Consents
Name This Consent: “[Customer’s name], for your protection I do need to inform you that this call may be monitored and recorded, and may be shared with insurance companies who administer the plans we sell. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800- Medicare- 24 hours/7days a week- to get information on all your options. I also want to let you know that you will not be required to provide any health related information unless it is necessary to determine enrollment eligibility.”
CMS Consent
What if a client does not have an email address but we still need to have a Quote Object made in Salesforce automatically?
Use "noemailprovided@springventuregroup.com"
What must be confirmed for doctors on every call?
What is something that is read for PPO plans but not HMO?
Out of network costs
Each available payment option has unique associated required scripting. What are these available payment options?
Coupon book/monthly bill, Pay from bank account, Social Security Check withholding, Railroad Retirement withholding
How many SalesForce Consents must be read on a call?
8, including TCPA
What does the SEP code, NLS represent?
Gain, Lose or a Change in LIS-Eligible Status
True or False: You must confirm with VA/Tricare clients whether or not they have PCP, specialists or meds
True
True or False: SMIA MA Agents do not need to continue to use the Universal Enrollment Script anymore, as long as they are reading directly from the SunFire application.
TRUE: SunFire will populate scripting during the enrollment process that dynamically changes based on the enrollment scenario. The scripting is clearly labeled and best of all, it's CMS approved
True or False: Aetna transfer calls require enrollment scripting
False
What must be confirmed with each client on every call?
POA
What 4 things must be gathered at the beginning of each voice enrollment call?
Consent to enroll, re-confirm POA, re-read CMS consent and re-read TPMO consent
What 3 things must you ask for on medications?
Name, frequency and dosage of medication
What must be read for mental health care?
Inpatient and outpatient individual costs, as well as group costs (if listed)
What 3 consents must be collected on every call, even if you have spoken before?
SOA, TPMO and CMS consents
When should the CMS consent be read?
Both at the beginning of each call and on the enrollment portion of each call
What must be read in order to complete a compliant text/email enrollment?
Nothing other than reading the questions on sunfire verbatim
Assuming a client has LIS, what must be read on every call for Part D costs?
Tier copays and cost of their individual medications
Name 10 required benefits that must be listed on every call
Premium, Part B reduction, deductibles, doctor copays, ambulance copays, ER copays, urgent care copays, mental health copays, Part D tiers, additional benefits, preventative care, inpatient and outpatient hospital costs, out of network benefits (if PPO)
What type of enrollment has the highest placement rate?
Which SalesForce consent is this a part of? “SmartMatch Insurance Agency is a licensed and certified representative of Medicare Advantage [HMO, HMO SNP, PPO, PPO SNP and PFFS] organizations [and stand-alone PDP prescription drug plans]. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal.” [Disclaimer]
Personal Information Consent
In no particular order, what 8 consents are required to be read, verbatim, on every call.
POA/Auth Rep, Scope of Appointment, Permission to Call, TCPA, Federal Contracting Disclaimer, Privacy Disclaimer, TPMO, and BEQ Consent.
Explain the Initial/Coverage Gap/Catastrophic phases for Part D (aka the Donut Hole)
You pay the costs below until your total drug costs reach $4,660. You pay the copay listed below or the cost of the drug, whichever is lower. These cost shares may also apply to Home Infusion drugs when obtained through your Part D benefit; The coverage gap lasts until your out‑of‑pocket drug costs reach $7,400; You pay a small cost share for each drug. Generic Drugs You pay the greater of 5% of the cost of the drug or $4.15. Brand Name Drugs You pay the greater of 5% of the cost of the drug or $10.35.
Assuming a client doesn't have LIS, what must be read on every call for Part D costs?
Deductible, Tier Copays, Initial/Coverage Gaps/Catastrophic, clients' specific medication costs
1. Aetna Transfers; 2: COS Transfers; 3) Text/Email Enrollments; 4) All other placement activities