%ofallRecordingsmustbepostedtotheCignaMedicaresecureFTPsitewithinfive(5)businessdaysorseven(7)calendardays.
› CignaMedicarewillensuretheRecordingsarestoredfor10yearsperCMSrequirements.
› AgenciesmustnotifyCignaMedicareofanychangestotheirInternetProtocol(IP)address.
Option two (requires approval):
› Agencyisrequiredtoprovidefive(5)RecordingsforthefirstweekofAEP.
– RecordingsmustbeuploadedtotheCignaMedicaresecureFTPsitewithinfive(5)businessdaysorseven(7)calendardaysfromthedateofenrollment.
› AgencyisrequiredtoprovideRecordingsasrequestedbyCignaMedicareforQualityAudits.TheCignaMedicareIntegrityteamwillidentifythenumberofRecordingstobeprovidedquarterly.
– AgencywillreceiveanemailfromtheAccountManager,outliningtheRecordingstobeprovided.
– RecordingsaretobeuploadedtothesecureFTPsitewithinfive(5)businessdaysorseven(7)calendardaysoftherequest.FailuretoprovidethecompletecallswithintherequiredtimeframemayresultinAgencySDAPviolation.RefertoSectionIII:SuspensionandTerminationforadditionaldetailsandremediationrequirements.
› ForAgentcomplaintsandCMS/Compliancerequests,AgencyisrequiredtoprovidetheRecordingtoCignaMedicareviathesecureFTPwithinthefollowingtimeframes.
– Urgent/immediateneedCMSrequestswithin24hours
– Standardrequestwithinfive(5)businessdaysorseven(7)calendardays
– AgencymusthaveandprovideacontactthatwillprovideRecordings,andrespondtourgent/immediateneedCMSrequestswithin24hours,sevendaysaweek.
› AgencyisrequiredtoprovideRecordingsasrequestedforvirtualRide-Alongreviews.
– AgencyisrequiredtoprovideRecordingsasrequestedbytheCignaMedicareComplianceteam.
– AgencywillreceiveanemailfromtheClientServiceManageroutliningtheRecordingstobeuploadedtothesecureFTPsite.
– RecordingsaretobeuploadedtothesecureFTPsitewithinfive(5)businessdaysorseven(7)calendardaysoftherequest.FailuretoprovidethecompletecallswithintherequiredtimeframemayresultinAgencySDAPviolationsandremediationrequirements.
› AgencyisrequiredtomaintainallRecordingsinaccordancewiththeCMSrecordsretentionguideline(minimumof10years).
› Agencyisrequiredtoconductself-auditstoensure100%oftelesalesenrollmentshaveRecordingsonfile.AgencymustimmediatelyreportanyreconciliationdiscrepanciestoCignaMedicare.
› AgenciesmustnotifyCignaMedicareofanychangestotheirInternetProtocol(IP)address.
TwofailurestoprovideRecordings,basedontheaboverequirements,mayresultinrevocationofOptiontwo.
Remote Telesales Agency
› AdeterminationwillbemadebyCignaMedicaretoallowAgenciestohaveremotetelesalesAgents.
– AgencymusthavesoldtelephonicallywithaphysicallocationforatleastoneyearwithaproventrackrecordwithCignaMedicare.
– Agencymusthaveadedicatedtrainingstaffthathassoldtelephonicallyandunderstandsthenuancesofsellingoverthephone.
– Agencymustbewillingtoaccommodatein-housetrainingforremoteAgentsnotclosetoaphysicalcallcenterlocationandtheassociatedfeeswithflyingatrainertoremoteAgentsforthispurpose.
› RemotetelesalesAgencies/Agentsmustmeetthesamerequirementsoutlinedforin-housetelesalesAgencies/Agents.
RULES OF ENGAGEMENT – 2021 HANDBOOK 24
› RemotetelesalesAgentsmustusethesametechnologyandcallsystemasin-housetelesalesAgents.Agencymusthavetheabilitytolistentolivecallsandconductsilentorside-by-sidemonitoring.Agencymustbeabletorecordallremotetelephonicneedsassessments,salespresentations,andenrollmentsforthedurationofthecall,includingtransfers.
