Individual U65: Exchange Compliance monitoring – July 2019
All agents selling Federally-facilitated Marketplace (FFM) products for Wellmark are considered delegated or downstream entities (DDEs) by the Centers for Medicare and Medicaid Services (CMS). CMS has specific compliance requirements that all DDEs must follow, including all Wellmark contracted agent DDEs.
This BBO will provide detailed information about the compliance requirements that will be monitored in July 2019. The goal in monitoring the compliance requirement listed below is to work collaboratively with contracted agents and agencies to ensure both Wellmark and its agents are aware of the listed requirements and the steps needed to evidence that compliance standards are being adhered to.

Which requirement will be monitored?
Completion of training on CMS’ privacy and security standards to all senior management, board members, employees, temporary employees, volunteers, contractors and downstream or related entities will be monitored in July 2019. Note: the CMS privacy and security standards are set forth in the agent DDE’s contract with CMS.

How can I show that I am compliant with this requirement?
A copy of the training administered, as well as evidence of the name of each person that has completed training, their role and the date of completion will be requested.
Wellmark has provided a training that can be utilized and can be found on the Producer Connection page.
A sample training completion log can also be found on the Producer Connection page.

How will I know if I am being monitored?
The following monitoring process will be followed during this monitoring month:
1. Sales Compliance will randomly select agents to be monitored.
2. Sales Compliance will email a monitoring request to agents selected for monitoring. The email will include additional details on the above compliance requirement being monitored and what evidence must be submitted by the agent.
3. Agents being monitored will have 10 business days to respond to the monitoring request.

Marketplace Privacy & Security Requirements for Agents and Brokers

Agents & Brokers Learning on Demand: Privacy & Security Standards

Part II: Marketplace Privacy & Security Requirements for Agents and Brokers

As a reminder, monitoring periods for DDE compliance will occur periodically throughout the calendar year. Additional monitoring in 2019 is scheduled for the month of October.

Any questions should be directed to the agent DDE’s General Agency or Wellmark’s Sales Compliance at SalesCompliance@wellmark.com.  You may also contact the PIPAC Health Department, 319-277-8541.