2018 PRODUCT TRAINING

Transcription

1 PRODUCT TRAINING 2018

2 Certification Overview Care N Care History / Values CNC Plan Offerings Providers Healthcare Concierge Agent Concierge Enrollment Process/Application Submission Agent Oversight Agent Compensation Important Information Wrap Up 2

3 Introduction Hello and welcome to the 2018 Care N Care Agent Certification module. My name is Tana Kersten, Senior Manager of Sales. This training module will help you learn about Care N Care and what sets us apart from other Medicare Advantage companies. With your help, we anticipate 2018 being a banner year and look forward to a mutually rewarding relationship. 3

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5 Care N Care is a local Medicare Advantage option for residents of the Dallas/Fort Worth area located in Fort Worth, Texas. The Mission of Care N Care is: To be the most loved healthplan in the communities we serve Care N Care is an affordable alternative to Medicare Supplement insurance that offers Medicare Advantage Plans starting at $0 monthly premium. Our goal is to assist our members in living healthier and happier lives. 5

6 Care N Care Service Area Care N Care HMO Collin County Denton County Tarrant County Care N Care PPO Collin County Dallas County Denton County Johnson County Parker County (76008, 76020, 76108, and only) Rockwall County Tarrant County HMO & PPO PPO 6

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8 PPO Care N Care is an affordable alternative to Medicare Supplement insurance and other types of Medicare health plans. To assist its members in living healthier and happier lives, the health plans provide the following benefits to eligible Medicare beneficiaries: Predictable copayments and low annual out-of-pocket maximums A $0 premium option is available Optional dental or combination rider that covers comprehensive vision, dental, and hearing benefits for additional monthly premium Health club membership through Silver&Fit Service area cover the following counties: Collin, Dallas, Denton, Johnson, Parker(76008, 76020, 76108, and only), Rockwall, Tarrant 8

9 HMO Predictable copayments and low annual out-of-pocket maximums $0 premium, $0 deductible, $0 PCP Copay, and $0 Tier 1 Prescription Copay Enrollees must select an In-Network Primary Care Physician, which will work closely with members to meet healthcare needs and coordinate plan benefits, such as referrals to specialists, medication refills and other needed services Optional dental or combination rider that covers comprehensive vision, dental, and hearing benefits for additional monthly premium Health club membership through Silver&Fit Service area cover the following counties: Available in Denton, Collin, and Tarrant only 9

10 Optional Riders for PPO & HMO Plans Dental Rider: (Dental Only) At Care N' Care, we believe our members dental health can have a direct impact on their overall health and well-being, and may have an influence on the development of certain conditions such as diabetes and heart disease. Care N' Care s Dental Rider covers services most often used, without the need for a referral or preauthorization. Members can choose from more than 1500 in-network dentists. Plan Highlights (Refer to benefits for complete details) 10

11 Dental Rider (cont.) Plan Highlights (Refer to benefits for complete details) 11

12 Combination Rider: (Dental, Hearing, and Vision) Sometimes, we need a little something extra to care for our eyes, ears, and teeth. Care N' Care offers a supplemental combination rider to fill the gap. Preventive and Comprehensive Dental Services Hearing Services (82 locations) Vision Services (302 providers) Plan Highlights (Refer to benefits for complete details) 12

13 Combination Rider (cont.) Plan Highlights (Refer to benefits for complete details) 13

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15 Choosing an In-Network Provider Choosing the right physician can greatly influence many factors in our lives. At Care N Care, quality of care is an important focus. Choosing in-network providers can help: Lower copayments and out of pocket costs for members Ensure that plan benefits are properly coordinated, to provide a seamless continuation of care Ensure that plan providers follow plan processes to minimize billing errors Members properly and effectively manage challenging and costly chronic health conditions Assist in working towards higher STARS Ratings 15

16 Finding Providers On Care N Care s Website Find a Provider at Click Find a Provider - Search Now on our homepage From the Find a Provider list, select Find a Provider 16