› AgenciesmustdemonstratearobusttrainingprogramtailoredtoAgentsinaremoteenvironment.AgencymustprovidedocumentationoutliningtheirtrainingprogramforremotetelesalesAgents.CignaMedicaremayrequireupdatesorchangestothistrainingprogramtocomplywithCMSandCignaMedicareguidelinesandwillnotifyAgencyinadvanceoftheserequiredupdatesorchanges.
– RemotetelesalesAgentsmusttrainwithseasonedtelesalesAgentsusingside-by-sidelisteningsessionsandroleplays.
– RemotetelesalesisonlypermittedforseasonedorprovenAgentswithacleancompliancerecord.
– ProspectiveremoteAgentsmustsitwithaseasonedtelesalesAgentforatwo-weekprobationaryperiodinwhichtheAgencywillmonitorcallsandconfirmtheAgentcansuccessfullyandcompliantlyselltelephonicallypriortobeingpermittedtosellremotely.Attheendofthetwo-weekprobationaryperiod,theAgentmustpassatelephonicRide-Alongwithascoreof85%orhigher.FailuretopassthisRide-Alongwillresultindenialoftherequesttosellremotely.
› Agencyisrequiredtohavestand-alonesupervisororteamleadavailabletoremotetelesalesAgentsbyphoneand/orinstantmessaging.
› RemotetelesalesAgentsmustonlyworkfromasecurelocationwithintheUnitedStates.AgencymustmaintainalistofaddresseswhereRemotetelesalesAgentsarebasedandensuresuchlocationsaresafeandappropriate.
– RemotetelesalesAgentsmustnothaveprintcapabilityorbeabletostoreanyProtectedHealthInformation(PHI)intheirhomeoffice.
– IfAgentshaveprintcapability,theyshouldhavealockingfilecabinetforstorageandashredderfordestructionofPHIitems.
› RemotetelesalesAgenciesmustcreateaseparateremoteworkers’policyconfirmingadherenceandcompliantuse,storageanddisposalofPersonallyIdentifiableInformation(PII)andPHIaswellasoutlininghowtheywilltrackandmonitorAgentcompliancetothispolicy.RemoteaccesstotheAgencynetworkmustmeetthesamerequirementsoutlinedforin-houseconnectivity,includingbutnotlimitedto,DataLossPreventionmeasures,Multi-FactorAuthenticationutilization,andencryptionintransitandatrest.
RULES OF ENGAGEMENT – 2021 HANDBOOK 25
SECTION VII
OPERATIONAL REQUIREMENTS Marketing materials and scripts
Anybrandedmarketingmaterials,ormaterialswhichdiscloseCignaMedicarebenefitsincluding,butnotlimitedto,letters,brochures,andadvertisementsmailedordistributedtoCignaMedicarecustomersandpotentialenrollees,telemarketingscripts,andpackagingpreparedorproducedbyAgentmustbesubmittedtoCignaMedicareforreviewandapprovalpriortousetoensurecompliancewithfederalandstatelaws,rules,regulations,CMSguidance,andCignaMedicarerequirements.OnlyCignaMedicareandCMS-approvedmaterialscanbeusedwithregardtoinbound/outboundcallscripts,advertisingviaanymedia(including,butnotlimitedto,directmail,newspaper/magazineads,TVcommercials,radioads,socialmedia,websites,etc.).
AnyandalloutboundscriptsutilizedbytheAgency,itsAgentsand/orsubcontractors,tocontactbeneficiaryonbehalfofCignaMedicare,mustbesubmittedtoCignaMedicarepriortouse.ScriptsmustbesubmittedtoCignaMedicarePrivacyforreview.UponapprovalfromPrivacy,scriptswillultimatelybesubmittedtoCMSforreviewandapprovalpriortouseinthemarketplace.Inaddition,whenconductingoutboundcalls,theAgency,itsAgentsand/orsubcontractorsmustensurethescriptsincludeaprivacystatementclarifyingthebenefitsisnotrequiredtoprovideanyhealthrelatedinformationtoCignaMedicareorAgentandthattheinformationprovidedwillinnowayaffectthebenefitsmembershipintheMedicareAdvantageand/orPartDPlan.PleaserefertoCignaMedicarepolicyforadditionalguidance.
