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GR-PT-44/1.PPT (11/8/2012) 1 GR-PT-44/1.PPT (10/19/2012) PersonalBlue PPO SM Quarter One - 2013.

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Presentation on theme: "GR-PT-44/1.PPT (11/8/2012) 1 GR-PT-44/1.PPT (10/19/2012) PersonalBlue PPO SM Quarter One - 2013."— Presentation transcript:

1 GR-PT-44/1.PPT (11/8/2012) 1 GR-PT-44/1.PPT (10/19/2012) PersonalBlue PPO SM Quarter One - 2013

2 GR-PT-44/2.PPT (11/8/2012) 2 Proprietary and Confidential Information — Do Not Distribute What we’ll cover today What’s New? 2013 Plan Designs Underwriting Enrollment and Billing New Payment Options Competitive Analysis Commissions Important Contacts

3 GR-PT-44/3.PPT (11/8/2012) 3 Proprietary and Confidential Information — Do Not Distribute What’s new? No filed rate increase Saver plan with $5,000 deductible Pay premiums with credit card

4 GR-PT-44/4.PPT (11/8/2012) 4 Proprietary and Confidential Information — Do Not Distribute Personal Blue PPO SM PersonalBlue PPO SM is offered to individuals and families in the 21-county Capital BlueCross service area

5 GR-PT-44/5.PPT (11/8/2012) 5 Proprietary and Confidential Information — Do Not Distribute Who can join Personal Blue PPO SM ? Persons living in the 21 county service area for at least 6 months of the year and; Are at least nineteen (19) and have not yet reached their 65th birthday; Are not eligible for or enrolled in Medicare or Medicaid. – At least one adult family member must pass for – the policy to be written – Dependents can be covered to age 26

6 GR-PT-44/6.PPT (11/8/2012) 6 Proprietary and Confidential Information — Do Not Distribute Personal Blue PPO SM Available copay plan deductibles: – $500, $1,100, $1,500, $2,500 and $5,000 Copay Plans Single Deductible $500$1,100$1,500$2,500$5,000 Family Deductible $1500$2,200$3,000$5,000$10,000

7 GR-PT-44/7.PPT (11/8/2012) 7 Proprietary and Confidential Information — Do Not Distribute Personal Blue PPO SM Coinsurance: 85% in Network; 50% out of network — In-Network Out of Pocket Maximums: Copay Plans continued Single Deductible$500$1,100$1,500$2,500$5,000 Single OOP$1,500$2,250 $2,500$5,000 Family Deductible$1,500$2,200$3,000$5,000$10,000 Family OOP$4,500 $5,000$10,000 Total Out of Pocket = Deductible + Out of Pocket Maximum

8 GR-PT-44/8.PPT (11/8/2012) 8 Proprietary and Confidential Information — Do Not Distribute Copay Plans continued Office Visit Copayments Primary Care: $30 Specialist: $40 Deductible waived on Office Visits Personal Blue PPO SM

9 GR-PT-44/9.PPT (11/8/2012) 9 Proprietary and Confidential Information — Do Not Distribute Copay Plans continued Urgent Care Copay: $50 Emergency Room Copay: $100 Deductible and coinsurance waived for Urgent and Emergency care Copays are inclusive and apply in or out of network Emergency copay waived if admitted Personal Blue PPO SM

10 GR-PT-44/10.PPT (11/8/2012) 10 Proprietary and Confidential Information — Do Not Distribute Optional Prescription Drug: MyRx Annual Deductible (separate from medical) $100 Single / $300 Family Retail Copays (30 day supply) $15/$40/$60 Mail Service (90 day supply) $40/$100/$150 Specialty (30 day supply) $60/$100/$200 Benefit Period Max Generic: Unlimited fills Brand: Up to 12 fills; combined retail, mail service and specialty pharmacy FormularyOpen Mandatory Generic Substitution Yes

11 GR-PT-44/11.PPT (11/8/2012) 11 Proprietary and Confidential Information — Do Not Distribute Prescription Discount Card RxSavingsPlus sm Good at 60,000+ pharmacies Discount available at point of sale Discounts vary by drug and pharmacy Greater savings with generic medications Use for pet medications!

