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Health First Health Plans
Medicare Advantage 2018 Sales & Product Training
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Agenda Welcome and Introductions Health First History and Services
Mission, Vision and Values Membership, Products and Service Area Basics of Medicare MAPD, MA, PDP
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Agenda Health First Health Plans MAPD Plans and Benefits
Broker Expectations Sales & Enrollment Procedures Compensation Questions and Answers Product Certification Test
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Health First History Health First has roots in Brevard County that date back to 1937, when Brevard Hospital opened in Melbourne with only 27 beds. Now known as Health First’s Holmes Regional Medical Center, it is the largest hospital in Brevard with 514 beds.
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Health First History In 1962, Health First’s Cape Canaveral Hospital opened during the onset of the space program. In 1992, Health First’s Holmes Regional Medical Center opened an additional facility, Palm Bay Hospital.
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Health First History Health First formed when Holmes Regional Medical Center, Cape Canaveral Hospital and Palm Bay Hospital joined together in 1995 and create an integrated not-for-profit health system.
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Health First History Health First’s newest hospital, Viera Hospital, was opened in April 2011 and is the cornerstone of the 50-acre Viera Health Park campus.
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Our Network Hospitals Health First Hospitals Florida Hospital
Holmes Regional Medical Center Cape Canaveral Hospital Palm Bay Hospital Viera Hospital Florida Hospital Memorial Medical Center Deland Fish Memorial Oceanside Flagler When you are a member of Health First Health Plans, you have access to 24 hospitals. These include: The four Health First Hospitals: Holmes Regional Medical Center Cape Canaveral Hospital Palm Bay Hospital Viera Hospital Sixteen Florida Hospitals: Memorial Medical Center in Daytona Beach Deland Fish Memorial in Orange City Oceanside in Ormond Beach Flagler Apoka East Orlando Orlando Winter Park FH for Children Celebration Kissimmee Altamonte Wauchula Heartland Lake Placid In addition to four other hospitals: Bert Fish Medical Center in New Smyrna Kindred Hospital – an Acute Care hospital in Melbourne Sebastian River Medical Center in Sebastian Indian River Medical Center in Vero Beach Applicable Disclaimers Appear at the End All applicable disclaimers are on page <13>
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Our Network Hospitals Florida Hospital (cont.) Apopka East Orlando
Winter Park FH for Children Celebration Kissimmee Altamonte Wauchula Heartland Lake Placid When you are a member of Health First Health Plans, you have access to 24 hospitals. These include: The four Health First Hospitals: Holmes Regional Medical Center Cape Canaveral Hospital Palm Bay Hospital Viera Hospital Sixteen Florida Hospitals: Memorial Medical Center in Daytona Beach Deland Fish Memorial in Orange City Oceanside in Ormond Beach Flagler Apoka East Orlando Orlando Winter Park FH for Children Celebration Kissimmee Altamonte Wauchula Heartland Lake Placid In addition to four other hospitals: Bert Fish Medical Center in New Smyrna Kindred Hospital – an Acute Care hospital in Melbourne Sebastian River Medical Center in Sebastian Indian River Medical Center in Vero Beach Applicable Disclaimers Appear at the End All applicable disclaimers are on page <13>
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Our Network Hospitals Other Network Hospitals Bert Fish Medical Center
Kindred Hospital Sebastian River Medical Center Indian River Medical Center When you are a member of Health First Health Plans, you have access to 24 hospitals. These include: The four Health First Hospitals: Holmes Regional Medical Center Cape Canaveral Hospital Palm Bay Hospital Viera Hospital Sixteen Florida Hospitals: Memorial Medical Center in Daytona Beach Deland Fish Memorial in Orange City Oceanside in Ormond Beach Flagler Apoka East Orlando Orlando Winter Park FH for Children Celebration Kissimmee Altamonte Wauchula Heartland Lake Placid In addition to four other hospitals: Bert Fish Medical Center in New Smyrna Kindred Hospital – an Acute Care hospital in Melbourne Sebastian River Medical Center in Sebastian Indian River Medical Center in Vero Beach Applicable Disclaimers Appear at the End All applicable disclaimers are on page <13>
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Health First Services Health First was formed to create a truly integrated not-for-profit healthcare delivery network (IDN) and fulfill a common mission of improving the health of our community.