AgenciesandAgentsarerequiredtoadheretotheCMSMedicareCommunicationsandMarketingGuidelines(MCMG),stateandfederalregulations,andCignaMedicarepolicies.TheMCMGprovideinformationpertainingto,butnotlimitedto,marketing,materialtypes,disclaimers,promotionalevents,rewards,reviewprocesses,scripts,andoversightresponsibilities.Agents/AgenciesarerequiredtocomplywiththenewAffordableCareAct(ACA)Section1557regulationsasofJuly18,2016.ThisprohibitsAgent/Agenciesfromdiscriminatingonthebasisofrace,color,nationalorigin,gender,age,ordisabilityinhealthprogramsoractivitiesthatreceivefederalfinancialassistance,orareadministeredbyanExecutiveAgencyoranyentityestablishedunderTitle1oftheACA.
AspartoftheACA,themulti-languageinsert(MLI),andthenondiscriminationnoticeandstatementarerequiredwithallmarketingmaterials.
TheMLIprovidestaglinesinthetop15non-EnglishlanguagesspokenbyindividualsinthestatesthatCignaMedicareoffersMedicareAdvantageandMedicarePartDplans.Thenondiscriminationstatementandnoticesarealsorequired.
Agents/AgenciesmustalsoincludetherequiredMLIsandthenondiscriminationnoticeandstatementonanypublic-facingwebsite(awebsitewhichdoesnotrequireonetologinwithcredentials)whichdisplaystheCignaMedicarenameorlogo,regardlessifplanbenefitsarediscussed.
FormoreinformationpleasecontactyourToplineorLocalSalesManager.
Scope of Appointment
AllAgentsconductingone-on-oneappointmentswithbeneficiariesregardlessofthevenue(e.g.,inhome,byphone,oratalibrary),mustfollowtheScopeofAppointment(SOA)guidance.AnSOAcanbesubmittedtelephonically,electronicallyorbypaper.
TeleScope line
TeleScopeistheconvenientandrecommendedCignaMedicarealternativetocompletingapaperSOAform.ThecustomercallstheTeleScopelinetorecordtheSOA.Afteranappointmentissetupwiththebeneficiary,theAgentwillrequestthecustomercalltheTeleScopeline.Athree-waycallwiththeAgent,thebeneficiary,andourTeleScopeAgentisoftenrecommended.
AgentscanreachtheCignaMedicareTeleScopelineat866.398.6055.CARL’shoursofoperationare:
› October1–December7(AEP):Monday–Saturday7:00am–9:00pmCSTandSunday9:30am–6:00pmCST
› December8–September30(Lock-In):Monday–Friday7:00am–6:00pmCST
Thebeneficiary(ortheirAuthorizedRepresentative)mustprovidethefollowinginformation.
› Customer’sfirstandlastname
› Customer’saddressandphonenumber
› Timeanddateofupcomingappointment
RULES OF ENGAGEMENT – 2021 HANDBOOK 26
› Agent’sfirstandlastname
› AgentID(yourwritingnumber)
› Yourinitialmethodofcontact
CignaMedicare’sTeleScopeAgentwillthengivetheAgentorcustomeraconfirmationnumbertoconfirmtheSOAhasbeenrecorded.TheconfirmationnumberwillalsobeemailedtotheAgent’semailaddressonfile.
TheAgentwillneedtoenterthisconfirmationnumberintheScopeofAppointmentIDnumberfieldontheenrollmentformbeforefaxingorelectronicallysubmittingthenewcustomer’sapplication.TheAgentshouldnotgoontheappointmentunlesstheyhavereceivedtherecordedpermissionfromtheTeleScopeline.
Paper Scope of Appointment form
AnAgentshoulduseapaperSOAifanadvancecalltotheTeleScopelineisunreasonable.UseapaperSOAforminthesesituations.
Thebeneficiary:
› AttendsyourSeminarorSalesMeetingandwantsapresentationrightafter.
› Walksintoyouroffice.
