In our field, even simple mistakes can mean the difference between a payday and a rejection. Humana has shared a simple guide to avoid some of the most common mistakes agents make when working with Humana plans.

Member Consent

One of the most common complaints Humana experiences pertains to the issue of member consent during enrollment. Complaints include unauthorized enrollment in a healthcare plan, and being lead to enrollment by misinformation. Some instances involved effective dates that were not communicated correctly, the wrong election codes were selected, members were enrolled in the wrong plan, and information was misrepresented.

Avoid This Problem By:

Making sure to gather complete and accurate information during enrollment
Being knowledgeable of the plans you present
Knowing and adhering to CMS and Humana rules
Following established procedures while presenting plan benefits and completing enrollments
When presented with a question you cannot answer, DON’T GUESS! Ask an expert, or recheck your training materials!

Keep In Mind the Code of Ethics:

Agents cannot sign the enrollee’s name, even with permission (this also applies to e-signatures)
An agent cannot accept signatures made by anyone other than the enrollee, except in the case of an authorized Power of Attorney for Healthcare or court-appointed legal guardian
Even if signed, agents cannot knowingly accept an incomplete application
If a prospect is uncertain if they wish to enroll in the plan, agents are not to complete or accept an application

Spousal Enrollment

While spousal enrollment is great for business, it can present unique challenges for agents and cause applications to pend or reject. Often times, one spouse will fill in the other’s application, resulting in incorrect or duplicate information. Also, things can get tricky when using T-Sig or the IVR system to capture double enrollments.

Keep Things Running Smoothly By:

Verifying that the information entered on spousal applications belongs to the enrollee
Keep in mind that spouses may have different election period options available to them, and select the appropriate one for each
When using T-Sig or IVR, verify that the correct application ID is reflected on BOTH applications and that they are both submitted

Sales Presentations

Issues surrounding sales presentations and full disclosure continue to be in the Top 3 causes of Section A complaints for Humana. Members experience buyer’s remorse after feeling they did not receive full disclosure during the plan presentation. This means lost sales due to member cancellation or disenrollment, and negative associations with the agent and Humana.

Keep Prospects Well Informed by:

Presenting all applicable plan rates and benefits, including RX if applicable using CMS and Humana approve materials
Describing the difference between a Medicare Advantage and Medicare Supplement plan
Knowing the details and making them understandable to the prospect
Communicating if the plan covers prescriptions when asked by the beneficiary
Verifying participating providers via Physician Finder Plus or the Provider directory
Asking follow up questions throughout the presentation to confirm that the beneficiary has an understanding of the material
Clarifying any questions prospects ask during and after the presentation

For more information about Humana and CMS regulations, visit https://www.empowerbrokerage.com/carrier-downloads/humana/

If you have any questions, please call us toll-free (888) 539-1633.