The Health Insurance Marketplace Contact Center

1. The Health Insurance Marketplace Contact Center Overview June 2, 2013

2. 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

3. 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. • 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

4. Contact Center Inquiries • 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

5. 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

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

7. Marketplace Scripting(Summer)

8. Example of Scripting

9. 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

10. 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.

11. Example of Referral Scripting

12. 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

13. Reporting Dashboards

14. Call Center Metrics

15. Questions?