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Opening

Greeting Landing Page

Introduction:

  • Branding

  • First and Last Name of Agent

  • Agent acknowledge they are licensed

Discovery Note (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 Plan:

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

Gathering Medications and Pharmacy:

To Create a Profile:

Required Information to enter (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:

All Plan Details below are required, regardless if they went over the plan details with another agent on a previous call.

  1. Plan name and premium -Located in Plan Details

    1. Extra Help (EH)/ Medicaid: quote premium based off LIS table and original premium of the plan

  2. Medical deductible - Located in Plan Details

  3. PCP & Specialist Copays - Located in Plan Details

  4. ER Copays - Located in Plan Details

  5. Pharmacy Deductible - Located in Plan Details

    1. Extra Help (EH)/ Medicaid: Quote deductible based off LIS table

  6. List at least 1 preferred pharmacy - Located in Plan Details

  7. Mail order (CVS Caremark)

  8. REQUIRED to identify 1 PCP & at least offer to look up Specialist and Hospitals - Located in Plan Details

PDP/MAPD Call Requirements:

PDP/MAPD Call Requirements

  • All Plan Details below are required, regardless if they went over the plan details with another agent on a previous call.

  • NOTE: MAPD and PDP have certain information that we are required to provide. Missing any of these items will result in an auto-fail.

  1. Plan name & Premium - Located in Plan Details

    1. Extra Help (EH)/ Medicaid: quote premium based off LIS table and original premium of the plan

  2. Pharmacy Deductible - Located in Plan Details

    1. Extra Help (EH)/ Medicaid: quote deductible based off LIS table

  3. List at least 1 Preferred Pharmacy - Located in Plan Details

Note: If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:

4. Mention Mail order (CVS Caremark)

5. Mention any Drug restrictions (if applicable) - Located in Prescriptions Tab

Note: Regardless if the member has medications or not, we MUST quote all tiers at a preferred pharmacy

6. Quote Medications - Located in Prescriptions Tab

a. Address each Tier of medication

b. If the Tier applies to the deductible

c. Quote medications tiers that will apply to the caller that year

7. Quote drug restrictions for each medication - Located in Prescriptions Tab

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 to send ekit or paperkit

Switch back to Contact Center

Enrollment Section to End of Call

Enrollment_1 Landing Page:

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

  • Confirm is they are calling for themselves or someone else

  • Re-verify the caller information

Enrollment_2 Landing Page:

  • 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

      • Confirm if they are an existing patient

It is required to select an PCP for an HMO plan

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:

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