Transcript Slide 1

Broker/Agent Product Training
PersonalCare Insurance
of Illinois
Medicare Advantage (MA) Coordinated Care Plans (CCP) 2012
CONFIDENTIAL
© 2011 Coventry Health Care, Inc.
AGENDA
•
•
•
•
•
Top Performers Presentation
2012 Product Review
Servicing the Member
Servicing our Partners
Q & A Review
2
Before we begin…
Reminders:
• Silence Your Phone
• Handling Questions
• Complete all 2012 Requirements
PRIOR to Selling
3
PERSONALCARE
IS GOING…
GREEN!
4
PersonalCare’s Value Proposition
• Local presence and understanding
• National experience and infrastructure
• Products that are relevant and valuable to YOUR
clients
• High quality network
• History of provider collaboration
• Patient-centered care model & case management
• Local and personalized for both members AND
brokers
• Fastest growing MAPD in our service area for the
past 3 years…and #1 in Coventry AEP sales 2011!
• 4-Star rated plans
5
2012 Product Information
Service Areas
2012 Counties:
Adams, Boone, Brown, Champaign, Coles, Douglas,
Marshall, McLean, Moultrie, Ogle, Peoria, Piatt, Sangamon,
Stark, Stephenson, Tazewell, Vermillion, Winnebago,
Woodford
Network Highlights*:
Rockford Memorial & Swedish American Hospital
(includes Coventry Total Care)
Freeport Memorial Hospital
Peoria Methodist Medical Center & Proctor Hospital
Pekin Memorial Hospital
BroMenn Hospital Bloomington
Advocate Eureka Hospital
Kirby Hospital Monticello
Provena Covenant and Carle Hospitals in Urbana
United Samaritan Medical Center
Sarah Bush Lincoln Health Center
Blessing Hospital Quincy
St. John’s Hospital & Memorial Medical Center in Springfield
* Service area network only
7
Product Details - 2012
Benefit
Monthly Premium
MOOP
Original Medicare (2011)
Advantra PPO
Total Care HMO
$96.40/$110.50
$13
$0
N/A
$3,300
$180/day Days 1-10
$0/day Days 11-90
$175/day Days 1-10
$0/day Days 11-90
$1,750 max/stay
N/A
30%
NONE
PCP
20% Coinsurance
$10
$5
Specialist
20% Coinsurance
$35
$25
$0 Days 1-20
$117/day Days 21-48
$0 Days 49-100
$0 Days 1-20
$100/day Days 21-53
$0 Days 54 -100
$40
$40
Inpatient Hospital
Out-of-Network
$1,100 for days 1-60
$275 for days 61-90
$550 for days 91-50
$3,315 IN
$5,100 IN & OON
Skilled Nursing
$0 Days 1-20
$137.50 Days 21-100
Outpatient Mental Health
40% Coinsurance
8
Product Details – 2012…continued
Benefit
Original Medicare (2011)
Advantra PPO
Total Care HMO
Preventive Services
Annual Physicals
0 - 20% Coinsurance
$0 (office visit copay
may apply)
$0 (office visit copay
may apply)
Immunizations
$0 Flu, Pneumonia
20% Hepatitis B
$0 Flu, Pneumonia,
Hepatitis B
$0 Flu, Pneumonia,
Hepatitis B
Gyn Exams
20% Coinsurance
$0 Pap, Exam 20%
Coinsurance
$0
Pap $0
$0
Pap $0
Mammograms
20% Coinsurance
$0
$0
Bone Mass
20% Coinsurance
$0
$0
Colorectal &
Prostate
Screenings
20% Coinsurance
$0
$0
9
Product Details – 2012…continued
Benefit
Original Medicare (2011)
Advantra PPO
Total Care HMO
Outpatient Surgery
20% Coinsurance
20% Coinsurance
20% coinsurance
Urgent Care
20% Coinsurance
$35
$35
20% Coinsurance for BOTH
Doctor and facility
$65
Waived if admitted
$65
Waived if admitted
20% Coinsurance for
x-ray
20% Coinsurance for
x-ray
$150 copay for
diagnostic
$150 copay for
diagnostic
$10
$0 if preventive
ER
X-Rays/Diagnostic
Radiology/Therapeutic
Radiology
20% Coinsurance for
diagnostic tests, x-rays,
diagnostic radiology
Labs
20% Coinsurance
$20
$0 if preventive
Physical Therapy
20% Coinsurance
$35
$25
Cardiac/Pulmonary
Rehab
20% Coinsurance
$0
$0
10
Product Details – 2012…continued
Benefit
Diabetic Supplies
Original Medicare (2011)
20% Coinsurance
Advantra PPO
Total Care HMO
20% Coinsurance
$0 strips, shoes,
inserts
$0 copay
$0 copay
$5-$25 for additional
Services
ONE pair of glasses
every (2) years
Vision
20% Coinsurance
$10-$35 for additional
services
Hearing
20% Coinsurance
$35 copay
$25 copay
$0 copay includes:
1 oral exam/year
1 cleaning/year
1 x-ray/year
$0 copay includes:
1 oral exam/year
1 cleaning/year
1 x-ray/year
$500 annual limit
$500 annual limit
$35 copay for
Medicare-covered
Silver & Fit
Dental
N/A
$35 copay for
Medicare-covered
Fitness
N/A
Silver & Fit
11
Product Information
Outpatient Rx Benefit Information
Part D Prescription Drug Plan included in all products!
Still No deductible – first dollar coverage!
Tier 1: Preferred Generics with a 90-day supply available through
mail-order at discount
Tier 2: Generics with 90-day supply available through mail-order at discount
Tier 3: Non-Preferred Brand, Non-Preferred Generic with 90-day supply available
Tier 4: Specialty Drugs - Mail order not available for Tier 4
•
Pharmacy network made up of over 60,000 contracted retail pharmacies
across the United States. Large national and regional chains plus local
pharmacies
•
Pharmacy network includes:
• Retail, Mail Order, LTC
• Home Infusion
• Indian Tribes and Tribunal Organizations and Urban Indian Organizations (I/T/U)
12
Product Information
Outpatient Rx Benefit Information
The OTC Medications we cover as part of Step Therapy with no
copay are as follows:

