GPS
What does GPS stand for
Guided Personal Service
How to view documents MB's send to us
IOP/CWAS
How old does a MB have to be to get Medicare
65/Under 65 with Certain Disabilities
What system besides GPS Knowledge Articles can we use to find help with processes and policies?
E.Policies
When validating a members account, what do you select for case origin?
Phone Inbound
Before exiting GPS what two things must you do first
Complete SR and put a comment
How to find what Broker is listed on members account?
MP
When is IEP and how long do they have
3 months before their 65th birthday, month of their birthday, and 3 months after their 65th birthday/ 7 months
Where can you find links to many different systems you would use
Wiki Tools
What is LEP and where does that charge come from
Late Enrollment Penalty/ Medicare
Where do you find Medicare ID # and effective dates
Medicare Attributes
What system do we use to mail a disenrollment form to the member?
OBC
Charlie Crunchy is dissatisfied with his plan and wants a new one but he used his SEP to move into this new plan. What do you tell the MB? The date is 11/8/23 Be specific if there is an election they can use
Provide empathy, advise of AEP, transfer to Telesales.
What company is considered a Joint Venture with Aetna
Allina Health
Sally Sue is complaining about how upset she is with a provider and says that she needs the number to Medicare to file a complaint. What do you do?
Provide empathy, advise MB that you can file the grievance for her and file the grievance for her in GPS, also offer to find a new provider for her.
Can you help someone who is not a MB and not authorized on the account
Yes, you can give level 1 information
Strawberry Shortcake calls in furious because she didnt know she was being enrolled into the plan when she was talking to an Agent and wants to cancel her enrollment. You see that she receives extra help (LIS) Enrollment begins: 05/22/22, the date is 07/15/22
Provide empathy advise MB how to disenroll, file a grievance for MB misrepresentation
Where can you refer members if they do not have certain benefits on their plan that they want access too
Resources for Living
Jelly Fish calls to say they do not want to have their Aetna insurance anymore. What do you do? Enrollment begins: 03/01/23, the date is 02/28/23
Provide empathy and cancel plan
What is needed to authorize account when it is not fully validated through IVR
Mbr ID, Name, DOB, & verify Address, ph#
Laura Loopy is not pulling up in the system. What can you do to find her enrollment
Check Marx or Market Prom
Luna Starlight just moved from Alaska to Texas and wants to change her plan. What election period can she use to change her plan? The date is 08/30/2023
SEP
What can you offer to members that provides discounts of different benefits
Value Added Items and Services (VAIS)
If a member calls asking for their Member ID, can we provide it over the phone?
As long as they are able to provide their MBI#, yes.