Introducing Blue Cross

Transcription

1 Introducing Blue Cross Medicare Advantage Plans New Mexico A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2 AGENDA Why choose Blue / Industry Trends Compensation Our Partnership with ABQ Health Partners Product Portfolio Compliance Certification Process Enrollment Process Marketing Overview What does this mean to you? Next Steps Questions 2

3 Question? Who here is getting older? 3

4 DID YOU KNOW? The 77 Million members of the Baby Boom generation began turning 65 in The Medicare eligible population will continue to grow and by the year 2030, 1 out of every 5 Americans will be age 65 or older. Seniors control nearly 75% of the wealth in the United States with a staggering 7 trillion dollars. 4

5 WHY THE SENIOR MARKET? 5

6 Customers have different needs Blue Cross Blue Shield can provide the solutions to fit all of your customer s needs 6

7 Why Blue? A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

8 We Understand the New Mexico Market Largest health plan in New Mexico Solid Financial Ratings Standard & Poor s A.M. Best Moody s AA- / Very Strong A+ / Superior A1/ Good Sources: Standard & Poor s (Oct 2010), A.M. Best (Oct 2011), Moody s (Jan 2010) 8

9 Advantages of Blue Strong Product Portfolio Competitive Pricing New PDP Offerings Low Cost Sharing Supplemental Benefits - SilverSneakers - Travel Benefit - Hearing Key Network Partners Brand Recognition 9

10 We Need Producers / Agents to Succeed High Commissions Faster Payment Strong Market Presence Regular Communications Support Staff 10

11 Our promise to our members is to make insurance Simple. Affordable. Accessible. 11

12 Commissions MAPD & PDP A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 12

13 Commissions. Individual Product Type Policy Year Compensation Rate Blue Cross Medicare Advantage Initial Compensation 1 $425 Renewal Lifetime $213 Blue Medicare RX Initial Compensation 1 $56 Renewal Lifetime $28 Initial Compensation: Subscribers identified by CMS as in their initial year of enrollment are considered to be new enrollments. HCSC will provide compensation for the initial year after receipt of the first month s premium. The Initial Compensation amount is paid for new enrollments and enrollments into different plan types. Renewal Compensation: Lifetime renewals HCSC shall pay renewal compensation owed for business written with a 2014 effective date and consistent with the Agent/Broker compensation requirements in the CMS Medicare Marketing Guidelines. HCSC will provide compensation after receipt of the first month s premium. Renewal compensation is contingent upon completion of annual training and certification requirements prior to the HCSC established deadline. 13

14 MAPD Products 2014

15 Our Medicare Advantage in 2014 Better Product in 2014 More Product Choice Network Advantage 15

16 Medicare Product Themes for 2014 Range of products available that can be sold to a variety of customers (Medicare Advantage, Prescription Drug, and Medicare Supplement plans) Both Medicare Advantage & PDP products will be better in 2014 New Preferred Pharmacy Network Structure for both MAPD and PDP Lower cost sharing Competitive pricing Increased Compensation Supplemental benefits Dental Vision Hearing SilverSneakers Fitness Program Travel benefit Worldwide emergency care 16

17 NM Medicare Advantage - MA HMO Service area will expand into 2 additional counties in the Albuquerque area (Bernalillo, Sandoval, Torrance, Valencia) - MA PPO Service area will expand into 12 counties (Bernalillo, Sandoval, Torrance, Valencia, Cibola, Guadalupe, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Socorro) Benefit NM Plan Landscape Current t2013 NM HMO Proposed d2014 NM HMO Plan Plan Comparison Name Blue Cross Medicare Advantage Basic (HMO) Plan Number H H Premium $0 $0 MOOP $3,000 $2,400 + Hosp Inpatient $200 Copay (days 1 4) $150 Copay (days 1 5) $750 annual max + Primary Care Physician $5 $0 + Specialist $30 $20 + Ambulatory Surgical Centers (ASCs) $375 $150 + PT/SP Therapy $30 $5 + Cardiac/Pul Rehab $25 $25 RXRX (Preferred/Non Preferred) Ded $325 $3/$12/$45/$95/25% $0/5 $2/7 $35/40 $85/95 33% + * Counties in bold are new in