Loratadine, 10mg Tablets (Claritin)

Loratadine, 5mg/5ml Syrup

Loratadine-D, 12 Hour Tablets

Loratadine-D, 24 Hour Tablets

Cetirizine, 5 & 10 mg Tablets and Chewable Tablets (Zyrtec)

Cetirizine, 1 mg/ml Syrup

Cetirizine-D, 5mg, 12 Hour Tablets

Physician written prescription is needed for covered OTC drugs
13
Product Details – 2012…Rx
Benefit
Original Medicare (2011)
Advantra PPO
Total Care HMO
N/A
$5 copay
$12.50 copay for 90
days through mail
order
$5 copay
$12.50 copay for 90
days through mail
order
Tier 2:
Preferred Brand Name
N/A
$40 copay
$90 copay for 90 days
through mail order
$40 copay
$90 copay for 90 days
through mail order
Tier 3:
Non-Preferred Brand
Non-Preferred Generic
N/A
$80 copay
$79 copay
Tier 4:
Specialty
N/A
33% Coinsurance
33% Coinsurance
Coverage Gap
N/A
(On brand name
drugs) 86% of
the plan’s costs
for generic drugs
(On brand name
drugs) 86% of
the plan’s costs
for generic drugs
Outpatient Part B
N/A
20%
20%
Tier 1:
Preferred Generic
14
PersonalCare’s Value Proposition
- Product Design 2012
• PPO – Advantra Silver®
– Available in all 19 counties of the PersonalCare
service area.
– Designed to give the most provider freedom
available for those who need a wide network.
– Perfect for Medicare Supplement members who
are tired of high premiums but want access
freedom.
– Offers BOTH financial freedom AND protection.
– Everything in ONE package for one LOW price.
15
PersonalCare’s Value Proposition
- Product Design 2012
• HMO – Coventry Total Care®
– Available in Winnebago and Boone counties
ONLY
– Partnership with SwedishAmerican Hospital.
• Co-branded – Coventry Total Care (HMO): A
Partnership with Swedish American
– Patient-centered care model/case management
• Primary Care Physician becomes the member’s
“Quarterback” of their health care team.
– Designed to improve the overall quality and
efficiency of care received by the member.
• i.e. – keep the member healthy
• Improved efficiencies mean lower costs for the
member.
16
PRODUCT INFORMATION
Value Added
•
PersonalCare is backed by the strength and stability of Coventry Health
Care
•
Designed to save money – compare us to a Medicare Supplement and see
how much money can be saved!
•
NO DEDUCTIBLES!
•
Rx Coverage included
•
Vision, Hearing, Fitness AND Dental!
•
Coordination with Illinois CaresRx
•
The AMA ranked Coventry #1 in the country in Claims Processing
Accuracy in its 2010 and 2011 National Health Insurer Report Card
(NHIRC)
•
Our support to you and your clients…local plan staff with proven
commitment to helping you grow your business and support your needs.
17
Selling Medicare Advantage
When Comparing PersonalCare to Other Plans…
• APPLES to APPLES
• Do the Math – how do the premiums and main
copays impact the prospect financially for the YEAR.
• Deductibles?
• Network comparison – HMO/PPO
• Financial protection?
18
Servicing the Member
Your Medicare Advantage Solutions
Y0022_2011_6002_092a_FINAL9
CMS Approval Date: 04/14/2011
© 2011 Coventry Health Care, Inc.
SERVICING THE MEMBER
Sales Presentation – How To Use
The use of Coventry’s Sales Presentation, including the notes
section, is MANDATORY for all sales events involving Coventry products.
This includes Face-to-Face Meetings and Marketing/Sales Seminars.
Latest version dated 8.15.11
Display Recommendations
• Sales Seminar: print copies without notes for audience, with notes for presenter.
• Face-to-Face Meeting: Use the presentation in a flip chart format by placing the
visual slide facing the prospect and the notes facing the presenter (you).
Notes Pages Instructions
•To view the notes pages go to the PowerPoint menu bar, click on "View," and
select "Notes Page."
•To print the PowerPoint so that it displays the notes, click on "Print" and on the
bottom left you will see "Print What" with a drop down underneath. Select "Notes"
and your print out will display both the slides and notes.
21
SERVICING THE MEMBER
Sales Presentation - Agenda
• Do You Qualify?
• Understanding Your Needs
• Who We Are
• How Medicare Works
• Plan Benefits
• Network
• Member Rights/Responsibilities
• Plan Value
• Enrollment
• What Happens Next (if you enroll)
22
Physician number
needed for ALL
HMO/HPN
applications:
PCP ONLY
No Physician # = Pended App.
23
Servicing The Member
