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Introducing Humana’s 2007 Medicare Program Presenters:Paul Cantrell, Peggy Taylor, Sue Suchan November 2, 2006
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Topics for Discussion Today Our 2007 National Presence Key Dates Education and Outreach Humana’s Partners; Relationship with Wal-Mart Our Member Value Proposition: Benefits & Services Recruiting, Selling, Enrollment and Oversight Processes Humana’s Medicare Products and Benefits Contacts for Ongoing Dialogue
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2007 Medicare Markets Local PPO & HMO Markets PFFS & PDP States only Regional PPO, PFFS & PDP States PDP only States Local PPO only Markets PFFS, HMO, SNP & PDP Markets Local HMO only Markets Local PPO, HMO & SNP Markets Partial county PFFS & PDP States only
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Humana’s Suite of Medicare Products Humana Gold Plus HMO HumanaChoice PPO Humana Gold Choice PFFS Medicare Supplement Primary Care Physician YesNo Provider Network Smaller Network but generally increased benefits Generally larger network; includes coverage for both participating and non- participating provider use; out-of-pocket costs increase using non-par providers No network; members may use any doctor or hospital accepting Medicare and Humana’s payment terms and conditions No network; members may use any doctor or hospital accepting Medicare Referral Requirements Yes, in most cases, PCP must refer members needing specialty care No, but some procedures, services and inpatient care still require prior authorization or pre- certification No, but pre-certification of inpatient care and advance coverage determinations are strongly encouraged No, Supp plan pays secondary to Original Medicare; no referrals are required Service Area Limitations Yes, HMOs are generally located in more urban metropolitan areas and cover specific counties within that area Yes, PPOs have a specific service area; Local PPOs are generally in more urban areas; Regional PPOs may cover an entire state or multiple states as defined by CMS Yes, PFFS plans have specific service areas-- usually state-wide; premium, however can vary by counties within the state even when benefits are the same Yes, Supp plans are available only in states where DOI has approved; premium can vary by state and by regions within the state World-wide emergency care coverage Yes Varies by Plan Routine vision, hearing and dental care covered Yes No Prescription drug coverage Yes No SilverSneakers or SilverSteps Yes No Humana Active Outlook Yes
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Key Dates October 1, 2006 Plans may begin marketing 2007 benefits October 12, 2006 Plan benefit information available on Medicare.gov October 15, 2006 CMS mails 2007 Medicare & You Handbook October 31, 2006 Current members are notified of benefit changes for 2007 November 15 – December 31, 2006 Annual election period (AEP) January 1, 2007 New 2007 plan benefit period begins January 1 – March 31, 2007 Open enrollment period (OEP)
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Humana Medicare Outreach and Education 8 RVs traveling through 34 states Senior, civic centers and select Wal*Mart locations in both urban and rural areas Prior to October 1, Humana sales associates were on hand to provide general educational information on PDP and MA plans as well as important dates related to the enrollment process and how Medicare beneficiaries can research prescription drug availability. After October 1, Humana sales associates will share information about specific Humana Medicare products.
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Humana Partners Co-branded partner - Wal*Mart USAA State Farm
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Humana - Wal Mart Relationship Co-branded relationship since 2005 Humana full-service workstations in approximately 2,100 Wal-Mart/Sam’s Club stores. Manned by licensed, appointed reps who use CMS-approved materials. Humana informational kiosks being piloted in 100 Wal-Mart/Sam’s Club locations with basic plan benefit information. Where possible, these will provide direct phone access to Humana licensed telephone sales reps for information and agent appointment requests. Located in highly visible, general merchandise areas. Both station types are clearly identified as Humana Medicare sites and those staffed with agents are available for both walk-ins and appointments.
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Adding Value to our Products Guiding our members in using their benefits New member Welcome Kit Wide range of Value-Added Services Local presence in most markets New Member Orientations and “Re-Orientations” Continuing education throughout the year; not just during open enrollment Meeting beneficiaries where they are: shopping, at home, community sites, on the phone or in person
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New Member Welcome Kit New for 2007 –Mailing a personalized package to all members to simplify and improve the new member experience. Packet includes: Welcome letter Copy of application Summary of benefits Privacy notice Access to benefits instructions Abridged Formulary Geo-access directory (non-HMO) Member handbook Description of all value added services RightSource (mail order) brochure Humana Active Outlook brochure
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Humana – Value Added Services Services beyond traditional benefits: SilverSneakers Fitness Program Humana Active Outlook Program Cooking and nutrition classes SilverSneakers Plus Posit Science Brain Fitness Program SmartSummaryRx Statements MyHumana.com Other value-added services and opportunities that may vary by market, region or product
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Humana PDP SmartSummary Unique, monthly statement with detailed accounting of medications and prescription costs. Suggestions for cost savings, including less expensive medication alternatives, mail order. Educational articles about relevant chronic conditions Members approaching the coverage gap also receive outbound calls to better prepare financially.
