The Health Insurance Marketplace Contact Center

Overview

June 2, 2013

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Customer Service

What will drive a positive Consumer experience?

• Clearly communicated places to get help where customers can use any mix of service channels and receive assistance at any point in the process.

• Coordinated content, messaging and answers to questions across channels and entry points .

Operational Efficiencies• Leveraging existing 1-800

MEDICARE call center technologies and utilizing proven customer service models.

• As a result, we can focus on continuous improvement and expanding the channels for the new consumer base

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Initial Projected Volumes

• Based on information on the types of calls and potential spikes, we estimate approximately 26.8 Million calls by the end of the first Open Enrollment Period.

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1,000,000

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Call VolumeWeb Chat

• Initially, we will have 6 sites (VA, IA, KY, KS, AZ, FL) which will scale to 14 sites (VA, IA, KY*, KS, AZ, FL, MS, UT*, TX*, ID) by open enrollment

• The Representative numbers will also scale to support the incoming call and web chat volumes.

• 1,500-2,500 Representatives during the summer• 5,000-9,000 Representatives during open enrollment

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• June – September 2013: – The contact center will launch in conjunction with the new look and feel of HealthCare.gov – The contact center will respond to general inquiries about the program, educational,

primarily related to:• Health Insurance (“What’s a premium?” “What’s a deductible?”) • Program (“I have insurance, will I be impacted?”) • Preparation (“Where can I go to get additional information?” “When will I need to make a decision?)

– Begin training customer service representatives June 3rd

• Will have training and content available for states and partners middle of June• October 2013 – March 2014 :

– The contact center will assist with completing an enrollment application and eligibility determination, performing a plan compare to assist callers with selecting their insurance options, addressing issues related to premium information (based on adjusted gross income), determining tax credit eligibility, and issuers complaints.

– Begin training customer service representatives on the various web tools in September• January 2014 – beyond:

– The contact center will be available to assist with additional questions as coverage begins such as income adjustments, referrals and complaints to the insurance plans

Contact Center Inquiries

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Training

• Training content is being developed to support the Health Insurance Marketplace, some of the modules include:– Healthcare Coverage Education– Increasing Marketplace Awareness– Eligibility & Enrollment– SHOP

• The training will expand and increase in preparation for open enrollment to include training on the Application, Plan Compare and Enrollment

• Initial representatives will be migrated over from the 1-800 MEDICARE representative pool and trained on specific Health Insurance Marketplace curriculum– Representatives are experienced with call center processes, including

providing immediate feedback on the types of inquiries and trends within the contact center

– Representatives are experienced with the existing call center technologies

Marketplace Training Curriculum (Summer)

• FFM focused training contains the following modules• Additional training modules will include navigating the call center

application and “soft skills” training

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Module 1: Affordable Care Act General Inquiries Curriculum Overview

Module 2: Health Insurance Basics

Module 3: Affordable Care Act Basics

Module 4: Marketplaces

Module 5: Individual Marketplace Eligibility and Enrollment

Module 6: Medicaid and CHIP

Module 7: Qualified Health Plans

Module 8: Insurance Affordability Programs

Module 9: Other Resources and Assistance

*Call Center Representatives will be required to pass the various modules and a certification exam.

Marketplace Scripting(Summer)

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Example of Scripting

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Benefits of Health Insurance CSR NOTE Before considering Marketplace health insurance plans, consumers may want to know why they should buy health insurance, especially if they are healthy individuals. READ There are many benefits to having health insurance. Insurance protects you from the high costs of medical care resulting from serious illness and injury. Health insurance helps you pay for treatment of unexpected illness or injury. Even young, healthy individuals can benefit from coverage; it protects everyone from unknown future costs. Health insurance plans also offer coverage for routine and serious medical care. All plans include coverage for minimum essential health benefits, such as vaccines, blood pressure tests, diabetes screenings, hospital stays, and prescription drugs. Essential benefit coverage is also available for prenatal and maternity care, mental health and substance abuse services, and children’s vision and dental care. ASK Do you want to find out more about buying health insurance?

Choosing a Doctor and a Hospital

Marketplace Type Marketplace Products

Essential Health Benefits

Qualified Health Plan (QHP) Eligibility

Quality Assurance

• Quality Assurance involves a review of services delivered by call center representatives, the identification of deficiencies and implementation of strategies to address them.

• 100% call recording • Incorporates:

– CSR feedback– Track performance trends of individuals, teams, and

call centers– Determine effectiveness of training– Identify refresher training needs– Monitor adherence to policies and procedures

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Referrals

• Customer Service Representatives (CSRs) will have access to referral points of contact in each state

• Referrals will be made to local assistance (i.e., Navigator programs, state Medicaid offices, etc.)

• CSRs will refer to the insurance plans for specific coverage and payment related inquiries

• We are working with other federal agencies (i.e., IRS, SSA, Education etc.) to provide common scripting for automated messages and to be used within their call centers

• We will have a special “assistor” phone line available to support Navigators and Medicaid Offices. Provides assistors quicker access to call center representatives for support with consumer issues.

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Example of Referral Scripting

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Health Insurance Marketplace Call Center Referral

General Health Insurance Marketplace Information

The Health Insurance Marketplace, also called the Exchange or Marketplace, is a new way to buy health insurance. Through the Marketplace, individuals and small businesses can compare health plans, get answers to questions, determine eligibility for financial assistance, and enroll in health plans, allowing you to make the best insurance decisions for you and your family.

Marketplace Call Center Information

English and Spanish-speaking customer service representatives (CSRs) at the Marketplace Call Center can answer your questions about the Health Insurance Marketplace. For example they can help you with questions about:

The Health Insurance Marketplace Eligibility determinations/redeterminations Comparing Qualified Health Plans Enrollment in plans Plan Complaints Appeals Password resets on Healthcare.gov Requests for Marketplace publications Small Business Health Options Program (SHOP)

Contacting the Marketplace Call Center

Customer service representatives (CSRs) are available for assistance at 1-800-318-2596 24 hours, 7 days a week, including some federal holidays. It is a toll-free phone number. Hearing impaired callers using TTY/TDD technology can dial 1-888-871-6594 for assistance.

You can also visit the Health Insurance Marketplace’s website at www.healthcare.gov/marketplace, live web chat assistance is also available.

The interactive phone system at the Marketplace Call Center is available 24 hours every day of the year.

Assistance in Languages Other Than English or Spanish

In addition to English and Spanish, the Marketplace Call Center also provides assistance in more than 150 languages, through an interpretation and translation service.

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Contact Center Metrics & Reporting

• The Contact Center will provide trend analysis of data such as call volumes, call types, and population changes to assist CMS with proactively addressing potential concerns of the consumers.

• Examples of the reporting available– Number of calls (nationally and by state)– Call center enrollments (nationally and by state)– What callers are calling about (i.e., Topics)– Where are callers being referred (i.e., Referrals)– Customer Satisfaction reporting– Various Call Center metrics, including Average Handle

Time, Average Speed of Answer

Reporting Dashboards

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Call Center Metrics

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Questions?

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