1. Ethics, Advertising & Compliance
New Agent Orientation
Part 2
HMIA000635

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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)

14. Advertising

15. 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

16. 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
Communications

17. 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

18. 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

19. 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

20. 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

21. 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 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

22. 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

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

24. 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

25. 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.

26. 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

27. 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”

28. 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

29. Telemarketing Guidelines
If consumers have questions regarding our Do Not Call program, they can call
Or they can their questions

30. Product Presentation Guidelines

31. 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.

32. 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

33. 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

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

35. Agent Regulatory Responsibilities
HIPAA & PPACA
Agent Regulatory Responsibilities

36. 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

37. 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

38. 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) 38

39. Complaint Handling

40. 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

41. 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
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

42. 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

43. 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”

44. 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