SEP Hunting 1
How long should you take with each lead! For example SEP hunting, pitching ancillary sending them on their way!
10 - 15 minutes per lead!
Pace and National Pace are the same thing! T or F
False
I have PACE where do I live?
PA
What should you do to increase the likelihood of your UHC CSNP's being approved?
Fax the form to the doctors office, prefilled
Call to confirm they have received it and verify if they are going to fax it to UHC or send via email back to you to send to AOS for completion.
Is okay to submit a supplement application if you are not sure if they are going to qualify even though they said no to every health question?
Yes of course, take their word. Worst case it doesn't get approved. It doesn't hurt your placement since it never went into effect.
Which of the following is incorrect? If any regarding a MOVING SEP -
If they moved within last 3 months-- You have MOV-SEP
If they moved for a while and was just notified by their insurance company their plan won’t cover them (the month of notification and up to 2 months after that)
If they moved and CMS still has their old address -- You have MOV-SEP
All are correct
If someone moves to a different zip code but the same county is that an SEP?
Yes! Legally has to have at least 1 new plan in area to qualify.
Carrier Portals
What should you do when you are unsure if someone qualifies for a CSNPs?
Just roll through the health questions to determine if it is worth submitting an application and hitting home a doctor needs to be able to verify it!
When helping someone with a supplement plan, should first check to see if you can even beat their rate? or should you do health underwriting?
I would personally check to see if you can beat their current rate first
If they have a Plan F see if you can even beat it first with the carriers you can sell, then see if Plan G would actually make more sense based on rates and situation
If a client has no SEP's, what's the next step?
Pitch ancillary
Name at least 2 SEP's you can see without having to ask the cilent?
FEMA
SEP INT
What is DST?
What should you read to the client when using a FEMA for your protection? & where can that be found?
Reside, or resided at the start of the incident period, or POA in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance. •Had another valid election period at the time of incident period; and •Did NOT make an election during that other valid election period.
So Gladys there is a Federal Emergency Declaration in your state/county due to _______. Since that happened and you missed an enrollment period you are able to make a change to this new Medicare Advantage Plan, ok! You've missed ________ enrollment period so that's what we will be using to get you enrolled into the ___________. Found on the SEP checklist
Name 4 SPAPS Programs that are easy to qualify for?
IN - Hoosier Care
WI - Senior Care
PA - PACE
NJ - PAAD
When does someone have no health underwriting for Supplements?
OE - new to Medicare
GI - special circumstances
What is LT2?
How is that different from LTC?
LT2 - Do they currently live in any type of medical institution?
LTC Did they recently leave of any type of medical institution?
What is LEC?
When can someone decide to leave their group or union coverage?
They recently lost or LEFT a group or union coverage NOT retirement coverage.
You can switch at the start of any month and come off Employer coverage, Medicare says that is a life changing event.
What is SPAP?
What is the new process for that?
Once per year, change for individuals who are eligible for an State Pharmaceutical Assistance Program. Can also be used if they no longer qualify and lose that status
Give them the information, Program contact number, read the statement on the SEP checklist & enroll. No need to verification or call back
How is LCC different from LEC?
LCC is for individuals who lost any type of creditable coverage! Example: if you see any individual who randomly has Part D ending I would do discovery & assume that's an SEP you can use!
What are the Supplement carriers we can sell? (unless you have more previously)
Aflac, Aetna, Mutual of Omaha (MOO)
What is IEP - 2? How is that different from ICEP?
IEP - When someone who had Medicare prior to turning 65, turns 65 year's old
ICEP - Did they Medicare just Part B start recently? May enroll 2 month prior
What is the CDC SEP?
Individuals who have Tricare, Champ or VA that are okay with leaving Part D coverage. Use this to disenroll from PDP/MAPD and enroll into MA-Only.
What is MCD? & How is it different from NLS?
What is SNP - SEP?
If you submit someone for a CSNP and they don't get approved does that trigger another SEP? if so which one?
Individuals enrolled in an SNP plan and who no longer qualify for special needs status. SEP begins the month they no longer qualify and extends 2 months after.
For your resub it would trigger EOC - Is the client being notified that their coverage will be ending within the next month or did they lose coverage within the last 2 months?
Explain Plan F vs Plan G vs Plan N
Plan F - just premium everything covered
Plan G - premium, Part B deductible then everything covered
Plan N - premium, Part B deductible, 20 doctor copay 50 ER copay everything else covered