STANDARDS FOR MARKETING REPRESENTATIVES. A. General Requirements 1. Only a trained marketing representative of the contractor's plan who meets the DHS, DHSS, and DBI requirements shall be permitted to market and to enroll prospective NJ FamilyCare enrollees. All marketing representatives shall be registered with both the Department of Banking and Insurance (DBI) and the Division of Medical Assistance and Health Services (DMAHS). Delegation of enrollment functions, such as to the office staff of a subcontracting provider of service, shall not be permitted. 2. The contractor shall submit to DMAHS no less frequently than once a month, a listing of the contractor's marketing representatives. Marketing schedules shall be submitted at least five days in advance of marketing activities. Information on each marketing representative shall include the names, three digit Identification Numbers, and marketing locations. 3. All marketing representatives shall wear an identification tag that has been prior approved by DMAHS with a photo identification that must be prominently displayed when the marketing representative is performing marketing activities. The tag shall be at least three inches (3") by five inches (5") and shall display the marketing representative's name, the name of the contractor, and a three-digit identification number. 4. In those counties where enrollment is in a voluntary stage, marketing representatives shall not state or imply that enrollment may be made mandatory in the future in an attempt to coerce enrollment. 5. Canvassing shall not be permitted. 6. Outbound telemarketing shall not be permitted. For NJ FamilyCare (Plans B, C, D), telemarketing shall be permitted after review and prior approval by DMAHS of the contractor's marketing plan, script, and methods to use this approach. 7. Marketing in or around a County Welfare Agency (CWA) office shall not be permitted. The term "in and around the CWA" is defined as being in an area where the marketing representative can be seen from the CWA office and/or where the CWA facility can be seen. The fact that an obstructed view prohibits the marketing activities from being seen shall not mitigate this prohibition. 8. No more than two (2) marketing representatives shall approach a Medicaid/NJ FamilyCare beneficiary at any one time.
Appears in 1 contract
STANDARDS FOR MARKETING REPRESENTATIVES. A. General Requirements
1. Only a trained marketing representative of the contractor's plan who meets the DHS, DHSS, and DBI requirements shall be permitted to market and to enroll prospective NJ FamilyCare and ABD enrollees. All marketing representatives shall be registered with both the Department of Banking and Insurance (DBI) and the Division of Medical Assistance and Health Services (DMAHS). Delegation of enrollment functions, such as to the office staff of a subcontracting provider of service, shall not be permitted.
2. The contractor shall submit to DMAHS no less frequently than once a month, a listing of the contractor's marketing representatives. Marketing schedules shall be submitted at least five days in advance of marketing activities. Information on each marketing representative shall include the names, three digit Identification Numbers, and marketing locations.
3. All marketing representatives shall wear an identification tag that has been prior approved by DMAHS with a photo identification that must be prominently displayed when the marketing representative is performing marketing activities. The tag shall be at least three inches (3") by five inches (5") and shall display the marketing representative's name, the name of the contractor, and a three-digit identification number.
4. In those counties where enrollment is in a voluntary stage, marketing representatives shall not state or imply that enrollment may be made mandatory in the future in an attempt to coerce enrollment.
5. Canvassing shall not be permitted.
6. Outbound telemarketing shall not be permitted. For NJ FamilyCare (Plans B, C, D), telemarketing shall be permitted after review and prior approval by DMAHS of the contractor's marketing plan, script, and methods to use this approach.
7. Marketing in or around a County Welfare Agency (CWA) office shall not be permitted. The term "in and around the CWA" is defined as being in an area where the marketing representative can be seen from the CWA office and/or where the CWA facility can be seen. The fact that an obstructed view prohibits the marketing activities from being seen shall not mitigate this prohibition.
8. No more than two (2) marketing representatives shall approach a Medicaid/NJ FamilyCare beneficiary at any one time.
9. Marketing representatives shall not encourage clients to disenroll from another contractor's plan or assist an enrollee of another MCE in completing a disenrollment form from the other MCE.
10. Marketing representatives shall ask the prospective enrollee about existing relationships with physicians or other health care providers. The prospective enrollees shall be clearly informed as to whether they will be able to continue to go to those providers as enrollees of the contractor's plan and/or if the Medicaid program will pay for continued services with such providers.
