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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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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 CopaysREQUIRED to identify 1 PCP & and inpatient hospital copays
Dental, Vision, and Hearing (if applicable)
Identify 1 PCP and at least offer to look up Specialist and HospitalsHospital 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 “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.Tier 1 drugs
State all of the member’s tier 2 drugs
state all of the
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 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 ALWAYS state pricing per tier, even if the member currently has no prescriptions. |
| Note |
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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. |
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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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