Base Line Benefits
What must be compared
Premium , pcp copay
specialist copay
When doing a legacy call , what must you do prior to submitting the application
transfer to ivr
TRUE - if the client sees doctors outside of the va we want to check for coverage. If the client states they do not then you have satisfied qa
What is the correct way to ask for Prescriptions?
What prescription's are you taking currently
Grab your medicine bottle
Milliman
How many points are lost if you do not read the Medicare disclaimer verbatim
11
If a client has lis/medicaid what premium cost must be given
The original cost
In the application: what needs to be read for payment disclosures
IF not a 0 dollar premium - all options along with the statement about penalties
If a client sees a doctor out of the network or you are unable to find the doctor what information must be given
network participation and how it works *if doctors office agrees and accepts medicare*
oon cost
What are the RX restrictions?
step therapy
quantity limits
prior authorization
If you do not compare premium/pcp copay and specialist copay . how many points do you lose
12
If an additional benefit is offered based on chronic illness/low income - what is required
Letting the customer know that they MAY qualify due to chronic illness/low income.
True or False- IF a customer has cognitive impairment but does not have a poa , we can write them a policy if we take it slow
FALSE
What is the correct way to ask about preferred hospitals
What is your preferred hospital ?
* not in case of an emergency
True or false : If a customer has LIS you do not have to read original cost
FALSE
If you only present the LIS cost how many points can you lose
11
When going over additional benefits ( dental/ hearing etc) in the sob what must be discussed
Every need identified
For Humana plans what statement must be read
•HUMANA ONLY- If the plan has prescription coverage the agent must read the Humana pharmacy opt-in statement
True or false :If the doctor does not come up in our system- its okay you tried!
FALSE- use google , carrier website
If a costumer has LIS what must be read
ORIGINAL cost of drugs/deductible and premium
If you miss one thing on drugs how many points can you loose
18
What statement ends the pre enrollment script
For beneficiary with existing Medicare Advantage coverage the agent read the following:
For you to start receiving these benefits we will need to switch you out of your current plan. That means your new coverage will replace your current coverage on [EFFECTIVE DATE]. Prior to continuing, do you understand you will be enrolling in a new plan?- Verbatim language is NOT required
For beneficiary with other existing coverage the agent reads the following:
Your new coverage will replace your current coverage on [INSERT DATE]. Prior to continuing, do you understand you will be enrolling in a new plan?-Verbatim language is NOT required
What are the 5 things you must go over post sale
1.Agent must inform the beneficiary to ignore any additional advertisements or marketing they may see
2. If the beneficiary is switching from one MAPD plan to a new plan they must inform the beneficiary they will be receiving communication from their previous carrier regarding the plan change
3. Agent must recap the benefits/reason for enrolling in the new plan
4. Agent provides their direct phone number (agent extension is not required)
5. Agent must ask for refferals
If a doctor does not have a pcp code can we still use them in the application
NO
If the drugs are already in the system you must verify what?
everything!
Drug name/type/dosage/quantity
what is the highest qa score you can get if you miss quantity limits and do not ask for a specialist
67