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Health First Services Health First Health Plans - 1996
Formed in 1996 as a for- profit company, Health First Health Plans administers Medicare Advantage, Commercial Group and Individual insurance plans, and provides Third Party Administration services throughout Brevard/Indian River, Volusia/Flagler, Highlands/Hardee and Seminole Counties.
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Health First Services Health First Health Plans Locations: Main Office
6450 U.S. Highway 1, Rockledge, FL 32955 Hours: Monday thru Friday, 8 a.m. to 5 p.m. Indian River Office 2040 Treasure Coast Plaza, Vero Beach, FL 32960 Hours: Monday thru Friday, 8:30 a.m. to 5 p.m. Ormond Beach Retail Office 1425 West Granada Blvd, Ormond Beach FL 32174 Hours: Monday thru Friday, 8:00 a.m. to 5 p.m. Health First Services
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Health First Services Health First Home Care Health First Private Duty
Health First Diagnostic Centers Health First Now: Urgent Care Centers Health First Aging Services Health First Sleep Center Health First Wound and Hyperbaric Center
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Health First Services First Flight - 1988
First Flight, Brevard County's only air ambulance serving East Central Florida, is the emergency helicopter transport service of Health First. It is based at Health First’s Holmes Regional Medical Center’s Trauma Center in Melbourne.
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Health First Services Health First Aging Services - 2002
The Health First Aging Institute is dedicated to improving the health and well-being of older adults in Brevard County by increasing the availability of high quality geriatric care services across the care continuum. Created in 2002 through the generous donations of the then Health First’s Cape Canaveral Hospital Foundation.
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Health First Services Health First Family Pharmacy
Located at Health First’s Holmes Regional Medical Center, Health First’s Viera Hospital, and Health First Medical Group - Gateway office. The Family Pharmacy offers retail, mail order, and specialty medication services to Health First Health Plans members, Health First associates and their dependents, Hospice of Health First patients, discharged hospital patients, and indigent patients. Health First Family Pharmacy offers many benefits to its patients, including: Free RX mail order program Discounts for Health First Health Plans members
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Health First Services Health First Home Care
Health First Home Care offers a wide range of professional health services in the home, including, but not limited to: Skilled nursing care Wound care Ostomy care Respiratory care and tracheostomy care Physical, Occupational and Speech Therapy
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Health First Services Health First Medical Equipment
Health First Medical Equipment offers a large inventory of the latest medical products available. Durable medical equipment products offered by Health First Medical Equipment include, but are not limited to Respiratory care products Hospital room set-ups for the home Walkers Wheelchairs Lift chairs
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Health First Services Health First Medical Group
In February 2013, Health First Physicians joined with Melbourne Internal Medicine Associates (MIMA), to form Health First Medical Group. Health First Medical Group is Brevard’s largest multi-specialty physician group in Brevard County with more than 246 employed physicians
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Health First Services Pro-Health & Fitness Centers - 1983
Three fitness centers located in: Melbourne Merritt Island Viera Provide unique and engaging fitness programs to suit every fitness level
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Not-for-Profit Health System
What is a not-for-profit, or community-minded health system? Not-for-Profit/Community-Minded Investor-Owned Assets stay in the community Assets belong to the investors Local board of trustees serve without pay and balance financial decisions with community concerns Major decisions are often made by individuals outside the community who emphasize creating profits for the stockholders Not for profit – no private person or corporation makes any profit. Stockholders might be physicians who practice at the hospital; community members are generally not allowed to purchase stock All income above expenses is used to improve the health of the community Profits often leave the community Provides a full spectrum of care – education, prevention and treatment – that benefits all members of the community Provides a full range of care that benefits the community they serve; however, focus is also placed on how to best serve investors
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Mission and Vision Mission
Our team positively changing the health and well-being of you and your family through excellent and compassionate health care. Vision Skilled and dedicated people delivering high quality, patient centered care that improves lives and communities. Every person. Every time.
