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Request Contracting


NOT APPOINTED WITH ONE OF THE CARRIERS BELOW


CLICK THE BUTTON ABOVE TO REQUEST A CONTRACT


MEDICARE ADVANTAGE TOOLS

Medicare Supplement Toolsclick here


TO ACCESS, THESE FILES EMAIL IS – MEDICAREISMYMIDDLENAME@GMAIL.COM


TO ACCESS, THESE FILES PASSWORD IS: MEDICARE


CLICK ON THE FILE ICON TO ACCESS MEDICARE SUPPLEMENT UNDERWRITING DOCUMENTS.

FEMA SEP Check w/ Wellcare if one exists
RitterQuote Engine
E-Health MAPD Plan Finder
Medicare.govclick here
Doctors Look-Up
NJ DSNP Doctors Look-Up


NJ DUAL SOB


ACTIVATE NATIONS CARD


NJ AETNA BETTER HEALTH SITE

NJ OTC
NJ Healthy Foods
NJ Extra Benefits Card



Doctors Look-Up




NJ DUAL SOB

Doctors Look-Up
Request Contracting
Braven Choice Look-Up
Out of State Doctors Look-Up




BRAVEN- USE CODE - B7U

Horizon Code- YHZ

Horizon BCBS DSNP Look Up


NJ DUAL SOB


DUAL WELCOME KIT

Doctors Look-Up
New Broker Portal
Request ContractingGet Appointed
PDP 2024 Benchmark Plans
Medicaid/Extra Help Overview
NJ PAAD Applicationhttps://www.state.nj.us/humanservices/doas/services/paad/


2024 PAAD LEVELS



Doctors Look-Up
Broker Portal


Doctors Look-Up
Doctors Look-Up


NJ Doc Look-Up
DE Doc Look-Up
Search Plans


DUAL PLANS DE APP


VT PLANS


DE PLANS


NH PLANS


OHIO PLANS


AGENT RESOURCES

NJ Dual Welcome Kit

Doctors Look-Up


NJ DUAL SOB


NJ ENROLLMENT GUIDE DSNP


UCARD ACTIVATION

Doctors Look-Up
Doctors Look-Up


DUAL & LIS ELIGIBILITY STATUS


MLTSS

Covers home and community-based services for members who require the level of
care typically provided in a nursing facility and allows them to receive
necessary care in a residential or community setting. MLTSS services include
(but are not limited to): assisted living services; cognitive, speech,
occupational, and physical therapy; chore services; residential modifications
(such as the installation of ramps or grab bars); vehicle modifications; social
adult day care; and non-medical transportation. MLTSS is available to members
who meet certain clinical and financial requirements.



It is important to verify that all of their providers are participating in our
network including their preferred homehealth agency. The prospect may continue
with an existing out-of-network provider during the transition period but must
select an in-network provider following that time. 


SEP:


DUAL-ELIGIBLE & LIS AND GENERAL SEP REMINDERS ATTENTION VALUED PARTNER, A
SPECIAL ENROLLMENT PERIOD (SEP) IS A PERIOD OUTSIDE OF THE ICEP, AEP OR MA OEP
WHEN BENEFICIARIES CAN ENROLL, BASED SOLELY ON LIFE EVENTS THAT CAUSE AN VALID
SEP.




DUAL-ELIGIBLE & LIS ELIGIBLE MEMBER 4TH QUARTER REMINDERS:


DUAL-ELIGIBLE AND LIS BENEFICIARIES THAT ARE NOT AT-RISK MAY USE THE SEP ONCE
PER EACH OF THE FIRST THREE CALENDAR QUARTERS ONLY. THIS SEP MAY NOT BE USED IN
THE 4TH QUARTER OF THE YEAR (OCTOBER – DECEMBER). IN THE 4TH QUARTER, AEP IS THE
ONLY VALID ENROLLMENT PERIOD. ANY PLAN CHANGES/ENROLLMENTS REQUESTED IN THE 4TH
QUARTER MUST BE MADE DURING AEP AND NO LATER THAN DECEMBER 7TH. PLEASE NOTE THAT
OCTOBER 1 – OCTOBER 15 AND DECEMBER 8 – DECEMBER 31 THERE IS NO AVAILABLE LIS
SEP. BENEFICIARIES WILL ONLY BE ABLE TO FOLLOW THE STANDARD AEP TIMEFRAME FOR
MAKING PLAN CHANGES DURING THE 4TH QUARTER (OCTOBER 15 – DECEMBER 7) AND THEIR
EFFECTIVE DATE WILL BE JANUARY 1, 2021.



