1. 2018 Broker Training Molina Marketplace Washington

2. Thank you to all our broker partners!
For the great support in helping Molina Marketplace double our member enrollment in WA for 2017

3. Perspective change for 2018….
a particular attitude toward or way of regarding something;
a point of view
Survive 18 to thrive in 19

5. What’s the future look like???

6. 2018: We’re fixing the plane while in flight!
Core Ops
Care Delivery
Cost of Care
Serve our members and support our agents as we prepare for future growth.

7. We have an opportunity to improve Molina's
performance to reach our goals….
Maximize value creation
Facilitate effective care management
Improve administrative efficiency and eliminate barriers
Strike a balance between growth and profitability – 2% net margin goal
Break down barriers to accessing care
Grown 3x in 5 years—Fortune 200 company
Market leader in Duals
Large share of Marketplace
Operate health plans in 13 states, Puerto Rico and (Mississippi in 2018)
11 health plans accredited by NCQA

9. ACA Repeal Update Repeal the individual and employer mandates:
On September 13, 2017 Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) announced new legislation (“GCHJ”) that proposes to replace the Affordable Care Act’s (ACA) subsidies for individual market health insurance and Medicaid expansion with reforms that would give states broad flexibility in using federal block grants to design their own systems.
Senate leaders are taking this proposal seriously, but are not expected to schedule a vote unless 50 senators are committed to supporting the bill. To reach 50 votes, the bill’s supporters would need to secure the votes of at least two of the three senators – Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK) – who voted “no” on the McConnell ACA repeal amendment in late July.
Repeal the individual and employer mandates:
The bill would eliminate the penalty, retroactive to 2016.
Repeals Obamacare subsidies and ends Medicaid expansion funding: 
The legislation would eliminate Obamacare subsidies that lower premiums, deductibles and co-pays in It would also jettison federal funding for Medicaid expansion, which 31 states use to provide coverage for residents with incomes up to about $16,000.
Loosens Obamacare's regulations regarding pre-existing conditions and financial protections: 
The bill would also let states alter several key Obamacare protections for those with pre-existing conditions. While it would still require insurers to provide coverage to everyone, states could loosen a lot of other rules.
Revamps funding for Medicaid overall: 
The legislation would turn the federal funding for Medicaid expansion and the subsidies into a block grant program. States would be given a lump sum of money and would have a lot of leeway over how to spend it. The legislation would send the states a fixed amount of money per Medicaid enrollee, known as a per-capita cap, starting in 2020.

10. Molina States for MP2018
Molina is selling on-exchange products in 7 states:
California
Florida
Michigan
New Mexico
Ohio
Texas
Washington

11. Molina Marketplace Product Strategy - 2018
Keeping To Our Mission -
To provide quality healthcare services to people receiving government assistance
Overall 2018 Product Priorities –
Provide profitability in all viable markets -- address MP product strategy and financial performance at the State level
Retain Silver CSR Members -- minimize changes the FFM Silver Plans
Retain CMS Standard Product Offering (Molina Options) where it supports strategy and performance
Implement product enhancements addressing member access to care and cost containment
Attack Opportunities for Benefit Definition, Clarification, and Administrative efficiency

12. Molina Marketplace Product Strategy - 2018
Product Portfolio –
Plan Design Positioning –
Bronze – Discontinue as needed to meet profitability targets
Eliminated in WA - Discontinued Bronze members will be mapped to new Silver Std 250% plan
Retained in CA, NM, TX,OH, MI, FL
Silver – Reduce Silver Standard 250% Plan to minimum AV of 67%.
Gold -- Continue to increase premium and plan cost share on Gold Plans where we want to avoid enrollment
Plan cost share changes
Minimized cost share change impact to Silver 100 & 150 CSR Plans where we have significant enrollment
2018 AV calculator is forcing higher cost share on remaining Silver plans to meet AV targets
Cost share changes were also made to reflect expected claims experience and admin costs
Service area reduction: withdrew from six WA counties (Adams, Chelan, Douglas, Grant, Kittitas, Okanogan)
Service area expansion: MI, WA, OH
Exiting On-Exchange: UT and WI

