Section 1: Greeting

1

Inbound call or transfer on non-RSVP toll-free numbers

{Review the call to action for the toll-free number that was dialed. If the toll-free number is for MA/MAPD/DSNP, lead with those plans.  If the toll-free number is for PDP only, you must lead with PDP only.  Unless the caller asks for MA/MAPD/DSNP.}

“<Hi/Hello> and thank you for calling <Brand> Medicare. This is <Your First and Last name>. {If licensed say: A licensed agent.} How many I help you today?

{Use your note pad to take notes regarding the reason for the call. If caller self-identifies as a member and needs to speak to member services, capture name, ZIP Code, and proceed to logic below.}

[{“Ok/Great, I can assist with <repeat reason for the call> but first, can I have your name so that I may address you properly?”}]

First name [   ]
Last name [   ]

“Are you calling for yourself or someone else?”

{Self [   ], proceed below}

{Someone else [   ] say: “Great, I can discuss plan benefits and any other information with you, but if you would like to enroll the beneficiary you would need to have Power of Attorney to complete the enrollment.” {proceed below}

“May I have your phone number?”
Phone number [  ]

“If the phone number you provided is a mobile phone, do you give us permission to call or text you?”

Yes [  ]
No [  ]

{If No, say: “Mr./Mrs. <Last Name> do you have an alternate phone number we can reach you at?”
If Yes, capture phone number in field above.
If No, continue with your call. This is not a required field unless a lead is being set up.

“And your permanent address so we may review the information in your area?” {Address [  ]} “Thank you.”

{If caller refuses to provide address say:} “No problem, <Mr./Mrs.> <Last Name>, can you provide me you zip code? This is so we can verify the plans in your service area.” {ZIP Code [  ]}

{If caller doesn’t provide zip code say:} “Without your zip code I can only provide you generic plan information. Is that ok?

{If yes, continue below}

{If no, say:} “Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”

{If this information has already been provided, do not ask the question again and proceed to the logic below.}

“Are you a current <Brand> Medicare member?”
Yes [   ]
No [   ]

{If Yes or No proceed with logic below}

{Based off the caller’s inquiry you’ll select the correct path to direct the call:

• Caller states they are a current <Brand> Medicare member and they are calling about their current plan, proceed to step 2
• Caller states they are a current <Brand> Medicare member and they are looking for a new plan or to switch plans, proceed to step 2.1
• Caller states they are current <Brand> Medicare member and they are looking to add an Optional Supplemental Benefit, proceed to step 2.2
• Caller states they are not a member or are new to Medicare Parts A and B, and looking for MAPD coverage, proceed to step 3
• Caller is not a member and would like to meet/speak with a local agent, proceed to step 3.0.1
• Caller is not a member, they know what plan they want and are ready to enroll, proceed to step 3.0.2
• Caller is not a member and interested in a prescription drug plan only, proceed to step 3.0.3
• All others interested in enrolling, proceed to step 3.1}

Inbound call or transfer on RSVP toll-free numbers

“Hello and thank you for calling <Brand > Medicare <Seminar/Webinar> line. This is <Your Name>. How may I help you today?”

{If beneficiary would like to make a reservation, proceed to prospect RSVP script-internally reviewed as a communication material}

{If No to reservation: Review the instructions above and determine the reason for the call. Select the correct path from the bullet point list to direct the call.}

Section 2: Members

2

Current member transfer to Member Services

“Mr./Mrs. <Last Name>, you mentioned you were a member, may I have your member ID number?”

Member ID [  ]

“Thank you for being a member, please hold while I connect you with a representative from Member Services. The phone number I’ll be transferring you to is <Member Services toll-free number, (TTY: 711)>. It’s also on your ID card.”

{Proceed to transfer list}

2.1

Current Medicare member looking to switch plans

“Mr./Mrs. <Last Name>, may I have your member ID number?”
Member ID [  ]

“Thank you, since you are a member and looking to complete a plan change I will need to connect you with our dedicated plan change team. Don’t worry, I’ll provide them the information you’ve provided so far.”  The phone number I’ll be transferring you to is <Dedicated Plan Change Team toll-free phone number, (TTY: 711)>.

{Proceed to transfer list}

2.2

Current member looking to add Optional Supplemental Benefit

“<Mr./Mrs.> <Last Name>, may I have your member ID number?”
{Capture Member ID}

“Just to confirm, you’re calling today to add the <optional supplement benefit> to your plan. Is that correct?”

{Yes, say:} “Thank you for being a member, please hold while I connect you with a representative from Member Services who can process your request. The phone number I’ll be transferring you to is <Member Services phone number, (TTY: 711)>.”

{Proceed to transfer list}

{No, say:} “May I ask the reason for your call today?”

{Review the instructions in step 1 when you determine the reason for the call. Select the correct path from the bullet point list to direct the call.}

Section 3: Non-member and Eligibility

3

New to Medicare or non-member and interested in MA/MAPD beginning 10/1.