General SEP Reminders:


ENROLLMENT APPLICATIONS MUST BE FILLED OUT CORRECTLY AND COMPLETELY, INCLUDING
ANY APPLICABLE SEP CODE. DON'T FORGET TO NOTE AN APPLICABLE SEP ON ELECTRONIC
ENROLLMENTS. FOR PAPER APPLICATIONS, BE SURE TO NOTE THE APPLICABLE SEP ON PAGE
6. FOR EMERGENCY AND DISASTER DECLARATIONS, BE SURE TO EITHER SELECT OPTION 18
INDICATING A NATURAL DISASTER OR OPTION 19 AND WRITE “SEVERE WEATHER” – WARNING!
ONLY SELECT ONE ELECTION TYPE


DUALLY ELIGIBLE BENEFICIARIES UNDER MEDICAID AND MEDICARE

4 kinds of Medicare Savings Programs

-Qualified Medicare Beneficiary (QMB) Program

-Specified Low-Income Medicare Beneficiary (SLMB) Program

-Qualifying Individual (QI) Program

-Qualified Disabled and Working Individuals (QDWI) Program



Go to Medicare.gov for full information:

https://www.medicare.gov/basics/costs/help/medicare-savings-programs



AGENTS SHOULD ALWAYS CHECK DSNP VERIFICATION TO MAKE SURE THE DSNP ACCEPTS THAT
SPECIFIC LEVEL OF MEDICAID.



To apply for LIS beneficiaries can call SSA at 1-800-772-1213 or

apply online at https://secure.ssa.gov/i1020/start ⬅ (This link will take you to
the SSA.gov Website.)

Look in the Evidence of Coverage to find which levels of Medicaid are accepted
by the plan.

Use the shortcut "Control F" to search.




To check DSNP verification for Anthem https://mproducer.anthem.com/

call their DSNP verification line or by using Mproducer to confirm eligibility
at




To check DSNP verification for Humana

you can log into Humana Vantage by going to www.humana.com and logging in.

Under quote and enroll click on Eligibility Verification.





TO CHECK DSNP VERIFICATION FOR UHC HTTPS://WWW.UHCJARVIS.COM


YOU CAN LOG INTO JARVIS AT AND THEN CLICK ON THE ENROLLMENT TAB AND FIND THE
MEDICARE AND MEDICAID ELIGIBILITY LOOKUP TOOL.


MEDICARE AHIP 2023

Medicare AHIP for 2023 will be available on June 20th. The cost will remain $175
for the 2023 certification course and exam. The certification is $125 when taken
through a number of the insurance company certification portals.



Completing the 2023 cert will certify you for the remainder of 2022. AHIP is not
required for Medicare supplements. Most carriers (UHC/AARP is an exception) do
not require certifications to sell their Medicare supplements.



Medicare AHIP $175 vs. $125 https://www.ahipmedicaretraining.com/page/login



Accessing AHIP through the AHIP Portal will cost $175. The certification
(Medicare + Fraud, Waste and Abuse (MFWA)) will be available on June 20th 2023.
We suggest waiting to take the course through one of the carrier training
portals. There will be a need to wait a few days to access through the carrier
but it will lower the price to $125.


MAPD COMPLIANCE UPDATE 2022 MAY

Remember, it must be clear that you are not affiliated with or endorsed by the
government or Medicare. A couple common ways to do this are listed below:

• “Not affiliated with or endorsed by the government or Federal Medicare
Program."

• "<Agency name> is an insurance agency not affiliated with the government or
Federal Medicare Program." or "Advertisement – Not affiliated with the
government."




If material is asking for consumers to call/contact you, it needs to be clear
who they are contacting (i.e. a licensed insurance/sales agent). You can list it
as a disclaimer or work that language into other areas of the piece:

• “Calling the number above will direct you to a licensed insurance agent.”

• “To speak with a licensed insurance agent, call the number below!” or “Call
now to speak with a licensed insurance agent about your Medicare options!”




Permission to contact:

if your marketing/advertising material (including website) is being used to gain
permission to contact a consumer, it must include certain language. This
language should include 1) who will contact them, 2) how they will contact them,
and 3) what products will be marketed.




For example:

• “By providing the information above/below, I grant permission for licensed
insurance agent, <agent/agency name>, to call me regarding my Medicare options
including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans.”