13. Molina Marketplace Product Portfolio Strategy - 2018
State
Service Area Action
Plans WA
Product Withdrawal: Rating area 5, impacting – Adams, Chelan, Douglas, Grant, Kittitas, Okanogan
Discontinue all Bronze, Silver, and Gold plans
Retained service area: Clark, Ferry, King, Lincoln, Mason, Pend Oreille, Pierce, Skamania, Spokane, Stevens, Thurston;
Service Area Expansion: Klickitat County
Renewing Silver and Gold plans
Discontinuing Bronze plans in retained counties
Adding Silver & Gold Plans in Klickitat WI
Product Withdrawal from the following counties: Brown, Calumet, Dodge, Door, Florence, Fond Du Lac, Forest, Jefferson, Kenosha, Lincoln, Manitowac, Marathon, Marinette, Menominee, Millwaukee, Oconto, Oneida, Outagami, Ozaukee, Portage, Racine, Shawano, Sheboygan, Vilas, Walworth, Washington, Waukesha, Waupaca, Winnebago, Wood
Discontinue all On-Exchange plans (Bronze, Silver, and Gold)
Off-Exchange: Bronze Indemnity Plan in Shawano County only UT
Product Withdrawal from the following counties: Davis, Salt Lake, Utah, Weber, Box Elder, Summit, Tooele
Off-Exchange: Gold Plan in Salt Lake and Weber Counties only

14. Molina Marketplace counties in 2018w

15. Member Communication Calendar

16. Renewal Letters

17. 2018 Open Enrollment California FFM Washington
10/11/17 - Active Renewal Begins (existing Covered California members)
11/1/17 – Open Enrollment Begins (consumers new to Covered California)
11/11/17 – 12/4/17 - Passive Renewal
12/15/17 – Deadline to Enroll for Jan 1 Coverage
1/31/17 – Open Enrollment Ends
FFM
10/10/17 – 10/31/17 - Passive Renewals
11/1/17 - Open Enrollment begins
11/3/17 – 12/15/17 – Switch files from Exchange
12/15/17 – Open Enrollment Ends
Washington
12/15/17 – Deadline to Enroll for January 1 Coverage
1/15/17 – Open Enrollment Ends

19. Molina Marketplace Plan Design Changes for 2018 – WA
Silver Choice 100
Silver Choice 150
Silver Choice 200
Silver Choice 250
Gold Choice
ACCUMULATORS
Medical Deductible, Ind / Fam
$525 / $1,050
$2,500 / $5,000
$4,950 / $9,900
$3,800 / $7,600
Rx Deductible, Ind / Fam
$400 / $ (Tiers 3 & 4 only)
$400 / $ (Tiers 3 & 4 only)
OOPM, Ind / Fam
$1,250 / $2,500 
$2,450 / $4,900
$5,850 / $11,700
$7,350 / $14,700
COST SHARING
Emergency Room
$175
$250 (after ded)
$400 (after ded)
Urgent Care
Office Visit — Primary Care
$30
$10
Office Visit — Specialty Care
$60
$75
Hab Services / Rehab
$35
Outpatient Hospital/Facility Services: Mental/Behavioral/SA
 10% ded waived
40% (after ded)
Radiology Services (X-rays)
$65
Laboratory Tests
$40
Inpatient Hospital Services
Rx Tier 1
$20
Rx Tier 2
Rx Tier 3
30%
50% (after ded)
Rx Tier 4
30% 

20. 9/18/2018

21. 9/18/2018

22. Provider Network

23. Main Provider Groups UW Medicine Swedish Providence Overlake Hospital
MultiCare Health
Rockwood
Vancouver Clinic
Peacehealth
Franciscan
Sea Mar (FQHC)
HealthPoint (FQHC)
Community Health (FQHC)
Northshore

24. www.molinahealthcare.com or directly at
Online Provider Search
or directly at

25. Referral vs. Authorization
Molina Healthcare does not require referrals for contracted specialists.
In referring a patient, the PCP should forward pertinent member information and findings to the specialist.
Some specialists may require referrals (however Molina does not)
Authorization
designed to assure the medical necessity of service, prevent unanticipated denials of coverage,
ensure participating providers are utilized, and
all services are provided at the appropriate level of care for the member’s needs.