“Have you already reviewed Medicare plans?”
Yes [   ]
No [   ]

{If Yes proceed to 3.0.2}

{If No, say:}
“What are the things you’re looking for a in a plan?”

{If caller has questions, capture and answer the questions. Then proceed to verbiage below.}

{If caller has questions about price or convenience, say:}

“Many of our customers are looking for plans that offer those features. We can discuss your <Brand> plan options with you today or <a local agent can come meet you so they can explain the plans in person/we can arrange a call from a local agent that can provide a one on one consultation> and make it easy for you to find the right plan for you. I can schedule a[n] <appointment/call> at a time that’s convenient for you, how does that sound?”

{If caller has questions about access to doctors, preventive health or support say:}

“Mr./Mrs. <Last Name>, we understand there is a lot to consider and we’ve found it helpful to have a one-on-one consultation about which <Brand> plan meets your health needs.”

“I can schedule a[n] <appointment/local agent call> at a time that’s convenient for you, how does that sound?”
Yes [  ]
No [  ]

{If Yes, say}
“Great, I’ll ask you a few questions to ensure you’re eligible to enroll and verify that the service is available.”

{Proceed to step 3.2}

{If No, proceed to 3.1}

3.0.1

Caller is not a member and would like to meet/speak with an agent and interested in MA/MAPD.

“Mr./Mrs. <Last Name>, to schedule your <home appointment/local agent call back> I’ll need to ask you a few questions to ensure you’re eligible to enroll and to verify that the service is available.”

{Proceed to step 3.2}

3.0.2

Ready to enroll

“Sounds like you’ve done your homework. What plan are you considering?” {Wait for response} ”Great, do you have specific questions about <Plan name> that I can help you with today?”

{If caller has questions, capture and answer the questions. Then proceed to question below.}

{If caller has no concerns, proceed to question below.}

“Mr./Mrs. <Last Name>, now just a couple more questions to ensure you’re eligible to enroll.”

{Verify address that was provided in step 1}

“I have your permanent address as.”
Address 1 [   ]
Address 2 [   ]
City [   ]
Caller’s State
Caller’s ZIP Code

{Proceed to step 3.2}

3.0.3

Caller is only interested in PDP

“If you are interested, I can send you an email after our call covering some of the plan information we are going to discuss. You will be able to keep it as a reference — would you be interested?

{If Yes, say:} “Great! By providing us with your email address, you agree to receive email communications from Aetna until you opt out of further emails. You can opt out at any time.”

May I please have your email address?
[  ]

{If No, say:} “No problem, if you change your mind, you can let me know at any point in this call.”

{Proceed to step 3.2}

3.1

Eligibility questions

“<Mr./Mrs.> <Last Name> to better help you and to ensure you’re eligible to enroll, I’ll ask a couple of qualifying questions, is that ok?”
Yes [  ]
No [  ]

{If Yes, proceed to step 3.2}

{If No, say:} “<Mr./Mrs.> <Last Name>, you mentioned you were ready to enroll, to do that we have to verify your eligibility. Is that ok?”

{If Yes, proceed to step 3.2}

{If No, say:} “Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”

3.2

Employer coverage

{Agent note: If the answer to this question has been provided, please do not ask for the information, instead verify it.

“Do you currently have health coverage that’s sponsored by your or your spouse’s current or former employer?”
Yes [  ]
No [  ]

[{If Yes, and in an OH ZIP code, ask:}
"Are you a part of the Ohio Public Employee Retirement System (OPERS)?"

{If Yes, say:}
"You’ll need to contact <1-844-287-9945 (TTY: 711)> to get more information on the plans offered to you.”]

[{If Yes, and in an TX ZIP code ask:}
"Is that coverage through Texas Retirement System (TRS)?"

{If Yes, say:}
"You’ll need to contact <1-800-307-4830 (TTY: 711)> to get more information on the plans offered to you.”]

[{If Yes, and in an IL ZIP code ask:}
"Are you retired from the State of Illinois?"

{If Yes, say:}
"You’ll need to contact <1-855-223-4807 (TTY: 711)> to get more information on the plans offered to you.”]

[{If Yes, and in a NJ ZIP code ask:}
"Are you part of the NJ State Health Benefits Program?"

{If Yes, say:}
"You’ll need to contact <1-866-234-3129 (TTY: 711)> to get more information on the plans offered to you.”]

[{Placeholder to insert additional groups that may need to contact their benefits administrator before making an enrollment decision:}

{If Yes, and in a <state> ZIP code ask:}

["Are you part of the <state /employer/program/retirement system>?"]

[“Is that coverage through <state/employer/program retirement system>?”]

{If Yes, say:}
"You’ll need to contact <state/employer/program/retirement phone number> to get more information on the plans offered to you.”]

