2017 Humana MAPD and PDP. Plan Summary. Individual Medicare Mid-Atlantic & Mid-South Regions VA MD DE DC

Transcription

1 2017 Humana MAPD and PDP Individual Medicare Mid-Atlantic & Mid-South Regions Plan Summary VA MD DE DC Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage

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3 August 2016 Dear Valued Humana Agent, Welcome to the VA, MD, DE, Washington DC Market resource book for 2017! Thank you for your commitment to providing Medicare beneficiaries with an opportunity to join the Humana family. We value your contributions and hope that you find this new resource useful as you bring a personal touch to our members during the 2017 selling season and plan year. We ve built this book on Humana s Values: Pioneer Simplicity: We wanted to make it easier for you as an agent to have the resources you need to sell Humana plans in this market by bringing you a tool to have at your disposal in the field with easier access to a Customer Service process, Agent Support information, and plan information throughout the market Inspire Health: We encourage you to share our resources such as Silver Sneakers and our Nurse Hotline while enabling members to use their plans to their fullest and to partner with us and their Primary Physicians in working to achieve their best health Cultivate Uniqueness: We strive to offer a best in class experience in the healthcare delivery industry by being proactive and helping members become healthier instead of just helping pay their claims when they re sick Thrive Together: Here s where we need your help. This book is a first attempt by the management team in providing you a more comprehensive market-level sales aide. It may not be perfect, so please make sure you send corrections, suggestions or comments to Richie Gallimore at jgallimore@humana.com or Heather Allen at hallen2@humana.com. We can provide you with a link to our ever-evolving on-line version and will attempt to notify you when updated versions of this booklet are available online. Rethink Routine: We wanted to consolidate in this one document a lot of the information that has been put out there by Humana to help you build your business by making our members happy and growing Humana s brand. Thank you again from the VA, MD, DE, and Washington, DC MarketPOINT leadership team for all you do in helping Humana become the best in class brand that Medicare beneficiaries have come to trust. Happy Selling in 2017 and BEYOND! Mnason Plumb Mnason Plumb Market Director, VA MD DE DC 3

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5 Table of Contents Important Contact Information Plan Information 19 Richmond Territory 27 Roanoke Territory 33 Tidewater Territory 37 Northern Virginia Territory 43 Southwest Virginia Territory 47 Delaware 51 Maryland 55 PFFS Plans 57 RPPO Plans 65 PDP Plans 71 SNP Plans 79 Appendix - Regional Maps (Landscape) - How to Use Humana s IVR for Scope of Appointment Line - How to Order Medicare Materials - Election Periods and SEP Job Aid

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7 For Agent Training Use Only 2017 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits*** Humana MarketPoint Offices Glen Allen Office 4191 Innslake Drive Suite 100 Glen Allen, VA Toll-free Fax Roanoke Office 3800 Electric Road Suite 406 Roanoke, VA Toll-free Fax Tidewater Office 780 Lynnhaven Parkway Suite 400 Virginia Beach, VA Toll-free

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9 For Agent Training Use Only 2017 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits*** Manager Territory & Contact Information Territory Field Sales Manager Contact Number Address Southwest VA Richie Gallimore Northern VA Jose Cabrera Richmond North Doug Bradt Richmond South Errick Jones Roanoke Dale Ellis Tidewater Christian Carpenter

10 Agent Support Guide (For Agent (non-member) Issues related to writing business, Humana Technology, etc.) Phone: /web support: Agent Support Issues CART, CORE, MAPA, iphone Option 5 AgentSupport@humana.com Technology Issues IT Issues CSS CSS online support: -Password Issues and Resets -Option 3 Go.Humana.com/css -Outlook/ issues -Option 4, then 2 Go.Humana.com/css -Microsoft Office support (Word, -Option 4, then 2 Go.Humana.com/css Excel, etc.) -Connection/Array issues -Option 4, then 1 Go.Humana.com/css -Other (not related to CART, CORE, MAPA or IPhone) -Option 2, then 3 Go.Humana.com/css Selling MA/MAPD/PDP and Medicare Supplement Menu Option quick guide (subject to change) Agent Support Issues: (for other options listen to prompts) Career Independent & MECA Licensing/Appointment/SAN Number/ Option 1, then option 1 Agent Portal -Product Questions Option 1, then option 2 -Enrollment Eligibility (including SNP) Option 1, then option 3 -Customer Service for Existing Member Option 1, then option 4 (preferably use customer service guide that follows) -Marketing Materials Option 1, then option 5 -Commissions Questions Option 1, then option 6 -Medicare Supplement Option 2 -Referral to Maximus for CCC (QMB+) Duals Other agency toll free support numbers Follow prompts for correct department/topic Bankers Life Thrivent USAA General Strategic Partner State Farm Please contact your Local Market Manager (See Market office contacts page) if issue(s) aren t resolved through phone calls to resources listed in both the Customer Service and Agent Guide pages. 10

