Election Period
Call date: 09/09/2026
"Hi, I am calling because I recently moved from Tennessee to Ohio. I need to get in a new plan."
What is the election period + effective date?
SEP - Change in Residence
Effective Date: 10/01/2026
I have Tricare
MA-Only
Junie is calling for her grandma. Her Grandma recently moved and needs a new plan. She was with another company, but heard that UHC has good plans in the new area. Junie's Grandma is NOT with her
Set an appointment. Be sure to put election period + effective date in opportunity.
Medicaid is run by
the State
Explain the drug coverage stages
Deductible - consumer pays the full cost of the medication
Initial Coverage - Consumer pays copays/coinsurance, plan pays for the rest of the drug
Catastrophic Coverage - Consumer pays $0
"Once what you pay, plus what the plan pays = $2100, you will pay nothing for your covered prescriptions for the rest of the year"
Call Date: 09/09/2026
"Hi. I am calling because I am retiring. I already had Parts A and B, but now I need to get into a Medicare Advantage Plan. My coverage with my employer ends on 10/31/2026"
What is the Election Period + Effective Date
Election Period: SEP - Loss of EGHP
Effective Date: 11/01
I receive coverage through the VA
MAPD
Shawn is calling for his Uncle. His uncle is a member and he needs to look into a bill for him. He says that he is legally authorized to speak on his behalf.
Check to see if Shawn is listed as an authorized rep or POA
If he is not, post in chat so leadership can check
LIS is run by
the Federal Government (SSA)
How does it work if someone has VA coverage and an MAPD for their medications?
VA Doctor - VA Pharmacy - Billed to the VA
Civilian Doctor - Civilian Pharmacy - Billed through the MAPD
"Hi. I am calling because I am retiring. I need a Medicare Advantage Plan. My last day of coverage is 12/31/2026"
What is the Election Period + Effective Date
Election Period Not Valid. Set an appointment! Make sure to include the election period + effective date in the opportunity
I have ChampVA
MA-Only
Ryan is calling because he got a bill about his Late Enrollment Penalty. He is so confused, he had prescription coverage through his employer before he started this Medicare Plan
Transfer to CS
This is typically the name of UHC Medicaid Plans
UHC Community Plan
What are two things we can NEVER release on calls?
MBI, SSN, DOB, what plan they are in (if it's with another company)
Call Date: 09/09/2026
Hi! I already signed up for a supplement plan. I need some drug coverage. Can you help me out?"
Part A effective: 11/01/2026
Part B effective: 11/01/2026
What is the election period + effective date
Election Period: IEP
Effective Date: 11/01/2026
I am a Group Retiree through AT&T
Transfer!
Gary is calling because he has a question about the copays for one of his medications. He is a current member, and has LIS.
Transfer to an LIS certified agent
Part D Premiums, Deductibles, Copays/Coinsurance
What is the election period called for consumers who's Part B is starting for the first time after waiting to get it for more than 3 months?
ICEP Delayed B
Call date: 09/09/2026
"Hi. I am calling because I went to the pharmacy and somehow my plan turned off or something. Member Services said I moved but I didn't actually move!! I have lived in the same house forever. Help me!!!!"
What is the Election Period + Effective Date
Election Period: SEP - Involuntary Loss of Creditable Coverage
Effective Date: 10/01/2026
I have an SPAP
Do a thorough needs assessment. Likely MAPD though because if they have an SPAP they likely qualify because they are low income and cannot afford a high premium
Lily is calling because her name is misspelled on her UHC card. She is frustrated because she feels like we do not care about her since we can't even spell her name right.
Acknowledge, show compassion and empathy. Explain to her that she will need to reach out to SSA directly. The name that appears in our system is what appears in the SSA system.
Do all consumers that have LIS have Medicaid? Why or Why not
NO - you can qualify for LIS with a higher income so you may have LIS and not have Medicaid
Susie had a plan with UHC this month. She submitted an application with another company for a plan to start on 10/01 but she regrets it and just wants to stay with her current plan. What do you tell her?
She needs to call the other company and cancel her application. It can take up to 10 days for CMS to process and for it to reflect in our systems. After the other plan is cancelled, her plan with UHC will automatically continue.