Ethics, Advertising & Compliance New Agent Orientation Part 2 HMIA000635

Agenda Ethics Advertising Product Presentation Guidelines Fraud Advertising Advertising Regulations Telemarketing and Do Not Call Guidelines Product Presentation Guidelines HIPAA & PPACA Complaint Handling Disciplinary Policy

Ethics HealthMarkets and its directors, officers, employees and agents are committed to a culture of compliance in all business dealings Doing the right thing at all times HealthMarkets requires all agents to observe the highest standards of business and personal ethics in the conduct of their duties and responsibilities Agents must practice honesty and integrity in every aspect of dealing with their customers and the business community

Ethics Insurance is a heavily regulated industry. Among the agencies that oversee insurance companies: State Departments of Insurance (DOI) State Offices of the Attorneys General Federal agencies, such as the United States Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), and the Federal Trade Commission In order to comply with state and federal laws and regulations and uphold our reputation, HealthMarkets has established mandatory policies and procedures

Ethics Agents must observe all insurance laws, and all HealthMarkets and other carriers’ policies These laws and policies, along with a strong sense of personal ethics, constitute a solid foundation for agents’ professional behavior

Together, laws and ethics underpin an agent’s code of conduct Laws are rules established by the government which dictate minimum standards of conduct Ethics are standards set by society that influence personal and professional conduct Together, laws and ethics underpin an agent’s code of conduct Legal Ethical

Ethics We are committed to Serving our customers by offering coverage that meets their needs Offering coverage in a manner that is compliant with state and federal requirements Fairly and accurately representing product benefits using approved materials and compliant sales practices Competing fairly in the marketplace by focusing on the strengths of the products and services we offer

Ethics As a licensed agent, you are expected to Treat all customers and carrier partners with courtesy and respect Stay current with and abide by all HealthMarkets and carrier requirements Disclose all plan provisions to customers, including exclusions and limitations Be accurate and forthright with information and truthful in answering questions Admit when you don’t know the answer and then find it

For concerns or questions, call the Ethics Hotline at (866)318-9084 Compliance As a licensed agent, you are the face of the company. Your actions directly influence your business and directly affect the reputation of HealthMarkets and its carriers partners. HealthMarkets requires that its agents provide the service that is expected by our customers and required by regulators. For concerns or questions, call the Ethics Hotline at (866)318-9084

Use and Disclosure of Information Fairness and Transparency – is providing customers with complete and accurate information clearly and understandably; inspires trust in our company and the products of our carriers Product Understanding – is educating current and prospective customers about our products; equips them to make informed choices, resulting in fewer misunderstandings and greater customer satisfaction

Unfair Inducements You may not do any of the following to persuade a customer to buy insurance Offer kickbacks (paying or rebating any portion of the premium) Imply that claims will be paid over the limits of the plan Claim that premiums are an introductory, initial, or special offer

Fraud Fraud is a deception made for personal gain Forgery is a type of fraud that is an unauthorized alteration of documents, such as applications, bank authorizations, and other forms Other types of fraud include signing an application when you did not make the presentation, false advertising, and non- disclosure of known medical information Submitting applications for additional coverage without the customer’s knowledge

Fraud Don’t sign any document on behalf of a policyholder, applicant or beneficiary under any circumstances, even with written authorization Do not transfer a wet signature to an electronic signature, even at client request Don’t allow a customer to sign documents on behalf of another customer (for example, a wife cannot sign an application for her husband when she is not on the application or is not the primary insured)

Advertising

Advertising Advertising rules and regulations are for the protection of agents, consumers, and insurers HealthMarkets expects agents to adhere to all guidelines, requirements, regulations, and laws Guidelines for advertising and use of branded material are available in the HealthMarkets agent handbook available through CourseMill The definition of “advertisement” is very broad; do not think that information you distribute to generate interest in purchasing insurance is not advertising because it does not mention a specific carrier or a specific product

What is Advertising? All methods of communication – either written and oral – with the general public in connection with an insurance carrier or insurance products, or to generate interest in purchasing insurance, is considered advertising. This includes (but is not limited to): Newspapers Magazines Other publications Notices Circulars Pamphlets Sales Illustrations / Pitch Books Letters Posters Radio Television Websites Social Media - Facebook Email Communications