Outbound Education and Verification Calls
What Happens After an application is submitted?
•
A Coventry Health Care Representative will call your client within 10
days of receiving the completed Enrollment Form to:
1. Confirm their enrollment in the Coventry plan of their choice.
•
•
2. Review the plan rules and make sure they understand how their
new plan works.
Coventry Health Care will make three attempts to reach your client
by phone. If we are unable to speak with them after the first attempt,
they will receive a letter outlining the plan rules.
Both the telephone calls and letters will cover the same information
that your client has in their enrollment kit.
24
Servicing The Member
Member Resources
• Customer Service is open…
– 7 am – 7 pm Central, 7 days/week
– Closed Holidays
– Telephone number on back of ID Card – (866-784-4916)
• Customer Service for Rx (Medco) is open…
– 24 hours/day, 7 days/week
– Telephone number on back of ID Card
• We will have extended hours during 2012 AEP
• Website: www.coventry-medicare.com
– My Online Services
– Up-to-date provider directories
– Current formularies
25
Servicing The Member
ID Cards and New Member Kits
•
ID Cards will be mailed to the member’s home within 2 to 3 weeks of the
date the application is received.
NOTE: If a member requires assistance regarding their membership/member ID, the
member MUST call Member Services.
•
New member kits will be mailed within 10 days of verification of eligibility by
CMS. The new member kit contains:
– Welcome letter.
– Evidence of Coverage (gives members detailed information about the plan’s
policies, procedures and benefits).
– Formulary drug list.
– Other health-related informational flyers.
– Does NOT include a provider directory. Please leave a provider directory at the
point of sale.
•
Newsletters to help members learn how to use their plan, including
education on specific health-related topics.
26
Servicing The Member
Appeals & Grievances
•
The member's treating provider can make a coverage request by contacting
the number on the back of the member's ID card (called an Initial Coverage
Determination).
•
An “appeal” is a type of complaint requesting us to reconsider and change a
decision we have made about what services are covered for a particular
member or what we will pay for (i.e. denied request for a Part D drug the
member thinks should be covered, early discharge from the hospital, etc.).
•
A “grievance” is a type of complaint the member can make if they have any
other type of problem with Coventry Advantra or one of our plan providers
(i.e. quality of care, accessibility issues, involuntary disenrollment, etc.).
•
Detailed information on the initial coverage, appeal and grievance processes
can be found in the member's Evidence of Coverage.
27
www.BenefitsCheckUp.org/Coventry
One-stop resource for determining eligibility for
programs that can help with all types of expenses,
including health care, prescriptions, taxes,
utilities and more!
28
Servicing Our Partners
Broker Servicing Department
• A dedicated Broker Servicing
Department (BSD) in our operations
department that will assist you with
questions pertaining to:
– Commissions / contracting questions,
including attestation
– Broker portal, website support
• BSD Contact Information:
– (866) 714-9301
– [email protected]
– 7am–7pm Central Time, Monday-Friday
Please check
here regularly
for updated
information
and resources
• Broker Portal: broker.cvty.com
30
Broker Resources
Certification Process – Steps to become “Ready-to-Sell”
•
Complete the online AHIP Medicare Marketing Training and Test
– Minimum passing score is 90%  within 3 attempts
•
Successfully complete the Coventry Advantra CCP Overview
Training and Test
– Minimum passing score is 90%  within 3 attempts
•
Successfully complete the PersonalCare Specific PowerPoint and
complete the online attestation.
– No test component but you must attest that you reviewed the health plan specific
presentation for EACH Coventry plan you wish to sell.
•
•
•
•
Must have State appointment –each state where you are licensed. (Illinois
is not an appointment state.)
Must Have Errors & Omissions Insurance
New Agents: Complete your online Coventry “contract package”
