RULES OF ENGAGEMENT · 2020. 7. 13. · RULES OF ENGAGEMENT – 2021 HANDBOOK 6 › A Managing...

909928 a 07/20

RULES OF ENGAGEMENT

2021 Agent and Agency Sales Handbook Effective: 7/1/2020

TABLE OF CONTENTSSECTION I: SalesDistributionManagement...............................................................................................................................................3

SECTION II: Contracting,LicensingandTraining.....................................................................................................................................5

SECTION Ill: SuspensionandTermination..................................................................................................................................................12

SECTION IV: Commissions..................................................................................................................................................................................14

SECTION V: Oversight........................................................................................................................................................................................16

SECTION VI: TelesalesRequirements............................................................................................................................................................18

SECTION VII: OperationalRequirements.....................................................................................................................................................22

This Rules of Engagement Handbook is a supplement to the Sales Agency Agreement for Cigna Medicare Advantage & Prescription Drug Plans (“Agreement”) between Cigna Medicare and Agent/Agency and shall be a part of the Agreement as if fully restated therein. In the event of any conflicting terms between the Rules of Engagement and the Agreement, this Rules of Engagement shall supersede and control, unless otherwise specified in the Agreement.

This overview is for Agencies and Agents who are contracted, certified, licensed and appointed to sell Cigna Medicare Advantage & Prescription Drug Plan products. Due to the high degree of compliance required, and that Medicare Advantage & Prescription Drug Plan products are governed by state and federal regulations, the Agencies and Agents must fully comply with all applicable Cigna Medicare policies and procedures, including, but not limited to, those set forth below. The Rules of Engagement may be amended by Cigna Medicare, at its sole discretion, upon thirty (30) days advance written notice to Agencies and Agents. Notwithstanding the foregoing, Cigna Medicare may make any changes to the Rules of Engagement without advanced written notice if changes are necessary to comply with any law, rule, regulation or Centers for Medicare and Medicaid Services (CMS) instructions.

Agencies and Agents agree to comply with all state and federal rules and regulations, as well as all Cigna Medicare policies and regulations as set forth, and shall require each individual subordinate Agent affiliated with the Agency to likewise comply.

AEP AnnualEnrollmentPeriod

AOC AssignmentofCommissions

AOR AgentofRecord

CMS CentersforMedicareandMedicaidServices

CSV CustomerServiceViolation

CTM MedicareComplaintsTrackingModule

DOB DateofBirth

Downlines Agenciesdownstreamfromdirectlycontractedagency

DSA DelegatedServicesAgreement

EFT ElectronicFundsTransfer

FDR FirstTier,DownstreamandRelatedEntities

FMO FieldMarketingOrganization

FTP FileTransferProtocol

GA GeneralAgency

GTS GrievanceTrackingSystem

CARL CignaAgentResourceLine

HPMS HealthPlanManagementSystem

MA/MAPD MedicareAdvantage/MedicareAdvantageandPrescriptionDrug

MIPPA MedicareImprovementsforPatientsandProvidersAct

MGA ManagingGeneralAgency

MLI Multi-languageInsert

MCMG MedicareCommunicationsandMarketingGuidelines

NPN NationalProducerNumber

PDP MedicarePartDPrescriptionDrugPlan

PHI ProtectedHealthInformation

RFI RequestforInformation

ROE RulesofEngagement

SDAP SalesDevelopmentActionProgram

SGA SupervisingGeneralAgency

SOA ScopeofAppointment

SSN SocialSecurityNumber

SSA SocialSecurityAdministration

TIN TaxIdentificationNumber

Toplines Directlycontractedagencies

Uplines UpstreamAgencies

KEY ACRONYMS AND TERMINOLOGY

CALENDAR YEAR AT A GLANCE

January

› OEPbegins

› AEPnewapplicationcommissionsdistributed

› Renewalsdistributed

March

› AgencyProducers’Universityattestationfinaldeadline3/31

› OEPends3/31

April

› AHIPreimbursementdistributedforagentswhomeetqualifications

July

› Annualcertificationrelease

September

› AHIPreimbursementeligibilitydeadline9/15

October

› AEPkick-off10/15

November

› Lastdayfor2020effectivesales11/30

December

› AEPends12/7

› 2021Agentcertificationsanduptodatelicensesandappointmentsdeadline12/31

› 2021AgencyProducers’Universityattestationsinitialdeadline12/31

– Updatebusinesslicensesandappointmentsby12/31orapplicableadministrativefeerenewalswillbeforfeited

AEPOEP

LOCK-IN

AEP READLINES

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

4

SECTION I

SALES DISTRIBUTION MANAGEMENTLevels of Agencies

TherearefivedifferentlevelsofAgencieswithinthehierarchystructureatCigna-HealthSpring.

› FieldMarketingOrganization(FMO)

› SupervisingGeneralAgency(SGA)

› ManagingGeneralAgency(MGA)

› GeneralAgency(GA)

› Agent

– PersonalBusinessEntity

Field Marketing Organization (FMO)

FMOisaninsuranceAgencythatmayalsocontractwithIndependentAgents,GAs,MGAs,and/orSGAs,asdefined byCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestate(s)inwhichFMO,SGA,MGA,orGAisappointedandinwhichCignaMedicareoperates.FMOmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.

Supervising General Agency (SGA)

SGAisaninsuranceAgencythatmayalsocontractwithIndependentAgents,GAs,and/orMGAs,asdefinedbyCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestate(s)inwhichSGA,MGA,orGAisappointedandinwhichCignaMedicareoperates.SGAmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.

Managing General Agency (MGA)

MGAisaninsuranceAgencythatmayalsocontractwithIndependentAgentsand/orGAs,asdefined byCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestatesinwhichMGAorGAisappointedandinwhichCignaMedicareoperates.MGAmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.AgenciescontractingasanMGAmustcontractthroughanuplineagency.

General Agency (GA)

GAisaninsuranceAgencythatmayalsocontractwithIndependentAgentsasdefinedbyCignaMedicarethatoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestatesinwhichGA/AgentisappointedandinwhichCignaMedicareoperates.GAmustmeetorexceedtheCignaMedicareengagementcriteriaaswellasmeetallapplicablelaws,rules,andregulations.AgenciescontractingasaGAmustcontractthroughanuplineagency.

Independent Agent/Broker

IndividualsalesAgents/Brokersusingtheirpersonalcredentials(SSN,NPN,andlicenses)tocontractaswritingAgentsforCignaMedicareneedtocontractdirectlywithCignaMedicareorcontractthroughanuplineAgency.WithoutCignaMedicare’spriorapproval,CignaMedicare’sdirectlycontractedAgentsareprohibitedfromcontractingwithaGA,MGA,SGAorFMO.

Personal Business Entity

PersonalBusinessEntityisanentityanenrollingagentmaybepermittedtoassigntheircommissionstothatdoesnotqualifyasaGA,MGA,SGAorFMO.Thisentityoperatesunderafederaltaxidentificationnumberandpossessesallrequisitepermits,licensesandotherapprovalsissuedbytheregulatoryinsuranceAgencyoftheapplicablestatesinwhichPersonalBusinessEntityisappointedandinwhichCignaMedicareoperates.Onlytheagentthatownsthepersonalbusinessentityandhis/herspouseorbusinesspartnermayassigncommissionstotheentity.Thisentitydoesnotqualifyforadministrativefees.PersonalBusinessEntitymustmeetallapplicablelaws,rulesandregulations.PersonalBusinessEntity’sarenotrequiredtocompleteannualagencyattestations.

Exclusive/Non-exclusive

Exclusive Agent/Agency–Agent/AgencythatislicensedandappointedwithCignaMedicareandrepresentsonlyCignaMedicare’sMedicareAdvantage/PrescriptionDrugPlanproductswithinaCignaMedicaregeographicservicearea.Agent/Agencyagreesnottorepresentorsellotherentities’MedicareAdvantage/PrescriptionDrugproductsincluding,butnotlimitedto,HMO,PPO,RegionalPPO,andPFFSplans.

RULES OF ENGAGEMENT – 2021 HANDBOOK 5

Engagement criteria for each Agency level

ToenterintoanAgencyAgreement,theAgencymusthaveaminimumnumberofactiveAgentsandannuallymeetorexceedthesalesproductionrequirementsasoutlinedinthetablebelow.ExpansionmarketAgencytargetsmayvarybasedonnetworkandotherfactorsatmarketlaunch.

Agency LevelMinimum number of active Agents

Minimum annual total of MA enrollment

applications

Number of states required to be

contracted

General Agency 3 150 –

Managing General Agency 5 300 –

Supervising General Agency 5 500 –

Field Marketing Organization 37 3,200 2

AgenciesmayonlyupgradetoahighercontractlevelaftersixmonthscontractedattheirexistingcontractlevelandifdownlineagentandproductionrequirementsfortheirdesiredcontractlevelaremetandCignaMedicareapprovalisgranted.

AgenciesshouldworkwiththeiruplineiftherearequestionsorconcernsrelatedtomeetingormaintainingtheminimumAgentrequirement.CignaMedicarereservestherighttoreviewallAgency-levelcontractstoensurethespecificrequirementsarebeingmet.CignaMedicareutilizesAccountabilityLetterssentquarterlyviaemailtoallAgenciestotrackAgencyprogresstowardmeetingdownlineAgentandannualproductionrequirementsfortheirAgencylevel.

IntheeventanAgencyisdowngradedorterminatedduetofailuretomeetengagementcriteria,CignaMedicarewillnotifyAgency’stopline.

› AnAgencydowngradetoPersonalBusinessEntitywillresultinforfeitureofadministrativefees.Alldownlineagents,asidefromthePersonalBusinessEntityownerandpartner/spouse(ifapplicable),willbemovedtothenextdirectupline.AgentcommissionswillcontinuetobepaidprovidedAgentsmeetallrequiredvalidations(contracted,certified,licensedandappointed),PersonalBusinessEntitymeetsallrequiredvalidations(contracted,licensedandappointed)andthecustomerremainsenrolled.

› AnAgencydowngradetoAgent-levelwillresultinforfeitureofadministrativefees.Alldownlineagentswillbemovedtothenextdirectupline,andagentcommissionswillcontinuetobepaidprovidedAgentsmeetallrequiredvalidations(contracted,certified,licensedandappointed)andthecustomerremainsenrolled.TerminationofaGeneralAgencyandalldownlineagentswillresultinforfeitureofanycommissionpayments.

Non-exclusive Agent/Agency–Agent/AgencythatislicensedandappointedwithCignaMedicarebutrepresentsotherMedicareAdvantage/PrescriptionDrughealthplansinadditiontoCignaMedicarewithinaCignaMedicaregeographicservicearea.

The Difference between an Agent/Broker and Agency

Agent/Broker–Anindividualwhoisusinghis/herpersonalcredentials(SSN,NPN,andLicenses)tocontractasawritingAgentforCignaMedicare.

Agency–Anorganization(PersonalBusinessEntity,GA,MGA,SGA,orFMO)thatisusingitsownuniquebusinesscredentials(TIN/EIN,NPN,License)tocontractasanAgencyforCignaMedicare.AgencieswillnotbeallowedtocontractwithCignaMedicareusinganindividualperson’s/Agent’scredentials.


› AManagingGeneralAgencydowngradetoGeneralAgencywillresultinadministrativefeesbeingpaidaccordingtothedateofenrollment.EnrollmentscompletedatMGAlevelwillcontinuetobepaidattheMGAlevelwhileenrollmentscompletedafterthedowngradewillbepaidatthenewGAadministrativefeelevel.Alldownlineagencieswillbemovedtothenextdirectupline.DownlineAgentandAgencycommissionswillcontinuetobepaidprovidedAgentsandAgenciesmeetallrequiredvalidations(contracted,certified/attestationcompleted,licensedandappointed)andthecustomerremainsenrolled.TerminationofaManagingGeneralAgencyandalldownlineagentsandagencieswillresultinforfeitureofanycommissionpayments.