11 Agent Support Guide (For Agent (non-member) Issues related to writing business, Humana Technology, etc.) Medicare Application Submission Guidelines MUST SUBMIT WITHIN 24 Hours of application signing INCLUDING weekends U.F.O. (Upload, Fax, Overnight) Upload: From MAPA same day of application Fax: (Preferred method for Paper Applications) Overnight: UPS Overnight (not preferred) to: Humana Medicare Enrollment P.O. Box Lexington, KY Scope of Appointment (SOA) Guidelines (SOA is REQUIRED before conducting an MAPD or PDP appointment) Telephonic IVR: Establish 3-way call with a prospect and call IVR line: (write down confirmation # and include on application) *Paper: Submit completed form to Humana. Humana handles 10 year retention requirement Fax: Mail: Humana MarketPoint PO Box Lexington, KY DO NOT PHOTOCOPY BLANK PAPER SOA FORMS! Each form has a unique barcode number that must be copied onto the paper application so they can be linked. Order paper forms from Humana. Also include the barcode from the enrollment application on the paper SOA if possible. SOA Type to be used on Enrollment Application INH = In home OTH = Other Company s Form F2F = Face to Face SEM = Seminar WAL = Wal-Mart RET = Non Wal-Mart Retail location 11

12 Agent Support Numbers Noncompliance, fraud, waste, abuse suspicions, report to: - ETHICS Helpline ethics@humana.com siureferrals@humana.com - Website Key Numbers for Members Customer Service MAPD/PDP Rx Pharmacist/Physician inquiries (for members by Pharmacy/Physician staff) Humana Pharmacy Nurse Advice Line Silver Sneakers

13 Humana Pharmacy Member Contact Numbers 13

14 Customer Service Agent Guide Agent Retail Sales Operations Support (ARSOS) partners with agents and internal teams within Humana to coordinate customer service (CS) needs for members. ARSOS can be accessed in three ways (presented here in preferred order). Preferred Method - Mobile CORE Customer Service Call MobileCORE allows ARSOS to directly contact the member. The CS Call will only work in MobileCORE for active MA/MAPD member with the following information in CORE: In the Contact record in CORE the Medicare ID must be entered twice (to verify) In the Policy record for the contact in CORE they must have a Medicare MA or MAPD Policy The member must be active; in other words, past the proposed Effective Date but without an End Date This information should be updated automatically if the member was enrolled using MAPA. If a paper application was used, add the data to CORE manually. 2nd Method - Customer Service Request Agents can ARSOS for support for all member issues regardless of policy type (including H1). The agent NEVER gives the ARSOS address to the member; instead, the agent relays information between ARSOS and the member. AgentRSOS@humana.com in the following format: Subject: Member Last Name, Member First Name (Medicare OR HumanaONE) Body of should include: Agent Name: Required Agent SAN: Required Member ID#: Required Member Name: (Required) Reference No.: If available Summary of Issue: (e.g. Claims: with claim #s and Date of Service, Provider issue: include PCP name and Number if available) 3rd Method - Escalated Customer Service phone line This line allows any agent (career and external) to by-pass IVR and triage frustrated members with ESCALATED issues directly to the MA customer service area for assistance. Calls using this line go to the front of the call queue and will be answered by the first available Customer Care Specialist. This line is ONLY to be used when the member has called customer service several times and is frustrated because issues have not been resolved. The AGENT makes the call and is on the line with the member. Use this number from your phone only with the member on a 3-way call or in the room with you. Please note that this line is to Customer Service only. ARSOS is not involved when this option is used. The usage of this number is tracked. This phone number should NEVER be given to members or to any external entity. Phone

15 Market Specific Contacts Key Contacts Humana Corporate Customer Service: MAPD PDP Med. Sup Humana Pharmacy: Escalations Concierge Team Inpatient/SNF/Referrals/Auths. (Mid-Atlantic, VA, MD, DE): Phone: x (VA/MD/DE except SW VA) in this format: Subject Line options: -Inpatient Issue Referral -DME Issue Referral -SNF/IRF/LTACH Issue Referral -Case Management Issue Referral -Cross Regional Referral SW VA: Inpatient/SNF/Referrals/Auths.: above is 1 st option, 2 nd option are contacts below with manager approval x (SW VA Wythe/Grayson/Tazewell westward) UM Manager Jeanie Coulter: jcoulter@humana.com CM Manager Ruth Vaught; rvaught@humana.com 15

