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COMPLIANCE CORNER

 Agents contracted with GarityAdvantage are expected to review and follow the compliance policies and procedures on this page. Reach out if you have any questions: compliance@garityadvantage.com

Compliance

Agent Licensure, Appointment & Certification

Scope: All agents, regardless at which level they are contracted at, must be aware and comply with CMS “Medicare Marketing Regulations,” as well as any applicable State laws and regulations. This policy applies to any agent marketing MAPD or PDP plans. These guidelines are revisited and updated annually by CMS.

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Agent Oversight

It is the policy of our agencies to maintain strict and complete compliance with all laws and regulations that address the products we sell. This includes any and all Federal laws and regulations as well as any and all State laws and regulations. Furthermore, it is our intention to fully support and comply with any specific Company policies and guidelines as they relate to representing the Company and/or the products we represent on their behalf. Read more…

Agent Sales and Marketing Practices

Scope: All agents, regardless at which level they are contracted at, must be aware and comply with CMS “Medicare Marketing Regulations,” as well as any applicable State laws and regulations. This policy applies to any agent marketing MAPD or PDP plans. These guidelines are revisited and updated annually by CMS.

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Code of Conduct Addendum

Last Reviewed 8/19/23
Anonymous reporting to Medicare Insurance Carriers

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Downline Oversight & Monitoring

Scope: All downline entities with contracted relationships with GarityAdvantage Agencies are subject to the following oversight and monitoring.

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Licensed Agent Quality Assurance Process

Overview:
Garity Advantage follows Centers for Medicare & Medicaid’s (CMS) regulatory requirements contained in but not limited to 42 CFR Part 422, and associated guidance. Garity Advantage is responsible for sales training, oversight and monitoring of licensed agents, and other processes to ensure that sales activities are compliant with CMS requirements and consistent with Garity Advantage Policies and Procedures. This policy is reviewed annually and based upon need due to regulatory and business changes. Read more…

Garity Advantage Downstream oversight Policy:

The purpose of this policy is to implement relevant provisions of 42 C.F.R. Section 422.503(b)(4)(vi), and 423.504(b)(4)(vi), Chapters 9 and 21 of the Medicare Managed Care Manual and the Prescription Drug Benefit Manual which outlines the Centers for Medicare and Medicaid Services (CMS) requirements for Part C and D sponsors and their First Tier, Downstream and Related entities (FDRs) to implement an effective compliance program, including implementation and operation of an effective system for oversight of Medicare activities and downstream entities.

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GarityAdvantage Terms of Service

Please read these Terms of Service (“Terms”) carefully before using the [Garity Advantage] (the “Company”) Resources (as defined below), applying to become an insurance agent for the Company, or otherwise seeking affiliation with the Company. Read more…

Marketing Promotional Activities & Gifts

Scope: All licensed employees and independent agents must be aware of the Medicare Marketing Regulations, which are reviewed and updated each year by CMS. This policy will be amended as necessary based on changes in regulations.

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Marketing Terminology and TPMO

Prohibited Terminology
Scope: All licensed employees and independent agents must be aware of the Medicare Marketing Regulations, which are reviewed and updated each year by CMS. This policy will be amended as necessary upon reviewing new Regulations. Read more…

Compliance Corner

Garity Advantage Annual Downline Compliance


 Agents contracted with GarityAdvantage are expected to review and follow the compliance policies and procedures on this page. Reach out if you have any questions: compliance@garityadvantage.com

Background

The Centers for Medicare & Medicaid Services (CMS) requires that we communicate general compliance program information and requirements, as well as provide training and education and monitor specific Compliance and Fraud, Waste and Abuse (FWA) requirements to our employees, first tier, downstream, and related entities. (FDR)

Action Required

Review the following compliance and FWA requirements now to make sure you, your employees and any applicable affiliate organizations meet all the requirements. Employees are defined as hired staff, management and temporary workers for your company or subcontractors that have involvement in or responsibility for a core function in the administration or delivery of Medicare Advantage Part C, Part D, or Medicaid health plan benefits and have access to personal health information/personally identifiable information (PHI/PII).

Reporting a CMS Violation

If you suspect misconduct or identify an excluded individual, report it to us immediately so we may investigate and respond appropriately. Go to GarityAdvantage.com/compliancecorner and click on “report a CMS violation”. This is an anonymous communication and GarityAdvantage prohibits retaliation for reports made in good faith.

 

GarityAdvantage

Compliance Team

17 Accord Park Drive | Norwell, MA 02066

Email: kfennessy@garityadvantage.com