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Surveys
2014
December
H
HRINJ
HRINJ
Health Republic of NJ Call-In Questionnaire_December
0%
Questions marked with an
*
are required
Exit Survey
*
Staff
*
Caller Name
Hi _____. How can I help you?
*
Nature of the Call
Repeat Caller
General Question
Billing & Enrollment Concerns : 855-465-5270
Medical Claims/Coverage Questions : 732-529-8700
Provider Participation/Rx Coverage Inquiry
SALES Individual
SALES Small Business
RENEWAL Individual
RENEWAL Small Group
How did you hear about Health Republic Insurance of New Jersey?
*
How did you hear about us?
TV, Radio, Newspaper or on-line digital advertisement.
HRINJ website
Healthcare.gov website
An outside event or meeting
Word of Mouth/Referral
Not Applicable (for repeat callers)
QUALIFYING QUESTIONS
Okay, I can help you with that.I just need to gather some information...
*
Application Name
*
Phone Number
*
Email
Before I proceed ________, have you or any of your family members that you're going to cover experience any life changing event that could qualify you for the Special Enrollment Period?
*
Qualifying Life Events
-- Select --
Loss of coverage
Marriage
Having a baby or adopted a child
Moved
Gained citizenship or lawful presence in the U.S.
Released from incarceration
Death of a covered loved one
None
Was this within 60 days from today (30 days for emplyer-based coverage)?
*
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