18 NM Medicare Advantage More Choice Name Benefit Proposed 2014 NM Premium HMO Plan Blue Cross Medicare Advantage Premier (HMO) NM Plan Landscape Proposed 2014 NM Buy Down HMO Proposed 2014 NM HMO POS Plan Plan Blue Cross Medicare Advantage Value Blue Cross Medicare Advantage (HMO) Premier Plus (HMO POS) Proposed 2014 NM PPO Plan Blue Cross Medicare Advantage Choice (PPO) Plan Number H H H H Premium $32 $0 $37 $27 MOOP $1,500 $2,800 $2,350 $4,500 $6,500 Hosp Inpatient $100 Copay (days 1 4) $350 Copay (days 1 5) $200 Copay (days 1 4) $150 Copay $300 Copay (days 1 7) (days 1 7) Primary Care Physician $0 $5 $5 $10 30% Specialist $15 $20 $20 $35 30% Ambulatory Surgical Centers (ASCs) $150 $200 $200 $125 30% PT/SP Therapy $5 $25 $25 $40 30% Cardiac/Pul Rehab $10 $30 $30 $45 30% RXRX (Preferred/Non Preferred) Preferred) $0/5 $2/7 $35/40 $85/95 33% $2/7 $35/40 $85/95 33% $0/5 $2/7 $35/40 $85/95 33% $2/7 $35/40 $85/95 33% $0/5 $2/7 $35/40 $85/95 $0/5 $2/7 $35/40 $85/95 33% $2/7 $35/40 $85/95 33% 33% $32 premium HMO Basic HMO network plan with richer benefits than than the $0 HMO plan HMO Buy down plan (Part B buy-down of $10) Basic HMO network Leaner benefits than the $0 HMO, but HCSC contributes to the members Part B premium $37 HMO-POS Basic HMO network with POS option Similar benefits to the HMO, but with the ability to go out of network (escape hatch) $27 Blue Cross Medicare Advantage Choice (PPO) will be offered Large PPO network Competitive plan for people who like a PPO out of network option 18

19 NM Medicare Advantage Network Advantage Key physician network partner with ABQ Health Partners Physician led, patient driven centering around patient s needs Team approach network of nurses, specialists, case managers, diagnostic team members and others, all working in sync to help our patients stay healthy Total Care Model is a patient-centered comprehensive model designed to help carefully manage our patient s health Proven to increase quality outcomes and patient satisfaction while still reducing healthcare costs 19

20 Background NM SNP Blue Cross Medicare Advantage Dual Care BCBSNM applied for a Dual Eligible Subset Non-Zero Cost Share Who can enroll? Members must be eligible ibl for Centennial Care QMB+ SLMB+/Other AND members must be enrolled in HCSC Centennial Care at the time of the DSNP Application BCBSNM must verify eligibility at the time the application is received. What does Non-Zero Cost Share Mean? Some members will have all of their Medicare A/B Service cost share covered by Centennial Care (no liability for cost share) Others will have liability for Medicare A/B Service cost share that the State does not cover 20

21 Background cont d NM SNP D-SNP Premium Part C No additional premium. Medicare Part B Premium covered by State of NM for most members. Part D - $12.60 plan premium covered for most members because of Low Income Subsidy status D-SNP Benefits Medicare A and B Services covered identical to Original Medicare 80% of most outpatient services Inpatient deductible Supplemental Benefits Dental (2 exams, 2 cleanings, 1 bitewing) Vision (exam, $150 toward hardware every 2 years, $25 copay/lenses) Hearing Aid (exam, $1000 every for aids every 3 years) SilverSneakers (annual membership) Centennial Care Benefits Coverage of Medicare cost share (varies depending on member s eligibility category) 21

22 2014 PDP Products A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

23 Overview of NEW Basic Plans and improved value and plus offerings Blue Cross MedicareRx Basic (PDP) SM (NEW PRODUCT FOR 2014) Value Propositions: Provides a low cost option to the healthier Age In population and a less expensive alternative for those that combine Part D with Medicare Supplement. Only about 40% of our Med Supp members have our Part D Benefits & Sales Stories: Monthly premiums at about 50% of the cost of our current Basic Plan offerings; most Tier 1 & 2 drugs can be obtained for $2 or less; products to compete with United and Humana low cost options Blue Cross MedicareRx Value (PDP) SM Value Propositions: Lower cost enhanced offering with better benefits than the previous Value Plans. Offers our largest client base a product with lower deductibles, cost sharing and monthly premiums. Benefits & Sales Stories: Monthly premiums are about $2 less than the current Value Plans; all Tier 1 & 2 drugs can be obtained for $2 or less; lower initial deductible than Value Plans in 2013 Blue Cross MedicareRx Plus (PDP) SM Value Propositions: Improved high end option, that provides less expensive cost sharing levels and coverage on all generics as well as some brands in the gap. Benefits & Sales Stories: All Tier 1&2d drugs can be obtained df for $2 or less; gap coverage extended d from all generics to include some brands; possible to have $0 cost share until the catastrophic phase with Tier 1 drugs at Preferred Pharmacies 23

