COMMISSIONER'S BULLETIN # B-0019-16
September 12, 2016
To: ALL PERSONS MARKETING MEDICARE ADVANTAGE, MEDICARE ADVANTAGE PRESCRIPTION DRUG PLANS, MEDICARE PRESCRIPTION DRUG PLANS, 1876 COST PLANS, MEDICARE-MEDICAID PLANS, AND EMPLOYER OR UNION-SPONSORED GROUP 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
The annual Medicare open enrollment period is from October 15, 2016, through December 7, 2016. The Texas Department of Insurance issues this bulletin to remind companies, agents, subcontractors, and consumers that the marketing of Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Medicare Prescription Drug Plans, and 1876 Cost Plans is subject to the Medicare Marketing Guidelines (Guidelines) established by the Centers for Medicare and Medicaid Services (CMS). Also, when applicable, the Guidelines apply to employer- or union-sponsored group plans, including employer- or union-only group waiver plans. Additionally, these requirements apply to Medicare-Medicaid Plans, except as modified or clarified in state-specific marketing guidance for each state's demonstration. The Guidelines provide that state-specific guidance is considered an addendum. State-specific marketing guidance for Medicare-Medicaid Plans will be available at:
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:
Plan sponsors and Part D sponsors must ensure that all agents selling Medicare-related products, regardless of whether the agents are employed, captive, or independent, are trained and tested annually on Medicare rules and regulations and on details specific to the plan products that they sell under 42 USC §1395w-21(j)(2)(E); 42 CFR §422.2274(c) and (d); 42 CFR §423.2274(c) and (d); and Guideline No. 120.3, Page 86. Guideline No. 120.3 explains that the training and testing must take place before the agent sells the product and states that an agent must obtain a passing score of at least 85 percent on the test. Plan sponsors and Part D sponsors must provide information about their training and testing to CMS when CMS requests the information.
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 under 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 concerning a Medicare-related product under Insurance Code §4004.252(a) and 28 Texas Administrative Code §19.1024(a) (relating to Medicare-Related Product Certification Course). This requirement applies to licensees who may otherwise qualify for the exemptions provided under Insurance Code §4004.052(b) and 28 TAC §19.1004(b) or (c) (relating to Licensee Exemption from and Extension of Time for Continuing Education), as provided under Insurance Code §4004.255 and 28 TAC §19.1024(g).
To continue their authorization to sell or solicit Medicare-related products in Texas, licensees must also complete at least four hours of TDI-certified continuing education on Medicare-related products under Insurance Code §4004.253(b) 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 who may otherwise qualify for the exemptions provided under Insurance Code §4004.052(b) and 28 TAC §19.1004(b) or (c), as provided under 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 under 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, 4056.056, and 4056.057(a), and in 28 TAC §19.1004(d). But under those sections and Insurance Code §4056.057(b), 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 before selling or soliciting Medicare-related products in this state.
A nonresident licensee who 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).
For information on required certification courses for currently licensed agents to market Medicare-related products, please see the TDI website at 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 Agent and Adjuster Licensing Customer Service by phone at 512-676-6500, or by sending an email to License@tdi.texas.gov. For general information, please email firstname.lastname@example.org.
For more information contact:
Last updated: 09/13/2016