2015 Optimum Healthcare Sales Presentation Video Transcript-

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1 2015 Optimum Healthcare Sales Presentation Video Transcript- H5594_15SalesPresVidv2_CMS_Approved Welcome to this presentation on Optimum HealthCare s Medicare Advantage Plans. Today you will learn about the many benefits and savings available to Optimum members. If you have questions, one of our skilled Benefit Consultants will be available at the end of this presentation. And if you are ready to take advantage of the tremendous value of an Optimum HealthCare plan you will have the opportunity to sign up today. Thank you for joining us to learn about Optimum HealthCare s Medicare Advantage H-M-O Point of Service H-M-O Special Needs and H-M-O Point of Service Special Needs Plans. This is a great opportunity to review your current coverage and compare Medicare Advantage plans to Original Medicare. As you ll soon learn Optimum HealthCare Medicare Advantage Plans have many benefit options to choose from so you can find a plan that fits you and your lifestyle. Please hold any questions you may have for the end of this presentation when one of our Benefit Consultants will be happy to meet with you. Let s start by explaining Medicare. Most of you already know it s federal health insurance for people 65 and older younger people with certain disabilities and people with End Stage Renal Disease with limited exceptions. Medicare has several parts. A B C and D. Part A is hospital insurance and helps cover the care of patients in hospitals skilled nursing facilities hospice or even home health care. Part B is medical insurance and helps cover doctor s visits outpatient care and some preventive services. Part C is also called Medicare Advantage which is a health coverage option that is run by a private insurance company so it may offer extra benefits. Medicare Advantage Plans are approved and under contract with Medicare. They include Parts A B and usually prescription drug coverage which is also known as Part D. Like Medicare Advantage Part D is run by private companies approved by and under contract with Medicare to help cover the cost of prescription drugs. To be eligible for Medicare Advantage you must have both Medicare Parts A and B and you must be a permanent resident in the area where the plan is offered. People with End Stage Renal Disease are not eligible for Medicare Advantage with limited exceptions. So why should you choose a Medicare Advantage Plan from Optimum HealthCare? Optimum is owned and operated by doctors who focus on preventive care they don t just see patients who are sick or have a health concern. Optimum HealthCare is headquartered in Tampa Florida and has convenient concierge centers all around the state. Optimum HealthCare is accredited by The National Committee for Quality Assurance or N-C-Q-A which gave Optimum a Commendable rating and awarded a three year accreditation. Finally Optimum HealthCare is an H-M-O Plan with a Medicare contract and a

2 contract with the Florida Medicaid program. Enrollment in Optimum HealthCare depends on contract renewal. Members love Optimum HealthCare! Here s what just some of them have to say (Member Testimony) I looked it up in the dictionary and Optimum is a good name for the company. It s the best. You can save money, that s the most important thing I m looking for. So I found it in there, in the company. There is an Optimum HealthCare Plan to fit almost every need and lifestyle. There are Medicare Advantage H-M-O Plans with prescription drug coverage and a Point of Service Benefit. Optimum HealthCare also offers two types of Special Needs Plans or S-N-Ps. There are Full and Partial Dual Eligible Special Needs Plans with drug coverage that are available to anyone who has both medical assistance from the State and Medicare. Optimum also offers Chronic Condition Special Needs Plans with drug coverage and a Point of Service benefit for people who have been diagnosed with chronic or disabling conditions including Cardiovascular Disorders Chronic Heart Failure Diabetes Mellitus or Chronic Lung Disorders. Premiums co-pays co-insurance and deductibles may vary based on the level of Extra Help you receive. If you qualify to join a Medicare S-N-P you get all of your hospital and medical health care services through that Plan including Medicare prescription drug coverage. To join an Optimum HealthCare C-S-N-P the Plan will need to obtain verification of the chronic condition from your doctor within 30 days of enrollment. If you lose eligibility or there are changes to your eligibility or qualifying condition you will be disenrolled from your Special Needs Plan but you will be eligible for a Special Election Period so you can enroll in another plan. You can contact the Plan to confirm your eligibility or get any questions answered. Optimum HealthCare offers benefits and savings you can use every day and that means more value to members. For instance Optimum s O-T-C Allowance covers over the counter health related items and supplies that most people buy regularly. You just call them and you give them your information and your number of your policy and somebody always answers the phone. You never go into voic . You tell them what you want, you have a little brochure, you just go down the brochure and say I want this, this and this and it comes right to your door free. With the O-T-C Allowance Optimum members can receive between $29 and $46 dollars each month based on Plan Selection Over the course of a year that could mean between $348 and $552 dollars in savings! Plus members can place their order on-line or over the phone and have their supplies delivered direct to their home at no additional cost!

