Provider Education

Providers May:

At the request of a patient or as a matter of a course of treatment:

• Provide the names of plan sponsors with which they contract and/or participate.
• Answer questions or discuss the merits of a plan or plans, including cost sharing and benefits information (these discussions may occur in areas where care is delivered.)
• Refer patients to Plan marketing materials available in common areas.
• Provide information and assistance in applying for the Low Income Subsidy.

If asked:

• Provide objective information about all health care options (remain neutral when presenting patient with options).
• Let patient know of any partnerships.

Provide resource material or refer patients to:

• Plan Sales Agent
• CMS: http://www.medicare.gov or 1-800-Medicare
• State Health Insurance Assistance Program (SHIP): Ohio Senior Health Insurance Information Program, 1-800-686-1578.
• Social Security: 1-800-772-1213
• Medicaid: Ohio Jobs and Family Service: 1-800-324-8680, TTY 1-800-292-3571

Providers May Not:

• Make phone calls/mail or persuade patients to enroll in a specific plan based on any financial or other interests of the provider.
• Give items of value to a patient to select a particular plan over another.
• Give items of value to an enrollee to select them as their provider.
• Conduct health screenings as a marketing activity.
• Accept compensation from a plan for beneficiary enrollments.

Providers May:

• Allow Sales Agents to give sales presentations and conduct marketing activities, including having a table in common areas like Hospital Lobbies, Cafeterias, Community or recreational rooms, and Conference rooms including office waiting rooms.
• Allow Sales Agents to distribute marketing materials and/or accept a BRC (Business Reply Card) from a beneficiary to contact at a later time.

Providers May Not:

• Allow Sales Agents to conduct presentations and marketing activities in healthcare settings where patients primarily intend to receive health care services. Restriction applies both during and after normal business hours.
• Accept or distribute Scope of Appointment forms from a patient.
• Offer to fill out the sales lead forms/BRCs.
• Accept or distribute enrollment forms on behalf of the plan.

Providers May:

• Make available and/or distribute plan marketing materials.
  • Marketing materials are used to draw a beneficiary’s attention to a plan and include their decision. Marketing can materials contain information about a plan’s benefits structure, cost-sharing, rankings, etc.
• Display marketing posters or other health plan / sales agent materials in common areas such as the provider’s waiting room.
  • Providers are free to determine which type of materials it will make available and/or distribute.
• Providers must make available and/or distribute materials from all of the plans with which it participates.
• Share information with patients from CMS’ website, including the “Medicare and You” Handbook or “Medicare Options Compare,” or other documents that were written by or previously approved by CMS.

Providers May Not:

• Show preference towards certain contracted health plans in regards to displaying their marketing materials.
• Accept or distribute enrollment forms on behalf of the plan.
• Distribute marketing materials or enrollment forms within an exam room, patient room, treatment area or pharmacy counter area.
  

Providers May:

• Make available, distribute and display communication materials including in areas where patient care is being delivered.
  • Communication materials are used to provide information to current or prospective enrollees. It is not intended to influence a beneficiary’s decision-making process. Communication materials do not contain any marketing content such as benefit structure, cost-sharing, etc.