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Important Milestones 2004: Introduced direct access – Members are not assigned a Primary Care Physician; no referrals for network specialists 2007: Began offering Pro-Health & Fitness Center membership to members 2012: Expanded service area throughout Indian River County 2014: Expanded into Volusia and Flagler Counties through partnership with Florida Hospital via Florida Hospital Care Advantage
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Important Milestones 2014: Health First Health Plans contracted with Bert Fish Medical Center (New Smyrna, Volusia) effective August 25, 2014 2015: Florida Hospital Care Advantage expanded into Highlands and Hardee Counties 2017: Florida Hospital Care Advantage expanded into Seminole County
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Service Area We have different Medicare Advantage plan options available depending on the county the prospective member lives in: Brevard/Indian River - Health First Health Plans Volusia/Flagler/Highlands/Hardee/Seminole - Florida Hospital Care Advantage
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Medicare Products Florida Hospital Care Advantage Medicare Advantage
Health First Health Plans Medicare Advantage Individual Plans Classic HMO-POS Value HMO Rewards HMO Secure HMO Group Medicare Plans Group Plus A HMO Group Plus B HMO Group POS Florida Hospital Care Advantage Medicare Advantage Individual Plans SunSaver HMO-POS Group Medicare Plans Group Plus C HMO Group Plus D HMO Group B HMO-POS
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Accreditations and Awards
For 2017 The Centers for Medicare & Medicaid Services (CMS), recognized Health First Health Plans with a 4 out of 5 Stars as an Overall Plan Rating “Commendable” accreditation status by the National Committee for Quality Assurance (NCQA) NCQA ranked Health First Health Plans 4 out of 5 Stars in Florida and 4 out of 5 Stars in the nation among Medicare Advantage Plans for When choosing a Medicare Advantage plan, CMS Overall Plan Ratings should be an important part of your decision-making process. Each year, Medicare rates all health and prescription drug plans. Star ratings are based on: Measurements of clinical quality and customer service Take into account how a health plan works to keep you healthy and manage long-term illness Quality of customer service that a plan provides. For 2018, Health First Health Plans has received a 4 out of 5 stars rating. You can use this Plan Rating to compare our plan’s performance to other plans. All star ratings are available at Health First Health Plans has been awarded by the National Committee for Quality Assurance (NCQA) with an Excellent Accreditation. They have also ranked us 4 out of 5 Stars in the state of Florida and 4 out of 5 Stars in the nation among all Medicare Advantage Plans. All NCQA rankings are available at Applicable Disclaimers Appear at the End All applicable disclaimers are on page <13>
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Sales Procedure Beneficiary initiates contact
Agent completes Scope of Appointment (48 hours in advance) Agent conducts presentation in person Medicare Basics, Part D, Enrollment Periods Benefits at a Glance (BAG) Summary of Benefits, Formulary, Directory Answer questions Complete Enrollment Application Agent submits application within 24 hours
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Scope of Appointment Forty-eight hours prior to any sales appointment, sales representatives must clearly identify the types of product(s) that will be discussed, obtain agreement from the beneficiary and document that agreement
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Marketing Appointments
During individual appointments, brokers may not: Promote non-health care related products Solicit/accept an enrollment request for a January 1 effective date prior to the start of the Annual Election Period on October 15. Discuss plan options that were not agreed to in the Scope of Appointment
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Prospective Medicare Members
Prospective Member (PM) Education Options: Sales kits (can be mailed upon request) Home appointments Websites myHFHP.org Phone – customer service Walk-in Medicare (medicare.gov or MEDICARE)
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Marketing/Sales Activities
Inappropriate and prohibited Marketing/Sales Activities Conduct health screenings Provide cash or monetary rebates Making unsolicited contact
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Marketing/Sales Activities
Potential consequences of engaging in inappropriate or prohibited Marketing/Sales activities Disciplinary action Termination Forfeiture of future compensation
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Marketing/Sales Activities
Sales Event Example of do’s and don’ts: Do provide light snacks, refreshments Don’t solicit enrollment applications prior to start of the Annual Election Period (AEP) Don’t require information as a prerequisite for events (contact information)
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Marketing/Sales Activities
Educational Events Example of do’s and don’ts Don’t talk about Medicare plan specific premiums and or benefits. Don’t display and or distribute summary of benefits provider directory Don’t - absolutely no sales activities Do provide light snacks refreshments
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Medicare ID Use the beneficiary Medicare ID card to:
Verify name and spelling Verify and record Medicare Claim Number Verify and record Medicare Part A and Part B effective dates It is not required to submit a copy of the Medicare card.
