Scope of Appointment Resources

October 29, 2010

CMS requires agents to obtain a Scope of Appointment (SOA) before they meet with a prospect on Medicare Advantage and Medicare Part D plans.  There are a few exceptions.  UnitedHealthcare produced a pretty comprehensive job aid for agents (UHC SOA Job Aid).  On the last page, it lists three situations when a SOA is not required. 

My advice: Obtain an SOA every time.

Branded vs. Generic SOAs – Agents like to use a generic SOA because they need the flexibility of presenting any number of plans based on the prospect’s needs.  Some companies allow agents to use a generic SOA and others do not. 

Below are a list of MAPD & PDP companies and links to their approved SOAs:

  • Aetna – Not available yet
  • Anthem (WellPoint) – Generic SOA & Generic Guidelines: Anthem only uses a generic SOA
  • ArcadianSOA English & SOA Spanish: They will accept the generic Scope of Appointment
  • Care Improvement PlusSOA: CIP will accept the generic SOA (Updated 11/15/10)
  • CarilionSOA: They will accept the generic SOA
  • CIGNASOA: They will NOT accept the generic SOA
  • CoventrySOA PDFs: They will accept the generic SOA. This link is to Coventry’s website.  You can download the SOA and other useful tools.
  • HealthSpringSOA: They prefer their company specific SOA
  • HumanaSOA: They prefer their company specific SOA
  • OptimaSOA: They prefer their company specific SOA
  • Today’s OptionsSOA: They will accept any CMS approved SOA
  • Sterling Health Plans - SOA: They will accept the generic SOA
  • UnitedHealthcareSOA, Generic SOA, Generic SOA Fax Cover Sheet
  • Universal Health CareSOA, Automated Scope of Appointment Line: They will accept any CMS approved SOA

I’ll post additional updates and links as they become available.  I hope this helps!

Politics & Medicare Supplements (Medigap)

October 28, 2010

It was just a matter of time before the political machine started looking into Medicare Supplements.  Earlier this month, Senate Democrats targeted one Medicare Supplement company for high rates increases.  Senate Majority Leader Harry Reid, D-Nev., joined with Sen. Max Baucus, D-Mont., and Sen. John Kerry, D-Mass., to send a letter about Medicare Supplement rate increases to U.S. Secretary of Health and Human Services Kathleen Sebelius.

They were responding to reports of up to 40% rate increases on a few policy holders.  These rate increases only applied to about 1% of the company’s entire block of business due to policy holders enrolling during a pending rate increase. 

Example: Pending rate increase (10%) + Attained Age rate increase (10%) + Next Year’s rate increase (10%) = One BIG rate increase on the policy holder’s 12-month anniversary date.

Here is a link to the National Underwriter’s article on the topic.

Here is a link to THE HILL’s article on the topic.

The additional attention from DC may encourage Medicare Supplement companies to better explain rates increase to their policy holders.  It may even encourage them to soften the blow of large rate increases by spreading them out over more policy holders or larger blocks of business.

On the flip side, it seems like politicians are always trying to make insurance companies the villains.  In this case, they are probably trying to change public perceptions of Health Care Reform and why it is needed.

Universal Health Care – Automated Scope of Appointment Line

October 27, 2010

Universal Health Care is excited to announce the opening of their Automated Scope of Appointment line to assist Prospective Members, Agents and Brokers. This automated line will satisfy all of the requirements of a traditional Scope of Appointment. The call takes approximately 2 minutes and 30 seconds and is very user-friendly. Please see process below:

  1. Agent receives the request from prospective member for appointment.
  2. Agent instructs prospective member on requirement for Scope of Appointment.
  3. Agent provides Automated Scope line phone number (888-388-8637) and instructs the prospective member to call.
  4. Member calls into Automated Scope line and at the end of the call is given a Scope of Appointment ID number to provide the agent.
  5. Member provides this number to the agent to enter on the enrollment application at the time of the appointment.

Here is a link that provides the CMS approved Automated Scope of Appointment script your prospects will hear when calling in. We hope that you find this a valuable tool in making your Annual Election Period a successful one.

Please feel free to call my office with any questions, 1-800-962-4693.

Dedicated AgentPipeline Broker Support for Universal Health Care:

Krista (ext. 214), Shannon (ext. 215), or Sally (ext. 234)

Forethought Medicare Supplement Released in IA, LA, MS, OH, OK, SC & WV

October 27, 2010

Great News!  Forethought has released their new Medicare Supplements in seven states (IA, LA, MS, OH, OK, SC, WV).  Forethought has very competitive rates and great commissions.  Below are reasons to sell their plans:

  • Very Competitive Monthly Premiums
  • Top Agent Commission
  • Simplified Application Process
  • Easy Yes/No Application
  • Advanced Commission Available
  • Commission Paid Weekly
  • Quick Issue Process

In addition to these great benefits, Forethought has a strong company history and great financials.