› ASupervisingGeneralAgencydowngradetoalowerAgencylevelwillresultinadministrativefeesbeingpaidaccordingtothedateofenrollment.EnrollmentscompletedatSGAlevelwillcontinuetobepaidattheSGAlevelwhileenrollmentscompletedafterthedowngradewillbepaidatthenewadministrativefeelevel(MGA/GA).Downlineagenciesmaybemovedtothenextdirectupline,asneededbasedonthenewagencylevel.DownlineAgentandAgencycommissionswillcontinuetobepaidprovidedAgentsandAgenciesmeetallrequiredvalidations(contracted,certified/attestationcompleted,licensedandappointed)andthecustomerremainsenrolled.TerminationofaSupervisingGeneralAgencyandalldownlineagentsandagencieswillresultinforfeitureofanycommissionpayments.

› AFieldMarketingOrganizationdowngradetoalowerAgencylevelwillresultinadministrativefeesbeingpaidaccordingtothedateofenrollment.EnrollmentscompletedatSGAlevelwillcontinuetobepaidattheSGAlevelwhileenrollmentscompletedafterthedowngradewillbepaidatthenewadministrativefeelevel(MGA/GA).Downlineagenciesmaybemovedtothenextdirectupline,asneededbasedonthenewagencylevel.DownlineAgentandAgencycommissionswillcontinuetobepaidprovidedAgentsandAgenciesmeetallrequiredvalidations(contracted,certified/attestationcompleted,licensedandappointed)andthecustomerremainsenrolled.TerminationofaSupervisingGeneralAgencyandalldownlineagentsandagencieswillresultinforfeitureofanycommissionpayments.

Individual leads

CignaMedicaremay,atitssolediscretion,supplyoverflowleadstoAgencyorSubordinateAgency,BrokerorAgent.However,CignaMedicareisnotresponsibleforsupportingtheAgencywithleadsorfinancialsupportintheirprospectingefforts.Duringavisitwiththeprospect,AgencyorSubordinateAgency,BrokerorAgentcanpresenttheCignaMedicareAdvantageproductswithfulldisclosureandenrolltheprospect.ReferralsmayonlybesoughtinaccordancewithCignaMedicarepolicyandCMSguidelines.AgencyorsubordinateAgency,BrokersorAgentsmustfollowallguidelinesandregulationsthatgoverntheproperprocedureforprospectingandsellingCignaMedicareproducts,includingallrequirementssetforthunderMIPPAandtheCMSMedicareCommunicationsandMarketingGuidelines(MCMG).


SECTION II

CONTRACTING, LICENSING, AND TRAININGAgency qualificationsTobeanauthorizedCignaMedicareAgency,youmust:

› CompleteAgencycredentialingadministeredbyCignaMedicareoritsdesignee

› CompleteAgencyProducers’UniversityattestationadministeredbyCignaMedicareoritsdesigneeuponcontractingandannuallythereafter

› BealicensedhealthAgencyintheCignaMedicarestate(s)inwhichAgencyintendstosellandsubmitapplicationstoCignaMedicare,beingoodstanding,andsupplyCignaMedicarewithacopyofthelicenseuponrequest

› BeappointedbyCignaMedicareasanAgencyinthestatesAgencyintendstosellandsubmitapplicationstoCignaMedicare,perstateregulations

› HaveanexecutedagreementwithFMO,SGA,MGA,GAorCignaMedicare

› Complywithalllegal,complianceandregulatoryguidanceinaccordancewithapplicablestateandfederallawsandCignaMedicarepolicies

› ReceivecontinuingeducationrelativetothecurrentMedicareAdvantage/PrescriptionDrugPlanproductsandcomplywithanychangesthatoccurrelativetothisprogram

› ParticipateinintegrityoversightevaluationsandtheCignaMedicareSalesDevelopmentActionProgramasrequiredbyCMSandCignaMedicare

› Havereasonableaccessibilityforreceivingcommunicationsconcerningimmediateregulatoryornetworkchanges(i.e.,phone,email,fax,pager,voicemail,etc.)

› Maintainaproficiencyin,andknowledgeof,Cigna’sMedicareAdvantage/PrescriptionDrugPlanproductsaswellasallnecessarycompliancerequirements

› ComplywithCignaMedicare’ssalesperformanceanddisciplinarystandardsassetforthinCignaMedicare’spoliciesandprocedures,hereinincorporatedbyreference

› HaveanexecutedHIPAAAgreementforAgentsaffiliatedwithAgency

Agent qualificationsTobeanauthorizedCignaMedicareAgent/Broker,youmust:

› CompleteAgent/BrokercredentialingadministeredbyCignaMedicareoritsdesignee

› CompletetheCignaMedicareAgent/BrokercertificationtrainingandpasstherequiredcertificationexaminationsadministeredbyapprovedCignacertificationvendorsorCignauponcontracting(priortoselling)andannuallythereafter

› Completeanyinstructor-ledvirtualorin-persontrainingthatmayberequired

› BealicensedhealthAgentintheCignaMedicarestate(s)inwhichyouintendtosellandsubmitapplicationstoCignaMedicare,beingoodstanding,andsupplyCignaMedicarewithacopyofthelicenseuponrequest

› BeappointedbyCignaMedicareasanAgentinthestatesyouintendtosellandsubmitapplicationstoCignaMedicare,perstateregulations

› HaveanexecutedagreementwithFMO,SGA,MGA,GAorCignaMedicare

› Complywithalllegal,complianceandregulatoryguidanceinaccordancewithapplicablestateandfederallawsandCignaMedicarepolicies

› ReceivecontinuingeducationrelativetothecurrentMedicareAdvantage/PrescriptionDrugPlanproductsandcomplywithanychangesthatoccurrelativetothisprogram

› Attendanymeetingsrequiredtostayinformedofcomplianceandregulatory,proceduralandnetworkchanges

› ParticipateinintegrityoversightevaluationsandtheCignaMedicareSalesDevelopmentActionProgramasrequiredbyCMSandCignaMedicare

› Havereasonableaccessibilityforreceivingcommunicationsconcerningimmediateregulatoryornetworkchanges(i.e.,phone,email,fax,pager,voicemail,etc.)

› Maintainaproficiencyin,andknowledgeof,Cigna’sMedicareAdvantage/PrescriptionDrugPlanproductsaswellasallnecessarycompliancerequirements

› ComplywithCignaMedicaresalesperformanceanddisciplinarystandardsassetforthinCignaMedicarepoliciesandprocedures,hereinincorporatedbyreference

› HaveanexecutedHIPAAAgreementforAgentsaffiliatedwithanAgency,orhaveaBusinessAssociateAgreementforAgentsdirectlycontractedwithCignaMedicare


Agent/Broker credentialing

Agents/Brokersmustbeproperlylicensed,contractedwithCignaMedicareafterasuccessfulbackgroundcheck,appointedbyCignaMedicare,andcertifiedviacompletionoftheannualcertificationprocessbeforebeingabletosellanyCignaMedicareproducts.

Maintainingproperlicensure,contracting,appointment,andcertificationensuresanAgentremainsingoodstandingwithCignaMedicareinordertoservicecustomersandmaintainrenewalcommissions.

Licensing

AnAgentmustbelicensedandappointedintheirprimarystateofresidenceandallotherstatestheAgentwillmarketandsellCignaMedicareproducts.TheAgentisresponsibleforobtainingandkeepingtheappropriatelicensure.Licensingrulesvarybystate.

TheAgentmustcontacttheirToplineorLocalMarketManagerforfurtherdetails.

AgenciesmustbelicensedandappointedinallstatestheyandtheirAgentssellandmarketproductsforCignaMedicare.TheAgencyisresponsibleforobtainingandkeepingtheappropriatelicensure.

Licensingrulesvarybystate.Agenciesmustcontinuetobelicensedandappointedtoservicecustomersinordertocontinuereceivingrenewalcommissions.

ThefailureofanAgent/Agencytomaintaintheappropriatelicensure,appointments,andcertification,willresultintheAgent/AgencybeingterminatedfromsellingCignaMedicareproductsandwillceaseanyrenewalcommissions/administrativefees.

Contracting

Sales Agency Agreement

TheSalesAgencyAgreementisforAgenciesandAgentswhoaredirectlycontractedwithCignaMedicare.TheagreementestablishesthetermsandconditionsunderwhichtheSalesAgencyanditsdownlineAgenciesandAgentsareauthorizedtosellMedicareAdvantageandPrescriptionDrugPlansofferedbyCignaMedicare,includingthecompensationCignaMedicarewillpaytheSalesAgencyanditsdownlineAgenciesandAgentsforsellingsuchhealthplans.

Subordinate Agent Agreement

ThisSubordinateAgentAgreementisexecutedbyandbetweenCignaMedicareandaSubordinateAgentorAgency.ThisagreementstatestheSubordinateAgent/AgencyagreestobelegallyboundbythetermsandconditionsoftheSalesAgencyAgreement.

Contracting process

AnAgentmusthaveanexecutedagreementwithanFMO,SGA,MGA,GA,orwithCignaMedicare,asapplicable.ExternalToplineAgenciesareresponsibleforinitiatingonboardingandmaintenancerequestsfortheirdownlineAgenciesandAgentsthroughtheeContractingsystem(ProducerExpress).TheCignaMedicareContractingDepartmentisresponsibleforreviewingandprocessingonboardingandmaintenancerequests,communicatingtorecruitersinregardtocurrentstatus,activatingAgents,andarchivingcontractingdocumentation.

AnAgent’sfirststepintheonboardingprocessistocompletethedataentryassociatedwiththeonboardingeviteandelectronicallysignalldocumentsforsubmissiontoCignaMedicare.

Bulk Onboarding

Agenciesmustmeetminimumonboardingrequirements,meetorexceedCignaMedicarebackgroundcheckstandardrequirements,andbeapprovedbyCignaMedicareinordertoutilizebulkonboardingfordownlineAgents.ShouldAgencybeapprovedforbulkonboarding,CignaMedicaremayperformongoingcriminalbackgroundchecksonanyorallappointedAgents.

Recruitment ethics

WhenrecruitingnewAgentsasyoubuildyourAgency,itisoftencommontocomeacrossexistingCignaMedicareAgentsandAgencies.Asarule,youcannotcontractwithanycurrentCignaMedicaredirectlycontractedoremployedAgentswithoutwrittenconsentfromCignaMedicare.ThedirectlycontractedoremployedAgentcanrequestreleasefromtheirLocalSalesManager.

Asageneralguideline,werequestyourespectfullywalkawayfromanycurrentCignaMedicareAgentorAgencywritingunderanexistinghierarchy.

InanefforttominimizerunningintoexistingCignaMedicareAgents,eachlocalmarketcanscrubyourrecruitinglistsagainstactiveCignaMedicareAgents.Pleasesubmittoyourlocalsalesrepresentativebeforestartingyourmailorcallcampaign.

CignaMedicarelooksforwardtoworkingwithyouasyougrowyourorganization.WeencourageallofoursellingAgents/Agenciestomaintainthehighestlevelsofprofessionalism,courtesyandrespecttowardothers.


Contracting platform

ProducerExpressistheCignaMedicaredatasourceforlicenseandappointmentinformation.Appointmentsareprocessedaccordingtostatelicensureandappointmentlawsviatheautomatedonboardingandappointmentprocessingsystem.

New Agent onboarding processDownline Agent contracting packet

ThefollowingitemsarerequiredandareincludedintheAgentonboardingevite:

› AgentApplication

› AuthorizationtoConductaBackgroundInvestigation/Questionnaire

› SubordinateAgentAgreement–referencedabove

› AssignmentofCommissionsAgreementForm(applicableifAgentisassigningcommissionstotheiruplineAgency)–authorizesandempowerstheCompanytopayAssigneeAgencyallcompensation

› Hierarchyform

› W9(applicableifagentispaidcommissionsdirectly)

› EFTform(accompaniedbyvoidedcheck)–completethisformifDirectDepositisdesired;ifnotcompleted,checkswillbemailed.Note,thisformmustbesubmittedseparatelyfromthepacket,followingtheinstructionswithintheform.

Step one

NewAgentsareonboardedviaProducerExpress.

› ExternalAgentsareonboardedbytheirrespectiveToplineAgencyrecruiter(s).

› DirectlycontractedAgentsareonboardedbytheCignaMedicareContractingDepartment.

Step two

OnceonboardingiscompletedandsubmittedtotheCignaMedicareContractingDepartment:

› AbackgroundcheckwillbeautomaticallyinitiatedandtheautomatedappointmentprocessingwiththeNationalInsuranceProducerRegistry(NIPR)databasewillbeginforstatesselectedbytherecruiterduringonboarding.

– Backgroundcheck:IfanAgentpassesthebackgroundcheck,thecontractingprocesswillcontinue.IfanAgentfails,theywillreceiveanemailwithadditionalinformationregardingtheappealsprocess.Backgroundcheckscantakeanywherefromtwoto14businessdays,dependingontheAgent’sresidentstate.

Step three

Oncethebackgroundcheckiscompletedandatleastoneappointmentisinplace,arecordfortheAgentisestablished.

› ThenewAgentprofiledictatestheappropriatecertificationmodulesassignedinCignaMedicareProducers’University.

› RequeststoswitchagentstoaCommissionedTelesalesprofiletype,whichmaymodifythecertificationmodulesassignedinCignaMedicareProducers’University,mustbereviewedandapprovedbyCignaMedicare.

Step four

AnAgentisnotactivatedtomarketandsellCignaMedicareplansuntilthefollowinghavebeenvalidated.

› Thereisatleastoneactivelicenseandappointmentinplace.

› Thebackgroundcheckwassuccessfullypassed.

› Successfulcompletionofcertificationrequirements.

Oncecertificationiscomplete,the“Ready-to-Sell”emailissenttotheAgentadvisingthathe/sheisreadytobeginmarketingandsellingforCignaMedicare.Theemailidentifiesthestate(s)inwhichtheAgentisappointedandtheAgent’swritingnumber.AnAgentisonlyapprovedtosellinthestate(s)inwhichtheAgenthasbeenappointedandnoothers.IftheAgentintendstosellCignaMedicareproductsinadditionalstate(s),theymusteithersendanemailrequesttotheCignaMedicareContractingDepartmentorinformtheirrecruiterwhowillinitiatetherequest.TheAgentorrecruitercancontactContractingbyemailingContractingMailbox@Cigna.comwiththeAgentIDandarequesttobeappointed.AnAgentisnotapprovedtobeginsellinginadditionalstate(s)untiltheyreceiveconfirmationoftheirstateappointment(s)fromCignaMedicare.

IfanAgenthasanyquestionsorneedsassistancewithanypartoftheonboardingprocess,pleasecontactCignaMedicareContractingatContractingMailbox@Cigna.com.


New Agency onboarding process

Downline Agency contracting packet

ThefollowingitemsarerequiredandareincludedintheAgencyonboardingevite:

› AgencyApplication

› SubordinateAgentAgreement–referencedabove

› Hierarchyform

› PrincipalDesignationform

› W9

› EFTform(accompaniedbyvoidedcheck)–completethisformifDirectDepositisdesired;ifnotcompleted,checkswillbemailed.Note,thisformmustbesubmittedseparatelyfromthepacket,followingtheinstructionswithintheform.

Step one

NewAgenciesareonboardedviaProducerExpress.

› ExternalAgenciesareonboardedbytheirrespectiveToplineAgencyrecruiter(s).

› DirectlycontractedAgenciesareonboardedbytheCignaMedicareContractingDepartmentfollowingsuccessfulcompletionoftheFDRIntakeprocess.

Step two

Onceatleastoneappointmentisinplace,arecordfortheAgencyisestablished.

Step three

AnAgent/AgencyisnotactivatedtomarketandsellCignaMedicareplansuntilthefollowinghavebeenvalidated.

› Thereisatleastoneactivelicenseandappointmentinplace.

› Successfulcompletionofattestationrequirements.AgenciesarerequiredtologintoCignaMedicareProducers’UniversityandattesttothePoliciesandProceduresandRulesofEngagement.

Onceonboardingiscomplete,the“Ready-to-Sell”emailissenttotheAgencyadvisingthatAgencyisreadytobeginonboardingdownlineAgents.Theemailidentifiesthestate(s)inwhichtheAgencyisappointedandtheAgency’swritingnumber.AnAgencyisonlyapprovedtosellinthestate(s)inwhichtheAgencyisappointed.

IftheAgencyintendstosellCignaMedicareproductsinadditionalstate(s),theymusteithersendanemailrequesttotheCignaMedicareContractingDepartmentorinformtheirrecruiterwhowillinitiatetherequest.TheAgencyorrecruitercancontactContractingbyemailingContractingMailbox@Cigna.comwiththeAgencyIDandarequesttobeappointed.AnAgencyisnotapprovedtobeginsellinginadditionalstate(s)untiltheyreceiveconfirmationoftheirstateappointment(s)fromCignaMedicare.

Note,ifAgencyprincipalisasellingprincipal,he/shemustalsocompleteaseparateDownlineAgentcontractingpackettocontractasanindividualsellingagent.

IfanAgencyhasanyquestionsorneedsassistancewithanypartoftheonboardingprocess,pleasecontactCignaMedicareContractingatContractingMailbox@Cigna.com.

Contracting and changing hierarchies

MostcontractedAgentswhoareappointedtosellforCignaMedicarealignunderacompany-approvedandcontractedTopline.WhenanAgency/Agentchangeshierarchies,residualoverridecommissionsareretainedbythehierarchystructureandaresubjecttothecontracttermsinplaceatthetimeoftheoriginalsale.

IfanAgent/Agencywishestochangehierarchiestheymustfollowthestepsbelow.

Agent/Agency Request to change hierarchies with a new Topline

TheAgent/AgencymustbeingoodstandingwithCignaMedicare.TheAgent/Agencycannotbeunderinvestigationinternallyorexternally,musthaveacceptablecompliancemetrics,sufficientsales,notbeindebttoCignaMedicare,nothavethird-partypaperprohibitingamoveinhierarchy,andmustpossessanactivewritingnumberwithCignaMedicare.

AnAgent/AgencymusttransfertothesameorlowercontractlevelwiththenewToplineAgency.TheAgent/AgencymayonlyupgradetoahighercontractlevelaftersixmonthsfromthechangedateandifdownlineagentandproductionrequirementsaremetandCignaMedicareapprovalisgranted.


TheAgent/AgencymustbesuccessfullyreleasedfromthecurrentToplineAgencybeforeanymovecanbemadetoanewToplineAgency.Asuccessfulreleasecanbeaccomplishedinoneofthreeways.

1. ObtainareleaselettersignedbythecurrentToplineAgency.

2. IftheAgenthasbeencontinuouslyactiveunderthesameToplineAgencyforatleastthepreviousninety(90)calendardaysbuthasnotproducedanybusinessduringthattime,noreleaseisrequiredtochangehierarchies.

3. IftheToplineAgencyisunwillingtograntarelease,andtheAgent/Agencyhasproducedbusinessinthatpreviousninety(90)calendardays,theAgent/Agencycansubmitasignedanddated“Request for Release from Topline Form”totheContractingDepartmentviaemail([email protected]).ThiswillserveastheAgent’s/Agency’snoticeofintenttochangetoanewsaleshierarchyandwillstartaninety(90)calendardaywaitingperiodtobeeligibletoswitchhierarchieswithoutarelease.Theninety(90)calendardaytimeframeforareleaseofficiallybeginsonthedaytheContractingemailboxreceivesthereleaseform.

Aftertheinitialacknowledgmentofthechangerequest,noadditionalnoticesorreminderswillbesentfromCignaMedicareregardingtheeligibilitydate.Attheendoftheninety(90)calendardaywaitingperiodtheAgent/AgencywillbefreetoonboardwiththeAgencyoftheirchoosing.Agentsmaycontinuetosellduringtheninety(90)calendardays,butthebusinesssoldinthatninety(90)calendardaytimeframeremainsunderthehierarchyinplaceatthetimethebusinessiswritten.TheacceptingToplineAgencyisresponsibleforinitiatinganonboardingevitefortheAgent/AgencyinProducerExpress(Sircon).

AgentsandotherentitiesintheToplinehierarchyarepermittedtochangesaleshierarchiesnomorethanoncepercalendaryearundertheninety(90)calendardaynoticescenario(Option3above).

WhenanAgencyisreleased,thecontracteddownlineAgencies/Agentsareconsideredtobeincludedinthatrelease,unlessotherarrangementsarerequestedbytheToplineAgencyandapprovedbyCignaMedicare.TheacceptingToplineAgencyisresponsibleforinitiatingonboardingevitesforany/alldownlineAgencies/AgentsinProducerExpress(Sircon).

Agent/Agency request to change hierarchies within the same Topline Agency

TheToplineAgencyhasdiscretiontomoveandchangethelevelofAgentsandsolicitorswithintheirhierarchystructureatareasonablefrequency.

TheToplineAgencydoesnotneedtheconsentoftheAgentorAgencytocompleteamoveordowngradewithinitsownhierarchy.TheToplinedoes,however,needtonotifytheAgent/Agencyofthemoveordowngrade.TheToplineAgencywillinitiateanagreementmaintenanceeviteforanymoveordowngraderequests,whichwillbecompletedbytheAgent/AgencyandsubmittedtoCignaMedicareContracting.Residualoverridecommissionsareretainedbythehierarchystructureandaresubjecttothecontracttermsinplaceatthetimeoftheoriginalsale.

TheToplineAgencyisresponsibleforinitiatingagreementmaintenanceevitesforanydownlineAgencies/AgentsinProducerExpress(Sircon).

Agent/Agency training and certification at Cigna Medicare

CignaMedicareapproachestrainingasatooltohelpourAgentsandAgenciesbecomesuccessful.Tothisend,weofferavarietyofperformance-focusedtrainingandongoinglearningopportunitiesforallournewandexistingAgentsandAgencies.

TrainingandcertificationcanbeaccessedthroughtheCignaMedicareProducers’UniversityatCignaHealthSpringProducers.com.

Accessing training

Mostcoursesareofferedasself-pacedeLearningontheCignaMedicareProducers’University.CoursesareavailableatCignaHealthSpringProducers.com.ThissystemallowsAgentsandAgenciestohaveeasyaccesstotrainingandlearnattheirownpace.Afewothercoursesareinstructor-led(face-to-face)orvirtualinstructor-led(webinars).Somemayalsobeofferedasblendedlearning–incorporatingbotheLearningandinstructor-ledcontent.

› InordertoaccesstheProducers’UniversityandanyofoureLearningcontent,includingcertificationandothercourses,AgentsandAgencieswillneedtocompleteregistrationonthesite,firstasanewAgentandAgencyandthenannually.OnlyAgentsandAgencieswhohavebeenfullyonboardedinProducerExpressandsetupinourSalesforcesystemmay


registerandaccesstheProducers’University.ThesesystemsfeeduserinformationtotheProducers’UniversitytoenableanAgentorAgencytoregisterandpreventanyunauthorizedaccess.AnAgent’sorAgency’susernameonProducers’UniversityisusuallytheNationalProducerNumber(NPN).AgentsandAgencieswillneedtocreateasecurepasswordtogowiththeusername.AgentsandAgenciescanaccesstheirlearningortrainingtrackuponloggingintoProducers’University.Agentscanalsoregisterforinstructor-ledtrainingusingtheInstructorLed-Trainingscheduleavailableonthesite.

› TheResourceLibrarypageoftheProducers’UniversitycontainsseveraldownloadablejobaidsandreferencematerialsonanabundanceoftopicsthatAgentsandAgenciescanfindusefulbefore,during,andafterthesale.