12 GR-PT-44/12.PPT (11/8/2012) 12 Proprietary and Confidential Information — Do Not Distribute Qualified High Deductible Plans Individual Deductible Family DeductibleCoinsurance Individual Out of Pocket Maximum Family Out of Pocket Maximum $1,500$3000100%$2,500$4,000 $2,500$5,000100%$3,500$6,000 $3,500$7,000100%$4,500$8,000 $5,000$10,000100%$6,000$11,000 Out of Pocket Maximums include copays, deductible and coinsurance

13 GR-PT-44/13.PPT (11/8/2012) 13 Proprietary and Confidential Information — Do Not Distribute Copayments and Deductibles Primary Care: $30 Specialist: $40 Emergency Room: $100 Urgent Care: $50 Urgent and Emergency apply in or out of network

14 GR-PT-44/14.PPT (11/8/2012) 14 Proprietary and Confidential Information — Do Not Distribute QHDHP Drug Benefits CopaymentsRetail (Up to 30-day supply) Mail Service (Up to 90-day supply) Specialty Pharmacy GenericPlan Deductible and Coinsurance Preferred BrandPlan Deductible and Coinsurance Non-preferred BrandPlan Deductible and Coinsurance Benefit Period Maximums GenericUnlimited Preferred and Non-preferred Brand 12-prescription limit, including refills (combined retail, mail service and specialty pharmacy)

15 GR-PT-44/15.PPT (11/8/2012) 15 Proprietary and Confidential Information — Do Not Distribute Health Savings Account Client chooses their own HSA administrator Can be attached to any of the qualified plans Contributions for 2013 are: Individual: $3,250 Family: $6,450 Catch-up for 55+: $1,000

16 GR-PT-44/16.PPT (11/8/2012) 16 Proprietary and Confidential Information — Do Not Distribute Personal Blue Saver PPO sm Plans Available plan deductibles: – $750, $1,500, $2,500 and $5,000 Single Deductible $750$1,500$2,500$5,000 Family Deductible $1500$3,000$5,000$10,000

17 GR-PT-44/17.PPT (11/8/2012) 17 Proprietary and Confidential Information — Do Not Distribute Personal Blue Saver PPO sm Plans Coinsurance: 20 percent in-network; 50 percent out-of-network – In-network out-of-pocket maximums: – Out-of-pocket includes deductible and coinsurance Single Deductible$750$1,500$2,500$5,000 Max Out-of-pocket$2,250$3,000$5,000$10,000 Family Deductible$1,500$3,000$5,000$10,000 Max Out-of-pocket$4,500$6,000$10,000$20,000

18 GR-PT-44/18.PPT (11/8/2012) 18 Proprietary and Confidential Information — Do Not Distribute Personal Blue Saver PPO sm Plans Office Visit Copayments Primary care: $40 Specialist: $50 Up to six combined office visits per Member, per calendar year; excludes preventive visits Deductible waived on office visits

19 GR-PT-44/19.PPT (11/8/2012) 19 Proprietary and Confidential Information — Do Not Distribute Personal Blue Saver PPO sm Plans Urgent care copayment: $100 Emergency services copayment: $300 Deductible and coinsurance waived for urgent and emergency care Copayments are inclusive and apply in-network or out-of-network Emergency copayment waived if admitted

20 GR-PT-44/20.PPT (11/8/2012) 20 Proprietary and Confidential Information — Do Not Distribute Personal Blue Saver PPO sm Plans No deductible; no limit on fills Generic medications covered as follows: – Retail: $15 copayment – Mail-order: $30 copayment – Specialty: $45 copayment Brand preferred and nonpreferred not covered Coverage for diabetic supplies and other mandated benefits Prescription Drugs

21 GR-PT-44/21.PPT (11/8/2012) 21 Proprietary and Confidential Information — Do Not Distribute Personal Blue Saver PPO sm Plans Inpatient hospitalization covered 80 percent – $500 Copay per admission, exempt from deductible

22 GR-PT-44/22.PPT (11/8/2012) 22 Proprietary and Confidential Information — Do Not Distribute Preventive Care Preventive Care covered at 100% Pediatric and Adult Care preventive care includes: Routine physical exams and screenings Annual Ob/Gyn exams and mammograms Immunizations

23 GR-PT-44/23.PPT (11/8/2012) 23 Proprietary and Confidential Information — Do Not Distribute Covered Benefits for All Plans Most therapies: – Physical – Occupational – Speech – Respiratory Home Health Spinal Manipulations Skilled nursing facility Hospice

24 GR-PT-44/24.PPT (11/8/2012) 24 Proprietary and Confidential Information — Do Not Distribute Non-Covered Benefits Routine pregnancy and delivery claims Behavioral health care Substance abuse care

