new plans and new benefits for 2022

New plans and new benefitsfor 2022

2021 STAR RATING

KCA HISTORIC STAR RATING.•5 Star Rated for 5 years in a row (2017, 2018, 2019, 2020, 2021)

•Only one in 20 plans in 2020 rated 5 Stars

•The ONLY plan in Houston in rated 5 Stars for 5 CONSECATIVE

•Voted Best MA Plan in Texas by US News (2017, 2018, 2019, 2020, 2021)

MEDICARE

5 STAR RATING

KELSEYCARE ADVANTAGE SERVICE AREA

• Austin

• Brazoria

• Chambers

• Fort Bend

• Galveston

• Grimes

• Harris

• Liberty

• Montgomery

• San Jacinto

• Waller

• Walker

• Wharton

New clinic locations

Number of Clinics: 22Number of Providers: 540




New Plans = New Names

2021 Plan Names 2022 Plan Name MA Type Plan Type Service Area

- Platinum – NEW! MA-PD HMO 5 Counties

Rx Gold MA-PD HMO 5 Counties

Rx+Choice Gold Freedom MA-PD HMO-POS 5 Counties

Essential Silver MA Only HMO 5 Counties

Essential+Choice Silver Freedom MA Only HMO-POS 5 Counties

Essential Select Silver Community MA Only HMO-POS Surrounding Counties

Rx Select Gold Community MA-PD HMO-POS Surrounding Counties

5 Counties = Harris, Brazoria, Fort Bend, Galveston, MontgomerySurrounding Counties = Austin, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, Wharton

New Plan NameMonthly Premium

Drug Coverage

Provider NetworkComprehensive

Dental

Platinum – NEW! $0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC X

Gold Freedom $0(down from $77)

XIn-Network Cost-Share: KSC + Affiliates (no referral)

Out-of-Network Cost-Share: All other providers (no referral)X

Gold $0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC Only w/ add-on

Silver $0 Kelsey-Seybold Clinic: Referrals needed for outside of KSC X

Silver Freedom $0In-Network Cost-Share: KSC + Affiliates (no referral)

Out-of-Network Cost-Share: All other providers (no referral)X

Silver Community

$0In-Network Cost-Share: KSC + Affiliates (no referral)

Out-of-Network Cost-Share: All other providers (no referral)Only w/ add-on

Gold Community $15 XIn-Network Cost-Share: KSC + Affiliates (no referral)

Out-of-Network Cost-Share: All other providers (no referral)Only w/ add-on

Quick Comparison

New Freedom PlansGold Freedom | Silver Freedom

You can keepyour current doctorIn addition to Kelsey-Seybold physicians, Freedom Plans allow members

to keep their out-of-network doctor with a low copay & $0 monthly premium.

Talk about a game-changer!

Taking Advantage on In-Network Cost-Share Accessing Out-of-Network Cost-Share

Member sees aKelsey-Seybold Clinic PCP

$0Member sees an

out-of-network PCP$10

Member sees aKelsey-Seybold Clinic specialist

$25Member sees an out-of-network

specialist$35

Member sees an affiliate providercontracted with Kelsey

$25 Member sees anMD Anderson provider

40%

No referrals needed! No referrals needed!

Freedom in action

MEDICAL+DRUGCOVERAGE

Gold (HMO) 5 core counties

Gold Freedom (POS) 5 core counties

Gold Community (POS) 8 outlier counties

Platinum (HMO) NEW! 5 core counties

11

MAPD w/Drug Coverage / Value-Added Benefits

Platinum Gold Gold Freedom Gold Community (outlier counties)

IP Hospital $350/stay $375/stay $375/stay $375/stay

T2 Drug $0/$15 $0/$15 $0/$15 $0/$15

DentalComprehensive with

$1,500 limitPreventive + option to purchase

supplemental ($32.80)Comprehensive with

$1,500 limit

Preventive + option to purchase supplemental

($32.80)