Inactive Agents/Agencies

AgentsorAgencieswhonolongerhaveanactiveagreementwithCignaMedicarearenotallowedtoaccessanyofourtraining.InactiveAgentsorAgencieswillneedtocompletetherecontractingprocessinordertoaccesstraining.

Agent training requirements

› CertificationisrequireduponcontractingasanAgent/BrokerandannuallythereafterbythedatespecifiedannuallybyCignaMedicare.

› Agentsarerequiredto:

– Completecertificationpriortosellinganyofourproducts.

– CompletecertificationbythedeadlinescommunicatedbyCignaMedicaretoremainactive,qualifyforrenewalsandserviceexistingcustomers.

– PasseachcoursebythedeadlinescommunicatedbyCignaMedicare,withaminimumscoreof85%.

– Passeachcourseinnomorethanthreeattempts.AgentsshouldcontacttheirBrokerSalesRepresentativeintheeventacourseisfailed3timesandlocked.

› CertificationincludesstandardMedicaretraining,referredtoas“universal”trainingandCignaMedicarespecificcourses.

› AgentsarerequiredtocompleteuniversaltraininginadditiontotheCignaMedicarecorecertificationcourses.Agentsmaychoosetocompletetherequiredexternal(universal)MedicareandFraud

WasteandAbusetrainingprovidedbyanyofthecompaniesbelow.

CignaMedicarewillreimbursecertificationcostsfor2021MedicareAdvantageagentcertificationwhereeligibilityrequirementsaremet.Tobeeligibleforreimbursementagentsmustcomplete2021certificationbySeptember1,2020andsellfive(5)January1,2021effectiveapplicationsthatareingoodorder.Aftermeetingtheserequirements,agentswillbeeligibleforreimbursementasoutlinedbelow:

– AHIP($125reimbursement)www.AHIPMedicareTraining.com

– GormanHealth($99reimbursement)http://www.medicaresalestraining.com

– PinpointGlobal($89.95reimbursement)https://medicareonlinecertification.com

BothAHIPandPinpointGlobalcertificationscanbeaccesseddirectlyfromtheProducers’University.

› Forreasonsofemphasis,clarityorCMSdirectives,Cigna-Medicare’scertificationcoursesmayrepeatcertaintopicsthatAgentsmayhavecoveredintheexternalcertificationadministeredbyAHIP,PinpointorGorman.

Training Steps

1. GotoProducers’University

2. LoginwiththeNPNandpassword

3. Click“MyLearning”toseetracks

4. Selectanycoursetostart.Agentshavethreeattemptstopasseachcourse

5. LaunchandcompleteAHIPorPinpointMedicareTraining,oruploadavalidcertificatefromAHIP,PinpointorGormanHealth

CignaMedicare’strainingandtestingprogramsaredesignedandimplementedinawaythatmaintainstheintegrityofthetrainingandtesting,andensuresthateachindividualistakingthetestindependently.

Agents/brokersmaynotallowsomeoneelsetocompletetrainingontheirbehalforsharetheirloginstotheCignaMedicareProducers’Universitywithanyoneelse.DoingsowillviolatetheintegrityofthetrainingprocessandCMSAgentandTestingGuidelines.

CignaMedicaremaintainsevidenceofthetrainingtools,trainingexamsanddocumentationdemonstratingevidenceofcompletionandcanprovidethisinformationtoCMSuponrequest.


Annual attestation

AgentsandAgenciesarerequiredtoreviewandabidebytheCignaMedicarePoliciesandProcedures,RulesofEngagement,andSocialMediaPolicyandconsentthroughelectronicattestationpriortomarketingorsellinganyofourproductsandannuallythereafterbythedeadlinescommunicatedbyCignaMedicare.Note,sellingprincipalsmustcompleteboththeirindividualAgentattestationaswellastheirAgencyattestationseparately.AttestationscanbechangedatthediscretionofCignaMedicare.FailuretocompleterequiredattestationsbythedeadlinescommunicatedbyCignaMedicarewillresultinforfeitureofAgent-levelcommissionsand/orAgencyadministrativefeerenewals.

Product knowledge

AgentsmustmaintainaproficiencyinandknowledgeofCigna’sMedicareAdvantage/PrescriptionDrugplansaswellasallnecessarycompliancerequirements.

Policies and Procedures

AgentsmustcomplywithallapplicableCignaMedicare’ssalesperformanceanddisciplinarystandardsassetforthinstateandfederalregulations,andCignaMedicare’sPoliciesandProcedures.

Welcome email and call

OnceanewAgentisfullycontractedandsuccessfullycertifiedandtrained,heorshewillreceiveawelcomeemailcontaininganAgentwritingnumber.AgentsshouldnotbeginmarketingCignaMedicareplansuntiltheyhavereceivedaWelcome/Ready-to-Sellnotificationemail.ThisemailwillcontaintheAgentwritingnumberandlistofapprovedstatesinwhichtheAgentcansellCignaMedicareproducts.

AgentswillalsoreceiveawelcomecallfromCigna’sAgentResourceLinetoansweranyquestionsandassistwithinitialsaleskitorders.


Cigna-HealthSpring Certification Curriculum*

Course name Key focus

Selling with Integrity** Oursellingprocess

Howtosellconsultativelyandcompliantlyinone-on-onesettingandtelephonically

Ourvalueproposition

Products and Benefits Overview Lineofproductsandfeatures

Modelofcare

Eligibility

Snapshotofallplansandthekeybenefits

Our Compliance Program KeyrequirementsofourComplianceProgram

HIPAAandComplianceculture

Agent’sroleinourComplianceProgram

Reportingviolations

New Agent Training*** DoingbusinesswithCigna-HealthSpring:tools,processes,keyrequirementsandourvalueproposition

Attestations ReviewandattestationofRulesofEngagement,Policies&Procedures,SocialMediaandPrivacy

Cigna-HealthSpring Rx (PDP) Ourstand-alonePartDproduct

*The curriculum and content may change slightly from year to year.

**Selling with Integrity is offered in three different versions: Field, Telesales and Combined Field and Telesales. Agents will be assigned one based on their contract or their upline’s contract with us. If an Agent switches channels (i.e., Field to Telesales), the agent will be required to complete the appropriate Selling with Integrity course in order to fulfill training requirements for the new channel.

***New Agent Training is recommended for all newly contracted Field Agents and may be online, instructor-led (face-to-face), or virtual instructor-led.

Remediation training

ThistrainingisfocusedonhelpingAgentsimprovecomplianceperformanceandsatisfyviolationrequirements.

› Remediationcoursesareassignedasneededandmayrequireagentstoretakeapreviouslycompletedcourse

› AgentsarerequiredtocompletetimelytocontinuetobeingoodstandingwithCignaMedicare

› AcoachingsessionwithaCignaMedicareemployeemaybearequiredcomponentoftheremediationtraining

Invitation only

Certaintrainingcoursesandeventsareinvitationonly.Whenapplicable,Agentswillbeinvitedtoregisterforthetrainingandattendonlineorinperson.AnexampleofthisisourSalesEventTrainingforAgentswhohavebeenhandpickedtoconductsaleseventsonbehalfofCignaMedicare.


SECTION III

SUSPENSION AND TERMINATIONSuspension of sales and marketing

CignaMedicareexpectsyoutocomplywithallCentersforMedicare&MedicaidServices(CMS)regulations,stateandfederallaws,guidelines,andCignaMedicarerules,policies,andprocedures.

› IfatanytimeyourperformanceoractiondamagesorthreatenstodamageanyMedicarebeneficiariesorthereputationofCignaMedicareordoesnotmeettheCignaMedicare’sstandards,CignaMedicarecan,atitsdiscretion,initiatesuspensionofyoursalesandmarketingactivities.

› Adeterminationtosuspendcanalsobebasedontheseverityofanallegation(s),thenumberofpendingcomplaintsorinvestigations,thenatureandcredibilityofinformationinitiallyprovided,and/orthenumberofcustomersorbeneficiariesaffected,andcanbebasedonotheroversightcriteria.Insuchcases,suspensionisineffectuntiltheinvestigationiscompleted,afinaldisciplinaryrecommendationhasbeenmadeandanyrequiredremediationhasbeencompleted.

› CignaMedicaremayberequiredtoreportthesuspensiontotheapplicablestateorgovernmentAgency.

Suspension process

› Whenadeterminationtosuspendyoursalesandmarketingactivitiesismade,youwillbesentasuspensionnotificationfromCignaMedicareContracting,withacopysenttoyourTopline.

› YouarenottosolicitorsellCignaMedicareproductswhileonasuspensionstatus.

› Agentscannotwritenewbusinesswhileundersuspension.Ifnewbusinessiswrittenduringthesuspensionperiod,agentswillnotbeeligibleforcommissionsand/orrenewals.Furtherdisciplinaryactionmaybelevied.

› CignaMedicarewillsatisfysuspensionreportingrequirementswithnotificationtotheappropriatestateAgencies.

› Wearenotobligatedtoreportyourstatustoagovernmentagencyunlessfurtheractionisrequired.

Temporary hold status

Dependingonthecircumstances,anAgentmaybeplacedon“temporaryhold.”Whenarecommendationtoplaceyoursalesandmarketingstatusontemporaryholdismade,youwillbesentatemporaryholdnotificationfromCignaMedicareContracting,withacopysenttoyourTopline.Thestatusof“temporaryhold”means:

› YouarenottosolicitorsellCignaMedicareproductswhileonatemporaryholdstatus.

› Anyoutstandingcommissionswillcontinuetobepaidduringthisperiod.

› Wearenotobligatedtoreportyourstatustoagovernmentagencyunlessfurtheractionisrequired.

Agent termination: not-for-cause and for-cause

Allcontractandappointmentterminationsareclassifiednot-for-causeorfor-cause.TerminationofappointmentmayberecommendedbyCignaMedicare,theToplineorimmediateupline,aregulatoryAgency,orstateDepartmentofInsurance,oranAgentmayrequestavoluntaryterminationoranalterationtotheToplinehierarchy.

Not-for-cause termination (Agent/Agency)

Anot-for-causeterminationcanbeinitiatedbyyourToplineorimmediateupline,CignaMedicare,oryou,foranyreasonincluding,butnotlimitedto,relocation,expiredlicense,expiredErrorsandOmissionsinsurancecoverage.Thefollowingprocessisfollowedwhenanot-for-causeterminationisrequested.

› Terminationrequestsmustbesubmittedinwritingviaemailoraterminationformoutliningthereasonfortermination.Thetermination formmaybeobtainedbyContractingatContractingMailbox@Cigna.com.TheterminationrequestmustbesubmittedtoContractingatContractingMailbox@Cigna.com.

› TheterminatedAgent/Agencywillbesentaterminationnotification,whichwillidentifytheeffectiveterminationdate.

› State-levelappointmentswillbeterminatedinconjunctionwiththedatetheagreementisterminated.


› WhenanAgencyisterminated:AnydownlineAgents/Agencieswillbemovedunderthenexthighestentityinthehierarchy.

› Terminationwillceasepaymentofcommissions.

Agent

IfyouareterminatedbyyourToplineAgencyorfallunderaToplineAgencythatwillnolongerholdacontractwithCignaMedicarebutareingoodstandingwithCignaMedicare,(i.e.,notunderinvestigationinternallyorexternally,haveacceptablecompliancemetrics,sufficientsales,notindebttoCignaMedicareand/orcurrentupline,donothavethird-partypaperprohibitingamoveinhierarchy),youmayre-contractunderanewhierarchyordirecttoCignaMedicare.Ifrecontracting,onboarding,certification,andactivationarecompletewithinthirty(30)calendardaysoftheterminationdate,commissionsandrenewalsmayberestored.

Agency

IfanAgencyisterminatedbyitsToplineorfallsunderaToplineAgencythatwillnolongerholdacontractwithCignaMedicareandisingoodstandingwithCignaMedicare,theAgencymayrecontractunderanewhierarchyordirecttoCignaMedicare.

For-cause termination

Afor-causeterminationcanbeinitiatedbyCignaMedicareorbyanexternalregulatoryAgency.