26. New Member Application - Data Inconsistencies
Upon submitting an application, members must provide all documents required by the Exchange to support their application for coverage.
Types of documents the Exchange may request to prove identity, eligibility status, or income:
Citizenship
Immigration
Yearly Household Income
Self-Employment
Unearned Income
Veteran Status
Incarceration
American Indian / Alaska Native
Employer-Sponsored Coverage
No Minimal Essential Coverage
Residency
Social Security Number
Failure to submit documents within 90 days will ultimately result in either a loss of APTC and/or eligibility for coverage. Members will not be able to apply again until the following Open Enrollment period and may incur tax penalties.
CMS and Covered CA send notices to members advising what information is needed and by when to avoid termination of eligibility or loss of APTC. As of July 2017, Molina no longer sends a subsequent notice for FFM members.

27. Invoicing and Payment Options
Binder invoice mailed upon receipt of enrollment file from the Exchange and monthly thereafter
(No paperless option at this time)
Binder Due Date
FFM and CA Binder Due Date is 1st of coverage effective month
WA Binder Due Date is 10th of coverage effective month
Premium Due Date thereafter is:
25th of the month prior to the coverage effective month for FFM and WA
26th of the month prior for CA, or 4 business days prior to the beginning of the coverage effective month, whichever is earlier
AutoPay
* Autopay debits on the 23rd of the month, or next business day *
Payment Channels offered by Molina
(always include the Subscriber ID or Account Number with payments to avoid processing delays)
AutoPay – for convenience and peace of mind. Register at MyMolina.com
Online (Mobile Device or Desktop) - can use savings or checking account, credit or debit card at MolinaPayment.com. Or log in to MyMolina.com.
IVR – savings or checking account, Visa, MasterCard or Discover card.
Mail – submit payments with coupon from invoice. Allow 15 days for receipt and processing.
Cash – go to MoneyGram.com to find a location, or call (800)
Member Services phone number and hours are located on the invoice and welcome letter

28. Communications Process for New Members
Correspondence triggered daily when 834 file transaction is received from the Exchange
If payment made upon application, invoice will show $0 balance
Application
Welcome letter
Binder Invoice
Start
Members who do not pay the full binder upon application will not have the ability to select a PCP.
A PCP will be selected for them.
Members can register for Autopay during enrollment application
Payment
PCP Selection
ID Card and
Welcome Kit
During OE, binder reminder robocall and outreach is performed

29. Welcome Letter
Sent upon receipt of enrollment transaction from the Exchange
Messaging:
Subscriber ID
My Molina registration
How to Make Premium Payments
PCP Selection Options / Auto-Assignment
Wellness Check Appointment Information
ID Card – process and timing to receive
Drug Formulary location
Member Services – contact information
Accessibility to information – language and disability options

30. Member ID Cards
New Members - Sent once full binder payment is received and processed
Active Renewals – Sent as members actively renew during Open Enrollment
Passive Renewals – Sent in early to mid-December
Important Information about ID Cards
Mailed only once the full binder payment is received and posted
In paper form (not laminated)
Comes in a large envelope, first sheet in the package, tear along perforated line
Includes one ID card per covered family member
ID cards can be printed from MyMolina.com
Available on mobile devices and can be printed or ed
Front
Back

31. New Member - Application Accuracy
Ask brokers to double check application and contact information from applicants for accuracy
Will help to avoid:
Incorrect premiums due to inaccurate DOB
APTC adjustments due to inaccurate income information
Undeliverable mail resulting in lapsed payments and termination for non-payment
Inability to contact the member concerning important medical or administrative issues
Molina cannot correct application inaccuracies. To correct inaccuracies in their application or *contact information, members must call the Exchange or access their online account with the Exchange.
*Robocall and outreach performed monthly for members with bad addresses instructing them to contact the Exchange to correct.

32. My Molina – Self Service Member Tool
MyMolina.com
View invoice and real-time balance
Change PCP
Sign up for AutoPay, or make a payment
View Claim History
View Plan and Benefits
Print ID Card
View/Print SBC or EOC
Get Reminders for Health Services
View Drug Formulary
…and much more!

