UnitedHealthcare® LEAN™ Landmark Electronic - Ready
Contents
1. Nathaniel J Moore MD Estimated Distance 1 9 miles 14991 E Hampden Ave Ste 165 More about this provider Aurora CO 80014 3980 Compare with other providers 720 878 7055 Map 1 Additional Location Text Me E Add to List ae Specialty Family Practice Accepting New Patents Denver Metro Proprietary PCPID 0195462274 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 19 j UnitedHealthcare LEAN E BIE Sales Outreach amp Development l _ 3 Once the PCP is identified copy the PCPID Number from the Provider Search Nathaniel J Moore MD Estimated Distance 1 9 miles 14991 E Hampden Ave Ste 165 More about this provider Aurora CO 80014 3980 E Compare with other providers 720 878 7055 Map 1 Additional Location Text Me Add to List Specialty Family Practice Acceptng New Patents PCPID 0195462274 Paste or enter the PCPID into the PCP ID field on the screen 5 Enter the PCP Name Indicate Current Patient of PCP with a yes or no PCP Search Name 000 000 0000 Save Discard Continue to Payment Information 7 Tap the Continue to Payment Information button to continue the application If you have not completed any required fields on this page you will be2. View Submitted Application Display Receipt Exit Application To view the application after submission click on the View Submitted Application button Managing Applications Viewing Applications 1 To view applications click on My Applications button from the left hand Navigation Bar on the Home Page 2 Submitted and incomplete applications are displayed based on status and date submitted e To open and finish an incomplete application tap on the Incomplete tab and tap on Open App button e To delete the incomplete application click on the Delete App button 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 25 UnitedHealthcare LEAN BEEE sates outreach amp Development Met Cerda 11 10 So hisdik art D ESectwe Dat Oroi2015 To view submitted applications open the My Applications section and select the Submitted tab To view a specific submitted application choose View App incomplete Submitted i Cont FIRST NAME LAST NAME Signed Date Status Date Submitted 1 E 47378062615 Arnold Palmer 6 26 2015 Submitted 6 26 2015 D08 11 18 1919 Medicare ID 123456789A Effective Date 08 01 2015 6 25 2015 Submitted 6 25 2015 John Search for an Application Search for Submitted and incomplete applications usi
3. Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 13 UnitedHealthcare LEAN WDD s s outreach amp Development 5 Choose Plan Product Select IND AARP MedicareComplete SecureHorizons Plan 3 HMO MAPD IND AARP MedicareComplete SecureHorizons Plan 2 HMO MAPD IND AARP MedicareRx Preferred PDP PDP IND AARP MedicareRx Saver Plus PDP PDP IND AARP MedicareComplete SecureHorizons Plan 1 HMO MAPD IND AARP MedicareComplete SecureHorizons Essential HMO MA Once a plan is selected the monthly Plan Premium and H PBP code will appear IND AARP MedicareComplete SecureHorizons Plan 2 HMO M 6 Choose the Dental Rider from the drop down menu if applicable for plan chosen If no Riders are available No Rider Available will display Select HighOptionDental OptionalDental e lf the consumer chooses to add an applicable Dental Rider to their plan the monthly Dental Premium will appear e Ifa Dental Rider is chosen enter the current Dental Facility Number HighOptionDental Y 7 Choose the Fitness Rider from the drop down menu if applicable for plan chosen No Rider Available lf Fitness Riders are available for the plan chosen choose the preferred Fitness Rider If no Riders are available No Rider Available will displa
4. For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 15 U n ited ealth Ca re LEAN grg Sales Outreach amp Development 9 If you selected SEP in the previous step you will now see the SEP Reason Code Field Select the appropriate reason from the drop down menu Note This list may be reduced based on questions answered in previous two pages Plan Premium Per Month Change in Residence eHorizons Plan 2 HMO M 0 00 LIS NonMedicaid Mntning LIS LIS Loss of Status Contract Termination Contract Non Renewal Invol Loss of Creditable Cvg Institutional PDP ADP Loss of EGHP Coverage Dual Eligible Full amp Partial SPAP Enrollee Special Need Chronic 65 800 Series Employer Coordinating PDP 5 Star Cost Dual Eligible Status Loss Be Elgbl for Other Creditable Cov Need assistance with SEP Reason Code some reason codes apply only to MA or PDP for questions with SEP Reason Codes please refer to the Need assistance with SEP Reason Code button on the right hand side to determine the appropriate reason for the product 10 Tap the Continue to Product Questionnaire button to continue the application If you have not completed any required fields on this page you will be prompted to complete them at this time Continue to Product Questionnaire Impor
