Telephonic Application Medicare Advantage Sales - PowerPoint

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					Introducing Humana’s 2007 Medicare Program

        Presenters:   Paul Cantrell, Peggy Taylor, Sue Suchan

                      November 2, 2006
        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
                                      2007 Medicare Markets

       WA                                                                                                                                               ME
                                MT                      ND
                                                                          MN                                                                        MA
     OR                                                                                  WI                                              NY
                 ID                                     SD                                               MI                                        CT
                                                                                                    Milwaukee                                                RI
                                   WY                                                                                   ClevelandPA           NJ
                                                           NE                                                    OH Columbus
                        Salt Lake City                                                                          Dayton                                  DE
          NV                             Boulder                                              IL        IN      Cincinnati                              MD
                      UT                                                                                 Indianapolis    WV                             DC
                                         Denver                              Kansas City                      Louisville             VA
                                         CO                      KS              MO                              Lexington
                                           Colorado Springs
  CA              St. George                                                                                      KY                      Raleigh
                   AZ                                              OK                               Memphis                    SC
                                      NM                                           AR
                  Phoenix                                     Dallas                                         AL        GA
                                                                 TX                 LA                                             Jacksonville
                                                          Austin                               Baton Rouge                            Daytona Beach
                                                   San Antonio            Houston
                                                                                                    New Orleans                        Orlando
AK                                                                                                                     Tampa

                                                                        Corpus Christi
                                                                                                                                    PUERTO RICO

Local PPO & HMO Markets                       PDP only States                                            Regional PPO, PFFS & PDP States
Local PPO only Markets
                                              PFFS, HMO, SNP & PDP Markets                               PFFS & PDP States only
Local HMO only Markets
Local PPO, HMO & SNP Markets                  Partial county PFFS & PDP States only
                                  Humana’s Suite of Medicare Products
                           Humana Gold Plus            HumanaChoice             Humana Gold Choice               Medicare
                                HMO                        PPO                        PFFS                      Supplement
Primary Care Physician              Yes                       No                           No                        No

Provider Network           Smaller Network but    Generally larger network;     No network; members         No network;
                           generally increased    includes coverage for both    may use any doctor or       members may use
                           benefits               participating and non-        hospital accepting          any doctor or
                                                  participating provider use;   Medicare and Humana’s       hospital accepting
                                                  out-of-pocket costs           payment terms and           Medicare
                                                  increase using non-par        conditions

Referral Requirements      Yes, in most cases,    No, but some procedures,      No, but pre-certification   No, Supp plan pays
                           PCP must refer         services and inpatient care   of inpatient care and       secondary to Original
                           members needing        still require prior           advance coverage            Medicare; no
                           specialty care         authorization or pre-         determinations are          referrals are required
                                                  certification                 strongly encouraged
Service Area Limitations   Yes, HMOs are          Yes, PPOs have a specific     Yes, PFFS plans have        Yes, Supp plans are
                           generally located in   service area; Local PPOs      specific service areas--    available only in
                           more urban             are generally in more urban   usually state-wide;         states where DOI has
                           metropolitan areas     areas; Regional PPOs may      premium, however can        approved; premium
                           and cover specific     cover an entire state or      vary by counties within     can vary by state and
                           counties within that   multiple states as defined    the state even when         by regions within the
                           area                   by CMS                        benefits are the same       state

World-wide emergency                Yes                       Yes                         Yes                  Varies by Plan
care coverage
Routine vision, hearing             Yes                       Yes                         Yes                        No
and dental care covered
Prescription drug                   Yes                       Yes                         Yes                        No
SilverSneakers or                   Yes                       Yes                         Yes                        No
Humana Active Outlook               Yes                       Yes                         Yes                        Yes
                            Key Dates
October 1, 2006      Plans may begin marketing 2007 benefits

October 12, 2006     Plan benefit information available on

October 15, 2006     CMS mails 2007 Medicare & You Handbook
October 31, 2006     Current members are notified of benefit changes for
November 15 –        Annual election period (AEP)
December 31, 2006
January 1, 2007      New 2007 plan benefit period begins
January 1 –          Open enrollment period (OEP)
March 31, 2007
        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.
           Humana Partners

 Co-branded partner - Wal*Mart


 State Farm
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

   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.
          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
 Meeting beneficiaries where they are: shopping, at home,
  community sites, on the phone or in person
              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
       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


 Other value-added services and opportunities that may vary by market,
  region or product
                Humana PDP SmartSummary
   Unique, monthly statement with
    detailed accounting of
    medications and prescription

   Suggestions for cost savings,
    including less expensive
    medication alternatives, mail

   Educational articles about
    relevant chronic conditions

   Members approaching the
    coverage gap also receive
    outbound calls to better prepare
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 –

     On-line application through the CMS at the Medicare
      website –
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

   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.
What You Should Know about the Sales Presentation

  Sales presentation includes:

     Specific plan information including all Humana MA, MAPD and PDP

     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

     A non-sales associate-initiated telephonic or written verification process
      is conducted to determine the enrollee’s understanding of the product
     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
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.
          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
           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

   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.
           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
                  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

                  Government Relations Contact:
                       Harry Spring
                                Phone:    [850] 224-9996
                                Fax:      [850] 224-9998

Description: Telephonic Application Medicare Advantage Sales document sample