Thursday, December 16, 2010

Mandated Member Communications: It’s the Most Wonderful Time of the Year?

“It’s the most wonderful time of the year
with the kids jingle belling and 
everyone telling 
you’ll be of good cheer
It’s the most wonderful time of the year.”

Let me be the first to say that it’s pretty clear Andy Williams did NOT work at a health plan!!

While he is singing about parties for toasting and marshmallows for roasting, the rest of us are neck deep in the enrollment season and the stress, long hours and craziness that go hand-in-hand with this supposed “most wonderful time of year”.

Health plans are in the middle of orchestrating a successful enrollment season. With three major communication initiatives occurring, plans must create, produce and distribute Agent/Broker Communications, Pre-Enrollment materials and Post-Enrollment materials accurately, on time and within compliance. Any mistake made along the way can have a devastating effect on the plan’s ability to attract or retain members. Because of this, plans have a laser focus on these activities ensuring they are executed flawlessly.

Often lost amongst all these activities is another major initiative that needs to be handled with kid gloves: Preparing and executing mandated post enrollment communications. While these communications often fly below the radar during this time of year, they can have a major impact on a business if they are not handled properly. With changing regulations, new exhibits and addendum, and increased monitoring by regulatory bodies, failure to adhere to the requirements can lead directly to penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

While the other communications rightfully get most of the attention and resources, don’t let mandated member communications be the straw that breaks the camel’s back. Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process, and with the enactment of the Affordable Care Act and tightening regulatory guidelines, the process has only been compounded. Worse, failure to comply with strict service level agreements and deadlines can result in penalties, including monitoring, fines, and the risk of contract non-renewal. Taking the proper time will build positive momentum and will ensure that all your other enrollment activities were not for naught.

And you know what, if all of these communications are executed properly, this year’s enrollment season could very well end up being "the most wonderful time of year" for your plan.


Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at

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