{If Yes, and not in one of the ZIP codes/groups mentioned above, say:}
Are you considering keeping your employer coverage?

{If Yes, say:}
“Your <employer/group/union> plan generally provides different benefits than coverage purchased as an individual. By enrolling in an individual plan, you may lose access to those group benefits.”

“Would you like to continue?”
Yes [  ]
No [  ]

{If Yes, proceed to 3.3}

{If No, say:} “You may want to contact your benefits administrator for more information. Thank you for your interest in <Brand> Medicare, please call us back if you have any more questions.”

3.3

Medicare Parts A and/or B

{Agent note: If the answer to this question has been provided, please do not ask for the information, instead verify it.

Example: You mentioned your A&B effective dates were <date>, is that correct?}

“Are you currently eligible or will you be eligible for Medicare parts A and/or B within the next three months?”
Yes [  ]
No [  ]

{Agent note: If unsure, ask for the Part A and/or B effective dates.}
{If Yes, proceed to 3.4}
{If No, say:}

“Will you be eligible for Medicare A &/or B in the next six months?”
Yes [  ]
No [  ]

{If Yes, proceed to 3.4}

{If No, say:}

“I’m sorry, you don’t qualify for a Medicare plan at this time. We would be happy to send you information about our current plans. Would you be interested in receiving a free information kit?”

{If Yes, proceed to 5.1}

{If No, say:}
“Is there anything else I can help you with today?”

{Answer questions.}

“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”

3.4

Medicaid, Extra Help

{Agent note: If the answer to this question has been provided, please do not ask for the information, instead verify it.

Example: Earlier you mentioned you had Medicaid, what about Extra Help? Or <Mr./Mrs./Ms.>, <Last Name> I heard you mention you had Extra Help, what about state Medicaid? }

“Are you enrolled in your state Medicaid program?” {If Yes, ask:}

“Does your Medicaid cover the cost of all your medical services?”
{If Yes, proceed to step 4.}

{If No, ask:}
“Do you receive Extra Help to pay for your Medicare prescription drug plan?”
Yes [  ]
No [  ]

{If Yes to either Medicaid or Extra Help, the caller may have a Special Enrollment Period, proceed to 4}

{If No to both Medicaid or Extra Help, and you have established an enrollment period, proceed to 4}

{If No to both Medicaid or Extra Help, and you have not established an enrollment period, proceed to 3.5}

3.5

Determining eligibility for callers who are Medicare- eligible but are calling outside of annual enrollment period (between December 8 and October 14) and do not have Medicaid or Extra Help.

Read and have person verbally verify only 1 applicable eligibility question.

Once an eligibility reason is selected agent should go to step 4.

Agent note: If caller is enrolling for AEP, between <10/15 thru 12/7> proceed to step 4, no selection is required.

{Agent note: Do not read if you already know the caller’s enrollment period, instead confirm the information: Example: “I understand you’re ready to enroll because <SEP reason>, <state SEP time-frame>”}

“Typically, you may enroll in a Medicare Advantage plan only during the Annual Enrollment Period from October 15 through December 7 each year. There are exceptions that may allow you to enroll in a Medicare Advantage plan outside of this period. I would like to ask a few questions to confirm enrollment eligibility. By answering yes to any of these options, you certify that, to the best of your knowledge, you are eligible for an enrollment period.”

{Agent note: AEP option will only display during AEP}

1. <Are/is> <you/he/she> or will <you/he/she> be new to Medicare?
2. Did <you/he/she> previously have Medicare but <are/is> now or will be turning 65?
3. Are <you/he/she> enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP)?
4. Did <you/he/she> recently move, or will <you/he/she> be moving outside of the service area of <your/his/her> current Medicare plan or will this plan be a new option? If yes, on what date did <you/he/she> move? _/_ _/_ _
5. Were <you/he/she> recently released from incarceration? If yes, What date were <you/he/she> released? __/__/____
6. Did <you/he/she> recently return to the United States after living permanently outside of the U.S? If yes, What date did <you/he/she> return to the U.S.? _/_ _/_ _
7. Did <you/he/she> recently get lawful presence status in the United States? If yes, If yes, on what date did <you/he/she> receive status? __/__/____
8. Did <you/he/she> recently have a change in Medicaid coverage (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid)? If yes, when did it change?_ _/_ _/_ _
9. Did <you/he/she> recently have a change in Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help or lost Extra Help)? If yes, when did it change? _ _/_ _/_
10. Do <you/he/she> have both Medicare and Medicaid or does the state help pay for <your/his/her> Medicare premiums? If yes, what is your Medicaid number? ____________________
11. Do <you/he/she> get Extra Help paying for Medicare prescription drug coverage but haven’t had a change?____________________
12. <Do/Does> <you/he/she> live in or did <you/he/she> recently move into or out of a long-term care facility (for example a nursing home)? If yes, What date did <you/he/she> move? _ _/_ _/_
13. Did <you/he/she> recently leave a PACE (Program of All-Inclusive Care for the Elderly) program? If yes, What date did <you/he/she> leave? _ _/_ _/_ _
14. Did <you/he/she> recently involuntarily lose prescription drug creditable coverage (coverage as good as Medicare’s)? If yes, What date did <you/he/she> lose drug coverage? _ _/_ _/_ _
15.  Did <you/he/she> leave or <are/is> <you/he/she> leaving employer or union coverage? If yes, What date did <you/he/she> leave or are you leaving? _ _/_ _/_ _
16. <Do/Does> <you/he/she> belong to a pharmacy assistance program provided by <your/his/her> state?
17. Is <your/her/his> plan ending its contract with Medicare or is Medicare ending its contract with <your/his/her>  plan? If yes, what is the effective date?__/__/____
18. Were <you/he/she> enrolled in a plan by Medicare (or your state) and want to choose a different plan? The enrollment in that plan started on __/__/__
19. <Were/was> <you/he/she enrolled in a Special Needs Plan but lost the special needs qualification to be in the plan? If yes, what was the disenrollment date from the SNP? __/__/____
20. Were <you/he/she> affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA)?  Or did one of the other reasons we discussed apply to <you/him/her>, but <you/he/she> <were/was> unable to make <your/his/her> enrollment because of the natural disaster?

