2008 Medicare product cycle sales training

2008 Medicare product cycle sales training Presented by ISGBU Sales Training October 2007 October 2007 objectives By the end of this session, using your training materials, you will be able to: • • • • • • • • • • • • Identify 2008 Blue Shield of California Medicare business goals Identify Medicare enrollment periods for 2008 Identify beneficiary cost-sharing amounts for 2008 Describe the standard Medicare Part D benefit for 2008 Describe 2008 Blue Shield Medicare Rx Plans benefits Describe 2008 Blue Shield 65 Plus benefits Identify the 2008 calendar-year maximum copayment amounts for Medicare Supplement plans K and L Identify the Medicare Supplement closed-plan rates for 2008 Identify key mailing dates for Blue Shield 65 Plus members Identify key mailing dates for Blue Shield of California Medicare Supplement members Identify key mailing dates for Blue Shield Medicare Rx Plans members Describe the Blue Shield 65 Plus producer certification program page 3 Blue Shield Goals – Medicare 2008 •Improve customer experience resulting in attraction and retention of high-value customers •Focus on long-term growth •Grow Medicare Advantage membership 200% (net) over 2007 growth •Modest membership growth for Medicare Supplement and PDP page 4 2008 Medicare October 2007 overview Enrollment Periods •Annual Coordinated Election Period (AEP) 11/15 – 12/31/07 – Medicare beneficiaries may enroll in the PDP, MA or MA-PD plan of their choice for a 1/1/08 effective date •Open Enrollment Period (OEP) 1/1 – 3/31/08 – Medicare beneficiaries who have elected MA coverage as of 12/31 can make one more election to another plan with “like” prescription coverage • MA members can only switch to another MA plan • MA-PD members can switch to another MA-PD plan, or to Original Medicare and a stand-alone PDP – The OEP cannot be used to elect a prescription drug plan for the first time unless the beneficiary is new to Medicare. Beneficiaries who were eligible to elect prescription coverage between 11/15 and 12/31, and did not, will have to wait until the next AEP (11/15 – 12/31/08) “Lock-In” goes into effect for PDP on 1/1/08 “Lock-In” goes into effect for MA-PD plans as of 4/1/08 page 6 Original Medicare 2008 Beneficiary Cost Sharing Premiums •Part A – Less than 30 quarters = $423 – Between 30 – 39 quarters = $233 •Part B = $96.40 Deductibles •Part A = $1,024 •Part B = $135 Hospitalization (per benefit period) •Days 61 – 90 = $256 •Days 90 – 150 = $512 Skilled Nursing (per benefit period) •Days 21 – 100 = $128 page 7 let’s review! October 2007 2008 Medicare Prescription Drug Coverage October 2007 Defined Standard PDP Benefits Item Premium Member Responsibility $27.93 (Part D Base Beneficiary Premium) Deductible $275 Coinsurance 25% after $275 deductible Coverage gap No coverage for drug costs once total drug costs (member and plan) reach $2,510 After TrOOP costs have reached $4,050, the greater of $2.25 for generic (including brand drugs treated as a generic) and $5.60 for all other drugs, or 5% coinsurance Catastrophic coverage page 10 2008 Blue Shield Medicare Rx Plans October 2007 What’s New In 2008, Blue Shield of California will: •Continue to offer an enhanced alternative plan – No deductible – Ease of fixed copayments •Offer a defined standard plan – Mirrors the standard Medicare Part D plan – Deductible and coinsurance Effective 1/1/08 page 12 Blue Shield Medicare Rx Enhanced Plan (001) Item Monthly Plan Premium Deductible Member Responsibility $42.30 $0 Tier 1 – Formulary Generic Drugs (including selected CMS-excluded drugs) Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred pharmacy - 90-day supply/non-preferred pharmacy Mail Order - 90-day supply CMS-excluded drugs include: Phenobarbital, Butalbital combination products, selected Benzodiazepines, selected cough/cold preparations, selected vitamins and minerals, Niacin $20 Covered at the applicable copayments listed above $10 $20 $30 Initial Coverage Limit: $2,510 – No coverage through the gap page 13 Blue Shield Medicare Rx Enhanced Plan (001), continued Item Tier 2 – Formulary Brand Name Drugs Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred pharmacy $30 $60 Member Responsibility - 90-day supply/non-preferred pharmacy