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Jeremy Stanly HumanaOne Benefits Humana. Landing Page Affordable Care Act compliant – what does that mean Essential Health Benefits Benefit Grids Vision.

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Presentation on theme: "Jeremy Stanly HumanaOne Benefits Humana. Landing Page Affordable Care Act compliant – what does that mean Essential Health Benefits Benefit Grids Vision."— Presentation transcript:

1 Jeremy Stanly HumanaOne Benefits Humana

2 Landing Page Affordable Care Act compliant – what does that mean Essential Health Benefits Benefit Grids Vision Dental PCP ID Card Cost Sharing Deductibles Common Transfer Numbers 2 Verification of Benefits Training Agenda

3 What is it- HumanaOne is for individuals who purchase their own insurance. They are not affiliated with a group or programs such as Medicaid. 3 Humana One – Individual Line of Business

4 The landing page is the first place you will be taken when receiving a member call. The next slide will show what the Landing Page looks like. 4 Insert form number via Header and Footer option or delete, if not needed Landing Page Insert date via Header and Footer option

5 Screen shot and circle or highlight 5 Landing Page

6 What does this mean? The benefits that you will be quoting are plans that went into effect on or after 1/1/14 is considered to be ACA compliant. There are 10 essential health benefits that must be included in all of these plans. Mentor Doc: Essential Health Benefits OverviewEssential Health Benefits Overview 6 Affordable Care Act Compliant

7 The ACA compliant plans fall under one of four metallic tiers, and are named as such:  Platinum  Gold  Silver  Bronze An example plan name would be: FL HMO Premier 80 IMM Silver 1 Connect Silver 7 Insert form number via Header and Footer option or delete, if not needed Affordable Care Act Compliant Insert date via Header and Footer option

8 Deductible- The portion of the covered member’s health care expenses that must be paid out of pocket before the member’s plan begins paying its share Coinsurance- A percentage of health care costs for which the member is responsible under the member’s health benefit policy. For example, a member might pay for 20 percent of the cost of a service, with the health coverage policy paying the remaining cost Copayment-A fixed amount of health care costs for which the member is responsible under the member’s health benefit policy. For example, a member might pay $15 for each visit to a physician, with the health coverage policy paying the remaining cost. 8 Insert form number via Header and Footer option or delete, if not needed Terms Insert date via Header and Footer option

9 Maximum Out of Pocket-The amount a member is required to pay for treatment or services. Example: You will see something like this maybe $5000/$6500 The $5000 is the deductible and the $6500 is the Maximum Out of Pocket (Moop) Cost Sharing- The portion of the deductible or out of pocket that the member may get a reduction on due to income levels. Example: A member may have a deductible of $5,000, but receive a cost share discount to bring their deductible down to $3500 based off of their income level. 9 Insert form number via Header and Footer option or delete, if not needed Terms Insert date via Header and Footer option

10 Benefit grids are where the member’s benefit information comes from. To populate these grids, in CCP click the benefits tab: 10 Benefit Grids

11 11 Benefit Grids

12 The slide prior shows what the benefit tab looks like. The grid then will populate in mentor: 12 Benefit Grids

13 The name of the member’s plan is the hyperlink that you actually click to get into the grid: 13 Benefit Grids

14 On the bottom there are tabs where the medical benefits and the Pediatric Vision benefits are available. The benefit tab is what is used most often, unless the member has a question about Pediatric Vision 14 Benefit Grids

15 15 Benefit Grids

16 Some members may have their deductibles populate for you in CCP on the benefits tab: 16 Insert form number via Header and Footer option or delete, if not needed Deductibles Insert date via Header and Footer option

17 Some members may qualify for cost share through the federal government. Cost share is where the government picks up a portion of the members deductible. For example if the plan calls for a $4600 deductible, with cost sharing it may drop it to $2500. To locate the cost share go back to the landing page and hover over the member details button at the top. A drop down will appear and click on Cost Share. 17 Insert form number via Header and Footer option or delete, if not needed Deductibles Insert date via Header and Footer option

18 18 Insert form number via Header and Footer option or delete, if not needed Locating Cost Share Insert date via Header and Footer option

19 19 Insert form number via Header and Footer option or delete, if not needed Locating Cost Share Insert date via Header and Footer option

