Eligibility Verification: HIPAA Authorization (Agent How‑To)

Overview

Eligibility Verification is completed after the HIPAA Authorization step in the application. The eligibility verification system supports the Standard Issue (SI) product by assessing risk based on prescription history, alongside the existing health questions.

When This Applies

- Domestic underwriting workflow for the Standard Issue (SI) product.

- HIPAA Authorization step is required before eligibility verification runs.

What Happens After HIPAA Authorization

Once the agent completes the HIPAA Authorization process and selects **Next Step(s)**, the system will run Standard Issue (SI) eligibility verification.

Possible outcomes:

- If the applicant qualifies for SI, the agent can proceed with the application as usual.

- If the applicant does not qualify for SI, the agent will be notified that the Guaranteed Issue (GI) product is available.

- The agent will then have the option to requote for the GI plan and continue the application flow.

Key Notes (Read Before Starting)

- Completing the existing health questions remains required.
- Steps 1, 2, 6, and 7 may not allow updates once the HIPAA authorization and eligibility verification are completed.
- For the Voice option: the pre‑recorded HIPAA recording code does **not** replace the required voice recording ID used for the applicant’s signature at the end of the application.
- Eligibility verification begins after **Next Step(s)** is selected following HIPAA Authorization.

Where HIPAA Authorization Appears in the Application

HIPAA Authorization is an authentication step within the application workflow. For phone applications, the agent will have to confirm Authorization/Consent in Step 1, then complete the HIPAA Authentication step later in the application flow (HIPAA Authentication step is shown as Step 7 in the workflow list).

Choose a HIPAA Authorization Method

The agent can obtain the applicant’s HIPAA Authorization using one of the following methods:
- Signed Consent via Text
- Signed Consent via Email
- Signed Consent via Voice

Method A: Signed Consent via Text

Agent Actions

1. The agent will have to select **Signed Consent via Text**.
2. The phone number will prepopulate based on the number entered in the application.
   - The agent can update the phone number for the text invite if needed.
   - Updating the phone number here does **not** change the phone number stored in the application.
3. The agent must read the HIPAA disclaimer prior to sending the text invite.
4. The agent will have to select **Initiate Session** to send the text invite.

Applicant Actions (What the Client Will Have To Do)

1. The applicant will have to open the text message and select the secure link.
2. The applicant will have to select **Continue** and verify identity by entering the last 4 digits of their Social Security number.
   - If the applicant enters the information incorrectly up to 5 times, the session will time out for 5 minutes before the applicant can try again.
3. The applicant will have to confirm their name in the document, then select **Next**.
4. The HIPAA Privacy Authorization document will appear. The applicant can zoom in to read it, then select **Next**.
5. The applicant will have to sign the document (select signature, sign, then select **Save and Sign**).
6. The applicant may download the completed document for their records.

Optional Agent Tools (Text or Email)

- **Check Status:** refresh to get updated signing status.
- **Resend Invitation:** resend the text/email invite.
- **Enter the Signing Session:** follow along with the applicant during the signing process.

Finish

After the portal shows the HIPAA document is complete, the agent will have to select **Next Step(s)** to proceed. Selecting Next Step(s) triggers eligibility verification.

Method B: Signed Consent via Email

Agent Actions

1. The agent will have to select **Signed Consent via Email**.
2. The email address will prepopulate based on the email entered in the application.
   - The agent can update the email address for the invite if needed.
   - Updating the email address here does **not** change the email stored in the application.
3. The agent must read the HIPAA disclaimer prior to sending the email invite.
4. The agent will have to select **Initiate Session** to send the email invite.

Applicant Actions (What the Client Will Have To Do)

1. The applicant will have to open the email and select the secure link.
2. The applicant will have to verify identity by entering the last 4 digits of their Social Security number.
   - If the applicant enters the information incorrectly up to 5 times, the session will time out for 5 minutes before trying again.
3. The applicant will have to confirm their name, review the HIPAA Privacy Authorization document, and sign.
4. The applicant may download the completed document for their records.

Finish

After the portal shows the HIPAA document is complete, the agent will have to select **Next Step(s)** to proceed. Selecting Next Step(s) triggers eligibility verification.

Method C: Signed Consent via Voice (Pre‑Recorded HIPAA Recording)

Agent Actions

1. The agent will have to select **Signed Consent via Voice**.
2. The agent will have to conference the provided HIPAA recording number (English or Spanish).
3. At the beginning of the recording, the system will provide a **3‑digit code**.
   - The agent will have to write down the 3‑digit code.
4. The agent will have to allow the full HIPAA recording to play for compliance.
5. At the end of the recording, the agent will have to obtain verbal authorization.
6. The agent will have to end/disconnect the HIPAA conference portion of the call.
7. The agent will have to enter the 3‑digit code into the application and then select **Next Step(s)**.
   - **Important:** The agent must disconnect the conference call before selecting Next Step(s).

Suggested Verbal Authorization Script

Agent will have to say something like:
- “To complete the application, verbal consent is needed to obtain medical information. A recorded HIPAA authorization will now play.”
- After the recording: “Do I have your verbal consent to obtain your medical information?”
- If the client agrees: “Please state your full name and full address.”

Pop‑Up Error / Validation Failures

A code validation error may occur if:
- The code is entered incorrectly.
- Next Step(s) is selected before the conference call is disconnected.
- The agent exceeds 5 attempts entering a valid code.

If validation fails after 5 attempts, the system will revert the application to the GI product.

Troubleshooting & Common Questions

**The applicant is not receiving the text/email invite**

- The agent will have to confirm the phone/email used for the invite.
- The agent can use **Resend Invitation**.
- If still not received, switch to an alternate method (Email/Text/Voice) if appropriate.

**The applicant is stuck on identity verification**

- The applicant will have to enter the last 4 digits of their SSN.
- After 5 incorrect attempts, the session will time out for 5 minutes before trying again.
- The agent can use **Check Status** to refresh and confirm the current state.

**The portal still shows ‘in progress’**

- The agent can use **Check Status** to refresh.
- The agent can enter the signing session to follow along with the applicant.
- If the applicant completed signing, confirm the portal shows completion before selecting **Next Step(s)**.

**When does eligibility verification run?**

Eligibility verification starts after HIPAA Authorization is complete and the agent selects **Next Step(s)**.

- **Q:** What triggers eligibility verification?
  **A:** Eligibility verification begins after HIPAA Authorization is completed and the agent selects **Next Step(s)**.

- **Q:** What does the applicant need for Text/Email HIPAA verification?
  **A:** The applicant will have to enter the last 4 digits of their SSN when prompted.

- **Q:** What happens after 5 incorrect SSN attempts?
  **A:** The session times out for 5 minutes before the applicant can try again.

- **Q:** What can cause a Voice code validation error?
  **A:** Entering the code incorrectly, selecting Next Step(s) before disconnecting the conference call, or exceeding 5 attempts.

- **Q:** What happens if SI eligibility verification fails?
  **A:** The system notifies the agent that GI is available; the agent can requote the GI plan and continue the application.