Advertising Materials HealthMarkets provides pre-approved advertisements Pre-approved advertising pieces can be found on the Point & Click On Demand Professionally produced Customized with your personal contact information Download high resolution PDFs in seconds Professionally print your ads or print from your own home or office printer

Point & Click On Demand Access marketing materials by clicking this icon located on the Marketing Tools page of the Resource Center Start marketing with these simple steps Select your State Pick a Category from the menu tabs Choose the Advertising Piece you want Customize your ad and verify your contact info

Point & Click - Printing Options Download your PDF and self-print most ads like Flyers, Pull-Tabs and Labels Send your ad to any printer to have items created like Magnets, Postcards, and Car Signs Or use the full service print and mail service provided directly through the Point & Click site host, Xpressdocs. Important: when printing a PDF file, to ensure that your printer settings do not shrink the advertisement Click File Click Print to open the printer settings Under Page Scaling or Page Handling Options, select None

Point & Click On Demand The first time you visit Point & Click, be sure to verify your personal contact information for accuracy Note: Some contact info, like your website address and your website photo will not auto-populate Enter your contact info by clicking Edit, then click Save as Default and it will be retained for future visits To upload your photo from a JPEG file, see the Upload New Headshots area at the bottom of the page Your photo will be saved for optional use on ads that accommodate photos. Simply click the Use My Photo box when applicable

Agent-Created Advertising HealthMarkets encourages agents to use the pre-approved ads already available All ads you create or edit must first be approved by the compliance department Territory Vice Presidents must send your ad and an Ad Approval Request Form to Advertising@healthmarketshq.com for review and approval consideration Details are located on the Marketing Tools page of the Resource Center Failure to obtain approval for any advertisement is against company policy. Agents who use unapproved advertising are subject to disciplinary action. Unapproved advertising will not be eligible for reimbursement through LeadForward. 21

Advertising Regulations Download the Advertising Guidelines from the Resource Center as a reference General guidelines Only use ads approved for your state and distribution methods Advertising is updated periodically on Point and Click; agents must ensure they use the most current version of approved advertising Agents may not use carrier names or logos in their advertising

Fax and E-mail Fax blasting and e-mail spamming are prohibited forms of lead generation You may contact existing leads and customers via email Compliance approved e-mail templates are available through the Activity Center (CRM) The email templates include a link that allows a customer to “opt-out” of receiving future emails; these requests are handled automatically through internal processes Content an agent creates must be submitted to the Compliance Department for approval Emails must allows a customer to “opt-out” of receiving future emails Don’t use deceptive subject lines.  The subject line must accurately reflect the content of the message

Telemarketing: Do Not Call Requirements The Telephone Consumer Protection Act (TCPA) and additional state legislation allows many consumers to place their names on “Do Not Call” lists Violations of these regulations could result in fines of up to $25,000 per incident The leads loaded into the Activity Center are automatically scrubbed for compliance Agents are responsible for compliance with Do Not Call requirements for leads they acquire through their own sources Following “Do Not Call” requirements is your responsibility

Telemarketing Guidelines The following requirements apply to telemarketing calls made by agents: Do not intentionally block your caller ID Introduce yourself, the company you represent, and the purpose of your call within the first 30 seconds You may not use an auto-dialer to make your calls. Calls made with an auto-dialer are subject to additional regulatory requirements, including prior express approval of the individual being called.

Calling Periods Leads may only be contacted during the approved calling periods Go to the Telemarketing Do Not Call section of the agent marketing guidelines on the agency website for additional information, including your state’s calling period Only after you have personally spoken to the customer, and he/she requests to be called outside of the calling period, may you do so A lead cannot be contacted more than once every 8 hours unless permission is granted

Telemarketing Guidelines While on the call, the consumer may request to be placed on our company-specific DNC list and the request must be honored Listen for “Do not call me again” “Stop calling me” “Put my number on your company Do Not Call list/registry” “I’m tired of getting calls from you/your company”

Telemarketing Guidelines When a consumer requests to be placed on our DNC list, take note of Consumer’s name and number Date and time the request was made Register this information online Agents have 10 days to enter customer requests to our Company Specific Do Not Call (DNC) List or to enter requests for copies of our Do Not Call Policy You can register a person on the Activity Center

Telemarketing Guidelines If consumers have questions regarding our Do Not Call program, they can call 1-888-731-4447 Or they can email their questions TDNC@healthmarketshq.com

Product Presentation Guidelines

Product Presentation Identify yourself as a licensed insurance agent representing the carrier before presenting any insurance benefits If selling multiple carriers’ products to the customer, you must name all of the carriers you are representing As a licensed and appointed agent with the company, you may represent the policies and contracts offered by carriers, but not change or amend coverage on behalf of the carrier Writing or notes made by the agent could change the terms of the coverage and ultimately become part of the contract. They are not allowed.

