N.J. Admin. Code § 10:74-4.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:74-4.1 - Marketing

(a) The contractor shall obtain written approval from the Division prior to the commencement of marketing activities, regarding the form and content of the following:

1. Informational and instructional materials to be distributed to inform Medicaid/NJ FamilyCare enrollees of the scope and nature of benefits provided by the contractor;

2. Informational and instructional materials to be distributed to inform Medicaid/NJ FamilyCare enrollees of changes in program scope or administration;

3. Public information releases pertaining to the enrollment of Medicaid/NJ FamilyCare individuals in the contractor's plan; and

4. Instruction to community-based organizations that will empower them to provide instruction to their beneficiaries to achieve better health outcomes.

(b) The contractor shall ensure that:

1. All of the contractor's marketing presentations accurately and clearly represent the benefits and limitations of the contractor's plan, and are not false or misleading in any way;

2. All of the contractor's marketing representatives and agents have received sufficient instructions and training to be capable of performing such marketing activities;

3. All of the contractor's marketing representatives represent themselves as agents of the contractor involved in marketing;

4. All marketing presentations make it clear whether a specific MCO enrollment is voluntary or mandatory;

5. There are no activities which influence an individual's enrollment with the contractor in conjunction with the sale of any other insurance;

6. None of the contractor's marketing representatives offer or give any form of compensation or reward as an inducement to a Medicaid/NJ FamilyCare beneficiary to enroll in the contractor's plan. However, for marketing purposes, the MCO may offer health-related promotional giveaways that shall not exceed $ 15.00 per item and non-health-related promotional giveaways that shall not exceed $ 10.00 per item, the combined total value of both health related and non-health related promotional giveaways shall not exceed $ 50.00 in the aggregate annually per individual;

7. No door-to-door canvassing, telephone, telemarketing or "cold-call" marketing of enrollment activities by the contractor, or by an employee, or an agent of an independent contractor shall be performed on behalf of the contractor; and

8. All marketing materials are distributed throughout all enrollment areas for which it is contracted to provide services.

N.J. Admin. Code § 10:74-4.1

Amended by 51 N.J.R. 1359(a), effective 8/19/2019