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AGENT USE ONLY HumanaOne health plans for individuals and families.

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AGENT USE ONLY HumanaOne health plans for individuals and families.

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Presentation on theme: "AGENT USE ONLY HumanaOne health plans for individuals and families."— Presentation transcript:

1 AGENT USE ONLY HumanaOne health plans for individuals and families

2 AGENT USE ONLY Product Portfolio Map HumanaOne New Business States TX AZ * CO IL FL * GA LA MO KS NE IN WI * MS SC NC OH MI * AR KY TN UT NV OK AL VA Old Plans NM New Plans * Association States – AZ, FL, MI, WI

3 AGENT USE ONLY Portability If a client has a child who attends college in another state, that child will receive in-network benefits by seeing an in-network provider If a client moves to another state they can take their policy with them even if HumanaOne is not sold in that state This is not the case for new sales in FL Open Access counties, WI Coalition Counties and GA policies

4 AGENT USE ONLY 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 Virginia

5 AGENT USE ONLY PORTRAIT Share 80 Plus Rx Unlimited 80% coinsurance Deductibles: –single: $1,000; $2,500 –family: $2,000; $5,000 Unlimited doctor visits Separate $500 Rx deductible –$0 Rx deductible buy-up option

6 AGENT USE ONLY AUTOGRAPH Share 80 Plus Rx 80% coinsurance Deductibles: –single: $3,500; $5,000; $6,000 –family: $7,000; $10,000; $12,000 Six office visits, then 80% after deductible Separate $1,000 Rx deductible –$500 Rx deductible buy-up option 35% reduction in premium over Portrait!

7 AGENT USE ONLY Rx benefit for Portrait and Autograph Plans Level 1: $15 copay ONLY –no deductible –38% of Rx claims fall into Level 1 Separate $500 (Portrait) or $1,000 (Autograph) deductible then copay: –Level 2: $35 copay –Level 3: $55 copay –Level 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.

8 AGENT USE ONLY 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 AGENT USE ONLY AUTOGRAPH Total Plus Rx / HSA HSA-Qualified 100% coinsurance Deductibles: –single: $1,500, $2,500, $3,500; $5,000 –family: $3,000, $5,000, $7,000, $10,000 Rx expenses integrated with medical deductible

10 AGENT USE ONLY AUTOGRAPH Total / HSA 100% coinsurance Deductibles: –single: $2,000, $3,000, $4,000; $5,200 –family: $4,000, $6,000, $8,000, $10,400 No Rx benefit; but discount card –Use HSA to fund discounted prescriptions –Allows for favorable UW and rate-ups are avoided Does not cover mental health (except where mandated by the state)

11 AGENT USE ONLY MONOGRAM Total Plus Rx 100% coinsurance Deductibles: –single: $7,500 –family: $15,000 Separate $1,000 Rx deductible –Same Rx tier structure with slightly higher copays on tiers 2-4 (see your benefit summary) Monthly premium for a 25 year old male = $51.72

12 AGENT USE ONLY 12 Back by popular demand - Share 70 Plus Rx 70% coinsurance Deductibles –Single: $2,500 or $5,000 –Family: $5,000 or $10,000 Out-of-pocket maximum coinsurance –Single: $3,000 –Family: $6,000 Separate $1,000 Rx deductible Available in CO, FL, GA, MI, TX, WI

13 AGENT USE ONLY Important Notes If an applicant has not had coverage in the last 63 days –Earliest effective date is 30 days from the date of complete application –UW will complete a not replacing questionnaire If an applicant has not had coverage in the last 2 years –Underwriting will require the applicant to have a physical examination prior to application Applicants Who Are Not Replacing Coverage Other Notes Integrated 4 th Quarter deductible carry-over on non-HSA plans 90 day wait period for preventive care Optional Benefits covered in next section with New Plan Designs –Dental, Term Life and Supplemental Accident Coverage