11. Marketing representatives shall secure the signature of new enrollees (head of household) on a statement indicating that an explanation has been provided to them regarding the important points of the contractor's plan and have understood its procedures. A parent or, where applicable, an authorized person, shall enroll minors and ABD beneficiaries, when appropriate, and sign the statement of understanding. However, the contractor may accept an application from pregnant minors and minors living totally on their own who have their own Medicaid ID numbers as head of their own household.
12. Prior to approval of this contract by HCFA, the contractor's staff or agents are prohibited from marketing to, contacting directly or indirectly, or enrolling Medicaid beneficiaries.
13. Marketing representatives shall not state or imply that continuation of Medicaid benefits is contingent upon enrollment in the contractor's plan.
14. Attendance by the contractor's marketing representatives at State-sponsored training sessions is required at the contractor's own expense.
B. Commissions/Incentive Payments
1. Commissions/incentive payments may not be based on enrollment numbers alone but shall include other criteria, such as but not limited to, the retention period of enrollees enrolled (at least three (3) months), member satisfaction, and education by the marketing representative.
a. The contractor shall also review disenrollment information/surveys and all complaints/grievances specifically referencing marketing staff.
2. Marketing commissions (including cash, prizes, contests, trips, dinners, and other incentives) shall not exceed thirty (30) percent of the representative's monthly salary.
C. Enrollment Inducements
1. The contractor's marketing representatives and other contractor's staff are prohibited from offering or giving cash or any other form of compensation to a Medicaid beneficiary as an inducement or reward for enrolling in the contractor's plan.
2. Promotional items, gifts, "give-aways" for marketing purposes shall be permitted, but will be limited to items that promote good health behavior (e.g., toothbrushes, immunization schedules). However, the combined total of such gifts or gift package shall not exceed an amount of $10 to any one individual or family. Such items:
a. Shall be offered to the general public for marketing purposes whether or not an individual chooses to enroll in the contractor's plan.
b. Shall only be given at the time of marketing presentations and may not be a continuous, periodic activity for the same individual, e.g., monthly or quarterly give-aways, as an inducement to remain enrolled.
c. Shall not be in the form of cash. For NJ FamilyCare, other promotional items shall be considered with prior approval by DMAHS.
3. Raffles shall not be allowed.
Appears in 1 contract
STANDARDS FOR MARKETING REPRESENTATIVES. A. General Requirements
1. Only a trained marketing representative of the contractor's plan who meets the DHS, DHSS, and DBI requirements shall be permitted to market and to enroll prospective NJ FamilyCare and ABD enrollees. All marketing representatives shall be registered with both the Department of Banking and Insurance (DBI) and the Division of Medical Assistance and Health Services (DMAHS). Delegation of enrollment functions, such as to the office staff of a subcontracting provider of service, shall not be permitted.
2. The contractor shall submit to DMAHS no less frequently than once a month, a listing of the contractor's marketing representatives. Marketing schedules shall be submitted at least five days in advance of marketing activities. Information on each marketing representative shall include the names, three digit Identification Numbers, and marketing locations.
3. All marketing representatives shall wear an identification tag that has been prior approved by DMAHS with a photo identification that must be prominently displayed when the marketing representative is performing marketing activities. The tag shall be at least three inches (3") by five inches (5") and shall display the marketing representative's name, the name of the contractor, and a three-digit identification number.
4. In those counties where enrollment is in a voluntary stage, marketing representatives shall not state or imply that enrollment may be made mandatory in the future in an attempt to coerce enrollment.
5. Canvassing shall not be permitted.
6. Outbound telemarketing shall not be permitted. For NJ FamilyCare (Plans B, C, D), telemarketing shall be permitted after review and prior approval by DMAHS of the contractor's marketing plan, script, and methods to use this approach.
7. Marketing in or around a County Welfare Agency (CWA) office shall not be permitted. The term "in and around the CWA" is defined as being in an area where the marketing representative can be seen from the CWA office and/or where the CWA facility can be seen. The fact that an obstructed view prohibits the marketing activities from being seen shall not mitigate this prohibition.
8. No more than two (2) marketing representatives shall approach a Medicaid/NJ FamilyCare beneficiary at any one time.
9. Marketing representatives shall not encourage clients to disenroll from another contractor's plan or assist an enrollee of another MCE in completing a disenrollment form from the other MCE.
