AGENT USE ONLY HumanaOne health plans for individuals and families.

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Presentation transcript:

AGENT USE ONLY HumanaOne health plans for individuals and families

AGENT USE ONLY Offering your clients More choices More options More affordable plans Tools for their lifelong well-being

AGENT USE ONLY What’s different? Deductibles Benefits Preventive care Waiting periods Effective dates Marketing materials Based on your feedback and our members needs, we made the following enhancements to our portfolio, to include:

AGENT USE ONLY Effective as of 2/26/07 - Effective 4/24/10 Product availability UT CO WI AZ MI LA

AGENT USE ONLY HumanaOne’s portfolio of individual products offers the right blend of features and benefits HumanaOne’s portfolio 100%, 80% and 70% in-network coinsurance levels Single deductibles from $500 to $7,500 Family deductibles starting from $1,500 Office visit co-pay coverage options Rx coverage available Optional dental and life, supplemental accident coverage

AGENT USE ONLY Portfolio of plans

AGENT USE ONLY HumanaOne Copay plans

AGENT USE ONLY Copay plans Prescription drug coverage included What you need to know: These plans have a higher benefit level, but the premiums are typically higher HumanaOne plans available –Enhanced Copay 80% –Copay 80% –Copay 70% Designed for people who want benefits similar to what they’d get with an employer’s plan

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 (includes preventive, illness and injury visits) –$35 copay primary care physician/$60 copay specialist –$60 copay for an urgent care visit Combined preventive and diagnostic x-ray and lab: –First $500 at 100%, then 80% coins after deductible $5M lifetime coverage (buy-up to $8M) Separate $500 Rx deductible (buy-up to $150)

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 (combined preventive, illness and injury visits) –$35 copay primary care physician /$60 copay specialist –$60 copay for an urgent care visit –After six visits then 80% after deductible Combined preventive and diagnostic x-ray and lab: –First $400 at 100%, then 80% coins after deductible $3M lifetime coverage (buy-up to $5M) Separate $700 Rx deductible (buy-up to $300)

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 (combined preventive, illness and injury visits) –$35 copay primary care physician /$60 copay specialist –$60 copay for an urgent care visit –After 3 visits then 70% after deductible Combined preventive and diagnostic x-ray and lab: –First $300 at 100%, then 70% coins after deductible $3M lifetime coverage (buy-up to $5M) Separate $1,000 Rx deductible (buy-up to $500)

AGENT USE ONLY Optional benefits Buy-up options: –Rx deductible buy-up options (Enhanced Copay $150, Copay 80% $300, Copay 70% $500) –Lifetime max: up to an additional $3M buy-up option Plan add-on options: –Deductible carryover credit (does not apply to Rx deductible) –Supplemental accident ($1,000 and $2,500) –Dental –Term life insurance

AGENT USE ONLY HumanaOne 100% after deductible plans

AGENT USE ONLY 100% after deductible plans Prescription drug available on select plans What you need to know: This group of plans has the widest choice of deductible options HumanaOne plans available –Value 100% –Enhance HSA 100% –HSA 100% Designed for people who want a health plan that pays 100% for covered in-network services after the deductible is met

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 Preventive care - 100% up to $500 of covered expenses per person per calendar year on services not subject to the deductible $2M lifetime coverage (buy-up to $5M) Separate $1,000 Rx deductible Perfect plan for first time insurance buyers and those not yet eligible for Medicare

AGENT USE ONLY Optional benefits Buy-up options: –Lifetime max: up to an additional $3M buy-up option Plan add-on options: –Deductible carryover credit (does not apply to Rx deductible) –Supplemental accident ($1,000 and $2,500) –Dental –Term life insurance

AGENT USE ONLY Health Savings Account plans Designed for people who want –A lower cost plan and the ability to put tax-free money in a HSA; tax deductibility varies by state Prescription drug coverage available on select plans What you need to know –There’s a limit to how much you can put in the HSA every year HumanaOne plans available –Enhanced HSA 100% –HSA 100%

