introducing humana’s 2007 medicare program presenters:paul cantrell, peggy taylor, sue suchan...
TRANSCRIPT
Introducing Humana’s 2007 Medicare Program
Presenters: Paul Cantrell, Peggy Taylor, Sue Suchan
November 2, 2006
Topics for Discussion Today Our 2007 National Presence
Key Dates
Education and Outreach
Humana’s Partners; Relationship with Wal-Mart
Our Member Value Proposition: Benefits & Services
Recruiting, Selling, Enrollment and Oversight Processes
Humana’s Medicare Products and Benefits
Contacts for Ongoing Dialogue
ME
VT
NHMA
RICT
NY
PA NJ
DEMDDCVA
NC
SC
GA
FL
ALMS
LATX
NMAZ OK
AR
Nashville
KY
OH
WV
MI
INIL
WIMN
IA
MOKS
Salt Lake City
SD
NDMT
WY
CO
UTNV
CA
ID
WA
OR
AK
HI
Milwaukee
Phoenix
Corpus Christi
San Antonio
Shreveport
Baton RougeJacksonville
Daytona Beach
Tampa
Austin
Dallas
HoustonNew Orleans
Denver
Orlando
Atlanta
LexingtonKansas City
Chicago
Louisville
TN
Cincinnati
Memphis
DaytonColumbus
South Florida
Indianapolis
Cleveland
NE
Colorado Springs
Boulder
RaleighSt. George
PUERTO RICO
2007 Medicare Markets
Local PPO & HMO Markets
PFFS & PDP States only
Regional PPO, PFFS & PDP States PDP only StatesLocal PPO only Markets
PFFS, HMO, SNP & PDP MarketsLocal HMO only MarketsLocal PPO, HMO & SNP Markets Partial county PFFS & PDP States only
Humana’s Suite of Medicare Products Humana Gold Plus
HMOHumanaChoice
PPOHumana Gold Choice
PFFSMedicare
Supplement
Primary Care Physician Yes No No No
Provider Network Smaller Network but generally increased benefits
Generally larger network; includes coverage for both participating and non-participating provider use; out-of-pocket costs increase using non-par providers
No network; members may use any doctor or hospital accepting Medicare and Humana’s payment terms and conditions
No network; members may use any doctor or hospital accepting Medicare
Referral Requirements Yes, in most cases, PCP must refer members needing specialty care
No, but some procedures, services and inpatient care still require prior authorization or pre-certification
No, but pre-certification of inpatient care and advance coverage determinations are strongly encouraged
No, Supp plan pays secondary to Original Medicare; no referrals are required
Service Area Limitations Yes, HMOs are generally located in more urban metropolitan areas and cover specific counties within that area
Yes, PPOs have a specific service area; Local PPOs are generally in more urban areas; Regional PPOs may cover an entire state or multiple states as defined by CMS
Yes, PFFS plans have specific service areas--usually state-wide; premium, however can vary by counties within the state even when benefits are the same
Yes, Supp plans are available only in states where DOI has approved; premium can vary by state and by regions within the state
World-wide emergency care coverage
Yes Yes Yes Varies by Plan
Routine vision, hearing and dental care covered
Yes Yes Yes No
Prescription drug coverage
Yes Yes Yes No
SilverSneakers or SilverSteps
Yes Yes Yes No
Humana Active Outlook Yes Yes Yes Yes
Key Dates
October 1, 2006 Plans may begin marketing 2007 benefits
October 12, 2006 Plan benefit information available on Medicare.gov
October 15, 2006 CMS mails 2007 Medicare & You Handbook
October 31, 2006 Current members are notified of benefit changes for 2007
November 15 – December 31, 2006
Annual election period (AEP)
January 1, 2007 New 2007 plan benefit period begins
January 1 –
March 31, 2007
Open enrollment period (OEP)
Humana Medicare Outreach and Education
• 8 RVs traveling through 34 states
• Senior, civic centers and select Wal*Mart locations in both urban and rural areas
• Prior to October 1, Humana sales associates were on hand to provide general educational information on PDP and MA plans as well as important dates related to the enrollment process and how Medicare beneficiaries can research prescription drug availability.
• After October 1, Humana sales associates will share information about specific Humana Medicare products.
Humana Partners
Co-branded partner - Wal*Mart
USAA
State Farm
Humana - WalMart Relationship Co-branded relationship since 2005
Humana full-service workstations in approximately 2,100 Wal-Mart/Sam’s Club stores. Manned by licensed, appointed reps who use CMS-approved materials.
Humana informational kiosks being piloted in 100 Wal-Mart/Sam’s Club locations with basic plan benefit information. Where possible, these will provide direct phone access to Humana licensed telephone sales reps for information and agent appointment requests.
Located in highly visible, general merchandise areas.
Both station types are clearly identified as Humana Medicare sites and those staffed with agents are available for both walk-ins and appointments.
