humana one health plans for individuals and families

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HumanaOne health plans for individuals and families

AGENT USE ONLY

Product Portfolio Map

• HumanaOne New Business States

TX

AZ*

CO

IL

FL*

GA

LA

MOKS

NEIN

WI*

MS

SC

NC

OH

MI*

AR

KY

TN

UTNV

OK

AL

VA

Old Plans

NM

New Plans

* Association States – AZ, FL, MI, WI

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Portability

• If a client has a child who attends college in another state, that child will receive in-network benefits by seeing an in-network provider

• If a client moves to another state they can take their policy with them even if HumanaOne is not sold in that state

• This is not the case for new sales in FL Open Access counties, WI Coalition Counties and GA policies

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HumanaOne Individual Health Plans(OLD PRODUCTS)

Alabama, Arkansas, Illinois, Indiana, Kansas, Kentucky, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Ohio,

Oklahoma, South Carolina, Tennessee and Virginia

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PORTRAIT Share 80 Plus Rx Unlimited

• 80% coinsurance

• Deductibles:

– single: $1,000; $2,500

– family: $2,000; $5,000

• Unlimited doctor visits

• Separate $500 Rx deductible

– $0 Rx deductible buy-up option

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AUTOGRAPH Share 80 Plus Rx

• 80% coinsurance

• Deductibles:

– single: $3,500; $5,000; $6,000

– family: $7,000; $10,000; $12,000

• Six office visits, then 80% after deductible

• Separate $1,000 Rx deductible

– $500 Rx deductible buy-up option

• 35% reduction in premium over Portrait!

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Rx benefit for Portrait and Autograph Plans

• Level 1: $15 copay ONLY

– no deductible

– 38% of Rx claims fall into Level 1

• Separate $500 (Portrait) or $1,000 (Autograph) deductible then copay:

– Level 2: $35 copay

– Level 3: $55 copay

– Level 4: 25% copay (Up to $2,500 maximum out-of-pocket per person per calendar year)

• Option to buy up to a $0 deductible on Portrait or a $500 deductible on Autograph.

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Office Visit Co-pay

• Doctor visits for injuries / illnesses

• UNLIMITED Office Co-pays (Portrait) or 6 Co-pays per person (Autograph Share 80 Plus Rx)

• $35 co-pay for primary care physician

• $50 co-pay for specialist

• $200 allowance for diagnostics and labs at 100% before deductible

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AUTOGRAPH Total Plus Rx / HSA

• HSA-Qualified

• 100% coinsurance

• Deductibles:

– single: $1,500, $2,500, $3,500; $5,000

– family: $3,000, $5,000, $7,000, $10,000

• Rx expenses integrated with medical deductible

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AUTOGRAPH Total / HSA


• Deductibles:

– single: $2,000, $3,000, $4,000; $5,200

– family: $4,000, $6,000, $8,000, $10,400

• No Rx benefit; but discount card

– Use HSA to fund discounted prescriptions

– Allows for favorable UW and rate-ups are avoided

• Does not cover mental health (except where mandated by the state)

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MONOGRAM Total Plus Rx


• Deductibles:

– single: $7,500

– family: $15,000


– Same Rx tier structure with slightly higher copays on tiers 2-4 (see your benefit summary)

Monthly premium for a 25 year old

male = $51.72

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Back by popular demand - Share 70 Plus Rx

• 70% coinsurance

• Deductibles – Single: $2,500 or $5,000

– Family: $5,000 or $10,000

• Out-of-pocket maximum coinsurance

– Single: $3,000

– Family: $6,000


• Available in CO, FL, GA, MI, TX, WI

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Important Notes

• If an applicant has not had coverage in the last 63 days

– Earliest effective date is 30 days from the date of complete application

– UW will complete a “not replacing” questionnaire

• If an applicant has not had coverage in the last 2 years

– Underwriting will require the applicant to have a physical examination prior to application

Applicants Who Are Not Replacing Coverage

Other Notes

• Integrated 4th Quarter deductible carry-over on non-HSA plans

• Optional Benefits covered in next section with New Plan Designs

– Dental, Term Life and Supplemental Accident Coverage

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HumanaOne Individual Health Plans(NEW PRODUCTS)

Arizona, Colorado, Florida, Georgia, Louisiana, Michigan, Texas, Utah and Wisconsin

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What’s different?

