AGENT USE ONLY HumanaOne health plans for individuals and families.
Presentation on theme: "HumanaOne health plans for individuals and families"— Presentation transcript:
1 HumanaOne health plans for individuals and families 111
2 Product Portfolio Map * Association States – AZ, FL, MI, WI WI* MI* NE HumanaOne New Business StatesWI*MI*NEOHNVILINUTVACOKSMOKYNCTNAZ*OKSCNMARMSALGATXLAFL*Old PlansNew Plans* Association States – AZ, FL, MI, WI
3 PortabilityIf a client has a child who attends college in another state, that child will receive in-network benefits by seeing an in-network providerIf a client moves to another state they can take their policy with them even if HumanaOne is not sold in that stateThis is not the case for new sales in FL Open Access counties, WI Coalition Counties and GA policies
4 HumanaOne Individual Health Plans (OLD PRODUCTS)Alabama, Arkansas, Illinois, Indiana, Kansas, Kentucky, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Virginia44
5 PORTRAIT Share 80 Plus Rx Unlimited 80% coinsuranceDeductibles:single: $1,000; $2,500family: $2,000; $5,000Unlimited doctor visitsSeparate $500 Rx deductible$0 Rx deductible buy-up optionRead slide.For family deductible, two individuals must meet their single deductibles.
6 AUTOGRAPH Share 80 Plus Rx 80% coinsuranceDeductibles:single: $3,500; $5,000; $6,000family: $7,000; $10,000; $12,000Six office visits, then 80% after deductibleSeparate $1,000 Rx deductible$500 Rx deductible buy-up option35% reduction in premium over Portrait!First 2 of 5.Read slide.As with the Portrait plan, the “Share 80” and “Share 70” describes the coinsurance portion of the plan, and the “Plus Rx” signifies that both of these plans have Rx coverage.
7 Rx benefit for Portrait and Autograph Plans Level 1: $15 copay ONLYno deductible38% of Rx claims fall into Level 1Separate $500 (Portrait) or $1,000 (Autograph) deductible then copay:Level 2: $35 copayLevel 3: $55 copayLevel 4: 25% copay (Up to $2,500 maximum out-of-pocket per person per calendar year)Option to buy up to a $0 deductible on Portrait or a $500 deductible on Autograph.Read slide.Level 1, like amoxicillin, are lowest cost generic and brand-name drugsLevel 2 are higher cost generic and brand-name drugsLevel 3 are higher cost, mostly brand-name drugs that may have generic or therapeutic equivalents in Levels One or TwoLevel 4 – are high technology drugs (certain brand-name drugs, biotechnology drugs and self-administered injectable medications)
8 Office Visit Co-pay Doctor visits for injuries / illnesses UNLIMITED Office Co-pays (Portrait) or 6 Co-pays per person (Autograph Share 80 Plus Rx)$35 co-pay for primary care physician$50 co-pay for specialist$200 allowance for diagnostics and labs at 100% before deductible
9 AUTOGRAPH Total Plus Rx / HSA HSA-Qualified100% coinsuranceDeductibles:single: $1,500, $2,500, $3,500; $5,000family: $3,000, $5,000, $7,000, $10,000Rx expenses integrated with medical deductible
10 AUTOGRAPH Total / HSA 100% coinsurance Deductibles: single: $2,000, $3,000, $4,000; $5,200family: $4,000, $6,000, $8,000, $10,400No Rx benefit; but discount cardUse HSA to fund discounted prescriptionsAllows for favorable UW and rate-ups are avoidedDoes not cover mental health (except where mandated by the state)
11 Monthly premium for a 25 year old male = $51.72 MONOGRAM Total Plus Rx100% coinsuranceDeductibles:single: $7,500family: $15,000Separate $1,000 Rx deductibleSame Rx tier structure with slightly higher copays on tiers 2-4 (see your benefit summary)Read slide.As with the other plans, the “Total” represents that coinsurance is 100%, and the plan has Rx coverage.Monthly premium for a 25 year old male = $51.72
12 Back by popular demand - Share 70 Plus Rx 70% coinsuranceDeductiblesSingle: $2,500 or $5,000Family: $5,000 or $10,000Out-of-pocket maximum coinsuranceSingle: $3,000Family: $6,000Separate $1,000 Rx deductibleAvailable in CO, FL, GA, MI, TX, WI1212
13 Important Notes Applicants Who Are Not Replacing Coverage Other Notes If an applicant has not had coverage in the last 63 daysEarliest effective date is 30 days from the date of complete applicationUW will complete a “not replacing” questionnaireIf an applicant has not had coverage in the last 2 yearsUnderwriting will require the applicant to have a physical examination prior to applicationOther NotesIntegrated 4th Quarter deductible carry-over on non-HSA plans90 day wait period for preventive careOptional Benefits covered in next section with New Plan DesignsDental, Term Life and Supplemental Accident Coverage