5. a Wi Fi network make sure Wi Fi is turned on and choose scan to find additional networks Connecting to Wi Fi will allow you to take applications online and in real time Required for Soft Launch 7 To exit any application press the Control button 8 To get to your task manager press the control button twice in succession This will allow you to close out applications by swiping them to the top 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 3 UnitedHealthcare LEAN BEEE sates outreach amp Development samsung Tablet Basics Power button SAMSUNG one Unveils GALAXY Tab3 Series _ 3 an expanded range PONS and the new wilt a olen re Sleek aep a Multimedia TP 19 10 tableti a 1 sear maey COPMDINes b in Home button iittan 1 To power on the Android press and hold the power button 1 2 seconds The screen will light up to indicate it is turning on 2 To power off press and hold the power button about 3 5 seconds until you get menu on the screen choose Turn Off Tap or press on the Cancel option at the bottom to keep it active 3 Once the Android tablet is on swipe your finger across the slide to unlock message at the bottom of the screen 4 Enter your Passcode 5 Once the p
6. check or be billed directly by Medicare of RRB DO NOT pay UnitedHealthcare the Part D IRMAA People with limited incomes may qualify for extra help to pay for their prescription drug costs If eligible Medicare could pay for 75 or more of your drug costs including monthly prescription drug premium annual options check mark is ee Additionally those who qualify will not be subject to the coverage gap or a late enroliment penalty Many people are eligible for these savings and don t needed regardless of petit mt A AA E AAE EEE Security at 1800 722 1213 TTY users shouk call 1 800 325 0778 You whether the plan iS a If you qualify for extra help with your Medicare prescription drug coverage costs Medicare will pay all or part of your plan premium If Medicare pays only a portion of this premium it is recommended you choose the Direct Pay or EFT option zero premium or not ee has Reviewed and Accepts 4 Indicate the consumer s preferred Premium payment option 5 If Electronic Funds Transfer EFT was selected an additional notice and additional fields will appear Premium Payment Option Electronic Funds Transfer EFT Direct pay Monthly Statement SoOA RRB Social Security Administration or Railroad Retirement Boa Account Details Account Type Checking Savings FIRST NAME Middle Name LAST NAME ogi Number Account Number Checking Account Authorization Agreement we hereby authorize UnitedHealthcare hereinafte
7. have not completed any required fields on this page you will be prompted to complete them at this time Continue to Physician Information Gather Primary Care Physician PCP Information lf you have selected a Chronic Dual MA or MAPD plan you will need to select a Primary Care Physician Name and PCP ID Search for Primary Care Physician Tavie aaarcuicela To search for or verify if the PCP is in network for the chosen plan tap PCP Search 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 18 UnitedHealthcare LEAN NN Sales Outreach amp Development PCP Search Discard Continue to Payment Information 1 Anew window will open with the Plan Type Zip Code County and State already identified 2 Search for a specific PCP using the search bar at the top of the screen Find a Physician Medical Group Clinic or Facility Start New Search Help Sse Mame Group Facility Specialty or Condition 90 2015 AARP MedicareComplete SecureHorizons Essential HMO ee All Primary Care Physicians Less than 5 miles from CO 80013 Narrow Your Results Show only those accepting Female i31 Family Practice H Internal Medicine i45 O Print IB Create Directory Sort By Distance 1 2 30f5 gt