25 GR-PT-44/25.PPT (11/8/2012) 25 Proprietary and Confidential Information — Do Not Distribute Deductible Carry-Over If deductible not met in first year of coverage: Any claims from 4th quarter that count toward deductible are applied to deductible for second year of coverage All Benefits, deductibles, coinsurance run on calendar year

26 GR-PT-44/26.PPT (11/8/2012) 26 Proprietary and Confidential Information — Do Not Distribute Out of Area Care Urgent and Emergency Care worldwide Emergencies are covered in or out of network BlueCard ® available for Out of Area care www.bcbs.com 800-810-2583

27 GR-PT-44/27.PPT (11/8/2012) 27 Proprietary and Confidential Information — Do Not Distribute Medical Underwriting Application look back is 5 years Turnaround is approximately 7 business days Outcome can be pass, rate-up or fail

28 GR-PT-44/28.PPT (11/8/2012) 28 Proprietary and Confidential Information — Do Not Distribute Medical Underwriting (continued) Pre-ex clause waived if condition disclosed on application or during telephone interview. Pre-existing condition clause in force for first 12 months of policy 10 rating tiers

29 GR-PT-44/29.PPT (11/8/2012) 29 Proprietary and Confidential Information — Do Not Distribute Medical Underwriting Elements Besides the application we also: Review Capital BlueCross claims Conduct a medication inquiry and review

30 GR-PT-44/30.PPT (11/8/2012) 30 Proprietary and Confidential Information — Do Not Distribute Medical Underwriting Elements (continued) From time to time we request: Telephone Interviews Medical Records Required for dependents less than one year old CBC requests, acquires, pays for these Physical Exams Required for applicants 50 or older with no medical care in past 12 months

31 GR-PT-44/31.PPT (11/8/2012) 31 Proprietary and Confidential Information — Do Not Distribute Applications Submit applications by: the 25 th for 1 st of the month effectives the 10th for 15th of the month effectives

32 GR-PT-44/32.PPT (11/8/2012) 32 Proprietary and Confidential Information — Do Not Distribute Offers Offer or denial letters emailed or mailed to client Copies available in the Broker Portal and Sales360

33 GR-PT-44/33.PPT (11/8/2012) 33 Proprietary and Confidential Information — Do Not Distribute Rate Ups and Declines Rate-up reasons given in offer letter Height and weight Responses to certain questions Responses given during a telephone interview Declined applicants can: Inquire for more information Appeal underwriting decision Instructions for both are in letter

34 GR-PT-44/34.PPT (11/8/2012) 34 Proprietary and Confidential Information — Do Not Distribute Premium Payment Do not collect money with application Available Options: Check It Out® (ACH debit transfer—recommended) eCheck Credit Cards (!) Bank bill payer service Capital BlueCross sends monthly bill

35 GR-PT-44/35.PPT (11/8/2012) 35 Proprietary and Confidential Information — Do Not Distribute Premium Payment Guidelines Members should always pay first invoice Enrolling for 15 th of month receive two invoices—pay both Check It Out takes 1 full billing cycle to set up

36 GR-PT-44/36.PPT (11/8/2012) 36 Proprietary and Confidential Information — Do Not Distribute eCheck – New! No-cost, online payment option Member logs into mycapbluecross.com Click “Pay My Premium” link Bank transfers money day of transaction

37 GR-PT-44/37.PPT (11/8/2012) 37 Proprietary and Confidential Information — Do Not Distribute Credit Cards – New! Available at mycapbluecross.com Click “Pay My Premium Link” Call 877-889-7282 Processing time is 48 hours No debit or credit card info stored

38 GR-PT-44/38.PPT (11/8/2012) 38 Proprietary and Confidential Information — Do Not Distribute Billing Cycle 1234 567891011 12131415161718 19202122232425 262728293031 Premiums for current month due and CIO premiums withdrawn Terms from previous month processed Delinquency report runs Bills for next month generate Delinquency report runs

39 GR-PT-44/39.PPT (11/8/2012) 39 Proprietary and Confidential Information — Do Not Distribute Top Five Selling Plans* $5,000 Copay $500 Copay $2,500 Saver $2,500 Copay $750 Saver * Last Six Months

