Definitions
A kind of cost sharing where costs are split on a percentage basis.
Coinsurance
Quoting General Medical Benefits
Review Medical Benefits
What are the different types of Medicare?
Part a, Part b, part c, and part d
who is the most talkative person in class?
Gabriel
YESTERDAY! Alicia stated that she liked rap music along with other genres. What was the Name of the first rap artist she named?
Eminem
A group of drugs on a formulary. Each group has a different level of cost sharing.
Tier
Member is requesting a new ucard. What intent should we use?
Member materials
Eligibility rules could involve ...
65+ qualify.
Long-term illness clause
Employment status
Disability status
Medicare coverage
east =?
west =?
east- cosmos
west-nice
What should you do if you get a suicide caller? More than one answer!
....
A copy of a brand name drug; usually costs less.
Generic Drug
I need help finding a dentist in my area that is INN. What intent would we use?
Search and Assign Provider
When to enroll ...
During the annual open enrollment period
With life events such as marriage, divorce, or adoption.
with termination of employment.
upon death of the primary insurer
On immigration date
with other qualifying events
What is retro?
1st of current month
Who are kris favorite people to call on?
Joreilys , Mercedes, Constance and Jonquil.
The price members pay for a policy, usually as a monthly payment.
Premium
Where in Maestro can we find the plan name?
Under the plan tab
What is OEP
this period allows for individuals enrolled in a Medicare Advantage Plan the opportunity to switch plans or disenroll from a Medicare Advantage Plan and go to Original Medicare during the open enrollment period from January 1 to March 31
I have been calling UHC for the last week and no one has helped me yet! is there anyone with more then half a brain working here? What should you do for this member?
File a grievance.
Do we allow members to Speak with RSS?
No
The amount members toward the cost of their prescription drugs including deductible, copays, and coinsurance (but not including premiums).
TrOOP
What are three things a caller must verify if they are not IVR verified? and where can you find it in Maestro?
and member details
This period occurs annually between October 15 and December 7 and allows Medicare eligible individuals an opportunity to add, change, or leave a plan. What is the name of this?
AEP- Annual Election Period
how long can you leave a member on hold?
2 minutes
there is one agent that is not herself when she is hungry. Who is it?
Shadarryle