24 Issues Addressed with the 2014 Blue Cross MedicareRx (PDP) SM Product Designs 2013 Issue or Competitive Deficiency 2014 PDP Plan Solution No Low Cost option to compete with Humana and United s Plans Value Plans are not competitive in terms of premium Opportunity for members to fill prescriptions at a preferred pharmacy for a discount Robust offering of Tier 1 generics and deductible only counting on Tiers 3-5, were not as beneficial as anticipated HISC will offer Basic Plans that are competitive on benefits and premium to United and Humana For 2014 there will be an inexpensive Basic offering and the Value Plans will be about $2 cheaper per month with better benefits than 2013 Members will save at least $5 per 30 day on Tiers 1-4 at CVS, Wal-Mart/Sam s Club, a local grocer and an independent d pharmacy group The Basic offerings have a deductible on all tiers and Value/Plus Plans have narrower Tier 1 formulary; similar to competitor s offerings 24

25 New Preferred Network Pharmacies for All States in 2014 The preferred network option has no impact on whether a member can fill at any of the 63,000+ network pharmacies nationwide Members can save at least $5 per 30 day fill on all three PDP Plans, if they fill at a preferred pharmacy versus any other network pharmacy Tier 1 & 2 drugs on all three PDP Plans can be obtained for $2 or less at a preferred pharmacy during the initial coverage period (OK is $4 or less on the Basic Plan) Discounts not applicable to deductibles, but do apply to gap coverage on the Plus Plans Preferred Network Pharmacies for 2014: CVS Wal-Mart/Sam s Club SuperValu (Jewel/Osco), HEB & Albertson s s Good Neighbor Independent Pharmacies and PPOK 25

26 Blue Cross MedicareRx Basic (PDP) SM Offering Details for 2014 We currently don t have a plan that competes with the price point of the AARP United and Humana Wal-Mart Plans New for 2014 HISC will be introducing i a low cost option that t will compete well in the marketplace with existing low cost plans Meets the needs of a wider spectrum of the over 65 population Matches United's and beats Humana s Tier 1 & 2 pricing at Preferred Pharmacies Premium range from $14 to $26 for 2014, which is in line with other similar offerings Highlights and Sales Points on the New Blue MedicareRx Basic Plan in New Mexico Most premiums are in the low to mid $20 s, in line with United and Humana Basic Plan Offerings; NM is $14.90 Members can obtain Tier 1 & 2 drugs for $2 or under at Preferred Pharmacies Provides another option to use in tandem sales with Medicare Supplement Offerings Provides alternative to the healthier Age-In population that had been unaddressed 26

27 Changes to Blue Cross MedicareRx Value (PDP) SM in Value Plan 2014 Value Plan $325 deductible only counts towards Tiers 3-5 Tier 1 drugs were $3 and Tier 2 were $10-$14 $14 at any Pharmacy No discounted cost sharing for Preferred Pharmacies No Insulin option on Tier 1 or 2 Premiums in high $30 s to low $40 s in all States Broad range of generics on Tier 1 $200 deductible d only counts towards Tiers 3-5 Tier 1 drugs are $0 and Tier 2 are $2 at Preferred Pharmacies Out of Preferred Pharmacies, Tier 1 is only $5 and Tier 2 is $7 Insulin option available on Tier 2 Premiums around $2 cheaper per month in all States Narrow, more focused set of generics on Tier 1 With the addition of the Blue Cross MedicareRx Basic (PDP) SM Plan, the Value plan is now an Enhanced Alternative under CMS guidelines Members will not be moved if they are currently a part of the Value Plan Deductible is $200 in NM 27

28 Changes to Blue Cross MedicareRx Plus (PDP) SM in Plus Plan 2014 Plus Plan All generics covered in the gap Tier 1 drugs were $3 and Tier 2 were $10 at any Pharmacy No discounted cost sharing for Preferred Pharmacies No Insulin option on Tier 1 or 2 Premiums under $100 in all States Broad range of generics on Tier 1 All generics and some brands covered in the gap Tier 1 drugs are $0 and Tier 2 are $2 at Preferred Pharmacies Out of Preferred Pharmacies, Tier 1 is only $5 and Tier 2 is $7 Insulin option available on Tier 2 Premiums around $100 in all States, with better benefits Narrow, more focused set of generics on Tier 1 Since there will be two Enhanced Alternatives in 2014, the Plus Plan now includes coverage of some brand drugs in addition to all generics in the coverage gap Tier 1 generics are now more narrowly focused on major CMS disease states for both the Plus and Value Plans 28

