Enter Title

Open Enrollment

100

The advocacy you can locate the Open Enrollment/Prospective Member information  

Benefits and Coverage Advocacy 

200

The first thing you select on the ISET Search screen, when a prospect member calls in.

Select other as the originator type 

300

The name of the website/program you use for Open Enrollment calls.

OpenDoor

400

The search function of OpenDoor allows you to search for employer by:

• Employer Group Name
• Group Number
• Also Known As Name

500

A new website to support benefit plan shopping and enrollment during the groups enrollment period.  

***500 bonus points for the technical support department for this website

Unitedhealthcare Digital Onboarding  877-726-2360 M-F 9-9pm EST

Open Enrollment Part 2

100

The tab in ISET where you can locate the OpenDoor website

Benefits tab 

200

The contact category and reason code for an Open Enrollment call 

• Contact Category: Eligibility
• Reason Code: Open Enrollment

300

If the name of the group is not loaded in OpenDoor for an existing member

Advise the member to contact their employer for assistance during open enrollment.

Best Practice Note: Provide the member with the employer's phone number and offer to connect mbr to them.

400

The default amount of records displayed when clicking the "Display All Open Enrollment Information" link in OpenDoor

The default display is 50 records per page, but it can be changed to 10, 25, or All.

500

You review this first if the mbr has a question about a specific drug for an Open Enrollment call 

• On the OpenDoor > Pharmacy tab, review Coverage/PDL for Drug.

SOPs

100

Where you would locate the process if a member is being billed more than what is listed on the claim

Claims advocacy

200

Where you can locate FAQ about hearing aids

benefits and coverage advocacy 

300

Where you can locate the compassion card process

Building Trust through advocacy

400

Where you can find the myuhc.com site demo

Self Service advocacy

500

Where you can locate dashboard processes

Proactive Member Advocacy

Building Trust Through Advocacy

100

• Provide the caller with the appropriate toll-free number for future calls.
• Explain next steps to the caller.
  Note: If an extended hold time is listed on the My Aim tool, provide the expected wait time to the member.
• Select Cold Transfer from Manual Dial drop-down list.
• Select Manual Dial radio button.
• Click the Dial Pad icon to enter numeric responses, if needed.
  Notes:
  • To close the Dial Pad window, click the X in the upper right corner.
  • Keyboard may also be used as a dial pad, but the dial pad must be up to use the keyboard.
• Advocate is dropped from the call and placed in ready status.

Cold Transfer Guidelines 

200

 877-842-3210

Provider Services phone number

300

• The agent says call opening, and caller does not respond.
• Repeat the call opening, wait for another ten seconds.
• Attempt to locate a callback number for the member.
  Note: The telephone number may have populated in VCC or the member's number may be on file.

Ghost call process 

400

The aux you would use on floor to make an unscheduled callback 

Default 

500

The site used to determine if there is a customer-specific form for a policyholder for the type of form they requested 

Form Fulfillment Crosswalk// also know as Crosswalk 

COB

100

• The plan that covers the person as an employee, enrollee, subscriber, or retiree (other than as a dependent) will be primary to a plan that covers same person as a dependent.
• This rule applies when:
  • Both spouses cover each other as dependents under their respective plans

Rule 1 - Non-dependent/Dependent

200

• A plan that covers a person as an employee - who is neither laid off nor retired - is primary. The other plan may not have a rule for laid off or retired employees similar to this rule. In this case, the rule is ignored.
• The only situation in which the laid off/retiree rule may apply is when a member is employee/subscriber for both the active and inactive plan. Therefore, if member is a subscriber on an inactive plan and is a spouse or dependent on an active plan, then the plan in which member is a retiree is primary.

Rule 4 - Active/Inactive Employee (Laid Off/Retiree)

300

• If preceding rules do not determine the order of benefits, the benefits of the plan that covered an employee longer are determined to be primary over those that covered the employee for a shorter period of time.
• There are instances when an employee has two jobs and is covered under group plans with each employer.
• This rule applies when a married dependent child is covered under a spouse's plan and is covered under a parent's plan when none of the rules above apply.
• This rule also takes over when all other rules (applied in the sequence here) do not determine an order of benefits.
• In determining the length of time an individual has been covered under a plan, two plans shall be treated as one continuous plan if the individual was eligible for coverage within 24 hours of the prior plan's termination. A change in benefits, type of plan, or carrier does not constitute the start of a new plan.
• If an individual's effective date of coverage under a plan is subsequent to the effective date of the actual insurance plan, the individual's length of time covered under the plan is measured from the individual's effective date of coverage.

Rule 6 - Longer/Shorter Length of Coverage

400

This includes parents who live together, but are not married.

• The plan of parent/legal guardian whose birth date is earlier in the calendar year will be primary for children, and plan of parent/legal guardian whose birth date is later in the calendar year will be secondary.
• The term birthday refers only to the month and day in a calendar year, not year person was born.
• If both parents have same birthday, then plan of parent who has been in effect the longest is primary over plan that covered other parent for shorter period of time.
• If other plan does not follow the birthday rule, but follows gender rule (male's coverage is always primary over female's) or another conflicting rule, then other plan's rule will determine which plan is primary.
• Birthday Rule: Compare parents' birthdays to determine which plan is primary.
  • Whichever month is earlier in the year, that plan is primary.
  • If month is the same, go by the day. Whichever day is earlier in the month, that plan is primary.
  • If birthday is exactly the same, whichever plan has been in effect longer is primary.

Rule 2 - Dependent Child/Parents Not Separated or Divorced/The Birthday

500

• There are situations when individuals can be covered under a group health plan and under a COBRA plan. If an individual was covered with a group health plan with their employer and had coverage under another group health plan through their spouse, they would have two group health coverages. If that individual then moved to a COBRA plan through their employer, they can still retain the group health coverage through their spouse. They would then have a COBRA plan and group health coverage.

Rule 5 - COBRA Continuation of Coverage