› Needsapresentationimmediatelytomaketheend-of-the-monthdeadline.
› Haschildrenwhoneedtobeinvolved,buttheyareonlyavailabletoday.
› Isleavingforanextendedtimeandneedstoseethepresentationimmediately.
e-Scope
Anagent/brokerhastheoptiontocompleteanelectronicSOAform(e-Scope)viatheeEnrollmentportal.
› Theagent/brokernavigatesthroughtheScopeofSalesAppointmentConfirmationFormscreens–completingallrequiredinformationfields.
› Boththeagent/brokerandthecustomer/authorizedrepresentativesignthee-Scopeformusingelectronicsignature.
› Whentheagent/brokercompletesthee-ScopeprocessaPDFfileisgeneratedwheretheinformationcapturedelectronicallyisplacedontheexistingSOAPDFthatisusedforpaperSOA’s,completewiththeagent/brokerandcustomer/authorizedrepresentativesignatureintheappropriateplaces.
› Thecompletee-Scopeisarchivedautomatically.
Hybrid Agent Guidelines
Theseguidelinesareprovidedforagentsclassifiedas“hybrid”andthereforelookingtoconductsalesviabothfieldandtelesalesmethods.
› Agents/Agenciesareresponsibleforaclearunderstandingofallcomplianceandlegalrequirementsforbothfieldandtelephonicsales.
› Inordertobeapprovedforhybridagentsub-delegation,AgenciesmustbedelegatedforfieldandtelesalesbycompletingCigna’sCallCenterIntakeprocess.Anyagentsdesignatedas“hybrid”mustbedirectlycontractedunderanapprovedfieldandtelesales-delegatedagency.
› AgenciesmustdemonstratearobusttrainingprogramtailoredtoAgentssellingviabothfieldandtelesalesmethods.Agencymustprovidedocumentationoutliningtheirtrainingprogramforhybridagents.CignaMedicaremayrequireupdatestothistrainingprogramtocomplywithCMSandCignaMedicareguidelinesandwillnotifyAgencyinadvanceoftheserequiredupdatesorchanges.
Face-to-Face
› Whensellingfacetoface,Agentsmustcompleteafullandcompliantpresentation,includingacomprehensiveneedsassessmentandfullreviewofbenefits.
› Agentsmustobtainascopeofappointmentpriortothepresentation.Scopesmustberetainedfor10yearsandprovideduponrequest.
› Ifthecustomerwishestoenroll,Agentmustuseapprovedenrollmentsubmissionmethods(seebelow).
– Paper(faxormail-in)
– CignaE-Enrollment
– Thirdpartyenrollmentvendors–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation
› Ifdataisbeingpassedbackandforthwiththesevendors,aCignaInformationProtection(CIP)reviewisneededtoensuredatasecurity.Ifwrittenconfirmationisprovidedthatnodataisbeingpassed,noCIPreviewwillbeneeded.
› Oncetheabovehavebeenprovided,thethirdpartyenrollmentvendorsmustrequestapprovalfromCignaMedicaretoactivatethebrokerenrollmentcapabilitiesforAgency.
– EnrollmentfilesviasFTP(OEC)–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation
RULES OF ENGAGEMENT – 2021 HANDBOOK 27
› AgenciesusingOECfilesforenrollmentsubmissionsmustcompleteaCignaInformationProtection(CIP)reviewtoensuredatasecurity.
› OECfilesmustbetestedpriortoutilizingthissalesmethodtoensureCignaMedicarecanacceptandapprovetheenrollmenttypes.
Telesales
› Whensellingtelephonically,AgentmustuseAgency’sapprovedtechnologyandcallsystem.
– Agentmustperformacomprehensiveneedsassessmentandreviewofhealthplanbenefitsinorderforthepotentialcustomertomakeaneducateddecisiononenrolmentintotheplan.
– AgentmustfollowCMS-approvedscriptsforbothpre-enrollmentandenrollmentportionsofthecall.
– Enrollmentrequestsareacceptedonlyduringanincoming(orinbound)telephonecallfromapotentialcustomer.