29 The SilverSneakers Experience Health plan members can experience SilverSneakers in various ways: Work out and take classes at any of more than 11,000 fitness locations Use SilverSneakers Steps at home or on the go Participate in SilverSneakers FLEX classes and activities at local venues Go online 29

30 SilverSneakers Fitness Locations Venue-based Program Component Fitness membership includes: Use of all equipment and amenities included in a basic fitness membership Access to more than 11,000 fitness locations nationwide SilverSneakers classes taught by certified instructors A SilverSneakers Program Advisor SM for guidance and assistance Fun social activities Health education seminars 30

31 SilverSneakers Steps Self-directed Program Component Non-venue based physical activity program Convenient alternative for members without easy access to a full-service location Choice of four fitness kits with tools to use at home or on the go Kit choices (one per member): General fitness Strength Walking Yoga Information and kit ordering instructions at silversneakers.com General Fitness Strength Yoga Walking 31

32 SilverSneakers FLEX Outside the Gym Classes and activities offered in parks, recreation centers, churches and other local l venues Examples: tai chi, yoga, walking groups Led by certified instructors Offerings and easy online enrollment available at my.silversneakers.com 32

33 SilverSneakers Online Web-based Program Component Offers members a secure, easy-to-use website where they can: Find fitness locations by ZIP code Enroll Order replacement member ID card 33

34 Compliance A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 34

35 Medicare Marketing Do s Do only use materials available on the Producer portal after successful completion of 2014 Producer Certification Requirements Do market only within Blue Cross Medicare Products service areas Do complete a Scope of Appointment (SOA) form 48 hours before each face to face appointment and retain hard copy in your records for 11 years (current year plus 10 years) Do clearly mark optional on any sign-in sheets used at sales events Do clearly describe eligibility requirements, benefits, premiums, network use, enrollment periods, lock in periods and extra help to every enrollee 35

36 Medicare Marketing Do s Do file and report all sales events through the Blue Access for Producers portal no later than the 15 th of each month for the following month, and follow CMS requirements for cancelling any previously scheduled events Do submit your client s enrollment form within 48 hours of producer receipt and keep all records relating to your client for 11 years (current year plus 10 years) Do be familiar with producer responsibilities when performing sales and educational events, including understanding di all requirements outlined in the Compliance Program (which can be found at HISCCompliance.com) Do report any suspected violations to the Fraud Line at , anonymous and available 24 hours a day Do familiarize yourself with the 2014 Medicare Marketing Guide available on the Blue Access for Producers website portal Do indicate at all sales and/or educational events that you are a licensed agent of BCBS of IL/OK/TX/NM (as applicable) 36

37 Medicare Marketing Don ts Don t create any marketing or enrollment materials on your own Don t engage in door-to-door marketing or sales Don t engage in outbound telemarketing, campaigns or calls to those in the process of voluntarily disenrolling for the purpose of retaining membership Don t discuss other health products unless stated in advance on the Scope of Appointment form Don t engage g in activities that intentionally mislead or confuse beneficiaries Don t engage in discriminatory activities such as conditional enrollment based on physical or mental illness, claims experience or disability 37

38 Medicare Marketing Don ts Don t serve meals at sales events or host them in a health care setting that is not a common area such as a cafeteria or auditorium Don t accept an enrollment form prior to the client s enrollment period (and hold it until they are eligible) Don t offer inducement, monetary or otherwise, to enroll or switch to a Blue Cross Medicare product Don t engage in high pressure sales tactics, make absolute statements, use superlatives or provide personal opinions when discussing Blue Cross Medicare products Don t pressure attendees at sales events to complete sign-in sheets 38

39 Monitoring & Oversight Program The monitoring and oversight program consists of the following: Monthly and quarterly reviews of various marketing activities including, but not limited to: Confirmation of certification status, including status at time of a submitted enrollment Disenrollment trends Scope of Appointment form use and retention Sales event monitoring (submission of events and onsite observation) Advertising gp placements (via clipping service) Enrollment submission and retention of paper form Secret Shopping Review of Producer complaints received internally and from CMS 39