20 20 Insert form number via Header and Footer option or delete, if not needed Pediatric Vision Insert date via Header and Footer option

21 For questions regarding Pediatric Vision: Use the benefit grid the same way you learned how to quote the medical benefits. 21 Insert form number via Header and Footer option or delete, if not needed Pediatric Vision Insert date via Header and Footer option

22 Some members may have a dental benefit. To find if a member has one of these you would check on the Member tab of CCP. 22 Insert form number via Header and Footer option or delete, if not needed Dental Insert date via Header and Footer option

23 This plan has a CB next to it, so that would be a warm transfer to the Dental CompBenefits area at For Dental Plans that do not have a CB, warm transfer to Insert form number via Header and Footer option or delete, if not needed Dental Insert date via Header and Footer option

24 To verify who a member’s PCP is (primary care physician) go to the benefits tab again. Click the PCP tab: The types of providers that can be PCPs are; Family Practice, General Practitioners, OBGYN’s, Internal Medicine and Pediatricians 24 PCP

25 25 PCP Changes

26 To assist a member with a PCP change go to the PCP tab on the benefits screen Go to physician finder and make sure the PCP is in network. To get the physician ID click on the physician’s name Then click on the hyperlink that says “more” under Locations and Affiliations. The PCP number appears. The following slides will show you the process. If the member is a 1/1/14 effective date you can backdate the PCP effective date. The change will take 24 hours to take effect in CCP. 26 Insert form number via Header and Footer option or delete, if not needed PCP Changes Insert date via Header and Footer option

27 27 Insert form number via Header and Footer option or delete, if not needed PCP Changes Insert date via Header and Footer option

28 28 Insert form number via Header and Footer option or delete, if not needed PCP Changes Insert date via Header and Footer option

29 29 Insert form number via Header and Footer option or delete, if not needed PCP Changes Insert date via Header and Footer option

30 If for some reason the change doesn’t work in CCP then follow the below process: All Primary Care Physician (PCP) Changes should be made in CCP. NOTE: If the network says FL HMO Premier, it is not a true HMO and does not require a PCP. If you are unable to update the PCP in CCP because the system is giving you an error message, please use the following scripting. Scripting: “I’ll send a request for your PCP change now, you will be getting a new ID in an estimated business days. What is the best number to reach you at if we have any additional questions or concerns with your new choice?” 30 Insert form number via Header and Footer option or delete, if not needed PCP Change Insert date via Header and Footer option

31 Then please document your inquiry with the following information and send it to the tank below. Please include in your notes the following information, all of which can be found in Physician Finder Plus (PFP) except for the member’s phone #:  Physician’s Name:  Physician’s Address:  CAS #:  Member’s Call Back Phone #: After filling out the above information, send your inquiry to:  Service Center: Green Bay  Department: INDALLS Calls  Team: PCP Update  User: Blank 31 Insert form number via Header and Footer option or delete, if not needed PCP Change Insert date via Header and Footer option

32 For ID card orders please advise the member to go to Humana.com and they can view or print their ID Cards. If they are having problems doing this assure them that their cards are on the way. In the mean time double check the member’s effective date to be 1/1/14. Also inform them of their member ID and their Group #. Those are what they will need to attain care from their provider. 32 ID Cards

33 33 ID Cards

34 Some calls may require you to transfer to other departments: For more in depth medical benefit or referral questions please cold transfer to HumanaOne claims and benefits at For any pharmacy claim and benefit questions transfer to For member calls where they have a procedure scheduled and want to know if authorization is needed, transfer to our Clinical Intake Team (CIT) Transfer Types

35 When logging the benefits please copy verbatim from the grid, and paste the benefit into your free text. If multiple benefits are given then paste all the benefits into one CCP Inquiry. Your CRD’s for the call will be: Category- VOB Reason- (type of benefit) such as Preventive Disposition- (what you did) such as info given 35 Call Logging

36 36 Insert form number via Header and Footer option or delete, if not needed Call Logging Insert date via Header and Footer option

37 If for some reason there is an error in CCP or Mentor where the information is not populating or you get an actual error of some kind. Please send a screen shot as well as a description of the error to Dana Vandenlangenberg 37 Insert form number via Header and Footer option or delete, if not needed Technology Errors Insert date via Header and Footer option

38 ??????????????????? 38 Questions???


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