Policy Number: SLS-021
The intent of this operational policy is to document the sales training, certification requirements, and identify business owners and other participants related to training development, execution, and documentation for both employed and contracted Sales Agents.
America’s Health Insurance Plans (AHIP): National association representing member companies providing health insurance coverage.
Annual Enrollment Period (AEP): Time period each calendar year from October 15 to December 7. This time period is when Medicare beneficiaries can make changes to their coverage to take effect on January 1 of the following calendar year.
Centers for Medicare and Medicaid Services (CMS): The federal agency within the Department of Health and Human Services that administers the Medicare program.
Field Marketing Organization (FMO): An FMO is an agency contracted to provide broad coverage for the marketing and sales of a health plan. Areas of support will include, but are not limited to Marketing/ Lead Generation, Call Center capabilities, and Administrative functions.
Gorman Health Group (GHG): Company contracted by CNC to administer the CNC Sales Agent certification program, including collection of required documentation (i.e. daily state licensing, AHIP certification, background checks) and facilitation of online sales certification training and examination.
Medicare: The Federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS).
Medicare Advantage (MA): A Medicare program that allows for more choices among Medicare health plans. Everyone who has Medicare Parts A & B and resides in the plan’s approved service area is eligible, except those who have End-Stage Renal Disease (ESRD).
Medicare Advantage (MA) Organization: A public or private entity organized and licensed by a state as risk-bearing entity (with the exception of provider sponsored organization receiving waivers) that is certified by CMS as meeting the Medicare Advantage contract requirements.
Medicare Managed Care Manual – Chapter 3 Medicare Marketing Guidelines: Manual written and published by CMS for use by Medicare Health Plans and Agents to use to ensure compliance in regards to marketing to potential plan enrollees. It sets guidelines for communication and enrollment for these entities.
Sales Agent: Licensed insurance agents that are employed by CNC and/or external agents who are licensed, contracted and are certified to sell CNC Medicare Advantage Plans.
Sales Entity: Field Marketing Organization (FMO), General Agency (GA) or Agency.
Care N’ Care (CNC) follows the Centers for Medicare & Medicaid’s Services (CMS) requirements contained in the Medicare Managed Care Manual – Chapter 3 Medicare Marketing Guidelines, and in the applicable regulations, in regard to Sales Agent training.
CMS requires that Medicare Advantage (MA) plans have effective training programs for all Sales Agents that sell Medicare products. In addition, CMS requires that all Sales Agents pass a regulated written test and take an agent training course to demonstrate their knowledge of the Medicare program and the plan specific products they intend to sell.
CNC believes that each Medicare beneficiary should be able to understand the benefits of the Medicare plans they are reviewing and be able to select the Medicare plan with the right health care coverage that appropriately meets their personal needs. CNC recognizes that Sales Agents play a significant role in helping Medicare beneficiaries with their coverage choices. Accordingly, CNC’s policy states that each Sales Agent selling our plans should be highly qualified and properly trained according to the company’s philosophy, policies and processes.
It is CNC’s direct policy that Sales Agents will not be authorized/certified to sell our Medicare health plans until all of CNC’s training requirements are completed and documented.
Our policy is that any appointed CNC Sales Agent who wishes to continue selling our Medicare products must go through annual recertification.
CNC does not recognize the certification status of any other Medicare Advantage organization. CNC recognizes AHIP as the CMS approved on-line training site. Agents who have already taken and passed the AHIP training test for the certification year will not be required to take the certification exam again. They will need to register on the Gorman Health Group site and provide their AHIP certification information and acknowledge that all required documentation related to selling CNC plans has been read and understood. The AHIP information once submitted by the agent, is queued up on Gorman’s site and reviewed one-by-one by a member of their team for authenticity, matching name and a current plan year completion date. Once reviewed, the agent will receive an email stating that the AHIP was approved or rejected. If rejected, an explanation as to why it rejected is provided to the agent allowing them the opportunity to resolve the issue.
CNC is committed to ensuring that only qualified agents sell CNC Medicare products and has created this P&P to outline the training and certification requirements for Sales Agents.
This policy and the related procedures apply to all Sales Agents employed, contracted, or otherwise representing Care N’ Care Company, Inc., and its subsidiaries who represent and are authorized to sell CNC Medicare Health Plans. This includes, but is not limited to all internal Sales Agents and External Sales Agents contracted by CNC, including independent Agents, and Sales Entity (Agency, General Agency (GA) or Field Marketing Organization (FMO)).
Sequence of CNC’s Certification Policy
CNC’s Medicare certification process means that all Sales Agents will be required to complete the following training program annually, in addition to any other on-boarding requirements/state appointment:
- All Sales Agents will be required to begin the certification registration process by contacting the Senior Manager of Sales, Agent Concierge, or their immediate upline if applicable who will provide instructions on accessing the CNC Gorman Group certification code.
