Ticket
What Ticket do we make if the policy says CONFIRM on the carriers side but TERM on our side?
Termination Not Found Ticket
How many days will a cx have to enroll into plan after getting the PHE Notice?
90 days
True or False: Can someone get coverage through the marketplace IF they have MA?
True. They can BUT they would not be able to get APTC.
True or False: Do we take binder payments?
False, we do not take any form of payments, those are made to the carrier
When does OEP begin and end?
November 1st to Jan 15th
What Ticket do we make if the policy shows APTC on our end but not on the carrier's side?
Subsidy Not Found Ticket
How many times a year are State-based Marketplaces required to run the PDM process?
2 times per year
True or False: If a cx calls in with only PART A coverage is that considered MEC?
True- It is considered MEC and they would not be able to get APTC on their plans and would need to pay full price.
What is Cigna's Phone Number?
(800) 997-1654
If a cx wants their coverage reinstated and they are in PDM ROP what ticket do we make?
We would make a complaint ticket IF there is nothing else we can do for them to reinstate their policy
What is the QLE you would select for ROP?
Exceptional Circumstances or Plan/Program error
True or False: Is Medicaid Family First considered MEC?
False it is not considered MEC, if a cx calls in about having MA Family First they can get a plan through us with APTC applied
When you term a cx coverage how will they receive the confirmation?
They will receive confirmation based on communication preference selected (secure inbox or mail)
Income: Verbal attestation or self-attestation letter (Agents cannot verbally attest for customers)
Death: Verbal attestation or self-attestation letter
Non-ESI: Verbal attestation or self-attestation letter
Incarceration: Verbal attestation or self-attestation letter
What ticket do we make if a cx policy shows as CONFIRM on our end but TERM on the carriers side?
Enrollment Not Found Ticket
What is the target audience for PDMs?
Those who might have other essential coverage and unreported deaths.
What is the age for Medicare?
65
When you are terming a cx coverage how many days does it take the carrier to receive the update?
2-3 business days
How many times do we do the Silent Caller script before disconnecting the line?
3 times
What ticket do we create if the primary is incorrect and needs to be swapped with another member of the household?
Primary/Self Switch ticket
What are the 3 ways you can tell if an account is in PDM ROP?
A notice in their inbox will read "Action to Retain health Coverage"
Go to the account activity and it will say DMI or PDM expired
the account might also say DMI created if they haven't been ROP'd yet
What is the backdate rules for Medicaid and Medicare?
Medicare- they can backdate to the month they got the coverage
MA- Have to report within 60 days on the eligibility notice. After the 60 days it would term normally.
TRUE or FALSE: When we do a reinstatement request ticket it guarantees the policy will be reinstated by the carrier.
False
What triggers a ROP?
Non resolved PDM DMI