CARE Script

This script is intended to be used when a representative or someone with power of attorney
(POA) is enrolling on behalf of the beneficiary. This script will be used by Licensed Agents who
will be facilitating the enrollment process.

Instructions are in italic. Verbiage spoken to the representative/POA is in regular text.

Introduction

Before we begin the enrollment process, I want to confirm that <you/you as the authorized
representative for the beneficiary> understand that you will be submitting an application for
enrollment into <Plan Name>. At the end of this process, we will submit <your/his/her>
enrollment request to the Centers for Medicare & Medicaid Services, known as CMS, for
enrollment into the plan. CMS is the federal agency that runs the Medicare program.

Typically, <you/he/she> may enroll in a <Medicare Advantage plan/ Prescription Drug Plan> only
during the annual enrollment period from <October 15 through December 7 each year>. There
are exceptions that may allow you to enroll in a Medicare Advantage plan outside of this period. I
would like to ask a few questions to confirm enrollment eligibility. By selecting any of these
options, you certify that, to the best of your knowledge, <you/he/she> <are/is> eligible for an
enrollment period.

About the Plan

The <Plan Name> is a <Medicare Advantage plan/ Prescription Drug Plan> and has a contract
with the Federal government. <You/he/she> will need to keep <your/his/her> Medicare Parts A
and B, and continue to pay your Part B premium. <You/He/She> can only be in one Medicare
Advantage plan at a time. <You/You as the authorized representative for the beneficiary>
<understand/understands> that <your/his/her> enrollment in this plan will automatically end
<your/his/her> enrollment in another Medicare Advantage plan or prescription drug plan.

By joining this Medicare health plan, <you/you as the authorized representative for the
beneficiary> acknowledge that < Plan Name> will release <your/his/her> information to
Medicare and other plans as is necessary for treatment, payment and health care operations. You
also acknowledge that < Plan Name> will release <your/his/her> information {MA-PD/ PDP plans
insert:} [including prescription drug event data], to Medicare, who may release it for research and
other purposes which follow all applicable Federal statutes and regulations. The information
collected on this telephonic enrollment transaction is correct to the best of your knowledge. You
understand that if you intentionally provide false information on this call, <you/he/she> will be
disenrolled from the plan

Disclaimer

<Brand> Medicare is a [HMO, PPO, PDP] plan with a Medicare contract. [Our SNPs also have
contracts with State Medicaid programs.] Enrollment in our plans depends on contract renewal.
Plan features and availability may vary by service area.

For MA-only Plans

{For MA-only Plans} <You/He/She> <understand/understands> that if <you/he/she>

<don’t/doesn’t> have Medicare prescription drug coverage, or creditable prescription drug
coverage (as good as Medicare’s), <you/he/she> may have to pay a late enrollment penalty if
<you/he/she> <enroll/enrolls> in Medicare prescription drug coverage in the future.

For HMO Plans

{For HMO Plans} You understand that on the date <Plan Name> coverage begins, <you/he/she>
must get all of <your/his/her> health care from <Plan Name> network providers, except for
emergency or urgently-needed services or out-of-area dialysis services.

For PPO Plans

{For PPO Plans} You understand that beginning on the date <Plan name> coverage begins, using
services in network can cost less than using services out of network except for emergency or
urgently needed services or out-of-area dialysis services. If medically necessary, the <Plan
Name> provides refunds for all covered benefits, even if <you/he/she> <get/gets> services out
of network.

For D-SNP plans

{For D-SNP plans} This plan is a dual eligible special needs plan (D-SNP). Your ability to enroll will
be based on verification that you are entitled to both Medicare and medical assistance from a
state plan under Medicaid.
For PDP plans

{For PDP plans} <You/He/She> <understand/understands> that if <you/he/she>

<don’t/doesn’t> have Medicare prescription drug coverage, or creditable prescription drug
coverage (as good as Medicare’s), <you/he/she> may have to pay a late enrollment penalty if
<you/he/she> <enroll/enrolls> in Medicare prescription drug coverage in the future.

Closing

Out-of-network/non-contracted providers are under not obligation to treat <Plan> members,

except in emergency situations. Please call our customer service number or see your Evidence of
Coverage for more information, including the cost-sharing that applies to out-of-network
services.

Services authorized by the <Plan Name> and other services contained in <your/his/her> <Plan
Name> Evidence of Coverage document (also known as a member contract or subscriber
agreement) will be covered. Without authorization, neither Medicare nor the <Plan Name> will
pay for the services.

You understand that your verbal attestation on this application means that you have heard and
understand the contents of this application. It also confirms your intent to enroll in the <Plan
Name>.

I am acting on behalf of <Plan Name> and may be compensated based on <your/her/his>

enrollment in a plan.

In addition, you understand and agree to this conversation being re corded.