40 Certification Process A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 40

41 Why Certify Now? In accordance with the guidelines established by the Centers for Medicare and Medicaid Services (CMS), all agents must be trained and certified annually in order to market, sell and/or service PDP and MAPD products. CMS guidance states that an agent must be certified in order to receive renewal compensation for policies sold after the 2008 plan year. Failure to complete 2014 HCSC/HISC Producer Training & Certification requirements by deadline will result in: Blue Cross MedicareRx and Blue Cross Medicare Advantage (where applicable) Book of Business for CYs 2009 and forward being moved to an HISC House Account. Blue Cross MedicareRx and Blue Cross Medicare Advantage (where applicable) Book of Business is NOT returned if certification occurs after December 6, 2013 deadline or in a subsequent year. 41

42 Milestone Dates December 3, HCSC/HISC Certification closes for sub producers at 11:59 p.m. December 6, HCSC/HISC Certification closes for all individual id producers and agency principles i January 4, HCSC/HISC Certification reopens Applicable for February 2014 effective dates and beyond Certification on or after this date does not result in reinstatement of lost Blue Cross MedicareRx/Blue Cross Medicare Advantage Book of Business 42

43 Access Training Go to Blue Access for Producers (BAP); click Certify to Sell 2014 Products link OR Access certification link via Certification Launch If you have never accessed training as an individual: Use 9-digit HCSC assigned Producer ID #, which is also the same number used to login to BAP. If accessing training as an agency: Use 9-digit HCSC assigned Agency ID # Note: Do not use your Social Security # or Tax ID # as login. If unsure of your HCSC assigned Producer or Agency ID #, call the Producer Service Center at for help. 43

44 Password If you have never accessed Knowledgewire, your initial password is your 9-digit HCSC Producer number You will be then prompted to create a new password If you have previously accessed Knowledgewire, use established password Keep password in an easily accessible location If you need help with resetting a forgotten password, please contact the HCSC Helpdesk at

45 2014 Courses and Exams Individual Producer Annual Information Form Sales Agent Requirements Medicare Basics course Medicare Basics exam Medicare Marketing Rules & Regulations course Medicare Marketing Rules & Regulations exam PDP/MAPD Product course PDP/MAPD Product exam FWA course FWA exam Certification Form Medicare Amendment Sub Producer Annual Information Form Sales Agent Requirements Medicare Basics course Medicare Basics exam Medicare Marketing Rules & Regulations course Medicare Marketing Rules & Regulations exam PDP/MAPD Product course PDP/MAPD Product exam FWA course FWA exam Certification Form Note: Subagents are not deemed certified until the Agency Principal completes the agency certification requirements 45

46 2014 Courses and Exams AHIP Individual Producer or Sub Producer Annual Information Form Sales Agent Requirements PDP/MAPD Product course PDP/MAPD Product exam FWA course FWA exam Certification Form Medicare Amendment (applicable to individual producers) Agency Principal Annual Information Form Sales Agent Requirements Medicare Marketing Rules & Regulations course Medicare Marketing Rules & Regulations exam FWA course FWA exam Certification Form Medicare Amendment Note: Principal must complete all Producer courses and exams in order to market, sell and/or service PDP and MAPD products. 46

47 Exams Passing score is 85% on all exams per CMS guidelines Three attempts per exam (4 exams) No lockout period Can re-take exam immediately after a failed attempt Exam questions are randomly selected; not all questions are the same for each attempt 47

48 Continuing Education Credits Illinois: 4 credits approved for individual producers/subagents 2 credits approved for AHIP producers/subagents in Illinois New Mexico, Oklahoma and Texas 4 credits approved for individual producers/subagents 2 credits approved for AHIP producers/subagents Upon successful completion of all 2014 requirements, HCSC will submit credits to the respective DOI. Producers should confirm with Department of Insurance to confirm credits are applied. 48

49 Communications Curriculum Completion Confirms completion of all 2014 HCSC/HISC Producer Training & Certification Requirements and includes link to access supplies Notice received Incomplete Curriculum States there are outstanding items for 2014 HCSC/HISC Producer Training & Certification Requirements One task on the to-do list must be completed to alert a notice Notice received approximately 7 days after user begins training Agency Amendment Execution Confirms at least one subagent has completed their 2014 HCSC/HISC Producer Training & Certification requirements Outlines principal s 2014 HCSC/HISC Producer Training & Certification requirements Requires completion within 2 weeks of notification ed approximately 1-3 business days after at least one subagent completes their 2014 HCSC/HISC Producer Training & Certification requirements Failed Exams Informs producer they failed one of the exams after three attempts thus failing the certification 49