14 AGENT USE ONLY HumanaOne Individual Health Plans (NEW PRODUCTS) Arizona, Colorado, Florida, Georgia, Louisiana, Michigan, Texas, Utah and Wisconsin

15 AGENT USE ONLY In-network coinsurance and deductibles are shown Enhanced Copay 80% (Similar to Portrait) 80% coinsurance Deductibles –Single: $500, $1,000, $1,500, $2,000, $2,500, $3,500, $5,000 –Family: Once three family members meet their single deductibles, the family deductible will be met for all other family members Out-of-pocket maximum coinsurance –Single: $2,500 / Family: $5,000 Unlimited doctor office visits $35 copay primary care physician/$60 copay specialist –$60 copay for an urgent care visit Separate $500 Rx deductible (buy-up to $150)

16 AGENT USE ONLY In-network coinsurance and deductibles are shown Copay 80% (Similar to Autograph Share 80 Plus Rx ) 80% coinsurance Deductibles –Single: $3,500, $5,000 –Family: Once three family members meet their single deductibles, the family deductible will be met for all other family members Out-of-pocket maximum coinsurance –Single: $3,500 / Family: $7,000 Six doctor office visits –$35 copay primary care physician /$60 copay specialist –$60 copay for an urgent care visit –After six visits then 80% after deductible Separate $700 Rx deductible (buy-up to $300)

17 AGENT USE ONLY In-network coinsurance and deductibles are shown Copay 70% (Similar to the Autograph Share 70) 70% coinsurance Deductibles –Single: $1,500, $2,500, $5,000 –Family: Once three family members meet their single deductibles, the family deductible will be met for all other family members Out-of-pocket maximum coinsurance –Single: $5,000 / Family: $10,000 Three doctor office visits $35 copay primary care physician /$60 copay specialist –$60 copay for an urgent care visit –After 3 visits then 70% after deductible Separate $1,000 Rx deductible (buy-up to $500)

18 AGENT USE ONLY In-network coinsurance and deductibles are shown Value 100% (Similar to Monogram) 100% coinsurance Deductibles –Single: $5,000, $7,500 –Family: Once three family members meet their single deductibles, the family deductible will be met for all other family members Separate $1,000 Rx deductible Perfect plan for first time insurance buyers and those not yet eligible for Medicare

19 AGENT USE ONLY Prescription benefit: Rx4 Level 1: $15 copay (No deductible applies- copay only) –50% of all Rx claims fall into Level 1 Level 2: $35 copay ($40 copay for Copay 70% and Value 100%) –40% of all Rx claims fall into Level 2 Level 3: $60 copay ($65 copay for Copay 70% and Value 100%) –10% of all Rx claims fall into Level 3 Level 4: 35% copay –Up to $5,000 copay maximum, level 4 only out-of-pocket expense per person per calendar year –No maximum that Humana will dispense –Less than 1% of all Rx claims fall into Level 4 Separate prescription deductible applies for Levels 2 through 4:

20 AGENT USE ONLY Enhanced HSA 100% (Similar to Autograph Total Plus Rx HSA) 100% coinsurance Deductibles –Single: $1,500, $2,500, $3,500, $5,000, $5,950 –Family: Benefits will be paid once the family deductible is met, regardless of the number of members on the plan Rx expenses integrated with medical deductible

21 AGENT USE ONLY HSA 100% (Similar to Autograph Total/HAS) Deductibles –Single: $1,500, $2,500, $3,500, $5,000, $5,950 –Family: Benefits will be paid once the family deductible is met, regardless of the number of members on the plan No Rx benefit; discount card available at up to 25% savings Does NOT cover mental health (except where mandated by state) Applicants will NOT be rated up for current Rx medications Coverage for spinal manipulations, adjustments and modalities is not included (except where mandated by the state)

