Introducing Blue Cross

(1)

Introducing

Blue

Cross

Medicare Advantage Plans

Medicare

Advantage

Plans

(2)

AGENDA

Why choose Blue / Industry Trends

Compensation

Our Partnership with ABQ Health Partners

Product Portfolio

Compliance

C

f

Certification Process

Enrollment Process

M

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Marketing Overview

What does this mean to you?

Next Steps

Questions

(3)

Question?

Who here is getting older?

(4)

DID YOU KNOW ?

• The 77 Million members of the “Baby Boom”

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i

65 i 2011

generation began turning 65 in 2011.

• The Medicare eligible population will continue

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2030 1

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5 to grow and by the year 2030, 1 out of every 5

Americans will be age 65 or older.

• Seniors control nearly 75% of the wealth in the

United States with a staggering 7 trillion

dollars.

(5)

(6)

Customers

have

different

needs

6

(7)

(8)

We Understand the New Mexico

Market

• Largest health plan in New Mexico

Solid Financial Ratings

Standard & Poor’s

AA- / Very Strong

Standard & Poor s

AA / Very Strong

A.M. Best

A+ / Superior

Moody’s

A1/ Good

8

(9)

Advantages of Blue

• Strong Product Portfolio

• Competitive Pricing

• New PDP Offerings

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t Sh i

• Low Cost Sharing

• Supplemental Benefits

SilverSneakers®

- SilverSneakers®

- Travel Benefit

- Hearing

• Key Network Partners

(10)

We Need Producers / Agents to Succeed

• High Commissions

• Faster Payment

• Strong Market Presence

• R

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C

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• Regular Communications

• Support Staff

(11)

Our promise to our members is to

make insurance

Simple Affordable Accessible

Simple. Affordable. Accessible.

(12)

Commissions

MAPD & PDP

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

(13)

Commissions

. _{Individual Product Type} _{Policy Year} _{Compensation Rate} Blue Cross Medicare Advantage

Initial Compensation 1 $425 Initial Compensation 1 $425 Renewal Lifetime $213 Blue Medicare RX Initial Compensationp 1 $56 Renewal Lifetime $28 Initial Compensation:

Subscribers identified by CMS as in their initial year of enrollment are considered to be new

enrollments. HCSC will provide compensation for the initial year after receipt of the first month’s premium.

The Initial Compensation amount is paid for new enrollments and enrollments into “different plan types.”

Renewal Compensation: Lifetime renewals

HCSC shall pay renewal compensation owed for business written with a 2014 effective date and consistent with the Agent/Broker compensation requirements in the CMS Medicare Marketing G id li HCSC ill id ti ft i t f th fi t th’ i

Guidelines. HCSC will provide compensation after receipt of the first month’s premium.

(14)

(15)

Our Medicare Advantage in 2014



Better Product in 2014



More Product Choice

(16)

Medicare Product Themes for 2014

• Range of products available that can be sold to a variety of customers

(Medicare Advantage, Prescription Drug, and Medicare Supplement

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plans)

• Both Medicare Advantage & PDP products will be better in 2014

• New Preferred Pharmacy Network Structure for both MAPD and PDP

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• Lower cost sharing

• Competitive pricing

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• Increased Compensation

• Supplemental benefits

• Dental • Vision • Hearing

• SilverSneakers® Fitness Program

T l b fit

• Travel benefit

• Worldwide emergency care

(17)

NM Medicare Advantage

- MA HMO Service area will expand into 2 additional counties in the Albuquerque area (Bernalillo, Sandoval,

Torrance, Valencia)

MA PPO Service area will expand into 12 counties (Bernalillo Sandoval Torrance Valencia Cibola

- MA PPO Service area will expand into 12 counties (Bernalillo, Sandoval, Torrance, Valencia, Cibola, Guadalupe, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Socorro)

Benefit

NM Plan Landscape

C t 2013 NM HMO P d 2014 NM HMO

Benefit Current 2013 NM HMO

Plan Proposed 2014 NM HMO Plan Comparison Name Blue Cross Medicare Advantage Basic (HMO) Plan Number H3822‐002 H3822‐002 Premium $0 $0 MOOP $3 000 $2 400 MOOP $3,000 $2,400 +

Hosp Inpatient $200 Copay (days 1‐4) $150 Copay (days 1‐5)

$750 annual max + Primary Care Physician $5 $0 + Specialist $30 $20 + Ambulatory Surgical Centers (ASC ) $375 $150 + (ASCs) $ $ PT/SP Therapy $30 $5 + Cardiac/Pul Rehab $25 $25 ‐ RXRX (Preferred/Non‐Preferred) Ded $325 $3/$12/$45/$95/25% $0/5‐$2/7‐$35/40‐$85/95‐ 33% +

(18)

NM Medicare Advantage – More Choice

Benefit NM Plan Landscape

Proposed 2014 NM Premium HMO Plan Proposed 2014 NM Buy Down HMO Plan

Proposed 2014 NM HMO‐POS

Plan Proposed 2014 NM PPO Plan

Name Blue Cross Medicare Advantage Premier (HMO)

Blue Cross Medicare Advantage Value

(HMO)