– Allportionsofthecall(needsassessment,pre-enrollment,enrollment,andanytransfersbetweenagentsornon-licensedreps)mustberecordedandstoredfor10yearsperCMSguidelines.
– Uponcompletingatelephonicenrollmentrequest,Agentmustprovideaconfirmationnumbertothecustomerfortrackingpurposes.
– Enrollmentsubmissionmethods:
› Carrierplatform(Salesforce)
› Thirdpartyenrollmentvendors–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation(seeabove).
› EnrollmentfilesviasFTP(OEC)–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation(seeabove).
› AgenciesmusthaveP&Psoutliningtheserequirementsandtheirprocesstooverseeandmonitoragentcompliancewiththeseguidelines.
› TheseguidelinesareintendedtoprovideageneraloverviewofCignaMedicaretelesalesagentconductandcompliancerequirements.Thesearenotinclusiveofallofthestateandfederallaws,CMSregulations,companypolicies,orotherrequirementsapplicabletoyou.
Enrollment applications
Itisimportanttofillouttheenrollmentapplicationcompletelyandaccuratelyinordertoavoidprocessingdelaysandpossiblerejectionoftheenrollment.TherearemultiplemethodsAgents/BrokerscanusetosubmitenrollmentrequeststoCignaMedicare.ValidCignaMedicaresubmissionmethodsareasfollows.
Paper Application
WhenanAgentreceivesacompletedapprovedMA/MAPDpaperenrollmentrequestfromthecustomer,anAgentorBrokersignsanddatestheformandfaxesittotheappropriateCignaMedicareregionalenrollmentfaxnumberalongwiththeSalesApplicationCoverSheet.
Agentshavetheoptiontocompleteapaperenrollmentapplicationduringameetingwithacustomer.Inorderfortheenrollmenttobeprocessed,theAgentisexpectedtofaxthecompletedandsignedapplicationtotheenrollmentteamandensuretheirreceiptofenrollmentwithintwocalendardays.TheAgentmustfaxthecompletedenrollmentformtoCignaMedicare,usingthefaxnumberlistedforthemarketontheApplicationCoverSheet.Whenfaxingseveralapplicationsatonetime,theagentmustincludeacoversheetasthefirstpageofeachapplication.IfthecustomerchoosestosendtheapplicationdirectlytoCignaMedicarebymailorfax,thenthedatethattheformisreceivedistheofficeapplicationreceiptdate.ApplicationssentbymailwhichdonotmeetthetwocalendardaytimeframewillresultinanSDAPviolationforapplicationtimeliness.ForTelephonicenrollments,theofficeapplicationreceiptdateisthedateofthecall.Toconfirmreceiptoffaxedapplications,anAgentcanuseCignaforBrokersorcallCARL.
eEnrollment
TheCignaMedicareeEnrollmentformisapaperlesselectronicapplicationaccessibleviahttps://broker.hsconnectonline.com/.
TheeEnrollmentform:
› Isavailablevialaptopandtabletbrowsers.
› Isaninternetapplicationaccessedthroughawebbrowser.
› Createsacompleteapplicationthatcanbeverifiedandsignedbeforesubmission.
› AllowstheAgent/customertosubmitacompletedapplicationimmediatelyforprocessing.
RULES OF ENGAGEMENT – 2021 HANDBOOK 28
Cigna for Brokers
ContractedandapprovedtelesalesAgentsmayusethetelephonicenrollmentscriptonCignaforBrokersviawww.cignaforbrokers.comtosubmitenrollmentrequests.
IntheeventatelesalesAgency/AgentdoesnotusethetelephonicenrollmentscriptonCignaforBrokers,enrollmentsoverthephonemustbeacceptedbyapprovedtelephonicenrollmentmechanismsandfollowtheapprovedenrollmentscript.
Supporting documentation
Power of Attorney
Whenapplicable,acustomermaystateontheelectionformthattheyhaveaPowerofAttorney.InordertoacceptPowerofAttorneyforacustomer,copiesoftheexecutedlegaldocumentmustbeattachedwiththeapplication.ThePowerofAttorneywillstatetheperson’snameandmayincluderelationshiptocustomer.ThePowerofAttorneywillbeabletoactontheirbehalfshouldtheybecomeincapacitated.ThePowerofAttorneydocumentshouldindicatethatitisformedicalreasons.
