WellCare Health Plans, Inc.

Transcription

1 WellCare Health Plans, Inc. AEP Houston, TX

2 Welcome! Company Overview Contracting Annual Certification Process The WellCare Advantage WellCare Physician Partners Sales Process Online Member Enrollment 2018 Sales Process: Plan Provider Lookup 2018 Sales Process: Formulary Lookup Producer Personalized URL Producer Portal 2018 PDP Product Design Contact Information

3 WellCare Health Plans, Inc. Company Snapshot OUR PRESENCE All numbers are approximations and are as of March 31,

4 Contracting All Producer Level contracts are submitted online for 2017 to Producers already certified with WellCare do not need to submit a new contract each year Producers new to WellCare can access the link to contracting at for instructions on how to receive a contract Once the contract is completed, producers will receive a link to access the training site within 72 hours. Page 4

5 Annual Training Requirements All training is offered online Training requirements include: America s Health Insurance Plans (AHIP) Annual Certification Training (ACT) WellCare offers a $50 discount for AHIP training by using the Co-Branded Link Producers have 3 attempts to pass the ACT Mastery Exam with a score of 85% or higher

6 Transmitting AHIP 1. Login to AHIP using the WellCare/AHIP co-branded link. 2. Access your profile. 3. Add either your National Producer Number (NPN) or WellCare University (LMS) ID to provide recognition for a successful transfer to WellCare. Your LMS ID your WellCare University username, and is the first initial of your first name, your last name and the last four digits of your Social Security Number (SSN). Example: JDoe0000 for John Doe ***-**-0000.

7 The WellCare Advantage

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9 WellCare of Texas Houston: Harris, Montgomery, Ft. Bend, Galveston, Jefferson Dallas: Tarrant, Dallas, Denton, Johnson San Antonio: Bexar El Paso: El Paso Houston Market Provider Partnerships 1. Memorial Hermann Health System 2. Village Family Practice 3. Harris County Hospital District (Clinics & Hospitals) 4. Legacy Clinics 5. UT Physicians 6. Texas Coastal Care 7. Texas Independent Providers 8. St. Joseph Health System 9. Integranet Gulf Coast 10. Tenet Health System 11. Tomball Regional 12. HCA Gulf Coast 70 Hospitals, 1,100 Primary Care Physicians, 3,121 Specialists

10 Texas 2018 Plan Consolidations State PBP Plan Name Counties Impacted Status TX H WellCare Access (HMO SNP) Bexar, El Paso, Harris, Jefferson, Tarrant Consolidating with Access H TX H WellCare Essential (HMO-POS) Bexar, Harris Consolidating with Value H

11 Plan Benefits WellCare Value (HMO-POS) H WellCare Dividend Prime (HMO) H Counties Bexar, Dallas, Denton, El Paso, Harris, Jefferson Bexar, Dallas, Denton, El Paso, Fort Bend, Harris Premium Part B Giveback $0 $80 Total Premium (Part C part D) $0 $0 In-Network Plan Deductible N/A N/A Maximum Out of Pocket (MOOP) $6,700 $6,700 Inpatient Hospital - Acute $295 co-pay per day for Days 1-6 $350 co-pay per day for Days 1-5 PCP Office Visits $0 $5 Specialist Office Visits $35 $50 Over-the-Counter Items $13 / Every Month $5 / Every Month Medically Necessary Transportation N/A N/A Fitness Membership $0 $0 Dental Benefits Dental 500 Dental 500 Vision Benefits Vision 100 Vision 100 Hearing Benefits Hearing 750 Hearing 750 Rx Deductible $0 $200 Deductible Tiers N/A Tiers 2-5 Tier 1: Preferred Generic $0 $0 Tier 2: Generic $7 $20 Tier 3: Preferred Brand $30 $47 Tier 4: Non-Preferred Drug 48% 48% Tier 5: Specialty Tier 33% 25%

12 Plan Benefits WellCare Access (HMO SNP) H WellCare Liberty (HMO SNP) H Counties Bexar, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Jefferson, Johnson, Montgomery, Tarrant Bexar, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Jefferson, Johnson, Montgomery Premium Part B Giveback $0 $0 Total Premium (Part C part D) $0 $0 In-Network Plan Deductible N/A N/A Maximum Out of Pocket (MOOP) $6,700 $6,700 Inpatient Hospital - Acute $0 co-pay up to 90 days per admission $0 co-pay up to 90 days per admission PCP Office Visits $0 $0 Specialist Office Visits $0 $0 Over-the-Counter Items $40 / Every Month Every Month$60 / Medically Necessary Transportation 48 One-way trips every year 48 One-way trips every year Fitness Membership $0 $0 Dental Benefits Dental 1500 Dental 2000 Vision Benefits Vision 100 Vision 300 Hearing Benefits Hearing 1000 Hearing 1000 Rx Deductible $0 $0 Deductible Tiers Tiers 2-5 Tiers 2-5 Tier 1: Preferred Generic Tier 2: Generic Tier 3: Preferred Brand Tier 4: Non-Preferred Drug Tier 5: Specialty Tier Tier 1 - $0 Preferred Generics Generics: $0 / $1.25 / $3.35 / 15% Brands: $0 / $3.70 / $8.35 / 15% Tier 1 - $0 Preferred Generics Generics: $0 / $1.25 / $3.35 / 15% Brands: $0 / $3.70 / $8.35 / 15%