Mail Order - 90-day supply $90 $60 Initial Coverage Limit: $2,510 No coverage through the gap page 14 Blue Shield Medicare Rx Enhanced Plan (001), continued Item Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred pharmacy $60 $120 Member Responsibility Tier 3 – Non-Preferred Brand Name Drugs (Generally, no prior authorization required) - 90-day supply/non-preferred pharmacy Mail Order - 90-day supply $180 $120 Initial Coverage Limit: $2,510 No coverage through the gap page 15 Blue Shield Medicare Rx Enhanced Plan (001), continued Item Tier 4 – Injectables Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy Mail Order - 90-day supply 25% of Blue Shield’s contracted rate Member Responsibility Tier 5 – Formulary Specialty (Unique High Cost Drugs with a cost >$600) Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy Mail Order - 90-day supply 25% of Blue Shield’s contracted rate Initial Coverage Limit: $2,510 – No coverage through the gap page 16 Blue Shield Medicare Rx Enhanced Plan (001), continued Item Catastrophic Coverage (For drug costs when member’s TrOOP is >$4,050) Member Responsibility The greater of $2.25 for generic, including brand drugs treated as a generic, and $5.60 for all other drugs, or 5% coinsurance Same copays apply as for a 30-day supply at a preferred or nonpreferred retail pharmacy Same copays apply as for a 30-day supply at a preferred or nonpreferred retail pharmacy Long-term Pharmacy - One-month (34-day) supply Out-of Network (Covered when the member is outside the plan’s service area where there is no network pharmacy) - 30-day supply Initial Coverage Limit: $2,510 No coverage through the gap page 17 Blue Shield Medicare Rx Plan (002) Item Monthly Plan Premium Deductible Tier 1 – Formulary Generic Drugs Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy Mail Order - 90-day supply Tier 2 – Formulary Brand Name Drugs Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy Mail Order - 90-day supply 25% of Blue Shield’s contracted rate 25% of Blue Shield’s contracted rate Member Responsibility $37.70 $275 Initial Coverage Limit: $2,510 – No coverage through the gap page 18 Blue Shield Medicare Rx Plan (002), continued Item Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy Mail Order - 90-day supply Tier 4 – Injectables Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy 25% of Blue Shield’s contracted rate 25% of Blue Shield’s contracted rate Member Responsibility Tier 3 – Non-Preferred Brand Name Drugs (Generally, no prior authorization required) Mail Order - 90-day supply Initial Coverage Limit: $2,510 – No coverage through the gap page 19 Blue Shield Medicare Rx Plan (002) cont. Item Retail - 30-day supply/preferred or non-preferred pharmacy - 90-day supply/preferred or non-preferred pharmacy Mail Order - 90-day supply Catastrophic Coverage (For drug costs when member’s TrOOP is >$4,050) Long-term Pharmacy - One-month (34-day) supply Out-of Network (Covered when the member is outside the plan’s service area where there is no network pharmacy) - 30-day supply 25% coinsurance The greater of $2.25 for generic, including brand drugs treated as a generic, and $5.60 for all other drugs, or 5% coinsurance 25% coinsurance 25% of Blue Shield’s contracted rate Member Responsibility Tier 5 – Formulary Specialty (Unique High Cost Drugs and Self Injectables with a cost >$600) Initial Coverage Limit: $2,510 – No coverage through the gap page 20 let’s review! October 2007 2008 Blue Shield 65 Plus October 2007 What’s New Effective 1/1/08 • Withdrew Blue Shield 65 Plus from San Francisco County • Part B premium reduction for Riverside/San Bernardino Counties and Blue Shield 65 Plus Choice Plan • New name for Lifepath Nurseline is NurseHelp 24/7 page 23 2008 Blue Shield 65 Plus Benefits LA/OR County highlights - medical Item Monthly Plan Premium Office Visit to Personal Physician/Specialist Outpatient Hospital/Ambulatory Surgery Centers (ASC) Inpatient Hospital Member Responsibility $0 $5/$10 $50 $55 each day for day(s) 1-10 $0 each day for day(s) 11-90 $550 annual copay max Ambulance $100 copay per trip (one-way) page 24 2008 Blue Shield 65 Plus Benefits LA/OR County highlights - pharmacy Item Deductible Tier 1 – Formulary Generic Drugs including selected CMS-excluded drugs Member