2017 texas agent training & product...
TRANSCRIPT
2017 Texas Agent Training & Product Launch
We Are Here to Stay!!
#201 on the Fortune 500 List
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• Molina experiencing unprecedented growth from the ACA
– In 2015 we added over 750K members
• 450K from Medicaid expansion
• 250K from Marketplace growth – Molina one of the top
10 carriers in the country
• 60K growth from the Duals Demonstrations – Molina
the largest duals carrier in the country
– In 2016 we added 400k Marketplace members – Molina is
one of the top 5 carriers in the country
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Major Opportunity in Market Place
Molina Healthcare of Texas
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Molina Healthcare of Texas
Health Insurance Marketplace
2015 Texas Membership Data
1,292
6,866
3,470
1,327 1,563
217 14 0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Bro
nze
Silv
er
100
Silv
er
150
Silv
er
200
Silv
er
250
Gold
Tribal
TX Enrollment by Plan
9 3
332
17 32
353
5 29
0
100
200
300
400
500
CA
ME
RO
N
CO
LL
IN
DA
LL
AS
DE
NT
ON
EL P
AS
O
HA
RR
IS
HID
AL
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JE
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AN
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WE
BB
TX Enrollment by County 1,701 9,837 2,431
Molina Marketplace has
14,749 TX members as of
September 1, 2015.
10,500 TX Consumer
Choice Plans
4,249 TX Standard Plans
Membership focus is the
Choice Silver 100 – 6,021
members with 72% of that
membership centered in
Dallas.
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2016 Open Enrollment Period
Molina was priced to grow enrollment in
2016!
HARRIS 68,778 45%
DALLAS 59,591 39%
COLLIN 15,579 10%
EL PASO 5,552 4%
STARR (Rio Grande) 2,098 1%
JEFFERSON 874 1%
WEBB (Laredo) 711 0%
HIDALGO
(McAllen/Edinburg)
242
0%
CAMERON
(Brownsville)
99
0%
Total 153,578 100%
Molina’s Value Proposition Over the Competition
1. We are the lowest priced plan in most of
our states.
2. Deductibles do not apply for MOST OP
Services on the silver and gold plans
3. Labs and Radiology services have
copays NOT Coinsurance
4. Molina does not require a PCP referral to
see a specialist
5. System enhancements to cut down on
broker time
My Molina (website for members)
Molina Healthcare Website (Has new
“Broker Feature”)
VUE Broker Portal
6. No Captive Sales Team
7. Strong broker support through our
dedicated broker support unit.
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2017 Molina Marketplace Product Designs
Molina will have 3 different Product Designs:
1. Marketplace Standard Plans (Texas Design)
2. Marketplace Option Plans (Federal Design)
3. Marketplace Consumer Choice Plans
Molina Marketplace 2017 Choice Plan Benefits At-A-Glance
2017 Molina Marketplace - Texas Choice &
Options
Bronze Silver 100 Silver 150 Silver 200 Silver 250 Gold
2017 MP ConsumerChoice 2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
Medical Deductible, Individual $6650
Combined Med/Rx
(Ded waived for Preventive
Services, Primary Care OV,
Other Practitioner OV, MH/SA
OV, Generic Drugs,
Preventive Drugs, Family
Planning, Pediatric Vision, and
Hospice.)
N/A
$500
(Applies to OP Facility and
IP services only)
$2275
(Applies to OP Facility and
IP services only)
$2400
(Applies to OP Facility and
IP services only)
$1025
(Applies to OP Facility and
IP services only)
Medical Deductible, Family
— Entire Family of 2 or more $13,300
Combined Med/Rx
(Ded waived for Preventive
Services, Primary Care OV,
Other Practitioner OV, MH/SA
OV, Generic Drugs,
Preventive Drugs, Family
Planning, Pediatric Vision, and
Hospice.)
