Medicare Advantage. Producer Training 2015

Transcription

1 Medicare Advantage Producer Training 2015

2 Agenda Producer Certification Requirements Premera s Product Focus 2015 Plan Options and Benefit Design AEP Marketing and Advertising Sales Collateral and Tools Compliance Administration and Sales Support Key Contacts 2

3 Producer Certification Requirements

4 Disclaimer Information about Premera Blue Cross Medicare Advantage must not be shared with the general public until October 1,

5 Producer Certification Requirements Submit completed contracts to Premera/FMO Log in to Premera AHIP site to transfer AHIP scores Attend 2015 Premera product training Review Premera compliance and ethics policies Complete final 2015 certification test online Producers that complete the above by 9/26 will receive notification/producer number to sell 2015 products You may not sell a Premera Medicare Advantage plan, and Premera may not pay commissions to any producer that has not attended training and completed the certification test 5

6 Premera and the Medicare Advantage Landscape

7 Premera Strengths Premera brings unique strengths to the Medicare Advantage field positioning us for success: In-depth understanding of health insurance Excellence in product design, sales, marketing Strong brand recognition as a Blue plan Product distribution and agent support expertise Established regional presence and reputation 7

8 2015 Five County Service Area 8

9 Plan Options and Benefit Design

10 Plan Options Premera is proud to present our NEW 2015 Medicare Advantage Products Premera Blue Cross Medicare Advantage (HMO) Premera Blue Cross Medicare Advantage (HMO- POS) Premera Blue Cross Medicare Advantage Plus (HMO) Premera Blue Cross Medicare Advantage Plus (HMO- POS) 10

11 Comparing Advantage Plans Benefit Advantage HMO Advantage HMO- POS In Network In Network Out of Network Monthly Plan Premium $0 $59 Annual Out- of- Pocket Max $6,700 $5,000 PCP Office Visit $15 copay $15 copay 40% Specialist Office Visit $50 copay $40 copay 40% InpaPent Hospital $430 (days 1-4) $300 (days 1-5) $400 (days 1-12) OutpaPent Services 20% $300 40% Emergency Room $65 (WWC) $65 (WWC) $65 (WWC) Ambulance Copay $300 $300 $300 SilverSneakers Included Included Included Lab Services $15 $10 40% X- Rays $30 $25 40% RouPne 11 Vision Exam (1x/yr) Not Covered $40 40% Medicare Advantage Confidential & Proprietary Vision Hardware Not Covered Not Covered

12 Advantage Prescription Coverage Benefit* Advantage HMO Preferred Pharmacy Standard Pharmacy Advantage HMO-POS Preferred Pharmacy Standard Pharmacy DeducPble $0 $0 Preferred Generic $4 copay $9 copay $4 copay $9 copay Non- Preferred Generic $9 copay $15 copay $9 copay $15 copay Preferred Brand $45 copay $45 copay Non- Preferred Brand $95 copay $95 copay Injectable Drugs 33% coinsurance 33% coinsurance Specialty 33% coinsurance 33% coinsurance Standard Part D coverage gap applies *Note all costs are for a 30- day supply Transition Policy: Premera transition policy will provide a 30-day fill (unless the prescription is written for less than 30 days), with multiple refills as necessary for up to a 90 day supply during the first 90 days of a members enrollment 12

13 Comparing Advantage Plus Plans Benefit Advantage Plus HMO Advantage Plus HMO- POS In Network In Network Out of Network Monthly Plan Premium $110 $146 Annual Out- of- Pocket Max $3,400 $2,800 PCP Office Visit $10 copay $10 copay 40% Specialist Office Visit $40 copay $30 copay 40% InpaPent Hospital $300 (days 1-6) $200 (days 1-7) $300 (days 1-7) OutpaPent Services $250 $250 40% Emergency Room $65 (WWC) $65 (WWC) $65 (WWC) Ambulance Copay $150 $150 $150 SilverSneakers Included Included Included Lab Services $5 $0 40% X- Rays $15 $0 40% RouPne 13 Vision Exam (1x/yr) $40 $30 40% Medicare Advantage Confidential & Proprietary Vision Hardware $150 Hardware Reimbursement $150 Hardware Reimbursement