8. insurance company Group Number and ID Number 0000000000 0000000000 4 Additional Drug Coverage Indicate Yes or No If the consumer has additional prescription drug coverage in addition to the plan in which they are enrolling enter the applicable information in the fields that appear This will help determine if there is a need for coordination of benefits for drugs 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Page 17 Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group U n ited eag Ith Ca re L FAN TM g a a a Sales Outreach amp Development Note If you selected yes to State Pharmaceutical Assistance Program on the prior page this will automatically default to Yes and must be completed for the State Pharmaceutical Assistance Program coverage Some individuals may have other drug coverage including Yes No other private insurance TRICARE VA benefits State Pharmaceutical Assistance Program or Federal Employee Health Benefits coverage Will you have other prescription drug coverage in addition to the plan This information helps determine if there is a need for coordination of benefits for prescription drugs Name of the Plan Member ID Group ID Effective Date F F me F 5 Tap the Continue to Physician Information button to continue the application If you
9. prompted to complete them at this time 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 20 U n ited H ealth ca re LEAN Bag Sales Cutreach amp Development select Payment Method 1 Review with the consumer the Premium Payment Summary including their monthly premium Select Payment Method 2 Read the Payment seers Disclaimer content tothe mas IND UnitedHealthcare Dual C lete HMO SNP PD Premium 0 00 consumer verbatim eee O oe 3 Tap the box to adda E check mark to confirm th IS was re ad z If you have a monthly plan premium you can pay your monthly plan premium including any late enroliment penalty that you currently have or may owe by mail Electronic Funds Transfer EFT each month or we will provide you an invoice for Direct Payment You can also choose to pay your premium by automatic deduction from your Social Secunty or Railroad Retirement Board RRB benefit check each month 7 If ige are assessed a Part D Income Related Monthly Adjustment Amount IRMAA you will be notified by the Social Security Administration SSA You will NOTE The payment be responsible for paying this extra amount in addition to your plan premium You will either have the amount withheld from your Social Security benefit
10. 5 Fill in all required fields that are marked with an You must enter all required fields to move forward with the application Once all fields are entered move to next screen by clicking Continue to Applicant Information button Continue to Applicant Information Collect Consumer Information Permanent Address Permanent Residence Street Address PO Box is not allowed Address Line 2 City Zip Code County State X 1 Fill in all required fields that are marked with an You must enter all required fields to move forward with the application 2 Enter the Permanent Residence Street Address and the City and Zip Code The State and County will prepopulate based on the information entered If the consumer s mailing address is different from what was entered in the Permanent Address section tap the box to add a check mark 3 Choose the correct County from the drop down menu 4 Enter the Mailing Address City and Zip Code Select the State from the drop down menu 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 10 U n ited eag Ith Ca re L EAN TM g a a a Sales Outreach amp Development Mailing address is different from permanent address Mailing Address Mailing Address Mailing Address 2 City Z
11. UnitedHealthcare LEAN Landmark Electronic Application Navigator User Guide J UnitedHealthcare MEDICARE amp RETIREMENT N Sales Outreach amp Development ron ll E Sales Outreach amp Development UnitedHealthcare LEAN Be Cs ca alison ee eee lee eee eee eer 2 ADDIO gece lal dle 2 O a nr er ee eee ee eee ee ee eee eee eee 3 Samsung Tablet Basics eee ne ene ne ane ne ee mn ese een et meee eee nee ee ee eee ee 4 Creating an Internet Connection from your PNONG ccceseeeeeseeeeeeeeeesaeeeeeaaeess 5 HOWTO ACOOSS LEAN aoirean 5 BN a eee wes ee ee ele eee eee 6 Mobile App ACCESS c cccccceeccceeeeceeeeseeeeeeeeseuceseueeseeceseueeseueesaueesaueeseeeeseeeeseeeeaees 6 LEAR RO E I E Fi LEAN Navigation Bar dncdercient situa tina tineinaianasincicaaiinalenevenetancteunleuaiinsiineieuwinnatinctiaenetes 8 Stan a Ie cetera ce cedar ae edaee pe deen pe deneoepedeiceeaeduneeupedeesauaedueepeceiees 9 Complete the Application aaa secede cvedceebereteeedceedenaisieetieeieceteceeredeectinee 9 Collect Consumer Information ix cciececnsesedncoseinceveroninceseieewnneeencerneneeereeaineeiewinrens 10 Primat Spoken ee 9 o 0 6 2 ean ee arnt ae earn ean an kanina 11 Preferred Materials Format ccccccccsscccssecceececuceceuceceueeceuseceueesueessusessusesauees 12 sales NAM AU sees ccs cts sates rss sce nee ceca weenie esse eee 12 Authorized Representative cccccccsscccsseccsseecseeeceeeeceeece