Company History

  • Forethought Life Insurance Company is rated A-(Excellent)by AM Best and A-(Strong) by Standard & Poor’s.
  • Forethought, through its life insurance subsidiary, has assets owned and under management in excess of $4.5 billion, and has served more than 2 million policyholders since 1985.
  • Forethought Life Insurance Company was named among the prestigious 2010 Ward’s 50 list of the nation’s top 50 highest performing life-health insurance companies.

Interested?  Call my office today and we will send you state specific rates and contracting.  1-800-962-4693

Munich Re has agreed to acquire Windsor Health Group, Inc.

October 26, 2010

Munich Re is the parent company of Sterling Health Plans of Bellingham, Washington.  Sterling offers plans to seniors in all fifty states.  They offer Medicare Advantage (PFFS, NPFFS & PPO), Medicare Part D and Medicare Supplements.  Windsor offers Medicare Advantage Plans (HMO) in Alabama, Arkansas, Mississippi, South Carolina and Tennessee.  Combined, the companies serve over 200,000 members.

The combination of Sterling and Windsor will create a larger and more complete healthcare organization, with the products, services, distribution channels and resources needed to compete in the years ahead.

This acquisition is similar to HealthSpring’s purchase of Bravo Health.  I wouldn’t be surprised if we see more mergers/acquisitions like these.  It enables companies to compete with the big boys (UnitedHealthcare, Humana and WellPoint).

Here is a link to Munich Re’s press release.

Here is a link to Bloomberg’s article.

What does this mean to you?  Better Medicare Advantage options in 2012.

Humana – Agent Certification Required for Renewal Commission

October 26, 2010

Humana announced today that agents will need to recertify each year in order to receive renewal commissions.  Humana references the following CMS guidance in its announcement:

 “Plan sponsors must not pay agents who are no longer appointed to sell in the State (if required), agents who have not been annually trained and tested per the plan’s policies and procedures with a passing score of eighty-five percent or agents who have been terminated for cause by the plan.”

The Good News – Humana originally closed recertification on October 15th.  If a current agent didn’t recertify by that date, they were not able to sell Humana’s MAPDs or PDPs for twelve months.  Now agents will be able to recertify through November 30th.

Don’t miss this chance to recertify!

Here is the link to our Humana Agent Compliance Alert.

2011 Medicare Part D and Medicare Advantage Means Testing for Higher Premiums

October 25, 2010

Have you heard about this?

(Below is an excerpt from the 2011 Medicare & You Handbook pg. 134)


If your income is above $85,000 (and you file an individual tax return) or $170,000 (and you file a joint tax return), you will pay an income‑related monthly adjustment amount in addition to your Part D plan premium. If you have to pay a higher amount based on your income, Social Security will notify you in November. You can also visit to find out your Part D monthly premium. 

Part D Monthly Premium

The income-related monthly adjustment amount will be deducted from your monthly Social Security check, no matter how you usually pay your plan premium. If that amount is more than the amount of your check, you will get a bill from Medicare.


The feedback I’m receiving from one Medicare Advantage & Part D company is the income-related monthly adjustment amount will also impact the Part D coverage beneficiaries are receiving from their Medicare Advantage Prescription Drug (MAPDs) plans.  As of today (10/25/2010), CMS has not released the 2011 means tested combined premium (income-related monthly adjustment amount).  It is believed CMS will release the information soon because beneficiaries will need to use it to determine which plans to enroll starting Nov 15th.

The Bottom LineIf your have client’s income is higher than the amounts above, they may pay a substantially higher premium for their PDP or MAPD (via deductions from their social security check).

I just received this today and I’ll update this post as more information comes in.  If you have any additional information, please leave a comment.

Stay Tuned…

UPDATE:  Here is a link to Medicare Part B: Three Different Premium Amounts.  This post includes information on means testing for Medicare Advantage and Medicare Part D.

Medicare Basics – Humana Videos

October 25, 2010

Humana has created several YouTube videos to help seniors (or anyone for that matter) better understand Medicare and its different parts.  These videos are a great resource for agents and their clients or prospects.  Most of them are less than five minutes and super easy to understand.  I know of a few agent websites that use these videos to help their clients better understand Medicare. 

Below are four videos I think you’ll like. 

Stay Smart Stay Healthy is the new media venture producing these videos.  Here is a quote from their YouTube site…

“Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry.