› Afor-causeterminationnotificationletter,detailingtheoffense,terminationeffectivedate,andtheappealprocess,issenttoyouviacertifiedU.S.mail.

› YourToplineoruplineisemailedacopyofyournotificationletter.

› State-levelappointmentswillbeterminatedinconjunctionwithfederalandstaterequirements.CommunicationtoanystateinwhichtheAgent/Agencyisappointedwillbemadeinaccordancewithallfederalandstaterequirements.

› WhenanAgencyisterminated,anyactivedownlineAgents/Agencieswillbemovedunderthenexthighestentityinthehierarchy.

› TerminationwillresultintheAgent/Agencybeingineligibletoreceiveanyfurthercommissionpayments.

› Insomecases,asdirectedbytheCignaMedicareSalesDevelopmentActionProgram,yourprofileinthecontractingsystemscouldalsobemarkedas“DoNotRecontract.”

› Ifyouareterminated“for-cause”or“notfor-cause”duetocomplianceand/orotherdisciplinaryreason,perourpolicy,youmustwaitatleastoneyearbeforeapplyingforreinstatement.

“Do Not Recontract” reinstatement process

Ifyouareflagged“DoNotRecontract,”youmaynotcontractwithanyCignacompanyoritsaffiliates,including,butnotlimitedto,allCignaMedicareandcommercialproducts.

Thefollowingistheprocesstorequestreconsiderationofyour“DoNotRecontract”status.

› Whenyoureceiveyourterminationletter,youhaveten(10)businessdaystoappealbysubmittingtheRequestforReinstatementofAppointmenttotheContractinginbox.PleasesenditviaemailtoContractingMailbox@Cigna.com.

› Iftherearenoopenviolationsagainstyou,therequestwillbeconsideredattheSalesDevelopmentActionProgram(SDAP)meeting.Ifthereareopenviolations,youandtheappropriatesalesleaderwillbenotifiedviaemailortelephonethatthereinstatementrequestwillnotgotothecommitteeuntiltheopenviolationshavebeenclosed.

› Thereinstatementrequest,alongwithanypertinentnewinformation,isreviewedbytheSDAP.Whenthecommitteehasmadeadetermination,theoutcomewillbedocumentedinyourAgentfileandyouwillbenotifiedinwritingviaemailwithanelectroniccopytoyourTopline.

› Ifyouareapprovedforreinstatement,youwillberequiredtorecontractbysubmittinganewcontractingpacket.

› Ifyouarenotapprovedforreinstatement,youmustwaitatleastoneyearbeforesubmittinganyadditionalrequestsforreconsideration..


TheinformationcontainedinthissectionprovidesageneralsummaryoftheCompensationRulesofEngagementandtheMedicareAdvantagePrescriptionDrugCompensationSchedule.Pleaserefertoeachrespectivedocumentforadditionaldetails.TheMedicareAdvantagePrescriptionDrugCompensationScheduleandtheCompensationRulesofEngagementshallsupersedeintheeventofaconflictwiththisSectionIII.

Compensation overview

CignaMedicareannuallypublishestheMedicareAdvantagePrescriptionDrugCompensationScheduleandRulesofEngagement,whichprovidesadditionaldetailspertainingtoourcommissionprocessing.TheCompensationRulesofEngagementcanbefoundonCignaMedicareProducers’University.

PerCMSguidelines,CignaMedicaredefinesacompensationyearasJanuary–December(anormalcalendaryear).CignaMedicareisrequiredtopayAgentsatthecompensationrateswithinrangesfiledandattestedannuallywithCMS.AgentswithanAssignmentofCommissions(AOC)mustsimilarlybepaidbytheAssigneeunlessacompliantcompensationplanissubmittedwithdocumentedapprovalfromCignaMedicare.MorespecificcompensationinformationcanbefoundintheCignaMedicareCompensationRulesofEngagement.

Commissions – individual sales

EnrollmentsmustbearesultofthedirectcontactbetweentheAgent/Brokerandtheindividualprospect.CignaMedicarewillpayacommissionforeachindividualwhotheAgencyorSubordinateAgency,BrokersorAgentsenrollinaCignaMA/MAPDplan.Agent-levelcommissionsandAgencyadministrativefeesfornewapplicationsarepaidperthecurrentCignaMedicareCompensationRateSchedulesetforthannuallylocatedonCignaMedicareProducers’University.

PaymentswillbemadeduringthenormalcommissionpaymentscheduleassetforthbyCignaMedicarepolicyunlessotherwiseagreedbetweentheparties.

New application commission payments

InordertobeeligibletoreceiveAgent-levelcommissionpayments/AgencyadministrativefeesfromCignaMedicare,boththeAgentandAgencymustbeproperlycontracted,licensed,andappointed(basedoneachstate’sregulations)priortomakingasale.WritingAgentsarealsorequiredtocompleteannualtraining/certificationrequirementspriortomakingasale,perCMS.IfthewritingAgentisnoncompliant,paymentwillnotbeadministeredtoanyparty,includinghierarchy,fortheapplicableenrollment.IntheeventanAgencyisnoncompliant(i.e.isnotproperlycontracted,licensedandappointed,and/orhasnotcompletedrequiredattestation),thespecified.Agencywillnotreceivepayment,butallothercompliantentitiesinthehierarchymayreceivepayment.CignaMedicarepaymentsonnewapplicationsaremadepertheschedulesetforthintheCignaMedicareCompensationRateScheduleandalsolocatedonCignaMedicareProducers’University.Paymentschedulesmaybechangedannuallyand/oratthediscretionofCignaMedicare.

Commission Department services

TheCommissionDepartmentexiststoprocessnewapplications,chargeback,CMSreconciliationandrenewalcommissionpayments,aswellastoprovideservicetotheAgentandAgencypartnerssurroundingthesepayments.AnyinquiriestotheCommissionDepartmentshouldbesentfromtheBrokerpartnerthroughsecuremessagingviaCignaMedicare’ssecurewebportaloranothersecureportalutilizedbytheBrokerpartner.InquiriesareveryimportanttotheCommissionDepartmentandallinquirieswillreceivearesponsewithin72hoursofreceipt,exceptduringhigh-volumeperiods,suchasfollowingtheJanuaryrenewalpaymentandtheJanuary1newsalescycles.AllcommissioninquiriesshouldbemadetoCommissions@CignaMedicare.com.

SECTION IV

COMMISSIONS


Commission statements

DuringpayperiodsinwhichanAgentorAgencyhastransactions(newapplication,chargeback,CMSreconciliationorrenewalrecords),acommissionstatementwillbegenerated.CignaMedicarestatementsareemailedtoallproducersviasecureemailfromtheCommissionDepartment.ArizonaAgents/AgenciescanaccesscommissionstatementsforbusinesswrittenunderaCignaLegacyArizonacontractwithintheEvolveNXTBrokerportal.ThesestatementsarenotemailedunlessrequestedfromCignaProducerCommissions:[email protected].

Currently,CignaMedicareusesProofpointasthesecureemailsite.Registrationtothissite(loginandpassword)isrequiredtoaccessCignaMedicarestatements.AgentsorAgencieswhohavetroubleopeningtheirstatementsthroughthesecuredProofpointsystemshouldcalltheCignaAgentResourceLine(CARL)[email protected].

Allcommissionstatementsoutlinetheactivitywhichhasoccurredwithinthegivenpayperiodforeachproducer.

Cigna Agent Resource Line (CARL)

CARLisCignaMedicare’sHelpCenterstaffedbyemployeestrainedtoprovidevaluablesupporttoactiveInternalandExternalAgents.

CARL’shoursofoperationare:

› October1–December7(AEP):Monday–Saturday7:00am–9:00pmCSTandSunday9:30am–6:00pmCST

› December8–December31(Post-AEP):Monday–Friday7:00am–6:00pmCST

› January1-March31(OEP):Monday–Saturday7:00am–7:00pmCST

› April1–September30(Lock-In):Monday–Friday7:00am–6:00pmCST

Selling or Transferring an active commissionable book of business

SubjecttoCMSrulesandregulations,asamendedfromtimetotime,andwhenapprovedbyCignaMedicareProducerCommissionsmanagement,AgentsandAgenciesmaybepermittedtotransfertheiractivecommissionablebookofbusinesstoanotherAgentorAgencyingoodstandingwithCignaMedicare.Thetransfermustbetheresultofanacquisition,merger,sale,consolidation,deathofanagent,orotherlegaltransaction,andthetransferringAgent/AgencymustbeterminatingtheircontractwithCignaasaresultofthesale/transfer.DetailedrulesandrequirementsforaBookofBusinesssaleortransfercanbefoundintheCignaMedicareCompensationRulesofEngagement.


Compliance/oversight responsibility

ToplineAgencies,pleaserefertoCignaMedicareFDRIntegrityOversightGuide.Furthermore,theDelegatedServicesAgreementcontainsadditionalobligationsforcomplianceandoversightactivitiesbyToplineAgencies.TheFDROversightGuideandDelegatedServicesAgreementshallcontrolintheeventofaconflictwiththisSectionV.

TheToplineAgencywillregularlyreviewtheperformanceofitsdata,aswellastheperformanceofallitsdownstreamdata.TheAgentisresponsibleforreviewinghisorherdataonaregularbasis.Thisincludesanydownstreamdataasapplicable.CignaMedicareAgentsandAgenciesmustreviewandinvestigatecomplaintsinatimelymanner.FailuretocooperatewithaCignaMedicareinvestigationmayresultinterminationoftheAgencyorAgentcontract.

AgentsmustactivelyparticipateintheCignaMedicareoversightprogram,standardsofwhichmaybechangedorenforcedinthesolediscretionofCignaMedicare,andwhichmayinclude,butarenotlimitedto:

a. PeriodicreviewofAgent’scontractualobligationstoensureAgentismeetingrequirements

b. ParticipationinCignaMedicare’sevaluationprograms(e.g.,ridealongs,telephonicreviews,secretshops).Evaluationsmustreceiveapassingscore.AllfailureswillbeprocessedthroughtheSalesDevelopmentActionProgram(SDAP).

c. ReviewofapplicationstoensuretheyarecompletedperCignaMedicareandCMSstandards.

d. ReviewofScopeofAppointments(SOA)toensuretheyareobtainedandcompletedperCignaMedicareandCMSstandards.

e. Asapplicable,ensuresaleseventsareapprovedbyCignaMedicarepriortoeventsandwithintheCMStimeframeforsubmission.

f. EnsureapplicationsaresubmittedtimelyperCignaMedicareandCMSpolicy.

g. Agentsmustregularlyreviewcomplaintrates,voidratesandrapiddisenrollmentrates.

h. PeriodicreviewofotherCignaMedicarepoliciesandprocedurestoensurecompliance.

SECTION V

OVERSIGHT


Sales Development Action Program

CignaMedicarehasimplementedadevelopmentactionprogramwhichismanagedbytheSalesDevelopmentActionProgram(SDAP).TheSDAPiscomprisedofseniorleadershipwithinCignaMedicareandmeetsregularlytoreviewpotentialCignaMedicareandCMSpolicyviolationsbyanAgentorAgency.Policyviolationsmaytriggeraremediation/correctiveactionplanwhichtheAgentorAgencymustcomplete.

Agentremediation/correctiveactionplansmayinclude,butarenotlimitedto:

a. Retraining.

b. MeetingwithaCignaMedicarerepresentativetoreviewtheviolation(s)anddiscusspolicyrequirements.

c. Ride-alongs.

d. Secretshops.

i. Aformalaudit.

j. Financialpenalties.

k. Suspensionofsellingactivity,whichmustbereportedtostateandfederalAgencies.

l. Temporaryholdofsellingactivities.

m.Terminationofcontract.

Agencyremediation/correctiveactionplansmayinclude,butarenotlimitedto:

a. MeetingwithaCignaMedicarerepresentativetoreviewtheviolation(s)anddiscusspolicyrequirements.

b. Aformalaudit.

c. Financialpenalties.

d. Temporaryholdofsellingactivities.

e. Terminationofcontract.