12. assword is entered you will be directed to the homepage of application icons A second swipe to the left will bring you to the Settings icon 6 Tap the Settings icon to open it To add or connect to a Wi Fi network make sure Wi Fi is turned on and choose scan to find additional networks Connecting to Wi Fi will allow you to take applications online and in real time 7 To exit any application press the Home button 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 4 g a a a Sales Cutreach amp Development UnitedHealthcare LEAN Creating an Internet Connection from your Phone lf you are not in range of a Wi Fi network you can still access the internet with an iPad Android tablet or a computer by setting up a personal hotspot A personal hotspot lets you share the cellular data connection of your smartphone Wi Fi Cellular with your mobile device For specific instructions on how to set up a Hot Spot from your mobile device please reference your phone s user manual How to Access LEAN Mobile Devices f LEAN Download the free LEAN App from the App Store or Google Play gt Laptop or Desktop Computer Access LEAN on a laptop via URL https lean uhc com prweb PRServletCustom LEAN is
13. be prompted to complete them at this time Continue to Plan Selection 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 12 U n ited eag Ith Ca re L EAN g a a I Sales Outreach amp Development Choosing Plan Product 1 Choose Proposed Effective Date from the drop down List Proposed Effective Date Select a 07 01 2015 jSi entin 09 01 2015 spitall 09 01 2015 olled in yo 2 Indicate whether the consumer is a resident in an Institution If yes enter the additional required Institution Information 1 Are you a resident in an institution e g skilled nursing facility tae Yes No rehabilitation hospital Institution Information Name of Institution Address City State State Y Zip Code Telephone Number Admission Date F F T 3 Indicate whether the consumer is enrolled in their state Medicaid program If yes enter the consumer s Medicaid ID Number 2 Are you enrolled in your state Medicaid Program ie Yes No Medicaid ID Number 4 Indicate whether the consumer is a member of a State Pharmaceutical Assistance Program SPAP 3 Are you a member of a State Pharmaceutical Assistance Yes ie No program 8 20 15 Confidential property of UnitedHealth Group For
14. compatible on the following browsers Google Chrome Windows and Mac OX Safari Mac OX Internet Explorer IE11 32 bit and 64 bit 0 Firefox Windows and Mac OX For desktop or laptop Windows 7 8 XP Professional with SP2 or higher 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 5 a a a a Sales Outreach amp Development UnitedHealthcare LEAN Compatible Devices The offline version of LEAN is coming and will be available late September 2015 Until then in order to use LEAN you must provide a compatible device and an internet connection The recommended methods of internet connection are to purchase an additional cellular package for your device use a mobile hot spot or connect to a Wi Fi connection LEAN is geared towards tablets and laptops Recommended devices are windows and Apple laptops iPad and Android Tablets If you have a Windows tablet Surface you will use the URL to log in instead of the LEAN app because the Surface will work as a computer Note Once the offline version becomes available a Microsoft Surface will continue to operate as a laptop require internet access and will not be available in the Offline mode Do not use Android and Apple Smart phones because the user e
15. ealth Group Page 8 UnitedHealthcare LEAN BEHE sates outreach amp Development To begin a new application tap on the New Application bution at the top to open the Enrollment form or from the side Navigation Bar To begin an application using LEAN complete the required fields MEDICARE lt HEALTH INSURANCE SO FIRST NAME MIDDLE NAME LAST NAME First Name Middle Name Last Name MEDICARE CLAIM NUMBER GENDER 000 00 000 A Select IS ENTITLED TO EFFECTIVE DATE HOSPITAL PART A sm Om v HOSPITAL PART B se W Ki e 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 9 U n ited ealth Ca re LEAN grg Sales Outreach amp Development 1 The Consumer s First Middle and Last name Verify the names are exactly as displayed on the ID card 2 Enter the Medicare Claim Number exactly as it appears on the card Capitalization is not required 3 Choose the consumer s gender from the drop down menu as it appears on the Medicare ID card 4 Tap in the Month field to get a drop down of months and in the Year field for a drop down of year to enter the Part A and Part B effective dates The day field will be automatically set to 01 and will not require any additional attention