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 Preventive care - 100% up to $500 of covered expenses per person per calendar year on services not applied to the deductible $5M lifetime coverage (buy-up to $8M) Rx expenses integrated with medical deductible

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 $2M lifetime coverage (buy-up to $5M) 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)

AGENT USE ONLY Optional benefits Buy-up options: –Lifetime max: up to an additional $3M buy-up option Plan add-on options: –Supplemental accident ($1,000 and $2,500) –Dental –Term life insurance

AGENT USE ONLY Premium Spectrum Comparing average premiums of new products to old products

AGENT USE ONLY Price Spectrum: Average Premiums = New Products = Old Products More options and price points Closed gaps in price points More options to fit your clients’ budget needs

AGENT USE ONLY Prescription and optional benefits

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:

AGENT USE ONLY Prescription benefit - Rx4 If the actual cost of the drug is less than the copay, the member will only be charged the actual cost of the drug and not the copay RightSourceRx.com – prescription home delivery service is one of many ways to free up the members time and money Get the most value for your Rx benefits –Humana.com: member links, tools & resources, prescription tools & resources, Rx 4 is the plan name If plan does not include prescription coverage, discount plan available – up to 25% discount

AGENT USE ONLY Prescription benefit: updates Brand vs Generic –If a brand name drug is dispensed when there is a generic equivalent, the member is responsible for paying the generic copay plus the difference in cost between the brand & generic Rx –If member selects a generic drug, this helps to reduce theirs cost without sacrificing care

AGENT USE ONLY Supplemental Accident Benefit option $1,000 or $2,500 benefit choice is provided for accidental injuries only 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!

AGENT USE ONLY Deductible carryover credit Now an optional benefit* Covered medical expenses that apply to a deductible between Oct. 1 and Dec. 31 will apply to a medical deductible for the next year Easier to meet the deductible for the following year Applies to medical, mental health and Condition Specific Deductibles. Does not apply to the prescription deductible * Is not available on the HSA Enhanced 100% and HSA 100% plans

AGENT USE ONLY Dental option Dental options Complete dental benefits as an optional rider – your client chooses the type of coverage that meets their needs –Optional, can continue even if medical plan terminates –Can add anytime; including renewal No additional underwriting required –Dental will not be rated up if medical is rated up Separate dental ID card and contract Up to 27% discount at in-network providers

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

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 * Please refer to your state specific summary as benefits may vary

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

AGENT USE ONLY HumanaOne plan enhancements

AGENT USE ONLY So what’s different Preventive care Rate classes – preferred rating Separate maximums Condition specific deductible Sickness effective date And more

AGENT USE ONLY New plan enhancements Extend more first dollar coverage Office visit is an office visit regardless of preventive care or illness Simplicity Preventive care Your clients will be covered for preventive care immediately, not after 90 days

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 don’t 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:

AGENT USE ONLY New plan enhancements Replacing coverage (current or within past 63 days) Non tobacco Non ratable build No actionable conditions (CSD, rate, rider) No maintenance medications Primary and spouse 18 and older Preferred rating A member will receive a preferred rate – 10% savings if they are:

AGENT USE ONLY New plan enhancements Chiropractic maximum: –Separate 10-visit spinal manipulations, adjustments and modalities maximum that doesn’t reduce outpatient therapy benefit –Benefits no included in the HSA 100% (except where mandated by the state) Outpatient therapy benefit maximums: –30-visit outpatient therapy benefit now includes cardiac rehabilitation and respiratory therapy in addition to Physical therapy /Occupational therapy/Speech therapy, cognitive, and audiology therapy Separate maximums

AGENT USE ONLY New plan enhancements CSDs are at the member level Prescription drugs do not apply to the CSD Members will receive the Humana network discount Once the CSD is met, benefits are payable at 100% for the calendar year Condition specific deductibles Allows members to receive benefits for conditions that were typically excluded from coverage based on underwriting review

