OTHER CALLS 11/20/2025

DECEASED CUSTOMER

• A customer's passing may be reported by a legal representative. And when is it reported. IDENTIFY THE CALLER PHI CONFIRM THE STATUS OF THE ACCOUNT CONFIRM PAYMENTS AND REFUNDS DOCUMENT TE CUSTOMER'S ACCOUNT

SETTLING A DECEASED CUSTOMER'S ESTATE (REFUND REQUEST)

• If an individual is calling about a refund request made out of someone other than customer, they must.
• SUBMIT REFERRAL TO BILLING > INFORM CALLER OF THE 7-10 BUSINESS DAYS TO RECEIVE THE FROM > ADVISE THE CALLER TO FILL IT AND SEND IT BACK WITH CHECK > ONCE APPROVED, CHECK WILL BE REISSUED.
• SUBMIT THE APPROPRIATE LEGAL DOCUMENTATION NAMING EXECUTOR/EXECUTRIX OF THE ESTATE

NOTIFICATION OF THE MEMBER HAS PASSED AWAY

• Check members status in MARx/BEQ if the member acct is already D00 - means deceased) MARx/BEQ does not need to be verified.

LOCAL ENTITY - means SSA

HIGH RISK CALLER - caller who express homicidal or suiciidal thoughts or appears to be in state that will place themselves in danger

HOMICIDAL - capable of having a tendency towards killing other human being.

SUICIDAL - self destructive - likely to commit, or attempt to do suicide

REASSURANCE

• acknowledge the caller
• Tell that you would like to verify their currect conatct info just in case the call got diconnected (phone and add)
• Ask the if they would like to be transffered to a CGNA BEHAVIORAL HEALTH CARE MANAGER.
• if said YES, advise the caller you wuill rtransfer trhem to CBH and you will stay on the line until they reach spmeone at CBH.

TRANSFER CALL TO CBH

• 1-800-241-4057 ext 7961545
• VERBIAGE; "Good day/night. This is calling from Cigna (PDP). I have <customer's name> a MEDICARE Prescription Drug customer on the line. < Explain issue>. The customer's ID number is <customer ID#>, date of birth is , and where the customer can be reached."

ABUSIVE -Abusive calls are calls that are derogatory verbal exchanges that are aimed personally at the contact center employee. This can be comments made to the contact center employee that are based on religion, gender, ethnicity, sexual preference, or sexist in nature. These calls would be considered personal attacks on one's character. Please note that an angry caller may not be an abusive caller, unless they make personally offensive remarks to the call center employee.

HANDLING AN ABUSIVE CALLER

• Handling an abusive call in a contact center requires a delicate balance of professionalism, assertiveness, and empathy. Here's an in-depth look at the steps involved in effectively managing such situation: · Remain Calm and Polite · Remind Caller of Recording · Address the Behavior · Warn of Call Termination · Terminate the Call · Inform Supervisor or Manager · Document the Call · Send Documentation to Compliance

TL LINE When a caller is upset or asks for a Supervisor, MSAs must try to deescalate.

MSAs should first attempt to calm upset callers. If the caller says they'll file a Medicare complaint, the call must go to the Escalation Team via ICX EXT 75069. Calls involving Medicare complaints must be escalated to the Escalation Team. The Escalation Team ("TL Line") handles and resolves escalated customer complaints. -> The Escalation Team manages and resolves serious complaints. The goal is to fix the issue and improve customer service. Their aim is resolution and better service experience. Advocates must recognize when a call needs escalation to a supervisor. -> Know when a call requires escalation. Calls must be transferred to the Escalations Team in specific situations. -> Escalate certain calls to the Escalations Team. " If a caller threatens to contact Medicare, media, lawyers, government, or company officials, it must be escalated. -> Escalate if threats to report externally are made (possible CTM).

-Customer Disconnected Calls Important: If it appears that the customer hung up intentionally (i.e. out of anger, frustration, etc.), advocates must forward the case to the Cigna Escalation Team (ICX EXT# 75069) to follow up with the customer by exercising the steps outlined in the Job Aid MS0075 - POTENTIAL CTM PROCESS. " Remember to submit any grievances prior to transferring as well as advising supervisor prior to completing warm transfer.

HANDLING RETURN CALLS

• Cigna may attempt to contact customers by telephone for a variety of reasons. Because of HIPAA laws, it is next to impossible to leave a very detailed message in situations where we connect with an answering machine.
• Research the customer's account to provide the correct resolution.
• Check the following to determine reason (and possibly a resolution) · Account Notes · Call History Mail History

Cigna Outbound Campaigns

• Exhibit 19 - Payment Reminder: Monthly notice to customers at risk of disenrollment due to unpaid premiums.
• Customer Correspondence: Daily responses to written inquiries; Low volume.
• Unqualified Broker: Informs customers their enrollment was handled by an unqualified broker; allows SEP to switch plans.
• Refill Reminder Requests: Reminds Cigna Rx Extra customers to refill/pick up medications; reinforces the message is from Cigna