3 Speaking of no cost Optimum members can also enjoy a Silver Sneakers Fitness membership for zero dollars. There are many locations to choose from that offer exercise equipment pools saunas you name it! Or if it s more convenient you can order a Silver Sneakers Steps home fitness kit to stay active. Optimum Members can also save with a Part B Premium refund. Depending on Plan selection Members can receive between $50 and $ dollars each month. Over the course of the year that could mean between $600 and $ dollars back in your Social Security check! Optimum offers vision dental and hearing benefits. Members can even receive a transportation allowance for doctor visits up to 12 one way trips. And Optimum encourages you to see your doctor there is a list of preventive services available to members at no cost. Plus you ll get your Annual Wellness Visit screenings vaccines and other services to keep you healthy. We mentioned that Brand and Generic prescription drug coverage is available on plans that offer Part D coverage. With Optimum HealthCare s home delivery pharmacy members can receive a three month s supply of their covered drug for just two month s co-pay on most plans with the prescription drug coverage benefit. And with the home delivery pharmacy, there is easy ordering and delivery within fourteen days offers easy ordering and delivery within fourteen days. For Plans with prescription drug coverage there are four cost sharing tiers and every drug on the Plans list is in one of these tiers. Cost sharing Tier One covers preferred generic prescription drugs. Cost sharing Tier Two covers preferred brand prescription drugs. Cost sharing Tier Three is for non-preferred brand prescription drugs and cost sharing Tier Four is dedicated to specialty prescription drugs. In general cost sharing Tier One drugs are the lowest tier and include some Generic drugs and some Brand drugs. Tier Two drugs include Preferred Brand drugs and some Non-Preferred Generic drugs. Tier Three drugs include Non-Preferred Brand Drugs and Non-Preferred Generic drugs. Tier Four drugs are the highest tier and include specialty Tier Drugs. To find out which cost sharing tier your drug is in look it up in the Plan s Formulary and then refer to the benefits section for specific cost sharing. Eligible beneficiaries must use network pharmacies to take advantage of their prescription drug benefit except in non-routine circumstances. Quantity limits and restrictions may apply. There are two ways to find a drug within the Formulary. You can look it up depending on the type of medical conditions it is used to treat. For example drugs used to treat a heart condition can be found under the category Cardiovascular Agents. The index of the Formulary also provides an alphabetical listing of the all the drugs along with the page number where you can find coverage information. Any drug restrictions will also be noted in the Formulary. How much you pay for your prescription drugs depends on your coverage stage. Stage One is the initial coverage stage and the Plan will pay its share of the cost of your drugs and you are responsible for your

4 share. You remain in Stage One until your payments for the year PLUS the Plan s payments equal $2960 dollars. Stage Two is the Coverage Gap stage many of you may know it as the Donut Hole. In Stage Two you pay 65% percent of generic drugs costs as well as discounted costs for brand drugs until your yearly out of pocket drug costs reach $4700 dollars. This total may be different if you are already getting Medicare Extra Help. For certain plans, you may pay $0 or $5 dollars for drugs in Tier One during the Coverage Gap or Donut Hole. Contact the Plan for more information. The third stage is the Catastrophic Coverage Stage. Once you have paid enough for your drugs to move into this last payment stage the Plan will pay most of the cost of your drugs for the rest of the year. You will pay the greater of 5 percent or $2.65 dollars for generic or preferred multi-source drugs and the greater of 5 percent or $6.60 dollars for all other drugs. A great feature of Optimum HealthCare Plans is the Medical Home. It allows your Primary Care Provider or P-C-P to act as your personal physician and coordinate all your health care needs. Your P-C-P focuses on prevention and your overall wellness not just treating you when you are sick which means a higher quality of overall service. You must use Optimum HealthCare providers except in emergent or urgent car situations out of area renal dialysis or other services. If you choose to get routine care from an out of network provider neither Medicare nor Optimum HealthCare will be responsible for the cost. Optimum HealthCare understands that most people on Medicare are living on a budget and need to make their dollars count. Did you know you may be eligible for Extra Help from State or Federal programs to assist you with premiums co-pays co-insurance or other expenses? Often times people aren t aware of available assistance or don t take action due to cumbersome paperwork. The Optimum Assistance Program is available to both members and those interested in becoming an Optimum member in a number of ways including to help verify eligibility for Part D prescription Extra Help benefits like the Low Income Subsidy as well as other social programs. And when you become an Optimum member we can submit these applications for you. You can talk to a Benefit Consultant for more information. If you are eligible for a Medicare Advantage Plan you can enroll or end your enrollment each year during the Annual Enrollment Period or A-E-P. The A-E-P occurs October 15th through December 7th of each year. Most enrollments submitted during this time will have an effective date of January 1st of the following year. If you are eligible for a Medicare Advantage H-M=O Plan you can only enroll during specific times of the year but if you are eligible for an H-M-O Special Needs Plan you can enroll at any time of the year. If you have a Special Enrollment Period or Initial Coverage Election Period you may be able to enroll with an earlier effective date. As with all Medicare Advantage Plans benefits formulary pharmacy or provider network premiums and or co-payments or co-insurance may change on January 1st of each years.