17 Care N Care s Website (cont.) 1. Select Plan 2. Search by: Name Address City County Phone Number Zip Code Facility Type Specialist Type The Care N Care Provider Search Tool is updated every 24 hours to reflect network changes. 17

18 Silver&Fit Silver&Fit Staying healthy and active is important to a member s overall health. When they join a Care N Care PPO or HMO plan, they will receive a membership to Silver&Fit Exercise and Healthy Aging program at no cost. This program is a unique opportunity to help them stay active whether they are at home or on the road. FITNESS AT A LOCATION The Silver&Fit Exercise and Healthy Aging program provides members access to a broad network of participating fitness facilities and instructor led classes. FITNESS AT HOME Prefer to exercise at home? No problem! Members can exercise in their own home using the Home Fitness program and can choose up to 2 Home Fitness Kits each year. These kits may include DVDs, guides, and other items to help them get fit on their own terms. 18

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20 Healthcare Concierge At Care N Care, we work hard to provide our members excellent customer service. Whenever a member has a question, we are always just a phone call or away. When a member enrolls in a Care N Care PPO or HMO plan, they will have a personal Healthcare Concierge (HCC) who will work closely with them each time they need assistance, as well as follow up with them when needed. At Care N Care, the HCC can help: Explain health plan benefits Coordinate healthcare services with an In-Network doctor Verify health plan coverage with a participating provider Find a healthcare facility nearest to the member. And much more! 20

21 Welcome Call As part of its quality assurance process, Care N Care completes a welcome call with each new enrollee. The purpose is to confirm the accuracy of the information on the enrollment form, ensure that the enrollee understands the plan and wants to enroll in the Care N Care Medicare Advantage Plan. The agent should cover the purpose of the welcome call during enrollment process. During the member s initial Welcome Call, the Healthcare Concierge will cover the following: Verification of plan selection as well as any riders if applicable. Verification of Primary Care Physician (PCP) selection and if they selected an Out-Of-Network provider, the HCC will cover the benefits of utilizing an IN- Network provider. *If the member enrolls in HMO, an In-Network PCP has to be selected. Reminder of the Welcome to Medicare Preventive Visit or Annual Wellness Visit. Payment method for enrollment in plans with premiums. Emergency contact information and who member would like as their HIPAA contact. 21

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23 Agent Concierge The Agent Concierge department is dedicated to assist contracted Care N Care agents throughout the sales and enrollment process and continues as long as that member is enrolled in CNC. The Agent Concierge team is available from 8 AM to 5 PM, Monday through Friday. For Assistance: Phone: (855) agentsupport@cnchealthplan.com or appstatus@cnchealthplan.com An Agent Concierge Can Help: Check Application Status Check Enrollment Status Check Eligibility Answer Benefit Questions (this does not guarantee coverage) Product Certification Answer Commission Questions Provide Enrollment Kits & Supplies Online Application Support 23

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25 Enrollment Process 1. Determine eligibility 2. Identify the election period. Make sure you submit the attestation form along with the application as proof of the eligibility 3. Select a plan 4. Explain the MA PD monthly premium amount and supplemental coverage 5. Select a payment option 6. Explain disenrollment procedures 7. Explain the Welcome Call 8. Submit the enrollment form along with Scope Of Sales, Attestation Form, and the Application Checklist (Preferred method is via one of our electronic enrollment options) 9. Member will have the option to select all future communications to be sent electronically to them. 25

26 Care N Care Application Page 1 Plan selection Beneficiary full name (including middle initial), birth date, sex and contact information such as home phone number, and/or cell phone number Permanent residence street address (PO Box can only be used for mailing address) and need to include mailing address if different than permanent address Include an emergency contact with contact phone number In addition to contact information enter E- mail address if provided, indicate if none Enter Medicare Claim number and Part A and B effective dates Double check spelling and other pertinent information as noted on the beneficiary s Medicare card Write legibly with a black ball point pen 26

