Telephone Enrollment Activities and How to Complete Them


Medicare beneficiaries may request to enroll in a plan over the phone when they make a call to you or during an outbound call from you. Depending on who initiated the call, your telephone enrollment activities are limited (MMG, Sections 80.2 and 80.3). There are different requirements for telephone contact, sales scripts, and sales activities. But this article gives you a breakdown of what you can and can’t do when a beneficiary makes an enrollment request over the phone.

When Can You Complete Telephone Enrollments?

You can only complete a telephone enrollment during an inbound call from a beneficiary. A beneficiary may initially call for plan information and then request to enroll, at which time you must confirm if the individual wants to proceed with enrollment. Ideally, you should confirm with a statement that prompts a “yes” or “no” response.

Here’s an example: “I’m required to let you know that this call is now a request for enrollment in [plan name and plan type]. Do you agree to continue?”

A statement like this is required for informational scripts (MMG, Section 80.2) and sales scripts (MMG, Section 80.4). If the caller agrees to enroll, you would then transition to using a telephone enrollment script.

What If an Enrollment Request Is Made During an Outbound Call?

CMS doesn’t allow telephone enrollments when you make an outbound call to a beneficiary—you can only verify eligibility for enrollment. Additionally, you can’t transfer the beneficiary to an inbound telephone line to complete the enrollment. In this situation, you can let the beneficiary know that Medicare only allows telephone enrollments via inbound calls. You can ask the beneficiary to call you. Another option is to set up a face-to-face meeting to provide application assistance.

How to Use Telephone Enrollment Scripts

Enrolling beneficiaries over the phone requires that you use a telephone enrollment script that meets CMS requirements. These include:

  1. Language that clearly states the individual is requesting enrollment in [plan name and plan type].
    • Here’s an example: “To confirm, you’re requesting to enroll in [plan name and plan type] over the phone. Is this correct?”
  2. A statement that the individual will receive a notice acknowledging the enrollment request. Acknowledging means the individual accepted or denied the telephone enrollment, or requested additional information.

After you include these statements in your script, you will need to submit it verbatim (no bullets or talking points) to the plan sponsor for approval. The plan sponsor then submits it to CMS.

Providing Enrollment Confirmation

After you complete a telephone enrollment, you’re required to provide the enrollee with a confirmation tracking number or other tracking information. You must also provide contact information for questions, including the plan sponsor’s toll-free customer service and TTY numbers.

What Else Do the Medicare Guidelines Say?

You can get more Medicare marketing tips through our online resource center on topics such as using telephone sales scripts and selling for AEP. Want more guided support? Contact us to learn how our senior market experts can help you convert more prospects into clients, increase your income, and keep your business profitable.

 

Source: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY-2018-Medicare-Marketing-Guidelines_Final072017.pdf

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