Introduction
How many seconds do you have to answer the phone?
10 seconds
"Thank you for calling Aetna Medicare"
When collecting the name of providers what else should you confirm with the member?
Provider's full address
What document outlines what is required to read when presenting a plan?
Quick reference guide (QRG)
What should be done on all calls to set proper expectations?
Set an agenda and complete the reason and commitment statement.
Example "Mr. Brown I will be more than happy to help you find a plan in your new area to do that I will ask you some questions to identify your needs, offer solutions to those needs, to get you protected today how does that sound?"
When should you offer the ekit?
BEFORE you open the application.
What are the 4 required eligibility questions?
"Do you have employer or union coverage?"
"Do you have Medicare parts A and/or Part B or will have it in the next 3 months?"
"Do you have Medicaid?"
"Do you receive Extra help to pay for your Medicare prescription drug plan?"
When collecting medications what things should you verify?
Drug name (brand vs. generic)
Release type (if applicable)
Dose
Quantity/frequency
Fill rate
What document can help you find a special election period (SEP)?
SEP uptraining PowerPoint or Medicare.gov
If someone new joins the line what is the first thing you should do?
Introduce yourself on the call with your full name and state that you are a licensed agent.
Who must provide the answers during the application?
The beneficiary, POA or legal authority must provide all answers during the application process.
What two things are you required to say during your introduction?
Full name and that you are a licensed agent
"My name is John Doe and I’m a licensed insurance agent.”
True or False
It is not required to ask about current or existing premium?
False
From QA score card "Agent asked questions to understand the beneficiary’s current premium and/or monthly budget for their plan selection."
Mr. Gomez is not sure if he has Medicaid in his state. What system can assist with confirming if he has Medicaid or not?
MaRx (Medicare Advantage Prescription Drug)
True or False
If you need to get the Medicare Beneficiary Identifier (MBI) before the application you must give a reason why?
True, If you take an MBI from the beneficiary or POA outside of the enrollment application you must give context to what you are doing with it, otherwise, you are violating Health Insurance Portability and Accountability Act (HIPAA).
True or False
Questions marked as optional in the application are not optional for the agent to ask.
True, All application questions must be asked even though some are listed as optional. If the caller previously answered the questions please confirm it again.
Once you collect the caller's phone number what three things should you follow up with?
"Is this a mobile number or landline?"
"Do we have permission to call or text you at that number?"
"Consent can be revoked at anytime standard messaging rates apply"
David is a MAPD member and uses a standard pharmacy. Is it required for the agent to still share the cost of a preferred pharmacy?
Yes, although David is using a standard pharmacy the agent would need to go over the cost of a preferred pharmacy so that David understands his saving opportunity.
If the member does not have their Medicaid number what system can you use to find it?
Think agent (TA)
What is the hold procedure?
(A)sk; Gain permission from the member for the hold
(R)eason; Let the member know why you need to place them on old
(T)ime; Provide member with estimate time quality is two minutes
(T)hank; Upon return thank the member for waiting
True or False
When you are in the application it is ok to skip over prepopulated or known information.
False, even if you already received the information you need to confirm it with the member.
Example: "I have your address as 123 apple street Ocean Springs, MS 39564 is that correct?"
What must you read before discussing ANY plan information?
Scope of appointment (SOA)
Mrs. Smith does not have a SEP but she wants to know her dental allowance. Since you are just sharing current plan benefits would you still need to share the plan's name, type and premium?
Yes
From QA score card "The agent provided the name, type, and premium of the plan quoted."
True or False
It is ok to read scripting from memory if you are not on that page.
False, you should always be on the page as you are saying the scripting.
If your call dropped during an enrollment and you call the member back what is required to be stated when you get them on the line?
-Introduce yourself using your full name and that you are a licensed agent
-Inform the caller the call is recorded and obtained consent to continue with the recorded call.
-Collect two pieces of Personally Identifiable Information (PII)
Before you submit the application should you gain the member’s explicit consent to submit the application?
Yes
Example: “Mrs. Smith do I have your permission to submit your application for the Aetna Medicare Select HMO H1609-086 with a $0 premium?”