Card Basics
What is the Healthy Spending Card?
A plan benefit card used to pay for eligible items or services under the members plan
When is AEP (Annual Enrollment Period)? and when does the plan go into effect?
October 15th-December 7th with the effective date of January 1st of the following year
Where would you find the termination reason in CRM?
Plan Member Page under Member plan information
Member called on 08/25 said she signed up with another carrier but wants to stay with humana. Does she have to speak to an agent?
No, member will need to contact the other insurance carrier to cancel the plan with them and allow 7 days to transmit to CMS and then to our systems.
Whats the difference between OTC mail order and regular Over the Counter benefit?
OTC mail order- you can only use that at centerwell by ordering over the phone, sending order form through the mail, or placing order online at centerwellpharmacy.com
What is the first action a member should take before trying to use a newly received benefit card?
activate card
When is Open Enrollment?
January 1st through March 31st OR within the first 3 months a newly eligible medicare member obtains Original Medicare parts A & B
What does the "107" term reason code mean? What mentor process would you follow?
Reinstatement due to joining another insurance carrier
Mentor: Reinstatement Due to Joining with Another Carrier
Member calls in and said her plan termed yesterday. You notice the term code is "118" What mentor document would you follow ?
Chronic Condition Special Needs Plan Incoming Call Guide
What self service options do the members have when referring to their HSAC or OTC benefits?
MyHumana Website/Mobile APP
Nations benefit Website/ Benefits pro app
Phone - for card activation and balance inquiries
A common reason two members in the same household may have different card amounts or categories.
benefits are plan-specific and member-specific (based on the selected plan and eligibility)
If a member calls in to check on the status of their enrollment application and its not displayed in CRM, where would you look next?
Customer Interface (CI)
What is the difference between Reinstatement & Termination?
Reinstatement: Reactivation of terminated benefits with no lapse in coverage for the member
Termination: The ending of a members plan
Member calls in stating they received a letter stating they lost Part B coverage through CMS. Who would you transfer the member to?
A. A licensed Sales Agent (DMS)
B. CMS
C. Original Medicare
D. Medicare Loss of Entitlement Member
D. Medicare Loss of Entitlement Member
What tool or portal would you use to check a members transactions and card status?
Nationsbenefits portal
If you are unsure if a specific item is covered using the HSAC, where would you find the answer?
Nationsbenefit Portal
How long does it take CRM to update after member becomes active in CI?
Which mentor would you begin with when a member calls in about a termed plan?
Medicare Termination Calls
Members plan is terming due to term reason code "110" and the member wants to know what that means and how to fix it. What is the next step?
Using "Research Humana Spending Account Card Denial Code" mentor, what does Address Verification Failed and what is the action you will take?
it means card was declined because of an invalid zipcode during the attempted transaction
action:
The document that explains what the card can be used for, including covered categories and limits.
Member’s plan Evidence of Coverage (EOC)
Who is the ONLY person who can determine if a member qualifies for an SEP? (Special Election Period?
A licensed sales agent
What would your classification and intent be in Quickstart + if a member calls in asking why their plan terminated or is set to be terminated?
Members plan is set to term due to "928" term reason code. What does that term reason code mean and what CI screen would you check to see what the RPLY TRNS code is?
928 Means member enrolled in another Humana Plan
MREP screen
Member calls in and says her card is not working at the store, what 5 things should you confirm before sending in a ticket to the spending account card department?
1.Did the member swipe appropriately?
2.Did the member select credit? Debit transactions will deny.
3.Did the member use the card at an eligible retailer?
4.What did the member try to buy? Is the item eligible?
5.Does the member have available funds based on Debut?