10. Marketing representatives shall ask the prospective enrollee about existing relationships with physicians or other health care providers. The prospective enrollees shall be clearly informed as to whether they will be able to continue to go to those providers as enrollees of the contractor's plan and/or if the Medicaid program will pay for continued services with such providers.
11. Marketing representatives shall secure the signature of new enrollees (head of household) on a statement indicating that an explanation has been provided to them regarding the important points of the contractor's plan and have understood its procedures. A parent or, where applicable, an authorized person, shall enroll minors and ABD beneficiaries, when appropriate, and sign the statement of understanding. However, the contractor may accept an application from pregnant minors and minors living totally on their own who have their own Medicaid ID numbers as head of their own household.
12. Prior to approval of this contract by HCFA, the contractor's staff or agents are prohibited from marketing to, contacting directly or indirectly, or enrolling Medicaid beneficiaries.
13. Marketing representatives shall not state or imply that continuation of Medicaid benefits is contingent upon enrollment in the contractor's plan.
14. Attendance by the contractor's marketing representatives at State-sponsored training sessions is required at the contractor's own expense.
Appears in 1 contract
STANDARDS FOR MARKETING REPRESENTATIVES. A. General Requirements
1. Only a trained marketing representative of the contractor's ’s plan who meets the DHS, DHSS, and DBI requirements shall be permitted to market and to enroll prospective NJ FamilyCare and ABD enrollees. All marketing representatives shall be registered with both the Department of Banking and Insurance (DBI) and the Division of Medical Assistance and Health Services (DMAHS). Delegation of enrollment functions, such as to the office staff of a subcontracting provider of service, shall not be permitted.
2. The contractor shall submit to DMAHS no less frequently than once a month, a listing of the contractor's ’s marketing representativesrepresentatives as updates and changes occur. Marketing schedules shall be submitted at least five days in advance of marketing activities. Information on each marketing representative shall include the names, three digit Identification Numbers, and marketing locations.
3. All marketing representatives shall wear an identification tag that has been prior approved by DMAHS with a photo identification that must be prominently displayed when the marketing representative is performing marketing activities. The tag shall be at least three inches (3"”) by five inches (5"”) and shall display the marketing representative's ’s name, the name of the contractor, and a three-digit identification number.
4. In those counties where enrollment is in a voluntary voluntary. stage, marketing representatives shall not state or imply that enrollment may be made mandatory in the future in an attempt to coerce enrollment.
5. Canvassing shall not be permitted.
6. Outbound telemarketing shall not be permitted. For NJ FamilyCare (Plans B, C, D), telemarketing shall be permitted after review and prior approval by DMAHS of the contractor's ’s marketing plan, script, and methods to use this approach.
7. Marketing in or around a County Welfare Agency (CWA) office shall not be permitted. The term "“in and around the CWA" ” is defined as being in an area where the marketing representative can be seen from the CWA office and/or where the CWA facility can be seen. The fact that an obstructed view prohibits the marketing activities from being seen shall not mitigate this prohibition.
8. No more than two (2) marketing representatives shall approach a Medicaid/NJ FamilyCare beneficiary at any one time.
9. Marketing representatives shall not encourage clients to disenroll from another contractor’s plan or assist an enrollee of another MCE in completing a disenrollment form from the other MCE.
10. Marketing representatives shall ask the prospective enrollee about existing relationships with physicians or other health care providers. The prospective enrollees shall be clearly informed as to whether they will be able to continue to go to those providers as enrollees of the contractor’s plan and/or if the Medicaid program will pay for continued services with such providers.
11. Marketing representatives shall secure the signature of new enrollees (head of household) on a statement indicating that an explanation has been provided to them regarding the important points of the contractor’s plan and have understood its procedures. A parent or, where applicable, an authorized person, shall enroll minors and ABD beneficiaries, when appropriate, and sign the statement of understanding. However, the contractor may accept an application from pregnant minors and minors living totally on their own who have their own Medicaid ID numbers as head of their own household.
12. Prior to approval of this contract by CMS, the contractor’s staff or agents are prohibited from marketing to, contacting directly or indirectly, or enrolling Medicaid beneficiaries.
13. Marketing representatives shall not state or imply that continuation of Medicaid benefits is contingent upon enrollment in the contractor’s plan.
14. Attendance by the contractor’s marketing representatives at State-sponsored training sessions is required at the contractor’s own expense.
Appears in 1 contract
Samples: Agreement to Provide Hmo Services (Amerigroup Corp)