14 Advantage Plus Prescription Coverage Benefit* Advantage Plus HMO Preferred Pharmacy Standard Pharmacy Advantage Plus HMO- POS Preferred Pharmacy Standard Pharmacy DeducPble $0 $0 Preferred Generic $3 copay $9 copay $3 copay $9 copay Non- Preferred Generic $8 copay $15 copay $8 copay $15 copay Preferred Brand $35 copay $35 copay Non- Preferred Brand $85 copay $85 copay Injectable Drugs 33% coinsurance 33% coinsurance Specialty 33% coinsurance 33% coinsurance Standard Part D coverage gap applies *Note all costs are for a 30- day supply Transition Policy: Premera transition policy will provide a 30-day fill (unless the prescription is written for less than 30 days), with multiple refills as necessary for up to a 90 day supply during the first 90 days of a members enrollment 14

15 Referrals and Prior Authorization The HMO Plans: ü members may only access in-network providers ü members will be assigned a PCP if they do not select one during enrollment ü referrals to specialists are required ü prior authorization is required for some non-emergent care services ü members that do not receive prior authorization for non-emergent care may be required to pay 100% of the cost of services The HMO-POS Plans: ü members may access both in-network and out-of-network providers ü members will be assigned a PCP if they do not select one during enrollment ü out-of-network services may have higher a cost share than in-network ü referrals to specialists are not required but members must receive a referral from their PCP to see an in-network specialist with a lower cost share ü prior authorization is required for some non-emergent care services ü members that do not receive prior-authorization for non-emergent care may be required to pay 100% of the cost of services 15

16 Out of Network Provider Utilization If a patient sees an out of network provider, the provider has 3 choices at each visit: See the patient and bill Premera See the patient, bill the patient, patient submits to Premera for reimbursement Don t see the patient Note: if the provider does not accept Medicare Assignment, they may balance bill the patient up to 15% 16

17 Medicare Advantage Network Highlights Key Network Providers Providence Medical Group Swedish Medical Group CHS / Rockwood Clinic Minor and James The Polyclinic Franciscan Health Systems The Everett Clinic (Most of) Northwest Physicians Network Columbia Medical Associates Overlake Western Washington Medical Group 17

18 Medicare Advantage Pharmacy Highlights Key Network Pharmacies Fred Meyer Pharmacy* Walgreens Pharmacy* Safeway Pharmacy* QFC Pharmacy* Costco Pharmacy* Bartell Drug* Wal-Mart Pharmacy Rite-Aid Pharmacy Target Pharmacy *Preferred Pharmacy 18

19 Medicare Member Discounts Advantage and Pharmacy Extras! Highlights All of Our Plans Include $0 drug deductibles $0 health deductibles Healthways SilverSneakers Fitness Program Premera 24/7 Nurse Line 19

20 SilverSneakers SilverSneakers is an award winning fitness program designed for older adults. At no additional cost to members, the program provides: Free Access to gyms and fitness centers at more than 11,000 facilities nationwide Specialized fitness classes designed for older adults and led by certified instructors Wellness tools and resources to create exercise and nutrition plans 20

21 Senior Dental Plan Premera s Senior Dental Plan: Offered as a stand-alone product for individuals enrolling in Medicare Advantage Plans Covers preventive services only for members over age 64 Preventive coverage includes: - Up to two routine oral exams and cleanings per year Routine x-rays Complete series or panoramic x-ray once every 36 consecutive months 21

22 Premera Medicare Supplement Plans No product changes to existing plans Waiting for Original Medicare cost share information from CMS Expected in early November Annual cost share mailings will occur Rate filings in process Washington filing early December Expect January 1 approval Annual cost share mailings will go out 30 days prior to rate effective dates 22