Receive “Ready to Sell” notification from Coventry and your Agent Writing
Number (AWN) ID Card for the benefit year.
31
Scope of Appointment
•
The beneficiary must agree to the scope of products to be presented to them prior
to the appointment date.
•
The agent must secure the Scope of Appointment documentation prior to the
appointment. If it is not feasible for the scope of appointment form to be executed prior to
the appointment, an agent may have the beneficiary sign the form at the beginning of the
marketing appointment. However, CMS expects plans to record and maintain
documentation on why it was not feasible to obtain the scope of appointment prior to the
appointment.
A new Scope of Appointment form is required if the beneficiary has requested to
discuss another MA or PDP product type during a personal/individual appointment.
However, a new appointment is not required. The additional product can be discussed as
soon as the beneficiary request is documented.
•
•
Per CMS< Agents cannot record Scope of Appointment. Only plan sponsors can record
the Scope of Appointment.
•
If the beneficiary requests another line of business to be discussed during a
personal/ individual appointment (i.e., Med Supp, Long Term Care), agent may leave
product information, excluding Enrollment Application, and a follow-up appointment
cannot be scheduled until at least 48 hours after the initial appointment (cooling-off
period).
•
The Scope of Appointment form should be documented with a CMS-approved Scope
of Appointment form (either model or non-model);
•
Please include the completed scope of appointment form with the paper enrollment
application when submitted to PersonalCare®.
32
Broker Resources
Tools at Your Disposal…
Directories
Forms
Other Helpful Tools
•PPO Physician Directory
•2011 Disenrollment Form
•CCP Fax Cover Sheet
•PPO Facilities Directory
•EFT Form
•FAQ
•HMO Physicians Directory
•LifeScan Form
•Prior Authorization List
•HMO Facilities Directory
•MEDCO Part D Reimbursement
•Who To Contact
•Member Designated Form
•Marketing Submission Form
•Scope of Appointment
Sales Presentations
Tutorials and Procedures
•Broker ONLY Version w/Notes
•How to Use Apptracker
•Prospect Version
•Reading Your Commission
Statements
•PowerPoint for Group Settings
•Seminar Cancellation Procedures
•Broker Training Presentation
33
How do you stay informed as to what the rules are so that your
marketing activities are in compliance with CMS?
•
Monitor the release of new CMS regulations by signing up for the
Federal Register List at http://www.gpoaccess.gov/fr/index.html.
•
CMS marketing guidance can be found at
http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketi
ngGuidelines.asp.
•
Watch for Coventry bulletins that include new guidance such as any
updates on Medicare Marketing Provisions. Once published, bulletins
will be posted on the Broker Portal.
•
Broker Portal
•
Adhere to Coventry Sales Presentation
34
IMPORTANT!
After Completion of Each Application
- Within 24 Hours Coventry Advantra has made it easy to meet the 24 hour time restraint
Applications can be delivered to PersonalCare in the following ways:
1) ON-LINE: www.coventry-medicare.com (Select Enroll Now)
Use CAPS & Tab Key
2) Fax: 866-669-2344
3) Deliver to PersonalCare Office: 2110 Fox Drive, Suite A Champaign
4) Self-Addressed, postage-paid envelope from enrollment kit
5) Scan and email application to [email protected]
35
Coventry Local Resources
PersonalCare Insurance of Illinois
Medicare Sales & Marketing Department
Medicare Sales Manager
Todd Brooks
309-686-3861 (office)
309-791-2808 (cell)
[email protected]
Broker Specialist
Karen Bidner
866-765-7658 (office)
217-552-9814 (cell)
[email protected]
Broker Specialist
Angela Hauser
866-765-7658 (office)
815-922-7577 (cell)
[email protected]
36
Q&A
Questions on:
- Scope Of Appointment?
- SEP/ADP?
- Premium Payment Methods
- Referrals?
- Member Materials (ID Cards, etc.)?
- Marketing?
- Seminars – Formal/Informal Sales Meetings
- Member Meetings
- Diabetic Supplies/DME?
- Getting Supplies?
37
COMING 2012
COVENTRY HEALTH CARE
OF
ILLINOIS
Same great company with a new name!
38
Thank you for attending the 2012
Kick-Off Training Class!
Don’t Forget to make sure all
Testing and Contracting has been
completed online!