Responsibility $0 Retail: $6 for 30-day supply (preferred or nonpreferred pharmacy) $12 for 90-day supply (preferred pharmacy) $18 for 90-day supply (non-preferred pharmacy) Mail Order: $12 for 90-day supply Tier 2 – Formulary Brand Drugs Retail: $25 for 30-day supply (preferred or nonpreferred pharmacy) $50 for 90-day supply (preferred pharmacy) $75 for 90-day supply (non-preferred pharmacy) Mail Order: $50 for 90-day supply Tier 3 – Non-Preferred Brand (Generally, prior authorization not required) Retail: $60 for 30-day supply (preferred or nonpreferred pharmacy) $120 for 90-day supply (preferred pharmacy) $180 for 90-day supply (non-preferred pharmacy) Mail Order: $120 for 90-day supply CMS-excluded drugs include: Phenobarbital, Butalbital combination products, selected Benzodiazepines, selected cough/cold preparations, selected vitamins and minerals, Niacin Initial Coverage Limit: $2,510 2008 Blue Shield 65 Plus Benefits LA/OR County highlights - pharmacy Item Tier 4 - Injectables Member Responsibility Retail: 20% of Blue Shield’s contracted rate for 30day or 90-day supply at preferred or non-preferred pharmacy Mail Order: 20% of Blue Shield’s contracted rate for 90-day supply Tier 5 – Formulary Specialty (Unique High Cost Drugs with a cost >$600) Retail: 25% of Blue Shield’s contracted rate for 30day or 90-day supply at preferred or non-preferred pharmacy Mail Order: 25% of Blue Shield’s contracted rate for 90-day supply Coverage Gap Catastrophic Coverage (for drug costs when member’s TrOOP is >$4,050) Tier 1: Formulary Generics only The greater of $2.25 for generic, including brand drugs treated as a generic, and $5.60 for all other drugs, or 5% coinsurance Initial Coverage Limit: $2,510 page 26 2008 Blue Shield 65 Plus Benefits LA/OR County highlights – pharmacy, continued See the Blue Shield 65 Plus 2008 Medicare Advantage Prescription Drug Plan (MA-PD) Summary of Benefits for information on prescriptions filled at out-of-network and long term care pharmacies page 27 2008 Blue Shield 65 Plus Benefits LA/OR County highlights – dental Basic dental not available for LA and OR Counties Dental Plus Plan through Pacific Union Dental not available for 2008 for all counties page 28 2008 Blue Shield 65 Plus Benefits RV/SB County highlights - medical Item Monthly Plan Premium Part B Premium Reduction Office Visit to Personal Physician/Specialist Outpatient Hospital/Ambulatory Surgery Centers (ASC) Inpatient Hospital Member Responsibility $0 $10 $5/$10 $50 $50 each day for day(s) 1-10 $0 each day for day(s) 11-90 $500 annual copay max Ambulance $110 copay per trip (one-way) page 29 2008 Blue Shield 65 Plus Benefits RV/SB County highlights - pharmacy Item Deductible Tier 1 – Formulary Generic Drugs (including selected CMS-excluded drugs) Member Responsibility $0 Retail: $5 for 30-day supply at preferred or nonpreferred pharmacy $10 for 90-day supply at preferred pharmacy $15 for 90-day supply at non-preferred pharmacy Mail order: $10 for 90-day supply Tier 2 – Formulary Brand Drugs Retail: $25 for 30-day supply at preferred pharmacy or non-preferred pharmacy $50 for 90-day supply at preferred pharmacy $75 for 90-day supply at non-preferred pharmacy Mail Order: $50 copay for 90-day supply Tier 3 – Non-Preferred Brand (Generally, prior authorization not required) Retail: $60 for 30-day supply at preferred or nonpreferred pharmacy $120 for 90-day supply at preferred pharmacy $180 for 90-day supply at non-preferred pharmacy Mail Order: $120 for 90-day supply CMS-excluded drugs include: Phenobarbital, Butalbital combination products, selected Benzodiazepines, selected cough/cold preparations, selected vitamins and minerals, Niacin Initial Coverage Limit: $2,510 2008 Blue Shield 65 Plus Benefits RV/SB County highlights - pharmacy Item Tier 4 - Injectables Member Responsibility Retail: 20% of Blue Shield’s contracted rate for 30day supply at preferred or non-preferred pharmacy Mail Order: 20% of Blue Shield’s contracted rate for 90-day supply Tier 5 – Formulary Specialty (Unique High Cost DrugS with a cost >$600) Retail: 25% of Blue Shield’s contracted rate for 30day supply at preferred or non-preferred pharmacy Mail Order: 25% of Blue Shield’s contracted rate for 90-day supply Coverage Gap Catastrophic Coverage (for drug costs when member’s TrOOP is >$4,050) Tier 1: Formulary Generics only The greater of $2.25 for generic, including brand drugs treated as a generic, and $5.60 for all other drugs, or 5% coinsurance Initial Coverage Limit: $2,510 page 31 2008 Blue Shield 65 Plus Benefits RV/SB County highlights – pharmacy, continued See the Blue Shield 65 Plus 2008 Medicare Advantage Prescription Drug Plan (MA-PD) Summary of Benefits for information on prescriptions filled at out-of-network and long term care pharmacies page 32 2008 Blue Shield 65 Plus Benefits RV/SB County highlights – dental Basic dental not available for the Inland Empire Dental Plus Plan through Pacific Union Dental not available for 2008 for all counties. page 33 2008 Blue Shield 65 Plus Benefits Blue Shield 65 Plus Choice Plan highlights - medical Item Monthly Plan Premium Part B Premium Reduction Office Visit to Personal Physician/Specialist Outpatient Hospital Inpatient Hospital Ambulance Member Responsibility $0 $22 $0/$0 $0 $0 $60 copay per trip (one-way) Waived if admitted to hospital page 34 2008 Blue Shield 65 Plus Benefits Blue Shield 65 Plus Choice Plan highlights - pharmacy Item Deductible Tier 1 – Formulary Insulin and Generics including selected CMS-excluded drugs Member Responsibility $0 Retail: $3.50 for 30-day supply at preferred or nonpreferred pharmacy $7 for 90-day supply at preferred pharmacy $10.50 for 90-day supply at non-preferred pharmacy Mail Order: $7 for 90-day supply Tier 2 – Formulary Brand Drugs Retail: $25 for 30-day supply at preferred or nonpreferred pharmacy $50 for 90-day supply at preferred pharmacy $75 for 90-day supply at non-preferred pharmacy Mail order: $50 for 90-day supply Tier 3 – Non-Preferred Brand Drugs (Generally, no prior authorization required) Retail: $60 for 30-day supply at preferred or nonpreferred pharmacy $120 for 90-day supply at preferred pharmacy $180 for 90-day supply at non-preferred pharmacy Mail order: $120 for 90-day supply CMS-excluded drugs include: Phenobarbital, Butalbital combination products, selected Benzodiazepines, selected cough/cold preparations, selected vitamins and minerals, Niacin Initial Coverage Limit: $2,510 2008 Blue Shield 65 Plus Benefits Blue Shield 65 Plus Choice Plan highlights - pharmacy Item Tier 4 – Injectables Member Responsibility Retail: 20% of Blue Shield’s contracted rate for 30day or 90-day supply at preferred or non-preferred pharmacy Mail Order: 20% of Blue Shield’s contracted rate for 90-day supply Tier 5 - Formulary Specialty (Unique High Cost Drugs with a cost >$600) Retail: 25% of Blue Shield’s contracted rate for 30day or 90-day supply at preferred or non-preferred pharmacy Mail Order: 25% of Blue Shield’s contracted rate for 90-day supply Coverage Gap Catastrophic Coverage (for drug costs when member’s TrOOP is >$4,050) Tier 1: Formulary Insulin and Generics The greater of $2.25 for generic, including brand drugs treated as a generic, and $5.60 for all other drugs, or 5% coinsurance Initial Coverage Limit: $2,510 page 36 2008 Blue Shield 65 Plus Benefits Blue Shield 65 Plus Choice Plan highlights – pharmacy, continued See the Blue Shield 65 Plus 2008 Medicare Advantage Prescription Drug Plan (MA-PD) Summary of Benefits for information on prescriptions filled at out-of-network and long term care pharmacies page 37 2008 Blue Shield 65 Plus Benefits Blue Shield 65 Plus Choice Plan highlights – basic dental Item Routine Dental Services administered by Pacific Union Dental Preventive Care provided through Pacific Union Dental – Covers specific ADA codes, copay varies by ADA code Member Responsibility $5 office visit copay $20 copay for first and second cleaning per year $5 copay for periodic oral exam (1 exam every 6 months) $15 copay for initial oral exam $0-$10 copay for X-rays every 2 years $5-$15 copay for fluoride treatment (2 per year) In Area Emergency Dental Services Applicable copay for each service received from a plan dentist Member is reimbursed up to $100 through Pacific Union Dental Out-of-Area Emergency Dental Services page 38 2008 Medicare Supplement October 2007 The Landscape •Membership: 60,209 (as of 7/31/07) •Product cycles – October: Annual Creditable Coverage Notices sent to members with prescription coverage on their