50 Enrollment Process A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 50

51 Enrollment Process Key Dates Key Dates October 1 st October 15 th December 7 th January 1 st February 14 th Once Certified. Begin accepting IEP and SEP enrollments which allow for January 1 st effective dates Extended hours of operation begin for customer service: 8 a.m. 8 p.m., 7 days a week, including holidays. Note: Customer service will be closed on Thanksgiving and Christmas. Begin accepting Annual Election Period (AEP) enrollments for January effective dates CMS does NOT allow any AEP enrollments to be accepted by producers prior to this date (e.g. cannot accept from beneficiary i and hold the application to submit on the 15 th ) Last day to receive AEP enrollments AEP enrollments effective and new benefits begin Last day of extended hours for customer service Resume operating 8 a.m. 8pm p.m., Monday through Friday, with alternate technologies (e.g. voice mail) available on weekends and holidays. 51

52 Enrollment Process - Elements Required to Consider the Enrollment Complete The Centers for Medicare and Medicaid Services (CMS) requires the following elements be provided to consider the enrollment complete: Plan Selection Beneficiary Name Beneficiary Date of Birth Beneficiary Gender Permanent Residence Address (cannot be P.O. Box) Beneficiary Medicare Number For MAPD, ESRD question Beneficiary Signature (or Authorized Representative Signature, if signed by someone other than the beneficiary) If signed by an Authorized Representative, all contact information fields Notes: Form CMS-1696 may not be used to appoint an authorized representative for the purposes of enrollment and disenrollment. This form is solely for use in the claims information and appeals. Producers should not include any of their information in the Authorized Representative sections of the enrollment form, nor sign as the Authorized Representative, unless they have been legally appointed as the beneficiary s legal guardian, Power of Attorney, etc. The above items are the only ones for which the enrollment can be pended or put in Request for Information (RFI) status, if not provided on the enrollment mechanism. CMS has separate timeframes for submission and notifications to the beneficiary only when one of these elements is missing from the enrollment request; however, CMS still counts these towards compliance with enrollment timeliness standards. 52

53 Enrollment Process - Elements Required to Consider the Enrollment Complete If any of the CMS-required fields are incomplete, the RFI (Request for Information) process begins: Conduct 3 outbound phone calls Send RFI letter to beneficiary requesting missing information Allow the extended timeframe (21 days or the end of the calendar month; or in the case of an initial enrollment period submitted early, up to the last day of the month prior to the Medicare Part D eligibility date) If the required information is not received within required timeframe, enrollment is denied If information related to other fields or questions on the enrollment mechanism are not provided, the enrollment cannot be pended. These fields, include, but are not limited to: premium payment option other coverage information long-term care information enrollment period and associated date (if applicable) producer-related fields Enrollments missing any information other than the required elements, as defined by CMS, MUST be submitted to CMS within 7 calendar days. 53

54 Enrollment Process Election Periods (AEP/IEP/SEP) Although CMS requires we validate the member is enrolling during an allowable election period, the enrollment period is not an element required to consider an enrollment complete. We must make the determination of whether the member is enrolling during a valid election period based on the information provided on the enrollment mechanism, and/or our validation of the member s Part D eligibility and/or Low-Income Subsidy status (IEP or SEP for LIS). This determination must be made within 7 days of the producer s receipt of the enrollment form, so we can meet the requirement of submitting to CMS within 7 days For enrollments that are denied due to not being able to confirm a valid election period, the denial letter must be mailed within 10 days of receipt If an election period or required date associated with an election period is missing: Maximum of two outbound calls are made on the day the enrollment is processed If we are unable to reach beneficiary/producer and/or no response received, the enrollment is denied It is especially important the producer ensure the appropriate election period is selected on the enrollment mechanism - and for those that require a date, the date is also provided - to prevent enrollments from being denied. 54

55 Enrollment Process - Timeframes The Application Date related to those enrollments facilitated by producers is defined by CMS as follows: For requests submitted to sales agents, including brokers, the application date is the date the agent/broker receives (accepts) the enrollment request and not the date the sponsor receives the enrollment request from the agent/broker. For purposes of enrollment, receipt by the agent or broker employed by or contracting with the sponsor, is considered receipt by the plan, thus all CMS required timeframes for enrollment processing begin on this date. The date the producer receives the form from the client is the date from which all CMS requirements are measured: Submission to CMS within 7 calendar days Acknowledgment letter, Request for Information Letter, or Denial letter mailed within 10 calendar days It is imperative producers submit all enrollments within 24 hours of receipt to ensure compliance with these mandated timeframes. 55

