CSRs and Brokers: You Can Only Be One


Brokers and customer service representatives (CSRs) often fulfill the same duties. Both roles communicate plan information, provide requested plan materials, and take demographic information to complete enrollment. However, broker and CSR positions are not, and cannot be, the same thing. But brokers can hire a CSR for assistance.

Acting as a Broker

Sales brokers (both employed and contracted) cannot also act as CSRs, according to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Marketing Guidelines, Section 80.7. This may seem like a trivial rule, but it has good intent.

Think of it this way: A broker’s main goal is to sell Medicare, and health-related products, to potential and current enrollees. Brokers often share helpful information with or educate their clients in the process. But the main goal is to end in a sale.

Acting as a CSR

An insurance company can use licensed brokers, but a state license isn’t required for CSRs. The company’s CSRs are compensated differently and have different expectations. A CSR, for example, may be a full-time, hourly employee of an insurance company who answers customer service calls. These representatives’ main expectation is to answer inquiries and help clients through any issues or confusion surrounding their current plan.

CSRs may also be asked to:

  • Conduct reviews of materials and activities if a complaint is made (by any source, including current and potential enrollees), when CMS determines it is appropriate to investigate.
  • Act as a “secret shopper” for CMS when requesting insurance provider materials, such as enrollment packets.

Can a Broker Hire Someone to Act as a CSR?

Absolutely. As we’ve mentioned, customer service representatives (CSRs) are not required to have state licenses. However, there are a few things you’ll have to know before adding a CSR to your team. First, you will have to hire, pay, and manage the CSR yourself. Second, you must follow any applicable state and federal laws concerning employment practices. You can find these at the Department of Labor (DOL) website. Finally, there are a limited number of activities related to beneficiaries that CMS will allow CSRs to conduct. These include, but are not limited to:

  • Providing plan-related information
  • Fulfilling a request for materials
  • Taking demographic information (such as age and gender) in order to complete an enrollment application at the request of a prospective enrollee

Outside of beneficiary-related activities, a CSR may also act as an assistant to you in your business. You may broaden the CSR’s job description by asking them to complete tasks such as but not limited to:

  • Reception and telephone duties
  • Physical office upkeep, including file and record maintenance
  • Shipping and receiving
  • Office supply ordering
  • Mailing, scanning, faxing, and copying materials

If you decide to hire a CSR who has a license, remember that they cannot simultaneously act as a broker—even though they are licensed. Here are a few examples of activities a CSR may not participate in:

  • Conduct enrollments for Medicare beneficiaries
  • Administer a one-on-one or walk-in appointments
  • Ask for referrals and leads from enrollees

Learn More With Excelsior

You can find more broker-related breakdowns of the Medicare Marketing Guidelines on our online resource center. Excelsior dives into MMG-centric topics such as the rules of telephone contact with potential enrollees and the consequences of misusing the Medicare name and marks. To learn more about the Excelsior team and how we can help you, contact us.


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References
https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf

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