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This training material for internal agents focuses on benefit administration processes including determination, care management, and claim payment initiation. It covers topics such as development of care plans, certification criteria, claim procedures, and provider verification. Participants will learn about efficient ways to handle inquiries, assist caregivers, and ensure timely payment processing within 10 days. The training emphasizes understanding insured individuals' needs, available support systems, and community services. By completing this program, agents will be equipped to navigate the complexities of benefit administration effectively.
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Training Material Benefit AdministrationFor Agent / Internal Training OnlyLD# L0511DW0Y(exp1207)MLIC-LD
Benefit Administration Department • Benefit Determination • Care Management • Provider Verification • Claim Payment
Initiating A Claim • Call to toll free number • RN/Care Manager works directly with insured or caregiver
Benefit Determination • Based on ADLS/Cognitive • Certified as Chronically III • Development of a Plan of Care • Recertification
Care Management • Discuss Plan Benefits • Assist with Plan of Care • Understand Insured/Family Issues, Goals and Available Support System • Consider All Community Services
Claim Payment • One Claim Form • Bills as Proof of Loss • Provider Discounts • Claims Paid Within 10 Business Days
