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EmblemHealth | New York non-Face-to-Face Enrollment Options

April 20, 2020

In preparation for all non-face-to-face enrollments, please ensure you have a member’s demographic information, and complete the following:

  1. SOA (Paper, voice recorded, fax, or email)
  2. Ensure beneficiary in receipt of Summary of Benefits and Star Ratings
  3. Complete needs analysis, including and not limited to, confirming medications covered, doctors in-network, PCP choice, plan selection, etc.
EmblemHealth

Complete one of the choices listed below:

Option 1: “NEW” Voice Recorded SOA and Application:

Important: Ensure the beneficiary understands the purpose of using the voice recorded line to obtain the SOA and enrollment before calling the voice recorded line. This will help facilitate the process in collecting the SOA and Enrollment over the recorded line.

Note: the recorded line does not complete the enrollment. A completed application is finalized when the broker completes and submits the application using the online application tool.

If a Recorded Scope of Appointment is Needed

(If you have a Scope of Appointment, go to Step Two)

Step One

  • Dial 1 (800) 447-8879 and have the member on the phone line SELECT EmblemHealth
  • State: This call is being recorded for quality and training purposes.
  • State: This call is to record for the SCOPE OF APPOINTMENT for your protection.
  • State the Broker’s first name, last name, and broker writing ID.
  • State the Member’s first name, last name, and date of birth.
  • Begin reading the Scope of Appointment over the recorded line.
    • SOA should be read as is
  • Read NY State: CMS Disclaimer to the beneficiary:
    • Health Insurance Plan of Greater New York (HIP) is an HMO/HMO-POS/HMO D-SNP plan with a Medicare contract. HIP has a contract with the New York Medicaid Program for HMO D-SNP. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.
  • Record in your notes the Sales Record number (SR), time, date, and representative’s name who helped to record the SOA.

Step Two

  • At this point, the Broker would have identified the plan the Beneficiary is ready to enroll in, and the Beneficiary has all of the documents, (SOB, Star Rating).
  • Make sure that the broker goes to this website.
  • Dial 1 (800) 447-8879 and have the member on the phone line.
  • SELECT EmblemHealth
  • State: This call is being recorded for quality and training purposes.
  • State: This call is to record the beneficiary enrollment.
  • State the Broker’s first name, last name, and broker writing ID.
  • State the Member’s first name, last name, and date of birth.
  • Begin reading and filling out the ONLINE APPLICATION from start to finish and the broker must read all disclaimers.
    • Note: when the broker arrives at the election period page, only read the election period that applies.
  • Submit the electronic application.
  • Record the electronic application’s confirmation number.
  • Share the electronic application number with the beneficiary.
  • Record in your notes the Sales Record number (SR), time, date, and representative’s name who helped record the enrollment.

Option 2: Using Emblem’s Recorded Line for SOA and Beneficiary is Using Emblem’s Enrollment Tool

  • Go to Step One.
  • Broker has already emailed, faxed, or mailed plan documents to the beneficiary with star rating prior to presentation.
  • You and member are both on this site.
  • Walk the member through the online enrollment process and make sure member types in your writing ID number.
  • The beneficiary shares the electronic application confirmation number with the broker.

Option 3: Broker has SOA and Beneficiary is Using Emblem’s Enrollment Tool

  • Go to Step Two.
  • Broker has already emailed, faxed, or mailed plan documents to the beneficiary with star rating prior to presentation.
  • You and member are both on this site.
  • Walk the member through the online enrollment process and make sure member types in your writing ID number.
  • Beneficiary shares electronic application number with broker.

Option 4: Using Emblem’s Recorded Line for SOA and using your FMO tool to do Enrollment

  • Go to Step One.
  • Broker has already emailed, faxed, or mailed plan documents to the beneficiary with star rating prior to presentation.
  • Continue to your FMO tool/portal

Option 5: Using Paper Applications

Step 1:

Collect Signed SOA by fax, mail, email, or telephonically detailed in Option 1.

Note: Fax paper SOA to EmblemHealth 1 (866) 890-7722

Step 2:

Broker mails plan documents to the beneficiary with star ratings and pre-filled application with broker writing ID.

Note: Do not date the application.

  • Beneficiary reviews application for accuracy
  • Beneficiary signs and dates the application
  • Beneficiary mails or faxes the application to Broker or EmblemHealth 1 (866) 890-7722
  • Enrollment is complete when EmblemHealth receives the application
For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881
support@pfsinsurance.com

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