Adding Value to our Products
Guiding our members in using their benefits
New member Welcome Kit Wide range of Value-Added Services Local presence in most markets New Member Orientations and “Re-Orientations” Continuing education throughout the year; not just during open
enrollment Meeting beneficiaries where they are: shopping, at home,
community sites, on the phone or in person
New Member Welcome Kit
New for 2007 –Mailing a personalized package to all members to simplify and improve the new member experience. Packet includes:
Welcome letter Copy of application Summary of benefits Privacy notice Access to benefits instructions Abridged Formulary Geo-access directory (non-HMO) Member handbook Description of all value added services RightSource (mail order) brochure Humana Active Outlook brochure
Humana – Value Added Services
Services beyond traditional benefits:
SilverSneakers Fitness Program
Humana Active Outlook Program Cooking and nutrition classes SilverSneakers Plus
Posit Science Brain Fitness Program
SmartSummaryRx Statements
MyHumana.com
Other value-added services and opportunities that may vary by market, region or product
Humana PDP SmartSummary
Unique, monthly statement with detailed accounting of medications and prescription costs.
Suggestions for cost savings, including less expensive medication alternatives, mail order.
Educational articles about relevant chronic conditions
Members approaching the coverage gap also receive outbound calls to better prepare financially.
What You Should Know about the Enrollment Process
Sales Agent presentation with application– Paper application– Electronic enrollment using a digital signature– Telephonic enrollment
On-line application through our website – www.Humana.com
On-line application through the CMS at the Medicare website – www.Medicare.gov
What You Should Know About Humana Sales Agents
All agents—both employed and independent--are state licensed, certified, registered and appointed.
All agents selling Medicare products required to attend sales and ethics training prior to the sale of our products.
Background check conducted on all agents appointed to sell Medicare products.
Required testing and certification for all agents prior to selling – initially and annually thereafter. Must sign Code of Conduct.
Allegations of agent misconduct or misrepresentation are thoroughly investigated pursuant to rigorous policies and procedures.
Agent conduct monitored. Consequences for founded violations of company policy and/or regulations can include disciplinary corrective action and contract termination.
What You Should Know about the Sales Presentation
Sales presentation includes:
Specific plan information including all Humana MA, MAPD and PDP products
Full disclosure of all enrollment options
Marketing materials that follow CMS requirements; are filed and approved by CMS prior to their use
Information about enrollment considerations including a beneficiary needs analysis and suitability assessment
Enrollment applications clearly identify the type of product and product name
A non-sales associate-initiated telephonic or written verification process is conducted to determine the enrollee’s understanding of the product purchased
Medicare Advantage Plan Options in [state]
Humana Gold Choice PFFS Low Option - Premium Range: $0Primary Care Physician OV – $[15] copaySpecialty Physician OV - $[30] copayOutpatient Hospital – [20%] coinsuranceInpatient Hospital – $[550] per stay
Humana Gold Choice PFFS High Option - Premium Range: $20Primary Care Physician OV – $[15] copaySpecialty Physician OV - $[30] copayOutpatient Hospital – $[0-100] copayInpatient Hospital – $[180/day for days 1-5]
HumanaChoice Regional PPO - Premium $69 Primary Care Physician OV – $[10] copay for network / $[35] copay for non-networkSpecialty Physician OV - $[30] copay for network / $[35] copay for non-networkOutpatient Hospital – $[50-95] copay for network / [30%] coinsurance for non-networkInpatient Hospital – $[550] per stay for network / $[750-$800] per stay non-network*
* $[750] if pre-certified; $[800] if not pre-certified
Humana Gold Choice Private-Fee-For-Service
Defining a Medicare Advantage Private Fee-For-Service (PFFS) Plan:
Includes the same basic Medicare Part A & B benefits
and payments as Original Medicare; generally, lower out of pocket costs overall.
Unlike Original Medicare, it is administered by a private insurance company like Humana.
Usually includes value-added services that are not part of Original Medicare.
May have Part D Prescription Drug coverage included.
More on Private Fee-For-Service
Plan and provider reimbursements:
Medicare pays Humana a monthly, fixed payment for each Medicare-eligible enrolled in the plan.
Humana then pays the doctor, hospital or other providers for services rendered to its members.
Humana’s PFFS plan pays 100% of Medicare allowable, less any applicable member copay or coinsurance amount.
More on Private-Fee-For-ServiceHow does a PFFS plan work?
There is no doctor or hospital “network” or directory for medical care.
PFFS members, however, do receive a pharmacy directory and must use a network pharmacy to obtain prescription drugs.
Providers must be licensed and eligible to receive Medicare plan payments.
Providers must agree to Humana’s terms and conditions, including acceptance of payment from Humana and agreement not to balance bill patients for Medicare-covered services if accepting Medicare assignment.
Providers who don’t accept Medicare assignment may bill the patient up to the limiting charge.
More on Private Fee-For-Service
What if a member finds his/her doctor or hospital does not accept Humana’s PFFS plan?
Physician and hospital participation is voluntary
Medicare beneficiaries are encouraged to contact their providers to determine if their doctors and hospitals accept or will accept Humana’s PFFS payment.
Humana provides outreach and education to help physicians and hospitals understand the PFFS billing process and how the plan works.
Members can request that a Humana Provider Relations Representative contact their health care providers to encourage their acceptance of the plan.
Ongoing Dialogue
Establish an ongoing dialogue:– Updates on new information– Questions– Issue resolution
Regulatory Compliance Contact:Sue Suchan
Phone: [386] 676-1831Fax: [904] 376-7798E-mail: [email protected]
Government Relations Contact:Harry Spring
Phone: [850] 224-9996Fax: [850] 224-9998E-mail: [email protected]