• “Please fill out the information below to have a licensed insurance agent
contact you regarding Medicare Supplement, Medicare Advantage, and Prescription
Drug Plans.”







If your material meets the definition of “marketing”, then these additional
disclaimers apply:

Federal Contracting Statement Required on all "marketing" materials, except
banners, banner-like ads, outdoor ads, text messages, social media, and
envelopes.




Example Text:

“Plans are insured or covered by a Medicare Advantage organization with a
Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the
plan depends on the plan’s contract renewal with Medicare.”

Third-Party Marketing Disclaimer Required on all third-party websites, marketing
materials, and television/radio ads that meet the definition of "marketing".
(Note: This disclaimer is not required for those that truly offer every option
in a service area.)




Required Text:

"We do not offer every plan available in your area. Any information we provide
is limited to those plans we do offer in your area. Please contact Medicare.gov
or 1-800-MEDICARE to get information on all of your options."

Benefits Disclaimer If plan benefits are marketed (i.e. Dental, Vision, Hearing,
OTC, Transportation, Fitness, etc.), the following disclaimer is needed:




Example Text:

"Not all plans offer all of these benefits. Availability of benefits and plans
varies by carrier and location. Deductibles, copays and coinsurance may apply."




Third-Party Marketing Disclaimer:

Required on all third-party websites, marketing materials, and television/radio
ads that meet the definition of "marketing". (Note: This disclaimer is not
required for those that truly offer every option in a service area.)

Required Text: "We do not offer every plan available in your area. Any
information we provide is limited to those plans we do offer in your area.
Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your
options."







Benefits Disclaimer:

If plan benefits are marketed (i.e. Dental, Vision, Hearing, OTC,
Transportation, Fitness, etc.), the following disclaimer is needed:




Example Text: "Not all plans offer all of these benefits. Availability of
benefits and plans varies by carrier and location. Deductibles, copays and
coinsurance may apply."







Part B Give-Back Disclaimer Required on all materials when Part B giveback info
is included.




Required Text:

"Part B Premium give-back is not available with all plans. Availability varies
by carrier and location. Actual Part B premium reduction varies."




STAR Ratings Disclaimer If STAR Ratings are mentioned, you need to convey that
plans are evaluated yearly by Medicare and that ratings are based on a 5-star
rating system:




Example Text: "Every year, Medicare evaluates plans based on a 5-star rating
system."




Quick Tips:

• Remember, any materials that meet the definition of “marketing”, must be
submitted to CMS for review.




• So our advice is to keep it Generic! If you want to avoid CMS/Carrier reviews
and disclaimers, refrain from using plan names, carrier logos, or plan specific
information; as well as benefits, premiums, or cost-sharing information (even if
in a general fashion). Just remember, including plan information (even in
general) will require additional disclaimers (see table above), most likely
submission to CMS.




• Focus your advertising on yourself or your agency rather than highlighting
plan details. The more you talk about Medicare Advantage plans and the benefits
they have, the more scrutiny they will receive, and most likely require
submission to CMS and additional disclaimers.




• Put yourself in the shoes of a Medicare beneficiary. Is your language
misleading or could it cause them confusion? Does your piece look “governmental”
or like it came from Medicare? Are you using “high-pressure sales tactics” or
language that could cause an undue sense of urgency or stress? If so, you should
remove that language.






NJ SOCIAL SERVICES OFFICES


CLICK HERE FOR NJ MEDICAID APPLICATION




MEDICARE ADVANTAGE ENROLLMENT LINKS


DSNP


(800) 297 6217


1-866-714-9301


Doc Look Up






DSNP


(844) 274-6355


800-918-3859


Doc Look Up






888-417-3479






Doc Look Up


855-979-2236


Doc Look Up


866-442-7516


Doc Look Up


844-256-2625


Doc Look Up





DSNP

(844) 722 2347


800-309-3163


Doc Look Up


888-381-8581


Doc Look Up






800-918-3859


Doc Look Up






DSNP


(866) 211-0544


866-822-1339


Doc Look Up

Specializing in Medicare and Senior Products

Long Term Care, Annuities, & Life Insurance


DENTAL & VISION PLANS


ADDRESS

Golden Years Design Benefits Inc.

55 Schanck Road Suite A-14


FREEHOLD, NJ 07728

Specializing in Medicare and Senior Products

Long Term Care, Annuities, & Life Insurance


DENTAL & VISION PLANS


ADDRESS

Golden Years Design Benefits Inc.

55 Schanck Road Suite A-14


FREEHOLD, NJ 07728