plan – January: Closed plan rate action – April: Open plan rate action page 40 2008 Medicare Supplement Calendar Year Maximum Copayment Plan K - $4,440 Plan L - $2,220 Note: The Calendar Year Maximum Copayment applies to those services that are covered on Plan K and Plan L (e.g., hospitalization). OOP costs for services that are NOT covered on Plan K and Plan L do not count toward the Calendar Year Maximum Copayment. page 41 let’s review! October 2007 Distributing MA-PD Plans through Producers October 2007 Overview New! •For 1/1/2008 plan effective dates, Blue Shield of California producers can choose to: – Become certified and sell the Blue Shield 65 Plus and Blue Shield 65 Plus Choice Plans, OR – Not become certified and participate in the HMO Producer Referral Bonus Program MA-PD sales will count toward MVP and Co-Op programs, and as a contract towards a producer’s book of business page 44 Rationale •Allow Blue Shield of California to establish the capacity to enroll a high volume in a short timeframe (Annual Election Period) •Put Blue Shield of California on par with our competitors’ distribution strategy – All competitors currently use producers to distribute MA-PD plans •Ensure more efficient use of resources •Provide a competitive advantage and a higher level of comfort regarding CMS compliance through the process of individual producer certification Individual producers are a small and growing niche in the Medicare market page 45 Certification and Oversight Certification will include: •Online training, customized for Blue Shield of California producers •Required passing test grade, to demonstrate understanding of product and compliance materials Note: Tracking system will notify PIPS when producers have passed the certification test Oversight will include: •Documented Blue Shield of California process for producers that act in bad faith •Warning system that: – Checks for rapid disenrollments and appeals and grievances issues – Periodically checks licensing and governing board reports Note: Producers that are flagged with rapid disenrollment or other grievances will not be compensated for sales page 46 Marketing and Communication • Cal Broker advertisements: • September “teaser” piece directing producers to contact their RSM • Additional ads in October, November and December • Shield Insider/BRAIN: • September “teaser” piece in the September/October issue • Additional program information in the November/December issue • Additional marketing: • Direct mail in October and December • Combined MedSupp/PDP/MA-PD PIB in October • Blue Shield 65 Plus plan pre-sale material in-stock in November page 47 Blue Shield 65 Plus Producer Referral Program Continuing into 2008 •Producers continue to earn $625 for referrals that result in enrollment into the Blue Shield 65 Plus and Blue Shield 65 Plus Choice Plan (1/1 – 12/1/08 effective dates) •Enrollments from current Blue Shield of California Medicare Supplement members who convert to Blue Shield 65 Plus or the Blue Shield 65 Plus Choice Plan are not included in the program •One-time $625 referral fee is paid after the referred enrollee remains a Blue Shield 65 Plus member for two consecutive calendar months •Blue Shield 65 Plus plan service area: All of Orange County, parts of Los Angeles, Riverside, and San Bernardino Counties •It’s easy to refer a client. Call (800)260-9692 and select option #3, or e-mail a referral to: producer.medicarehmo@blueshieldca.com Program is subject to change by Blue Shield page 48 Key Dates Task Marketing of 2008 benefits begins Non-renewal notice published in San Francisco County newspaper Non-renewal letter received by San Francisco County members 2008 benefits published on Medicare Compare 2008 pre-sale materials available 2008 Medicare & You handbook mailed Mailings to producers Communication to providers Combined ANOC/EOC mailing to members Responsible Group Medicare Marketing Medicare Marketing Medicare Marketing CMS Medicare Marketing CMS Medicare Marketing Provider Relations Medicare Marketing Due Date 10/1/07 10/2/07 10/2/07 10/11/07 Full kit 10/15/07 10/15-10/30/07 10/15/07 10/24/07 10/31/07 1/1/08 PDP and MA-PD plan enrollment applications can be accepted beginning 11/15/07 page 49 let’s review! October 2007 October 2007