Blue Cross Medicare Advantage

Premier Plus (HMO‐POS)

Blue Cross Medicare Advantage Choice

(PPO) Plan Number H3822‐003 H3822‐004 H3822‐005 H8634‐002 Premium $32 $0 $37 $27

MOOP $1,500 $2,800 $2,350 $4,500 $6,500

Hosp Inpatient $100 Copay (days 1‐4) $350 Copay (days 1‐5) $200 Copay (days 1‐4) $150 Copay (days 1‐7)

$300 Copay

(days 1‐7) ( y ) ( y ) Primary Care Physician $0 $5 $5 $10 30% Specialist $15 $20 $20 $35 30% Ambulatory Surgical Centers (ASCs) $150 $200 $200 $125 30% PT/SP Therapy $5 $25 $25 $40 30% Cardiac/Pul Rehab $10 $30 $30 $45 30% RXRX (Preferred/Non Preferred) $0/5 $2/7 $35/40 $85/95 33% $0/5 $2/7 $35/40 $85/95 33% $0/5‐$2/7‐$35/40‐$85/95‐ $0/5 $2/7 $35/40 $85/95 33% RXRX (Preferred/Non‐Preferred) $0/5‐$2/7‐$35/40‐$85/95‐33% $0/5‐$2/7‐$35/40‐$85/95‐33% 33% $0/5‐$2/7‐$35/40‐$85/95‐33% $32 premium HMO

• Basic HMO network plan with richer benefits than than the $0 HMO plan

HMO Buy down plan (Part B buy-down of $10)y p ( y )

• Basic HMO network

• Leaner benefits than the $0 HMO, but HCSC contributes to the members Part B premium

$37 HMO-POS

• Basic HMO network with POS option

• Similar benefits to the HMO, but with the ability to go out of network (escape hatch)

$27 Blue Cross Medicare Advantage Choice (PPO) will be offered

• Large PPO network

• Competitive plan for people who like a PPO out of network option

(19)

NM Medicare Advantage – Network Advantage

• Key physician network partner with ABQ Health Partners

• Ph sician led patient dri en

centering aro nd patient’s needs

• Physician led, patient driven – centering around patient’s needs

• Team approach – network of nurses, specialists, case managers,

diagnostic team members and others, all working in sync to help our

patients stay healthy

• Total Care Model is a patient-centered comprehensive model

designed to help carefully manage our patient’s health

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• Proven to increase quality outcomes and patient satisfaction while

still reducing healthcare costs

(20)

Background – NM SNP

Blue Cross Medicare Advantage Dual Care

• BCBSNM applied for a Dual Eligible Subset

Non Zero Cost

• BCBSNM applied for a Dual Eligible Subset – Non-Zero Cost

Share

• Who can enroll?

M b t b li ibl f C t i l C

• Members must be eligible for Centennial Care

– QMB+

– SLMB+/Other

• AND members must be enrolled in HCSC Centennial Care at the time of the DSNP Application

– BCBSNM must verify eligibility at the time the application is received.

• What does Non-Zero Cost Share Mean?

What does Non Zero Cost Share Mean?

• Some members will have all of their Medicare A/B Service cost share

covered by Centennial Care (no liability for cost share)

• Others will have liability for Medicare A/B Service cost share that the

State does not cover

(21)

Background cont’d– NM SNP

D-SNP Premium

• Part C – No additional premium. Medicare Part B Premium covered by State of NM for most members.

• Part D - $12.60 plan premium covered for most members because of Low Income Subsidy status

D-SNP Benefits

D SNP Benefits

• Medicare A and B Services covered identical to Original Medicare

• 80% of most outpatient services

• Inpatient deductible

• Supplemental Benefits

• Dental (2 exams, 2 cleanings, 1 bitewing)

• Vision (exam, $150 toward hardware every 2 years, $25 copay/lenses)

• Hearing Aid (exam $1000 every for aids every 3 years)

• Hearing Aid (exam, $1000 every for aids every 3 years)

• SilverSneakers® (annual membership)

Centennial Care Benefits

• Coverage of Medicare cost share (varies depending on member’s eligibility g ( p g g y category)

(22)

2014

PDP

Products

(23)

Overview of NEW Basic Plans and

improved value and plus offerings

Blue Cross MedicareRx Basic (PDP)

SM

_{(NEW PRODUCT FOR 2014)}

• Value Propositions:

– Provides a low cost option to the healthier “Age In” population and a less expensive alternative for those that combine Part D with Medicare Supplement. Only about 40% of our Med Supp members have our Part D

• Benefits & Sales Stories:

– Monthly premiums at about 50% of the cost of our current Basic Plan offerings; most Tier 1 & 2 drugs can be obtained for $2 or less; products to compete with United and Humana low cost options$ ; p p p

Blue Cross MedicareRx Value (PDP)

SM

– Lower cost enhanced offering with better benefits than the previous Value Plans. Offers our largest client base a product with lower deductibles, cost sharing and monthly premiums .

product with lower deductibles, cost sharing and monthly premiums .

