How do you disposition a caller that is not eligible for any plans we represent?
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Terms in this set (98)
What information can be used to full beneficiary info in MARx? (Select All)Full Medicare # SSN Name and DOB Name DOB Partial Medicare numberWhen completing enrollments, what do we use?The Plates PPE and Customer BrowserWho can complete enrollments? (select all)Beneficiaries POAIf someone says they need an interpreterit has to be one that we payOn telephonic enrollment form, everything must be read ____ in it's entirety.verbatimTo complete an enrollment, we need what information?Name DOB Address (physical and mailing, NO PO Box) MBI Gender A&B Effective DatesWhat method of enrollment is preferred (default) at Assurance?PPE (on the plates)A PPE enrollment method is completed where?shopper's browserTo send a PPE enrollment, what pieces of information must you enter in the plates?email gender MBI DOBWe have one voice signature method. What is it?Voice recordingsMedicare Part A does what? (select all)Hospital stays Skilled nursing facility Hospice Home healthDoes Medicare Part A Typically has how much monthly premium cost?$0In order to be eligible for Medicare Parts A & B a shopper needs? (Select All)65 years old Disabled and receiving SSI for 24 Mo. Diagnosed with ESRDPart A and Part B both have deductibles.$1556 $233the Medicare A Part benefit period1st admission day to the 60th daythe number $170.10 is associated with Medicare in what way?Part B mo premiumDoes medicare part B pay for prescriptions?NO, $0Only one office can enroll you in Medicare. Who is that?Social SecurityAutomatic enrollment in medicare occurs, regardless of age under which circumstances?ESRD or ALS disabled and receiving SSI for 24 moEvery Medicare Part D (PDP) plan has different drugs that are covered. This is calledFormularyCertain types of plans can be paired with Part D plans. (Select All)Medigap (Med Supp) PFFSDuring the catastrophic drug coverage phase, how much does a bene pay for generics?$3.95 or 5% of the retail cost, whichever is greater.To get a medicare Part D plan, you must have what? (Select All)A or BFor enrolling in a specific Medicare advantage plan, you must....LIVE IN SERVICE AREA, Part A&BWhen can shoppers enroll into an MA/MAPD?AEP, IEP, ICEP, OEP, SEPwhat are the plans called where the shopper has to pay 100% of the out of network costs?HMOSome travel benefits are available on ALL Medicare Advantage Plans. what are they?Emergency Urgent CareWhat is the Max Out Of Pocket?Max you will pay in one yearOriginal medicare does not cover:transportation hearing/vision OTC flex cardsFor every service that someone gets under their MA/MAPD plan, they will pay theCopay and CoinsuranceWhich plans don't require referrals, and DO have OON coverage?PPOWhere will you go to complete the Medigap sales?Carrier portalThere are two situations where you'll need medical underwriting for medigap:Where there is no GI or IEPAlong with Medigap premium, beneficiaries must also pay:PART B PREMIUMMedicare supplements do not includePRESCRIPTION DRUG PLANHow does medicare work with Tricare?MEDICARE PAYS FIRSTMost of the time, if someone with Tricare is asking about an MA/MAPD plan, it's for the _____ benefitsAncillary benefits: Dental Vision Hearing OTC Chiropractorsomeone with VA benefits might also enroll in an MA/MAPD plan for the(DO NOT SELECT ACCESS TO VA DRS)Having A&B is necessary even if they have VA Coverage (True/False)MUSTFor Medicare approved services, a person with QMB pays what for their medical services?$0What type of plan is best for a DE ShopperDSNPMedicaid participants are automatically enrolled into ____ and auto assigned a planExtra Help- LISIf the plan has a $1 rx copay for generic drugs and the shopper has Level 2 LIS How much will the shoppers copay be for generic drugs?$1.00How much does a Part B reimbursement plan pay to a DE beneficiary?$0What are not common CSNP conditions (select all)?Diabetes Lung Disease Heart DiseaseWhat type of plan requires a beneficiary to give their pcp a form to attest they have been diagnosed with a chronic condition?CSNPWhich questions below are examples of positive emotional greetingsGlad to hear from you I'm happy to hear from you It's a pleasure to speak to you!Which is not an Assurance approved guided question?How can I help you?Put the steps of opening a call in the correct order:Greeting with Emotion Guided Question Role Statement Permission Assumptive Close Set ExpectationOn which call will you read the permission and scope of appointment?Every callWhat tool/resource can agents use to verify shoppers Medicare eligibility? (Select all)MARx