2025
What´s going to happen to the coverage gap in 2025?
It´s being eliminated
From which date to which date is the AEP?
October 15th - December 7th
Whitin how many seconds should you answer the call?
Within 5 seconds.
How is a Cataract surgery classified?
Surgery, and the cost is per each eye.
Mention the 7 wonders of the world
Chichen Itza, Christ the Redeemer, the Great Wall of China, Machu Picchu, Petra, the Taj Mahal, and the Colosseum.
What's going to happen with the Flex Allowance?
Not offered on any plan in 2025.
Which mentor should you use for questions regarding the AEP?
Medicare AEP FAQ
RX alerts important pieces? And provide it like if you are in call
They are benefits
They come from Centerwell Pharmacy.
They can be transfer
If not visit website or provide phone number.
What's the new process for a PCP change and what mentor do we use?
Primary Care Physician Changes for Medicare Overview
Whats the name of the Results CX CEO?
Rajesh Subramaniam
How much will be the general deductible for 2025?
$590
Mention 3 do´s and when receiving calls regarding the AEP?
Do´s:
Do lead with empathy.
Do acknowledge what the member is expressing.
Do let them know you hear their concern.
Do subtly highlight benefit enhancements, if appropriate.
Do express that the benefit changes were made after careful consideration and with feedback from members.
Do confirm with members they're clear on the 2025 plan changes.
Do ask if there's anything you can do to help.
Important pieces of the authentication process? (Authenticated and Unauthenticated call)
If is authenticate already we must thank the member for authenticate the call, confirm members name.
If not, we must ask for members ID number or Medicare, Name, DOB, ZIPCODE, change the unauthenticated bottom to authenticated.
What is the C/I when members ask to to be connected to someone onshore?
Onshore Transferred Request Calls
Voice of the customer
What's New in 2025
Mention 3 don'ts and when receiving calls regarding the AEP?
Don'ts:
Don't use words such as CMS, rate notice, or benefit degradation.
Don't apologize as that creates a sense of admitting fault.
Don't tell callers how they're feeling, for example, "I know that you are upset."
Don't use blame statements such as, "I don't know why they did that."
Don't say things like "I can relate, I can't afford to go to the doctor either" or "Healthcare coverage is so expensive, and I work for an insurance company."
Mention the five pieces of the call flow?
Greeting
Understand the issue
Show Soft skill, adhere to alerts, use your tools.
Provide a resolution
Closing
If member is calling for dental services which C/I should we use?
Dental VOB / Transferred to Dental
What the goal for HOLD?
60 seconds per call
How much the TrOOP for 2025 on initial coverage?
$2000
What does Non-Renewal Calls
"while Humana will no longer offer a plan in your area, we can transfer you to our sales partner agency, Reliance Medicare. Their licensed agents can provide a range of plan options across carriers".
Roleplay time!!!
Benefit Scenario
How long does a medical auth takes to be approved?
Pre-Service: 14 calendar days
Expedited: 72 hours
Mention 3 powerful statements you use on your calls?
Let's take care of that for you today.
I can certainly help you with that.
I will be able to fix this for you right now.
I will do everything I can to to make as easy as possible.