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SeniorCare
and SeniorCare Rx
Medicare Products
Agent Reference Manual
November 2, 2012
www.seniorcaretexas.org
WELCOME!
Dear Producer,
It is with great pleasure we invite you to join the Scott & White Health Plan SeniorCare
Sales team by becoming a contracted agent.
Scott & White Health Plan has over 18 years experience in managing Medicare programs
successfully. We are delighted to offer quality agents and brokers the opportunity to sell
our products.
In the pages that follow, you will find useful information and instructions to assist you
with the process for becoming a certified sales agent for Scott & White Health Plan, as
well as information on our policies and procedures to help make the SeniorCare selling
experience positive for you and Medicare beneficiaries.
Scott & White Health Plan is committed to providing Medicare beneficiaries with
information that helps them make informed decisions about their health care choice. The
best interest of the beneficiary is our primary concern, and we insist our sales
representatives embody that mission.
We look forward to working with you. If you have any questions, or we can provide you
with additional information, or resolve any issues - no matter how small, please call our
Broker Services Department and one of our experienced Medicare representatives will
assist you.
Sincerely,
Tammy Lawson
Director, Regional Sales & Marketing
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TABLE OF CONTENTS
Welcome Letter from Tammy Lawson, Director, Regional Sales & Marketing . . . . . . .
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Our Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Definition of a Sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Appointment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Termination of Agent Appointment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Quick Reference Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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General Inquiries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Note: This information may be updated throughout the year.
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OUR PRIORITY
 Our members are our #1 priority.
 Our members deserve our best so they can make informed decisions about their
health care needs.
 We strive to ensure that each person we serve receives the greatest possible value for
their health care investment.
 Our products offer diversity to meet the financial and medical needs of the customer.
 SWHP offers solutions. We believe in team work and strong partnerships. Together
with providers and dedicated agents and brokers, we are providing accessibility to
high quality health care coverage.
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GETTING STARTED
Steps to become certified to sell Scott & White Health Plan (SWHP) SeniorCare:
1. Complete Agent Appointment Packet.
2. SWHP completes agent appointment process.
3. Agent completes SeniorCare product training and testing.
4. Agent ready to sell upon receipt of SWHP authorization letter.
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DEFINITION OF A SALE
The definition of a sale means:
The agent must be appointed with SWHP and eligible to sell the product.
Agents must have completed all required product training.
SWHP has received premium payment for the policy from the member.
An agent’s Identification (ID) number must appear on the enrollment application.
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APPOINTMENT PROCESS
An agent must complete the agent appointment packet. This packet must include:
Agent Application for Appointment
Copy of a valid Texas Department of Insurance (TDI) license.
Copy of AHIP certification.
E&O Form
Copy of Product testing and passing score
A $10 check payable to the TDI
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COMPENSATION
Every month the Marketing Executive Assistant is responsible for running individual sales
reported generated by agents and/or brokerages. Commission statements are available to
the FMO online at https://scottwhite.acteksoft.com/ACom3 ScottWhite/
 Initial compensation
Agents/brokers will be paid $413 for new/initial sales.
Commission payments are distributed monthly following premium received.
 Renewal Payments
Agents/brokers will be paid $207 for renewal sales in 2014.
Commission payments are distributed monthly following premium received.
 Commission Disputes
Occasionally, disputes will arise over credit of sale or commission amounts.
These decisions are decided by:
Tracy Mow, Marketing Executive Assistant, 254-298-3321, TMOW@ sw.org
Tammy Lawson, Director, Regional Sales & Marketing, 254-298-3360, tlawson@ sw.org
Evidence may include original enrollment forms, database entries, sales logs, e-mails from
the applicant, information from the agent or staff.
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TERMINATION OF AGENT APPOINTMENT
 Requirements are that required licenses are maintained and addendums to the
original appointment contract are signed if procedure changes are made.
 If an agent’s proper and required licensure requirements are not met, the
appointment is terminated.
 If an agent is found guilty of a violation deemed unethical by SWHP standards, we
reserve the right to terminate the appointment of the agent in question.
 Agents must be in good standing with TDI and SWHP to be appointed, make sales,
and receive commission for those sales.
 Agents appointed for Medicare products must be in good standing with TDI and
SWHP, completed training according to CMS requirements, and completes SWHP
Medicare product training in order to market and sell Medicare products.
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QUICK REFERENCE GUIDE
 Who do I contact at SWHP for contracting, commissions or certification questions?
Tracy Mow: 254-298-3321, [email protected]
Annual product and general compliance training
Commissions Inquiries
Contracting guidelines
Certification
Ready to Sell Status
 Who do I contact at SWHP for enrollment application questions?
Agent Line: 1-866-781-7008 or
Sharon Rinn: 254-298-3372, [email protected]
Maribel Morris: 254-298-3382, [email protected]
Enrollment application processing
Verification of Mailing address/fax number for submitting applications
Status of a Member Enrollment Application
Effective Date of Coverage
Disenrollment Date and Reason
Cancellation Date and Reason
 Who is my local contact?
Eileen St. Amant: 254-298-3387, estamant@ sw.org
Eileen is located at the Scott & White Health Plan (SWHP) Temple office. The mailing
address is:
Scott & White Health Plan
Mail Stop Code: MS-A4-126
1206 West Campus Drive
Temple, TX 76502
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 How do I submit an Enrollment Application?
Applications should be faxed directly to the Scott & White Health Plan. For questions or
concerns, call 254-298-3372 and ask to speak with the Marketing Assistant.
FAX NUMBER: 254-298-3567
 What information do I need to call about an application?
If you do contact SWHP about a matter that involves an enrollment application that you
have already submitted, please be prepared to provide the following:
Applicant’s full name
Applicant’s date of birth
 What is the enrollment application receipt date?
For requests submitted to sales agents, the application date is the date the agent
receives/accepts the enrollment request and not the date the Plan receives the
enrollment request from the agent. For purposes of enrollment, receipt by the agent
employed by or contracting with the Plan, is considered receipt by the Plan and all CMS
required timeframes for enrollment processing begin on this date.
 What if a member has questions about their plan or benefits?
Please instruct members to contact Customer Service at the number on the back of their
Member ID card or by calling 1-866-334-3141 (TTY: 1-800-735-2989) if they have
questions about:
Member ID Numbers
Copy/Regeneration of a Member ID Card
Provider (physician) information
Prescription or Provider service questions
Premium Information and payment status
Member Benefits information – including covered Medications
Member-Specific Materials (e.g., EOC)
Member Claims or payment information (for either medical or Part D services)
Status of Disenrollment/Cancellation of Plan
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NOTE: Changes to member information (e.g., address, PCP change, changes in the premium
payment option) must be requested by the member or their authorized representative.
Requests from the agent will not be honored.
Members should contact Customer Service at 1-866-334-3141.
SWHP Customer Service
1-866-334-3141
The best way to assist members!
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GENERAL INQUIRIES
General inquiries and any undefined issues should be directed to the Agent line at
1-866-781-7008.
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