Opening

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Greeting Landing Page

Introduction:

• Branding

• First and Last Name of Agent

• Agent acknowledge they are licensed

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• Customer First and Last Name

• Are they a Member

• Member ID

• Address

• Zip Code

• DOB

• Phone Number

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 If you are going to present a plan, Go to Unsure of Plan/Switch PlansPlan:

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Eligibility Landing Page:

Must read the Disclaimer :

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 Must read these areas:

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• If you have not identified an enrollment period, you must read this section:

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• DO NOT read if you already know the callers enrollment period, instead confirm the information.

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• Go over Needs Analysis

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Gathering Medications and Pharmacy:

To Create a Profile REQUIRED:

• Zip Code

• First and Last Name

• County

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• Verify name of Rx (Example: Lisinopril or Lisinopril/HCTZ)

• Dosage Type (Example: Capsule or Tablet, 5mg or 10 mg)

• Quantity for a 30 day supply

  • If there is a generic option, you MUST ask; Yes/No

Image Added

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Pharmacy

Must ask what the members preferred pharmacy is:

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Optional: Only offer if the member asks for it

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Presenting Plan Information:

(Note: Based on the needs analysis, medications and pharmacy, select plan details for the most cost effective plan)

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• Select a Plan and go to Plan details

MAPD Call Requirements:

MAPD ONLY Call Requirements:

1. Plan name and premium -Located in Plan Details

   1. Extra Help (EH)/ Medicaid: quote premium based off LIS table and original premium of the plan

2. Medical deductible - Located in Plan Details

3. PCP & Specialist Copays - Located in Plan Details

4. ER Copays - Located in Plan Details

5. Pharmacy Deductible - Located in Plan Details

   1. Extra Help (EH)/ Medicaid: quote Quote deductible based off LIS table

6. List at least 1 preferred pharmacy - Located in Plan Details

7. Mail order (CVS Caremark)

8. REQUIRED to identify 1 PCP & at least offer to look up Specialist and Hospitals - Located in Plan Details

   

PDP/MAPD Call Requirements:

PDP/MAPD Call Requirements

1. Plan name & Premium - Located in Plan Details

   1. Extra Help (EH)/ Medicaid: quote premium based off LIS table and original premium of the plan

2. Pharmacy Deductible - Located in Plan Details

   1. Extra Help (EH)/ Medicaid: quote deductible based off LIS table

3. List at least 1 Preferred Pharmacy - Located in Plan Details;

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4. Mention Mail order (CVS Caremark)

5. Mention any Drug restrictions (if applicable)

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- Located in Prescriptions Tab

6. Quote Medications - Located in Prescriptions Tab

a. Address each Tier of medication

b. If the Tier applies to the deductible

c. Quote medications tiers that will apply to the caller that year

7. Quote

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drug restrictions for each medication - Located in Prescriptions Tab

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ASK FOR THE SALE!!!

~If yes, move to Enrollment section - send the quick quote and read email disclaimer:

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~If no, Go back to Contact Center - Follow Offer Tree Landing Page instructions to send ekit or paperkit

Enrollment Section to End of Call

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Enrollment_1 Landing Page:

Enrollment Checklist Tab:

• Read all verbiage verbatim that is not optional- TE Checklist

• Have member gather the Medicare card and read the card verbatim: First Name, Last Name, Middle Initial, Medicare #, Effective Dates of Part A and Part B

Enrollment_1 Landing Page:

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• Confirm is they are calling for themselves or someone else

• Re-verify the caller information

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Enrollment_2

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Landing Page:

• Enter plan Contract number and PBP numbers (located in CNRX after the name of the plan selected)

• Re-Verify information

  • Receiving health coverage by Employer or Union

• After selecting what type of Plan

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CNRX Application:

Select “Add to Cart” to get to enrollment.

Section 1: Contact Info

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• Re-identify enrollment period to the caller - add date (if applicable)

• Acknowledge what the requested Effective Date

• Re-verify caller information

  • First Name and Last Name, Middle Initial

  • DOB

  • Gender (Example: For the recording, can you state your gender?)

  • Phone Number

  • Email (If you read the disclaimer already, you DO NOT have to reread this disclaimer)

  • Address Including:

    • City

    • State

    • Zip

  • Additional Mailing address

  • Physician Selection:

    • Primary Care Name

    • Confirm if they are an existing patient

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Selection 2: Benefit Info Tab

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• Please read verbatim:

  • Some individuals may have additional prescription drug coverage, including other private insurance, TRICARE, federal employee health benefits, VA benefits, or state pharmaceutical assistance

  • Read and Answer all Yes/No questions verbatim

  • Would you prefer your documents in a language other than English?

Section 3- Other Info

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• Phonetically re-verify the Medicare Number

• Re-verifying Part A and B effective dates

• Read all disclaimer verbiage verbatim in green:

  • Social Security

  • Extra Help

• You MUST offer all 3 payment options, Select payment option and read the bullets verbatim in that section:

  • You can pay by automatic from your Social Security Check or Railroad Retirement Board

  • You can choose automatic deduction from your bank account

  • You can pay by invoice (Choose this option if the plan has a $0 monthly premium)

Section 4 -Agent Info

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DO NOT READ, Select Yes, “You agree to the above statements”

Section 5 - Review & Submit

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• Read the verbiage in green verbatim and click on the Drop downs for: Personal Information, Important Questions and Medicare Information

  • Read these sections non-stop and ask caller to stop you if anything is incorrect, use phonetics if necessary

Enrollment_2 Landing Page

• Play the audio disclaimer

• Read this declaimer

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• Verify who is completing the enrollment

• Read the “What to expect” Section

• Provide the caller the confirmation number and have them repeat it back

  • Copy the Confirmation number

• Read this statement:

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• Read this section:

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