40 GR-PT-44/40.PPT (11/8/2012) 40 Proprietary and Confidential Information — Do Not Distribute $5000 Plan Copay Comparisons Capital BlueCross PersonalBlue SM $5,000 Deductible Aetna PPO 5000United HealthOne 5000 100% 25 Male $62$7419%$9350% 25 Female $97$12125%$14347% 35 Male $82$899%$12755% 35 Female $121$13512%$16133% 35 Family $314$3419%$46648% 45 Male $123$1262%$18449% 45 Female $152$1659%$21038% 45 Family $386$4086%$56446% 55 Male $195$2034%$31863% 55 Female $202$196-3%$29345% All rates for 01/01/2013 effective date unless noted; Family rate = M/F + 2 children age 10

41 GR-PT-44/41.PPT (11/8/2012) 41 Proprietary and Confidential Information — Do Not Distribute $500 Plan Copay Comparisons All rates for 01/01/2013 effective date unless noted; Family rate = M/F + 2 children age 10 Capital BlueCross PersonalBlue SM $500 Deductible HealthAmericaOne ® Copay 80% $500 CPA 1 Rates Highmark DirectBlue ® $500 90/10 25 Male $123 $1317%$15123% 25 Female $200 $21910%$29950% 35 Male $167 $1712%$21328% 35 Female $254 $28512%$36744% 35 Family $651 $586-10%$87434% 45 Male $258 $2819%$33128% 45 Female $323 $37416%$41930% 45 Family $811 $745-8%$1,04228% 55 Male $420 $4364%$57437% 55 Female $436 $4411%$57131%

42 GR-PT-44/42.PPT (11/8/2012) 42 Proprietary and Confidential Information — Do Not Distribute $2500 Saver Plan Comparisons Personal Blue Saver PPO HealthAmerica Rewards $2500 Aetna PPO Value 2500 Deductible$2,500 Coinsurance20%15%20% Total OOP $5,000 PCP Copayment $40; up to six per year combined with specialist $40 after deductibleVisits 1-5 $30; 6+ 100% of Aetna discount IP Hospital20% after $500 copay15% after deductible40% after deductible Rx Copayment$15/$30/$45; generic onlyTier 1: $15; Tier 2: $50$20 generic only Rx DeductibleN/AIncluded in annual deductible N/A Rx MaximumUnlimited Emergency Room $300 (waived if admitted)$400 after annual deductible $350 (waived if admitted) Specialist Copayment $50; up to 6 visits per year combined with PCP $50 after deductibleVisits 1-5 $50; 6+ 100% of Aetna discount

43 GR-PT-44/43.PPT (11/8/2012) 43 Proprietary and Confidential Information — Do Not Distribute All rates for 01/01/2013 effective date unless noted; Family rate = M/F + 2 children age 10 $2500 Saver Plan Comparisons Personal Blue Saver PPO $2,500 Deductible HealthAmericaOne Rewards $2500 Aetna PPO Value 2500 (8/1/2012) 25 Male $56$7428% $7326% 25 Female $94$12630% $12024% 35 Male $77$9721% $8911% 35 Female $121$16532% $1347% 35 Family $303$3346% $3408% 45 Male $123$16228% $125-2% 45 Female $155$21735% $1642% 45 Family $382$4288% $4062% 55 Male $203$25420% $202-4% 55 Female $211$25617% $194-11%

44 GR-PT-44/44.PPT (11/8/2012) 44 Proprietary and Confidential Information — Do Not Distribute $2500 Plan Copay Comparisons All rates for 01/01/2013 effective date unless noted; Family rate = M/F + 2 children age 10 Capital BlueCross PersonalBlue SM $2,500 Deductible HealthAmericaOne ® $2,000/10% CPA 1 Rates Highmark Advance Blue $2,600/10% 25 Male $86$11635%$860% 25 Female $137$19442%$16520% 35 Male $115$15131%$1193% 35 Female $173$25246%$20217% 35 Family $446$51916%$4859% 45 Male $176$24941%$1823% 45 Female $219$33151%$2295% 45 Family $552$66120%$5764% 55 Male $283$38636%$31210% 55 Female $293$39033%$3116%

45 GR-PT-44/45.PPT (11/8/2012) 45 Proprietary and Confidential Information — Do Not Distribute $750 Saver Plan Comparisons Capital BlueCross Personal Blue Saver PPO Highmark Simply Blue Deductible$750 Coinsurance20% Total OOP $2,250$4,750 PCP Copayment$40; up to six per year combined with specialist $35 IP Hospital20% after $500 copay$500 per admission then 20% Rx Copayment$15/$30/$45; generic only$8/$45/$95 Rx DeductibleN/A Rx MaximumUnlimited Emergency Room$300 (waived if admitted)$150 (waived if admitted) Specialist Copayment$50; up to 6 visits per year combined with PCP $50