Section 4: Offer tree

4

Plan availability

{Agent note: If the answer to this question has been provided, confirm the information}

{Display for counties with MA/MAPD or PDP plans:}

“<Mr./Ms./Mrs.> <Caller’s name>, we have <Medicare Advantage/Prescription Drug> plans available in your area. Which plan are you interested in?”

MA / MAPD or Unsure [  ]
DSNP [  ]
PDP [  ]

{If caller is interested in MA/MAPD, PDP, D-SNP or is unsure, proceed to step 4.1}

{If the caller is interested in a D-SNP but none are available, say:}

[“We currently do not offer any Special Needs Plans in your area. You can visit www.Medicare.gov to see what Special Needs plans are available in your area.”

{Agent note: If the caller doesn’t have internet access, refer them to a local Social Security office or SHIP.}

{If caller insists on hearing about our available plans that are not D-SNPs, say:}
"It appears that there are no <Brand> Medicare Advantage plans available in your area that will work with your Medicaid benefits. Enrolling in our standard Medicare Advantage plan could affect how your services are billed and could cause you to pay coinsurance or copayments for services.

“Would you like to hear more about the plans we have available?”
{If yes, proceed to 4.1}

{If No, say:}

“Is there anything else I can help you with today?”  

{Answer questions.}

“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”]

4.1

Understanding the consumers’ needs

{Agent note: If the caller is not a member and is ready to enroll, open the CNRx Call Center 1 link to ensure the plan they are interested is available and proceed to the pre-enrollment QQ, step 6. All others proceed below.}

{Agent note: Use any combination of the questions below to better understand the caller’s needs or any additional questions that will help you understand the caller’s needs.}

{For PDP, say:}

“To help you find the right plan we like to ask questions like which medications you take and which pharmacy you like to use. We’ll also discuss other potential costs, such as your share of costs, deductibles and plan premiums. This helps us best estimate your cost. If you provided an email address earlier, I will be able to email you information with access to the pricing and costs that we will cover today. We can also look up the pharmacies closest to you and review our mail pharmacy service. Does that work for you, or are you looking for an answer to a specific question?

{For MA/MAPD/D-SNP use any of the questions below:}
[ [] Do you travel?

{If yes: Ask if they need a plan that travels with them or if coverage for emergency/urgently needed services is enough.}
[] What kind of health coverage do you currently have?
[] Do you mind telling me the cost associated with that plan, such as the deductible, premium or your co-pays?
[] What is your monthly budget or ideal cost for your health care premium?
[] Fitness benefits are often included in Medicare Advantage plans. Would having access to a gym membership be beneficial to you?
[] Is Dental coverage important to you?
[] Are Hearing and Vision benefits important to you?
[] Are there any services I can look up for you to help you determine your medical cost?
[] What Pharmacy do you use to fill your prescriptions?
{If the Pharmacy is standard:} Would you be willing to go to a preferred pharmacy or use mail order if it could save you money?
[] Is having some out-of-network coverage important to you?
[] Are there any local Hospitals that I could look up for you?
[] Are there any Specialty providers I can look up for you?
[] Is preventive care important to you?
Examples of preventive care include- Annual physical exams, some health screenings, and hearing/eye exams.
[] Would Non-Emergency transportation be a benefit you would use?
{Agent note: VARIED BENEFIT. You would have to know it is in the market before asking.}
[] Is Vaccine coverage something you are concerned about?
[] Would Telemedicine be something you are interested in?
[] Are Chiropractic or Acupuncture services valuable to you?
[] Would an Over The Counter benefit be something you would like me to investigate?
{Agent note: VARIED BENEFIT. You would have to know it is in the market before asking.}]

{If the caller provides you answers to these questions proceed to CNRX Call Center 1 to look up plans, prescriptions and providers.
Or
If the caller is unsure, is new to Medicare, is interested in an MAPD and has a lot of questions or would rather speak to someone face to face proceed to 4.2
Or
If the caller is unsure and interested in a PDP plan only, proceed to step 5}

{Agent note: Once you have reviewed plan information and answered the caller’s questions say:

“If you’re comfortable with what we’ve discussed, I can help you enroll today. Would you like to enroll in the <Plan Name>?