Sales Complaints

AsalescomplaintisanallegationthatanAgentmisrepresentstheplanorplanbenefitsbyviolatingCMSguidelinesorregulationsand/orCignaMedicarepoliciesandprocedures.Salescomplaintsarereceivedfrommultiplesources:MedicareComplaintsTrackingModule(CTM),GrievanceTrackingSystem(GTS)orothersource.Salescomplaintsaretypicallyfiledbyacustomer,acustomer’srepresentative,aprovider,oraregulatoryAgency(SSA,congressionaloffice,etc.)onbehalfofacustomer.AllsalescomplaintsareinvestigatedandSDAPisengagedregardlessoftheoutcomeoftheinvestigation.

CTM Sales Complaints

ACTMisasalescomplaintthatisreceivedfromtheCentersforMedicare&MedicaidServices(CMS)directlyfromtheCMS’sHealthPlanManagementSystem(HPMS)ComplaintsTrackingModule(CTM),adatabasethatassistsCMSanditscontractedplansintrackingandresolvingcomplaints.Eachcomplaintreceivedwithinthedatabaseisconsidereda“CTM”orCTMcase.ACTMcanbefiledagainstanyCignaMedicareplancontracts(PDPandMAPD)andcanbeforanytypeofissue,suchascustomerservice,enrollment/disenrollment,copay/coinsurance,pricing/premium,claims,benefitcoveragedeterminations,organizationdeterminations,orappeals.ACTMconcerningtheactionsofanyAgentcanalsobealleged.EachCTMisassignedanissuelevelbyCMS,whichdeterminestheduedateoftheCTMcase.OurinternalguidelinesfollowtheCMSissuelevels.

› ImmediateNeedCTM–one-dayturnaroundtime

› UrgentCTM–seven-dayturnaroundtime(internalgoalthreedays)

› RegularCTM–30-dayturnaroundtime(internalgoal15days)

Customer Service Violation (CSV) Sales Complaints

ACSVisasalescomplaintthatisreceivedfromanyothersourceotherthanthatdescribedinCTMSalesComplaints.Thosesourcesinclude,butarenotlimitedto,theGrievanceTrackingSystem(GTS),aCignaMedicareinternaldatabasethattracksgrievancesinitiatedbycustomercommunications(verbalorwritten)withCignaMedicareCustomerService;theComplianceorEthicsHotline;DepartmentsofInsuranceofotherregulatoryauthorities;orothersourcedeemedapplicablebyCompliance.ACSVcanbefiledagainstanyAgentallegingtheactionsoftheAgentdirectlyorindirectlyledtothegrievance.ACSVistypicallyassignedaregularissueleveldeterminingtheduedatewitha30-dayturnaroundtime(internalgoal25days).

Reporting of identified compliance issues

AgencieswillreportpotentialissueswhichmaybeviolationsofCMS,state,federalorplan-specificpolicy,requirementsaffectingsellingprivilegestoCignaMedicareupondiscovery.PartiesagreetocooperatewithCignaMedicarebyprovidinganyandalldocumentationrequiredtoevaluate,correctandmonitortheidentifiedissueasapplicable.

AgenciesshouldrefertotheirCignaMedicareSalesIntegrityFDRoversightguidefordeadlinesforreportingschedulesandadditionalinformation.


SECTION VI

TELESALES REQUIREMENTS Establishing a Telesales Agency with Cigna Medicare

AtCignaMedicare,webelieveinprovidingqualitycareandresponsiveservicetoourcustomerswhenandwheretheyneedit.WearefocusedonputtingourcustomersatthecenterofallwedoandwelcomeAgencieswhosharethisfocus.Theseguidelinesprovideadditionaldetailsonhowtoestablishacompliantandcustomer-focusedtelesalesAgencyonbehalfofCignaMedicare.

Telesales Agency criteria

Allstate/federalandCignaMedicarerequirementsmustbefollowedbyanyorganizationthatwillperformtelephonicenrollmentfunctions(telesales).ThefollowingminimumrequirementsoutlinewhatisnecessarytoimplementandmaintaintelesalesfunctionsonbehalfofCignaMedicare.

Compliance requirements

› TelesalesAgenciesarerequiredtoadheretothetelesalessetupcriteria,theTelesalesAddendumintheDelegatedServicesAgreement,andtelesalespoliciesandprocedures.

› Iftheorganizationdoesnotadheretothetelesalesrequirements,andifappropriateremediationactionisnottakenwithin72hoursofwrittennotice,theorganizationmaybesubjecttoimmediatetermination.

› ThetelesalesfunctionwillbeevaluatedonanannualbasistoensurecompliancewithCMSguidelines,CignaMedicarepoliciesandcontractadherencewithregardtotelesalesproduction.

› TheAgencymustcreateandmaintainallapplicablepoliciesandprocedurestosupportthetelesalesfunctions,whichincludebothtechnicalandadministrativesafeguards.

› CallerIDSpoofingisprohibited.“CallerIDSpoofing”or“Spoofing”isapracticewhereacaller(e.g.,anagentorbroker)makesatelephonecalltoapotentialcustomerusingatechnologythathelpsmaskthecaller’sidentitybyshowingtherecipientacallerIDtelephonenumberthatisdifferentfromthecaller’sactualtelephonenumber.Thisoftenoccurswhenrobocalltechnologyisutilized.Spoofingisillegal

undertheTruthinCallerIDActwhichmakesillegalthetransmissionofmisleadingorinaccuratecallerIDinformationwiththeintenttodefraud,causeharm,orwronglyobtainanythingofvalue.Anyonewhoengagesinillegalspoofingcanfacepenaltiesofupto$10,000foreachviolation.Cignarequiresthatbrokersandagentscomplywithallapplicablefederalandstatelaws.CignadoesnotapproveoftheuseofcallerIDspoofingtechnologyandwillterminateitsrelationshipwithanyproducerwhoisfoundtobeusingthetechnologytomisleadpotentialcustomers.WeencourageallagentsandbrokerstoreviewtheFederalCommunicationsCommissionwebsitetolearnmoreabouttheTruthinCallerIDActandconsumerissuesassociatedwithrobocalling:https://www.fcc.gov/consumers/guides/stop-unwanted-robocalls-and-texts

AnyviolationofCignaMedicareorstate/federalrequirementsmayresultindisciplinaryactionuptoandincludingterminationoftheCignaMedicarecontract.

Organizational structure

› Priortostartup,theAgencywilldetermineiftheywilloperateyear-roundoronlyduringtheAnnualElectionPeriod(AEP).

› AgencyshouldnotifytheirAccountManagerinwriting30dayspriortomakingchangestotheiroperatingduration(daysofoperation,operationhoursorclosingoftelesalesoperations).ChangescannotbemadeuntilwrittenapprovalisreceivedfromCignaMedicare.

› ThetelesalesAgencyshouldhaveapointofcontactfordailymanagementaswellasescalationissues.

Production requirements

› Thereisa12-monthramp-upperiodfornewtelesalesAgenciestomeetproductionrequirements.

› ProductionrequirementsmustbemetattheAgencycontractlevel.

› Failuretomeetproductiontargetsfollowingtwoconsecutivemonthsafterthe12-monthramp-upperiodmayresultinterminationofthetelesalesportionofthecontractwith30-daynotice.


Licensure

› AllAgentsandAgenciesarerequiredtocompletetheappropriatelicensing,appointmentandstatespecificrequirementsinallstatestheAgencyorAgentsellstheCignaMedicareproduct.ThisincludesexternalcertificationtrainingadministeredbyAHIP,PinpointorGorman,aswellasadditionalrequiredtrainingmodules.

› Oncealltrainingiscomplete,theAgentwillbemade“active.”TheAgentwillthenbeassignedawritingnumberandAgentIDtoaccesstheCignaMedicareenrollmentplatform.AgentswillonlybereadytosellaftertheyreceivetheirCignaMedicare“WelcomeLetter,”listingthestatesandappointmentsinwhichtheyarepermittedtosell.

› CignaMedicarewillappointand/orterminateallAgentsprocessingtelephonicenrollments.

› AllAgentsmustcomplywithanyadditionaltrainingrequirementsidentifiedduringthetermoftheagreementwithCignaMedicare.

› TelesalestrainingwilloccurbetweenSeptember1andOctober15eachyear.Onsiteand/orwebinartrainingmaybeprovidedbyCignaMedicareatthetimeofinitialsetup,andannuallythereafter.

Initial setup of new Telesales Agency

› AnAgencysitevisitmustoccurpriortoproceedingwithimplementation.

› Sitevisitswillinvolveacompleteassessment,whichmayinclude,butisnotlimitedto,telesalesoperations,technicalcapabilitiesandcomplianceoversight.

› Anydeficienciesidentified duringthesitevisitwillbecommunicatedtotheAgencywithrequiredremediation.TimeframesforcompletingremediationworkwillbeagreeduponbyboththeAgencyandCignaMedicare.Ifremediationdeadlinesarenotmet,telephonicenrollmentcapabilitywillnotbegranted.

› TheAgencywillbeprovidedwithcopiesofallapplicableguidance(marketing,sales,etc.)thatwillneedtobecapturedinpoliciesandprocedures.

› AgencywillhavetocompleteaCignaMedicareITreview.IfAgencyanduplinehierarchyconfirmstheydonotexpecttoreceiveleadsfromCigna,ashortenedITreviewwillbeconducted.However,shouldanythingchangeinthefutureinthatAgencyorhierarchywishestoreceiveoverflowleadsfromCigna,amoreindepthITreviewwillberequiredbeforeleadscanbereceived,shouldtheybeavailable.

Telephonic systems

› AnAgencymusthaveatelephonesystemthatcanaccuratelyrouteprospectivecustomerstotrainedandqualifiedindividualemployeeswhocanappropriatelyhandletheircall.

› ThetelephonesystemmustbeabletotransfercallstoaparticularAgentasrequestedorneeded.Livedemonstrationmayberequiredduringsitevisit.

› Thetelephonesystemshouldhavethecapabilitytodoeithersilentorside-by-sidemonitoringoflivecalls.Livedemonstrationmayberequiredduringsitevisit.

› AgencywillhavetocompleteaCignaMedicareITreview.

› ThetelephonesystemmustalsohavevoicemailcapabilityoradministrativesupporttoanswercallswhenalicensedAgentisnotavailable.Agencymustreturnthecallwithinonebusinessday.Livedemonstrationmayberequiredduringsitevisit.

› AnAgencymustbeabletorecordalltelephonicneedsassessments,discussions,salespresentationsandenrollmentsforthedurationofthecall,includinginternaltransfers.

› AnAgencymustsuccessfullycompletetestingpriortogoinglive.Testingwouldincluderecordingcallsandsuccessfullyretrievingthestoreddata.Livedemonstrationmayberequiredduringsitevisit

› AnAgencymustbeabletosaverecordingsina.WAVor.MP3fileusingthefollowingnamingconvention(livedemonstrationmayberequiredduringsitevisit).

– Applicationcallsshouldbesavedas:

· Customer’sname_Agent’sname_YYYYMMDD_carriername

– Fact-findingcalls(includesneedsassessmentand/orpresalecall)shouldbesavedas:

· Customer’sname_Agent’sname_YYYYMMDD_carriername_FFPart1



– RewrittenApplicationcallsshouldbesavedas:

· Customer’sname_Agent’sname_YYYYMMDD_carriername_re-enroll


Telesales recording transfer and storage requirements

CignaMedicarehastwooptionsavailableforprovidingrecordedtelesalescalls.Thetelesalescallrecording(“Recording”)istoincludetheneedsassessment,presale/salespresentationandtheenrollmentprocess.Failuretomeettheoutlinedrequirementsmayresultindisciplinaryorremediationactions.

Fornewlyonboardedcallcenters,Optiononewillberequiredforaprobationaryperiodofsixmonthstoensuretransfertimelineexpectationsand100%callreconciliationcanbemetpriortoallowingelectionofOptiontwo.