14 HumanaOne Individual Health Plans (NEW PRODUCTS)Arizona, Colorado, Florida, Georgia, Louisiana, Michigan, Texas, Utah and Wisconsin1414
15 Enhanced Copay 80% (Similar to Portrait) 80% coinsuranceDeductiblesSingle: $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000Family: Once three family members meet their single deductibles, the family deductible will be met for all other family membersOut-of-pocket maximum coinsuranceSingle: $2,500 / Family: $5,000Unlimited doctor office visits $35 copay primary care physician/$60 copay specialist$60 copay for an urgent care visitSeparate $500 Rx deductible (buy-up to $150)Similar to PortraitOffice visit is an office visit regardless of preventive care or illnessIn-network coinsurance and deductibles are shown15
16 Copay 80% (Similar to Autograph Share 80 Plus Rx ) 80% coinsuranceDeductiblesSingle: $3,500, $5,000Family: Once three family members meet their single deductibles, the family deductible will be met for all other family membersOut-of-pocket maximum coinsuranceSingle: $3,500 / Family: $7,000Six doctor office visits$35 copay primary care physician /$60 copay specialist$60 copay for an urgent care visitAfter six visits then 80% after deductibleSeparate $700 Rx deductible (buy-up to $300)similar to Autograph Share 80 Plus Rx plansIn-network coinsurance and deductibles are shown16
17 Copay 70% (Similar to the Autograph Share 70) 70% coinsuranceDeductiblesSingle: $1,500, $2,500, $5,000Family: Once three family members meet their single deductibles, the family deductible will be met for all other family membersOut-of-pocket maximum coinsuranceSingle: $5,000 / Family: $10,000Three doctor office visits $35 copay primary care physician /$60 copay specialist$60 copay for an urgent care visitAfter 3 visits then 70% after deductibleSeparate $1,000 Rx deductible (buy-up to $500)similar to the Autograph Share 70 plans recently re-introduced in a subset of statesIn-network coinsurance and deductibles are shown17
18 Value 100% (Similar to Monogram) 100% coinsuranceDeductiblesSingle: $5,000, $7,500Family: Once three family members meet their single deductibles, the family deductible will be met for all other family membersSeparate $1,000 Rx deductiblePerfect plan for first time insurance buyers and those not yet eligible for MedicareSimilar to MonogramIn-network coinsurance and deductibles are shown18
19 Prescription benefit: Rx4 Level 1: $15 copay (No deductible applies- copay only)50% of all Rx claims fall into Level 1Level 2: $35 copay ($40 copay for Copay 70% and Value 100%)40% of all Rx claims fall into Level 2Level 3: $60 copay ($65 copay for Copay 70% and Value 100%)10% of all Rx claims fall into Level 3Level 4: 35% copayUp to $5,000 copay maximum, level 4 only out-of-pocket expense per person per calendar yearNo maximum that Humana will dispenseLess than 1% of all Rx claims fall into Level 4Separate prescription deductible applies for Levels 2 through 4:19
20 Enhanced HSA 100% (Similar to Autograph Total Plus Rx HSA) 100% coinsuranceDeductiblesSingle: $1,500, $2,500, $3,500, $5,000, $5,950Family: Benefits will be paid once the family deductible is met, regardless of the number of members on the planRx expenses integrated with medical deductibleEnhanced HSA is similar to today's Autograph Total Plus Rx HSA20
21 HSA 100% (Similar to Autograph Total/HAS) DeductiblesSingle: $1,500, $2,500, $3,500, $5,000, $5,950Family: Benefits will be paid once the family deductible is met, regardless of the number of members on the planNo Rx benefit; discount card available at up to 25% savingsDoes NOT cover mental health (except where mandated by state)Applicants will NOT be rated up for current Rx medicationsCoverage for spinal manipulations, adjustments and modalities is not included (except where mandated by the state)HSA is similar to today's Autograph Total/ HSA21
22 Reform Changes to Benefits Plans sold on or after Sept. 23, 2010 (excluding HumanaOne Short Term Medical plans) will have the following benefit changes:Plans will have an unlimited lifetime maximum benefitPlans will cover in-network preventive care services at 100 percent, and there will be no dollar limit on coverage for in-network preventive care servicesPlans will have no limit on coverage for ambulance servicesPlans will have no dollar limit on coverage for mental health care