Yes [  ]
No [  ]

{If Yes, proceed to pre-enrollment QQ, step 6.}

{If No, proceed to 4.2 if home visits are allowed or 4.3 if COVID restrictions are still in place}

4.2

Home visit – This will only display if:

• Not a current member
• Yes to Medicare eligibility within 3 months or valid SEP
• No to Medicaid or yes to Medicaid if a DSNP is available

and

• Yes to MA/MAPD service area.

[{This Agent note will display only if Connect Plus Plan is available:

Agent note: Connect Plus Plan is available in this county. Please refer to training regarding the Connect Plus Plan and attempt to help them while you have them on the phone.}]

"Because this is such an important decision, with so many things to consider, a great way to help you make your choice is to have a local agent meet with you. They’ll discuss options with you and help you select a plan. Our local agents are very familiar with the doctors, hospitals, pharmacies and <Brand> plans that will work in your area.”

“This service is free and there is no obligation to enroll. We can come out as soon as: <provide available date based on home visit lookup>.”

“Are you interested in scheduling this home appointment?”
Yes [  ]
No [  ]

{If No, proceed to 4.3.}

{If Yes:}
“Do you have a need for an interpreter or a signer, free of charge, to be at this home visit?”
Yes [  ]
No [  ]

{If Yes, please book the home visit (or meeting) within a minimum of three business days out to allow the market time to secure an interpreter.}

“What language do you need?”

{Text box to capture language}

“We’ll make every effort to accommodate your request for a <caller's request>. If we’re unable to coordinate these arrangements,  we’ll contact you for possible rescheduling.”

{Proceed to 4.2.1}

{If no, proceed to 4.2.1}

4.2.1

Home visit scheduling

“What is a good day and time to meet with one of our sales representatives?”

{Home visit time availability lookup:

Select the home visit from the results and proceed to 4.2.2.}

4.2.2

Home visit data

{Agent note: If this information has been provided, please do not ask again but instead verify it.

Example: We can reach you at <phone number> and your address is <state address> is that correct?}

{Agent note: If this information has not been provided, say:}

“Okay, may I get a phone number where you can be reached?”

Phone number [  ]

“If the phone number you provided is a mobile phone, do you give us permission to call you?”

Yes [  ]
No [  ]

{If No, say: “Mr./Mrs. <Last Name> do you have an alternate phone number we can reach you at?”

If Yes, capture phone number in field above.

If No, say: “Unfortunately without a phone number we are not able to schedule the home appointment. Is there anything else I can help you with today?”  {Answer questions.}

“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”}

[“Mr./Mrs. <Last Name>, we do offer reminders via text, would you like us to send you a reminder regarding this appointment?”
{Yes [  ]
No [  ] }]

“May I have your address?”

Address 1 (Required) [   ]
Address 2 [   ]
City (Required) [   ]

{Display for agents but do not allow editing
Caller’s state
Caller’s ZIP Code}

{Agent note: Only complete if caller would like to meet some place other than their home.}
Alternate meeting place [   ]

{Agent note: Comments should not contain data that should be provided in other data entry fields.

(Comments from conversation) (Required) [     ]}

{Additional notes}

Current coverage [  ]
Current carrier [  ]
Looking for coverage reason [  ]
Coverage effective date (YYYY-MM-DD) [  ]

{Proceed to 4.2.3}

4.2.3

Scope of appointment

“<Mr./Mrs./> <Last Name>, your home appointment is on <home visit date displayed> at <home visit time displayed>. Do you want the <sales representative/agent/broker> to discuss all products (if available) in your area?”

{Agent note: Select all plans that apply, must select Medicare Advantage.}

Medicare Advantage Plans (Part C) and Cost Plans [  ]

Medicare Supplement (Medigap) Plans [  ]

Stand-alone Medicare Prescription Drug Plans (Part D) offered by SilverScript [    ]

{The following ancillary plans will only display once Medicare Advantage is selected from the above option. Agent note: Choose all ancillary products that apply.

If caller asks what the hospital indemnity, recovery care or cancer, heart attack or stroke products are, check box below for explanation.}

Check box [  ]

{If box is checked, display the following talking points:

HIIP: “Hospital indemnity insurance provides a set benefit amount if you're admitted to the hospital. You select the benefit amount. It's paid directly to you, not the hospital.”