• Deductibles

• Benefits

• Waiting periods

• Effective dates

Based on your feedback

and our members needs,

we made the following

enhancements to our

portfolio, to include:

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In-network coinsurance and deductibles are shown

Enhanced Copay 80% (Similar to Portrait)

• 80% coinsurance

• Deductibles

– Single: $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000

– Family: Once three family members meet their single deductibles, the family deductible will be met for all other family members

• Out-of-pocket maximum coinsurance– Single: $2,500 / Family: $5,000

• Unlimited doctor office visits$35 copay primary care physician/$60 copay specialist

– $60 copay for an urgent care visit

• Separate $500 Rx deductible (buy-up to $150)

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Copay 80% (Similar to Autograph Share 80 Plus Rx )

• 80% coinsurance

• Deductibles

– Single: $3,500, $5,000



• Six doctor office visits

– $35 copay primary care physician /$60 copay specialist


– After six visits then 80% after deductible

• Separate $700 Rx deductible (buy-up to $300)

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Copay 70% (Similar to the Autograph Share 70)

• 70% coinsurance

• Deductibles

– Single: $1,500, $2,500, $5,000



• Three doctor office visits $35 copay primary care physician /$60 copay specialist


– After 3 visits then 70% after deductible

• Separate $1,000 Rx deductible (buy-up to $500)

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Optional benefits

• Buy-up options:

– Rx deductible buy-up options (Enhanced Copay $150, Copay 80% $300, Copay 70% $500)

• Plan add-on options:

– Supplemental accident ($1,000 and $2,500)

– Dental

– Term life insurance

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Value 100% (Similar to Monogram)


• Deductibles

– Single: $5,000, $7,500


• $2M lifetime coverage (buy-up to $5M)


• Perfect plan for first time insurance buyers and those not yet eligible for Medicare

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Optional benefits



– Dental


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Enhanced HSA 100% (Similar to Autograph Total Plus Rx HSA)


• Deductibles

– Single: $1,500, $2,500, $3,500, $5,000, $5,950

– Family: Benefits will be paid once the family deductible is met, regardless of the number of members on the plan

• Rx expenses integrated with medical deductible

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HSA 100% (Similar to Autograph Total/HAS)

• Deductibles

– Single: $1,500, $2,500, $3,500, $5,000, $5,950

– Family: Benefits will be paid once the family deductible is met, regardless of the number of members on the plan

• No Rx benefit; discount card available at up to 25% savings

• Does NOT cover mental health (except where mandated by state)

• Applicants will NOT be rated up for current Rx medications

• Coverage for spinal manipulations, adjustments and modalities is not included (except where mandated by the state)

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Optional benefits



– Dental


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Reform Changes to Benefits

• Plans sold on or after Sept. 23, 2010 (excluding HumanaOne Short Term Medical plans) will have the following benefit changes:

– Plans will have an unlimited lifetime maximum benefit

– Plans will cover in-network preventive care services at 100 percent, and there will be no dollar limit on coverage for in-network preventive care services

– Plans will have no limit on coverage for ambulance services

• Plans will have no dollar limit on coverage for mental health care

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Prescription and optional benefits

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Prescription benefit: Rx4

• Level 1: $15 copay (No deductible applies- copay only)

– 50% of all Rx claims fall into Level 1

• Level 2: $35 copay ($40 copay for Copay 70% and Value 100%)


• Level 3: $60 copay ($65 copay for Copay 70% and Value 100%)


