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Journey on.

2017

Medicare AdvantageBroker Product

Training

CarePlus

Welcome

Welcome

• Today will be an overview of new options and major changes for 2017

• Full product training will remain online• Too much information for one meeting• Available 24/7 as a reference• We will update training if there are changes and notify you

CarePlus

Legal Stuff

Confi dentiality

• The following information is confi dential. CMS prohibits release of any of this information to potential or existing clients prior to October 1st, 2016. Doing so will result in a CMS marketing violation.

Medicare Advantage Plans | True Blue® HMO

Why Blue Cross of Idaho?

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Excellence/Stability

• More Idahoans choose us than any other company• We’ve offered Idaho health insurance for over 70 years• We’ve offered Medicare Advantage plans since the program began in 1997

• True Blue (HMO) has a respected 4-Star quality rating from CMS

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Access

• We contract with more providers in Idaho than any other plan• No referrals required to see in-network specialistsfor any of our plans

• Members can choose to see any in-network provider, which includes all of Idaho’s major health systems


What’s new?

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What’s new?

New Plans

• True Blue Rx (HMO)• Lower premiums• $0 Medical and Part D deductibles• $15 PCP copay• $0 copay for preferred generic drugs

• Medicare Supplements (Medigap) plans available STATEWIDE• Competitively priced• We will offer plans A, F, K and N


What’s Changing?

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What’s Changing?

• We’re reducing our Medicare Advantage (MA) Idaho footprint in rural counties

• MA plans no longer offered outside of Service Area 1 and 2 including MA-only plans True Blue No Rx, Secure Blue No Rx, plus True Blue Freedom II. Members enrolled in these plans will receive letters of non-renewal

• Members of True Blue Connected Care, and Secure Blue Idaho will also receive letters of non-renewal in areas 1 and 2

• Medicare Supplements will be available Statewide

2017

Service Area 1

Service Area 2

Boundary

Bonner

Kootenai

Benewah

LatahClearwater

Idaho

Valley

Boise

Owyhee

ElmoreAda

GemCanyon

TwinFalls Cassia Oneida

Lemhi

Custer

BlaineCamas

Good

ing

Lincoln

Jerome

Butte

Clark Fremont

JeffersonMadison

Teto

n

Bonneville

Bingham

PowerBannock

Caribou

Franklin

BearLake

Min

idok

a

Adams

Washington

LewisNez Perce

Shoshone

Payette


Market Opportunity

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Area 1 Opportunity2017

Service Area 1

Boundary

Bonner

Kootenai

Benewah

LatahClearwater

Idaho

Valley

Boise

Owyhee

ElmoreAda

GemCanyon


Lemhi

Custer

BlaineCamas

Good

ing

Lincoln

Jerome

Butte

Clark Fremont

JeffersonMadison

Teto

n

Bonneville

Bingham

PowerBannock

Caribou

Franklin

BearLake

Min

idok

a

Adams

Washington

LewisNez Perce

Shoshone

Payette

Service Area 1Ada, Boise, Bonner, Boundary, Canyon, Clark, Elmore, Gem, Kootenai, Nez Perce, Owyhee, and Payette

• Approximately 100,000 Medicare Benefi ciaries are not currently enrolled in Medicare Advantage plan

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Area 2 Opportunity2017

Service Area 2

Boundary

Bonner

Kootenai

Benewah

LatahClearwater

Idaho

Valley

Boise

Owyhee

ElmoreAda

GemCanyon


Lemhi

Custer

BlaineCamas

Good

ing

Lincoln

Jerome

Butte

Clark Fremont

JeffersonMadison

Teto

n

Bonneville

Bingham

PowerBannock

Caribou

Franklin

BearLake

Min

idok

a

Adams

Washington

LewisNez Perce

Shoshone

Payette

Service Area 2Bannock, Bingham, Bonneville, Cassia, Fremont, Jefferson, Madison, Minidoka, Power, and Twin Falls

• Approximately 52,000 Medicare Benefi ciaries are not currently enrolled in Medicare Advantage plan

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Out-of-Market Opportunity2017