CHAS: “Cancer, heart attack and stroke insurance pays a lump-sum benefit to you upon diagnosis. You select the benefit amount. Hospitalization is not required.”

Recovery care: “<Brand's> recovery care insurance provides a set benefit amount if you're admitted to the hospital or are in a nursing facility. You select the benefit amount. It's paid directly to you, not the hospital or nursing facility.”

{Select all options that caller is interested in.}
Hospital indemnity products [  ]
Dental/Vision/Hearing products [  ]
Cancer, heart attack or stroke products [  ]
Recovery care products [  ]

“I want to inform you that you’re under no obligation to enroll. Your meeting with our agent will not affect your current or future Medicare enrollment status. It also won’t automatically enroll you into a Medicare plan.”

“If you decide to enroll in one of our plans, know that our agents are employed or contracted by <Brand> . They may be compensated based on your plan enrollment.”

“Do you agree to meet with an agent to discuss our plans?”
Yes [  ]
No [  ]

{If Yes, proceed to 4.2.4.}

{If No, proceed to 4.3.}

4.2.4

Home visit confirmation

“Great, our agent will make their best effort to arrive on time. Due to traffic and scheduling, allow a two-hour window for the appointment.”

{Display home visit confirmation.}

“Again, my name is < name>. If you need to contact us, give us a call at <phone number, (TTY: 711)>.”

“Is there anything else I can help you with today?” {Answer questions}

“If you have any other questions or would like to make changes to your appointment, we’re available <Display October 1 – March 31; 8 AM to 8 PM, local time, 7 days a week. Display April 1 – September 30; 8 AM to 8 PM, local time, Monday – Friday.>

Thank you for your interest in <Brand> Medicare, have a great <day/evening>.”

4.3

Local agent callback -

[{This Agent note will display only if Connect Plus Plan is available:

Agent note: Connect Plus Plan is available in this county. Please refer to training regarding the Connect Plus Plan and attempt to help them while you have them on the phone}]

[{If caller declines the home visit say,}
“Mr./Mrs. <Last Name> If you’re not interested in meeting with someone face-to-face in your home we do have an alternative. We have local agents in your area that can call and review the <Brand> plan details with you. Since they’re local, they can recommend which plan would best fit your needs. They know the hospital and provider networks in your area well.]

[{If the caller does not qualify for a home visit due to lack of Medicare eligibility or the home visit is not available due to COVID say:}

“We have local agents in your area that can give you a call and personally review the <Brand> plans available to you. These agents are aware of which plans will work well with the hospital and provider networks in your area. Would you like to have a local agent call you to review your plan options?”]

“Can I schedule this callback for you?”
Yes [  ]
No [  ]

{If Yes, proceed to 4.3.1.}

{If No, proceed to 5.}

4.3.1

Local agent callback booking

{Agent note: If this information has been provided, please do not ask again but instead verify it.
Example: We can reach you at <phone number> is that correct?}

{Agent note: If this information has not been provided, say:}
“May I have the best phone number where we can reach you?”
Phone number [  ] (required)

“If the phone number you provided is a mobile phone, do you give us permission to call you?”

Yes [  ]
No [  ]

{If No, say: “Mr./Mrs. <Last Name> do you have an alternate phone number we can reach you at?”

If Yes, capture phone number in field above.

If No, say: “Unfortunately without a phone number we are not able to schedule the callback. Is there anything else I can help you with today?”  {Answer questions.}
“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”}

[“Mr./Mrs. <Last Name>, we do offer reminders via text, would you like us to send you a reminder about this callback?”
{Yes [  ]
No [  ] }]

{Agent note: Comments should not contain data that should be provided in other data entry fields.}

{ (Comments from conversation) (Required) [     ]}
{Additional notes
Current coverage [Drop-down]
Current carrier [  ]
Looking for coverage reason [Drop-down]
Coverage effective date (YYYY-MM-DD) [  ] }

{Proceed to 4.3.2.}

4.3.2

Scope of appointment

“<Mr./Mrs./Ms.> <Last Name>, I’ve scheduled your local agent callback. Do you want the <sales representative/agent/broker> to discuss all products (if available) in your area?”

{Agent note: Select all plans that apply, must select Medicare Advantage.}

Medicare Advantage Plans (Part C) and Cost Plans [  ]

Medicare Supplement (Medigap) Plans [  ]

Stand-alone Medicare Prescription Drug Plans (Part D) offered by SilverScript [    ]

{The following ancillary plans will only display once Medicare Advantage is selected from the above option. Agent note: Choose all ancillary products that apply.

If caller asks what the hospital indemnity, recovery care or cancer, heart attack or stroke products are, check box below for explanation.}
Check box [  ]

{If box is checked, display the following talking points:

HIIP: “Hospital indemnity insurance provides a set benefit amount if you're admitted to the hospital. You select the benefit amount. It's paid directly to you, not the hospital.”