• Level 4: 35% copay

– Up to $5,000 copay maximum, level 4 only out-of-pocket expense per person per calendar year

– No maximum that Humana will dispense

– Less than 1% of all Rx claims fall into Level 4

Separate prescription deductible applies for Levels 2 through 4:

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Prescription benefit: updates

• Brand vs Generic

– If a brand name drug is dispensed when there is a generic equivalent, the member is responsible for paying the generic copay plus the difference in cost between the brand & generic Rx

– If member selects a generic drug, this helps to reduce theirs cost without sacrificing care

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Supplemental Accident Benefit option

• $1,000 or $2,500 benefit choice is provided for accidental injuries only

- Old product has $500 or $1,000 benefit

• Treatment must be administered within 90 days of the accident

• Not subject to deductible or coinsurance - first dollar coverage administered before applicable co-pays

• After benefit amount is exhausted, remaining charges are applied to the medical policy provisions

• No limit on number of accidents per year

• Ideal supplemental benefit to add on to higher deductible plans!

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Dental optionDental options

• Complete dental benefits as an optional rider – your client chooses the type of coverage that meets their needs

– Optional, can continue even if medical plan terminates

– Can add anytime; including renewal

• No additional underwriting required

– Dental will not be rated up if medical is rated up

• Separate dental ID card and contract

• Up to 27% discount at in-network providers

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Waiting periods, limitations and exclusions may applySee your benefit summary for complete details and covered services

Dental Traditional Plus

• Preventive Services: Plan pays 100% no deductible– Oral exams

– Routine cleanings

– X-rays

• Basic Services: Plan pays 50% after deductible– Emergency exams

– Composite fillings

– Oral surgery

• Major services: Plan pays 50% after deductible– Crowns

– Root Canals

– Dentures

• Other benefits: Orthodontia discount

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Dental Preventive Plus

• Preventive Services: Plan pays 100% no deductible– Oral exams– Routine cleanings– X-rays– Sealants and fluoride treatments

• Basic Services: Plan pays 50% after $50 deductible (six-month waiting period applies)*

– Extractions– Space maintainers– Composite fillings– Oral surgery

• Annual Maximum (excludes discount services) $1,000

• Discount services– Receive a discount on services not covered under this plan.

Savings average 27% nationwide on in-network services including Orthodontia services

• Checkbox add-on in AZ, CO, MI, UT, WI

* Please refer to your state specific summary as benefits may vary

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Term Life option

• Simple, convenient process

• Amounts start at $25,000 up to $150,000

• Combined Medical/Life Application - If your clients are approved for a health plan they are approved for life as well (up to $150K)

• 10, 15, and 20-year level premiums

• Rates are guaranteed for the full term of the policy

• Renewable to age 95 after the level premium period

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HumanaOne plan enhancements

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New plan enhancements

• Preferred rating: our best rate for applicants who are in good health overall, take no current medication (except birth control), and who have had major medial coverage within the past 63 days (proof may be required)

• Standard rating: applicants who don’t qualify for the preferred rating and/or have minor ongoing medical conditions

• Stardard+ rating: applicants who are in fair health and require additional rating due to moderate medical conditions

Rate classes HumanaOne offers three competitive rate classes for its medical products. These classes are:

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• Replacing coverage (current or within past 63 days)

• Non tobacco

• Non ratable build

• No actionable conditions (CSD, rate, rider)

• No maintenance medications

• Primary and spouse 18 and older

Preferred rating A member will receive a preferred rate – 10% savings if they are:

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• Chiropractic maximum:

– Separate 10-visit spinal manipulations, adjustments and modalities maximum that doesn’t reduce outpatient therapy benefit

– Benefits no included in the HSA 100% (except where mandated by the state)

• Outpatient therapy benefit maximums:

– 30-visit outpatient therapy benefit now includes cardiac rehabilitation and respiratory therapy in addition to Physical therapy /Occupational therapy/Speech therapy, cognitive, and audiology therapy