13 Texas 2018 D-SNPs by MSP Level and Contract Type State Contract_PBP Plan Name Contract Type MEDICARE SAVINGS PROGRAMS (AS DEFINED BY CMS) FBDE QMB+ SLMB+ QMB SLMB QI QDWI TX H WellCare Access (HMO SNP) Integrated X X X TX H WellCare Access (HMO SNP) Integrated X X X TX H WellCare Liberty (HMO SNP) Integrated X X TX H WellCare Liberty (HMO SNP) Integrated X X ADDITIONAL COVERAGE INCLUDED IN DSNP CONTRACT State Contract_PBP Plan Name A/B Cost Shares & Deductibles LTC Medicaid Benefits Other Medicaid Benefits LIS Copay Buydown TX H WellCare Access (HMO SNP) Yes No No No TX H WellCare Access (HMO SNP) Yes No No No TX H WellCare Liberty (HMO SNP) Yes No No No TX H WellCare Liberty (HMO SNP) Yes No No No WellCare Health Plans, Inc All rights reserved. 13

14 WellCare Unique Value Proposition Advocacy Programs HealthConnections Model Removes social barriers to accessing health care by connecting members to local, community-based public assistance services CommUnity Assistance Line (CAL): In all states, call (866) Helps connect people to social services including financial, food, education and utility assistance, transportation, disability and homeless services, support groups and child care Open to the public and is a referral service that matches needs with more than 1.2 million programs and services Staffed by 32 WellCare community liaisons who act as peer support specialists Two members of the team are deaf or hearing impaired and use video relay and video chat to assist callers who are deaf or hearing impaired. If the CAL database does not contain the programs and services needed, the community liaison will conduct research and/or work with local, community-based WellCare staff to try and fill the gap. 14 WellCare Health Plans, Inc All rights reserved.

15 2018 Diabetic Supplies There are no changes to diabetic supplies for 2018 Johnson & Johnson will continue to be WellCare s preferred vendor.

16 Overview of the Sales Process AVL

17 Online Member Enrollment Assistance by the producer is permitted By utilizing REQUIRED fields, producers can ensure a complete, accurate application Applications begin processing immediately after submission

18 Provider/Pharmacy Search Tool Tips Complete all fields Entering PCP in the How do you want to search? field will ensure more specific results Entering provider in the How do you want to search? field will populate provider-specific filters on search results pages

19 Formulary Search Tips The formularies can be found on the Formularies tab of the Producer Resources page Formulary offers alternative drugs

20 Producer Personalized URL (PURL) Members can self enroll! What is PURL? A Personalized URL (PURL) is a nonproducer assisted online enrollment tool used for beneficiaries to enroll into a WellCare plan, and ensure the writing producer is assigned as the Agent of Record (AOR). Available for access 24/7 CMS compliant enrollment How do Producers get a PURL? Within 7 days of certification, the PURL will be activated WellCare PURL: erid Ohana PURL: ID Easy Choice PURL coming soon!

21 Secured Producer Portal Marketing/sales materials available at your fingertips Access to applications submitted and active enrollments

22 2018 PDP Product Design Overview and what has changed: All Classic Plans have fewer drugs on Tier 1 when compared to the Essentials formulary. Note: Last year we moved a large number of plans to the Select formulary, and member complaints/disenrollment were minimal All PDPs will feature a preferred pharmacy network design Preferred-Member will pay lower cost sharing at CVS (most independents and regional chains). Note: Higher cost sharing at all other in-network pharmacies MAPD plans will continue to utilize the performance network and will continue to have access to all 64,000 in-network pharmacies for the same cost sharing New! Value Script piloting in 4 regions (LA, WI, AZ, OR, WA) Extra members in regions LA, WI, AZ, OR, WA will be consolidated into the Classic plan. This material is for internal use ONLY. Proprietary and confidential. Not to be distributed or shared with Medicare beneficiaries.

23 Contact Information Johanna Gutierrez (Linares), Sr. District Sales Manager (DSM) Phone: Producer Services Online Contact: Phone: Linda Capps, Retention Specialist Betty Jones, Sales Assistant Phone: