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MCC Brokerage's Agent Enrollment Checklist Flipbook PDF

MCC Brokerage's Agent Enrollment Checklist


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Agent Enrollment Checklist This checklist contains some of the most common items that we receive as allegations/complaints against agents. Please use this, as well as any carrier checklist, when you complete your enrollments. This is a private check list – not for beneficiary’s view.

PREPERATION CHECKLIST (Prior to presenting any plan) Certification o Have you taken and verified that you have completed the full certification for the carrier(s) you are presenting? o Don’t know for sure? Stop and check now! o Most carrier websites will indicate if you are ready to sell (RTS) for the current year. You can also contact your Support Specialist for verification. Current Coverage o What coverage do they have now? o Employer/Union plan? Enrolling in a MAPD, PDP will affect their employer/union plan and they will not be able to rejoin that plan. o VA Coverage? Enrolling in an MAPD or PDP could affect their VA coverage. Contact your Sales Director or Support Specialist for more information. Scope of Appointment o Do you have a completed Scope of Appointment (SOA) for your beneficiary and any other person attending the appointment? o If yes, proceed. o If no, stop and obtain it now. Providers and Hospitals o You must verify that the beneficiary’s doctors/hospitals are in network. o This can be done by checking the carrier site or using MCC EZ-Enroll. o Do not call the doctor’s office for verification. There are too many different types of carrier coverage (ACA vs. Group vs. Medicare) to take the word of the doctor’s office. Prescriptions o You must verify that the medications are covered by the plan. o This can be done by checking the carrier site or using MCC EZ-Enroll.

PRESENTATION CHECKLIST (During presentation of any plan) Identification o Ask the beneficiary for their Medicare (red, white and blue) card, as well as their Medicaid card, if applicable. Make sure that you copy the name and number EXACTLY as it appears on the card. o Do not use nicknames. o Stop and review the information after you have recorded it. Service Area o Verify the service area of the plan. o Verify the beneficiary lives at least 6 months of the year in the service area. o Verify with the beneficiary that their address matches that which Medicare/Social Security have for them. Proposed Effective Date o Verify the effective date of the plan. Plan information o Verify that the beneficiary understands the type of plan that you are discussing. o Verify the name of the plan with the beneficiary. o If you are doing an electronic enrollment, pause and review the plan name. Turn the screen around and also have the beneficiary read the plan name. It is very easy to “fat finger” an electronic enrollment and mistakenly enroll a beneficiary in the incorrect plan. o Verify the type of plan and type of coverage. o Medicare Advantage vs. Medicare Supplement o MA vs. MAPD vs. PDP o HMO vs. HMO-POS vs. LPPO vs. RPPO vs. PFFS o Review the full list of benefits found in the Summary of Benefits (SOB). o Monthly plan premium o Annual medical deductibles – Both Medical and Drug o Maximum Out-of-Pocket (MOOP) – Both in and out of network o Avoid using superlatives or absolute language. o Examples of Superlatives: “best”, “greatest”, “better”, etc. o Examples of Absolutes: “guarantee”, “promise”, etc. Premium o Verify the monthly premium, if applicable. o Remind beneficiary that they must continue to pay their Part B premium, even on a Part B giveback plan.

Referrals o Verify the beneficiary is aware of the referral requirements to see a Specialist. Travel o Explain coverage when traveling outside of the plan’s service area. Transportation o Explain the number of trips. o Specify whether they are round trips or one-way trip. o Explain the approved locations. Over-the-Counter (OTC) Benefits o Explain coverage amount. o Specify whether they are monthly, quarterly or annual. o Explain how and where to use the benefits. Prescription Drugs o Explain the following: o Deductible amount and o Mail order pharmacy the tiers it applies to option o Tier levels and o Prior authorizations copayments o Quantity limits o Part B vs. Part D drugs o Alternative covered o Coverage Gap Stage drugs o Catastrophic Stage o Compound drugs o Preferred pharmacies o Insulin Savings Program Star Rating of plan o Explain overall star rating system of how plans are rated. o Explain the numerical star rating 1-5. o Ensure the beneficiary is aware of the plan rating for the plan for which they are enrolling. Benefit Change o Remind beneficiary that benefits may change on January 1 of each year. o Explain they will receive an Annual Notice of Change (ANOC) before AEP. Enrollment Receipt o Provide an enrollment receipt or confirmation number of the enrollment. What’s next o Explain what happens next. o When they can expect to receive their ID cards/plan information. o If they have any questions, they may reach out to you or member services for the carrier. Agent information o Provide the beneficiary with your business card, or name, phone number and email for questions.