N/A
$1000
(Applies to OP Facility and
IP services only)
$4550
(Applies to OP Facility and
IP services only)
$4800
(Applies to OP Facility and
IP services only)
$2050
(Applies to OP Facility and
IP services only)
Rx Deductible, Individual Included in
Medical deductible N/A N/A N/A N/A N/A
Rx Deductible, Family
— Entire Family of 2 or more Included in
Medical deductible N/A N/A N/A N/A N/A
OOPM, Individual $7,150 $1,250 $2,250 $5,700 $7,150 $7,150
OOPM, Family
— Entire Family of 2 or more $14,300 $2,500 $4,500 $11,400 $14,300 $14,300
EMERGENCY/URGENT SERVICES
Emergency Room
— Cost-sharing waived if admitted (Inpatient
cost-sharing applies).
$350 (after ded) ▲ $150 $205 $400 $400 $300
Urgent Care $75 (after ded) ▲ $15 $30 $60 $75 $60
OUTPATIENT PROFESSIONAL SERVICES ‡
Office Visit — Preventive Care
— Includes prenatal and first postpartum exam. No Charge No Charge No Charge No Charge No Charge No Charge
Office Visit — Primary Care $35 $0 $10 $20 $20 $15
Office Visit — Specialty Care $80 (after ded) ▲ $10 $30 $55 $55 $35
Office Visit — Other Practitioner Care $35 $0 $10 $20 $20 $15
Habilitative Services 40% (after ded) ▲ 10% 20% 30% 30% 20%
Rehabilitative Services
40% (after ded) ▲ 10% 20% 30% 30% 20%
Mental / Behavioral Health Services $35 $0 $10 $20 $20 $15
Substance Abuse Services $35 $0 $10 $20 $20 $15
Dental Services Related to Accidental Injury 40% (after ded) ▲ 10% 20% 30% 30% 20%
Molina Marketplace 2017 Choice Plan Benefits At-A-Glance
2017 Molina Marketplace - Texas
Choice & Options
Bronze Silver 100 Silver 150 Silver 200 Silver 250 Gold
2017 MP
ConsumerChoice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
Outpatient Professional & Facility
— OP Surgery
— OP Non-Surgical Services 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
Specialized Scanning Services (CT/PET Scan, MRI)
40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
Radiology Services (X-rays) $80 (after ded) ▲ $10 $30 $55 $55 $35
Laboratory Tests $35 (after ded) ▲ $10 $10 $35 $35 $15
Mental / Behavioral Health
— Outpatient Intensive Psychiatric Treatment Programs 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
INPATIENT HOSPITAL SERVICES
Medical / Surgical, Maternity, Mental/Behavioral
Health, Substance Abuse, Skilled Nursing Facility 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
PRESCRIPTION DRUGS §
Tier 1 - Formulary Generic $33 $2 $5 $10 $10 $15
Tier 2 - Formulary Preferred Brand $65 (after ded) ▲ $15 $30 $55 $55 $50
Tier 3 - Formulary Non-Preferred Brand 50% (after ded) ▲ 20% 30% 40% 40% 30%
Tier 4 - Formulary Specialty (Oral & Injectable) 50% (after ded) ▲ 20% 30% 40% 40% 30%
Tier 5 - Formulary Preventive No Charge No Charge No Charge No Charge No Charge No Charge
ANCILLARY SERVICES
Durable Medical Equipment 40% (after ded) ▲ 10% 20% 30% 30% 20%
Home Healthcare
— Limit 20 visits per cal year. No Charge (after ded) ▲ No Charge No Charge No Charge No Charge No Charge
Emergency Medical Transportation
(Ambulance) 40% (after ded) ▲ 10% 20% 30% 30% 20%
OTHER SERVICES
Dialysis Services $80 (after ded) ▲ $10 $30 $55 $55 $35
Notes:
Green highlighting indicates that no Ded applies
▲Ded Applies. Ded is waived, except where indicated
‡ General Medical care provided by a Participating Provider
§Mail-order Rx drugs available for 2016 for tiers 1, 2, 3, and 5. For mail-order Rx, a 90-day supply is provided at twice the 30-day retail cost-sharing amount.
