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Care Improvement Plus
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Compliance

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Compliance

Licensure, Certification, and Agent Documents

All agents writing business must be fully licensed by the Department of Insurance in all states where they are conducting business and be certified by Care Improvement Plus. An agent becomes certified by Care Improvement Plus by successfully completing the credentialing process and online training with a passing score of 85% or greater.

Before an agent can begin selling, the following documents must be on file with Care Improvement Plus:
  • Copy of Agent License
  • Proof of $1,000,000 Errors and Omissions coverage
  • Proof of Certificate of Completion (Agent Certification)
  • Executed Agent Agreement

Use of Sub-agents Only licensed and certified agents with their own Care Improvement Plus Agent ID may represent Care Improvement Plus. The use of unlicensed and/or uncertified individuals to enroll Medicare beneficiaries in our plans or to conduct sales presentations without the presence of an agent licensed in the state and who has completed Care Improvement Plus training is strictly prohibited.

Agent responsible for the enrollment, Agent ID and Agent of Record must match The licensed and certified agent who conducted the sales presentation with the beneficiary must sign the enrollment application and clearly indicate the Agent ID on the enrollment application. This agent will be identified and credited as the Agent of Record. If the Agent ID is missing and/or illegible, this will increase the likelihood that the agent will not be identified and credited as the proper Agent of Record. An agent may not sign an enrollment application if that agent was not present at the sales presentation. No exceptions!

Disciplinary action We will notify the agent's Field Marketing Organization (FMO) and the agent by email in the event we receive a complaint against an agent. The agent's response to any investigation is due back within three business days (72 hours) unless there are circumstances beyond the agent's control that prevent compliance with this deadline. Your organization must provide proof to Care Improvement Plus in writing of disciplinary action taken against an agent.

Enrollment Verification Care Improvement Plus requires verification of all applications to ensure that we are enrolling individuals who understand our plan features and meet our eligibility criteria. A Verification Agent will call the prospective member to conduct an outbound verification call within 10 days after we have received the application.

Additional communication We will notify you from time to time regarding updates in CMS marketing requirements or clarifications of health plan and our policies. We appreciate any feedback from you regarding these policies and requirements.

Compliance with laws and fraud, waste and abuse, and anonymous hotlines We are committed to complying with all applicable laws and regulations and guidance, including CMS policies against fraud, waste and abuse. Healthcare fraud generally involves a person or entity's intentional use of false statements or fraudulent schemes to obtain payment for federal health care services. Program abuse results in unnecessary or increased costs to the Medicare program due to excess charges for services or supplies, providing medically unnecessary services or services that don't meet professionally recognized standards. Waste typically refers to careless or wasteful use of health care services.

We have established a fraud, waste and abuse telephone and fax service that may be used to report incidents of alleged noncompliance with laws and/or fraud, waste and abuse. All such reports of noncompliance or fraud, waste and abuse so that we may take appropriate corrective or disciplinary action.

Telephone hotline: 1-800-210-3312
Fax hotline: 1-443-524-8704

The hotlines are confidential. You do not need to identify yourself if you contact us through the hotline.

Reports of noncompliance or fraud, waste, and abuse may also be made in writing and can be sent to the following address:

Care Improvement Plus
351 West Camden Street, Suite 100
Baltimore, MD 21201
Attn: Compliance Officer

We appreciate your continued efforts in the area of compliance to ensure that enrollments are thorough and fair to the Medicare beneficiaries. We value your partnership and look forward to continuing a mutually beneficial relationship.



This page was last updated on: 4/13/2011 4:41:18 PM
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Copyright © 2006 - 2012 Care Improvement Plus
Y0072_OE12_4511 CMS Approved 11/15/2011


Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. Care Improvement Plus is owned by XLHealth Corporation, a UnitedHealthcare company. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.

Y0072_R3E12_4511 CMS Approved 02/09/2012