Opening
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Greeting Landing Page
Opening
Greeting Landing Page:
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Introduction:
Branding
First and Last Name of Agent
Agent acknowledge they are licensedlicensure acknowledgement
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Discovery Note (- All of the following items need to be requested and verified by phonetically repeating the spelling back to the caller) |
Customer First and Last Name
Are they a Member verification
Member ID
Address
Zip Code
DOB
Phone Number
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Must use members Last Name throughout the call; Example: Mr/Mrs Jones, can you provide me with your member ID? (Can use member first name if member requests it) |
If you are going to present a plan, Go to Unsure “Unsure of Plan/Switch Plan:”
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Eligibility Landing Page:Must read the Disclaimer
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The following Disclaimer must be read:
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Must read these areas The following scripting must be read:
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If you already know the member’s enrollment period, simply restate it for the recording. If you have not yet 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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Complete the Needs Analysis section
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Switch to CNRX |
Gathering Medications and Pharmacy
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To Create Start by creating a new Profile :
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by clicking “New beneficiary”
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Verify and accurately enter the following:
Zip Code
First and Last Name
County
If you have obtained the datafollowing, please also enter:
DOB
Phone Number
Home address
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Click Continue to Plans at Scroll to the bottom and click “Continue to Plans:”
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On the left side of the screen, click the “Preferences” dropdown for Preferences and Click on “Add Preferences”, followed by “Add Preferences:”
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Here are the things you need to verify Select the “Prescriptions” tab and search for each medication:
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The following items must be verified when gathering medications:
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Verify name Name of Rx (Example: Lisinopril or Lisinopril/HCTZ)
Dosage Type (Example: Capsule or Tablet, 5mg or 10 mg)
Quantity for a 30 day supply(Example: 30/60/90)
Frequency (Example: per month, etc)
If there is a generic option, you MUST ask
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the following:
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IMPORTANT: |
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You must ALWAYS offer to look up medications for the recording |
Pharmacy
Must ask what the members Verify the member's preferred pharmacy is:
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Optional: Only offer if the member asks for it
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Presenting Plan Information:
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Part B buy-down selection under “Other Preferences” is optional unless requested by the member |
Plan Presentation
Review plan details for the most cost effective plan
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by clicking “Plan details:”
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Select a Plan and go to Plan details
MAPD Call Requirements:
MAPD ONLY Call Requirements:
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MA ONLY Plans
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Missing any item in this section will result in an auto-fail. |
The following must be verified on EVERY call:
Plan name and premium -Located in Plan Details[Extra Help
(EH)/Medicaid:
quote premium based offShould be quoted from the LIS table and original premium of the plan
Medical deductible - Located in Plan Details
PCP & Specialist Copays - Located in Plan Details
ER Copays - Located in Plan Details
Pharmacy Deductible - Located in Plan Details
Extra Help (EH)/ Medicaid: Quote deductible based off LIS table]
Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table]
List at least 1 preferred pharmacy - Located in Plan DetailsMail order (CVS Caremark)
Medical deductible
PCP & Specialist Copays
ER Copays
State that the mail order pharmacy is CVS Caremark
REQUIRED to identify 1 PCP & at least offer to look up Specialist and Hospitals - Located in Plan Details
PDP/MAPD Call Requirements:
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All Plan Details below are required, regardless if they went over the plan details with another agent on a previous call.
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PDP/MAPD Call Requirements
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Plans
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Missing any item in this section will result in an auto-fail. |
Plan name & Premium - Located in Plan Details
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The following must be verified on EVERY call.
Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]
Pharmacy Deductible - Located in Plan Details[Extra Help
(EH)/Medicaid:
quote deductible based offShould be quoted from the LIS table]
List at least 1 Preferred Pharmacy - Located in Plan Details
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. If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:
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4. Mention Mail order (State that the mail order pharmacy is CVS Caremark)
5. Mention any Drug restrictions (if applicable) - Located in Prescriptions Tab
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Note: Regardless if the member has medications or not, we MUST quote all tiers at a preferred pharmacy |
6. Quote Medications - Located in Prescriptions Tab
a. Address each Tier of medication
b. If the Tier applies to the deductible
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6. Prescription Copays
a. State copays for each tier [Example: Tier 1 drugs have a $___ copay; Tier 2 drugs have a $ __ copay; etc] This must be stated regardless of whether the member currently has any prescriptions
b. State whether the tier applies to the deductible [Example: The deductible for this plan applies to tiers 3, 4, and 5. Some of your drugs are tier 3 so the deductible will apply to those drugs”]
c. Quote drug tiers that will apply to the caller that year ???
7. Quote State applicable drug restrictions for each medication - Located in Prescriptions Tab
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[ie: Quantity Limits, Step Therapy, and Physician Authorization]
Screenshot Needed
Note - To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the caller will go to the Total Costs Tab at the top:
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ASK FOR THE SALE!!!
~If yes, move Closing the Sale
Remember to ask for the sale
If Yes:
Move to Enrollment section - send the quick quote and read the following email disclaimer:
"Providing an email address authorizes us to contact you via email. Your email address will be handled consistent with our Privacy Policy, which you can find on our website at www.aetnamedicare.com”
Inform caller they will get 2 emails (check SPAM folders)
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Proceed to the Enrollment Checklist Tab
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in Contact Center
If No:
Go back to Contact Center - Follow
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the “Offer Tree Landing
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Page” instructions to send an ekit or paperkit
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Switch back to Contact Center |
Enrollment Section
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Enrollment_1 Landing Page:
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Enrollment Checklist Tab:
Read all mandatory 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 #Number, Effective Dates of Part A and Part B
Confirm is if they are calling for themselves or someone else
Re-verify the caller information
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Enrollment_2 Landing Page:
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Enter plan Contract number and PBP numbers (located in CNRX after the name of the plan selected)
Re-Verify information
Receiving health coverage by(don’t forget to verify whether they have Employer or Union
After selecting what health coverage)
Select the type of PlanMA plan:
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Transition Switch back to CNRX |
CNRX Application:
Select “Add to Cart” to get to enrollment.
Section 1: Contact Info
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Re-identify Restate the enrollment period to the caller - (add date ( if applicable)
Acknowledge what Restate the requested Effective Date
Re-verify caller Restate member 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
city, state, and zip
Additional Mailing address including city, state, and zip
Physician Selection
:Primary Care Name
Confirm if they are an existing patient
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It is required mandatory to select an a PCP for an HMO plan |
Selection 2: Benefit Info Tab
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Read the following verbatim:
Some “Some individuals may have additional prescription drug coverage, including other private insurance, TRICARE, federal employee health benefitsFederal Employee Health Benefits, VA benefits, or state pharmaceutical assistance State Pharmaceutical Assistance.”
Read and Answer all Yes/No questions verbatim
Would you prefer your documents in a language other than English?
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Section 3- Other Info
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Phonetically re-verify reverify the Medicare Number
Re-verifying Reverify 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 withdrawal from your Social Security Check or Railroad Retirement Board Benefits check
You can choose automatic deduction from your bank account (checking or savings)
You can pay by invoice mail (Choose this option if the plan has a $0 monthly premium)
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