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Opening
Greeting Landing Page:
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Introduction:
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Customer First and Last Name
Member verification
Member ID
Address
Zip Code
DOB
Phone Number
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Must use members member's 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 of Plan/Switch Plan:”
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Eligibility Landing Page:
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Remind agent to ask Medicaid/LIS questions
The following Disclaimer must be read:
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Complete the Needs Analysis section
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Switch to CNRX |
Gathering Medications and Pharmacy
Start by creating a new Profile by clicking “New beneficiary”
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Pharmacy
Verify the member's preferred pharmacy:
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Note 
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Plan Presentation
Review plan details for the most cost effective plan by clicking “Plan details:”
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MAPD Call Requirements:
MA MAPD ONLY Plans
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Missing any item in this section will result in an auto-fail. |
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Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]
Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table]
List at least 1 preferred pharmacy
Medical deductible
PCP & Specialist Copays
ER Copays
State that the mail order pharmacy is CVS Caremark
Verify if MOOP is required to state
REQUIRED to identify 1 PCP & at least offer to look up Specialist and Hospitals
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Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]
Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table]
List at least 1 Preferred Pharmacy. If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:
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4. State that the mail order pharmacy is CVS Caremark
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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 phases that will are projected to apply to the caller that year ???
7. State applicable drug restrictions for each medication [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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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)
Proceed to the Enrollment Checklist Tab in Contact Center
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Go back to Contact Center - Follow the “Offer Tree Landing Page” instructions to send an ekit or paperkit
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Switch back to Contact Center |
Enrollment Section
Enrollment_1 Landing Page:
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Read all mandatory verbiage verbatim - 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 if they are calling for themselves or someone else
Re-verify Reverify the caller information
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 ReVerify information (don’t forget to verify whether they have Employer or Union health coverage)
Select the type of MA plan:
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Switch back to CNRX |
CNRX Application:
Select “Add to Cart”
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Read the following 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 “Would you prefer your documents in a language other than English?”
Read and Answer all Yes/No questions verbatim
Section 3- Other Info
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Phonetically reverify the Medicare Number
Reverify Part A and B effective dates
Read all disclaimer verbiage verbatim in green:
Social Security
Extra Help
Elena suggested we add screenshots of the disclaimers
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 or Railroad Retirement Board Benefits check
You can choose automatic deduction from your bank checking account (checking or savings)
You can pay by mail (Choose this option if the plan has a $0 monthly premium)
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Read the verbiage in green verbatim and click on the Drop downs dropdowns 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
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NOTE: Re-verifying Reverifying the information on the 3 drop downs must be done before the audio disclaimer: |
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Switch back to Contact Center |
Enrollment_2 Landing Page
Play the audio disclaimer
Read this declaimerdisclaimer
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Switch back to CNRX |
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
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