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What You Should Know about the Enrollment Process Sales Agent presentation with application –Paper application –Electronic enrollment using a digital signature –Telephonic enrollment On-line application through our website – www.Humana.com www.Humana.com On-line application through the CMS at the Medicare website – www.Medicare.govwww.Medicare.gov
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What You Should Know About Humana Sales Agents All agents—both employed and independent--are state licensed, certified, registered and appointed. All agents selling Medicare products required to attend sales and ethics training prior to the sale of our products. Background check conducted on all agents appointed to sell Medicare products. Required testing and certification for all agents prior to selling – initially and annually thereafter. Must sign Code of Conduct. Allegations of agent misconduct or misrepresentation are thoroughly investigated pursuant to rigorous policies and procedures. Agent conduct monitored. Consequences for founded violations of company policy and/or regulations can include disciplinary corrective action and contract termination.
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What You Should Know about the Sales Presentation Sales presentation includes: Specific plan information including all Humana MA, MAPD and PDP products Full disclosure of all enrollment options Marketing materials that follow CMS requirements; are filed and approved by CMS prior to their use Information about enrollment considerations including a beneficiary needs analysis and suitability assessment Enrollment applications clearly identify the type of product and product name A non-sales associate-initiated telephonic or written verification process is conducted to determine the enrollee’s understanding of the product purchased
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Medicare Advantage Plan Options in [state] Humana Gold Choice PFFS Low Option - Premium Range: $0 Primary Care Physician OV – $[15] copay Specialty Physician OV - $[30] copay Outpatient Hospital – [20%] coinsurance Inpatient Hospital – $[550] per stay Humana Gold Choice PFFS High Option - Premium Range: $20 Primary Care Physician OV – $[15] copay Specialty Physician OV - $[30] copay Outpatient Hospital – $[0-100] copay Inpatient Hospital – $[180/day for days 1-5] HumanaChoice Regional PPO - Premium $69 Primary Care Physician OV – $[10] copay for network / $[35] copay for non-network Specialty Physician OV - $[30] copay for network / $[35] copay for non-network Outpatient Hospital – $[50-95] copay for network / [30%] coinsurance for non-network Inpatient Hospital – $[550] per stay for network / $[750-$800] per stay non-network* * $[750] if pre-certified; $[800] if not pre-certified
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Humana Gold Choice Private-Fee-For-Service Defining a Medicare Advantage Private Fee-For- Service (PFFS) Plan: Includes the same basic Medicare Part A & B benefits and payments as Original Medicare; generally, lower out of pocket costs overall. Unlike Original Medicare, it is administered by a private insurance company like Humana. Usually includes value-added services that are not part of Original Medicare. May have Part D Prescription Drug coverage included.
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More on Private Fee-For-Service Plan and provider reimbursements: Medicare pays Humana a monthly, fixed payment for each Medicare-eligible enrolled in the plan. Humana then pays the doctor, hospital or other providers for services rendered to its members. Humana’s PFFS plan pays 100% of Medicare allowable, less any applicable member copay or coinsurance amount.
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More on Private-Fee-For-Service How does a PFFS plan work? There is no doctor or hospital “network” or directory for medical care. PFFS members, however, do receive a pharmacy directory and must use a network pharmacy to obtain prescription drugs. Providers must be licensed and eligible to receive Medicare plan payments. Providers must agree to Humana’s terms and conditions, including acceptance of payment from Humana and agreement not to balance bill patients for Medicare-covered services if accepting Medicare assignment. Providers who don’t accept Medicare assignment may bill the patient up to the limiting charge.
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More on Private Fee-For-Service What if a member finds his/her doctor or hospital does not accept Humana’s PFFS plan? Physician and hospital participation is voluntary Medicare beneficiaries are encouraged to contact their providers to determine if their doctors and hospitals accept or will accept Humana’s PFFS payment. Humana provides outreach and education to help physicians and hospitals understand the PFFS billing process and how the plan works. Members can request that a Humana Provider Relations Representative contact their health care providers to encourage their acceptance of the plan.
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Ongoing Dialogue Establish an ongoing dialogue: –Updates on new information –Questions –Issue resolution Regulatory Compliance Contact: Sue Suchan Phone:[386] 676-1831 Fax:[904] 376-7798 E-mail:ssuchan@humana.comssuchan@humana.com Government Relations Contact: Harry Spring Phone:[850] 224-9996 Fax:[850] 224-9998 E-mail:hspring@humana.comhspring@humana.com
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