CHAS: “Cancer, heart attack and stroke insurance pays a lump-sum benefit to you upon diagnosis. You select the benefit amount. Hospitalization is not required.”

Recovery care: “<Brand's> recovery care insurance provides a set benefit amount if you're admitted to the hospital or are in a nursing facility. You select the benefit amount. It's paid directly to you, not the hospital or nursing facility.”

{Agent should select all options that caller is interested in}

Hospital indemnity products [  ]

Dental/Vision/Hearing products [  ]

Cancer, heart attack or stroke products [  ]

Recovery care products [  ]

“I want to inform you that you’re under no obligation to enroll. Your call with our agent will not affect your current or future Medicare enrollment status. It also won’t automatically enroll you into a Medicare plan.”

“If you decide to enroll in one of our plans, know that our agents are employed or contracted by <Brand>. They may be compensated based on your plan enrollment.”

“Do you agree to meet with an agent to discuss our plans?”

YES [  ]
NO [  ]

{If Yes, proceed to step 4.3.3}

{If No, proceed to step 5}

4.3.3

Local agent callback confirmation

“Great, your callback has been requested for <date> [and <time>], if an agent is unable to call you at that time, know that we’ll call you back in no more than three business days.”

“Again, my name is < name>. If you need to contact us, give us a call at <phone number, (TTY: 711)>.”

{Agent note: If customer needs a more immediate call, send an alert to the market. If caller wants to delay the call or has any other requests, make sure to make a comment in the notes.}

“Is there anything else I can help you with today?” {Answer questions}

“If you have any other questions or would like to make changes to your appointment, we’re available <Display October 1 – March 31; 8 AM to 8 PM, local time, 7 days a week. Display April 1 – September 30; 8 AM to 8 PM, local time, Monday – Friday>.

Thank you for your interest in <Brand> Medicare, have a great <day/evening>.”

5

Kits — Agent offers to send information kit

“<Mr./Mrs.> <Last Name>, are you interested in receiving a free information kit about the <Brand> plan[s] available in your area? The kit contains a description of the plan’s benefits, what is and isn’t covered, and what you should do to keep your coverage.”
Yes [  ]
No [  ]

{If Yes, proceed to step 5.1}

{If No, say:}

“Is there anything else I can help you with today?”  {Answer questions.}

“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”

5.1

Kit selection

“Okay. The quickest way to get your kit(s) is for me to email <it/them> to you.”

“May I have your email address?”
Yes [  ]
No [  ]

{If Yes, capture:}
Email Address [   ]

Providing an email address authorizes us to contact you via email. You can opt out at any time.  Your email address will be handled consistent with our Privacy Policy, which you can find on our website at < plan URL>

{Proceed to Call Center 1 link to send out the E-kit (Quick Quote).}

{If No or the caller does not have an email address:}
“All right, I’ll have the kit mailed to your home address. You should get it in <7 to 10> business days.”

{Agent note: Enter the address the caller wants their kit mailed to.}

Address 1: [  ]
Address 2: [  ]
City: [  ]
State: <State Displayed>
ZIP Code: <ZIP code displayed>
County: <County displayed>

{Agent note: Proceed to the OneKit to mail the kit.}

Kit order confirmation number: [  ]

“Okay. I just requested your kit. We’d like to follow up with you to review the information and answer any questions you may have. Would you prefer a morning, afternoon, or evening callback?”

{Would they like a callback?}
Yes [  ]
No [  ]

{If Yes, select the time provided:}
Morning [  ]
Afternoon [  ]
Evening [  ]

{If phone number wasn’t provided:}
“Great, may I have the phone number you’d like us to call you at?”

Phone number [   ]

“If the phone number you provided is a mobile phone, do you give us permission to call you?”

Yes [  ]
No [  ]

{If No, say: “Mr./Mrs. <Last Name> do you have an alternate phone number we can reach you at?”

If Yes, capture phone number in field above.

If No, say: “Unfortunately without a phone number we are not able to schedule the callback. Is there anything else I can help you with today?”  {Answer questions.}

“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”}

{If phone number was provided:}
“Can you confirm that <primary phone number> is the best phone number to call you at?”

Phone number [   ]

“If the phone number you provided is a mobile phone, do you give us permission to call you?”

Yes [  ]
No [  ]

{If No, say: “Mr./Mrs. <Last Name> do you have an alternate phone number we can reach you at?”

{If Yes, capture phone number in field above.}

{If No, say:} “Unfortunately without a phone number we are not able to schedule the callback. Is there anything else I can help you with today?”  {Answer questions.}

“Thank you for your interest in <Brand> Medicare. Have a great rest of your <day/evening>.”}

{Enter notes for callback agent[   ]}

“Is there anything else I can help you with today?” {Answer questions}

“Once you have reviewed your kit and you’re ready to enroll, you can call us back at <Callback Toll-Free Number> where one of our licensed agents can help you enroll.