– Monthly premiums are about $2 less than the current Value Plans; all Tier 1 & 2 drugs can be obtained for $2 or less; lower initial deductible than Value Plans in 2013

Blue Cross MedicareRx Plus (PDP)

₍

₎

SM

– Improved high end option, that provides less expensive cost sharing levels and coverage on all generics as well as some brands in the gap.

All Ti 1 & 2 d b bt i d f $2 l t d d f ll i t i l d

– All Tier 1 & 2 drugs can be obtained for $2 or less; gap coverage extended from all generics to include some brands; possible to have $0 cost share until the catastrophic phase with Tier 1 drugs at Preferred Pharmacies

(24)

Issues Addressed with the 2014 Blue Cross

MedicareRx (PDP)

SM

Product Designs

2013 Issue or Competitive Deficiency

2014 PDP Plan Solution

HISC will offer Basic Plans that are

competitive on benefits and premium

to United and Humana

No “Low Cost” option to compete with

Humana and United’s Plans

Value Plans are not competitive in

terms of premium

For 2014 there will be an inexpensive

Basic offering and the Value Plans will

be about $2 cheaper per month with

better benefits than 2013

Members will save at least $5 per 30

day on Tiers 1-4 at CVS,

Wal-Mart/Sam’s Club, a local grocer

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i d

d t h

Opportunity for members to fill

prescriptions at a preferred pharmacy

for a discount

Robust offering of Tier 1 generics and

deductible only counting on Tiers 3-5,

and an independent pharmacy group

for a discount

The Basic offerings have a deductible

on all tiers and Value/Plus Plans have

narrower Tier 1 formulary; similar to

24

were not as beneficial as anticipated

narrower Tier 1 formulary; similar to

_{competitor’s offerings}

(25)

New Preferred Network Pharmacies for

All States in 2014

• The preferred network option has no impact on whether a member can fill at any of the 63,000+ network pharmacies nationwide

• Members can save at least $5 per 30 day fill on all three PDP Plans, if they fill at a preferred pharmacy versus any other network pharmacy

• Tier 1 & 2 drugs on all three PDP Plans can be obtained for $2 or less at a preferred pharmacy during the initial coverage period (OK is $4 or less on the Basic Plan)

p y g g p ( $ )

• Discounts not applicable to deductibles, but do apply to gap coverage on the Plus Plans

Preferred Network Pharmacies for 2014:

CVS

Wal-Mart/Sam’s Club

Good Neighbor Independent

Pharmacies and PPOK

SuperValu (Jewel/Osco), HEB

& Albertson’s

Pharmacies and PPOK

& Albertson s

(26)

Blue Cross MedicareRx Basic (PDP)

SM

Offering Details for 2014

• We currently don’t have a plan that competes with the price point of the AARP United and Humana Wal-Mart Plans

N f 2014 HISC ill b i t d i l t ti th t ill t ll i th

g

• New for 2014 HISC will be introducing a low cost option that will compete well in the marketplace with existing “low cost” plans

– Meets the needs of a wider spectrum of the over 65 population

– Matches United's and beats Humana’s Tier 1 & 2 pricing at Preferred Pharmaciesp g

– Premium range from $14 to $26 for 2014, which is in line with other similar offerings Highlights and Sales Points on the New Blue MedicareRx Basic Plan in New Mexico

Most premiums are in the low

to mid $20’s, in line with United

and Humana Basic Plan

Offerings; NM is $14 90

Provides another option to use

in tandem sales with Medicare

Supplement Offerings

Provides alternative to the

healthier Age-In population

Members can obtain Tier 1 & 2

drugs for $2 or under at

Offerings; NM is $14.90

pp

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that had been unaddressed

Preferred Pharmacies

(27)

Changes to Blue Cross MedicareRx Value

(PDP)

SM

in 2014

$200 d d tibl l

t

2013 Value Plan

2014 Value Plan

• $200 deductible only counts

towards Tiers 3-5

• Tier 1 drugs are $0 and Tier 2 are

$2 at Preferred Pharmacies

• $325 deductible only counts

towards Tiers 3-5

• Tier 1 drugs were $3 and Tier 2

were $10 $14 at any Pharmacy

$

• Out of Preferred Pharmacies, Tier

1 is only $5 and Tier 2 is $7

• Insulin option available on Tier 2

were $10-$14 at any Pharmacy

• No discounted cost sharing for

Preferred Pharmacies

• No Insulin option on Tier 1 or 2

• Premiums around $2 cheaper per

month in all States

• Narrow, more focused set of

i Ti 1

• No Insulin option on Tier 1 or 2

• Premiums in high $30’s to low

$40’s in all States

• Broad range of generics on Tier 1

• With the addition of the Blue Cross MedicareRx Basic (PDP)SM _{Plan, the Value plan is now an}

“Enhanced Alternative” under CMS guidelines

generics on Tier 1

Broad range of generics on Tier 1

• Members will not be moved if they are currently a part of the Value Plan

(28)

Changes to Blue Cross MedicareRx Plus

(PDP)

