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Branding
First and Last Name of Agent
Agent licensure 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 |
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If you are going to present a plan, Go to “Unsure of Plan/Switch Plan:”Plan”
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Eligibility Landing Page:
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Remind agent to ask Medicaid/LIS questions The following Disclaimer disclaimer must be read:
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The following scripting must be read:
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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 and inpatient hospital copays
Dental, Vision, and Hearing (if applicable)
Identify 1 PCP and at least offer to look up Specialist and Hospital networks
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
OPTION 1: Prescription Copays (You must quote preferred pharmacy pricing. If the member would like to use standard or mail order pharmacies, you may quote that as well).
State copays applicable to member’s drugs [Example: “Your Metformin is a tier 1 Rx with a $__ copay. Your Eliquis is a tier 3 Rx with __% Coinsurance.”
State copay amounts for each tier [Example: Tier 1 drugs have a $___ copay; Tier 2 drugs have a $ __ copay; etc] This must be stated when members say they do not currently have any prescriptions.
State whether each 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 agent shoud go to the Total Costs Tab at the top.
OPTION 2: State Prescription copays/coinsurances for each tier. You must state pricing per tier, even if the member currently has no prescriptions.
You must quote preferred pharmacy pricing. If the member would like to use standard or mail order pharmacies, you may quote that as well).Tier 1 are your preferred generics which have a $__copay. The deductible does/does not apply. The following drugs are tier 1: [name all applicable medications and costs].
Tier 2 are your generics which have a $__copay. The deductible does/does not apply. The following drugs are tier 2: [name all applicable medications and costs].
Tier 3 are your preferred brand name drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 3: [name all applicable medications and costs].
Tier 4 are your non-preferred brand name drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 4: [name all applicable medications and costs].
Tier 5 are your specialty drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 5: [name all applicable medications and costs].
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You MUST quote preferred pharmacy pricing. If the member would like to use standard or mail order pharmacies, you may quote that as well. |
12. Quote drug phases that are projected to apply to the caller. To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the agent should go to the Total Costs Tab at the top.
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13. State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]
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PDP 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. 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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