Referral vs. Authorization Referral • Molina Healthcare does not require referrals for contracted specialists. • In referring a patient, the PCP should forward pertinent member information and
findings to the specialist. • Some specialists may require referrals (however Molina does not)
Authorization • designed to assure the medical necessity of service, prevent unanticipated denials
of coverage, • ensure participating providers are utilized, and • all services are provided at the appropriate level of care for the member’s needs.
Notification • Notifications is required by Molina Healthcare for specified services as long as:
The requirement complies with Federal or State regulations, and the Molina Healthcare Hospital or Provider Services Agreement
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Pharmacy Highlights 1. New Mail Order Benefit
Improves affordability and access
Applies to Tiers 1,2,3, and 5
(Specialty Drugs excluded)
Easy On-line Ordering
2. Lower Copay for Generics Removes financial barriers to care
3. New Rx tier for Preventive Drugs
available at $0 copay Helps members know which
prescriptions are No Charge
4. New Expedited Review for Non-
Formulary Drugs Decision must be provided within 72
hours for standard requests and
within 24 hours for urgent requests
Improves member access to non-
formulary drugs
5. Prior authorization may be required
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Welcome to MolinaHealthcare.com
Member Tab (RX Formulary and MyMolina)
Ways to Pay MORE THAN 400
walk-in locations
statewide that
take CASH
To find a MoneyGram
location near you, Click
Here. Please take the
information below with
you to your MoneyGram
Location
Check MoneyGram
website for
acceptable payment
BILLER NAME : Molina
Healthcare of WI
Receive Code : 14360
No
feesWalk-in locations
nationwide
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Online Provider Search
www.molinahealthcare.com
or directly at
https://eportal.molinahealthcare.com/Provider/ProviderSearch?RedirectFrom=MolinaStaticWeb
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HOSPITAL NETWORK – Dallas
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NAME OF PROVIDERS LOCATION
Hunt Regional Community Hospital (Pending) Dallas
Hunt Regional Medical Center (Pending) Dallas
Parkland Memorial Hospital Dallas
Wilson N. Jones Regional Medical Center Dallas
Dallas Medical Center Dallas
Dallas Regional Medical Center Dallas
Navarro Regional Hospital Dallas
Doctors Hospital at White Rock Lake Dallas
Centennial Medical Center Dallas
Lake Pointe Medical Center Dallas
Walnut Hill Medical Center Dallas
Crescent Medical Center Lancaster Dallas
Texas Scottish Rite Hospital for Children (Pending) Dallas
HOSPITAL NETWORK – Houston
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NAME OF PROVIDERS LOCATION
BEN TAUB HOSPITAL Harris
CYPRESS FAIRBANKS MEDICAL CENTER
Harris
HARRIS COUNTY HOSPITAL DISTRICT Harris
HOUSTON NORTHWEST MEDICAL CENTER
Harris
LYNDON B JOHNSON HOSPITAL Harris
NORTHWEST HEALTH CENTER Harris
PARK PLAZA HOSPITAL Harris
ST LUKES HOSP VINTAGE Harris
