How Many Points
How many points are the Medicare disclaimer and SOA worth
True or false- You CAN paraphrase disclaimers
False, disclaimers are in red and must be read verbatim
True of False: If the client has LIS you only need to go over the LIS range for drugs
False. You are required to go over the standard cost and LIS copay range
If the client has VA do doctors need to be discussed?
Yes, ask if they have civilian doctors to look up or if all their doctors are from the va
What are the 4 things you must get when gathering medications
1. Dosage
2. Quantity
3. Type
4. Any letter behind it
How many points are deducted for using the word free
5
How many disclaimers are in the intro
Two
What must be compared if the client has a current ma plan
Premium
PCP copay
Specialist Copay
What 3 things need to be asked in order to get all point for inquire about doctors
1 primary doctor
2. Specialist
3. Preferred Hospital
How many times must you ask for the drugs
If you ask for hospitals and primary care doctor, what is the maximum number of points you can get?
4 points.
During the application what disclaimer must be read
HMO/PPO disclaimer
When discussing dental benefits, what is required to discuss.
Dental – routine exam copay and number of routine exams per year
If assigning a new doctor what information must be given to the client
Name and address
What are the 3 types of limitations
Step Therapy
Quantity Limit
Prior Authorization
On the DTC score card what is the heaviest ranked category ( outside of compliance)
Drugs and doctors
Right before you start the application- What disclaimer must be read
'Enrollment Verification
• Agent reads the following:
(Verbatim - if exisitng MA plan) 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 [INSERT DATE]. Prior to continuing, do you understand you will be enrolling in a new plan?
(Verbatim - if other plan type) 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?
When discussing Hearing benefits , per Qa what is required
Hearing – Routine exam coverage
In the application: what must be asked about the clients PCP doctor
Are you a current/ established patient
If the customer can not recall the dosage they take what can you do
State that you are putting in the highest or lowest dosage
If you miss the dosage of one drug, what is the maximum number of points that can be lost. ( legacy)
46 points
inquire about drugs -11
ask a second time -3
Present formulary correctly -7
Inaccurate information 25
On January 3rd what did you commit to
Reading the Medicare disclaimer and SOA verbatim
What are the base line benefits
1. Carrier Name and plan name
2. Enrollment Effective Date
3. Preferred drug tiers as they appear in Marketplace (if customer has LIS agent should give standard price and LIS Rx copay range)
4. Out of network benefits need to be stated if the customer sees out of network providers
Compare New to Current (if prior MA)
5. Premium Part B Premium Reduction (if applicable)
6. Medical and Rx deductible (if applicable)
7. PCP copay
8. Specialist copay
9. Hospital copay (number of days per day / per stay with a copay and copay amount)
10. Any additional benefits are required if discussed at all in the presentation:
If you cannot find the doctor on market place-- where is the BEST place to look
Carrier portal
True or False: If a consumer has medicaid or lis and the drug is not covered by the plan they can still use their assistance to get the drug
False