Random
Samantha calls in because she heard of UHC's offering a plan that had fitness membership in it. What is the term for the extra's that UHC provides to consumers?
`Riders
What do you need to satisfy Hipaa for a consumer, witness, and Authorized Rep?
Consumer- first and last name; DOB
Witness/Authorized Rep- Caller's first and last name; Relationship to caller; Applicant's first and last name and DOB
Define IEP; SEP; and AEP.
IEP- Initial election period- 3 month before, month of, and 3 months after 65th birthday.
SEP- Special Election Period
AEP- October- December, effective day is 1/01
True or false: You can jump around in the call flow, its really just a suggestion.
FALSE. USE (clap) YOUR (clap) CALL (clap) FLOW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Tina has moved but her doctor is not in network she knew that her doctor would no longer be covered once she moved and she is fine as long as she can still see him,what type of plan would you choose?
PPO
What is the Handshake process and how do you not break it?
Handshake is when dealing with multiple enrollments. You must close out of lean properly and only close the opp. not the contact.
What Quality # talks about offering to look up consumer's medications? Is this a high or low point value? What system would you use to look up the medications?
#8; High; DCE
Explain the LIS/Dual Election Periods and when you use each.
Maintaining- 1 time every 3 calendar months.
Change is status- when they first get LIS/Dual, Change levels, or lose LIS/Dual.
Where is the transfer statement located on the call flow? What is the statement provided?
First Decision Point- What I'm going to do for you is gather a little more information and get you pointed in the right direction.
SueAnn has had an HMO plan, she likes that is covers what she needs but has recently started to travel they may call her a snow bird which product plan option would you be looking for SueAnn?
PPO; RPPO
If a new person takes over the call during the enrollment, what must you do?
Stop the lean process and review baseline benefits. Then restart the Lean process.
What quality # covers professionalism/ Communication/ active listening? What job aid is listed for help?
#34: Situational Guidelines
Michael calls in on October 27th. He tells you that he just recently received a purple letter in the mail. He was calling because he received the letter at his old address. He wants to change his address from 1012 N Main St to 276 E Walnut St.
What Election Period(s) do they have? Which would you use?
LIS (change in status) *
AEP
Sep: Change in Residence
Initial Needs
"i see you're in plan .... Are you looking to make a change?"
Bob just turned 65 and wants to get a plan. He doesn't really travel alot, and his doctor recently retired so he would be looking for a new one. He only sees his doctor a few times a month.
What plan type would you be looking at for Bob?
HMO
Anna needs you to locate a psychiatrist for her. Where would you look?
(demonstrate)
What do you have to provide to the consumer to pass Quality when it comes to drugs?
offer to look it up; provide Tier, UMs, Initial Costs, and if applicable Total drug cost (only if not covered); Pharmacy status; how many of the drugs are covered.
Call date: November 20th
Sarah is calling in because she wants to change her plan, she heard about a plan that has a $0 premium. She gets extra help for her prescription drugs, but she is still unable to pay for her plan. What Election Period(s) can you use for Sarah? Which would you use?
AEP
Dual/LIS maintaining **
When do you make your final considerations, costs, wellness benefits, path, ect.
Determine plan Gather
The consumer lives in Las Vegas, NV 88901 (Clark county) and uses Walgreens pharmacy.
• Dr. Michelle Mark (PCP)
• Dr. Eric Farbam (Neurologist)
• Dr. Carlos Emanuel (Cardiologist)
• Ibuprofen 800 mg TAB 2/day
• Eliquis 5 mg TAB 2/day
What are the top 3 plans you would be looking at?
ARRP Medicare Advantage Plan 1 (HMO)
AARP Medicare Advantage Premier (HMO)
UnitedHealthcare Complete Focus (HMO)
Nora is calling you, looking to get information on what she should do for insurance. She recently lost her husband and he was the one that dealt with these things. She goes to her doctor once a month. She plans to continue the country like her and her husband had planned. Her Zip is 42301. Kentucky Daviess county. She takes lisinopril 20 mg 1 time a day, and omeprazole 20 mg 3 times a day.
How would you explain the different pieces of medicare and what path would you recommend for her?
--Elevator conversation--
-Medsup+ part D
Where can you find Quality information on your call flow? what is on each one?
Gold stars; Read them out loud
David called in because he wants to review his options for health insurance. He currently has Med Sup and a PDP plan, but really wants to get all of the extras that UHC plans offers. His biggest concern is that if he signs up for a UHC plan he doesn't want to completely lose his Med Supp plan. What election period would he qualify for?
Indv Drop Medigap-Trial Period
Describe each part of the call flow and the goal of each.
Greeting- Hipaa
Determine Eligibility- medicare number and qualifications
(cont)
A consumer lives in Brown county, WI 54301. They need a drug plan and will use Walgreens pharmacy. They take:
• Norco (generic) 10-325 mg 4/day+
• Livalo 2 mg 1/day
• Advair Diskus 250/50; 60 blisters/month
What plan(s) covers all of their medications?
AARP MedicareRx Preferred PDP