SM

in 2014

All i

d

b

d

2013 Plus Plan

2014 Plus Plan

• All generics and some brands

covered in the gap

• Tier 1 drugs are $0 and Tier 2 are

$2 at Preferred Pharmacies

• All generics covered in the gap

• Tier 1 drugs were $3 and Tier 2

were $10 at any Pharmacy

$

• Out of Preferred Pharmacies, Tier

1 is only $5 and Tier 2 is $7

• Insulin option available on Tier 2

were $10 at any Pharmacy

• No discounted cost sharing for

Preferred Pharmacies

• No Insulin option on Tier 1 or 2

• Premiums around $100 in all

States, with better benefits

• Narrow, more focused set of

i Ti 1

• No Insulin option on Tier 1 or 2

• Premiums under $100 in all States

• Broad range of generics on Tier 1

•

Since there will be two “Enhanced Alternatives” in 2014, the Plus Plan now includes coverage

of some brand drugs in addition to all generics in the coverage gap

generics on Tier 1

•

Tier 1 generics are now more narrowly focused on major CMS disease states for both the Plus

and Value Plans

(29)

The SilverSneakers® Experience

Health plan members can experience

SilverSneakers® in various ways:



Work out and take classes at any of

more than 11,000 fitness locations



Use SilverSneakers® Steps at home or

on the go



Participate in SilverSneakers® FLEX

classes and activities at local venues

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(30)

SilverSneakers® Fitness Locations

Venue-based Program Component

Fitness membership includes:



Use of all equipment and amenities included

q p

in a basic fitness membership



Access to more than 11,000 fitness

locations nationwide



SilverSneakers® classes taught by

certified instructors



A SilverSneakers® Program Advisor

SM

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id

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i t

for guidance and assistance



Fun social activities



Health education seminars

(31)

SilverSneakers® Steps

Self-directed Program Component



Non-venue based physical activity program



Convenient alternative for members without

General Fitness

Strength

easy access to a full-service location



Choice of four fitness kits with tools to use at

home or on the go



Kit choices (one per member):

• General fitness

• Strength

Walking

• Walking

• Yoga



Information and kit ordering instructions at

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(32)

SilverSneakers® FLEX

Outside the Gym



Classes and activities offered in parks,

recreation centers, churches and other

l

local venues



Examples: tai chi, yoga, walking groups



Led by certified instructors



Offerings and easy online enrollment

available at my.silversneakers.com

(33)

SilverSneakers® Online

Web-based Program Component

Offers members a secure, easy-to-use

website where they can:



Find fitness locations by ZIP code



Enroll

(34)

Compliance

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(35)

Medicare Marketing Do’s

• Do

only use materials available on the Producer portal after

successful completion of 2014 Producer Certification

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Requirements

• Do

market only within Blue Cross Medicare Products

i

service areas

• Do

complete a Scope of Appointment (SOA) form 48 hours

before each face to face appointment and retain hard copy

in your records for 11 years (current year plus 10 years)

• Do

clearly mark “optional” on any sign-in sheets used at

sales events

• Do

clearly describe eligibility requirements, benefits,

premiums network use enrollment periods lock in periods

premiums, network use, enrollment periods, lock in periods

and extra help to every enrollee

(36)

Medicare Marketing Do’s

• Do file and report all sales events through the Blue Access for

Producers portal no later than the 15

th

of each month for the following

month and follow CMS requirements for cancelling any previously

month, and follow CMS requirements for cancelling any previously

scheduled events

• Do

submit your client’s enrollment form within 48 hours of producer

receipt and keep all records relating to your client for 11 years (current

year plus 10 years)

• Do be familiar with producer responsibilities when performing sales and

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educational events, including understanding all requirements outlined in

the Compliance Program (which can be found at HISCCompliance.com)

• Do report any suspected violations to the Fraud Line at 1.800.838.2552,

d

il bl 24 h

d

anonymous and available 24 hours a day

• Do familiarize yourself with the 2014 Medicare Marketing Guide

available on the Blue Access for Producers website portal

• Do indicate at all sales and/or educational events that you are a licensed

agent of BCBS of IL/OK/TX/NM (as applicable)

(37)

Medicare Marketing Don’ts

• Don’t

create any marketing or enrollment materials on

your own

• Don’t

engage in door-to-door marketing or sales

• Don’t

engage in outbound telemarketing, e-mail

campaigns or calls to those in the process of voluntarily

disenrolling for the purpose of retaining membership

• Don’t

discuss other health products unless stated in

• Don t

discuss other health products unless stated in

advance on the Scope of Appointment form

• Don’t

engage in activities that intentionally mislead or

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confuse beneficiaries

• Don’t

engage in discriminatory activities such as

diti

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h

i

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t l ill

conditional enrollment based on physical or mental illness,

claims experience or disability

(38)

Medicare Marketing Don’ts

• Don’t

serve meals at sales events or host them in a health

care setting that is not a common area such as a cafeteria

or auditorium

• Don’t

accept an enrollment form prior to the client’s

p

enrollment period (and hold it until they are eligible)

• Don’t

offer inducement, monetary or otherwise, to enroll or

it h t

Bl

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M di

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t

switch to a Blue Cross Medicare product

• Don’t

engage in “high pressure” sales tactics, make

absolute statements, use superlatives or provide personal

opinions when discussing Blue Cross Medicare products

• Don’t

pressure attendees at sales events to complete

sign-in sheets

(39)

Monitoring & Oversight Program

The monitoring and oversight program consists of the following:

• Monthly and quarterly reviews of various marketing activities including,

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but not limited to:

• Confirmation of certification status, including status at time of a

submitted enrollment

• Disenrollment trends

• Scope of Appointment form use and retention

• Sales event monitoring (submission of events and onsite

observation)

• Advertising placements (via clipping service)

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(

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)

• Enrollment submission and retention of paper form

• Secret Shopping

(40)

Certification

Process

(41)

Why Certify Now?

