Privacy and Disclosure
To search for a consumer's record what are the 3 pieces of info we need to open the call?
Name, DOB, and Address
A consumer is calling but they ask to speak to a Spanish CSR. Per Scripting what should you do?
You transfer the call to a Spanish Speaking CSR.
How long does the consumer have to resolve a SVI?
30 days from selecting the plan
What is phase 4 of the call flow?
Transfer/Close the call
Where do you go in NGD to view documents we send to the consumers?
The documents view on the FFM Contacts screen.
Mr. Green is calling and he provided his Name, DOB and Address. You were not able to pull up a record with that info. What else can we use to find her account?
Ask for Mr. Green's application ID and state.
A consumer that is not fluent in English calls. They are able to give you their info to pass disclosure. However, you are not able to go any further. What are your next steps and what script do you use?
Connecting to the language line script. Follow the action steps to connect to the language line and getting an interpreter to assist you with the consumers needs.
Donald calls the MP on July 13, he recently lost his employer coverage on June 30th. He wants to know what he needs to do to get coverage.
Update the application to report the loss of employer coverage.
While completing an application what should you do when you see attestation language while doing an application?
Read each attestation word for word and make sure they understand and agree.
Where should you do in NGD to see the status of all DMI's associated with the app?
DMI status field on the FFM app Detail screen DMI view?
If someone is not authorized and not available to give authorization, what script do we use and what is the statement we read to them?
Caller Is Not Authorized. Unfortunately, I’m unable to access specific information about this consumer. Please call back with the consumer or someone on the application age 18 or older. If you have any general questions about the Marketplace, I can help you.
Ms. Stone received a 1095-a that has info that she was covered Jan-July. She stated she had coverage for the whole year. Why would she received a form with missing dates?
She had more than 1 plan for the coverage year and should receive a second one with the other info.
Janice Smith calls in because she will have Medicare soon. What should you do to help Ms. Smith?
Ask probing questions to determine when her coverage will start.
Ms. Lopez calls to apply for coverage for her and her family. She has her husband and 2 children. Her 21 year old is still claimed as a dependent. Her 27 year old is not and files his own taxes. Who can she include on her application?
Herself, her husband and her youngest child.
Where do you view DMI end date in NGD under the DMI view?
Clock end date.
Jack is calling about his father's enrollment. There is an authorization on file but it is expired. Per the Authorization and Disclosure script what should your next steps be?
Ask to speak to the consumer so he can complete the disclosure process and see if he would like to authorize his son.
What should you do if a 1095-a has the wrong address on it and they need a reprint?
Submit a HICs escalation for the form with the correct address.
Ms. Smith and her husband are both on the Marketplace coverage. Ms. Smith is gaining Medicare coverage, but her husband still needs Marketplace coverage. Per Medicare scripting what is your next step?
Update the application with Ms. Smiths Medicare start date.
Mr. Daniels is calling to see if he and his wife are eligible for MP outside of OEP. They recently lost coverage they had through his employer. What is your next step?
Create a new application to see if the consumers are eligible for a SEP.
After reviewing documents you notice Ms. Lopez's SSN is incorrect. What can you do to fix the issues for her?
Update the application with correct info
What is the difference between Verbal permission and verbal authorization?
Verbal permission-allows a third-party caller to access the consumer’s account only for that call and while the consumer is on the line.
Complete a verbal authorization if the consumer:
A consumer has an issue with their SSN being incorrect on their 1095-A. What should you do to help them?
Tell them they can correct the SSN on the form 8962.
Mr. and Mrs. Howard use to have coverage with the Market place. He recently lost his employer coverage for both of them. We create an application with the life change. They now have new results. Based on the EDN are they eligible for cost sharing reductions and APTC? & Do they have a special enrollment verification (SVI) issue?
Yes they are both eligible for cost sharing reductions and APTC.
Yes the EDN prompts them to submit documents to confirm loss of coverage.
Ana Johnson is calling about her 7-year-old child with special needs. She needs the least expensive plan that covers his medications and doctors. What should we do to help her narrow down the results?
If one of the plans show easy pricing feature, how would you explain that to them?
Use the filter on the plan compare tool.
The feature shows other options in the consumers budget with the same out of pocket cost that are with in the same plan catagory.
Besides the DMI view, where else can you research a DMI issue in NGD?
Documents view