Option one (standard):

› 100%ofallRecordingsmustbepostedtotheCignaMedicaresecureFTPsitewithinfive(5)businessdaysorseven(7)calendardays.

› CignaMedicarewillensuretheRecordingsarestoredfor10yearsperCMSrequirements.

› AgenciesmustnotifyCignaMedicareofanychangestotheirInternetProtocol(IP)address.

Option two (requires approval):

› Agencyisrequiredtoprovidefive(5)RecordingsforthefirstweekofAEP.

– RecordingsmustbeuploadedtotheCignaMedicaresecureFTPsitewithinfive(5)businessdaysorseven(7)calendardaysfromthedateofenrollment.

› AgencyisrequiredtoprovideRecordingsasrequestedbyCignaMedicareforQualityAudits.TheCignaMedicareIntegrityteamwillidentifythenumberofRecordingstobeprovidedquarterly.

– AgencywillreceiveanemailfromtheAccountManager,outliningtheRecordingstobeprovided.

– RecordingsaretobeuploadedtothesecureFTPsitewithinfive(5)businessdaysorseven(7)calendardaysoftherequest.FailuretoprovidethecompletecallswithintherequiredtimeframemayresultinAgencySDAPviolation.RefertoSectionIII:SuspensionandTerminationforadditionaldetailsandremediationrequirements.

› ForAgentcomplaintsandCMS/Compliancerequests,AgencyisrequiredtoprovidetheRecordingtoCignaMedicareviathesecureFTPwithinthefollowingtimeframes.

– Urgent/immediateneedCMSrequestswithin24hours

– Standardrequestwithinfive(5)businessdaysorseven(7)calendardays

– AgencymusthaveandprovideacontactthatwillprovideRecordings,andrespondtourgent/immediateneedCMSrequestswithin24hours,sevendaysaweek.

› AgencyisrequiredtoprovideRecordingsasrequestedforvirtualRide-Alongreviews.

– AgencyisrequiredtoprovideRecordingsasrequestedbytheCignaMedicareComplianceteam.

– AgencywillreceiveanemailfromtheClientServiceManageroutliningtheRecordingstobeuploadedtothesecureFTPsite.

– RecordingsaretobeuploadedtothesecureFTPsitewithinfive(5)businessdaysorseven(7)calendardaysoftherequest.FailuretoprovidethecompletecallswithintherequiredtimeframemayresultinAgencySDAPviolationsandremediationrequirements.

› AgencyisrequiredtomaintainallRecordingsinaccordancewiththeCMSrecordsretentionguideline(minimumof10years).

› Agencyisrequiredtoconductself-auditstoensure100%oftelesalesenrollmentshaveRecordingsonfile.AgencymustimmediatelyreportanyreconciliationdiscrepanciestoCignaMedicare.

› AgenciesmustnotifyCignaMedicareofanychangestotheirInternetProtocol(IP)address.

TwofailurestoprovideRecordings,basedontheaboverequirements,mayresultinrevocationofOptiontwo.

Remote Telesales Agency

› AdeterminationwillbemadebyCignaMedicaretoallowAgenciestohaveremotetelesalesAgents.

– AgencymusthavesoldtelephonicallywithaphysicallocationforatleastoneyearwithaproventrackrecordwithCignaMedicare.

– Agencymusthaveadedicatedtrainingstaffthathassoldtelephonicallyandunderstandsthenuancesofsellingoverthephone.

– Agencymustbewillingtoaccommodatein-housetrainingforremoteAgentsnotclosetoaphysicalcallcenterlocationandtheassociatedfeeswithflyingatrainertoremoteAgentsforthispurpose.

› RemotetelesalesAgencies/Agentsmustmeetthesamerequirementsoutlinedforin-housetelesalesAgencies/Agents.


› RemotetelesalesAgentsmustusethesametechnologyandcallsystemasin-housetelesalesAgents.Agencymusthavetheabilitytolistentolivecallsandconductsilentorside-by-sidemonitoring.Agencymustbeabletorecordallremotetelephonicneedsassessments,salespresentations,andenrollmentsforthedurationofthecall,includingtransfers.

› AgenciesmustdemonstratearobusttrainingprogramtailoredtoAgentsinaremoteenvironment.AgencymustprovidedocumentationoutliningtheirtrainingprogramforremotetelesalesAgents.CignaMedicaremayrequireupdatesorchangestothistrainingprogramtocomplywithCMSandCignaMedicareguidelinesandwillnotifyAgencyinadvanceoftheserequiredupdatesorchanges.

– RemotetelesalesAgentsmusttrainwithseasonedtelesalesAgentsusingside-by-sidelisteningsessionsandroleplays.

– RemotetelesalesisonlypermittedforseasonedorprovenAgentswithacleancompliancerecord.

– ProspectiveremoteAgentsmustsitwithaseasonedtelesalesAgentforatwo-weekprobationaryperiodinwhichtheAgencywillmonitorcallsandconfirmtheAgentcansuccessfullyandcompliantlyselltelephonicallypriortobeingpermittedtosellremotely.Attheendofthetwo-weekprobationaryperiod,theAgentmustpassatelephonicRide-Alongwithascoreof85%orhigher.FailuretopassthisRide-Alongwillresultindenialoftherequesttosellremotely.

› Agencyisrequiredtohavestand-alonesupervisororteamleadavailabletoremotetelesalesAgentsbyphoneand/orinstantmessaging.

› RemotetelesalesAgentsmustonlyworkfromasecurelocationwithintheUnitedStates.AgencymustmaintainalistofaddresseswhereRemotetelesalesAgentsarebasedandensuresuchlocationsaresafeandappropriate.

– RemotetelesalesAgentsmustnothaveprintcapabilityorbeabletostoreanyProtectedHealthInformation(PHI)intheirhomeoffice.

– IfAgentshaveprintcapability,theyshouldhavealockingfilecabinetforstorageandashredderfordestructionofPHIitems.

› RemotetelesalesAgenciesmustcreateaseparateremoteworkers’policyconfirmingadherenceandcompliantuse,storageanddisposalofPersonallyIdentifiableInformation(PII)andPHIaswellasoutlininghowtheywilltrackandmonitorAgentcompliancetothispolicy.RemoteaccesstotheAgencynetworkmustmeetthesamerequirementsoutlinedforin-houseconnectivity,includingbutnotlimitedto,DataLossPreventionmeasures,Multi-FactorAuthenticationutilization,andencryptionintransitandatrest.


SECTION VII

OPERATIONAL REQUIREMENTS Marketing materials and scripts

Anybrandedmarketingmaterials,ormaterialswhichdiscloseCignaMedicarebenefitsincluding,butnotlimitedto,letters,brochures,andadvertisementsmailedordistributedtoCignaMedicarecustomersandpotentialenrollees,telemarketingscripts,andpackagingpreparedorproducedbyAgentmustbesubmittedtoCignaMedicareforreviewandapprovalpriortousetoensurecompliancewithfederalandstatelaws,rules,regulations,CMSguidance,andCignaMedicarerequirements.OnlyCignaMedicareandCMS-approvedmaterialscanbeusedwithregardtoinbound/outboundcallscripts,advertisingviaanymedia(including,butnotlimitedto,directmail,newspaper/magazineads,TVcommercials,radioads,socialmedia,websites,etc.).

AnyandalloutboundscriptsutilizedbytheAgency,itsAgentsand/orsubcontractors,tocontactbeneficiaryonbehalfofCignaMedicare,mustbesubmittedtoCignaMedicarepriortouse.ScriptsmustbesubmittedtoCignaMedicarePrivacyforreview.UponapprovalfromPrivacy,scriptswillultimatelybesubmittedtoCMSforreviewandapprovalpriortouseinthemarketplace.Inaddition,whenconductingoutboundcalls,theAgency,itsAgentsand/orsubcontractorsmustensurethescriptsincludeaprivacystatementclarifyingthebenefitsisnotrequiredtoprovideanyhealthrelatedinformationtoCignaMedicareorAgentandthattheinformationprovidedwillinnowayaffectthebenefitsmembershipintheMedicareAdvantageand/orPartDPlan.PleaserefertoCignaMedicarepolicyforadditionalguidance.

AgenciesandAgentsarerequiredtoadheretotheCMSMedicareCommunicationsandMarketingGuidelines(MCMG),stateandfederalregulations,andCignaMedicarepolicies.TheMCMGprovideinformationpertainingto,butnotlimitedto,marketing,materialtypes,disclaimers,promotionalevents,rewards,reviewprocesses,scripts,andoversightresponsibilities.Agents/AgenciesarerequiredtocomplywiththenewAffordableCareAct(ACA)Section1557regulationsasofJuly18,2016.ThisprohibitsAgent/Agenciesfromdiscriminatingonthebasisofrace,color,nationalorigin,gender,age,ordisabilityinhealthprogramsoractivitiesthatreceivefederalfinancialassistance,orareadministeredbyanExecutiveAgencyoranyentityestablishedunderTitle1oftheACA.

AspartoftheACA,themulti-languageinsert(MLI),andthenondiscriminationnoticeandstatementarerequiredwithallmarketingmaterials.

TheMLIprovidestaglinesinthetop15non-EnglishlanguagesspokenbyindividualsinthestatesthatCignaMedicareoffersMedicareAdvantageandMedicarePartDplans.Thenondiscriminationstatementandnoticesarealsorequired.

Agents/AgenciesmustalsoincludetherequiredMLIsandthenondiscriminationnoticeandstatementonanypublic-facingwebsite(awebsitewhichdoesnotrequireonetologinwithcredentials)whichdisplaystheCignaMedicarenameorlogo,regardlessifplanbenefitsarediscussed.

FormoreinformationpleasecontactyourToplineorLocalSalesManager.

Scope of Appointment

AllAgentsconductingone-on-oneappointmentswithbeneficiariesregardlessofthevenue(e.g.,inhome,byphone,oratalibrary),mustfollowtheScopeofAppointment(SOA)guidance.AnSOAcanbesubmittedtelephonically,electronicallyorbypaper.

TeleScope line

TeleScopeistheconvenientandrecommendedCignaMedicarealternativetocompletingapaperSOAform.ThecustomercallstheTeleScopelinetorecordtheSOA.Afteranappointmentissetupwiththebeneficiary,theAgentwillrequestthecustomercalltheTeleScopeline.Athree-waycallwiththeAgent,thebeneficiary,andourTeleScopeAgentisoftenrecommended.

AgentscanreachtheCignaMedicareTeleScopelineat866.398.6055.CARL’shoursofoperationare:

› October1–December7(AEP):Monday–Saturday7:00am–9:00pmCSTandSunday9:30am–6:00pmCST

› December8–September30(Lock-In):Monday–Friday7:00am–6:00pmCST

Thebeneficiary(ortheirAuthorizedRepresentative)mustprovidethefollowinginformation.

› Customer’sfirstandlastname

› Customer’saddressandphonenumber

› Timeanddateofupcomingappointment


› Agent’sfirstandlastname

› AgentID(yourwritingnumber)

› Yourinitialmethodofcontact

CignaMedicare’sTeleScopeAgentwillthengivetheAgentorcustomeraconfirmationnumbertoconfirmtheSOAhasbeenrecorded.TheconfirmationnumberwillalsobeemailedtotheAgent’semailaddressonfile.

TheAgentwillneedtoenterthisconfirmationnumberintheScopeofAppointmentIDnumberfieldontheenrollmentformbeforefaxingorelectronicallysubmittingthenewcustomer’sapplication.TheAgentshouldnotgoontheappointmentunlesstheyhavereceivedtherecordedpermissionfromtheTeleScopeline.

Paper Scope of Appointment form

AnAgentshoulduseapaperSOAifanadvancecalltotheTeleScopelineisunreasonable.UseapaperSOAforminthesesituations.

Thebeneficiary:

› AttendsyourSeminarorSalesMeetingandwantsapresentationrightafter.

› Walksintoyouroffice.