In accordance with the guidelines established by the Centers for Medicare and Medicaid Services (CMS), all agents must be trained and certified annually in order to market, sell

d/ i PDP d MAPD d

and/or service PDP and MAPD products.

CMS guidance states that an agent must be certified in order to receive renewal compensation for policies sold after the 2008 plan year.

Failure to complete 2014 HCSC/HISC Producer Training & Certification requirements

by deadline will result in:

• Blue Cross MedicareRx and Blue Cross Medicare Advantage (where applicable) Book of Business for CYs 2009 and forward being moved to an HISC House Account.

• Blue Cross MedicareRx and Blue Cross Medicare Advantage (where applicable) Book of Business is NOT returned if certification occurs after December 6 2013 Book of Business is NOT returned if certification occurs after December 6, 2013 deadline or in a subsequent year.

(42)

Milestone Dates



December 3, 2013 -

2014 HCSC/HISC Certification closes for sub

producers at 11:59 p.m.



December 6, 2013 -

2014 HCSC/HISC Certification closes for all

i di id

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d

i

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individual producers and agency principles



January 4, 2014 -

y ,

2014 HCSC/HISC Certification reopens

p

• Applicable for February 2014 effective dates and beyond

• Certification on or after this date does not result in reinstatement of lost Blue

Cross MedicareRx/Blue Cross Medicare Advantage Book of Business

(43)

Access Training



Go to Blue Access for Producers (BAP); li k C tif t S ll 2014 P d t li k

click Certify to Sell 2014 Products link

OR

Access certification link via Certification

L h il

Launch email



If you have never accessed training as an individual:

• Use 9-digit HCSCUse 9-digit HCSC

assigned Producer ID #, which is also the same number used to login to BAP.



If accessing training as an agency:

• Use 9-digit HCSC assigned Agency ID # g g g y

Note: Do not use your Social Security # or Tax ID # as login. If unsure of your HCSC assigned Producer or Agency ID #, call the Producer Service Center at 1-855-782-4272

(44)

Password

• If you have never accessed

Knowledgewire, your initial

password is your 9-digit

HCSC Producer number

• You will be then prompted

to create a new password

If

h

i

l

• If you have previously

accessed Knowledgewire, use established password

• Keep password in an easily accessible location

• If you need help with resetting a forgotten password, please contact

the HCSC Helpdesk at

1-888-706-0583

(45)

2014 Courses and Exams

Individual Producer



Annual Information Form

2014 Courses and Exams

Sub Producer



Sales Agent Requirements



Medicare Basics course



Medicare Basics exam



Medicare Basics course



Medicare Marketing Rules & Regulations course



Medicare Marketing Rules & Regulations exam



Medicare Marketing Rules

& Regulations course



M di M k ti R l

Regulations exam



PDP/MAPD Product course



PDP/MAPD Product exam



FWA course



PDP/MAPD P d t



FWA course



FWA exam



Certification Form



M di A d



FWA course



FWA exam



Medicare Amendment

(46)

2014 Courses and Exams

AHIP Individual Producer or

Sub Producer

Agency

Principal

Sub Producer



Principal



Medicare Marketing Rules & R l i



FWA course



FWA exam

Regulations course



FWA course



FWA exam



Certification Form



Medicare Amendment (applicable to individual producers)



FWA exam



Certification Form



Medicare Amendment

p )

Note: Principal must complete all Producer courses and exams in order to market, sell and/or service PDP and MAPD products

46 and MAPD products.

(47)

Exams

• Passing score is

85%

on all exams

per CMS guidelines

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• Three attempts per exam (4 exams)

• No lockout period

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• Can re-take exam immediately after a failed attempt

• Exam questions are randomly selected;

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;

(48)

Continuing Education Credits

• Illinois:

• 4 credits approved4 credits approved for individual producers/subagentsfor individual producers/subagents

• 2 credits approved for AHIP producers/subagents in Illinois

N

M

i

Okl h

d T

• New Mexico, Oklahoma and Texas

• 4 credits approved for individual producers/subagents

• 2 credits approved for AHIP producers/subagents

• Upon successful completion of all 2014 requirements, HCSC will submit credits

to the respective DOI. Producers should confirm with Department of Insurance

to confirm credits are applied.

