Opening
Greeting Landing Page
Introduction:
Branding
First and Last Name of Agent
Agent acknowledge they are licensed
Discovery: 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
Member ID
Address
Zip Code
DOB
Phone Number
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 of Plan/Switch Plans
Eligibility Landing Page:
Must read the Disclaimer
Must read these areas:
If you have not identified an enrollment period, you must read this section:
DO NOT read if you already know the callers enrollment period, instead confirm the information.
Go over Needs Analysis
At this point Switch to CNRX
CNRX
Gathering Medications and Pharmacy:
To Create a Profile REQUIRED: (Note: Take this opportunity to verify the information is correct)
Zip Code
First and Last Name
County
If you have the data, please enter:
DOB
Phone Number
Home address
Click Continue to Plans at the bottom:
On the left side of the screen, click the dropdown for Preferences and Click on “Add Preferences”
Here are the things you need to verify when gathering medications:
Verify name of Rx (Example: Lisinopril or Lisinopril/HCTZ)
Dosage Type (Example: Capsule or Tablet, 5mg or 10 mg)
Quantity for a 30 day supply
If there is a generic option, you MUST ask; Yes/No
IMPORTANT: We have to offer to look up medications
Pharmacy
Must ask what the members preferred pharmacy is:
Optional: Only offer if the member asks for it
Presenting Plan Information: (Note: Based on the needs analysis, medications and pharmacy, select plan details for the most cost effective plan)
Select a Plan and go to Plan details
MAPD Call Requirements:
MAPD ONLY Call Requirements:
Plan name and premium Plan Details
Extra Help (EH)/ Medicaid: quote premium based off LIS table and original premium of the plan
Medical deductible Plan Details
PCP & Specialist Copays Plan Details
ER Copays Plan Details
Pharmacy Deductible Plan Details
Extra Help (EH)/ Medicaid: quote deductible based off LIS table
List at least 1 preferred pharmacy Plan Details
Mail order (CVS Caremark)
REQUIRED to identify 1 PCP & at least offer to look up Specialist and Hospitals- Plan Details
PDP/MAPD Call Requirements:
PDP/MAPD Call Requirements
NOTE: MAPD and PDP have certain information that we are required to provide. Missing any of these items will result in an auto-fail.
Plan name & Premium Plan Details
Extra Help (EH)/ Medicaid: quote premium based off LIS table and original premium of the plan
Pharmacy Deductible Plan Details
Extra Help (EH)/ Medicaid: quote deductible based off LIS table
List at least 1 Preferred Pharmacy Plan Details;
Note: If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:
Mention Mail order (CVS Caremark)
Mention any Drug restrictions (if applicable)
Quote Medications: Prescriptions Tab
Address each Tier of medication
If the Tier applies to the deductible
Quote medications tiers that will apply to the caller that year
Quote and drug restrictions for each medication
Note: To Identify the phases the caller will go to the Total Costs Tab at the top:
ASK FOR THE SALE!!!
~If yes, move to Enrollment section - send the quick quote and read 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 Enrollment Checklist Tab
~If no, Go back to Contact Center - Follow Offer Tree Landing Page instructions send ekit or paperkit
Switch back to Contact Center
Enrollment Checklist Tab:
Read all 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 #, Effective Dates of Part A and Part B
Enrollment_1 Landing Page:
Confirm is they are calling for themselves or someone else
Re-verify the caller information
Enrollment_2
Enter plan Contract number and PBP numbers (located in CNRX after the name of the plan selected)
Re-Verify information
Receiving health coverage by Employer or Union
After selecting what type of Plan
Transition back to CNRX
CNRX Application:
Select “Add to Cart” to get to enrollment.
Section 1: Contact Info
Re-identify enrollment period to the caller - add date (if applicable)
Acknowledge what the requested Effective Date
Re-verify caller 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
Additional Mailing address
Physician Selection:
Primary Care Name
It is required to select an PCP for an HMO plan
Confirm if they are an existing patient
Selection 2: Benefit Info Tab
Please read 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 you prefer your documents in a language other than English?
Section 3- Other Info
Phonetically re-verify the Medicare Number
Re-verifying 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 from your Social Security Check or Railroad Retirement Board
You can choose automatic deduction from your bank account
You can pay by invoice (Choose this option if the plan has a $0 monthly premium)
Section 4 -Agent Info
DO NOT READ, Select Yes, “You agree to the above statements”
Section 5 - Review & Submit
Read the verbiage in green verbatim and click on the Drop downs 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
NOTE: Re-verifying the information on the 3 drop downs must be done before the audio disclaimer:
Switch back to Contact Center
Enrollment_2 Landing Page
Play the audio disclaimer
Read this declaimer
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
Switch back to Contact Center
Read this statement:
Read this section:
Paste the confirmation number
Closing:
