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Payment Overview

Deductible- Cx pay ($590 dollars) Initial Coverage (Insurance kicks in, 25% copay/coinsurance for cx and the rest will be the Plan) Catastrophic Coverage- 0 payment from cx

(Bills) Plan Premium (LEP ) Late enrollment penalty Premium subsidy

Initial enrollment Period- 7 month (3 months before 65 birth month, month of his bday, and 3 months after. (If cx will enroll to a new plan during the Oct 15- Dec 7 (Annual EP) The plan will take effect on January next year If cx still has an employer even after they are over 65 years old, they may not enroll in Part D plan but if they will resign, they will have 63 days to enroll for part D to avoid Late enrollment penalty. Special Enrollment Period

if cx wants to enroll to Plan D, they need to submit an application to CMS for approval then once received Medicare will either approve or deny it. Infos will be transmitted back to the plan.

Guardianship & Conservator- If member called in to change something on their behalf, push back and advise to have their Guardian to call instead Power of Atty and Healthcare surrogate- Both member and representative have authority

If member is dead, third party just wants to pay Bills (joint account)= No need for verbal authorization. Assist for billing purposes.

If an entity is calling and is not the MEMBER, seek VERBAL AUTH. EXCEPT: -Legal representative -POA -Guardianship -Deceased -Mentioned "Calling from Provider

BILLING New ACH: One time payment (Savings or checking acc) - 2-3 business days before it will be posted on their account New Credit Card- One time payment on CREDIT CARD

BEQ- Beneficiary Eligibility Query Referral- (If the discrepancy is on our side, we will file this. ) Sample scenario:

  1. If third party called in because the member is deceased need to ask them if they already informed their local SSA and then we will check the BEQ.

  2. Cx called in why they are disenrolled due to being enrolled with different company, check BEQ and search on the tracking number/ cx number and provide it to them. "You have part D but not with signa anymore"

TTY: Teletype writer TDD: Telecommunication Devices for the Deaf For interpreter: Get the name of the interpreter and then Provide the monitoring disclosure then provide your opening spiel.

Convey HS department

-Document Processing- Processing of datas -Membership Accounting - Complete or deny applications based on findings -Quality Assurance -Call monitoring -Reconciliation- Match plan data with Medicare records (Back office) -Premium Billing- Payment processing