22 AGENT USE ONLY 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 benefit –Plans will cover in-network preventive care services at 100 percent, and there will be no dollar limit on coverage for in- network preventive care services –Plans will have no limit on coverage for ambulance services Plans will have no dollar limit on coverage for mental health care

23 AGENT USE ONLY Supplemental Accident Benefit option $1,000 or $2,500 benefit choice is provided for accidental injuries only - Old product has $500 or $1,000 benefit Treatment must be administered within 90 days of the accident Not subject to deductible or coinsurance - first dollar coverage administered before applicable co-pays After benefit amount is exhausted, remaining charges are applied to the medical policy provisions No limit on number of accidents per year Ideal supplemental benefit to add on to higher deductible plans!

24 AGENT USE ONLY Waiting periods, limitations and exclusions may apply See your benefit summary for complete details and covered services Dental Traditional Plus Preventive Services: Plan pays 100% no deductible –Oral exams –Routine cleanings –X-rays Basic Services: Plan pays 50% after deductible –Emergency exams –Composite fillings –Oral surgery Major services: Plan pays 50% after deductible –Crowns –Root Canals –Dentures Other benefits: Orthodontia discount

25 AGENT USE ONLY Dental Preventive Plus Preventive Services: Plan pays 100% no deductible –Oral exams –Routine cleanings –X-rays –Sealants and fluoride treatments Basic Services: Plan pays 50% after $50 deductible (six-month waiting period applies)* –Extractions –Space maintainers –Composite fillings –Oral surgery Annual Maximum (excludes discount services) $1,000 Discount services –Receive a discount on services not covered under this plan. Savings average 27% nationwide on in-network services including Orthodontia services Checkbox add-on in AZ, CO, MI, UT, WI * Please refer to your state specific summary as benefits may vary

26 AGENT USE ONLY Term Life option Simple, convenient process Amounts start at $25,000 up to $150,000 Combined 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 premiums Rates are guaranteed for the full term of the policy Renewable to age 95 after the level premium period

27 AGENT USE ONLY New plan enhancements 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 dont qualify for the preferred rating and/or have minor ongoing medical conditions Stardard+ rating: applicants who are in fair health and require additional rating due to moderate medical conditions Rate classes HumanaOne offers three competitive rate classes for its medical products. These classes are:

28 AGENT USE ONLY New plan enhancements No longer moving the effective date forward 30 days Applicants will start with a plan (injury) effective data and a sickness effective date If applicant had a least 63 days of prior coverage at time of application, the sickness effective date will not apply Sickness effective date is the 15th day after the policy effective date for bodily injury Sickness effective date is issued at the member level Sickness effective date Applicants will have peace of mind knowing they are covered for an injury immediately after policy issue

29 AGENT USE ONLY Underwriting

30 AGENT USE ONLY Other Important Notes Eligible Ages –2 weeks to 64 ½ years old –No Child Only Applications Effective Dates –Any day of the month including the day they apply –Up to 45 days in advance –Special rules for those not replacing coverage

31 AGENT USE ONLY When do we need requirements? Medical Records (<15%): –Not replacing coverage & recent medical care –Chronic type conditions –Information obtained from 3rd party data Parameds (<10%): –Applicant is close to 50% ratable or declinable build –Information obtained from 3rd party data Additional Information –Blood Pressure/Cholesterol Readings (when applicants answer dont know). –Test Results –Physician or treatment information. –Third Party Data review/validation

32 AGENT USE ONLY Opportunity – Financial Protection Products

33 AGENT USE ONLY Humana Financial Protection products Further diversify your product portfolio Wider selection of products to offer your clients based on their varying budgets and needs Our consumer-focused products are simple to understand, easy to obtain, affordable, and transparent Cross sell: huge potential for consumers to purchase multiple products With health reform, consumers will be considering added protection for their personal and financial health

34 AGENT USE ONLY Life coverage: Memorial Fund* A whole life plan to offset final expenses; available in benefit amounts from $1,000 $25,000 Offers a graded death benefit with level premiums for prospects with health issues (becomes level after the third policy year) Guaranteed cash value Coverage for issue age is (nearest age) Premium options are life pay or 10-year pay * Product availability will vary by state.