16. edicaid program m DO rtant N oll ce 5 3 You have the right to appeal plan decisions about payment or services if you disagree We will release your information to Medicare only as necessary for treatment payment and healthcare operations Medicare may also release your information for research and other purposes which follow all applicable Federal statutes and regulations If you leave this plan and the signature and don t have or get other Medic are prescription drug coverage or creditable prescription drug coverage as good as Medicare s you may have to pay a late enrollment penalty in addition to your premium for Medicare prescription drug coverage in the future and date for both 4 If a sales agent helped you choose a plan the sales agent may receive compensation based on you enrolling in the plan To get the lowest cost coverage with your new plan you shouk use in network Providers pharmacies and services except in the case of an emergency To make yourself familiar with the services terms and conditions of the plan please the consumer and read the Evidence of Coverage document when you receive it or you can view it online Services covered by the plan are listed in the Evidence of Coverage document Services not listed in the Evidence of Coverage will not be paid for by Medicare or the plan without authorization This plan provides refunds for all medically necessary covered benefits even if out agent of network 5 The information on t
17. ermission of UnitedHealth Group Page 22 a a a a Sales Outreach amp Development UnitedHealthcare LEAN Statement of Understanding SOU The required fields on the final page of the application Statement of U de sta d g 1 This is a Medicare Advantage plan that has a contract with the Federal Government This is not a Medicare Supplement plan You ll need to keep your Medicare Parts A and B You are the check can only be in one Medicare Advantage or Prescription Drug Plan at a time Enrollment in this plan will automatically end your enrollment in another Medicare Advantage or Prescription Drug Plan If you have prescription drug coverage or receive any in the future from somewhere other than this plan it is your responsibility to let us know Statement of Understanding By completing this enroliment applic ation agree to the following boxes for both the 2 Enroliment in this plan is generally for the entire year You can only leave or change this plan during Medicare s open enrollment period of October 15th December 7th or under special circumstances This plan only covers the area that you live in If you re planning to move out of the area please call us and we ll help you find a plan in your new area Medicare SOU the doesn t usually cover you while out of the country with the exception of limited coverage near the U S border To be enrolled in a Dual Special Needs Plan you must be eligible for your 5 state s M
18. his enrollment is correct to the best of your knowledge If you currently have health coverage from an employer or union you coukd lose your employer or union health coverage if you join this plan If you have questions contact your benefits administrator or the office who answers questions about your employer or union coverage 1 Have the consumer verify data captured in The Recap section 2 Have the Consumer Authorized Rep sign in the grey box using their finger or stylus or mouse to sign LA Dv Applicants Name Medicare Signature Date John Doe 123456709A 0603 2015 3 The signature date fields will prepopulate with the current date The date field cannot be edited HINT Tap the field first and then enter your signature 4 Sign as the agent in the Signature fields under Agent Signature Agent Signature Agent Name Writing ID Signature Date LARRY DRENNAN 990001 06 03 2015 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 23 U n ited H Ca Ith Ca re L EAN g a a a Sales Cutreach amp Development 5 Use the clear button to erase and try again as needed Use of this button is unlimited Capture Signature x noc Send Enrollment Receipt lf the consumer previously provided an email address LEAN will disp