23 Supplemental Accident Benefit option $1,000 or $2,500 benefit choice is provided for accidental injuries only- Old product has $500 or $1,000 benefitTreatment must be administered within 90 days of the accidentNot subject to deductible or coinsurance - first dollar coverage administered before applicable co-paysAfter benefit amount is exhausted, remaining charges are applied to the medical policy provisionsNo limit on number of accidents per yearIdeal supplemental benefit to add on to higher deductible plans!Read slide.It also applies to both par and non par services. Previously we offered $500 and $1,000 benefit. We are providing the additional coverage as the agent desired to have an enhanced benefit.Do not read:The Medical Glossary of the members contract defines bodily injury as:“Bodily Injury means damage resulting from sudden, violent, external physical trauma which could not be avoided or predicted in advance. Bodily damage resulting from infection or muscle strain due to athletic or physical activity is considered a sickness and not a bodily injury.”This is an optional rider the members can elect to add to their plans.(Do not read: An accident is defined by the ICD codes (International Classification of Disease). These are standard with doctors, and are used in claims payments.)
24 Dental Traditional Plus Preventive Services: Plan pays 100% no deductibleOral examsRoutine cleaningsX-raysBasic Services: Plan pays 50% after deductibleEmergency examsComposite fillingsOral surgeryMajor services: Plan pays 50% after deductibleCrownsRoot CanalsDenturesOther benefits: Orthodontia discountRead slide.Waiting periods, limitations and exclusions may apply See your benefit summary for complete details and covered services
25 Dental Preventive Plus Preventive Services: Plan pays 100% no deductibleOral examsRoutine cleaningsX-raysSealants and fluoride treatmentsBasic Services: Plan pays 50% after $50 deductible (six-month waiting period applies)*ExtractionsSpace maintainersComposite fillingsOral surgeryAnnual Maximum (excludes discount services) $1,000Discount servicesReceive a discount on services not covered under this plan. Savings average 27% nationwide on in-network services including Orthodontia servicesCheckbox add-on in AZ, CO, MI, UT, WIRead slide.* Please refer to your state specific summary as benefits may vary
26 Term Life option Simple, convenient process Amounts start at $25,000 up to $150,000Combined Medical/Life Application - If your clients are approved for a health plan they are approved for life as well (up to $150K)10, 15, and 20-year level premiumsRates are guaranteed for the full term of the policyRenewable to age 95 after the level premium periodRead slide.
27 New plan enhancements Rate classes HumanaOne offers three competitive rate classes for its medical products. These classes are:Preferred rating: our best rate for applicants who are in good health overall, take no current medication (except birth control), and who have had major medial coverage within the past 63 days (proof may be required)Standard rating: applicants who don’t qualify for the preferred rating and/or have minor ongoing medical conditionsStardard+ rating: applicants who are in fair health and require additional rating due to moderate medical conditionsSimplicity, Competitive advantage and extend more first dollar coverage.Your client will be covered for preventive care immediately, not after 90 days. Preventive care is important and we’re extending the benefit.Enhanced Copay 80%, Copay 80%, Copay 70%Combined preventive and diagnostic office visit, and urgent care copay benefit (Unlimited, 6 and 3 visits based on plan)Urgent care copay increased to $60 regardless of the provider typeCombined preventive and diagnostic x-ray and lab first dollar coverage benefit ($500, $400 and $300 based on plan)Value 100% and Enhanced HSA 100%$500 Preventive Care maximum on services not subject to the deductible (e.g. exams, mammograms)HSA 100%No preventive care maximum but all services are subject to deductible