(49)

Communications

Curriculum Completion

•

Confirms completion of all 2014 HCSC/HISC Producer Training & Certification

R i t d i l d li k t li

Requirements and includes link to access supplies

•

Notice received

Incomplete Curriculum

•

States there are outstanding items for 2014 HCSC/HISC Producer Training &

C tifi ti R i t

Certification Requirements

•

One task on the to-do list must be completed to alert a notice

•

Notice received approximately 7 days after user begins training Agency Amendment Execution

•

Confirms at least one subagent has completed their 2014 HCSC/HISC Producer Training & Certification requirements

•

Outlines principal’s 2014 HCSC/HISC Producer Training & Certification requirements

•

Requires completion within 2 weeks of notification

•

Emailed approximately 1-3 business days after at least one subagent completes their 2014 HCSC/HISC Producer Training & Certification requirements

Failed Exams

•

Informs producer they failed one of the exams after three attempts thus failing the certification

(50)

Enrollment

Process

(51)

Enrollment Process –

Key Dates

Once Certified….

October 1st _{Begin accepting IEP and SEP enrollments which allow for January 1}st

ff ti d t effective dates

 Extended hours of operation begin for customer service: 8 a.m. – 8 p.m., 7 days a week, including holidays. Note: Customer service will be closed on

Thanksgiving and Christmas.

October 15th _{Begin accepting Annual Election Period (AEP) enrollments for January}

effective dates

 CMS does NOT allow any AEP enrollments to be accepted by producers prior to

thi d t ( t t f b fi i d h ld th li ti t b it

this date (e.g. cannot accept from beneficiary and hold the application to submit on the 15th₎

December 7th _{Last day to receive AEP enrollments}

January 1st _{AEP enrollments effective and new benefits begin}

February 14th _{Last day of extended hours for customer service}

 Resume operating 8 a m – 8 p m Monday through Friday with alternate  Resume operating 8 a.m. – 8 p.m., Monday through Friday, with alternate

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Enrollment Process

-Elements Required to Consider the Enrollment

Complete

•

The Centers for Medicare and Medicaid Services (CMS) requires the following elements be provided to consider the enrollment complete:

 Plan Selection

 Beneficiary Name

 Beneficiary Date of Birth

 Beneficiary Gender

 Permanent Residence Address (cannot be P.O. Box)

 Beneficiary Medicare Number

 For MAPD, ESRD question

 Beneficiary Signature (or Authorized Representative Signature, if signed by someone other than the beneficiary)

 If signed by an Authorized Representative, all contact information fields

•

Notes:

 Form CMS-1696 may not be used to appoint an authorized representative for the purposes of enrollment and disenrollment. This form is solely for use in the claims information and appeals.



 Producers should not include any of their information in the Authorized Representative sections of the y p enrollment form, nor sign as the Authorized Representative, unless they have been legally appointed as the beneficiary’s legal guardian, Power of Attorney, etc.

 The above items are the only ones for which the enrollment can be pended or put in “Request for Information (RFI)” status, if not provided on the enrollment mechanism.

 CMS has separate timeframes for submission and notifications to the beneficiary only when one of these elements is missing from the enrollment request; however, CMS still counts these towards compliance with enrollment timeliness standards.

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Enrollment Process

-Elements Required to Consider the Enrollment

Complete

•

If any of the CMS-required fields are incomplete, the “RFI” (Request for Information) process begins:

Complete

 Conduct 3 outbound phone calls

 Send “RFI” letter to beneficiary requesting missing information

 Allow the extended timeframe (21 days or the end of the calendar month; or in the case of an initial enrollment period submitted early up to the last day of the month prior to the Medicare Part D

enrollment period submitted early, up to the last day of the month prior to the Medicare Part D eligibility date)

 If the required information is not received within required timeframe, enrollment is denied

•

If information related to other fields or questions on the enrollment mechanism are not q provided, the enrollment cannot be pended. These fields, include, but are not limited to:

 premium payment option

 other coverage information

 l t i f ti

 long-term care information

 enrollment period and associated date (if applicable)

 producer-related fields

•

Enrollments missing any information other than the required elements as defined by CMSEnrollments missing any information other than the required elements, as defined by CMS, MUST be submitted to CMS within 7 calendar days.

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Enrollment Process –

Election Periods (AEP/IEP/SEP)

•

Although CMS requires we validate the member is enrolling during an allowable election period, the enrollment period is not an element required to consider an enrollment

complete. p

•

We must make the determination of whether the member is enrolling during a valid

election period based on the information provided on the enrollment mechanism, and/or our validation of the member’s Part D eligibility and/or Low-Income Subsidy status (IEP or SEP for LIS)

SEP for LIS).

 This determination must be made within 7 days of the producer’s receipt of the enrollment form, so we can meet the requirement of submitting to CMS within 7 days

 For enrollments that are denied due to not being able to confirm a valid election period, the denial letter must be mailed within 10 days of receipt

•

If an election period or required date associated with an election period is missing:

 Maximum of two outbound calls are made on the day the enrollment is processed

 If we are unable to reach beneficiary/producer and/or no response received, the enrollment is denied

•

It is especially important the producer ensure the appropriate election period is selected on the enrollment mechanism - and for those that require a date, the date is also provided - to q , p prevent enrollments from being denied.

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Enrollment Process

-Timeframes

•

The “Application Date” related to those enrollments facilitated by producers is defined by CMS as follows:

“For requests submitted to sales agents, including brokers, the application date is the date the agent/broker receives (accepts) the enrollment request and not the date the sponsor receives the enrollment request from the agent/broker. For purposes of enrollment, receipt by the agent or broker employed by or contracting with the sponsor, is considered receipt by the plan, thus all CMS required p y y g p p y p q timeframes for enrollment processing begin on this date.”