- All Sales Agents are required to have an America’s Health Insurance Plans (AHIP) Medicare certification to sell Care N’ Care health plans. Sales Agents are not required to re-take an already completed and passed AHIP Medicare exam. During the online training, you will be prompted to enter your AHIP information. Sales Agents who have not yet completed their AHIP Medicare certification may do so by going to the AHIP training site: https://www.ahipmedicaretraining.com.
- In addition to AHIP certification, Care N’ Care has partnered with Gorman Health Group to provide our Sales Agents the Care N’ Care Certification and Training course. This online program will provide an overview of the Care N’ Care health plans, coverage changes, and additional health plan benefits. All Sales Agents must complete the course with a minimum score of 85%.
- On the CNC Training and Certification page of the Gorman Group website, there will be documentation that all Sales Agents will be required to read and acknowledge before they can proceed to the next step. The documentation includes the CNC’s Introduction & Attestations of Required Certification, Agent Agreement, Code of Ethics, P & P Attestation, Acknowledgement & Authorization for Consumer Reports, W9, Electronic Signature, License Verification, Proof of E & O, Background Check, AHIP upload, CMS FWA, CMS Complaince Training, FWA Information Sheet, Product Final Exam, and then the last step is Appointment by the state.
- All Sales Agents must complete the CMS Compliance Training and CMS Fraud, Waste & Abuse training.
- Upon completion of the required steps, Sales Agents will be authorized to represent CNC Medicare plans for the selling season.
Training Modules and the Certification Exam(s)
- AHIP Medicare Exam: Beginning with the Medicare Annual Enrollment Period, CNC requires all Sales Agents must pass the AHIP Medicare exam each year with a score of 90% or greater before they will be permitted to sell CNC Medicare products.
- Each Sales Agent will be allowed three (3) attempts to successfully pass the AHIP certification exam. If the Sales Agent is unable to pass with a satisfactory score after three (3) attempts, they must meet with the Senior Manager of Sales to determine if they will be allowed to continue to attempt to contract with CNC.
- Sales Agents are strongly encouraged to study all modules prior to completing all random questions for the exam.
- CNC Certification Period: Sales Agents must be certified for the plan year in which they are selling. Additionally, Sales Agents must be product trained for the plan year of the products they are selling.
- EXAMPLE: A Sales Agent first becomes certified on March 18, 2016 to sell the current year’s CNC Medicare products. The certification will remain valid to sell through December 31, 2016 member effective dates.
- EXAMPLE: A Sales Agent first becomes certified to sell CNC Medicare products on August 22, 2016 by passing the 2016-2017 AHIP online training. The certification is accepted as valid for the remainder of 2016, and to sell through December 1, 2017 member effective dates.
- CNC Product Training Module and Exam: Sales Agents will learn specific information about the company, plan benefits and the enrollment process. Sales Agents must complete the Sales Training Module and pass the Module Exam with a minimum passing score of 85%. Each Sales Agent will be allowed three (3) attempts to successfully pass the CNC certification exam. If the Sales Agent is unable to pass with a satisfactory score after three (3) attempts, the Sales Agent will not be certified to sell CNC Medicare Advantage products for that Medicare selling season.
- Seminar Preparation and Training Requirements: Sales Agents will learn specific procedures to effectively and compliantly hold sales and educational events prior to being able to hold any said event. Each Sales Agent will be provided an Optional Sign In Sheet and a Seminar Report that will need filled out or referenced for every event. The expectations prior to holding an event will include but are not limited to the following processes:
- Attend two (2) scheduled events given by an approved sales agent or manager.
- Demonstrate Comprehension by performing two (1) trial sales events in a controlled environment.
Additional training available by Sales Management as needed.
- Sales Agents are monitored via ride-alongs with sales management or FMO Management to ensure compliant sales and marketing activities. In an effort to prevent non-compliant activities, CNC has developed a Medicare Sales Compliance Training module to ensure compliance with the Medicare Managed Care Manual – Chapter 3 Medicare Marketing Guidelines.
- Upon successful completion of all CNC Sales Certification requirements, the Agent will be deemed Certified to sell CNC Medicare Advantage plans.
Documentation and Record-Keeping
The CNC Sales department will document the completion of the Sales Agent certification training requirements through the Gorman Health Group. CNC has contracted with the Gorman Health Group to track and record that the Sales Agent has read all the required documentation plus verifying certification exam scores (in addition to other demographic information). In addition, the Gorman Health Group will maintain a database for CNC that will house information about CNC Sales Agent including but not limited to:
- AHIP certification
- CNC product specific certification exam results
- Signed agreement
- Copy of the appropriate and current state license(s) required to solicit and sell CNC Medicare Advantage products
- W9 (if directly contracted or affiliated with a contracted sales entity)
- Verification of completion of CNC Compliance Fraud, Waste & Abuse Module