Separate maximums

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• CSDs are at the member level

• Prescription drugs do not apply to the CSD

• Members will receive the Humana network discount

• Once the CSD is met, benefits are payable at 100% for the calendar year

Condition specific deductibles

Allows members to receive benefits for conditions that were typically excluded from coverage based on underwriting review

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• No longer moving the effective date forward 30 days

• Applicants will start with a plan (injury) effective data and a sickness effective date

• If applicant had a least 63 days of prior coverage at time of application, the sickness effective date will not apply

• Sickness effective date is the 15th day after the policy effective date for bodily injury

• Sickness effective date is issued at the member level

Sickness effective date

Applicants will have peace of mind knowing they are covered for an injury immediately after policy issue

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Additional enhancements

• Emergency Room services

– Access fee ranging from $100-$125 (depending on plan) then paid at the coinsurance level after deductible. Access fee is waived if admitted into the hospital

• Separate Mental Health Deductible

– Equal to the plan single/family deductible (includes Mental Illness, Alcohol and Chemical Dependency)

• Surgery Waiting Periods

– No more waiting periods as a result of introducing the separate Condition specific deductible

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Member discountsHumanaOne’s discounts

• Up to 35% on vision eyewear

• Up to 30% on alternative treatments like acupuncture and massage services

• Up to 25% on OTC and Rx medications

• Up to 20% on health living services such as health club facilities

• Clients can access these discounts through MyHumana

• If your client selects a plan without a prescription benefit, or if a prescribed medication is not covered under their pharmacy benefit they will still receive the Humana discounted rate on the drug – just by being a member. Discounts average around 20%

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Associations and HumanaOne

• The new HumanaOne plans require membership in the Peoples’ Benefit Alliance*

• Peoples’ Benefit Alliance provides:

– Member education (www.peoplesbenefitalliance.com)

– Discounts on goods and services

• $3.95 per month appears on member’s bill

• Required in AZ, FL, MI, WI

Peoples’ Benefit Alliance (PBA)

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Underwriting

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Pre-Existing Conditions

• We will waive the pre-existing conditions limitation for those conditions disclosed on the application provided benefits relating to those conditions are not excluded.

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Other Important Notes

• Eligible Ages

– 2 weeks to 64 ½ years old

– No Child Only Applications

• Effective Dates

– Any day of the month including the day they apply

– Up to 45 days in advance

– Special rules for those not replacing coverage

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Process for underwriter

• Review Third Party Data

– MIB (Medical Information Bureau)

– Prescription Information

– Claims History

• Make a Decision

– Standard

– Standard with Amendment

– Modified

• Rating

• Exclusion rider (state specific)

• Remove one or more of the family members

– Decline

– Request Additional UW Requirements

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When do we need requirements?

• Medical Records (<15%):

– Not replacing coverage & recent medical care

– Chronic type conditions

– Information obtained from 3rd party data

• Parameds (<10%):

– Applicant is close to 50% ratable or declinable build

– Information obtained from 3rd party data

• Additional Information

– Blood Pressure/Cholesterol Readings (when applicants’ answer “don’t know”).

– Test Results

– Physician or treatment information.

– Third Party Data review/validation

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Factors that drive different offers

• Plan design

• Premium

• Type of current treatment

– Brand or Generic prescription(s)

• Overall health history

Example: Asthma can go anywhere from a standard offer to a decline

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Opportunity – Financial Protection Products

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Humana Financial Protection products

• Further diversify your product portfolio

• Wider selection of products to offer your clients based on their varying budgets and needs

• Our consumer-focused products are simple to understand, easy to obtain, affordable, and transparent

• Cross sell: huge potential for consumers to purchase multiple products

• With health reform, consumers will be considering added protection for their personal and financial health

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Life coverage: Memorial Fund*

• A whole life plan to offset final expenses; available in benefit amounts from $1,000 − $25,000

• Offers a graded death benefit with level premiums for prospects with health issues (becomes level after the third policy year)

• Guaranteed cash value

• Coverage for issue age is 45 − 80 (nearest age)

• Premium options are life pay or 10-year pay

* Product availability will vary by state.