We’re available <Display October 1 – March 31; 8 AM to 8 PM, local time, 7 days a week. Display April 1 – September 30; 8 AM to 8 PM local time, Monday – Friday>.

Thank you for your interest in <Brand> Medicare, have a great <day/evening>.”

6

Pre-Enrollment Quick Quote Email.

“Mr./Mrs. <Last Name>, now that we’ve confirmed the plan is available and you’re eligible to enroll, I’d like to email you a summary of the information we discussed today. This will include the <name of the plan you’re enrolling into, your monthly plan premium, the pharmacy we selected, a copy of your Summary of Benefits> and a link to see the medications we discussed.

{If email has been provided say:}

To verify your email is: <Email address>

{If email had not been provided say:}

May I have your email address? [  ]

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 < plan URL>

“Great, thank you. Now Mr./Ms./Mrs. <Last Name> you’ll receive two emails. The first one includes the information I just mentioned and the second email is a passcode you can use to view the personalized plan details that will include your medication costs and a breakdown of the plan costs, such as your <PCP/Specialist and Hospital copays>. You can view those by clicking on the View Plan Details in the first link.

Now, the email may include a link to enroll, but don’t worry about that as that is what I’m here to help you with.”

{If the caller doesn’t have or want to provide an email address say the following:} “Not a problem <Mr./Ms./Mrs.> <Last Name>, if you didn’t get a chance to take notes, you’ll have an opportunity to do that now as I will confirm a couple pieces of information about your plan. You will also receive your Welcome packet in the mail that includes your Welcome Letter and plan information]. That usually takes about 7-10 business days once your application has been approved.”

“First I’d like to confirm that you’ll be enrolling in the <MA/MAPD/PDP plan name>.”

{For MA/MAPD:} [“<Brand> Medicare is a HMO, PPO plan with a Medicare contract. [Our SNPs also have contracts with State Medicaid programs.] Enrollment in our plans depends on contract renewal. Plan features and availability may vary by service area.”]

{For PDP:} [“SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Enrollment in SilverScript depends on contract renewal.”] 

“The <MA/MAPD/PDP plan name> has with a monthly plan premium of <monthly premium>.”

{If the caller would like to enroll an MA/MAPD with an Optional Supplemental Benefit (OSB) say} “Since you’ll be adding the optional supplemental benefit the total plan premium will be <monthly plan premium plus the OSB monthly premium>. This amount includes both your <MA/MAPD plan name> monthly premium of $<amount> and your optional supplemental benefit plan premium of $<amount>.”

{If the caller questions the amount due to Extra Help, say “Those with Extra Help may pay less than this amount.”}

“Mr./Mrs. <Last Name> You understand that this is a:

• [Medicare Advantage plan with drug coverage]
• [Medicare Advantage without drug coverage]
• [Medicare Prescription Drug Plan only]

And not a Medicare Supplement plan, is that correct?”

{For MAPD/MA only}

“Also, your Medicare Advantage Plan <does/does not> have a medical deductible.”

{If plan has deductible, state the amount for in-network and out of network.}

“And your <in-network/out of network>  PCP <copay/coinsurance> is <PCP copay/coinsurance amount>.”

“I’d also like to confirm that you understand how your doctors and hospitals will be covered in your plan’s network.”

{If No,} “What other doctors/hospitals can I look up for you?”

{If dental coverage is embedded or an Optional Supplemental Benefit (OSB) is added}

“The dental coverage [requires you to use a network dentist][is a reimbursement benefit that requires you to pay upfront and submit a receipt for reimbursement].

{If OSB} “This has an additional monthly premium of <OSB premium>.”

{For MAPD, say:}
“Since this plan includes prescription drug coverage, I’d like to ensure you understand how your medications and pharmacies are covered.”

{For PDP, say:}
“Since this plan is for prescription drug coverage I’d like to ensure you understand how your medications and pharmacies are covered.”

{If No,} “What other prescriptions/pharmacies can I look up for you?”

“Your <Medicare Advantage/Prescription Drug> plan <does/does not> have a prescription deductible.”

{If plan has deductible, state the amount and the tiers it applies to.}
“And the pharmacy <Pharmacy name> is considered <preferred/standard> for <Plan Year>.”

{Proceed to 6.1}

6.1

Telephonic enrollment Checklist cont.

“Now that we have those important details covered, we can start your application. You’ll need to provide your Medicare Number, your Part A and/or B effective date and your name exactly as it appears on your Medicare card.

{If Yes, continue to CMS approved enrollment script}

{If No,} “Mr./Mrs. <Last Name>, without this information we’re unable to process your enrollment, please call us back when you have the information available.”

“Thank you for calling <Brand>, have a great <day/evening>.”