33. Broker Information Welcome to MolinaMarketplace.com –
Easy Access to Broker Support Tools

34. Have you logged into your Broker Portal?

36. Marketing Materials

37. Molina Marketplace customizable marketing

38. Broker Support Unit (BSU)
Broker Services
Contracting
Reconciliation/
Commissions
Broker Support Unit (BSU)
Significant Trainings = SME
Fully staffed, Increased Spanish Speaking Capacity
Dedicated phone number
CARE Team (next slide)
Streamlined contracting process
Utilizing Technology – Broker Portal
DocuSign and eSignature
Identify and resolve commission discrepancies
Manage broker recon
Manual review of AOR exceptions
Ways we can help:
Marketing Material Distribution
Broker Communications, i.e., eBlasts
Process your Molina appointment and contracting to sell our MP products
Member Look Up/Issues
Commission Questions/Issues

39. BSU (Broker Support Unit)
Phone:
Broker Services - # 1
General inquiries, account access issues, member EOC and SBC questions
Broker Care Team- # 2
Member access to care issues, billing discrepancies, terminations in error
Commission Team- # 3
Broker Book of Business reconciliation for unpaid policies
Contracting Inquiries - # 4
Appointment requests, E&O/license/contact information updates
Monday through Friday – 8:00 AM to 5:00 PM (CST)

40. BSU (Broker Support Unit)
Ways we can help:
Marketing Material Distribution
Broker Communications, i.e., eBlasts
Process your Molina appointment and contracting to sell our MP products
CARE Team-Member Look Up/Issues/Resolution
Commission Questions/Issues
Broker Support Unit Team: 
Jamie Neslen, Director
Rhonda Clark, Manager
Tom Grady, Supervisor Broker Services
Ilse Galaz, Supervisor Contracting & Onboarding
Summer Brown, Supervisor Commission Recon

41. My Molina Site
24 hours once application is submitted successfully, Molina will be able to view in our internal member database.
Member will be able to create an account on Mymolina.com or mimolina.com
Once they create an account, member will be able to choose a PCP, make initial binder payment, and print ID cards

42. Cannot print ID till effective date.
Reminder:
Cannot print ID till effective date.

43. Member ID Card printable is same as original ID card
Donald Duck
Member ID Card printable is same as original ID card

44. Health In Hand App

45. HealthInHand Mobile Application – Key Facts
HealthInHand is our member facing mobile application for iOS and Android, and as of 6/30/17 it will be available for all LOBs and all currently contracted states in the US and Puerto Rico. HealthinHand allows members to have better insight into their health condition, and provides quick access Molina's services and care information that they may need.
The following should be noted:
HealthInHand follows the same flows as My Molina for Registration, Login, as well as the recently updated flows for Forgot Username and Forgot Password.
Usernames and passwords can be used interchangeably for MyMolina portals and HealthInHand.
Touch ID is a new feature, the application does not store any fingerprint information.
HealthInHand Rev 3.1 is for all SHPs, LOBs
iOS Release: June 30th, 2017
Android Release: July 6th. 2017

46. HealthinHand App
• View your Member ID Card • Pay your bill • View your health records
• Find a new doctor, change your doctor, or view your doctor's contact information • Access to many more services!
• View your benefits and eligibility

47. 2017 Open Enrollment Period
Marketplace open enrollment dates:
Shortening the 2018 annual open enrollment period
WA starts on November 1, 2017 and goes through January 15th, 2018
Members who enroll by December 15, 2017 will have a January 1, 2018 effective date
Those that enroll after December 15th will have a February 1, 2018 effective date.
Some individuals may qualify for a 60 day Special Election Period (SEP)
Special Enrollment Periods (SEP)
Requiring 100% pre-enrollment verification of all new consumers who seek to enroll in coverage during individual market special enrollment periods (SEPs) for all states served by the HealthCare.gov and WAHBE platform.
Website details:
2015 information will stay up until mid December
Open enrollment details:
Must enroll by 15th of month to be effective in the next month
Enrollment example: people who enroll by January 15th will be effective February 1. If enroll on January 16, effective date won’t be until March 1.
Special Election Period (SEP) qualifications based on a life changing event such as:
Job loss, change in income
Death of a spouse
Birth of a child

48. Molina Marketplace- WA Contact
James Maguire
Washington Broker Manager
Contact Phone #

49. Questions?