Highmark: 2025 TPMO Requirements: What You Need to Know, and more updates

2025 TPMO Disclaimer Requirements

In their 2025 Final Rule, CMS has codified the requirement that personal beneficiary data collected by a Third Party Marketing Organization (TPMO) for marketing or enrolling the individual into a Medicare Advantage or Part D plan may only be shared with another TPMO when prior express written consent is given by the individual.

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TPMOs must use the following standardized disclaimer:

We do not offer every plan available in your area. Currently, we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

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If a TPMO sells for all Medicare Advantage Organizations in a service area, they are required to use the following disclaimer:

Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. You can always contact medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.

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IMPORTANT CLARIFICATION: TPMO Compliance Obligation

Further, TPMOs understand that the TPMO shall not share personal beneficiary data with other TPMOs for marketing or enrollment purposes unless a prior express written consent is obtained from the beneficiary that allows the TPMO to share that information with other TPMOs. The prior express written consent from the beneficiary to share the data and be contacted for marketing or enrollment purposes must be obtained through a clear and conspicuous disclosure that lists each entity receiving the data and allows the beneficiary to consent or reject to the sharing of their data with each individual TPMO.

Below is a breakdown by state of how many plans Highmark agents represent:

• Pennsylvania: 80
• West Virginia: 11
• Delaware: 4
• New York: 13

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Medigap Plan Disenrollment / MA Plan Enrollment Member Responsibilities

It can be difficult to keep track of member responsibilities when it comes to changes in coverage.

Highmark wanted to confirm that in instances where a member is disenrolling from a Medigap plan and enrolling in an MA plan, the member must contact their carrier to formally disenroll. If the member does not inform their carrier, they will continue with both plans. Only the MA plan will pay claims, but the member will continue to pay for the Medigap plan even though it does them no good.

Some important guidelines for transitioning from Medigap plans to Medicare Advantage plans:

• Members must have a valid election to enroll into Medicare Advantage and an application must be received by the plan PRIOR to the effective date.
• Members must submit a disenrollment request, in writing, with a valid signature. Requests may be submitted via mail, member portal, or fax to: Medigap Blue | Enrollment Department, P.O. Box 535049, Pittsburgh, PA 15253-9801
• If attempting to cancel Medigap before the effective date, a written request can be submitted OR a verbal request can be taken on a recorded line with Member Service.

For additional guidance on disenrollment/enrollment member responsibilities, check out the quick reference guide by clicking here.

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Reminder: WV/DE Medigap Blue Loyalty Discount

What: WV/DE Medigap Blue Loyalty Discount: Offers an automatic 10% monthly savings off Medigap products for select Highmark members.

Who: Existing non-Medicare West Virginia and Delaware Highmark members who choose to stay with Highmark by enrolling with one of their Medigap products.

How: No action is required on the applicant's part; Highmark's system will pick up eligibility, for any future enrollments, based on prior coverage when applications are processed and apply the discount automatically.

Any Highmark-certified agent can assist with these applications to achieve the discount.

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OTC Catalogs Now Available on Marcom

Highmark's 2025 OTC catalogs are now available for order via Marcom!

To access Marcom and order your 2025 OTC catalogs:

1. Login to the Producer Portal using this link: Highmark Producer Portal Link
2. Select Medicare Dashboard
3. Under Quick Links, select Order Supplies - Over 65 (Marcom/ShopPro)
4. From the Catalog, select Medicare Enrollment Materials
5. Select 2025 MA Enrollment Materials
6. Select OTC Catalogs

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In Case You Missed It: Download Highmark's 2025 Agent Field Guide and Agent Product Guide Today!

New for 2025, Highmark has taken the popular and useful Agent Field Guide and reorganized it into two distinct resources: the Agent Field Guide and the Agent Product Guide!

For years one of the most comprehensive resources has been Highmark's Agent Field Guide. This single document has always served as a comprehensive source of information about how to do business with Highmark and provided detailed plan information for their products in all of their sales regions.

As scope and geographies have expanded, Highmark has embraced the opportunity to reorganize the elements of the traditional Field Guide into two more focused resources: the Agent Field Guide and the Agent Product Guide.  This will make it easier for you to find the information you need, when you need it. Be sure to download both documents so you'll be prepared with the answers you're looking for!

Highmark will include the most up-to-date version of the Field Guide and the Product Guide in emails each week, and will indicate when any changes are made.

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2025 Highmark Medicare Advantage, D-SNP, and ACA Individual Market Agent Field Guide

The Agent Field Guide is still your source for how to do business with Highmark. It includes information on their technical processes, commissions, compliance, and agent oversight. It also features details about all three lines of business (MA, D-SNP, ACA) including product overviews, value-added benefits, pharmacy networks, and in-network facilities.

To download the 2025 Highmark Medicare Advantage, D-SNP, and ACA Individual Market Agent Field Guide, click here.

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2025 Highmark Medicare Advantage, D-SNP, and ACA Individual Market Agent Product Guide

The Agent Product Guide is your new resource for plan information for MA, D-SNP, and ACA lines of business. This is where you'll find updated coverage maps and benefit detail grids for all products, as well as regional product highlights and supplemental/value-added benefits.

To download the 2025 Highmark Medicare Advantage, D-SNP, and ACA Individual Market Agent Product Guide, click here.

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