› Needsapresentationimmediatelytomaketheend-of-the-monthdeadline.

› Haschildrenwhoneedtobeinvolved,buttheyareonlyavailabletoday.

› Isleavingforanextendedtimeandneedstoseethepresentationimmediately.

e-Scope

Anagent/brokerhastheoptiontocompleteanelectronicSOAform(e-Scope)viatheeEnrollmentportal.

› Theagent/brokernavigatesthroughtheScopeofSalesAppointmentConfirmationFormscreens–completingallrequiredinformationfields.

› Boththeagent/brokerandthecustomer/authorizedrepresentativesignthee-Scopeformusingelectronicsignature.

› Whentheagent/brokercompletesthee-ScopeprocessaPDFfileisgeneratedwheretheinformationcapturedelectronicallyisplacedontheexistingSOAPDFthatisusedforpaperSOA’s,completewiththeagent/brokerandcustomer/authorizedrepresentativesignatureintheappropriateplaces.

› Thecompletee-Scopeisarchivedautomatically.

Hybrid Agent Guidelines

Theseguidelinesareprovidedforagentsclassifiedas“hybrid”andthereforelookingtoconductsalesviabothfieldandtelesalesmethods.

› Agents/Agenciesareresponsibleforaclearunderstandingofallcomplianceandlegalrequirementsforbothfieldandtelephonicsales.

› Inordertobeapprovedforhybridagentsub-delegation,AgenciesmustbedelegatedforfieldandtelesalesbycompletingCigna’sCallCenterIntakeprocess.Anyagentsdesignatedas“hybrid”mustbedirectlycontractedunderanapprovedfieldandtelesales-delegatedagency.

› AgenciesmustdemonstratearobusttrainingprogramtailoredtoAgentssellingviabothfieldandtelesalesmethods.Agencymustprovidedocumentationoutliningtheirtrainingprogramforhybridagents.CignaMedicaremayrequireupdatestothistrainingprogramtocomplywithCMSandCignaMedicareguidelinesandwillnotifyAgencyinadvanceoftheserequiredupdatesorchanges.

Face-to-Face

› Whensellingfacetoface,Agentsmustcompleteafullandcompliantpresentation,includingacomprehensiveneedsassessmentandfullreviewofbenefits.

› Agentsmustobtainascopeofappointmentpriortothepresentation.Scopesmustberetainedfor10yearsandprovideduponrequest.

› Ifthecustomerwishestoenroll,Agentmustuseapprovedenrollmentsubmissionmethods(seebelow).

– Paper(faxormail-in)

– CignaE-Enrollment

– Thirdpartyenrollmentvendors–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation

› Ifdataisbeingpassedbackandforthwiththesevendors,aCignaInformationProtection(CIP)reviewisneededtoensuredatasecurity.Ifwrittenconfirmationisprovidedthatnodataisbeingpassed,noCIPreviewwillbeneeded.

› Oncetheabovehavebeenprovided,thethirdpartyenrollmentvendorsmustrequestapprovalfromCignaMedicaretoactivatethebrokerenrollmentcapabilitiesforAgency.

– EnrollmentfilesviasFTP(OEC)–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation


› AgenciesusingOECfilesforenrollmentsubmissionsmustcompleteaCignaInformationProtection(CIP)reviewtoensuredatasecurity.

› OECfilesmustbetestedpriortoutilizingthissalesmethodtoensureCignaMedicarecanacceptandapprovetheenrollmenttypes.

Telesales

› Whensellingtelephonically,AgentmustuseAgency’sapprovedtechnologyandcallsystem.

– Agentmustperformacomprehensiveneedsassessmentandreviewofhealthplanbenefitsinorderforthepotentialcustomertomakeaneducateddecisiononenrolmentintotheplan.

– AgentmustfollowCMS-approvedscriptsforbothpre-enrollmentandenrollmentportionsofthecall.

– Enrollmentrequestsareacceptedonlyduringanincoming(orinbound)telephonecallfromapotentialcustomer.

– Allportionsofthecall(needsassessment,pre-enrollment,enrollment,andanytransfersbetweenagentsornon-licensedreps)mustberecordedandstoredfor10yearsperCMSguidelines.

– Uponcompletingatelephonicenrollmentrequest,Agentmustprovideaconfirmationnumbertothecustomerfortrackingpurposes.

– Enrollmentsubmissionmethods:

› Carrierplatform(Salesforce)

› Thirdpartyenrollmentvendors–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation(seeabove).

› EnrollmentfilesviasFTP(OEC)–pleaseworkwithyourCignaMedicareBrokerSalesteamformoreinformation(seeabove).

› AgenciesmusthaveP&Psoutliningtheserequirementsandtheirprocesstooverseeandmonitoragentcompliancewiththeseguidelines.

› TheseguidelinesareintendedtoprovideageneraloverviewofCignaMedicaretelesalesagentconductandcompliancerequirements.Thesearenotinclusiveofallofthestateandfederallaws,CMSregulations,companypolicies,orotherrequirementsapplicabletoyou.

Enrollment applications

Itisimportanttofillouttheenrollmentapplicationcompletelyandaccuratelyinordertoavoidprocessingdelaysandpossiblerejectionoftheenrollment.TherearemultiplemethodsAgents/BrokerscanusetosubmitenrollmentrequeststoCignaMedicare.ValidCignaMedicaresubmissionmethodsareasfollows.

Paper Application

WhenanAgentreceivesacompletedapprovedMA/MAPDpaperenrollmentrequestfromthecustomer,anAgentorBrokersignsanddatestheformandfaxesittotheappropriateCignaMedicareregionalenrollmentfaxnumberalongwiththeSalesApplicationCoverSheet.

Agentshavetheoptiontocompleteapaperenrollmentapplicationduringameetingwithacustomer.Inorderfortheenrollmenttobeprocessed,theAgentisexpectedtofaxthecompletedandsignedapplicationtotheenrollmentteamandensuretheirreceiptofenrollmentwithintwocalendardays.TheAgentmustfaxthecompletedenrollmentformtoCignaMedicare,usingthefaxnumberlistedforthemarketontheApplicationCoverSheet.Whenfaxingseveralapplicationsatonetime,theagentmustincludeacoversheetasthefirstpageofeachapplication.IfthecustomerchoosestosendtheapplicationdirectlytoCignaMedicarebymailorfax,thenthedatethattheformisreceivedistheofficeapplicationreceiptdate.ApplicationssentbymailwhichdonotmeetthetwocalendardaytimeframewillresultinanSDAPviolationforapplicationtimeliness.ForTelephonicenrollments,theofficeapplicationreceiptdateisthedateofthecall.Toconfirmreceiptoffaxedapplications,anAgentcanuseCignaforBrokersorcallCARL.

eEnrollment

TheCignaMedicareeEnrollmentformisapaperlesselectronicapplicationaccessibleviahttps://broker.hsconnectonline.com/.

TheeEnrollmentform:

› Isavailablevialaptopandtabletbrowsers.

› Isaninternetapplicationaccessedthroughawebbrowser.

› Createsacompleteapplicationthatcanbeverifiedandsignedbeforesubmission.

› AllowstheAgent/customertosubmitacompletedapplicationimmediatelyforprocessing.


Cigna for Brokers

ContractedandapprovedtelesalesAgentsmayusethetelephonicenrollmentscriptonCignaforBrokersviawww.cignaforbrokers.comtosubmitenrollmentrequests.

IntheeventatelesalesAgency/AgentdoesnotusethetelephonicenrollmentscriptonCignaforBrokers,enrollmentsoverthephonemustbeacceptedbyapprovedtelephonicenrollmentmechanismsandfollowtheapprovedenrollmentscript.

Supporting documentation

Power of Attorney

Whenapplicable,acustomermaystateontheelectionformthattheyhaveaPowerofAttorney.InordertoacceptPowerofAttorneyforacustomer,copiesoftheexecutedlegaldocumentmustbeattachedwiththeapplication.ThePowerofAttorneywillstatetheperson’snameandmayincluderelationshiptocustomer.ThePowerofAttorneywillbeabletoactontheirbehalfshouldtheybecomeincapacitated.ThePowerofAttorneydocumentshouldindicatethatitisformedicalreasons.

Requireddocumentationincludes:

› Name(s)ofeachPowerofAttorney

› Relationshiptocustomerifknown

› Initialsofpersonenteringthedata

› Departmentofpersonenteringdata

Request for Information (RFI) application

RFIapplicationsarerequiredwheninformationismissingfromanapplication.IfanAgentisprovidingmissingorrequestedinformationtofulfilltheoriginalapplication,theywillneedtochecktheRFIboxatthetopofanapplication.TherearemanyrulessurroundingthedeadlinesforRFIs,buttypicallycustomershave21daysfromthedateoftheirRFItosendustherequiredinformation.ItiscriticalRFIsbeaddressedwithintherequiredtimeframetoensureapplicationsarenotdenied.

Application submission policies/timeliness

CMShasstrictregulationsregardingthesubmissionofenrollmentapplications.PerCignaMedicarepolicy,AgentshavetwocalendardaystosubmitthecompletedapplicationformtoCignaMedicare.Thetwocalendardaywindowisapplicableregardlessofthedayoftheweekyouacceptedthecompletedformfromthecustomer.Thetwo-dayruleappliesforenrollmentsthroughouttheyear,includingAEP.

Ifthecustomerinsistsonsendingtheapplicationviamail,theAgentshouldnotsignordatetheAgentportionoftheapplication.TheAgentshouldalsoinformthecustomernottofillinthissectionatanytime.

Enrollmentsacceptedoverthephonemustbeacceptedbyapprovedtelephonicenrollmentmechanismsandfollowtheapprovedenrollmentscript.Telephonicapplicationsmustlistthedateofthecallastheapplicationdate.

Checklist for application process

Confirmeligibilityrequirements.

› CustomermusthaveMedicarePartAandPartBtojoinaMedicareAdvantageplan,andthecustomermustalsohaveMedicarePartDtojoinaMedicareAdvantagePrescriptionDrugPlan

› CustomermustresideintheapprovedServiceAreafortheirselectedplan

› For2020effectiveenrollmentsonly,Customermustnothaveend-stagerenaldisease(ESRD).Pleasenote,the21stCenturyCuresActamendedtheSocialSecurityActtoallowallMedicare-eligibleindividualswithESRDtoenrollinMAplansbeginningJanuary1,2021.

› CustomermusthaveactiveMedicaidifapplyingforaTotalCareplan,andtheagentshouldincludeproofofactiveMedicaidintheapplicationsubmissionwhenpossible

It’srecommendedthattheAgentsecureMedicaideligibilitystatusinformationforallcustomerscompletinganenrollmentrequest,andincludetheactiveMedicaidIDontheformifapplicable.PleasenotethatAgentsarerequiredtofollowallCMSapplicationrequirementsintheMCMG.(Appendix2:SummaryofDataElementsRequiredforPlanEnrollmentMechanismsandCompletedEnrollmentRequests.Referencedinsections:20,20.4,40.2,40.4.1)


Application must include:

4 The customer’s plan choice

4 Medicare insurance information

4 Customer’s:

–DOB

–Gender

–Phonenumber

–Permanentaddress/mailingaddress

–Emailaddress

–PCPfullname

–Emergencycontact

4 Premium payment option

4 ESRD question

4 Prescription drug coverage information

4 Additional medical health coverage information

4 Other prescription drug coverage question

4 Long-term care facility question

4 State Medicaid Program question

4 Multi-language/print necessities

4 Signature of applicant/customer/authorized representative

4 Checklist for Special Enrollment Period eligibility

Enrollment application cancellations or withdrawals

Ifacustomerwishestocancelorwithdrawanapplication,theymustsendalettertoCignaMedicareorcallCustomerServicepriortotheeffectivedate.

Pleasenotethatcancellationsmustbecompletedbeforetheeffectivedate,anddisenrollmentrequestsmustbecompletedaftertheeffectivedatewithawrittenandvalidreasonfordisenrollment.

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