56 Enrollment Process - Methods to Submit Enrollment Enrollment Method Requirements How to Submit: Health Plan Online Enrollment (BAP) Paper Enrollment Telephone Enrollment Must have signed paper enrollment on file Retention: current calendar year plus 10 years Retention: current calendar year plus 10 years Access through Blue Access for Producers (BAP) Image of paper enrollment form and/or scope of appointment form may be uploaded with the electronic submission MAPD: Blue Cross Medicare Advantage P.O. Box 4555 Scranton, PA Fax: PDP: Blue Cross MedicareRx P.O. Box 3897 Scranton, PA Fax: Overnight: 25 Lakeview Dr. Jessup, PA Enrollment area keeps telephone recording for current calendar year plus 10 years MAPD: Producer may not be on the phone or physically present with beneficiary) Can only be completed based on PDP: inbound call cannot transfer from an outbound call to an inbound call To check on enrollment status, please call the Producer Help Desk:

57 Enrollment Process - Health Plan Online Must use health plan online enrollment link through Blue Access for Producers (BAP) to be paid the appropriate compensation Use of the Direct Consumer Health Plan Online Enrollment available through our websites (vs. BAP) will prevent any producer-specific information from being captured and commissions will not be paid Enrollment Forms will be available October 15 Submission through the Health Plan Online Enrollment process is the most timely and efficient method: Eliminates any potential mailing delays associated with paper enrollments Reduces risk of producer information or election period information not being captured appropriately during telephone enrollments as a result of information provided (or not provided) by the beneficiary. 57

58 Enrollment Process Paper Ensure the correct Election Period is selected, and an associated date is provided if needed (as designated next to the option selected): 58

59 Enrollment Process Paper Ensure the producer attestation questions are answered completely and accurately. Note: If face-to-face appointment was conducted, the producer should have a scope of appointment form on file It is important the producer fully explain the items listed in the last question, most of which are also contained in the Decision Guide 59

60 Enrollment Process Paper Ensure the selling producer completes the producer-related fields on both copies of the paper enrollment form prior to submitting for processing Ensure the selling producer enters his/her unique identification number in the Writing Agent ID# field. In the case of producers that report up to an agency, etc. this should NOT be the number of the agency and/or entity to which commissions may be paid, but the Unique ID # of the selling producer (normally 5 or 6 digits, proceeded by zeros, not the tax ID #) The agency information should be included in the Agency Name and Agency Number fields, if applicable Ensure the selling producer signs and dates the form, as the signature date is the date used as the application received date 60

61 Enrollment Process - Telephone Phone enrollments are an option, however, the producer may not be present on the phone or physically present with the member during the telephone enrollment: The sponsor must ensure that the telephonic enrollment request is effectuated entirely by the beneficiary or his/her authorized representative, and that the plan representative, sales agent or broker is not physically present with the beneficiary or present on the phone at the time of the request Telephone enrollments may only be completed during an inbound phone call. The caller will be asked to confirm the producer is not on the line or physically present in order to complete the telephone enrollment. Telephone enrollments will take approximately minutes to complete. 61

62 Enrollment Process Tips for Effective Processing and Avoiding Grievances Do: Ensure all CMS-required fields are complete Ensure the appropriate election period is selected As the paper forms only offer a subset of the possible election periods, if the applicable enrollment period is not listed, use the Plan Use only section of the form to indicate the SEP reason Use the Plan Use section of the enrollment form to indicate the requested effective date on the model paper enrollment forms Note: only certain SEPs allow for future effective dates; many enrollment periods require the effective date to be the first of the month following receipt of the enrollment Submit enrollment forms within 24 hours of receipt Ensure all fields on the enrollment form are completed prior to the beneficiary signing the enrollment form Provide the client with the entire Decision Guide and a copy of their enrollment form 62

63 Enrollment Process Tips for Effective Processing and Avoiding Grievances Don t: Solicit enrollments from members just becoming eligible for Medicare PRIOR to their receipt of notification of the Medicare eligibility and Medicare number from SSA (e.g. do not assume what the Medicare # will be) This results in not being able to confirm the Medicare eligibility and pending the application for up to 3 months prior to the member s eligibility date, which impacts CMS required enrollment timeliness standards d Hold applications in an effort to get a preferred effective date for the client for those SEPs that become effective the first of the month after receipt This results in being out of compliance with CMS required notifications and submissions, as the date the producer receives the form is the date from which timeliness is measured Select the I am new to Medicare election period for beneficiaries just becoming eligible for Medicare Part B and enrolling in Blue Cross MedicareRx For example, member works until age 68; then retires, loses and/or gives up their group coverage and enrolls in Medicare Part B. This member is not new to Medicare as he/she would have been eligible for Medicare Part A and/or Part D when reaching age 65. The election period in these cases is normally either involuntarily losing creditable coverage due to retiring and/or making a change during the EGHP election period when their employer allows them to disenroll, etc. Use current year enrollment materials to enroll members for effective dates in the following year 63

