Presentation on theme: "BLUE CROSS of California Medicare Supplemental Products."— Presentation transcript:
BLUE CROSS of California Medicare Supplemental Products
MARKET POTENTIAL 2 Million people turn 65 each year in the U.S. = 166,667 each month, 5,574 each day 3.6 MILLION CALIFORNIA SENIORS Approximately 200,000 Californians become Medicare eligible each yr. = 16,000 each month * Based on 2000 U.S. census data.
MARKET POTENTIAL Guaranteed Issue – no underwriting in most situations! –Within 6 months after obtaining Part B –Within 6 months after terminating “Group” coverage Persistency –Average Blue Cross Member stays over 10 years –1 sale = 10 years of commission Simplicity –Medicare Supplemental Policies have remained basically unchanged since 1990
BLUE CROSS Supplemental Products Products CareResource Solutions Review of the Rules
BLUE CROSS Supplemental Products This product accounts for 25% of Blue Cross’ Medicare Supplemental sales. In Areas 1, 2, 3, the premiums are 56% less than the F Plan. In Areas 4, 5, 6 the premiums are 54% less than the F Plan.
BLUE CROSS Supplemental Products SmartChoice
BLUE CROSS SmartChoice The Classic F Plan with two major differences: –High Deductible F Plan: $1690 Deductible - After Medicare pays its portion of services –Includes Unlimited Generic Formulary Prescription Plan! NO Deductible $12 copay at Participating Pharmacies $15 copay for 90 day supply through the mail order program
BLUE CROSS SmartChoice Examples of expenses that may be used to satisfy the annual plan deductible: –Part A Deductible –Part A Hospital Copays –Part B Annual Deductible –Part B Coinsurance and Excess Charges –Skilled Nursing Facility Copays –Foreign Travel Coinsurance
BLUE CROSS SmartChoice Examples of expenses that may not be used to satisfy the annual plan deductible: â Services not covered by Medicare â Foreign Travel Emergency $250 Deductible â Prescription Drug Copays
BLUE CROSS SmartChoice
Important Points: –Plan coordinates with Medicare, so the member is responsible only for deductibles/coinsurance and/or copayment amounts –Once the member reaches the annual deductible, SmartChoice benefit levels are the same as Classic F –The Prescription Drug benefit covers Generic Formulary drugs ONLY and is available upon enrollment
BLUE CROSS SmartChoice vs. Classic F Out of pocket comparison (premium, office visit charges and Rx) for a member having 12 office visits ($100 per) and two $40 Rx/ month (one covered under SmartChoice formulary) Area 1, 2, 3 - Age 65 –Classic F - $2,172 –SmartChoice - $1,388 Area 4, 5, 6 - Age 65 – Classic F - $2,352 – SmartChoice - $1,496
BLUE CROSS SmartChoice Rates Commissions: 13%
BLUE CROSS Supplemental Products SmartChoice Plus & AdvantageCare
BLUE CROSS Supplemental Products To provide you with more selling options, we added a chronic care rider to our most popular selling Plan -- the F Plan. This rider is available on the Classic F Plan as well as the high deductible F Plan -- SmartChoice. This rider is not a Long Term Care Plan.
BLUE CROSS Smart Choice PLUS & AdvantageCare These are new products designed to provide benefits for: – SNF – Residential Care Facilities – Home Health As well as...