COVID-19Benefit

Yes Yes Yes Yes

OTC $25 monthly $25 quarterly $25 monthly $25 quarterly

Wellness Benefit

Yes No Yes No

MEDICAL COVERAGE ONLY

Silver (HMO) 5 core counties

Silver Freedom (POS) 5 core counties

Silver Community (POS) 8 outlier counties

1313

MA Only Value-Added Benefits

Silver Silver Freedom Silver Community(outlier counties)

IP Hospital $325/stay $325/stay $325/stay

DentalComprehensive with

$1,500 limitComprehensive with

$1,500 limitPreventive + option to purchase

supplemental ($32.80)

COVID-19Benefit

Yes Yes Yes

OTC $50 quarterly $50 quarterly $25 quarterly

Vision Allowance

$125 $125 $75

Wellness Benefit Yes Yes No

Morechangesfor 2022

Comprehensive dental*With $1,500 allowance

Plus …

• $0 copay for Tier 1 & 2 drugs*

• Increased vision allowance*

• Wellness benefit* –up to $100 a year in gift card rewards

• COVID-19-related care and waiver of IP copay

• Simplified in-hospital stay copays

• Monthly and/or quarterly OTC allowances*

* Available in specific plans

2022 PART D SUMMARY

MAPD w/ DRUG COVERAGE MA ONLYOUTLIER COUNTIES (MA/MAPD-POS)

Gold HMO (002)Platinum HMO

NEW (009)Gold Freedom

POS (004)Silver HMO

(001)Silver Freedom

POS (003)Silver Community

POS (007)

Gold Community POS (008)

$15 premium

Part D Deductible $100 (T3, T4, T5) $100 (T3, T4, T5) $100 (T3, T4, T5)

No Drug CoverageNo Drug

Coverage

$100 (T3, T4, T5)

T1 Drug $0/$3 $0/$3 $0/$3 $0/$3

T2 Drug $0/$15 $0/$15 $0/$15 $0/$15

T3 Drug $40/$45 $40/$45 $40/$45 $40/$45

T4 Drug $80/$90 $80/$90 $80/$90 $80/$90

T5 Drug 31% 31% 31% 31%EXCLUDED drugs covered

Generic Viagra with QL 6/30days




17

VALUE ADDED BENEFITS: DENTAL BENEFITS



POS (004)Silver HMO (001)

Silver Freedom POS (003)

Silver Community POS (007)


Embedded Preventive Dental (mandatory) + Optional Buy-Up (Supplemental)

Prev Included + Option to

Purchase Supp($32.80

premium)

No No No No


Purchase Supp ($32.80

premium)


Purchase Supp($32.80

premium)

Comprehensive included in plan (mandatory)

No$1,500 Comp

Included$1,500 Comp

Included$1,500 Comp

Included$1,500 Comp

IncludedNo No

$25 per visit copay*

Once the member reaches the $1,500 threshold everything else is their responsibility, which is 0%/0% for the preventive and diagnostic services and 50% coinsurance for each of those comprehensive procedures listed

in the Dental EOC. Product doesn’t have a per visit copay it has per procedure coinsurance.



*Covers certain preventative services: Oral exam, Comprehensive oral exam, Adult Cleaning – prophylaxis, Intraoral-Complete Series of Radiographic Images, Bitewings (2 or 4) 18

VALUE ADDED BENEFITS CONTINUED







Vision Allowance contacts/glasses

$75 $125 $125 $125 $125 $75 $75

OTC Monthly Benefit

-- $25 $25 -- -- -- --

OTC Quarterly Benefit

$25 -- -- $50 $50 $25 $25

Up to $100/yrWellness Benefit (based on health actions)

Not Offered Yes Yes Yes Yes Not Offered Not Offered

19

VALUE ADDED BENEFITS CONTINUED







Hearing Aid Allowance

$750 per ear every 3 years







Inpatient Cost Share waived with COVID19 diagnosis, all testing and related visits as well as Meal Delivery post discharge (w/ covid diagnosis) 2 meals per day for 7 days*

Yes Yes Yes Yes Yes Yes Yes

20 one-way trips to medical appointments

Yes Yes Yes Yes Yes Not Covered Not Covered

*EGWPs not covered20

Thank you!

new plans and new benefits for 2022

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