19. ip State State v Contact Information Primary Phone Alternate Phone Email Address Other Information 5 Enter a Primary Telephone Number if available The system will apply the dashes so you only need to type in the 10 digit number 6 Enter an Alternate Telephone if applicable The system will apply the dashes so you only need to type in the 10 digit number 7 Enter the Email Address if available 8 Enter the Birthdate by using the down arrow or tapping somewhere in each field for Month Day and Year to use the drop down menu Primary Spoken Language The Primary Spoken Language field defaults to English If the consumer s primary spoken language is not English select the primary language from the drop down list Choose the consumer s Primary Spoken Language If the consumer chooses a language other than English indicate if a translator is present at the prompt Primary spoken Language ENGLISH T Preferred Material Format Sales Initiative English Not Applicable 7 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 11 U n ited ea Ith Ca re L EAN TM g a a g Sales Outreach amp Development Preferred Materials Format Choose consumer s Preferred Materials Format Note UnitedHealthcare is currently
20. lay it in the email address field If an email address was not previously provided you can enter an email address at this time send Applicant an Enrollment Receipt Email Address submit and Begin Shared Residence Application To submit the current application and begin a shared residence application click in the box below Example If you are enrolling both a husband and wife who reside at the same residence click on the Submit and Begin Shared Residence Application box to carry over the address information from the first application into the new application Then access the new application on the My Applications tab in the Navigation Bar Submit and Begin Shared Residence Applicatior v To complete the current application tap on the Submit Application button to activate the submission of the application Submit Application 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 24 U n ited eag Ith Ca re L EAN TM g g a a Sales Outreach amp Development A Confirmation Number will display upon successful application submission To view the enrollment receipt tap on the Display Receipt button Submission Confirmation The application has been submitted Confirmation E 10409060315 Receipt emailed to
21. ng Application Search Criteria Tap on Application Search Criteria tab to access the search window My Applications Incomplete Submitted Cons FIRST NAME LAST NAME Signed Date Status Date Submitted K E 29265061015 Harrison Ford 6102015 Submitted 102015 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Page 26 Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group UnitedHealthcare LEAN My Applications AD plication Search Criteria Search All Applications lt End of User Guide gt a a a a Sales Outreach amp Development The length of time applications are visible and maintained on the Agent Dashboard depends on the status of the application e Incomplete applications are deleted 24 hours after application is saved e Submitted Applications remain available to view for up to 2 years 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 27
22. ng code is valid 9 Enter the Account for the bank account 10 Read the Checking Account Authorization Agreement verbatim to the consumer 11 Tap the box to add a check mark to confirm this was read 12 If SSA RRB Social Security Administration or Railroad Retirement Board was selected an additional notice will appear 13 Read the Payment Disclaimer word for word to the consumer 14 Tap the box to add a check mark to confirm this was read Premium Payment Option Electronic Funds Transfer EFT Payment Disclaimer Direct pay Monthly Statement e SSAVRRB Social Security Administration or Railroad Retirement Boa You can have the monthly premium for this Medicare plan automatically deducted from your Social Security payment If you don t choose this option the plan will send you a bill each month If you have chosen to have your monthly premium for this plan withheld from your Social Security payment remember that your benefit check will reflect this deduction Applicant has Reviewed and Accepts Tap the Continue to SOU Signature button to continue the application If you have not completed any required fields on this page you will be prompted to complete them at this time Continue to SOU Signature 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express p