27 Payment Options Page 2 Monthly Invoice Electronic funds transfer (EFT) from bank account each month Automatic deduction from monthly Social Security/Railroad Retirement Board (RRB) benefit check If you select this option: The Social Security/Railroad Retirement Board deduction may take two or more months to begin after Social Security/RRB approves the deduction. In most cases, if Social Security or RRB accepts the request for automatic deduction, the first deduction from the Social Security or RRB benefit check will include all premiums due from the enrollment effective date up to the point withholding begins. If Social Security or RRB does not approve the request for automatic deduction, we will send a paper bill for the monthly premiums. Note: if member does not wish to select a payment option for any reason Care N Care will automatically send a monthly invoice. To change this payment option, beneficiary can call the Health Care Concierge. 27

28 PCP Selection - Page 3 Make sure to answer questions 1-5 Enter the beneficiary s chosen PCP * All HMO require an In-Network Provider Select the option for other than English language format Read the important information 28

29 Broker Information - Page 4 Signatures and dates from either the beneficiary or an authorized representative To ensure proper commission credit, the Agent/Broker assisting must provide their name, plan selected, effective date of coverage, election period, and the NPN number. 29

30 Application Checklist To ensure timely enrollment processing, agents must complete and submit an Application Checklist with all enrollment applications. *All items need initialed by beneficiary as well as document signed and date. *All applicable items need to be filled out in its entirety 30

31 Application Attestation To ensure timely enrollment processing, agents must complete and submit an Attestation Form with all enrollment applications. 31

32 Electronic Communications We offer both new and existing members the opportunity to receive future correspondence from Care N Care electronically. We feel that many members are as conscientious of wasting unnecessary paper as we are. We continue to see more and more seniors involved in technology, so we are excited to offer this as an option for them. Members have the ability to opt-in for certain correspondence or to receive ALL correspondence electronically. 32

33 Scope of Appointment (SOA) A beneficiary or existing Member must agree on the SOA prior to the agent scheduling inperson presentation, other than a community sales meeting. Agents must have a signed CMS-approved SOA form prior to any in-person meeting. SOA is required for all such meetings with current or new clients to discuss Medicare Advantage or PDP products. Agent must disclose all product types to be discussed (i.e. MA, MAPD, PDP) during the appointment by securing a SOA prior to the meeting. 33

34 Scope of Appointment (SOA) (cont.) Exception Policy: if it is not feasible to obtain the SOA Form prior to the appointment, the agent may have the beneficiary sign the form at the beginning of the appointment. Agent must record in writing and maintain documentation on why it was not feasible to obtain the SOA prior to the appointment. CMS expects Care N Care to record and maintain this documentation, and upon request, must be able to produce it. A new SOA form is required if the beneficiary has requested to discuss another MA or PDP product type during an appointment. However, a new appointment is not required. The additional product can be discussed as soon as the beneficiary request is documented. NOTE: CMS requires SOA to be retained for 10 years. 34

35 Submitting Applications Online Applications (Preferred Method) Applications can be submitted online using either the standard Web App or the Step App. Web App Step App Paper Applications Paper applications may be dropped off at the Care N Care office or faxed. Applications may be faxed to any of the following fax numbers. Fax Numbers: For Assistance: Phone: (855) agentsupport@cnchealthplan.com or appstatus@cnchealthplan.com 35

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37 Oversight of Agent/Broker Sales & Marketing To maintain Compliance oversight and monitoring of agent/broker sales activities: Care N Care will monitor and track all agent/broker sales and marketing activities and respond to all issues or complaints related to member dissatisfaction or misrepresentation, including those requested by the Texas Department of Insurance (TDI) and CMS. Activities that are monitored may include, but are not limited to: Enrollments, cancellations, and disenrollments, including rapid disenrollment Sales and surveillance activities, including presentations and SOA s Complaints against an agent and/or inappropriate identified behaviors (e.g., suspicious application signatures, etc.) Training and testing Data submission/reporting of agent complaints to CMS annually State licensing and appointment requirements, including reporting terminations Compensation structures 37