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

AGENT USE ONLY New plan enhancements Additional enhancements Emergency Room services –Access fee ranging from $100-$125 (depending on plan) then paid at the coinsurance level after deductible. Access fee is waived if admitted into the hospital Separate Mental Health Deductible –Equal to the plan single/family deductible (includes Mental Illness, Alcohol and Chemical Dependency) Surgery Waiting Periods –No more waiting periods as a result of introducing the separate Condition specific deductible

AGENT USE ONLY Features that remain the same –Network: Over 545,000 providers nationwide –Portability: If you move or travel, your benefits go with you –10 day free-look policy: If a member is not satisfied, they can cancel their policy within 10 days for a full refund. –Member discounts: Save between 20 and 35 percent on vision, chiropractic and alternative medicine –Access to MyHumana: View claims, compare hospitals, research prescription costs and more

AGENT USE ONLY Member discounts HumanaOne’s discounts Up to 35% on vision eyewear Up to 30% on alternative treatments like acupuncture and massage services Up to 25% on OTC and Rx medications Up to 20% on health living services such as health club facilities Clients can access these discounts through MyHumana If your client selects a plan without a prescription benefit, or if a prescribed medication is not covered under their pharmacy benefit they will still receive the Humana discounted rate on the drug – just by being a member. Discounts average around 20%

AGENT USE ONLY Member services

AGENT USE ONLY Associations and HumanaOne The new HumanaOne plans require membership in the Peoples’ Benefit Alliance* Peoples’ Benefit Alliance provides: –Member education ( –Discounts on goods and services $3.95 per month appears on member’s bill Peoples’ Benefit Alliance (PBA) *PBA membership is required in Arizona, Michigan and Wisconsin

AGENT USE ONLY Member services Member certificates available electronically on Humana.com Employer “List Bill” is available (varies by state) End of month cancellations ID Card Changes

AGENT USE ONLY Plan changes Buy-ups from current HumanaOne plan to a new HumanaOne plan must be done at renewal Buy-downs from current HumanaOne plan to a new HumanaOne plan will be considered for an exception off-renewal All plan changes from a current HumanaOne plan moving to a New HumanaOne plan will take into consideration –Condition Specific Deductibles –Preferred rating –Deductible carryover credit –Maternity

AGENT USE ONLY Agent services and updates

AGENT USE ONLY Agent workbench

AGENT USE ONLY Create quote page New effective date language pop-up No prior insurance question Drop down selection box

AGENT USE ONLY Preferred rating Agent’s rating selection is shown on the details drop down Standard+ rating is calculated into payment

AGENT USE ONLY Opportunity – Financial Protection Products

AGENT USE ONLY Humana Financial Protection products Coming soon! 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

AGENT USE ONLY Life coverage: Junior Estate Builder* Easy-to-obtain term life insurance for children from 14 days to 24 years; converts to a whole life plan at age 25. Two plans with affordable premiums: –$15,000 of coverage for $35 per year –$20,000 of coverage for $45 per year At ages 25, 28 and 31, option of obtaining additional benefits with whole life coverage regardless of health status If original choice is $20,000 of insurance, option to add $20,000 of coverage at each option point (up to $80,000 total coverage) At each age interval, can increase the benefit: –Age 25: double original face amount –Age 28: triple original face amount –Age 31: quadruple original face amount * Product availability will vary by state.

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 45 − 80 (nearest age) Premium options are life pay or 10-year pay * Product availability will vary by state.

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.

AGENT USE ONLY Health coverage: Cash Cancer plan* Provides a one-time lump sum cash payment at the first diagnosis of internal cancer or malignant melanoma Benefit amount from $10,000 − $50,000 The same lump-sum amount applies for all covered family members regardless of age Return of Premium rider available in some states 30-day waiting period from policy effective date No benefit payable for pre-existing conditions for 12 months after date of policy Issue ages 0 − 69 (may vary by state) Premiums don’t increase with age Premium options are life pay or 20-year pay * Product availability will vary by state.

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.

AGENT USE ONLY What to expect Select products will be available in your state soon Integration of select products into Agent Workbench later this year We’ll continue to develop and expand this portfolio of products throughout 2010 Same great service and care we provide all of our customers Competitive commissions and tools to help grow your business

AGENT USE ONLY Questions