Out-of-Market

Boundary

Bonner

Kootenai

Benewah

LatahClearwater

Idaho

Valley

Boise

Owyhee

ElmoreAda

GemCanyon


Lemhi

Custer

BlaineCamas

Good

ing

Lincoln

Jerome

Butte

Clark Fremont

JeffersonMadison

Teto

n

Bonneville

Bingham

PowerBannock

Caribou

Franklin

BearLake

Min

idok

a

Adams

Washington

LewisNez Perce

Shoshone

Payette

Out-of-Market Area (formerly Area 3)Adams, Bear Lake, Benewah, Blaine, Butte, Camas, Caribou, Clearwater, Custer, Gooding, Idaho, Jerome, Latah, Lewis, Lincoln, Oneida, Shoshone, Teton, Valley and Washington

• Approximately 45,000 Medicare Benefi ciaries living here who will need health coverage

• Great opportunity to offer Medicare Supplement plans


True Blue Family

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True Blue Plans

True Blue Rx (HMO) NEW!True Blue Rx Option I (HMO)True Blue Rx Option II (HMO)True Blue no Rx (HMO)


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Why True Blue Rx

Value Proposition

True Blue Rx is an affordable planfeaturing inexpensive prescriptions

and Idaho’s largest provider network, providing you open access

to any in-network hospital system you want—at any time.

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True Blue Rx Talking Points

Choice

True Blue Rx is an open HMO network, with no referrals required.See the in-network doctors you want.

You can see doctors at all major health systems.

*Prior Authorizations for some services are still required

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True Blue Rx Talking Points

Patient-Centered

Members who are part of True Blue’s patient-centered plantend to get the care they need,

because a PCP helps them navigate.


Summary of Benefi ts

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True Blue Summary of Benefi ts

Premiums and Benefits True Blue Rx (HMO) True Blue Rx Option I (HMO) True Blue Rx Option II (HMO) True Blue no Rx (HMO)

Plan Number H1350-019-1 and H1350-019-2 H1350-015-1 and H1350-015-2 H1350-016-1 and H1350-016-2 H1350-006-0

Monthly Plan Premium You must continue to pay your Medicare Part B premium.

Service Area 1 (Blue area of service map) $74.00 $142.00 $108.00 $30.00

Service Area 2(Green area of service map) $89.00 $149.00 $108.00 $30.00

Medical DeductibleThese plans do not have a medical deductible.

$0 $0 $0 $0

Part D Prescription Drug Deductible

True Blue Rx Option II has a Part D Deductible. There is no deductible for Tier 1 and Tier 2 generic prescription drugs.

This plan does not cover Part D prescription drugs.

$0 $0 $200 per year for Tiers 3 through 5 prescription drugs $0

Maximum Out-of-Pocket Responsibility (does not

include prescription drugs or monthly plan premium)

The most you pay for copays, coinsurance and other costs for medical services for the year.

$6,700 $6,700 $6,700 $3,000

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Inpatient Hospital CoverageOur plans cover an unlimited number of days for an inpatient hospital stay.

$300 per day for days 1-6 $175 per day for days 1-5 $275 per day for days 1-5 $100 per day for days 1-5

Doctor Visits No referral required for specialist visits.

Primary Care $15 $5 $15 $10

Specialists $40 $25 $40 $25

Preventive Care

Any additional preventive services approved by Medicare during the contract year will be covered.There are some items not covered at $0 cost.

$0 $0 $0 $0

Emergency Care

If you are admitted to the hospital within 3 days for the same condition,you do not have to pay your share of the cost for emergency care.

$75 $75 $75 $65

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Urgently Needed Services

Cost sharing for necessary urgently needed services furnished out-of-networkis the same as for such services furnished in-network.

$40 $25 $40 $25

Diagnostic Services/Labs/Imaging

Prior authorization is required for some services by your doctor or other network provider.Please contact the plan for more information.

Diagnostic Radiology Service (like CT, MRI) 20% 10% 15% $175

Lab Services 20% 10% 15% $0

Diagnostic Testsand Procedures 20% 10% 15% $0

Hearing ServicesExam to diagnose and treat hearing and balance issues.