5 After you enroll you will receive some important items from Optimum HealthCare including your I-D card and Evidence of Coverage a provider directory and if your Plan offers Part D coverage a pharmacy directory and the Formulary which is the list of covered drugs as well as other member materials. This is what the Optimum HealthCare I-D card looks like and the information it provides. On the front you ll find your Plan benefits for your pharmacist if you have Part D coverage your Optimum HealthCare identification number the year you joined Optimum HealthCare the name of your Optimum Medicare Advantage Plan and your Plan number. On the back are the up-front payments or co-pays for your Plan benefits member services contact information and information for your doctor pharmacist or hospital. If you ever have a question that you would like answered face to face you can always stop by one of our seven concierge centers located around the state. These centers are open Monday through Friday from eight in the morning until five in the evening. Concierge centers are in Casselberry Bradenton Spring Hill Ft. Myers Tampa. Vero Beach and Ocala. Each location has helpful staff licensed agents and a one hour resolution time. To find a concierge center close to you go to our website at w-w-w dot your optimum healthcare dot com. You may have questions about what you have learned here and Optimum HealthCare wants to help you find answers easily. You can meet with the Benefit Consultant who is with you now and you can always go to our website w-w-w dot your optimum healthcare dot com. You can also call Member Services at T-T-Y users should call As we close with important information and disclaimers we want to thank you for your time today. Remember Optimum HealthCare is Care You Can Trust. (DISCLAIMERS ARE READ AND DISPLAYED SIMULTANEOUSLY ON THE SCREEN ANCHORS ARE NOT ON CAMERA) Optimum HealthCare is an H-M-O Plan with a Medicare contract and a contract with the Florida Medicaid program. Enrollment in Optimum HealthCare depends on contract renewal. The benefit information provided here is just a brief summary not a complete description of benefits. Benefits formulary pharmacy and provider network premium and-or co-payments co-insurance may change on January 1st of each year. You must continue to pay your Medicare Part B Premium. Limitations co-payments and restrictions may apply. Benefit amounts may vary based on Plan and County. The Part B Premium is covered for full dual members of Special Needs Plans. Optimum HealthCare s Special Needs Plans or S-N-Ps are available to anyone who has both Medical Assistance from the State and Medicare. Premiums co-pays co-insurance and deductibles may vary based on the level of Extra Help that you receive. Optimum HealthCare s Chronic Condition Special Needs Plans or C-S-N-Ps are available to anyone with Medicare who has been diagnosed with Diabetes Cardiovascular Disease Chronic Heart Failure or Chronic Obstructive Pulmonary Disease C-O-P-D. Optimum HealthCare is accredited by N-C-Q-A and received a Commendable rating and was awarded a three year accreditation from December 26th to December 26th N-C-Q-A accredits and certifies a wide range of healthcare organizations and manages the evolution of HEDIS the

6 performance measurement tool used by more than 90 percent of the nation s health plans. Optimum HealthCare passed these rigorous standards and reported their performance in dozens of clinical areas to earn the N-C-Q-A seal of approval. Optimum HealthCare has been approved by the National Committee for Quality Assurance N-C-Q-A to operate a Special Needs Plan or S-N-P until December based on a review of Optimum HealthCare s Model of Care. H-M-O eligible beneficiaries may enroll in the Plan only during specific times of the year. H-M-O S-N-P eligible beneficiaries can enroll at any time. A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings call T-T-Y users call This information is available for free in other languages. You can always contact the Plan for more information by calling Member Services at T-T-Y users should call 711. Hours of Operation are 8 am to 8 pm 7 days a week from October 1 to February 14 and 8 am to 8 pm Monday through Friday from February 15 - September 30.

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