ST LUKES LAKESIDE HOSPITAL Harris
ST LUKES PATIENTS MEDICAL CENTER Harris
ST LUKES SUGAR LAND HOSPITAL Harris
ST LUKES THE WOODLANDS HOSPITAL Harris
HOSPITAL NETWORK – Rio Grande Valley
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Provider Name Specialty County CityMEMORIAL MEDICAL CENTER CHILDREN HOSPITAL CALHOUN PORT LAVACA
NEW HORIZONS MEDICAL FEDERALLY QUALIFIED HEALTH CENTER (FQHC) CAMERON BROWNSVILLE
NEW HORIZON MEDICAL CENTER FEDERALLY QUALIFIED HEALTH CENTER (FQHC) CAMERON BROWNSVILLE
BROWNSVILLE DOCTORS HOSPITAL LLC GENERAL ACUTE CARE HOSPITAL CAMERON BROWNSVILLE
VALLEY BAPTIST HEALTH SYSTEM GENERAL ACUTE CARE HOSPITAL CAMERON BROWNSVILLE
VALLEY REGIONAL MEDICAL CENTER GENERAL ACUTE CARE HOSPITAL CAMERON BROWNSVILLE
SOLARA HOSPITAL HARLINGEN - BROWNSVILLE GENERAL ACUTE CARE HOSPITAL CAMERON BROWNSVILLE
VBMC BROWNSVILLE MED CTR - 1184911877 GENERAL ACUTE CARE HOSPITAL CAMERON BROWNSVILLE
HARLINGEN SURGICAL CENTER LLC AMBULATORY SURGICAL CENTER CAMERON HARLINGEN
VALLEY ENDOSCOPY CENTER LLP AMBULATORY SURGICAL CENTER CAMERON HARLINGEN
VALLEY BAPTIST AMBULATORY SURGERY CENTER AMBULATORY SURGICAL CENTER CAMERON Harlingen
PLATINUM SURGERY CENTER AMBULATORY SURGICAL CENTER CAMERON HARLINGEN
SU CLINICA FAMILIAR - WHC FEDERALLY QUALIFIED HEALTH CENTER (FQHC) CAMERON HARLINGEN
SU CLINICA FAMILIAR-BROWNSVILLE FEDERALLY QUALIFIED HEALTH CENTER (FQHC) CAMERON HARLINGEN
SU CLINICA FAMILIAR - FQHC FEDERALLY QUALIFIED HEALTH CENTER (FQHC) CAMERON HARLINGEN
VALLEY BAPTIST MEDICAL CENTER HARLINGEN GENERAL ACUTE CARE HOSPITAL CAMERON HARLINGEN
VHS HARLINGEN HOSPITAL COMPANY LLC GENERAL ACUTE CARE HOSPITAL CAMERON HARLINGEN
HARLINGEN MEDICAL CENTER LTD GENERAL ACUTE CARE HOSPITAL CAMERON HARLINGEN
SOLARA HOSPITAL OF HARLINGEN - HARLINGEN LONG TERM CARE HOSPITAL CAMERON HARLINGEN
LOS FRESNOS MEDICINE - RHC RURAL HEALTH CLINIC CAMERON LOS FRESNOS
P I MEDICAL DAY AND NIGHT CLINIC - RHC RURAL HEALTH CLINIC CAMERON Port Isabel
RIO HONDO MEDICINE - RHC RURAL HEALTH CLINIC CAMERON RIO HONDO
NUESTRA CLINICA DEL VALLE CLINIC/CENTER HIDALGO ABRAM
PLANNED PARENTHOOD ASSOCIATION OF HIDALGO COUNTY - EDINBURG CLINIC/CENTER HIDALGO EDINBURG
SOUTH TEXAS HEALTH SYSTEM REHABILITATION UNIT HIDALGO EDINBURG
DOCTORS HOSPITAL AT RENAISSANCE GENERAL ACUTE CARE HOSPITAL HIDALGO EDINBURG
SOUTH TEXAS HEALTH SYSTEM GENERAL ACUTE CARE HOSPITAL HIDALGO EDINBURG
CORNERSTONE REGIONAL HOSPITAL GENERAL ACUTE CARE HOSPITAL HIDALGO EDINBURG
SOLARA HOSPITAL OF MCALLEN LP- EDINBURG CAMPUS LONG TERM CARE HOSPITAL HIDALGO EDINBURG
RIO GRANDE SURGERY CENTER AMBULATORY SURGICAL CENTER HIDALGO MCALLEN
ENDOSCOPY CENTER AT MED POINT AMBULATORY SURGICAL CENTER HIDALGO MCALLEN
MCALLEN SURGICAL SPECIALTY CENTER LTD AMBULATORY SURGICAL CENTER HIDALGO MCALLEN
PLANNED PARENTHOOD ASSOCIATION OF HIDALGO COUNTY - MCALLEN CLINIC/CENTER HIDALGO MCALLEN
RIO GRANDE REGIONAL HOSPITAL GENERAL ACUTE CARE HOSPITAL HIDALGO MCALLEN
HOSPITAL NETWORK – Rio Grande Valley
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MISSION VALLEY DIALYSIS CLINIC/CENTER HIDALGO MISSION
