2015 Medicare Advantage Group Awareness Training CBIA Brokers. October 2014

Transcription

1 2015 Medicare Advantage Group Awareness Training i CBIA Brokers October 2014

2 Presenters David Pallotta Medicare Group Specialist 2

3 Agenda CBIA Medicare Advantage Group Plan Enrollment Member Services Important Reminders Q & A 3

4 CBIA Medicare Advantage Group Plan

5 CBIA Plan Highlights Comprehensive lower cost alternative for a monthly premium of $ Available to all CBIA Employer Groups Medicare-eligible Retirees (residing anywhere in the US) Medicare-eligible Employees Actively Working / Working Aged (For groups <20 employees) Medicare Advantage Point-of-Service plan Benefits are the same for In and Out of Network Maximum Out-of-Pocket: $3,400. Financial protection for members Worldwide Emergency / Urgent Care = up to $50,000 annually 3% Commissions i Effective January 1, 2015 Highly Rated Medicare Advantage plan in CT for Health Plan Quality 4 out of f5star STARs by CMS 5

6 CBIA Plan Highlights Open Part D formulary A Preferred/ Standard pharmacy network will be utilized again for 2015 Different formulary from ConnectiCare Commercial and Individual Medicare products National provider network: Express Scripts, Inc. Open Access: No referrals required to access providers Prior Authorization is required on some services Comprehensive Annual Physical (not covered by Original Medicare or Supplement plans) SilverSneakers Fitness Program included Vision discount program that offers discounts of 25% to 30% on frames, lenses, prescription contact lenses, and sunglasses when using participating optical providers ConnectiCare Touchpoints access to health & wellness resources and services Case Management COPD, Diabetes, Heart Disease, and Cancer Treatment Decision Support Important Health Reminders immunization and medication reminders 6

7 CBIA - Medical Benefit Monthly Premium Maximum Out-of-Pocket Annual Physical Exam PCP Office Visit Specialist Office Visit Routine Hearing and Vision Exams Lab and X-Ray Services Diagnostic Radiology Therapeutic Radiology Ambulance Outpatient Surgery: Ambulatory Surgical Center Hospital Inpatient Hospital In-Network & Out-of-Network $ $3,400 $0 $15 $30 $30 $0 $0 $0 $0 $200 $300 Days 1-7: $250 / day Additional Days: $0 7

8 CBIA Prescription Drug Benefit 30-Day Supply 90-Day Supply Supply Retail and Mail Order (*) Preferred (*) /Standard Retail Pref / Std Mail Order Preferred Only Tier 1: Preferred Generic $5 / $10 $15 / $30 $10 Tier 2: Non-Preferred Generic $5 / $10 $15 / $30 $10 Tier 3: Preferred Brand $35 / $40 $105 / $120 $88 Tier 4: Non-Preferred Brand $75 / $80 $225 / $240 $188 Tier 5: Specialty $75 / $80 $225 / $240 $188 Catastrophic Drug Coverage After member cost exceeds $4,700 The greater of: $2.65 or 5% for generic drugs $6.60 or 5% for all other drugs 8

9 Network More than 27,000 fully-credentialed health care providers All Hospitals in Connecticut (except CT Children s Medical Center) Different network from ConnectiCare Commercial The POS plan offers the flexibility to seek services from any Medicare-approved provider in the United States and its territories Participating In-Network Providers outside CT Westerly Hospital, RI New York providers Massachusetts providers National Pharmacy network Preferred Pharmacy network includes: Right Aid, Wal-Mart, Target, Costco, Stop and Shop, as well as many others Provider Directory available online at 9

10 Enrollment

11 Pre-Enrollment Materials Prior to enrollment, brokers should provide the following: Pre-enrollment Letter Enrollment form Benefit Summary Access to: Formulary Provider Directory All materials available on CBIA website (cbia.com/medicare) 11

12 Enrollment Process Eligible applicants must complete the Enrollment form Applicant submits directly to Broker (or employer) Broker (or employer) submits to CBIA Must be signed by applicant no later than December 31, 2014 for a January 1, 2015 effective date CBIA enters the enrollment into their system CBIA sends an electronic enrollment file to ConnectiCare ConnectiCare submits enrollment to CMS for approval 12

13 Post Enrollment Materials Newly enrolled beneficiaries will receive the following new member materials: ID card Evidence of Coverage Benefit Summary Provider Directory (if they do not opt out) Formulary 13

14 Communications after Enrollment Acknowledgement of Receipt of Enrollment Application (Intent Letter) Notice to Confirm Enrollment (CMS approval) Member ID card - Medical and Rx on same card Welcome Kit separate mailing from ID card Health Risk Assessment Call Connextions In-Home Health hassessment Inspiris Member Outreach Program Call Optum Premium Payment Assistance Call to determine qualification for Extra Help Altegra 14

15 Member Services

16 Member Services Member Service Representatives will be available seven days per week 800 8:00 am to 8:00 800pm EST ConnectiCare VIP Medicare (1-800-CCI-CARE) TTY/TTD users may dial

17 Important Reminders

18 Why ConnectiCare VIP Medicare? Per member per month premium: $ Broker commissions: 3% of premium Highly ranked Medicare Advantage plan in CT 4 out of 5 STARs for Health Plan Quality in 2015 Excellent comprehensive medical and prescription p coverage Flexibility to seek services from Medicare-approved providers in the United States or its territories Worldwide coverage for emergency and urgent care Financial protection with low $3,400 MOOP SilverSneakers Fitness Program Vision Discounts of 25-30% on frames and lenses Quality Disease & Care Management Programs through Touchpoints 18

19 CBIA Website (cbia.com/medicare) Enrollment Form Benefit Summary Link to ConnectiCare website: Online Provider search Provider Directory PDF Formulary PDF Claim reimbursement forms: Medical Pharmacy Next Steps Contact your CBIA Sales Representative for any additional information 19

20 Q & A 20