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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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Name of Rx (Example: Lisinopril or Lisinopril/HCTZ)
Dosage Type (Example: Capsule or Tablet, 5mg or 10 mg)
Quantity (Example: 30/60/9090…It is recommended to use 30 days)
Frequency (Example: per month, etc)
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Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]
Medical deductible
PCP & Specialist Copays
ER Copays
Verify if MOOP is required to state
REQUIRED to identify 1 PCP & at least offer to look up Specialist and Hospitals
Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table and original deductible of the plan]
List at least 1 Preferred Pharmacy. If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:
State that the mail order pharmacy is CVS Caremark
Prescription Copays
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.
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”]
Quote drug phases that are projected to apply to the caller (. To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the caller will go to the Total Costs Tab at the top).
State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]
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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:
State that the mail order pharmacy is CVS Caremark
Prescription Copays
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
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”]
Quote drug phases that are projected to apply to the caller (To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the caller will go to the Total Costs Tab at the top)
State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]
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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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 checking account
You can pay by mail (Choose this option if the plan has a $0 monthly premium)
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NOTE: Reverifying the information on the 3 drop downs dropdowns must be done before the audio disclaimer: |
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Switch back to Contact Center |
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