Requireddocumentationincludes:
› Name(s)ofeachPowerofAttorney
› Relationshiptocustomerifknown
› Initialsofpersonenteringthedata
› Departmentofpersonenteringdata
Request for Information (RFI) application
RFIapplicationsarerequiredwheninformationismissingfromanapplication.IfanAgentisprovidingmissingorrequestedinformationtofulfilltheoriginalapplication,theywillneedtochecktheRFIboxatthetopofanapplication.TherearemanyrulessurroundingthedeadlinesforRFIs,buttypicallycustomershave21daysfromthedateoftheirRFItosendustherequiredinformation.ItiscriticalRFIsbeaddressedwithintherequiredtimeframetoensureapplicationsarenotdenied.
Application submission policies/timeliness
CMShasstrictregulationsregardingthesubmissionofenrollmentapplications.PerCignaMedicarepolicy,AgentshavetwocalendardaystosubmitthecompletedapplicationformtoCignaMedicare.Thetwocalendardaywindowisapplicableregardlessofthedayoftheweekyouacceptedthecompletedformfromthecustomer.Thetwo-dayruleappliesforenrollmentsthroughouttheyear,includingAEP.
Ifthecustomerinsistsonsendingtheapplicationviamail,theAgentshouldnotsignordatetheAgentportionoftheapplication.TheAgentshouldalsoinformthecustomernottofillinthissectionatanytime.
Enrollmentsacceptedoverthephonemustbeacceptedbyapprovedtelephonicenrollmentmechanismsandfollowtheapprovedenrollmentscript.Telephonicapplicationsmustlistthedateofthecallastheapplicationdate.
Checklist for application process
Confirmeligibilityrequirements.
› CustomermusthaveMedicarePartAandPartBtojoinaMedicareAdvantageplan,andthecustomermustalsohaveMedicarePartDtojoinaMedicareAdvantagePrescriptionDrugPlan
› CustomermustresideintheapprovedServiceAreafortheirselectedplan
› For2020effectiveenrollmentsonly,Customermustnothaveend-stagerenaldisease(ESRD).Pleasenote,the21stCenturyCuresActamendedtheSocialSecurityActtoallowallMedicare-eligibleindividualswithESRDtoenrollinMAplansbeginningJanuary1,2021.
› CustomermusthaveactiveMedicaidifapplyingforaTotalCareplan,andtheagentshouldincludeproofofactiveMedicaidintheapplicationsubmissionwhenpossible
It’srecommendedthattheAgentsecureMedicaideligibilitystatusinformationforallcustomerscompletinganenrollmentrequest,andincludetheactiveMedicaidIDontheformifapplicable.PleasenotethatAgentsarerequiredtofollowallCMSapplicationrequirementsintheMCMG.(Appendix2:SummaryofDataElementsRequiredforPlanEnrollmentMechanismsandCompletedEnrollmentRequests.Referencedinsections:20,20.4,40.2,40.4.1)
RULES OF ENGAGEMENT – 2021 HANDBOOK 29
Application must include:
4 The customer’s plan choice
4 Medicare insurance information
4 Customer’s:
–DOB
–Gender
–Phonenumber
–Permanentaddress/mailingaddress
–Emailaddress
–PCPfullname
–Emergencycontact
4 Premium payment option
4 ESRD question
4 Prescription drug coverage information
4 Additional medical health coverage information
4 Other prescription drug coverage question
4 Long-term care facility question
4 State Medicaid Program question
4 Multi-language/print necessities
4 Signature of applicant/customer/authorized representative
4 Checklist for Special Enrollment Period eligibility
Enrollment application cancellations or withdrawals
Ifacustomerwishestocancelorwithdrawanapplication,theymustsendalettertoCignaMedicareorcallCustomerServicepriortotheeffectivedate.
Pleasenotethatcancellationsmustbecompletedbeforetheeffectivedate,anddisenrollmentrequestsmustbecompletedaftertheeffectivedatewithawrittenandvalidreasonfordisenrollment.
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