28 Sickness effective date New plan enhancementsSickness effective dateApplicants will have peace of mind knowing they are covered for an injury immediately after policy issueNo longer moving the effective date forward 30 daysApplicants will start with a plan (injury) effective data and a sickness effective dateIf applicant had a least 63 days of prior coverage at time of application, the sickness effective date will not applySickness effective date is the 15th day after the policy effective date for bodily injurySickness effective date is issued at the member levelSimplicity, Competitive advantage and extend more first dollar coverage.Your client will be covered for preventive care immediately, not after 90 days. Preventive care is important and we’re extending the benefit.Enhanced Copay 80%, Copay 80%, Copay 70%Combined preventive and diagnostic office visit, and urgent care copay benefit (Unlimited, 6 and 3 visits based on plan)Urgent care copay increased to $60 regardless of the provider typeCombined preventive and diagnostic x-ray and lab first dollar coverage benefit ($500, $400 and $300 based on plan)Value 100% and Enhanced HSA 100%$500 Preventive Care maximum on services not subject to the deductible (e.g. exams, mammograms)HSA 100%No preventive care maximum but all services are subject to deductible
30 Other Important Notes Eligible Ages Effective Dates 2 weeks to 64 ½ years oldNo Child Only ApplicationsEffective DatesAny day of the month including the day they applyUp to 45 days in advanceSpecial rules for those not replacing coverage
31 When do we need requirements? Medical Records (<15%):Not replacing coverage & recent medical careChronic type conditionsInformation obtained from 3rd party dataParameds (<10%):Applicant is close to 50% ratable or declinable buildAdditional InformationBlood Pressure/Cholesterol Readings (when applicants’ answer “don’t know”).Test ResultsPhysician or treatment information.Third Party Data review/validation
33 Humana Financial Protection products Further diversify your product portfolioWider selection of products to offer your clients based on their varying budgets and needsOur consumer-focused products are simple to understand, easy to obtain, affordable, and transparentCross sell: huge potential for consumers to purchase multiple productsWith health reform, consumers will be considering added protection for their personal and financial health
34 Life coverage: Memorial Fund* A whole life plan to offset final expenses; available in benefit amounts from $1,000 − $25,000Offers a graded death benefit with level premiums for prospects with health issues (becomes level after the third policy year)Guaranteed cash valueCoverage for issue age is 45 − 80 (nearest age)Premium options are life pay or 10-year pay* Product availability will vary by state.
35 Health coverage: Critical Illness Cash plan* Pays lump-sum cash benefits for critical illnesses such as heart attack, stroke, and cancerBenefit amount from $5,000 − $50,000Same lump-sum amount paid for all covered family membersIssue ages 0 − 69 (may vary by state)Pays in addition to any benefits client already hasGuaranteed renewable30-day free lookOptional Return of Premium rider* Product availability will vary by state.
36 Health coverage: Hospital Cash plan* Provides lump-sum benefits directly to client for:Hospital confinementOutpatient surgeryAccidental injury or sicknessIssue ages 0 − 69 (may vary by state)Guaranteed renewable to age 70Lump-sum hospital confinement from $250 − $2,000Maximum coverage $2,000 for all in-force policies$150 lump-sum accidental injury and sickness benefit per emergency room visit$150 lump-sum outpatient surgery benefitOptional hospital confinement daily benefit rider: $50 ($200 ICU); $100 ($400 ICU; $200 ($800 ICU)* Product availability will vary by state.
38 Quoting and Enrollment To create a quote go to humanaoneagentquote.comEnter Humana Agent SAN and click Next.Use for quoting and enrollment onlyAgent can not reassig the quote to another agent
39 Quoting and Enrollment Agent WorkbenchSimple Registration Process!Your Humana Agent number is required forregistration and can be found:– On your welcome letter after appointment– On your commission statement– From the Agent Service Center
40 Accessing Agent Workbench Log ontoEnter your username and passwordClick Log In
42 Accessing Agent Workbench To begin a quote, hover over Generate a New Quote in either of the two locations and select a product:Medical (Health and STM)Stand Alone Dental and VisionSupplemental InsuranceStand Alone Life
43 Generate a Quote Agent Workbench or humanaoneagentquote.com
59 E-Signature ProcessYour client will need to click on the link within the . A new browser window will open.The application number will pre-populate. Your client will enter the required information and click Next.
60 E-Signature ProcessThe applicant(s) are required to read and agree to the Online Service Agreement and the Notice of Privacy Practices.They should review each document and click the checkboxes next to their name. Click Next.