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Health coverage: Critical Illness Cash plan*

• Pays lump-sum cash benefits for critical illnesses such as heart attack, stroke, and cancer

• Benefit amount from $5,000 − $50,000

• Same lump-sum amount paid for all covered family members

• Issue ages 0 − 69 (may vary by state)

• Pays in addition to any benefits client already has

• Guaranteed renewable

• 30-day free look

• Optional Return of Premium rider


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Health coverage: Hospital Cash plan*

• Provides lump-sum benefits directly to client for:

– Hospital confinement

– Outpatient surgery

– Accidental injury or sickness

• Issue ages 0 − 69 (may vary by state)

• Guaranteed renewable to age 70

• Lump-sum hospital confinement from $250 − $2,000

• Maximum coverage $2,000 for all in-force policies

• $150 lump-sum accidental injury and sickness benefit per emergency room visit

• $150 lump-sum outpatient surgery benefit

• Optional hospital confinement daily benefit rider: $50 ($200 ICU); $100 ($400 ICU; $200 ($800 ICU)


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Questions

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Quoting

Quoting and Enrollment

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• To create a quote go to humanaoneagentquote.com

• Enter Humana Agent SAN and click Next.

www.Humanaoneagentquote.com• Use for quoting and enrollment only

• Agent can not reassig the quote to another agent

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Your Humana Agent number is required forregistration and can be found:– On your welcome letter after appointment– On your commission statement– From the Agent Service Center

www.humana.comSimple Registration Process!

Agent Workbench

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Accessing Agent Workbench

• If you have not yet registered for AWB, click Agents & Brokers

• Then click Register for Agent Self-Service and follow the instructions

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• Log onto www.humana.com

• Enter your username and password

• Click Log In

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• To begin a quote, hover over Generate a New Quote in either of the two locations and select a product:

– Medical (Health and STM)

– Stand Alone Dental and Vision

– Supplemental Insurance

– Stand Alone Life

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Generate a Quote Agent Workbench or humanaoneagentquote.com

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Generate a Quote

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Generate a Quote

• Once the quote is saved, the quote can be printed, e-mailed or applied for.

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Application Methods

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How Can Clients Apply?

Clients can apply two different ways:

1. Agent Initiated Application (AIA) – Online with your assistance

2. Agent Online Application (AOA) – Online, on their own

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Agent Initiated Application

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• On the agent disclaimer screen, the agent must read and agree to all statements by checking the boxes.

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• Enter the information for all applicants on the applicant details screen.

• Select which signature type the client wishes to use: e-signature or wet-signature. Click Next

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• The application is now ready to send to the client. In order to provide your client with a link to review and sign their documents, the agent must click Send E-mail.

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Signing an Agent Initiated App

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E-Signature Process

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E-Signature Process

• Your client will need to click on the link within the email. A new browser window will open.

• The application number will pre-populate. Your client will enter the required information and click Next.

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E-Signature Process

• The applicant(s) are required to read and agree to the Online Service Agreement and the Notice of Privacy Practices.

• They should review each document and click the checkboxes next to their name. Click Next.

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E-Signature Process

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Track Quotes and ApplicationsAgent Workbench

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Track Quotes and Applications

• Agents can access Track Quotes and Applications to view status up to the point of payment verification.

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• There are several different searches you can do:

– main search

– search for quotes

– search for applications

– search agent initiated apps

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• Enter your search criteria

• Search results can also be exported into excel

• Status Information

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Opening a Saved Application

1. Click on Track Quotes and Applications

2. Click on the Agent Initiated Applications tab.

3. Find the app to be completed in the search queue and click its Quote Ref #. The application will open to the next step you need to complete in the app process.

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Issued Business Tab

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humana one health plans for individuals and families

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