Carrier PortalsWho can use the Automatic Prescription Lookup tool?The BeneficiaryIs a shopper doesn't know what their current plan is, what should the agent do?Check Marx and continueWhen does the needs assessment begin?Beginning of the callIf a shopper is DE what needs are NOT important to be considered? (Select All)Moop Part B reimbursement Hospital Costs PremiumDuring AEP a shopper ________ a SEP.Does not needHow many times can a DE shopper change plans using SEP code per calendar year?3 x'swhat is the difference between qualifying a shopper and identifying their needs?Qualifying is what they are eligible for and identifying their needs is what they want or need in a plan.If MOOP, Rx Cost, and Provider choice were shoppers top 3 needs which plan would you recommend.Humana ChoiceWhen would you NOT choose the top recommended plan?When the shopper has specific needs not listed in the recommended planIf a shopper doesn't identify their top 3 needs, what are the typical default needs?Prescription drugs and providersIf hearing is the shopper's top priority which plan would you recommend?Amerigroup $1000When describing the recommended plan what benefits will you start withShopper's top 3 needsWhy do we proactively acknowledge the "bad" features of the plan that the shopper may not like?To mitigate the negatives right away and control the narrative.Why do we list the benefits to the shopper first?They shopper may become overwhelmed (information overload)If the top recommended plans are all scored at 100, how many plans should we recommend to the shopper at once?Just 1Why are non-stated needs important to discuss with a shopper?Shopper may not have known they needed that benefit but since the plan offers it that's great!All compliance problems can be solved by:Following the script and the sales process in the platesWhich of the following are required for a compliant introduction?That you represent Assurance or Prudential Your full name Asking whom you are speaking with That you are licensed in beneficiary's stateWhich prescription benefits are you required to disclose to a shopper? (Select all that apply)Tiers deductible Cost sharing for all shoppers prescribed medications STANDARD PharmacyAfter completing a Marx check, who can you disclose MBI or Medicare effective dates with?The beneficiary and or POAWhat information is required from a POA completing an enrollment for a beneficiary?POA can provide legal documentation to the carrier if asked later on. POA Name and addressWhy is it important to list all the shopper's medication on a MAPD plan?To make sure the prescriptions are in the plans formulary and estimate the cost of the rx for the shopper.What benefits do we disclose to remain compliant?All of them listedWhy do we ask this question before enrollment begins? "Great! Please do let me know if you have any other questions. If not, are you ready to enroll?"To make sure the shopper had no questions before enrollment To make sure the shopper understands they are enrolling in a health plan. To avoid any sales allegationsIf you suspect a medication is not covered by Part D, .because its OTC, what is the best way to verify this?Google itIf the shopper isn't sure if they want to switch plans, and doesn't have a current enrollment period, what should the agent do?Add the shopper to your PipelineWhich of these shoppers can enroll during OEP (Select all that apply)Shopper had HMO and wants to switch to PPO Shopper has PPO and wants to switch to HMO Shopper has PFFS and wants to switch to HMOIf you suspect a medication is brand with a generic equivalent, what is the best way to verify?Enter it into the prescription lookup tool on the plates and see if a generic equivalent shows up.If a doctor is not coming up in the provider lookup, what is most likely the error?The doctor's city is incorrectWhich best describes the Medicaid program?State run, overseen by the federal governmentWhere can a shopper find their medicare id number, and part a & b effective dates?Their red white and blue medicare cardWhat button does the shopper press to move to the next page of the PPE enrollment?Continue button at the bottom of the screenFrom the answers below, which of the shopper's information is put into the plates? (Select all)Top 3 needs Providers PrescriptionsWhere do you click to add notes?Notes TabA role statementLet's the shopper know exactly HOW you can help them.On a D-SNP, how do you check which levels of medicaid are accepted by the plan (select all)Plan Decider page toward the top under premium under deductible the summary of benefits usually in the first couple of pagesIf a shopper is on Level2 of LIS what do they pay for RX's?$0