•

The date the producer receives the form from the client is the date from which all CMS requirements are measured:



Submission to CMS within 7 calendar days



Acknowledgment letter, Request for Information Letter, or Denial letter mailed within 10 calendar days

10 calendar days

•

It is imperative producers submit all enrollments within 24 hours of receipt to

(56)

Enrollment Process

-Methods to Submit Enrollment

Enrollment Method Requirements How to Submit:

Health Plan Online Enrollment (BAP)

Must have signed paper enrollment on file

Access through Blue Access for Producers (BAP)

 Image of paper enrollment form and/or scope of f

Retention: current calendar year plus 10 years

appointment form may be uploaded with the electronic submission

Paper Enrollment Retention: current calendar year plus 10 years

MAPD: Blue Cross Medicare Advantage P.O. Box 4555

Scranton, PA 18505 Fax: 1.855.895.4747 PDP: Blue Cross MedicareRx

P.O. Box 3897 Scranton, PA 18505 Fax: 1.855.297.4245 Overnight: 25 Lakeview Dr.

Jessup, PA 18434 Telephone Enrollment Enrollment area keeps telephone

recording for current calendar year

plus 10 years MAPD: 1-888-657-4164 plus 10 years

Producer may not be on the phone or physically present with beneficiary) Can only be completed based on inbound call – cannot transfer from an

tb d ll t i b d ll

MAPD: 1-888-657-4164

PDP: 1-888-657-1215 outbound call to an inbound call

56 To check on enrollment status, please call the Producer Help Desk:

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Enrollment Process

-Health Plan Online

•

Must use health plan online enrollment link through Blue Access for Producers (BAP) to

be paid the appropriate compensation



Use of the Direct Consumer Health Plan Online Enrollment available through our websites



Use of the Direct Consumer Health Plan Online Enrollment available through our websites (vs. BAP) will prevent any producer-specific information from being captured and

commissions will not be paid.

•

2014 Enrollment Forms will be available October 15

•

Submission through the Health Plan Online Enrollment process is the most timely and efficient method:

•

Eliminates any potential mailing delays associated with paper enrollments

f f f

•

Reduces risk of producer information or election period information not being captured

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Enrollment Process –

Paper

•

Ensure the correct Election Period is selected, and an associated date is provided if needed (as designated next to the option selected):

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Enrollment Process –

Paper

•

Ensure the producer attestation questions are answered completely and accurately.

Note: If face-to-face appointment was conducted, the producer should have a scope of appointment form on file

form on file

•

It is important the producer fully explain the items listed in the last question, most of which are also contained in the Decision Guide

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Enrollment Process –

Paper

•

Ensure the selling producer completes the producer-related fields on both copies of the paper enrollment form prior to submitting for processing

•

Ensure the selling producer enters his/her unique identification number in the “WritingEnsure the selling producer enters his/her unique identification number in the Writing Agent ID#” field.

In the case of producers that report up to an agency, etc. this should NOT be the number of the

agency and/or entity to which commissions may be paid, but the Unique ID# of the sellingproducer (normally 5 or 6 digits proceeded by zeros not the tax ID #)

(normally 5 or 6 digits, proceeded by zeros, not the tax ID #)

The agency information should be included in the “Agency Name” and “Agency Number” fields, if applicable

•

Ensure the selling producer signs and dates the form, as the signature date is the date used as the “application received date”

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Enrollment Process

-Telephone

•

Phone enrollments are an option, however, the producer may not be present on the phone or physically present with the member during the telephone enrollment:

The sponsor must ensure that the telephonic enrollment request is effectuated entirely by the

beneficiary or his/her authorized representative and that the plan representative sales agent or broker beneficiary or his/her authorized representative, and that the plan representative, sales agent or broker is not physically present with the beneficiary or present on the phone at the time of the request

•

Telephone enrollments may only be completed during an inbound phone call.

•

The caller will be asked to confirm the producer is not on the line or physically present in order to complete the telephone enrollment.

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Enrollment Process –

Tips for Effective Processing and Avoiding

Grievances

Do:



Ensure all CMS-required fields are complete



Ensure all CMS-required fields are complete



Ensure the appropriate election period is selected

As the paper forms only offer a subset of the possible election periods, if the applicable enrollment period is not listed, use the “Plan Use” only section of the form to indicate the SEP reason



Use the “Plan Use” section of the enrollment form to indicate the requested effective date on the model paper enrollment forms

Note: only certain SEPs allow for future effective dates; many enrollment periods require the effective date to be the first of the month following receipt of the enrollment



Submit enrollment forms within 24 hours of receipt



Ensure all fields on the enrollment form are completed prior to the beneficiary signing the enrollment form



Provide the client with the entire Decision Guide and a copy of their enrollment form

62

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Enrollment Process –

Tips for Effective Processing and Avoiding

Grievances

Don’t:



Solicit enrollments from members just becoming eligible for Medicare PRIOR to their receipt of notification of the Medicare eligibility and Medicare number from SSA (e g do