64 Enrollment Process - Outbound Enrollment Verification Calls (OEV) Upon processing the enrollment request, CMS requires outbound enrollment verification (OEV) calls be made to all beneficiaries enrolled through a producer. 3 call attempts are made within 15 days of producer s receipt of the enrollment form If 1 st call unsuccessful, an OEV letter is sent Call script and letter are model language provided by CMS These calls occur concurrently with any RFI calls There is a separate cancellation timeframe associated with OEV calls/letters (vs. the other allowable cancellation timeframe where the beneficiary may verbally request the enrollment be cancelled prior to the effective date) For OEV cancellations of enrollments, beneficiaries may request their enrollment be cancelled during the OEV call, and/or within seven (7) calendar days from the date of the letter or call, or the last day of the month in which the enrollment request was received, whichever is later. For AEP enrollment requests, enrollments may be cancelled within seven (7) calendar days from the date of the letter or call, or by December 7, whichever is later. Cancellation of enrollments unrelated to the OEV process can be requested up to the day prior to the member s effective date. 64

65 Marketing Overview A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 65

66 Overview Marketing Lessons Learned Summary 2014 Timeline & Key Messages 2014 Collateral Overview 2014 Advertising Overview 66

67 Marketing Effectiveness The Marketing Team leveraged insight from key research projects and 2013 campaign performance metrics to inform marketing mix and optimize content. Collateral Updated collateral material to include more educational information Used more charts, graphs, and basic language Lessons Learned Redesigned Decision Guides and Welcome Kits Advertising Cable more efficient than spot TV Pre printed Business Response Cards (BRCs) with prospects information Incorporate positive headlines Developing new graphic TV spot and refreshed direct mail creative 67

68 2014 Collateral Overview

69 Key Marketing Messages The AEP campaign consists of cohesive cross-channel messaging Key marketing messages: Highlight new benefits, services and products for MAPD and new low-cost Part D plan Include a sense of urgency for AEP deadline (Dec. 7) Continue Blue Cross Medicare Options portfolio messaging and co-marketing Med Supp and Part D September Generate Pre- AEP awareness & soften the market October 1 AEP Marketing Begins October 15 AEP Begins October 15 AEP Begins TV Strong CTA November 25 Digital Message Increased Sense of Urgency December 7 AEP ends Marketing activity ends close of day 69

70 AEP Direct To Consumer Collateral Collateral consists of: Sales kit contents: enrollment forms, decision guides, formularies, etc Presentations Product brochures All marketing collateral is designed to be consistent with advertising. Goals Recognize HCSC branded materials Easy to understand Provide options for enrolling 70

71 2014 Sales Kits Content Blue Cross Medicare Advantage (MAPD) Blue Cross MedicareRx (PDP) Blue Medicare Supplement Enrollment Forms Enrollment Forms Enrollment Forms Blue Medicare Options Decision Guide Decision Guide Decision Guide Decision Guide Summary of Benefits (included multi-language insert) Summary of Benefits (included multi-language insert) Outlines of Coverage Formulary (will be removed in Jan.) Formulary (will be removed in Jan.) CMS Choosing A Medigap Policy Booklets Business Reply Envelope Business Reply Envelope Business Reply Envelope MAPD Provider directories will NOT be included in the MAPD kits, but can be ordered d as stand alone items 71

72 Online Tools

73 Online Supply Portal - Collateral Think Blue Ambassadors, producers and other internal employees are to order sales kits and event supplies from: com Houses the most up to date materials Blue Cross MedicareRx Blue Cross Medicare Advantage Event Materials Presentations Usage and Inventory Tracking 73

74 Online Supply Portal Advertising Templates 2014 Advertising Templates Available 10/1 for all products 74

75 Provider Finder Tool Access via the Microsite: com/medicare 75

76 What does this mean to you and your customers? Year round enrollment opportunities. A portfolio of health care solutions to meet your customer s needs. One of the most recognized brands, serving seniors in the Medicare market. Dedicated marketing and training resources. Local advertising commitment. 76

77 WHAT ARE THE NEXT STEPS? We re looking for a select group of agents who will complement our organization and offer innovative ideas to their clients. We re looking for agents with a great attitude, patience, persistence, passion, commitment and the willingness to work as a TEAM player! Contracted? If not please contact your Sales Rep or affiliated FMO Complete Certification Requirements AHIP / Knowledge Wire Order Supplies Sell, Sell, Sell! 77

78 Questions? Q? 78