HumanaOne health plans for individuals and families

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Presentation transcript:

HumanaOne health plans for individuals and families 1 1 1

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

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

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 4 4

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 Read slide. For family deductible, two individuals must meet their single deductibles.

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! 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.

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. Read slide. Level 1, like amoxicillin, are lowest cost generic and brand-name drugs Level 2 are higher cost generic and brand-name drugs Level 3 are higher cost, mostly brand-name drugs that may have generic or therapeutic equivalents in Levels One or Two Level 4 – are high technology drugs (certain brand-name drugs, biotechnology drugs and self-administered injectable medications)

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

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

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)

Monthly premium for a 25 year old male = $51.72 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) 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

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 12 12

Important Notes Applicants Who Are Not Replacing Coverage Other 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 Other Notes Integrated 4th 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

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

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) Similar to Portrait Office visit is an office visit regardless of preventive care or illness In-network coinsurance and deductibles are shown 15

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) similar to Autograph Share 80 Plus Rx plans In-network coinsurance and deductibles are shown 16

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) similar to the Autograph Share 70 plans recently re-introduced in a subset of states In-network coinsurance and deductibles are shown 17

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 Similar to Monogram In-network coinsurance and deductibles are shown 18

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: 19

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 Enhanced HSA is similar to today's Autograph Total Plus Rx HSA 20

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) HSA is similar to today's Autograph Total/ HSA 21

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

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! 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.)

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 Read slide. Waiting periods, limitations and exclusions may apply See your benefit summary for complete details and covered services

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

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 Read slide.

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 conditions Stardard+ rating: applicants who are in fair health and require additional rating due to moderate medical conditions Simplicity, 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 type Combined 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

Sickness effective date New plan enhancements Sickness effective date Applicants will have peace of mind knowing they are covered for an injury immediately after policy issue 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 Simplicity, 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 type Combined 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

Underwriting 29 29

Other Important Notes Eligible Ages Effective Dates 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

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 Additional Information Blood Pressure/Cholesterol Readings (when applicants’ answer “don’t know”). Test Results Physician or treatment information. Third Party Data review/validation

Opportunity – Financial Protection Products 32 32 32

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

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.

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.

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.

Quoting and Enrollment 37 37

Quoting and Enrollment www.Humanaoneagentquote.com 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

Quoting and Enrollment Agent Workbench www.humana.com Simple Registration Process! 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

Accessing Agent Workbench Log onto www.humana.com Enter your username and password Click Log In

Accessing Agent Workbench

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

Generate a Quote Agent Workbench or humanaoneagentquote.com

Generate a Quote

Generate a Quote

Generate a Quote

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

Application Methods 48 48

How Can Clients Apply? Clients can apply two different ways: Agent Initiated Application (AIA) – Online with your assistance Agent Online Application (AOA) – Online, on their own

Agent Initiated Application

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

Agent Initiated Application

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

Agent Initiated Application

Agent Initiated Application

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 E-mail.

Signing an Agent Initiated App

E-Signature Process

E-Signature Process Your client will need to click on the link within the email. A new browser window will open. The application number will pre-populate. Your client will enter the required information and click Next.

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.

E-Signature Process

Track Quotes and Applications Agent Workbench 62 62

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

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

Issued Business Tab