Our goal is simple: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.”


Reminder to certify with CIGNA

October 23, 2010

Just a reminder for agents that may have sold CIGNA’s PDP plans last year…

CIGNA requires agents to complete their re-certification to receive renewal commission.  Below is CIGNA’s Compliance Alert from Friday.


Product Year: 2011

Compliance Alert: 02

Medicare Training RequirementsProducers are reminded that in order to be paid renewal commissions, you must maintain your
license, be appointed by CIGNA and pass our broker training by December 31, 2010.  Failure to
complete the training by this timeframe will result in non-payment of your renewal commissions. 

On June 4, 2010, the Centers for Medicare & Medicaid Services (CMS) provided updated guidance to ensure
organizations use state-licensed, certified or registered individuals and that these individuals are trained and
tested annually on Medicare rules, regulations and plan details specific to the plan products being sold.  

CMS is enforcing the following guidelines on certification:

  • Any producer selling Medicare must be trained annually on Medicare rules, regulations and plan details
    specific to the plan products being sold.  Producers are tested annually on their knowledge of these rules
    and regulations and must pass with at least a score of 85%.
  • Producers must be state-licensed, certified or registered individuals.

To confirm completion of the 2011 Medicare lessons, please log into
Go to Learn > Learning Activity Reports > Training Transcript to view your completions.

  • NATIONAL Producers: Must complete and pass exams for both Lesson 1 and Lesson 2.
  • ARIZONA Producers: Must complete and pass exams for both Lesson 1 and Lesson 3.

For assistance with the training website you can contact the CIGNA University Help Desk directly at
1-800-973-9183 (Option 4) or The help desk is open from
8:00 AM to 8:00 PM EST, Monday – Friday (not available on weekends or holidays). Please note that the
CIGNA University Help Desk only supports the training and does not have any information on commissions,
submitting applications, licensing, or materials.

Please contact us at if you have any questions relating to this topic.

Medicare Advantage Season off to a slow start?

October 22, 2010

If you’re asking yourself this question, you’re not alone.  Agents across the country are feeling the same way.  This enrollment season is off to a slower start than usual.  Here are a few thoughts on why:

  1. Fewer Medicare Advantage Companies – Most markets are seeing fewer and fewer Medicare Advantage plans available.  This drives agents to a smaller number of companies and they are having a hard time managing the influx of new agents.
  2. Contracting Turn Around Time - Getting appointed with a company in July and August is a breeze.  September comes and it takes longer than you’d like.  Then October comes and the contracting timeline  is stuck in park.  It’s like going to the concession stand at half time.  The line starts on the stadium stairs and you move one step every 10 seconds.  By the time you get to the counter, the 2nd half has already started and you feel like you are missing all the good stuff.  The companies are overwhelmed with new agent contracts.  I’m seeing 4 & 5 week turn around times right now. 
  3. Certification - Personally, I don’t enjoy taking my re-certification tests.  It’s completely necessary though.  I still find myself fighting the urge to procrastinate.  The problem with procrastinating is that certification is the “golden ticket” for everything else.  A company looks at a certified agent like a teacher looks at the kid in the front row with her hand waving in the air.   Agents who certify early get the best seat at the table.  Their contract goes through faster, they can order supplies earlier and they can get in line for company leads sooner.
  4. No Supplies (AKA - Enrollment Kits) – This isn’t a new problem, but I think it’s something we all hope will fix itself.  Every year, companies have a hard time getting enough supplies for agent demand.  Part of it has to do with CMS’s approval process.  If CMS approves parts of the Enrollment Kit the last week of September, it’s almost impossible to have it ready for the SEP (Oct 1st).  Companies are to blame as well.  They are always underestimating what they’ll need and trying to skimp.  There is at least one company I can think of that has a supply ordering process that literally takes 20 minutes to place each order. 

The Good News…

Once you’re contracted, certified and supplied you will find a huge opportunity this year.   Medicare Advantage members are looking for solutions.  The reduction of PFFS counties, plan pull outs and premium increases have affected tons of Medicare Advantage members.  You, an independent agent, are the answer.  Like a knight in shinning armour…

Lessons for next year…

  1. Take 15 minutes in August to complete any new contracts.
  2. Take your certification the first week AHIP is available.  I know it hurts, but trust me on this one.  Then transfer your AHIP certification to all your companies as soon as you can.
  3. Finally, pre-order all the supplies you can.  Large FMOs have access to order supplies very early (July/August).  This will put you in the front of the line.  Exactly where you want to be.

Take heart.  If you’re not selling now, you will be soon.


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