38 Agent/Broker Complaints Tracking The Senior Manager Of Sales will track complaints from beneficiaries or their representatives regarding the agent/broker on an ongoing basis. Complaints may come in from, but are not limited to, the following sources: The CMS Complaints Tracking Module (CTM) in HPMS The CMS Regional Office The Member Service call center When a complaint is received by Care N Care involving an agent/broker, The Compliance Department will contact the Senior Manager Of Sales who will then contact the agent/broker and request statements of account for the complaint. Agent compliance will be tracked using a scoring system that assigns points to complaints based on the severity of the complaint. Agents crossing the threshold will be referred to the Agent Oversight Committee. 38

39 Agent/Broker Complaints Tracking (cont.) The agent/broker s cooperation with Care N Care is required by Care N Care during the investigation of the complaint, as well as during the implementation of any Corrective Action Plan (CAP) developed in response to such complaint Corrective Action(s) may include the following: Focus training; monitoring sessions Full re-training and re-testing Termination and prohibition from selling Care N Care plans Failure to respond within the required timeframe to any of Care N Care s requests during the investigation or corrective action phase will result in suspension or termination of the agent/broker s ability to market, sell and receive commissions. 39

40 Agent Termination Care N care is required by CMS to report the termination of any agent, and the reasons for the termination, to the state where the agent is appointed and to CMS, where required. The same applies for all contracted distribution partners. When a Care N Care agent is terminated, the agent cannot market our products. **Code of Ethics for Professionalism: Brokers are required to maintain highest levels of professionalism at all times when interacting with potential beneficiaries, other brokers, FMO (if applicable), and all plan employees. Agent of Record During an enrollment period (OEP/SEP), if we get multiple applications for a beneficiary, we recognize the AOR as the agent associated with the most recent application on file. If a member does a plan to plan change, the existing AOR on the policy will remain. 40

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42 Agent/Broker Compensation Compensation Rate Adjustment for CY 2017 As provided in 42 C.F.R (b)(1) and (b), the compensation amount paid to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cut-off amounts published yearly by CMS. The chart below summarizes the CY 2018 FMV cut-off amounts for all organizations. NOTE: The FMV amounts for CY 2018 are rounded to the nearest dollar. The Initial Year amount is the maximum allowable to be paid for enrollments during compensation cycle-year 1. The 2 renewal amount is the maximum allowable to be paid for enrollments during compensation cycle-years 2 and beyond. January February March April May June Cycle Year 1 $455 $455 $455 $455 $455 $455 All Others $228 $209 $190 $171 $152 $133 July August September October November December Cycle Year 1 $455 $455 $455 $455 $455 $455 All Others $114 $95 $76 $57 $38 $19 42

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44 Setting Expectations Early On It is important as an agent with both your reputation and the company s reputation on the line to communicate accurate information beginning with your first interaction/visit with the beneficiary. This will help eliminate any future complaints/grievances against both you and the plan in the future. The following are some helpful items that may help with some of the questions that you will be faced with during an appointment. There is also additional information on what you can do as an agent to communicate with the member on what to expect and some options available to them. The discussions around some of these items can help with our overall STARS rating which in the end effects both you and the member s experience since the STARS rating can effect the benefits from year to year. 44

45 Medication Therapy Management (MTM) Members may be automatically enrolled in CNC s MTM program if they meet 3 criteria (have the ability to opt-out) Members must meet three criteria in order to be selected for the program Fill at least eight Part D medications per month Accumulate at least $ in medication costs in the previous quarter Have at least three of the following conditions: Diabetes High Cholesterol Osteoporosis High Blood Pressure COPD The plan, in conjunction with our PBM (Pharmacy Benefit Management), Envision, determines who is eligible for the program based on Part D claims If determined to be eligible, Envision will notify the member of enrollment in the MTM program The program consists of two elements; 1) a detailed comprehensive medication review by either a pharmacist or nurse (can opt-out) or 2) a targeted medication review which identifies medications the member should be on, based on medical guidelines and member s medical conditions (can t opt-out) Please encourage members to complete the medication review when Envision notifies them MTM is a STAR measure and is used to calculate the overall STAR rating for CNC 45

