September 19, 2012
TO: ALL PERSONS MARKETING MEDICARE ADVANTAGE, MEDICARE ADVANTAGE PRESCRIPTION DRUG PLANS, PRESCRIPTION DRUG PLANS, AND 1876 COST PLANS, INCLUDING INSURANCE COMPANIES, CORPORATIONS, HEALTH MAINTENANCE ORGANIZATIONS, EXCHANGES, MUTUALS, RECIPROCALS, ASSOCIATIONS, LLOYD’S, OR OTHER INSURERS IN THE STATE OF TEXAS AND THEIR AGENTS AND REPRESENTATIVES, AND THE PUBLIC GENERALLY
RE: Medicare Marketing Guidelines and Agent Licensing Requirements Related to Certain Medicare Plans and Prescription Drug Plans
Texas Department of Insurance (TDI) issues this bulletin to remind companies, agents, subcontractors, and consumers that the marketing of Medicare Advantage (MA), Medicare Advantage Prescription Drug Plans (MA-PDPs), Prescription Drug Plans (PDPs), and 1876 Cost Plans, is subject to the Medicare Marketing Guidelines (Guidelines) established by the Centers for Medicare & Medicaid Services (CMS). Any company marketing these products must ensure that its agents and subcontractors are in full compliance with the rules, the Guidelines, transmittals, and other CMS requirements. An electronic copy of the current Guidelines is available online at the following location: http://www.cms.gov/ManagedCareMarketing/01_Overview.asp#TopOfPage.
TDI also reminds carriers, agents, and all regulated entities to comply with agent licensing requirements for the marketing of Medicare-related products. Medicare Advantage organizations may only use agents licensed under state law to sell Medicare plans in accordance with 42 USC §1395w–21(h)(7)(A). An agent may not sell, solicit, negotiate, or receive an application or contract for a Medicare-related product in this state, or represent an insurer in relation to a Medicare-related product in this state, unless the agent has completed a TDI-certified professional training program related to a Medicare-related product in accordance with Insurance Code §4004.252(a) and 28 Texas Administrative Code (TAC) §19.1024(a) (relating to Medicare-Related Product Certification Course). This requirement applies to licensees that may otherwise qualify for the exemptions provided under 28 TAC §19.1004(b) or (c) (relating to Licensee Exemption from and Extension of Time for Continuing Education) in accordance with Insurance Code §4004.255 and 28 TAC §19.1024(g) and to nonresident agent licensees who do not hold an insurance agent’s license in the person’s state of residence in accordance with Insurance Code §4056.057(b).
To continue their authorization to sell or solicit Medicare-related products in Texas, licensees must also complete at least four hours of TDI-certified Medicare-related products continuing education in accordance with Insurance Code §4004.253 and 28 TAC §19.1025 (relating to Medicare-Related Product Continuing Education), during each subsequent continuing education reporting period. This requirement also applies to licensees that may otherwise qualify for the exemptions provided under 28 TAC §19.1004(b) or (c) in accordance with Insurance Code §4004.255 and 28 TAC §19.1025(c) and to nonresident agent licensees who do not hold an insurance agent’s license in the person’s state of residence in accordance with Insurance Code §4056.057(b).
Nonresident agent licensees who hold a license in their state of residence and are authorized to sell or solicit Medicare-related products in their state of residence, may sell or solicit Medicare-related products in Texas without completing the Texas-specific training requirements, as provided in Insurance Code §4056.055 and §4056.056, and 28 TAC §19.1004(d). However under those sections and 28 TAC §19.1024 and §19.1025, a nonresident agent licensee who is not authorized to sell or solicit Medicare-related products in the agent’s state of residence must complete the required Texas training courses prior to selling or soliciting Medicare-related products in this state.
A nonresident licensee that becomes a Texas resident between renewals of the Texas license must comply with the continuing education requirements under 28 TAC §19.1004(d)(1)-(3).
Plan sponsors must ensure that all agents selling Medicare-related products are trained and tested annually on Medicare rules and regulations and on details specific to the plan products that they sell in accordance with 42 USC §1395w-21(j)(2)(E); 42 CFR §422.2274(b) and (c); 42 CFR §423.2274(b) and (c); and the Guidelines, No. 120.3, page 88. Under those provisions, plan sponsors must provide information about their training and testing to CMS when CMS requests the information.
For information on certification courses required of currently licensed agents to market Medicare-related products, please see the TDI website, http://www.tdi.texas.gov/licensing/agent/MedicareRelated.html. Information on the required related continuing education is also available at this site.
If you have any specific questions regarding this bulletin, please contact Christopher Bean at (512) 463-8917 or at christopher.bean@tdi.state.tx.us. For general information, please contact ChiefClerk@tdi.state.tx.us.
Eleanor Kitzman
Commissioner of Insurance
Commissioner of Insurance
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