$40 $25 $40 $25

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Dental Services

Limited Medicare covered dental services (this does not include services in connection with care, treatment, filling, removal,or replacement of teeth). Routine dental coverage is available with additional premium.

$0 $0 $0 $0

Vision Services Our plan pays up to $100 every year for eyewear, including contact lenses, eyeglasses, frames and lenses.

Exam to diagnose and treatdiseases and conditions of

the eye (including yearlyglaucoma screening)

$15 $25 $40 $25

Routine Eye Exam(One Annually) $40 $25 $40 $25

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Mental Health Services

Inpatient Visit $265 per day for days 1-6 $175 per day for days 1-5 $275 per day for days 1-5 $100 per day for days 1-5

Outpatient GroupTherapy Visit $40 $25 $40 $25

Outpatient IndividualTherapy Visit $40 $25 $40 $25

Skilled Nursing Facility (SNF)

Our plan covers up to 100 days per benefit period in a SNF.

$0 per day for days 1-20$160 per day for days 21-63$0 per day for days 64-100



$20 per day for days 1-20$0 per day for days 21-100

Rehabilitation Services

Occupational Therapy Visit $40 $25 $40 $15

Physical Therapy and Speechand Language Therapy Visit $40 $25 $40 $15

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AmbulanceIncludes ground or air transport.

$300 $200 $225 $175

Transportation Not covered.

Foot Care (podiatry services) Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions.

Foot Exams and Treatment $40 $25 $40 $25

Medical Equipment/ Supplies

Durable Medical Equipment (like wheelchairs, oxygen) 20% 20% 20% 10%

Prosthetics(e.g. braces, artificial limbs) 20% 20% 20% 10%

Diabetes Supplies $0 $0 $0 $0

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Wellness Programs(e.g. fitness)

You have the option of choosing between the Silver&Fit Gym Membership, which gives you access to network of fitness clubs for $50 annually, or you can participate in the home exercise program and receive up to two home exercise kits for $10 annually.

Silver&Fit Gym Membership $50 annually $50 annually $50 annually $50 annually

Silver&Fit Home Exercise kits $10 annually $10 annually $10 annually $10 annually

Medicare Part B Drugs

Part B drugs are drugs usually administered in a inpatient hospital setting, like chemotherapy drugs.These are not the same as outpatient Part D prescription drugs.

20% for chemotherapy drugs20% for other Part B drugs




Outpatient Surgery

Ambulatory Surgical Center $250 $175 $250 $100

Outpatient Hospital $250 $175 $250 $100

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True Blue Summary of Benefi tsHow Part D Prescription Drug Coverage Works

STAGE 1Annual

Deductible

STAGE 2Initial Coverage

Period

STAGE 3Coverage

Gap

STAGE 4Catastrophic

Coverage

If your drug plan has a deductible, you must meet it before coverage begins.

You pay a small amount until you reach $3,700

in total drug costs.

Until you pay $4,950 in true out-of-pocket costs,you pay a larger amount.

You pay a small amount when true out-of-pocket

costs are over $4,950.

You are responsible for thecost of your prescriptiondrugs until you have met

the deductible.

True Blue Rx Option II has a deductible for drugs from tiers 3, 4 and 5. Tier 1 and 2 generic drugs do not have a

deductible.

You then reach Stage 2 Initial Coverage Period.

During this stage of coverage, you either pay a copay, or coinsurance for your prescriptions.

Covered drugs fall into five tiers. The lower the tier,

the less you will pay.

This will continue until total drug costs – what you pay

and what we pay combined – reaches $3,700.

You then reach Stage 3 Coverage Gap.

During the Coverage Gap stage, you pay more for

covered Part D Drugs.

In most cases, you pay 51% for covered generic

drugs, and 40% for covered brand drugs.

This will continue until your true out-of-pocket costs for Part D drugs totals $4,950.

You then reach Stage 4 Catastrophic Coverage.

Once your trueout-of-pocket costs for

Part D drugs totals$4,950, you pay a smaller amount for covered drugs

than you did during theStage 3 Coverage Gap.

This will continue for the remainder of the plan year.