MISSION HOSPITAL INC GENERAL ACUTE CARE HOSPITAL HIDALGO MISSION
PLANNED PARENTHOOD ASSOCIATION OF HIDALGO COUNTY - SAN JUAN CLINIC/CENTER HIDALGO SAN JUAN
KNAPP SURGERY CENTER AMBULATORY SURGICAL CENTER Hidalgo Weslaco
PLANNED PARENTHOOD ASSOCIATION OF HIDALGO COUNTY - PROGRESO CLINIC/CENTER HIDALGO WESLACO
PLANNED PARENTHOOD ASSOCIATION OF HIDALGO COUNTY - WESLACO CLINIC/CENTER HIDALGO WESLACO
KNAPP MEDICAL CENTER GENERAL ACUTE CARE HOSPITAL HIDALGO WESLACO
WESLACO REHAB HOSPITAL REHABILITATION HOSPITAL HIDALGO WESLACO
ALICE PEDIATRIC CLINIC - RHC RURAL HEALTH CLINIC Jim Wells Alice
COMMUNITY ACTION CORP OF SOUTH TEXAS - PROJEC NINOS CLINIC/CENTER JIM WELLS ALICE
CHRISTUS SPOHN MEMORIAL GENERAL ACUTE CARE HOSPITAL NUECES CORPUS CHRISTI
CORPUS CHRISTI MEDICAL CENTER - NORTHWEST REGIONAL HOSPITAL GENERAL ACUTE CARE HOSPITAL NUECES CORPUS CHRISTI
CORPUS CHRISTI MEDICAL CENTER - BAY AREA GENERAL ACUTE CARE HOSPITAL NUECES CORPUS CHRISTI
CORPUS CHRISTI MEDICAL CENTER - DOCTORS REGIONAL GENERAL ACUTE CARE HOSPITAL NUECES CORPUS CHRISTI
CORPUS CHRISTI MEDICAL CENTER - THE HEART HOSPITAL GENERAL ACUTE CARE HOSPITAL NUECES CORPUS CHRISTI
KINDRED HOSPITAL CORPUS CHRISTI GENERAL ACUTE CARE HOSPITAL NUECES CORPUS CHRISTI
ROBSTOWN FAMILY CLINIC RURAL HEALTH CLINIC NUECES ROBSTOWN
FAMILY MEDICAL AND SPECIALTY CLINIC LLP FEDERALLY QUALIFIED HEALTH CENTER (FQHC) STARR RIO GRANDE CITY
SCMH ABMULATORY SURGERY UNIT AMBULATORY SURGICAL CENTER STARR RIO GRANDE CITY
PLANNED PARENTHOOD ASSOCIATION OF HIDALGO COUNTY - RIO GRAND CLINIC/CENTER STARR RIO GRANDE CITY
FAMILY HEALTH CENTER - RHC RURAL HEALTH CLINIC STARR RIO GRANDE CITY
STARR COUNTY MEMORIAL HOSPITAL GENERAL ACUTE CARE HOSPITAL STARR RIO GRANDE CITY
PEDIATRIC PRACTICE ASSOCIATION - RHC RURAL HEALTH CLINIC STARR ROMA
ROMA MEDICAL CLINIC - RHC RURAL HEALTH CLINIC STARR ROMA
GATEWAY COMMUNITY HEALTH CENTER INC FEDERALLY QUALIFIED HEALTH CENTER (FQHC) WEBB LAREDO
LAREDO LASER & SURGERY LTD AMBULATORY SURGICAL CENTER WEBB LAREDO
PLACE OF THE PEOPLE AMBULATORY SURGERY CENTER LLP AMBULATORY SURGICAL CENTER WEBB LAREDO
LAREDO DIGESTIVE HEALTH CENTER AMBULATORY SURGICAL CENTER WEBB LAREDO
LAREDO DIGESTIVE HEALTH CENTER LLC AMBULATORY SURGICAL CENTER WEBB LAREDO
LAREDO SLEEP CENTER CLINIC/CENTER WEBB LAREDO
GATEWAY COMMUNITY HEALTH CENTER INC FEDERALLY QUALIFIED HEALTH CENTER (FQHC) WEBB LAREDO
DOCTORS HOSPITAL OF LAREDO REHABILITATION UNIT WEBB LAREDO
LAREDO MEDICAL CENTER GENERAL ACUTE CARE HOSPITAL WEBB LAREDO
LAREDO SPECIALTY HOSPITAL GENERAL ACUTE CARE HOSPITAL WEBB LAREDO
DOCTORS HOSPITAL OF LAREDO GENERAL ACUTE CARE HOSPITAL WEBB LAREDO
HOSPITAL NETWORK – El Paso
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Provider Name County
El Paso Children's Hospital El Paso
University Medical Center of El Paso El Paso
The Hospitals of Providence Memorial Campus El Paso
The Hospitals of Providence East Campus El Paso
The Hospitals of Providence Sierra Campus El Paso
Broker Portal
Broker Portal Log In
• Log in to VUE Broker portal (Password resets in 60 Days)
https://molina.vuesoftware.com/PORTAL/