Grievances

receipt of notification of the Medicare eligibility and Medicare number from SSA (e.g. do not assume what the Medicare # will be)

This results in not being able to confirm the Medicare eligibility and pending the application for up to 3 months prior to the member’s eligibility date, which impacts CMS required enrollment timeliness

t d d standards



Hold applications in an effort to get a preferred effective date for the client for those SEPs that become effective the first of the month after receipt

This results in being out of compliance with CMS required notifications and submissions as the date This results in being out of compliance with CMS required notifications and submissions, as the date the producer receives the form is the date from which timeliness is measured



Select the “I am new to Medicare” election period for beneficiaries just becoming eligible for Medicare Part B and enrolling in Blue Cross MedicareRx

For example, member works until age 68; then retires, loses and/or gives up their group coverage and enrolls in Medicare Part B. This member is not “new to Medicare” as he/she would have been eligible for Medicare Part A and/or Part D when reaching age 65. The election period in these cases is

normally either involuntarily losing creditable coverage due to retiring and/or making a change during

th EGHP l ti i d h th i l ll th t di ll t

the EGHP election period when their employer allows them to disenroll, etc.

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Enrollment Process

-Outbound Enrollment Verification Calls (OEV)

•

Upon processing the enrollment request, CMS requires outbound enrollment verification (OEV) calls be made to all beneficiaries enrolled through a producer.



3 call attempts are made within 15 days of producer’s receipt of the enrollment form



If 1st _{call unsuccessful, an OEV letter is sent}



Call script and letter are model language provided by CMS



Call script and letter are model language provided by CMS



These calls occur concurrently with any RFI calls



There is a ‘separate’ cancellation timeframe associated with OEV calls/letters (vs. the p ( other allowable cancellation timeframe where the beneficiary may verbally request the enrollment be cancelled prior to the effective date)

 For OEV cancellations of enrollments, beneficiaries may request their enrollment be cancelled during the OEV call and/or within seven (7) calendar days from the date of the letter or call or the last day of the OEV call, and/or within seven (7) calendar days from the date of the letter or call, or the last day of the month in which the enrollment request was received, whichever is later.

 For AEP enrollment requests, enrollments may be cancelled within seven (7) calendar days from the date of the letter or call, or by December 7, whichever is later.



64  Cancellation of enrollments unrelated to the OEV process can be requested up to the day prior to the

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(66)

Overview

• Marketing Lessons Learned Summary

Marketing Lessons Learned Summary

• 2014 Timeline & Key Messages

• 2014 Collateral Overview

• 2014 Advertising Overview

(67)

Marketing Effectiveness

The Marketing Team leveraged insight from key research projects and 2013

campaign performance metrics to inform marketing mix and optimize content.

Lessons Learned

p g p

g

p

Collateral

Advertising

• Updated collateral material to include

more educational information

• Used more charts, graphs, and basic

l

• Cable more efficient than spot TV

• Pre‐printed Business Response Cards

(BRCs) with prospects information

language

• Redesigned Decision Guides and Welcome

Kits

• Incorporate positive headlines

• Developing new graphic TV spot and

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(69)

Key Marketing Messages

The AEP campaign consists of cohesive cross-channel messaging

• Key marketing messages:

• Highlight new benefits, services and products for MAPD and new

Highlight new benefits, services and products for MAPD and new

low-cost Part D plan

• Include a sense of urgency for AEP deadline (Dec. 7)

C

ti

Bl

C

M di

O ti

tf li

i

d

• Continue Blue Cross Medicare Options portfolio messaging and

co-marketing Med Supp and Part D

September Generate Pre-AEP awareness October 1 AEP Marketing Begins October 15 AEP Begins October 15 AEP Begins TV Strong CTA November 25 Digital Message Increased December 7 AEP ends Marketing AEP awareness

& soften the market

Begins TV Strong CTA Increased

Sense of Urgency

Marketing activity ends close of day

(70)

AEP Direct To Consumer Collateral

•

Collateral consists of:

• Sales kit contents: enrollment forms decision

• Sales kit contents: enrollment forms, decision guides, formularies, etc…

• Presentations

• Product brochures

•

All marketing collateral is designed to be consistent with advertising.

•

Goals

• Recognize HCSC branded materials

• Easy to understand

• Provide options for enrolling

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2014 Sales Kits Content

Blue Cross Medicare Advantage (MAPD) Blue Cross MedicareRx (PDP) Blue Medicare Supplement Blue Medicare Options

Enrollment Forms Enrollment Forms Enrollment Forms

Decision Guide Decision Guide Decision Guide Decision

Guide Summary of Benefits

(included multi-language insert)

Summary of Benefits

(included multi-language insert)

Outlines of Coverage

Formulary

(will be removed in Jan.)

Formulary

(will be removed in Jan.)

CMS Choosing A Medigap Policy Booklets

B i R l E l B i R l E l B i R l E l

Business Reply Envelope Business Reply Envelope Business Reply Envelope

MAPD Provider directories will NOT be included in the MAPD kits, but can

b

d

t

d l

it

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(73)

Online Supply Portal - Collateral

•

Think Blue Ambassadors, producers p and other internal employees are to order sales kits and event supplies from: