Selling Kaiser Foundation Health Plan of Washington's Medicare Advantage Plans
To sell Kaiser Permanente Washington Medicare Advantage plans, agents must have an active appointment with Kaiser Permanente Washington and have successfully completed the required annual Medicare training courses described below.
The Centers for Medicare & Medicaid Services (CMS) requires annual documentation showing that you have achieved threshold test scores on core training that meets CMS standards for Medicare Advantage and Part D plans. This includes the key differences between plans and permissible and prohibited marketing practices. There is a cost associated with the Medicare certification course. You must achieve a score of at least 90% for all tests.
CMS also requires annual Fraud, Waste and Abuse; general compliance; and plan-specific trainings for producers representing the Medicare Advantage plans. Kaiser Permanente Washington contracts with Convey Health Solutions to administer our annual Medicare certification training and testing. To meet the CMS requirement, appointed agents and brokers are required to successfully complete the following Medicare training courses:
- 2020 Medicare Core Certification, General Compliance, and Fraud, Waste & Abuse (FWA) training certifications A 3 to 4 hour online course licensed from Convey/Miramar:Agent that covers marketing requirements for any Medicare health plan.
If you have already completed the 2020 Medicare Core Training, General Compliance, and FWA training either through AHIP (America’s Health Insurance Plans) or Pinpoint Global, the Miramar:Agent KPWA 2020 External Certification program will prompt you to upload your certificates for verification and allow you to bypass the Convey Core, General Compliance, and FWA training, if approved.
- 2020 KPWA Medicare Product Training and Certification A 1 to 2 hour online course offered by Convey/Miramar:Agent that covers region-specific Kaiser Permanente Washington Medicare products and benefits for the individual plan segment.
Agents who sell Kaiser Permanente Washington individual Medicare products must receive a score of 90% or higher on all courses to successfully complete the training. Agents must successfully complete the Kaiser Permanente Washington 2020 External Certification program on Miramar:Agent to market Kaiser Permanente Medicare Advantage plans.
Kaiser Permanente Washington annual Medicare certification period for the 2020 plan year begins during the last week of August and ends on September 30, 2019. Agents appointed during the certification period who do not successfully complete the required courses by the September 30, 2019, deadline will not be able to market Kaiser Permanente Washington 2020 Medicare Advantage plans during the annual enrollment period or the 2020 plan year. Any commissions for existing members will cease to be paid after January 1, 2020.
Newly appointed agents to agencies/houses with an existing Medicare book of business must request certification training within 60 days of their appointment and will have 30 days to complete all training.
Contact the Kaiser Permanente Washington Medicare Sales team at 1-800-581-8252 or KPWA.firstname.lastname@example.org if you have questions.
Medicare Improvement for Patients and Providers Act (MIPPA) scope of appointment rules prevent producers and agents from selling Medicare plans that were not within the agreed-upon scope of the sales appointment. In brief, the rules require you to:
- Clearly identify products to your client. Sales representatives and appointed producers must clearly identify the types of products that will be discussed before marketing to a potential enrollee.
- Get documentation in writing. This documentation can be in writing by having the Medicare beneficiary agree to the scope of the appointment by signing and returning the Scope of Sales Appointment Confirmation Form (PDF) in advance of the sales appointment.
- Retain the form. MIPPA requires that you retain the Scope of Sales Appointment Confirmation form for 10 years. When applicable, please submit a copy of this form when submitting an election form on behalf of a Medicare Advantage enrollee.
The Scope of Sales Appointment Confirmation form should be used:
- When a producer meets with a beneficiary at a marketing event for follow-up meetings.
- When producers unexpectedly find other beneficiaries present for a properly solicited appointment. Additional beneficiaries will need to complete this form prior to conducting the sales discussion.
- Prior to discussing Medicare Advantage or Part D prescription drug plans. Agents/producers should note on the form if the beneficiary was a walk-in.
- The form does not apply to these situations:
- Sales presentations — the scope of products should be indicated in the event advertising.
- Health plan receipt of enrollment forms from prospective enrollees, or requests to enroll initiated by beneficiaries through means such as inbound calls to plans asking to enroll telephonically.
- Beneficiary walk-ins to a plan or agent/producer office or similar beneficiary-initiated face-to-face sales event. The form should still be signed before discussing any plan information.
- Health plans and agents/producers continue to be able to return beneficiary phone calls or messages as these are not unsolicited.
Kaiser Permanente Washington is responsible for ensuring that producer websites and other marketing materials that include a mention of our Medicare Advantage products are in compliance with all Medicare marketing guidelines.
Any marketing/sales materials that you may create require plan review, approval, and submission to CMS prior to using, displaying on your website, and/or providing to your clients. This includes:
- Agent/broker created marketing materials that provide rates, benefits, and/or use of the Kaiser Permanente logo
- Marketing/sales event talking points/presentations
Please reach out to Kaiser Permanente Washington Sales & Service Support team for review of any marketing materials that provide rates, benefits, and/or use of our logo. Specifically, printed items, websites, mobile apps, and any Kaiser Permanente Washington-specific social media posts.
The Kaiser Permanente Washington Sales & Service Support team needs be notified of any scheduled Marketing/Sales events where KPWA MA plans will be reviewed. Please email details of type of event (e.g., sales/marketing), time, place, and any created script or presentation for filing. Marketing events must be approved by the team prior to the scheduled date.
Refer to the Medicare Managed Care Manual, Chapter 3 (Medicare Marketing Guidelines) for additional details.
Based on MIPPA regulations, producer compensation will be reviewed annually and may be adjusted based on guidance from the Center for Medicare & Medicaid Services (CMS). For more information call us toll-free at 1-800-337-3196.
Medicare Advantage commissions are paid on a per member per year basis once the member's first month premium has been reconciled and are subject to the terms and conditions of your agent agreement.
Please login to the producer portal and navigate to Incentives and Commissions to view commissions schedules