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Home Page:
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Book of Business: - Click the purple “Search” icon
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Health Sherpa Prospect Management HealthSherpa HealthSherpa link is for enrolling the new members
Marketplace Broker Support
Phone #: 1.855.885.3179 Broker Services - Option 1 • Provide Support and Education on:
– Agency/Agent Portal/Book of Business/Prospect Management/Direct Enrollment (DE)/SEP's (Special Enrollment Period)/CIC (Change in Circumstance)/Yearly Renewal enrollment submission
– Plan Benefit - all states - all metals
– Molina Website
• MyMolina
• Payment Options
• Provider Search
• Mobile Apps Commission Recon Team- Option 3 • Provides research and resolution to commission inquiries
• Provides research for missing clients from your Book of Business
• Processes Agent of Record Updates Contracting Inquiries - Option 4 • Agency Contracting
• Agent Onboarding
• Maintenance of E&O/Licenses/Yearly Certifications
[email protected] [email protected] [email protected]
Broker Support Unit “BSU Team”
Phone #: 1.855.885.3179 • CARE Team – Option 2 (Marketplace Broker Communication And Resolution Experts Team!)
• Access to Care
– If your Molina client is seeking immediate medical services and/or medications, you, the agent may contact the
MP CARE Team. (Please note: The CARE Team does not take member calls. Member should always reach
out to Member Services)
• Billing Issue:
– Invoice Regeneration
– Non-Applied Payment
– Refund
– Update Accounts/Receivable (A/R)
– Update Payment Application
– Binder Payment & Pending Termination Restriction Removal
• Enrollments:
– APTC Adjustment
– Eligibility
– Missing Dependent
– No Member profile
– Restriction Removal
– Voluntary Cancellation
Broker Support Unit “BSU Team”
My Molina
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© 2013 Molina Healthcare, Inc.
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© 2013 Molina Healthcare, Inc.
11111111
Mickey Mouse
11111111
Donald Duck
Daisy Duck
Daisy,
Marketplace Materials
Molina Marketplace – Co-Branded Collateral
Brochure
with BAAG
Benefits
At-A-Glance
Brochure with
Lead Card
Lead Card
2017 Open Enrollment Period
• Marketplace open enrollment dates:
November 1, 2016 – January 31, 2017
• Molina’s website www.MolinaHealthcare.com will provide 2017 plan information starting October 1, 2016
• Someone who enrolls by December 15, 2017 will have a January 1, 2017 effective date
• Some individuals may qualify for a 60 day Special Election Period (SEP)
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Questions
Broker Support Unit Phone #: 1.855.885.3179 (New number) Broker Services - Option 1 CARE Team- Option 2 Commission Recon Team - Option 3 Contracting Team – Option 4 [email protected] [email protected] [email protected] [email protected]
Contact information
Adam Grimaldo, Broker Channel Manager Phone: (818) 428-9205 Email: [email protected]
Customer Support Phone: (888) 295-7651
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