All an Enrollee Needs Is an Enrollment Form, Right? Wrong.


CMS has rules about what materials are required to be included with an enrollment form (Medicare Marketing Guidelines, Section 30.6). We’ll explain more below.

What Else Should Come With a Medicare Enrollment Form?

When giving potential enrollees an enrollment form, brokers are required to also provide a Star Ratings document, Summary of Benefits, and pre-enrollment checklist. These items must be presented to the potential enrollee before enrollment. The Star Ratings document is a standardized information document, which is available through the carrier you are representing. CMS also requires the Star Ratings document to have the most updated information available. The pre-enrollment checklist is a one-page document that contains a list of important disclaimers. This checklist will help ensure that your client understands the benefits and rules associated with their chosen plan.

What About Online Enrollment Requests?

For online enrollment requests, brokers are required to make Star Ratings documents, Summary of Benefits, and pre-enrollment checklist available electronically. This means you would email a PDF of the documents to an enrollee. Alternatively, you could give an enrollee the website links where these documents can be accessed. CMS specifies that brokers have to provide these documents electronically before the completion and submission of the enrollment request.

What Other Medicare Guidelines Are Available Through Excelsior?

Other broker-specific Medicare guidelines—including CMS rules on referrals and leads, telephone contact, and walk-in appointments—are available on Excelsior’s online resource center. But that isn’t all Excelsior has to offer. Contact us to learn more about the Excelsior team and how we can help you.

 

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

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