No More LEAN for UHC Field Agents???

Sep 14, 2016

  1. insurance5511
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    insurance5511 Super Genius

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    Effective immediately, field agents must obtain a Scope of Appointment (SOA) form from the consumer prior to telephonically presenting a Medicare Advantage (MA) or Prescription Drug Plan (PDP).



    Telephonic Plan Presentation Rules of the Road

    A field agent may conduct telephonic sales presentations (e.g., a needs assessment), but is prohibited from electronically enrolling a consumer as the result of a telephonic presentation (e.g., field agents cannot use LEAN™ to enroll consumers via the phone).



    Have a consumer interested in enrolling? Field agents can assist a consumer with a paper enrollment application over the phone. Only UnitedHealthcare-approved and authorized call centers are permitted to conduct telephonic enrollments and must meet scripting, recording and other compliance requirements.



    Telephonic Plan Presentation Guidelines

    1. Obtain Permission to Call (PTC), if you are calling the consumer.

    2. Conduct a needs assessment in order to determine eligibility, and identify the plan best suited for the consumer. General Medicare education may be provided, but presenting a specific plan and/or plan specific information, such as benefits and costs, must not be done until a SOA has been obtained (see Step 4 below).

    3. Schedule a time with the consumer for the telephonic plan presentation.

    4. Mail or email* (you must obtain permission from the consumer to email) the Enrollment Guide for the plan(s) that you will present telephonically.



    § Instruct the consumer to print or remove the SOA form from the Enrollment Guide, complete, sign and return it to you prior to the telephonic plan presentation.

    § You may enter your Agent ID (only) on the enrollment application within the Enrollment Guide, but you must not sign or date the application until you receive the signed application back from the consumer.





    § Obtain the signed SOA from the consumer prior to the start of the telephonic plan presentation. Obtain the SOA form from the consumer by mail, email* or fax* 48 hours prior to the appointment when practicable. At this time, UnitedHealthcare does not have an electronic delivery/signature method or any form of telephonic recording available.



    * When the telephonic plan presentation is ad hoc and it is not practical to obtain the SOA 48 hours in advance of the presentation, use email (with consumer permission) to deliver a PDF of the Enrollment Guide and instruct the consumer to print the SOA page, complete and sign it, and either scan and email or fax it back to you prior to the start of the plan presentation and indicate why an exception was needed (e.g., beneficiary phone-in). You must receive the signed SOA from the consumer in order to proceed with the plan presentation.

    § If another Medicare-eligible individual, such as a spouse or sibling, is with the consumer on the telephone, you must obtain an SOA form from all individuals that will be present.

    § Fax all signed SOA forms to UnitedHealthcare within 48 hours following the telephonic presentation.



    5. Conduct the plan presentation just as you would a face-to-face appointment; use the Enrollment Guide to cover benefits, costs and limitations. For example:

    § Make sure to look up each of the consumer’s current providers to determine if they are in the plan’s network.

    § Explain how to enter the Primary Care Provider’s name and ID on the enrollment application if applicable.

    § Look up each of the consumer’s current prescription medications to determine if they are on the plan’s formulary, the tier placement and any utilization management requirements.



    6. Assist the consumer complete an enrollment application if the consumer decides to enroll.

    § Paper application – provide instructions to the consumer to return the completed and signed application. Do not solicit or accept a 2017 enrollment application prior to October 15, 2016. Advise the consumer to sign and date a 2017 application on or after October 15, 2016.



    7. Review the Plan Recap that follows the Enrollment Application in the Enrollment Guide. The Plan Recap is an interactive resource that allows you to check for consumer understanding of the plan in which he or she is enrolling. Encourage the consumer to remove the completed Plan Recap from the Enrollment Guide and keep it handy in order to reference it during Welcome Call and as he or she begins to use the plan.
     
  2. MedicareAgent
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    MedicareAgent Guru

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    They are so precious
     
  3. GreenSky
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    GreenSky Guru

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    It's a requirement. Any sales presentation requires a scope. Regardless of where it takes place.

    If a prospect calls and asks "are there any MA plans with zero premium" and you say answer, it's a sales presentation. All you need to do is send them a scope, wait for it to be returned, and then answer the question.

    No problem.

    Rick
     
    GreenSky, Sep 14, 2016
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  4. TN_agent
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    TN_agent Guru

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    Yes, every 85 year old dual-eligible has the ability to print off the SOA, fill it out, and SCAN it back to me. LOL!

    Sounds like they want to make it really difficult to do phone MAPD sales. Other carriers make it easy by having telescopes and eSOAs. This is a conscious choice by UHC.
     
    TN_agent, Sep 14, 2016
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  5. kstein
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    kstein Guru

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    So the eapp is that easy? It only takes 65 steps and your done. Get lost...
     
    kstein, Sep 14, 2016
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  6. MedicareAgent
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    answering a question and giving a phone presentation are two different things.
     
  7. GreenSky
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    GreenSky Guru

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    That's what normal people would believe but anytime you discuss benefits it's considered a sales presentation.

    Prospect: Do you have a zero premium plan?
    Agent: Yes, I have two.
    Prospect: How much are office visits.
    Agent: UHC is $5. Humana is $4.99.

    That's a sales presentation and requires a SOA.

    I'm not suggesting anyone will ever tell the prospect "I can answer that but let me get a SOA to you for signature first" but technically this is required.

    Rick
     
    GreenSky, Sep 15, 2016
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  8. FLM2
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    This is nothing new for UHC-they have never even allowed Med Supp enrollments electronically without a Face to Face and dinged thousands of agents last year for letting a client enroll in PDP plans through the consumer website with an agent either on the phone or in the room.
     
    FLM2, Sep 15, 2016
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  9. yogooglethis
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    yogooglethis Guru

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    I was wondering how agents can use LEAN for MA enrollments without being with the client in the first place? Isn't that fraudulent since it requires signatures? the LEAN enrollment for med supps is a brand new thing but previously they had another electronic enrollment method but that also required the agent to be with the consumer to capture the signature.


    i still use the http://www.mymedicareenroll.com/ where the consume rfills it out and enters you agent ID.You can not be in the same room with consumer however as far as I know its perfectly fine to walk them through it on the phone.
     
  10. vic120
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    vic120 Guru

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    1 or 2 agents on this forum posted about getting dinged,earlier this year, for just that being on the phone with client when enrollment was completed.This is the reason I stopped using it
     
    vic120, Sep 15, 2016
    #10
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