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 complete the Kaiser Permanente Washington Medicare certification program described below annually.
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 program requirements:
Kaiser Permanente has teamed up with Convey Health Solutions and utilizes Miramar:Agent to administer the required training and testing modules and certification verification necessary to complete our program and ensure agents are ready to sell.
The program includes the following courses:
- Medicare Core training course, Fraud, Waste & Abuse (FWA), and General Compliance training certifications. A 3- to 4-hour online course with exam, that covers Medicare basics, enrollment and disenrollment, communication and marketing requirements, and other regulations for any Medicare health plan. Once registered for the applicable plan year program in Miramar:Agent, agents will have a choice whether to complete the Convey Core Medicare training and exam ($99) or upload another acceptable core Medicare training certificate for the applicable plan year. Acceptable Medicare training certificates are:
The Medicare core training assessment requires a 90% or higher passing score within (3) attempts. If uploading a certificate, once Miramar:Agent has verified the certificate plan year and authenticity, the program will allow the agent to bypass the Convey Core Medicare training and assessment and move to the required KPWA product training module and assessment.
- KPWA Medicare product training and assessment. A 1- to 2-hour online course that covers region-specific Kaiser Permanente Washington Medicare products and benefits for the individual plan segment. For the 2022 program plan year, agents have (3) attempts to receive a score of 85% on the product assessment to successfully complete the program and begin soliciting 2022 Kaiser Permanente Washington Medicare Advantage products on or after October 1, 2021.
Once Miramar:Agent has verified the Core Medicare training, Fraud, Waste & Abuse, General Compliance, and KPWA Product training requirements have been met, agents will see the program name and year listed in the “Ready To Sell” tab of their Miramar:Agent dashboard.
Medicare certification training period for the 2022 plan year:
- Scheduled release - August 17, 2021
- Completion deadline - September 30, 2021
Agents appointed during the certification period who do not successfully complete the required courses by the September 30, 2021, deadline will not be able to market Kaiser Permanente Washington 2022 Medicare Advantage health plans during the annual enrollment period or during the 2022 plan year and any commissions for existing Medicare members will cease to be paid after December 31, 2021.
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 Medicare Sales Producer Support team at 1-800-581-8252 (Monday through Friday, 8 a.m. to-5 p.m.) 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 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.