THREE levels of PDP PLANS

LEVEL 1
-deductible. THEY PAY FOR FULL

LEVEL2
-Initial coverage . ONLY THE COINSURANCE OR CO- PAY TO PAY, THE REST IS FOR PART D

 LEVEL 3
-catastrophic coverage. FULL PART D. 0 PAYMENT FOR THE MEMBER


ANNULA DEDUCTIBLE
-deductible may only apply to drugs on specific tiers, which means may not have any deductible if you don't take any medications on those tiers.

tier 1 and 2 = 0 dollar 
tier 3,4,5= 590$ 
OOP- 2000$


*MEMBER PLAN COST
PLAN PREMIUM
- the monthly cost for coverage
LEP( LATE ENROLLEMNT PENALTY)
- corresponding fee for member who had been without coverage for a continuous period of 63 days or more
PREMIUM SUBSIDY
- corresponding amount that is paid by government financial aid for qualified beneficiaries


PREMIUM + late enrollment penalty= total billed amount ( regular customer)
PREMIUM+PREMIUN SUBSIDY= total billed amount

*PLAN PAYMENT SUBSIDY
PAYMENT SUBSIDY
-A government incentives or assistance in the form of financial aid extended to an economic sector.
-Medicaid
-extra help- LIS
-SPAP/ADAP
-MEDICARE savings programs


SPAP- STATE PHRAMACEUTICAL ASSISTANCE PROGRAM
ADAP - AIDS DRUG ASSISTANCE PROGRAM


*ELECTION PERIODS
 1EP
- Initial enrollment period. (7 MONTHS TOTAL. 3MONTHS BEFORE OR AFTER 3MONTH AFTER THE BIRTHDAY) 65TH birthday

SEP
-Special enrollment period(last 8 months)
only 2month to enroll to parts c and d

AEP
-annual enrollment period.

The following coding will display under the Market Source field in the Miramar system showing how the enrollment was submitted.

 PHONE
 - The enrollment was completed telephonically by a Telesales agent.
OEC_CLIENT 

- Plan online enrollment (enrollment was completed online, using the plan's website).

SPAP State Abbreviation
 - The enrollment was sent by a State Pharma


A Telesales Agent is available in English and Spanish. If the customer requests another language, advocates are expected to contact an interpreter prior to transferring the call to Telesales;

■ Prior to warm transferring the caller, capture the caller's basic information
■ First and Last name
■ Telephone number
■ Zip code
If the caller objects to providing the information, capture what info we can (if any) and transfer the call.
Once the advocate collects all necessary information from the customer, transfer the call to telesales and inform the telesales agent the need for and interpreter.

What Telesales and MS Advocates can do:

Telesales Agents are THE ONLY AGENTS that can process a telephonic enrollment / plan change with the customer, meaning the enrollment application is taken verbally, over a recorded line. The enrollment, however, MUST be completed on an inbound call.

 Cigna advocates CANNOT participate in any activities that could be viewed as “selling/marketing” the plan benefits. Any caller who requires assistance with deciding which plan to enroll in, must be directed (transferred) to a Telesales agent to discuss plan details and benefits (Plan comparison)