Product Presentation Review all benefits, exclusions and limitations with applicants Ensure that applicants understand all plan provisions including any benefit maximums and deductibles You may not compare the company’s products with other insurers’ products unless you provide a fair, complete, side-by- side comparison with the consumer’s current plan benefits Any personal or company Explanation of Benefits (EOB) should not be used to explain benefits Claims payment and discounts depend on the type of coverage purchased

Presentation Guidelines At the point of sale, leave any required disclosures with the applicant For example, in a Chesapeake Life Insurance Company sale, you are required to leave a product brochure, several disclosure forms, and an outline of coverage if required

Predicting Rate Increases Never predict rate increases Rate increases are based on numerous factors and cannot be anticipated

Agent Regulatory Responsibilities HIPAA & PPACA Agent Regulatory Responsibilities

HIPAA & PPACA HIPAA is an acronym for a federal legislative act, the Health Insurance Portability and Accountability Act of 1996, that included the following insurance reforms: Health Care Access, Portability and Renewability Provided guaranteed access to insurance for employees who were losing their group health coverage Established portability and guaranteed renewability requirements so individuals could keep their current coverage and not be singled out for cancellation or rate increase Privacy & Security Standards Established national standards for electronic health care transactions and the security and privacy of consumers’ protected information including health information

HIPAA & PPACA PPACA is the acronym for the Patient Protection and Affordable Care Act signed into law on March 10, 2010 by President Obama (may also be called the Affordable Care Act, or ACA) PPACA expands on protections started by HIPAA. For example: Guarantees access to health insurance to all Americans, regardless of health status Provides subsidies to low income Americans to help them pay for their health insurance Establishes “minimum essential coverage” requirements for health plans Regulates premium rates Provisions of the ACA are covered in more detail in a separate module

HIPAA Responsibilities - Privacy Guard all Protected Health Information (PHI) Keep all client information in your possession in a secure, safe place Do not share client information with unauthorized parties Guard personal computers that have PHI, including encryption of your computer in accordance with company policy Report any privacy breaches (for example, stolen laptop) to the Compliance Officer or the Agency Standards Unit immediately (within 24 hours) Agency.Standards@healthmarketshq.com 38

Complaint Handling

Complaint Handling HealthMarkets has established procedures to identify, log and respond to verbal and written complaints and grievances A complaint is an expression of dissatisfaction by a customer. Following are examples of indicators that a customer is making a complaint Customer states the agent: Didn’t provide the coverage requested Advised certain services would be covered and they were not Enrolled the customer in a plan they didn’t know about Did not cancel their coverage as requested Wants a company response to his/her complaint

Complaint Handling All complaints will be investigated by HealthMarkets. If an agent receives the complaint, the agent must report the complaint to the Agency Standards Unit at Agency.Standards@healthmarketshq.com If a customer complains about an agent, the agent will be asked to complete an Agent Statement to give his/her description of the sales presentation or situation. When filling out an Agent Statement, it is important to give as much factual and specific information as possible. Personal opinion about the customer or the carrier should not be included. Agent should confer with the Territory Vice President on the completion of the statement

Complaint Handling HealthMarkets and the carriers will evaluate the nature of the complaint and the agent’s complaint history to determine appropriate action For less severe issues, the company may send a coaching notification to the agent or recommend retraining Actions for more severe issues may include a warning, suspension or termination of appointment and/or contract

HealthMarkets Disciplinary Policy HealthMarkets has developed standard procedures for agent oversight and sales compliance to protect all agents The company will promptly review any complaint filed against an agent All agents are required to take the online compliance training under the HealthMarkets tab on your My Curriculum page Titled “Mandatory Training: Agent Guidelines”

Review You should now feel comfortable with HealthMarkets’ expectations on the following topics Ethical responsibilities Unlawful agent activity Acceptable advertising practices Marketing and Do Not Call regulations Complaint handling Company disciplinary policy