SEPs
Consumer has diabetes or a qualifying chronic condition
What is Chronic Special Need
It is March 2nd, the member has a MAPD and wants a PDP instead
What is PDP/OEP
Just got Medicare part A and B
What is IEP
A caller discloses they have dementia during the call. What is the appropriate next step?
What is offer to schedule a follow-up appointment when a trusted individual can be present to assist with enrollment?
What part of the call flow do you gather HIPAA
What is Opening
Consumers who enrolled into a MA plan when they first qualified for Medicare Part B at age 65 can disenroll at any time in the first 12 months of the health plan coverage into a PDP.
What is 65
Losing their MA-PD plan due to losing Medicare Part B
What is Lost MAPD and Part B
Lost L.I.S.
What is Dual/LIS (Change of Status)
A caller is upset after receiving a bill in the mail. How should you respond?
What is acknowledge and apologize, then complete a needs assessment to identify if a plan change is needed
What part of the call flow is the solution presentation
What is Determine Outcome
Consumer who was enrolled into a plan by their State or CMS.
What is CMS / State Assignment
Consumer lives in a declared disaster area and missed an Election Period during that time frame
What is FEMA (Declared Disaster/Emergency)
Enrolling into a 5 Star Plan rated by CMS
What is Five Star
Consumer calls in asking for their OTC balance
What is acknowledge that you are looking into the OTC balance and look for a SEP and complete a needs assessment to check for a better plan option
This section of the call flow is where you decide what is important to the caller
What is Needs Assessment
A consumer's MA or Part D plan changes its contract with CMS mid year and the consumer is forced to disenroll from the plan
What is Contract Termination
Enrolling or disenrolling from the Program of All-Inclusive Care for the Elderly
What is PACE Switcher
Moving out of a rehab facility and wants to enroll into a MA plan
What is OEPI
Caller states they need to speak to someone in Transportation
What is acknowledge that they are calling in for transportation and then transition into looking for a SEP and needs assessment for a better plan option
What part of the call flow is the Call Wrap Up
What is Determine Outcome
Consumer is currently enrolled into a MAPD or PDP and has creditable drug coverage from another source
Moving out of a nursing home and needs a PDP
What is Institutional
Consumers who qualifies for a state pharmaceutical assistance
What is SPAP
Caller states they need to sign up for supplemental insurance
What is acknowledge they are looking for supplemental insurance and then transition into the election period and needs assessment to see if they truly need a Supp or a MAPD
The part of the call flow where you learn what to compare benefits in the plan
What is the Needs Assessment