23 AEP Marketing and Advertising

24 Messaging and Creative Platform PREMERA BLUE CROSS 24

25 Messaging and Creative Platform Vignette: Fun Outdoors 25

26 Messaging and Creative Platform Vignette: Enjoying Friends and Family 26

27 Messaging and Creative Platform Vignette: Mentoring 27

28 Messaging and Creative Platform Vignette: Pursuing Your Passion 28

29 Messaging and Creative Platform Vignette: Passing on Knowledge 29

30 Messaging and Creative Platform Vignette: Modern Comforts of Home 30

31 Sales Collaterals and Member Materials

32 Enrollment Kits Enrollment Kits 32 Enrollment Kits are available for one-on-one appointments and group presentations Enrollment Kits include: " Premera Introduction Letter " Star rating form " Benefit Highlights " 2 Enrollment Applications " Return Envelope for Enrollment Application " Summary of Benefits " Multi-Language Insert " Enrollment Kit Folder and Envelope Copies of Provider / Pharmacy Directories and Formularies are available in limited quantities. Order via the Producer Portal: Sales Forms & Support Tools, or your FMO

33 Welcome Kits All new members will receive a New Member Welcome Kit Welcome Kits include: " New Member Booklet How to use your plan " CMS Confirmation Letter " Provider/Rx Directory " Formulary " Evidence of Coverage " LIS Rider " Welcome Kit Box 33

34 OEV - Welcome to Premera In addition to the New Member Welcome Kit, all members will receive: " OEV Letter " Welcome Call 34

35 Benefit Presentations CMS approved benefit presentations are available in electronic format for laptops, ipads, and tablets. 35

36 Compliance Expectations

37 Compliance Follow all Medicare Marketing Guidelines No unsolicited contact Must have permission to call No modification of marketing materials No creation of marketing materials Must meet Scope of Appointment requirements No bait and switch Educational events must be clearly labeled Marketing for 2015 products may not begin until 10/1 37

38 Scope of Appointment 38 Scope of Appointment (SOA) must be completed for all face-to-face presentations (except for seminars) If a stand-alone dental product is discussed at the time of the appointment, a SOA that includes dental must be documented. Scope of Appointment does not need to be submitted with the application " You are required to keep SOAs for 10 years " You must be prepared to produce SOAs when audited " Producers affiliated with an FMO must submit completed SOAs to their FMO

39 Scope of Appointment CMS Updates Scope of Appointment (SOA) must be documented at least 48 hours in advance of meeting with the beneficiary If any product other than what was originally indicated is requested, an SOA that includes that product must be documented The following must be included on all SOAs " Product type requested by beneficiary " Date of appointment " Beneficiary contact information and their signature " Method of contact " Agent information " If an SOA was not signed prior to appointment, an explanation as to why it was not practicable must be noted on the SOA form See the sales tool/memo from Premera 39

40 Administration and Sales Support

41 Enrollment Process Standard election periods apply Applications can be submitted via paper or electronically Electronic online applications (preferred): " Producers will receive a unique MA writing # " Producers will register for unique MA link Paper applications can be submitted: " Fax (preferred) " Scanned via secure MedAdvApps@premera.com " Drop off at Premera locations Mountlake Terrace Campus Spokane Sprague Campus " Applications must be submitted within 24 hours of receipt 41

42 Commissions Payments are calculated on the January through December enrollment year " Commissions are paid beginning in January of the plan year Premera must recover commissions (full or prorated): " When a beneficiary dis-enrolls before January 1 st of the following calendar year For questions about commissions, please contact: " Premera Producer Support " Your FMO Support 42

43 Key Contacts

44 Key Contacts Sales Leadership John Mychalishyn Director of Sales Sales and Account Management Kelly Jones Regional Sales Manager w c kelly.jones@premera.com Liz Cline Sales ExecuTve c liz.cline@premera.com Tiana Joiner Sales ExecuTve c Tana.joiner@premera.com Sherri Hannum Sales ExecuTve c sherri.hannum@premera.com Producer Support KaPe Dalton Team Lead Producer Support KaTe.dalton@premera.com Producer Support Team Laura Binder Lucy French Nicole Goodspeed , opton 1, then 1 Fax: producer.support@premera.com 44

45 Thank You ( )