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Betty is 64 years old and currently a Medicaid recipient

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Betty wants to switch to a Medicare Assured Plan

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Betty wants to switch to a Medicare Assured Plan

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Betty calls in to Customer Service and tells you that she is interested in Joining Highmark Wholecare for Medicare.
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Is she eligible yet?

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Betty Becomes Eligible for Medicare by Turning 65

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Betty Becomes Eligible for Medicare by Turning 65

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Members become eligible for Medicare when they:
1. Turn 65
2. Become disabled
3. Have End-Stage Renal Disease
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Remember: Betty is ALSO STILL eligible for Pennsylvania Medicaid

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Remember: Betty is ALSO STILL eligible for Pennsylvania Medicaid

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Now that Betty is actually eligible for one of the HMK Wholecare Medicare Assured Plans, she can apply.  There are a few ways to do this:
1. On HighmarkWholecare.com
2. By Calling our Sales Department
3. On the CMS.GOV website
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How can Betty reach our sales department?

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The enrollment department at Highmark Wholecare reviews Betty's application and determines that because she is eligible for full Medicaid and is 65 and eligible for Medicare parts A & B, that she is a valid candidate for Highmark Wholecare Medicare Assured Diamond, and approves her as a member.

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If Betty decides that she doesn't want Highmark Wholecare Medicare Assured anymore, but Enrollment has NOT YET added a profile for her in our systems, Betty can CANCEL her plan by speaking to our Retention department.
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What is a Cancellation Request?

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If she doesn't cancel, after Betty's application has been approved, Enrollment will allow an account to be made for Betty.  She should soon show up in the systems, have a member ID, and everyone at the company will be able to see her account.

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Since enrollment has already created Betty's  account, Customer Service Representatives should now be able to locate her account in our systems.  Note:  She's a new member, so she may not have an ID card yet!  To verify, you might ask for her social security number.

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Betty believes her plan effective date is incorrect and should have been earlier

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Betty believes her plan effective date is incorrect and should have been earlier

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Betty will most likely call customer service and expect CSRs to update that for her.  We cannot verify that information ourselves so we will need to transfer that call to Retention.
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What does the Retention department do?

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As she uses her insurance, she may call Customer Service every now and then to ask questions about her benefits, bills she gets, and supplemental benefits!

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Betty moves. She calls Customer Service to tell us

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Betty moves. She calls Customer Service to tell us

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Anytime a Medicare Assured member has any kind of demographic update (including name, DOB, etc.), we need to route that info to the Enrollment department using the Power Queue system.
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What is a demographic update?

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If Betty loses her Medicaid eligibility, she's going to be notified by Highmark Wholecare because BOTH of our Medicare Assured plans are considered D-SNPs.  If she calls Customer Service about this, there will be a Power Queue note on her account called "Loss of Medicaid LTR".  If you see this, she needs to speak to the RETENTION department to discuss her options!
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What is a Loss of Medicaid?

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What if Betty wants to disenroll from her Highmark Wholecare Medicare Assured plan?

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What if Betty wants to disenroll from her Highmark Wholecare Medicare Assured plan?

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This is called the Disenrollment Request.  She'll call Customer Service and we should try to figure out why she wants to disenroll and see if we can fix things first.  If she is adamant about disenrolling, we INITIATE the disenrollment REQUEST process for her.
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What is a Disenrollment?