Selling Kaiser Foundation Health Plan of Washington's Medicare Advantage Plans
To sell Kaiser Permanente Washington Medicare Advantage health plans, agents must have an active appointment with Kaiser Foundation Health Plan of Washington and annually complete the Kaiser Permanente CMS Medicare Sales Training program described below.
The Centers for Medicare & Medicaid Services (CMS) requires Kaiser Permanente to ensure all agents and brokers that sell our Medicare products are trained and tested annually on Medicare rules and regulations and on the specific plan types they sell. Training guidelines are based on CMS’ Medicare Managed Care Manual (MMCM), CMS’ Medicare Prescription Drug Benefit Manual (MPDBM), and regulations at Title 42 of the Code of Federal Regulations, Parts 417, 422, and 423). In addition to the core Medicare, Fraud, Waste and Abuse, and general compliance training, Kaiser Permanente requires agents to complete our individual Medicare Product & Benefit training and assessment, providing plan-specific highlights and benefit details for producers representing our Medicare Advantage health plans.
Kaiser Permanente Washington (KPWA) program requirements:
Kaiser Permanente has teamed up with Convey Health Solutions and utilizes Miramar:Agent to administer the required product training, testing modules and Medicare certification verification necessary to complete our program and ensure agents are ready to sell.
Agents affiliated with agencies appointed to sell Kaiser Permanente Washington Medicare Advantage plans, receive a program registration PIN code mid-August to complete the training by October 1, for the upcoming Annual Enrollment Period (AEP) and plan year.
The program includes the following components:
- Welcome Letter
- Benefits Guides
- 2024 Medicare, Fraud, Waste & Abuse (FWA), and General Compliance certificate upload. Once registered for the Kaiser Permanente program in Miramar:Agent, agents will be prompted to upload their Medicare core training certificate for the applicable plan year. Miramar:Agent will review and validate your certificate before your program can be marked complete. Validation can take 1-3 business days. Acceptable Medicare training certificates are:
- Kaiser Permanente 2024 Individual Medicare Products & Benefits Training and Assessment. A one-hour web-based course which covers region-specific KP Medicare products and benefits for the individual plan segment. You must pass an exam that covers the Individual Products Module of the Course, with a score of 85% or higher. Only three attempts are allowed. If your computer times out once you’ve begun your exam, that counts as an attempt.
Once Miramar:Agent has verified all program requirements have been met, agents should see the 2024 Kaiser Permanente program listed with a ‘Completed’ status in the ‘Programs’ tab of their Miramar:Agent dashboard.
Medicare certification training period for the 2024 plan year:
- Release date – August 15, 2023
- Completion deadline – October 1, 2023
Agents appointed during the certification period who do not successfully complete the required courses by the October 1, 2023, deadline will not be able to market Kaiser Permanente Washington 2024 Medicare Advantage health plans during the annual enrollment period or during the 2024 plan year and any commissions for existing Medicare members will cease to be paid after December 31, 2023.
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.
Be aware there are different registration PINs, depending on the agent’s affiliated agency and which Kaiser Permanente market they are selling for. If a KPWA agent is also affiliated with a field marketing organization (FMO) that is appointed to sell Medicare Advantage in another Kaiser Permanente market (for example, Kaiser Permanente Northwest), they will be provided a Kaiser Permanente registration PIN by their FMO. The individual product benefit training is the same for all regions, so KPWA will use the completion status and dates for those other groups or programs to calculate ready-to-sell status.
- Miramar:Agent Customer Service. Call (855) 856-7852 for concerns related to technical issues.
- Peak season (August 3–October 31): Monday through Friday, 5 a.m. to 4 p.m. Pacific time; Regular hours: Monday through Friday, 5 a.m. to 2 p.m. Pacific time
- KPWA Medicare Sales Producer Support team. Email email@example.com or call 800-581-8252 (Monday through Friday, 8 a.m. to 5 p.m. Pacific time) for questions on your Kaiser Permanente Washington (Medicare contract H5050) ready-to-sell status.
- KPWA Producer Operations team. Email firstname.lastname@example.org for questions concerning your Kaiser Foundation Health Plan of Washington agency appointment.
Need broker support for other KP markets? Appointment, contracting and commissions processes vary depending on the Kaiser Permanente market. Find producer contact information for other markets here.
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 the Kaiser Permanente Washington Medicare Sales Producer 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 Medicare Sales Producer Support team needs be notified of any scheduled marketing/sales events where KPWA MA health 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 Communications and Marketing Guidelines (MCMG), for additional details.
Based on MIPPA regulations, producer compensation will be reviewed annually and may be adjusted based on guidance from the Centers 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 (including dental premium and late enrollment penalty, if applicable) and are subject to the terms and conditions of your agent agreement.
To view commissions schedules, please sign in to the secure producer portal and navigate to Quotes tab and then to Incentives and Commissions.