You pay

You payYou pay

You pay

We payWe pay We pay

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What You Pay During STAGE 2 Initial Coverage PeriodTrue Blue Rx

(HMO)True Blue Rx Option I

(HMO)True Blue Rx Option II*

(HMO)Formulary Name Essentials Performance Performance

Part D Deductible $0 $0 $200*

Preferred Retail Cost 30-day supply 30-day supply 30-day supply

Tier 1 (Preferred Generic) $0 $0 $0

Tier 2 (Generic) $6 copay $6 copay $12 copay

Tier 3 (Preferred Brand) $36 copay $35 copay $37 copay

Tier 4 (Non-Preferred Drug) $85 copay $85 copay $90 copay

Tier 5 (Specialty Tier) 33% of cost 33% of cost 29% of cost

Non-Preferred Retail Cost 30-day supply 30-day supply 30-day supply

Tier 1 (Preferred Generic) $15 copay $5 copay $10 copay




Tier 5 (Specialty Tier) 33% of cost 33% of cost 29% of cost

Mail Order Cost 90-day supply 90-daysupply 90-day supply

Tier 1 (Preferred Generic) $0 $0 $0




Tier 5 (Specialty Tier) Not Offered Not Offered Not Offered

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Part D Drugs

Formularies

• True Blue Rx Option I and Option II use the PERFORMANCE Formulary. Wider distribution of generic and brand drugs across fi ve tiers

• True Blue Rx (HMO) uses the ESSENTIALS Formulary.• ESSENTIALS Formulary may have drugs in higher tiers than PERFORMANCE Formulary and fewer drug options

• Please be diligent in checking your client’s prescriptions


Travel Benefi t

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Travel Outside Idaho

Travel Benefi t

• $1,000 annual benefi t maximum ($500 for True Blue Rx)• Covers all plan services from out-of-network providersoutside the state of Idaho

• Allows you to pay in-network cost sharing• Available throughout the US, outside of Idaho• Included with all True Blue HMO plans


Out-of-Country Coverage

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Out-of-Country Coverage

Coverage Maximum

• $25,000 benefi t limit for Emergent and Urgent services outside US combined for all plans

• Ambulance and air transport are not covered services outside the US


Secure Blue No Rx (PPO) Option

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Secure Blue no Rx

MA-Only PPO

• No major changes to Secure Blue MA-Only plan in Area 1 and 2• Premium remains $42; MOOP remains $3,400 in- and out-of-network• Secure Blue will not be actively marketed in 2017• This plan is a good option for benefi ciaries who either don’t need prescription drug coverage, or they have creditable/comparable Part D coverage from an employer plan or other program like VA benefi ts

• Secure Blue enrollment kits are different from True Blue kits and available upon request

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Med Supp

Medicare Supplement or Medigap• Grandfathering Prime 65 and closing to new sales

• Prime 65 to new Supp. plans will require health underwriting (or underwriting approval)

• Introducing a new line of Medicare Supplement products through Blue Cross of Idaho Care Plus

• Idaho Care Plus (ICP) is a subsidiary of Blue Cross of Idaho• All Medicare business under one company• Allows us to re-price at a competitive premium

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Med Supp

Medicare Supplement or Medigap• Coming to market with plans A, F, K and N

• A – Required• F – Most popular plan; Part B deductible paid at 100%• K – Good option for people coming off high deductible health plan (HDHP)• N – Good replacement for group coverage

• Goal: We expect the DOI to approve materials in November


Enrollment

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Enrollment

Enrollment Kit

• Benefi ts at a Glance• Enrollment Booklet• Summary of Benefi ts, Provider Listing, two enrollment forms, multi-language insert, Star Ratings, Scope of Appointment, business reply envelope

• Kits are variable by service area; Benefi ts at a glance and enrollment forms differ by kit

CarePlus

Election Forms

1Form No. 16-522 (09-16)H1350_OP17018

2017 True Blue (HMO) Election Form

Already a Blue Cross of Idaho Care Plus Medicare member? Please check the box below:

oI have a Blue Cross of Idaho Care Plus Medicare Advantage plan and want to change to a different Blue Cross of Idaho Care Plus Medicare Advantage plan. My Medicare Advantage Member ID number is:

Please provide your information:Last Name First Name Middle Initial

Birth Date (mm/dd/yyyy) Gender:

o Male o Female

Phone

( )

Alternate Phone

( )

Email Address (optional) County

Race (Optional): o American Indian or Alaska Native o Asian o White

o Black or African American o Native Hawaiian or Other Pacific Islander

Ethnicity (Optional): o Hispanic or Latino

o Not Hispanic or LatinoPermanent Residence Street Address (PO Box not allowed) City State Zip Code

Mailing Address (only if different from above) City State Zip Code

Please provide your Medicare insurance information:

Please take out your Medicare card to complete this section. You must have Medicare Part A and Part B to join a Medicare Advantage plan. Please fill in the blanks so they match your red, white and blue Medicare card.

Name of Beneficiary: _______________________________

Medicare Claim Number: ____________________________

Hospital Part A Effective Date: _______________________

Medical Part B Effective Date: _______________________

After completing the election form and providing your signature on Page 4, return it to your agent/broker, or mail to: Blue Cross of Idaho, P.O. Box 8406, Boise, ID 83707-2406.

You may also enroll online at http://www.bcidaho.com/medicare.

Serv

ing select Idaho counties

Area 2

Serv


Area 1

Select CountiesSelect Counties

1Form No. 16-591 (09-16)H1350_OP17019

2017 True Blue (HMO) Election Form





o Male o Female

Phone

( )

Alternate Phone

( )















Serv


Area 2

Serv


Area 1

Select CountiesSelect Counties

1Form No. 16-592 (09-16)H1302_OP17020

2017 Secure Blue No Rx (PPO) Election Form





o Male o Female

Phone

( )

Alternate Phone

( )















Serv


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Enrollment

How to Enroll• Online• bcidaho.com/medicare or brokers.bcidaho.com

• Phone enrollment via Customer Service for agents• Call 1-855-854-3056, 8 a.m. to 8 p.m., seven days a week Paper enrollment form• Emailed to [email protected] • Mailed

• Faxed to 208-386-6808• Dropped off at District Offi ce

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Enrollment

Scope of Appointment

• A Scope of Appointment must be completed before a scheduled meeting on Medicare Advantage enrollment

• Scope of Appointment must be retained for 11 years and made available at request of Blue Cross of Idaho or CMS

• Blue Cross of Idaho does not keep these records. Brokers are responsible for keeping their own records

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When to Enroll

Annual Enrollment Period (AEP)• Beginning October 1, 2016, plans can begin marketing 2017 options; no enrollment forms can be received or submitted prior to Oct. 15, 2016

• Medicare benefi ciaries have from October 15, to December 7, to make decisions for the 2017 plan year

• Benfi ciares can choose between Original Medicare, Medicare Advantage, or Original Medicare with Med Supp

• A stand-alone Part D plan can be purchased with Med Supp, but not with Medicare Advantage

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When to Enroll

Special Enrollment Period (SEP)

• Non-renewal benefi ciaries receive a SEP that allows them to enroll between December 8, 2016 and February 28, 2017

• Non-renewal benefi ciares are ‘guaranteed issue’ of a Med Supp plan (A, B, C, F, K, L offered in Idaho) even if Medicare Advantage plans are available

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Broker Resources

• New Broker Portal• Online Learning Center Access• Tools and Resources

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Broker Resources

• Access to online enrollment• Book of Business• Resource page

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Broker Resources

• Online Learning Center• Product training• CMS certifi cation

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Broker Resources

• Co-Op Advertising• $750 per agent; up to 5 agents in offi ce or agency

• Blue Cross of Idaho shares 1/2 the marketing cost with agent up to $1,500

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Broker Resources

• Customizable to agentor offi ce

• Pre-approved by CMS

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Broker Resources

Contact Info

• Call the Broker Hotline at 1-855-230-6858 from 8 a.m.to 5 p.m.

• Additional support is available after-hours through Customer Service: 1-800-289-8617

• Email us at [email protected]• Visit the online broker portal at www.bcidaho.com/broker • Online enrollment available on the Blue Cross of Idaho website at www.bcidaho.com/medicare or through your Broker Portal

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Q&A

Questions?

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