Not covered by Medicare BLUE CROSS Smart Choice PLUS & AdvantageCare Home Support Services 4 Adult Day Care 4 Chore Services 4 Personal Care Services 4 Transportation to Physicians 4 Adaptive Equipment/Home Repair 4 Money Management 4 Home-delivered Meals 4 Respite Care
Benefit Triggers: Assistance to perform two (2) of the following Activities of Daily Living: –Eating –Bathing –Continence –Dressing –Toileting –Transferring OR, BLUE CROSS Smart Choice PLUS & AdvantageCare
Benefit Triggers: Assistance to perform three (3) of the following Instrumental Activities of Daily Living: –Using Transportation –Preparing Meals –Maintaining the physical upkeep of the home –Completing house cleaning chores –Performing necessary daily chores –Managing necessary finances BLUE CROSS Smart Choice PLUS & AdvantageCare
Care Coordination & Plan of Care –Written assessment of the subscriber’s disabilities and description of necessary chronic care services needed. –Developed by the care manager together with the subscriber, the subscriber’s physician and other healthcare professionals and family members. –Benefits will be provided for services that are pre- approved by Blue Cross and included in the Plan of Care. –Care coordinated through care manager. BLUE CROSS Smart Choice PLUS & AdvantageCare
Applying for Coverage Available to applicants age Member must be eligible for Classic F or SmartChoice Special ‘rider’ underwriting is required Premium paid until benefits are exhausted 2-party rates not available for the Rider attached to Classic F Plan or SmartChoice Rates are based upon age at time of enrollment and do not increase with age, but may be increased overall No Guarantee Issue for Rider BLUE CROSS Smart Choice PLUS & AdvantageCare
Nursing Facility or Residential Care: –Elimination Period of 100 days Met 1X for life of policy Coordinates with Medicare –Daily Benefit = billed charges up to $100 Home HealthCare and Home Support: –Home Care Deductible = $1000 Met in $100/day increments Met 1X for life of policy –Daily Benefit = billed charges up to $100 BLUE CROSS Smart Choice PLUS & AdvantageCare
Benefit Design Details No co-payments for covered Rider services Member responsible for amounts in excess of $100 Daily Max The maximum benefit is $36,500 ($100 x 365) Services from relatives are not covered A Classic F plan or SmartChoice prospect could conceivably be denied for AdvantageCare or SmartChoice Plus and still be accepted on Classic F or SmartChoice. Remember to check the boxes BLUE CROSS Smart Choice PLUS & AdvantageCare
AdvantageCare: Age 65: Classic F $101 AdvantageCare $39 $140 Same Member 5 yrs. later: Classic F $131 AdvantageCare $ 39 $170 New member age 70: Classic F $131 AdvantageCare $ 62 $193 SmartChoice Plus: Age 65: SmartChoice $44 SmartChoicePlus $39 $83 Same Member 5 yrs. Later: SmartChoice $62 SmartChoicePlus $39 $101 New member age 70: SmartChoice $62 SmartChoicePlus $62 $124 Examples of Rates in Areas 1, 2, 3 BLUE CROSS Smart Choice PLUS & AdvantageCare
AdvantageCare: Age 65: Classic F $116 AdvantageCare $ 39 $155 Same Member 5 yrs. later: Classic F $152 AdvantageCare $ 39 $191 New member age 70: Classic F $152 AdvantageCare $ 62 $214 SmartChoice Plus: Age 65: SmartChoice $53 SmartChoicePlus $39 $92 Same Member 5 yrs. Later: SmartChoice $74 SmartChoicePlus $39 $113 New member age 70: SmartChoice $74 SmartChoicePlus $62 $136 Examples of Rates in Areas 4, 5, 6 BLUE CROSS Smart Choice PLUS & AdvantageCare
Commissions: Classic F: % % % SmartChoice: All sales13% Rider: Yr. 185% Renewal 5% BLUE CROSS Smart Choice PLUS & AdvantageCare
BLUE CROSS Supplemental Products CareResource Solutions
BLUE CROSS CareResource Solutions The work of caregivers would cost an estimated $ Billion per year
BLUE CROSS CareResource Solutions $ Paid home care is the exception for most people receiving care
BLUE CROSS CareResource Solutions $ $ Caregivers spend an average of 20 hours/week providing care
BLUE CROSS CareResource Solutions $ $ Half of all caregivers are older caregivers -- these individuals have difficulty with the physical demands
BLUE CROSS CareResource Solutions 63% of Elderly caregivers (66+) who experienced stress and strain were susceptible to higher mortality rates.