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Outpatient Drug Coverage
Basics of Medicare Inpatient Coverage Hospital care SNF care Hospice Home health Deductible + coinsurance Outpatient Coverage Physician services Preventive care DME Some drugs Inpatient + Outpatient Coverage May include drug coverage and enhanced benefits Provided by private insurance companies Medicare Advantage Outpatient Drug Coverage Options: Stand-alone drug plan (PDP) – OR – Medicare Advantage plan with drug coverage
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Formulary Must show beneficiary how to access and use formulary
Available for download off of myHFHP.org Explain exception process for non-formulary medications Add picture
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Part D Coverage Three stages of Medicare drug coverage:
Stage 1: Initial Coverage Period Stage 2: Coverage Gap Stage 3: Catastrophic Coverage Most Part D plans are subject to the gap The gap is also known as “the doughnut hole”
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Basics of Medicare There are two ways for Medicare beneficiaries to get comprehensive Medicare coverage
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Medicare Advantage (MA) /Medigap Plan Comparison
Premium $0 premium plans available No underwriting Higher premiums than MA Underwriting Risk Hard to predict expenses High risk/high reward Easy to budget when premium is the only out-of-pocket expense Restrictions Must follow plan rules Use any provider that accepts Medicare Part D MAPD plans include Part D Must purchase separate PDP Renewal Renewal not guaranteed Renewal is guaranteed Pre-existing No pre-existing Pre-existing on some policies Cost Share Upfront costs when seeing a provider Generally no upfront costs when seeing a provider
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Enrollment Periods Initial Enrollment Period (IEP)
Applies when first eligible for Medicare Part A and/or Part B Seven month period Annual Election Period (AEP) October 15 thru December 7 Changes will be effective January 1 Medicare Advantage Plan Disenrollment Period (MADP) January 1 thru February 14
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Enrollment Periods Lock-in February 15 thru December 31
Special Enrollment Period (SEP) Applies when certain life events occur Low Income Subsidy eligibility
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2018 Medicare Sales Kit Benefits at a Glance (BAG), Summary of Benefits Enrollment application Postage paid return envelope Multi language insert Provider Directory, Formulary Privacy Policy Stars Rating Always use a complete kit
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2018 Benefits at a Glance (BAG)
Monthly premiums Out-of-pocket maximums No deductibles Preventive services and screenings Inpatient/Outpatient care Emergency and Urgent Care worldwide Additional benefits Out-of-Network benefits Prescription drug coverage
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Medicare Advantage with No Prescription Drugs
Secure Plan offered by Health First Health Plans: Premium: $0
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Get Help Paying Costs Medicare Part D Low Income Subsidy (LIS)
“Extra Help” to pay for your prescription drug costs and be exempt from the Coverage Gap Medicare Savings Program (MSP) Assists with paying for Part A and/or Part B premiums Medicaid may also help pay deductible, copays and coinsurance You may be able to get extra help to pay for your prescription drug premiums and costs. Federal programs are available, such as Low Income Subsidy and Medicare Savings Programs. Applicable Disclaimers Appear at the End All applicable disclaimers are on page <13>
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Added Value Services Care Level Management through Inspiris
Home visiting physician program for homebound members (Commercial and Medicare). Available to high-risk, frail members who meet the Health First Health Plans criteria for participation No cost for the program Considered a quality program (rather than a plan benefit)
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Added Value Services Complex Case Management
Assessment, planning, implementation, monitoring, evaluation and coordination of medical services CCM nurses collaborate with various Health First Health Plans providers to ensure quality, cost-effective care. For members with complex or serious medical conditions
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Added Value Services Healthy Living Programs (Optum)
Free program offered to all members to help them stay healthy and manage their current health issues. Available to members 24/7 online and by telephone. Registered Nurses are available to speak 24/7 Smoking cessation coverage Select smoking cessation medications covered Counseling is a preventive benefit with $0 cost share
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Added Value Services Medication Therapy Management (MTM)
Designed to target Medicare members who may benefit from added support with their medication therapies. Offered free to MAPD and PDP members who meet the following qualifications: Member must accumulate total drug costs exceeding $750 in one quarter Beneficiary must have filled seven or more chronic covered Part D drugs, and Must have documented illnesses in at least two chronic conditions
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Member Services Annual Medicare Member Benefit Sessions
Local Customer Service with walk-in assistance Beneficiary grievance and appeal rights (refer to EOC)
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Member Services Social Service Coordinators (AKA “My Advocate”) (Third Party Administrator for Health First Health Plans) TDD/TTY
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How to Submit a Medicare Application
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Login to the Broker Portal at: myHFHP.org or myFHCA.org
The branding will be different on each site however the processes remain the same.