46 Surveys CMS requires health plans to administer two surveys each year: CNC uses a third party vendor to administer the surveys (SPH Analytics) If selected, the member will receive a survey from SPH Though long, the survey results are very important to the overall STAR rating for CNC Please encourage members to complete the surveys and return them by the deadline CAHPS survey (Consumer Assessment of Health Plan Satisfaction): Will ask members about their satisfaction with the health plan and their physician STAR related measures are: Getting needed care Getting appointments and care quickly Customer service Overall rating of health care quality Overall rating of plan Care coordination Rating of drug plan Getting needed prescription drugs Getting information from the plan about prescription drug coverage and cost Annual flu vaccine 46

47 Surveys (cont.) HOS survey (Health Outcomes): Will ask members about their health status STAR related measures are: Improving or maintaining physical health Improving or maintaining mental health Monitoring physical activity Improving bladder control Reducing the risk of falling Preventative Screenings, Management of Conditions and Medication Utilization: CMS grades CNC on how many of our members get screenings, how well they manage their conditions and how well they fill their medications CNC will routinely reach out to members to encourage them to get screenings, manage conditions, take medications Encourage members to cooperate with requests for screenings Screenings include: Breast Cancer Screening Colorectal Cancer Screening Adult BMI (Ht and Wt) Bone Density Screening (It is vital that after a woman has a fracture she gets a bone density screening (has to be done within 6 months of fracture) 47

48 Surveys (cont.) Managing Conditions: Diabetes: Diabetics need to get a retinal eye exam Diabetics need to make sure that their hba1c is in control Diabetics need to get a Nephropathy screening High Blood Pressure: Members need to make sure that their BP stays in control Rheumatoid Arthritis: If a member has Rheumatoid Arthritis they need to take an Anti-Rheumatic drug Medications: Members prescribed high blood pressure medication need to fill all scripts written by doctor Members prescribes cholesterol medication need to fill all scripts written by doctor Members prescribed diabetes medication need to fill all scripts written by doctor 48

49 New Member ID Cards: New Care N Care members are expected to have their ID cards within two to three weeks of enrollment in plan. Handling of Out-Of-Network Medical Claims: Every doctor is different on how they may choose to handle Care N Care patients as Out-Of-Network. It is important that your beneficiary understand that even though we are a PPO, there may be some Primary Care Physicians, Specialists, or Facilities who will not accept Care N Care patients. We are willing to work with any Out-Of-Network doctors/facilities to help facilitate that claims process. In many instances, your beneficiary may be expected to pay the entire bill up front and would then submit that receipt with all the billable codes listed to their HCC for the reimbursable amount. That amount is based on the Medicare Allowable MINUS any applicable Out-Of-Network copay. It is best to have your beneficiary check with the doctor s office in advance of appointment to understand what they will be responsible for paying at the time of visit to avoid any confusion. Handling of Out-Of-Network Dental / Combo Rider Claims: Our riders are currently being handled through Avesis. Currently, if a member decides to go Out-Of- Network for a procedure, they are expected to pay the entire amount of the bill up front and then will be reimbursed by Avesis at the In-Network fee rate for covered service after applicable copay. 49

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51 Wrapping Up Hi again! Now you know about Care N Care Medicare Advantage Plans. Now that you ve viewed each slide of the presentation, you may proceed to the 2018 Care N Care Medicare Advantage Certification Exam. You will have three attempts to successfully pass the exam with a minimum score of 85%. Good luck! 51