BLUE CROSS CareResource Solutions Caregivers are more likely to suffer from depression (6 times the national average) 76% of caregivers say they don’t get consistent help Most difficult issue for many caregivers is the feeling of isolation
BLUE CROSS CareResource Solutions Information (i.e., educational materials, tip sheets, check lists) Referrals (wide scope of local services) Counseling and emotional support Skilled professionals with experience with Caregiving and Eldercare issues One-Stop Caregiver Support Resource
Saves time in researching Saves time in action plan development Helps individuals remain independent Support for those who can’t qualify or afford a LTC plan BLUE CROSS CareResource Solutions
Care Coordination -- CareGuide –Direct link with CareResource –Discounts on all levels of care planning, coordination, and monitoring
BLUE CROSS CareResource Solutions Personal Emergency Response System -- American Medical Alert –Discount on two-way voice-activated system –Discount on installation fee
BLUE CROSS CareResource Solutions Bill-paying Services -- MoneyTek –Bonded services –Discount on monthly charges –Discount on initial set-up fee
BLUE CROSS CareResource Solutions Partnership with Ceridian Corporation: An established leader in support services Provides employer and benefit services to 40,000 customers (40% of which are Fortune 1000 companies) Services provided by professionals who are experienced and certified in eldercare, counseling, legal and financial matters
BLUE CROSS CareResource Solutions Services accessible through toll-free 800 number 24 hours/day; 365 days/year $150 annual membership fee
Blue Cross Medicare Supplements Old Rules Worth Repeating
Blue Cross Medicare Supplements SELECT Plans –Medicare SELECT is a type of Medigap insurance policy which requires the member to utilize a contracted network of physicians or hospitals in order to receive full plan benefits. –ALL Blue Cross of California Medigap plans are SELECT plans with the exception of Standard Plan A
Blue Cross Medicare Supplements Common Guarantee Issue Rules:
Blue Cross Medicare Supplements Enrollment Tips –The applicant MUST have BOTH Parts A & B of medicare - check their medicare card! –You must provide an Outline of Coverage and the Guide to Medicare at the point of sale –Applicant must complete the medical health questions, signature, and date THEMSELVES –All questions - including the question regarding Prescription drug usage - must be completed regardless of plan applied for or whether the member is in a guarantee issue period
Enrollment Tips –If the member is coming from a Senior HMO plan, they MUST disenroll prior to becoming effective on the supplement plan. If they fail to do so, any and all resulting claims will be the members responsibility! –Applications may be submitted up to 90 days prior to the requested effective date. –Applications must be RECEIVED in Senior Services by the last BUSINESS day of the month to receive a 1st of the following month effective date. Blue Cross Medicare Supplements
Enrollment Tips –Applications received after the 1st of the month and prior to the 15th of the month will receive a 15th of the month effective date - unless a specific effective date that falls AFTER the receipt date is specified. –Any effective date other than the 1st or 15th must be the result of loss of coverage and the applicant must provide proof in the form of a letter or phone number.
Blue Cross Medicare Supplements Changing Supplement Plans within Blue Cross –Blue Cross will not process any changes (including disenrollments) until the “paid-to-date”. –If members are changing plans, make sure they receive the appropriate outline of coverage. –Both downgrades and upgrades in coverage require a new application. –Changing from Frozen (inactive) to Active Plans ALWAYS requires underwriting.
Blue Cross Medicare Supplements Underwriting Rules for Coverage Changes
Two party rates will only be accepted in the following situations: –Both individuals must be enrolled on the same plan. –The applicant is within their 6 month Medicare guaranteed enrollment period -- obtaining Part B coverage. –The applicant is terminating a group policy. –Both applicants pass medical underwriting. Blue Cross Medicare Supplements
Two party rates will only be accepted in the following situations: –If adding to an existing plan, the paid-to-date must coincide. If existing member paid-to-date is the following month, the enrolling member should pay one month as a single enrollee. The next month they may pay the 2 party rate. –Note: if the existing member has paid annually, it is possible to back out the premium to accommodate a 2 party rate - however, be aware that the premium will be reapplied at the current premium rate.
Blue Cross Medicare Supplements FREE Senior Passport Savings Program –Pharmacy Discount Program –Vision Care Discount Program –Medical Records Service –Hearing Care Discount Services –Travel & Car Rental Discounts –Lodging Discounts –Retirement Planning –Moving Services –Mail-Order Discounts
Blue Cross Medicare Supplements Free Senior Passport Savings Program –LifeResource Solutions One-Stop resource for issues relating to Elder Care Services, Legal & Financial matters, and everyday life –Unified Health Care Discount on medical equipment –HealthyExtensions Program Programs and services designed to help you stay healthy New
Blue Cross Medicare Supplements Broker of Record –If an individual converts from a BCC individual plan to a Senior Plan directly through BCC, the Agent of Record on the individual plan will be loaded onto the system and receive 8% flat commission –Per agent agreement, Agents will not be reflected as the Broker of Record when replacing an existing BCC supplement or on an existing policy. A 3 month lapse in coverage is required in order to be considered a ‘new policy’.
Blue Cross Cross Selling Opportunities Blue Cross Long Term Care Plans –Competitive Plans –Separate Agent Agreement required LifeBenefits Whole Life Insurance –85% first year, 5% renewal commissions –$3K - $25K Face Value –Simplified Underwriting Dental SelectHMO –Available in select areas
The impact of automatic bank draft: Members on Bank draft have a higher retention rate that non-bank draft members. Since the average Senior member stays with Blue Cross for 10 years, each additional year a members stays with Blue Cross would generate an additional $ in annual commissions*. 3 additional years = $ additional years = $1, additional years = $2, *This example is based on the sale of one F Plan to a 65 year old in Southern CA. Retention Tools
Blue Cross Medicare Supplements Agent Services Toll Free Line: – Customer Service Toll Free Line: –