23. only able to provide materials in English and Spanish If the consumer needs materials in a language other than English or Spanish direct them to contact customer service to request those materials Primary Spoken Language ENGLISH M Preferred Material Format Other MJ We are able to provide many of the post enrollment materials in alternate formats such as Large Print and Braille and in languages other than English and Spanish However this cannot be done until after the application has processed and the member is enrolled The member can contact us directly or you as the agent can assist in making this request by calling UHC Customer Service with the consumer on the line Sales Initiative Not Applicable 7v Sales Initiative Choose the Sales Initiative Authorized Representative lf an Authorized Representative is enrolling the consumer mark the check box and fill in the additional fields that appear Authorized Representative j Is there an Authorized Representative enrolling this beneficiary Relationship to Applicant Select F FIRST NAME Middle Name LAST NAME Primary Address Address Line 2 City Zip Code State State v Primary Phone Alternate Phone Email Address The information button shows you a description of an authorized representative Tap the Continue to Plan Selection button to continue the application If you have not completed all the required fields on this screen you will
24. r called company to initiate debit entries to my our checking account below and the depository named below hereinafter called depository to debit the same to such account The monthly health plan premium s will be deducted once a month from my our personal account we will be notified of my our initial deduction at least 10 days prior to the transaction date All subsequent health plan premium payment deductions will be reflected on the statement from my our financial institution My our bank account must have the full dollar amount due in the available funds on the agreed upon payment date in order for ithe preauthorized payment to be made If there are insufficient or uncollected funds in my our account my our back will return the preauthorized payment and may charge me us as if we had a check returned for the same reason Applicant has Reviewed and Accepts 6 Indicate Account Type Checking or Savings 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 21 U n ited Health ca re LEAN BEEE sates outreach amp Development 7 Enter the account holder s First Middle and Last Name 8 Enter a nine 9 digit numerical Routing and Transit number This value must be a valid routing code LEAN will verify the routi
25. rch the Benefit Review tool e Enrollment Handbook Open the Enrollment Handbook e Election Period Worksheet Assistance in choosing the correct Election Period 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 7 UnitedHealthcare LEAN BEEE sates outreach amp Development The LEAN Navigation Bar on the left hand side of the screen will help guide you through the tool Click the menu button to see the Navigation Bar e Home Brings you back to the Enrollment Tools page e New Application Starts a new application e Profile Allows you to see your current Agent Profile including Name Writing ID Email and Licensed States Always reference the Distribution Portal for the most up to date information e All Applications Allows you to view incomplete and submitted applications Only applications taken in LEAN are available to view Incomplete applications are only available for up to 24 hours after application was saved e Alerts Allows you to receive system notifications while out in the field 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedH
26. tant Questions Important Questions will appear based on the plan chosen earlier in the application 1 Do you have End Stage Renal Disease ESRD Indicate Yes or No 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 16 UnitedHealthcare LEAN BEIE sates outreach amp Development lf the consumer indicates Yes UnitedHealthcare will need to contact the consumer for additional information No additional information is required at this time Note to Member Because you answered Yes UHC will contact you for additional required information If you do not need regular dialysis anymore and or have had a successful kidney transplant please send a note or records from your physician to the address or Fax number below showing you do not need dialysis or have had a successful kidney transplant Fax 704 719 2703 Address IND AARP MedicareComplete SecureHorizons Plan 2 HMO MAPD PO Box 29650 Hot Springs AR 71903 0650 2 Do you or your spouse work Indicate Yes or No No additional information is required regardless of how the consumer answers the question 3 Additional Health Insurance Indicate Yes or No If the consumer has additional health insurance other than Medicare enter in the additional required fields including