35 AGENT USE ONLY Health coverage: Critical Illness Cash plan* Pays lump-sum cash benefits for critical illnesses such as heart attack, stroke, and cancer Benefit amount from $5,000 $50,000 Same lump-sum amount paid for all covered family members Issue ages 0 69 (may vary by state) Pays in addition to any benefits client already has Guaranteed renewable 30-day free look Optional Return of Premium rider * Product availability will vary by state.

36 AGENT USE ONLY Health coverage: Hospital Cash plan* Provides lump-sum benefits directly to client for: –Hospital confinement –Outpatient surgery –Accidental injury or sickness Issue ages 0 69 (may vary by state) Guaranteed renewable to age 70 Lump-sum hospital confinement from $250 $2,000 Maximum 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 benefit Optional hospital confinement daily benefit rider: $50 ($200 ICU); $100 ($400 ICU; $200 ($800 ICU) * Product availability will vary by state.

37 AGENT USE ONLY Quoting Quoting and Enrollment

38 AGENT USE ONLY Quoting and Enrollment To create a quote go to humanaoneagentquote.com Enter Humana Agent SAN and click Next. Use for quoting and enrollment only Agent can not reassig the quote to another agent

39 AGENT USE ONLY Quoting and Enrollment Your Humana Agent number is required for registration and can be found: – On your welcome letter after appointment – On your commission statement – From the Agent Service Center Simple Registration Process! Agent Workbench

40 AGENT USE ONLY Accessing Agent Workbench Log onto Enter your username and password Click Log In

41 AGENT USE ONLY Accessing Agent Workbench

42 AGENT USE ONLY 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 Vision –Supplemental Insurance –Stand Alone Life

43 AGENT USE ONLY Generate a Quote Agent Workbench or humanaoneagentquote.com

44 AGENT USE ONLY Generate a Quote

45 AGENT USE ONLY Generate a Quote

46 AGENT USE ONLY Generate a Quote

47 AGENT USE ONLY Generate a Quote Once the quote is saved, the quote can be printed, e- mailed or applied for.

48 AGENT USE ONLY Application Methods

49 AGENT USE ONLY How Can Clients Apply? Clients can apply two different ways: 1.Agent Initiated Application (AIA) – Online with your assistance 2.Agent Online Application (AOA) – Online, on their own

50 AGENT USE ONLY Agent Initiated Application

51 AGENT USE ONLY Agent Initiated Application On the agent disclaimer screen, the agent must read and agree to all statements by checking the boxes.

52 AGENT USE ONLY Agent Initiated Application

53 AGENT USE ONLY Agent Initiated Application Enter the information for all applicants on the applicant details screen. Select which signature type the client wishes to use: e-signature or wet-signature. Click Next

54 AGENT USE ONLY Agent Initiated Application

55 AGENT USE ONLY Agent Initiated Application

56 AGENT USE ONLY Agent Initiated Application The application is now ready to send to the client. In order to provide your client with a link to review and sign their documents, the agent must click Send .

57 AGENT USE ONLY Signing an Agent Initiated App

58 AGENT USE ONLY E-Signature Process

59 AGENT USE ONLY E-Signature Process Your 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 AGENT USE ONLY E-Signature Process The 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.

61 AGENT USE ONLY E-Signature Process

62 AGENT USE ONLY Track Quotes and Applications Agent Workbench

63 AGENT USE ONLY Track Quotes and Applications Agents can access Track Quotes and Applications to view status up to the point of payment verification.

64 AGENT USE ONLY Track Quotes and Applications Enter your search criteria Search results can also be exported into excel Status Information

65 AGENT USE ONLY Issued Business Tab

66 AGENT USE ONLY


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