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Click “SUBMIT A MEDICARE APPLICATION” from the “MEDICARE SALES” section then click “ONLINE APPLICATION SUBMISSION”
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Fill out the required fields and “COMMENTS” section
Fill out the required fields and “COMMENTS” section. Before clicking “SUBMIT”, ensure you have attached the application by using “ATTACHMENTS” tab.
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Upload your attachment by using the “BROWSE” button
Upload your attachment by using the “BROWSE” button. Type a description of the document and select “ADD.”
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Once the document is successfully attached, go back to the “”SALES MEDICARE-APPLICATION SUBMISSION”
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Click “SUBMIT” Keep in mind after submitting this request you can follow up on the status using the tracking number provided
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Premium Payment Options
For monthly premium plans: Monthly invoices Electronic funds transfer (EFT) Social Security withhold (preferred option)
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Do You Have Other Insurance?
If you currently have health coverage from an employer or union, joining a plan could: Affect your employer or union health benefits, including prescription drug coverage Cause loss of your employer or union coverage Important: Read the communications your employer or union sends. If you have questions, visit their website, or contact the office listed in their communications. If there isn’t any information on whom to contact, your benefits administrator or the office that answers questions about your coverage can help.
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What to Expect Next Within 10 calendar days they will receive:
An Acknowledgment letter showing their Member number, plan name and effective date. They use this as proof of coverage until they receive the ID card. A Medicare Enrollment Confirmation letter included with the Evidence of Coverage (EOC) document, also known as the contract. Within 15 calendar days they will receive: An Outbound Enrollment Verification letter. This letter verifies enrollment request onto the plan. A Membership ID card to be used for all medical and prescription needs in place of the red, white and blue Medicare card.
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What to Expect (continued)
Note: Beneficiaries who enroll in Medicare drug plans after they are first eligible, or who have had a break in coverage of 63 or more consecutive days will be mailed a Declaration of Prior Prescription Drug Coverage Form to show proof of prior drug coverage. This coverage form states that they understand enrollment in this plan will automatically end enrollment in another Medicare Advantage or Prescription Drug Plan. Medicare Supplement plans do not automatically cancel. They will need to contact the carrier to cancel your policy.
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Broker Expectations Cannot use non-Health First, non-CMS approved marketing materials Cannot encourage prospects to attend Sales Seminars Don’t encourage Corporate walk-ins as a means of enrollment Must follow scope of appointment guidelines Use the authorized Health First Health Plans presentation – Digital presentation will be ed upon request Submit completed enrollment form within 24 hours
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Privacy Policy Health First Health Plans wants you to be aware of our Privacy policy which is available online at myHFHP.org/privacy. If you would like a copy of our Privacy policy mailed to you or if you have any questions, please contact our Customer Service department at:
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Anti-Discrimination Policy
Plans/Part D Sponsors may not discriminate based on race, ethnicity, national origin, religion, gender, sex, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location. Plans/Part D Sponsors may not target beneficiaries from higher income areas or state/ imply that plans are only available to seniors rather than to all Medicare beneficiaries. Only Special Needs Plans (SNPs) and MMPs may limit enrollments to individuals meeting eligibility requirements based on health and/or other status. Basic services and information must be made available to individuals with disabilities, upon request.
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Agent Commissions 2018 Medicare Advantage (MAPD) – New
Change from other Carrier Initial Year Renewal Years (2-10) All Medicare Advantage Plans $455 $228 annually, paid in monthly installments of $19 Initial Year Renewal Years (2-10) All Medicare Advantage Plans $228 $228 annually, paid in monthly installments of $19
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Next Steps Brokers Selling Medicare are required to:
Answer the questions on the “2018 Broker Certification” Test Submit the completed test to Broker Services will send you the following: Results of the test (Passing grade of 80) Certificate of Achievement upon passing the test
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