46 GR-PT-44/46.PPT (11/8/2012) 46 Proprietary and Confidential Information — Do Not Distribute All rates for 01/01/2013 effective date unless noted; Family rate = M/F + 2 children age 10 $750 Saver Plan Comparisons Capital BlueCross Personal BlueSaver PPO $750 Highmark Simply Blue $750 25 Male $81$9011% 25 Female $137$15211% 35 Male $113$12511% 35 Female $177$1865% 35 Family $444$4839% 45 Male $180$1916% 45 Female $227$2354% 45 Family $561$5987% 55 Male $298$32910% 55 Female $309$3214%

47 GR-PT-44/47.PPT (11/8/2012) 47 Proprietary and Confidential Information — Do Not Distribute $5000 Saver Plan Comparisons Personal Blue Saver PPOHealthAmerica Rewards $5000 Deductible$5,000 Coinsurance20%15% Total OOP $10,000 PCP Copayment$40; up to six per year combined with specialist $40 after deductible IP Hospital20% after $500 copay15% after deductible Rx Copayment$15/$30/$45; generic onlyTier 1: $15; Tier 2: $50 Rx DeductibleN/AIncluded in annual deductible Rx MaximumUnlimited Emergency Room$300 (waived if admitted)$400 after annual deductible Specialist Copayment $50; up to 6 visits per year combined with PCP$50 after deductible

48 GR-PT-44/48.PPT (11/8/2012) 48 Proprietary and Confidential Information — Do Not Distribute All rates for 01/01/2013 effective date unless noted; Family rate = M/F + 2 children age 10 $5000 Saver Plan Comparisons Personal Blue Saver PPO $5,000 Deductible HealthAmericaOne Rewards $2,500 25 Male $46$5621% 25 Female $78$9623% 35 Male $64$7415% 35 Female $100$12626% 35 Family $252$2562% 45 Male $102$12422% 45 Female $129$16629% 45 Family $318$3283% 55 Male $169$19415% 55 Female $175$19612%

49 GR-PT-44/49.PPT (11/8/2012) 49 Proprietary and Confidential Information — Do Not Distribute Personal Blue PPO SM PersonalBlue PPO Commissions Remain UNCHANGED Commissions* Copay Plan Commissions Per ContractSingle Parent & ChildParent & ChildrenHusband & Wife Family Year 1$48.00$78.00$108.00$96.00$156.00 Year 2$16.00$26.00$36.00$32.00$52.00 Years 3-15$5.34$8.66$12.00$10.66$17.34 Qualified High Deductible Plan and PersonalBlue Saver PPO Commissions Year 120% of total premium Year 25% of total premium Years 3-153% of total premium *Commissions are paid monthly.

50 GR-PT-44/50.PPT (11/8/2012) 50 Proprietary and Confidential Information — Do Not Distribute Important Contact Information Who You Call or Email What Can I Do There? Customer Service for Members:800-962-2242; TDD/TTY 800-242- 4816 Member inquiries about coverage, billing, claims Broker Customer Service (Broker Hotline): 800-825-0802Inquiries regarding enrolled members Applicant Telephone Interviews: 866-432-2248 (MRS)Telephone interview Underwriting Secure Fax:(717)-346-3745 Underwriting Email Address: cbciamuppo@capbluecross.comcbciamuppo@capbluecross.com (underwriting correspondence only, please) Submit Acceptance forms, Attestation forms, physical exam results Capital BlueCross Attn: Accounts Receivable PO Box 779515 Harrisburg, PA 17177-9515 877-889-7282 Premium Payments (be sure to include Member ID Number on check) Credit Card Payments; Have ID card available Broker Portal: www.capbluecross.com (click on “Broker Tools” to log in) Enter applications, get copies of marketing materials Broker Portal Tech Support: 800-541-7577, ext. 7200 (be sure to have BRK number and answers to challenge questions handy) Reset broker passwords; trouble-shoot portal tech issues Account Administration Fax: (717)-541-6667 Email:cbcaafia@capbluecross.comcbcaafia@capbluecross.com Guaranteed Issue applications Cecilia Keeseckeer Phone: (717)-541-6115 Fax: (717)-540-2202 Email:Cecilia.keesecker@capbluecross.com

51 GR-PT-44/51.PPT (11/8/2012) 51 GR-PT-44/51.PPT (10/19/2012) Thank you!


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