These are the top 4 reported compliance violations according to the Senior Marketing Specialists. We list them here so you can take action to avoid violating compliance, especially during the Annual Enrollment Period (AEP). 

1 – Late Applications 

Applications must be received by the carrier within 24-48 hours of the agent’s signature. Submitting an application late is one of the top violations during AEP. Be sure to check your carrier guidelines for details. 

One way to avoid late applications is to use e-applications. Carriers will automatically receive your application if you submit it online. 

Note: for AEP business you cannot submit a Medicare Advantage or Prescription Drug plan until October 15th, the official start of AEP. 

2 – Not Ready-to-Sell   

It is essential to be sure that you have the correct certifications before you write business for AEP. You might be required to have: 

  • AHIP
  • Carrier Certifications 
  • DSNP certification
  • Events and Seminars 

Important: If you write business that you are not certified to sell, it can result in a range of consequences that can affect your commissions or contract terminations. 

For more information on certifications see the post on Starting a Rewarding Career as a Medicare Agent

3 – Client doesn’t remember enrolling 

How can this happen, you might be thinking. Sometimes it’s the case of an agent misleading a client and enrolling them into a plan without making sure the client understands everything that’s going on. 

Another way it can happen is that the client is suffering from cognitive challenges and doesn’t remember the appointment. If you have proof of consent of enrollment, the violation is usually waived. 

Some things you can do to prevent this from happening. 

  • Have a Signed Scope of Appointment before discussing Part C and D helps avoid these kinds of complaints. 
  • Taking detailed notes on every appointment and storing them in a Customer Relationship Management (CRM) can help too. 
  • If there is a Power-of-Attorney, have them join your client at appointments. 
  • When phone selling, make sure your appointments are recorded. A recording can be helpful in demonstrating the integrity of the meeting. 

You can also contact your General Agent if you have additional questions. If you are not working with a General Agent, call Arnie Fulmer at 702-820-3333 to join his team. 

4 – Your Client Calls Medicare Instead of You

Make sure your client knows to call you for any questions regarding their plan and coverage, not Medicare. This could be a result of an agent neglecting a client, which is why it is considered a violation. 

While they may not intend to complain if a client calls Medicare directly it is considered a complaint against you, their agent. 

If you are a Medicare agent and have questions about Compliance or Medicare, call Arnie Fulmer at 702-820-3133. Arnie Fulmer is a Senior Market Advisor and the principal owner of Fulmer Insurance Group, a Medicare Brokerage Agency located in Las Vegas and licensed in multiple states. 

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