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Permission to Contact Form

I have not seen any CMS generic permission to contact forms. UHC has an over view of their PTC guidelines (see attached).

Most PTC forms are carrier specific. However, if you were to create one, include a disclaimer such as:
According to Medicare rules, we need your permission to contact you to discuss your Medicare plan options. By accepting this form, you are agreeing to a sales telephone call or an email from a licensed sales agent to discuss the specific types of products above. The person who will be discussing plan options with you is with or contracted by a Medicare health plan or prescription drug plan that is not the Federal Government, and they may be compensated based on your enrollment in a plan. Signing this does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan.

If you ask for their email address, use this:
By providing my e-mail address or telephone number, I agree to allow a licensed sales representative to contact me regarding information related to Medicare health plans and health insurance plans, products, services and/or educational information related to health care.

NOTE: You can ask for Name, address, phone, email, ask if they are Medicare eligible or when they will be, but you cannot ask age.

None of this is CMS approved (I copied it from a website, there was no CMS approval verbiage on the site).
 

Attachments

  • Permission_To_Call_Compliance_Tool_Final.pdf
    67.3 KB · Views: 211
Humana did generate a PTC form which they wanted agents to use. Cant remember if any other carriers do. So far haven't used them.
 
Bumping this.

Does anyone have a generic PTC they use? I'm starting to do sales events for DSNPs at food banks, etc and will have a SOA in place, of course.

But if I can't write them there, I'd like to be able to call them to follow up.
 
Bumping this.

Does anyone have a generic PTC they use? I'm starting to do sales events for DSNPs at food banks, etc and will have a SOA in place, of course.

But if I can't write them there, I'd like to be able to call them to follow up.

Here's where CMS and the entire Medicare business gets @#$% silly! Why can't you take an "approved" branded card, take off the brand/logo or whatever that identifies the carrier, and have it reprint it without them. Voila, generic "approved" PTC card.
For the life of me, I can't imagine why this would not be acceptable.
So the attached is the generic I made up and use. Formatted to take to your printer, run some copies and have them cut for you. Most print shops will do it....
 

Attachments

  • 2019 Request Contact Form.pdf
    94.7 KB · Views: 171
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