Medicare Marketing Guidelines For Medicare Advantage Plans1, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, Employer/Union-Sponsored Group Health Plans, Medicare-Medicaid Plans, and Section 1876 Cost Plans Table of Contents (Issued: 07/02/2015) 10 – Introduction ........................................................................................ 1 20 – Materials Not Subject To Marketing Review .............................................. 3 30 – Plan/Part D Sponsor Responsibilities ....................................................... 4 30.1 – Limitations on Distribution of Marketing Materials and Activities .......... 4 30.2 – Co-branding ................................................................................. 5 30.2.1 – Co-branding with Providers or Downstream Entities .................... 5 30.2.2 – Plan’s/Part D Sponsor’s Relationships with State Pharmaceutical Assistance Programs (SPAP) ........................................... 6 30.3 – Plan/Part D Sponsor Responsibility for Subcontractor Activities and Submission of Materials for CMS Review ..................................................... 6 30.4 – Anti-Discrimination ........................................................................ 7 30.5 – Requirements Pertaining to Non-English Speaking Populations ............ 7 30.5.1 – Multi-Language Insert ............................................................. 7 30.6 – Required Materials with an Enrollment Form ..................................... 8 30.7 – Required Materials for New and Renewing Enrollees at Time of Enrollment and Thereafter ........................................................................ 8 30.7.1 – Mailing Materials to Addresses with Multiple Enrollees ................. 9 30.8 – Enrollee Referral Programs ........................................................... 10 30.9 – Star Ratings Information from CMS ............................................... 10 30.9.1 – Referencing Star Ratings in Marketing Materials ....................... 11 30.9.2 – Plans with an Overall 5-Star Rating......................................... 12 30.9.3 – Low Performing Plans ............................................................ 12 40 – General Marketing Requirements .......................................................... 13 40.1 – Marketing Material Identification ................................................... 13 1 While Medicare Advantage “plans” are specific benefit packages offered by a Medicare Advantage “organization,” in this chapter, “plan” is used both to refer to the MA plan and to the MA organization offering the plan. i 40.1.1 – Marketing Material Identification Number for Non-English or Alternate Format Materials ................................................................. 14 40.2 - Font Size Rule ............................................................................. 14 40.3 - Reference to Studies or Statistical Data .......................................... 15 40.4 – Prohibited Terminology/Statements ............................................... 15 40.5 – Product Endorsements/Testimonials............................................... 16 40.6 – Hours of Operation Requirements for Marketing Materials ................. 17 40.7 – Use of TTY Numbers .................................................................... 18 40.8 – Marketing of Multiple Lines of Business .......................................... 18 40.8.1 – Multiple Lines of Business - General Information ...................... 18 40.8.2 – Multiple Lines of Business - Exceptions .................................... 19 40.8.3 – Marketing Materials from Third Parties that Provide Non- Benefit/Non-Health Services ............................................................... 19 40.9 – Providing Materials in Different Media Types ................................... 20 40.10 – Standardization of Plan Name Type .............................................. 21 50 – Marketing Material Types and Applicable Disclaimers .............................. 21 50.1 – Federal Contracting Disclaimer ...................................................... 22 50.2 – Disclaimers When Benefits Are Mentioned ...................................... 22 50.3 – Disclaimers When Plan Premiums Are Mentioned ............................. 23 50.4 – Disclaimer on Availability of Non-English Translations ...................... 23 50.5 – Disclaimer on SNP Materials.......................................................... 23 50.6 – Disclaimer When Cost-Sharing is Mentioned on D-SNP Materials Targeting Potential Enrollees ................................................................... 24 50.7 – Disclaimer for Private Fee-for-Service Plans Targeting Potential Enrollees .............................................................................................. 24 50.8 – Disclaimers for Medicare Medical Savings Accounts (MSAs) Targeting Potential Enrollees ................................................................... 25 50.9 – Disclaimer for Materials that are Co-branded with Providers/Pharmacies ............................................................................ 25 50.10 – Disclaimer on Advertisements and Invitations to Sales/Marketing Events ................................................................................................. 25 50.11 – Disclaimer on Promoting a Nominal Gift ........................................ 26 50.12 – Disclaimer for Plans Accepting Online Enrollment Requests ............. 26 50.13 – Disclaimer When Using Third Party Materials ................................. 26 50.13.1 – Disclaimer When Third Parties List a Subset of Plan Options ..... 27 50.14 – Disclaimer When Referencing Star Ratings Information .................. 27 ii 50.15 – Pharmacy/Provider Directory and Formulary Disclaimers ................ 27 50.16 – Mailing Statements .................................................................... 28 50.17 – Disclaimer for Other Formulary Documents ................................... 29 60 – Required Documents........................................................................... 29 60.1 – Summary of Benefits (SB) ............................................................ 29 60.2 – ID Card Requirements.................................................................. 30 60.2.1 – Health Plan ID Card Requirements .......................................... 31 60.2.2 – Part D Sponsor ID Card Requirements..................................... 31 60.3 – Additional Materials Enclosed with Required Post-Enrollment Materials .............................................................................................. 32 60.4 – Directories .................................................................................. 32 60.4.1 – Pharmacy Directories ............................................................ 34 60.4.1.1 – Information about Pharmacies ............................................. 35 60.4.2 – Provider Directories .............................................................. 35 60.5 – Formulary and Formulary Change Notice Requirements .................... 36 60.5.1 – Abridged Formulary .............................................................. 37 60.5.2 – Comprehensive Formulary ..................................................... 39 60.5.3 – Changes to Printed Formularies .............................................. 40 60.5.4 – Other Formulary Documents .................................................. 40 60.5.5 – Provision of Notice to Enrollees Regarding Formulary Changes ... 41 60.5.6 – Provision of Notice to Other Entities Regarding Formulary Changes ........................................................................................... 41 60.6 – Part D Explanation of Benefits ....................................................... 41 60.7 – Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) .... 42 60.8 – Other Mid-Year Changes Requiring Enrollee Notification ................... 43 70 – Promotional Activities, Rewards, Incentives, Events and Outreach ............ 43 70.1 – Promotional Activities .................................................................. 43 70.1.1 – Nominal Gifts ....................................................................... 44 70.2 – Marketing of Rewards and Incentives Programs ............................... 45 70.3 – Exclusion of Meals as a Nominal Gift .............................................. 45 70.4 - Unsolicited Electronic Communication Policy .................................... 45 70.5 – Marketing through Unsolicited Contacts .......................................... 46 70.6 – Telephonic Contact ...................................................................... 47 70.7 – Outbound Enrollment and Verification Requirements ........................ 48 70.8 – Prospective Enrollee Educational Events ......................................... 51 70.8.1 – Enrollee-Only Educational Events ........................................... 52 70.9 – Marketing/Sales Events and Appointments ..................................... 52 iii 70.9.1 – Notifying CMS of Scheduled Marketing Events .......................... 53 70.9.2 – Personal/Individual Marketing Appointments ............................ 53 70.9.3 – Scope of Appointment ........................................................... 54 70.9.4 – Beneficiary Walk-ins to a Plan or Agent/Broker Office or Similar Beneficiary-Initiated Face-to-Face Sales Appointment ................. 55 70.10 – PFFS Plan Provider