27. usecsueeeeeeeeseeesseeesseeeesees 12 gies a1 8 Rl Pa POO innn ETEN 13 G6 gh 9 9 isa e an Elechon Peri asssissrasa emt ete atte Mi sen een eee TE NETE 15 Important QUESTIONS ccccccceeccccceeeceeceeeceecaeeceesaeeeeesseeecesseeeeesseeeeeesseeeeessaeeeeeaes 16 Gather Primary Care Physician PCP Information cccccsseeeeeeeeeteeeeeeeeeees 18 Search for Primary Care Physician sacs tece cece crcesacescecaneessecedesadiacadtnadecewexedecedeedenedsess 18 AEE LIe g Er E AE E E EREE TENE A EE E EE E EEE 18 Select Payment Method wiecicccvecedscevecedecctcrcdecctcrcdevetereterctencieretcecdeccteccicccrercieccteccis 21 Statement of Understanding SOU nannnannnnnnnnnnnnnnnnnnnnnsnnnnnnonrrsnrrnnrrnnnrnnrsnee gt 23 Send Enrollment Receipt es ceceesnedeseusustsussanedanennnsiissnaneiswsbonrdaveboundueeseweiacsbamedanseeets 24 Submit and Begin Shared Residence Application cccccsecccseceeeeeeteeeeeeeeeeas 24 Managing Totoro etic nai omecereneiennincnaiaenaxetouetoneeumianetoustonanenenenien 25 Viewing Pe Oe eecrnearnrecs tees rerstarseera kendra ctneriiersaeererniarierskercreenteraertberarvereedeereen 25 Search NN acceler eeepc NEEE 26 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group P age 1 g a a a Sales Cutreach amp De
28. velopment UnitedHealthcare LEAN User Guide Purpose The purpose of this user guide is to provide support and guidance in the use of the UnitedHealthcare LEAN Landmark Electronic Application Navigator LEAN is the newest next generation Medicare Advantage and Prescription Drug Plan enrollment tool 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 2 a a a a Sales Outreach amp Development UnitedHealthcare LEAN Apple iPad Basics Power button 1 To power on the iPad press and hold the power button 1 2 seconds The Apple symbol will appear on the screen to indicate it is turning on 2 To power off press and hold the power button about 3 5 seconds until you get a slide bar near the top of the screen Slide the dot to the right to complete the power off process or tap press on the Cancel option at the bottom to keep it active 3 Once the iPad is on swipe your finger across the slide to unlock message at the bottom of the screen Control 4 Enter your iPad Passcode 5 Swipe from right to left to get to the homepage of application icons A second swipe to the left will bring you to the utilities group 6 Tap the Utilities icon to open it To add or connect to
29. xperience for agent and consumer is less than ideal when used as a mobile device eReaders such as a Kindle or Nook are not supported therefore LEAN will not work using those devices Mobile App Access e Tap the LEAN icon LEAN e Tap inthe Username field to access the keyboard Enter your user name Writing ID and password that you use to access United Distribution Portal UDP NOTE Capitalize all letters in your user name 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 6 U n ited Health ca re LEAN BEEE sates outreach amp Development LEAN Homepage f UnitedHealthcare New Application Enrollment Tools O O 0 Q Provider UHC Drug Medicare Benefit Search Search Drug Search Review O Checklist Enrollment Election Handbook Period Worksheet Once you have logged in the application will open to the LEAN Homepage Click on the Enrollment Tools and Checklist for tips and links to the following helpful guides and tools e Provider Search Search for Providers e UHC Drug Search Look up Prescription Drug Coverage from the Agent Portal e Medicare Drug Search Search the Medicare Drug Search website e Agent Portal Go to the Agent Portal website e Benefit Review Sea
30. y 8 20 15 Confidential property of UnitedHealth Group For Agent use only Not intended for use as marketing materials for the general public Do not distribute reproduce edit or delete any portion without express permission of UnitedHealth Group Page 14 U n ited H ealth ca re LEAN Bag Sales Cutreach amp Development lf the consumer chooses to add applicable Fitness Rider to their Plan the monthly Fitness Premium will appear Choosing an Election Period 8 Choose the election period e When you choose an election period the options are narrowed down based on the consumer s product selection and eligibility which is determined by the answers to the Effective Date Institution and Medicaid questions e lf you have questions around the displayed Election Period tap on Election Period Worksheet or Terms and Conditions located at the bottom of the screen e The Help button located on the bottom right of every screen will take you to the Reference Guide while you remain in the application e You can make changes to the previous two screens of the application This may or may not alter the Election Period options e lf you still have questions with the options displayed for Election Period please contact PHD 1 888 381 8581 Election Period SEP SEP Reason Code Cost Election Period Select v SEP Election Period Worksheet 8 20 15 Confidential property of UnitedHealth Group
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