UHC Call Recording Policy

CMS Update Regarding Third Party Marketing Organizations

Several Centers for Medicare & Medicaid Services (CMS) requirements go into effect Oct. 1, 2022, following release of the Final Rule (April 29, 2022) and Medicare Communications and Marketing Guidelines (Feb. 9, 2022). Learn how CMS defines a third-party marketing organization, about the new requirements, and what UnitedHealthcare is doing to support agents and agencies.

CMS Definition of Third-Party Marketing Organizations (TPMOs) 

• Organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment related functions as a part of the chain of enrollment (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision) into a Medicare Advantage (MA) plan or Prescription Drug Plan (PDP).
• First tier, downstream or related entities (FDRs) or other entities that are not FDRs but provide services to an MA Plan or Part D Sponsor or an MA Plan’s or Part D Sponsor’s FDR.

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All entities and individuals contracted directly with UnitedHealthcare are considered FDRs and, therefore, TPMOs, including National Marketing Alliance (NMA) agencies, eAlliance Call Center agencies, Field Marketing Organization (FMO) agencies, Independent Marketing Organization (IMO) agencies, Master General Agent (MGA) agencies, General Agent (GA) agencies, and Agents.

TPMOs also include any entity contracted or subcontracted by an FDR that provide services to UnitedHealthcare or UnitedHealthcare’s FDR. This includes Solicitors.

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Agent/Agency Requirements

UnitedHealthcare expects agents and agencies to comply with the new requirements when conducting lead generating, marketing, selling, and enrollment activities with Medicare beneficiaries. These requirements include the following:

• Use the following standardized disclaimer where appropriate: “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.” The disclaimer must be:
• Used by any TPMO that sells MA plans on behalf of more than one MA organization unless the TPMO sells all commercially available MA plans in a given service area and by any TPMO that sells Part D plans on behalf of more than one Part D Sponsor unless the TPMO sells all commercially available Part D plans in a given service area.
• Verbally conveyed within the first minute of a sales call.
• Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication.
• Prominently displayed on TPMO websites.
• Included in any marketing materials, including print materials and television advertisements, developed, used, or distributed by the TPMO.

• Record all calls with beneficiaries that are part of the chain of enrollment into a Medicare Advantage or Part D Plan (the steps taken by a beneficiary from becoming aware of a Medicare plan or plans to making an enrollment decision) in their entirety and retain and make them available upon request for 10 years.
• Due to the variability in telephony devices and systems, UnitedHealthcare does not prescribe or recommend what technology or software/hardware to use to record, retain, and/or retrieve calls.
• Agents and agencies are reminded of the requirement to protect consumer/member Protected Health Information (PHI) and Personally Identifiable Information (PII). The recording and storage of calls must meet UnitedHealthcare security requirements

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• Disclose to the Medicare beneficiary when conducting lead generating activities, either directly or indirectly for UnitedHealthcare, that:
• Their information will be provided to a licensed agent for future contact. This disclosure must be provided:
• Verbally when communicating through telephone.
• In writing when communicating through mail or other paper.
• Electronically when communicating through email, online chat, or other electronic messaging platform.
• They are being transferred to a licensed agent who can enroll them into a new plan.

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• Disclose any subcontracted relationships used for marketing, lead generation, and enrollment to UnitedHealthcare. Watch for a future communication from UnitedHealthcare with instructions for disclosing these relationships.
• Report monthly to UnitedHealthcare any staff disciplinary actions or violations of any requirements that apply to UnitedHealthcare associated with beneficiary interaction. Watch for a future communication from UnitedHealthcare with instructions for disclosing these actions and violations.

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What UnitedHealthcare is Doing

• Communicating with CMS to get clarity on implementation and expectations.
• Looking into near- and long-term solutions for agents to use to record calls as required, including incorporating call recording capabilities into our current agent tools.

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