16 Provider Concierge Process PROVIDERS Authorization Line for Provider Use: (advise Providers to have TIN ready) For claim issues and claim payment discrepancies, Humana is asking providers follow an issue resolution process that relies on Humana Customer Service as the initial point of contact. If Customer Service is unable to provide satisfactory resolution to the issue, providers should submit the issue to Humana s Provider Concierge Unit (PCU) for review. The PCU will perform root cause investigation of the issue, define appropriate corrective actions and oversee the adjustments and corrections of impacted claims. 16

17 Provider Concierge Process (cont.) Claim Issue Resolution Process Guide to share with/ assist a Provider Here is the process to follow to achieve best results when disputing claim payment/determination: 1.) Initial inquiry: a.) Call Humana Customer Service b.) A Reference # will be issued to you by the CS Representative c.) write down the reference# in order to source it in the future, if necessary/applicable d.) If you feel CS was unable to satisfactorily respond to the inquiry, you may escalate the disputed claim(s) for additional research, and/or performance of root cause analysis 2.) Please enter the claim information using the attached Claim Submission Form. Make sure the reference number is included on the submission form in the appropriate column. 3.) Once completed, attach to an and send to: Humanaproviderservices@humana.com 4.) You will receive an Acknowledgement of Submission with a tracking # within 5-7 business days of your submission. 5.) Please allow the Provider Concierge Unit (PCU) Specialist a 30 day period from the date of the Acknowledgement notice to perform research and response to the inquiry. 6.) If you do not receive communication about the issue within 30 days, you can obtain status by calling Customer Service and providing them with the tracking number listed on the Acknowledgement . 17

18 Provider Claim Resolution Form 18

19 For Agent Training Use Only 2017 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits*** 2017 Value Proposition Footprint Counties VA: Albemarle ; Arlington City; Botetourt; Bristol City; Buchanan; Charlottesville City; Chesapeake; Chesterfield; Craig; Dickenson; Dinwiddie; Fauquier; Floyd; Franklin; Goochland; Grayson; Hampton; Hanover; Henrico; Hopewell City; Isle of Wight; James City; Lee; Loudoun; Louisa; Montgomery; Newport News; Norfolk; Norton City; Petersburg City; Portsmouth; Powhatan; Prince William; Pulaski; Radford City; Richmond City; Roanoke; Roanoke City; Russell; Salem City; Scott; Smith; Suffolk; Tazewell; Virginia Beach; Washington; Wise; Wythe; York DE: Kent, New Castle VA: Accomack; Alexandria City; Amelia; Caroline; Culpepper; Cumberland; Essex; Falls Church City; Fredericksburg City; Gloucester; King & Queen; King George; Manassas Park City; Manassas City; New Kent; Northampton; Northumberland; Page; Prince George; Rappahannock; Richmond; Southampton; Spotsylvania; Strafford; Surry; Sussex; Westmoreland Highest Value Proposition HMO LPPO MD: Garrett, Washington Alleghany; Augusta; Buckingham; Buena Vista City; Campbell; Charles City; Charlotte; Clarke; Covington City; Danville City; Fairfax City; Fairfax; Fluvanna; Frederick; Greene; Henry; King William; Lexington City Lunenburg; Lynchburg City; Madison; Martinsville City; Mathews; Nelson; Orange; Patrick; Pittsylvania; Rockbridge; Staunton City; Warren; Waynesboro City; Winchester; Amherst; Appomattox; Bath; Bedford; Bland; Brunswick; Carroll; Emporia City; Galax City; Giles; Greensville; Halifax; Harrisonburg; Highland; Lancaster; Mecklenburg; Middlesex; Nottoway; Prince Edward; Rockingham; Shenandoah PFFS RPPO 19

20 2017 Mid-Atlantic & Mid-South Service Area Contract PBP Prem. Prod. Reg. Mkt. St. Service Area Counties HMO H HMO Mid-Atlantic Rich VA Chesterfield, Colonial Heights City, Dinwiddie, Goochland, Hanover, Henrico, Hopewell City, Louisa, Petersburg City, Powhatan, Richmond City H HMO Mid-Atlantic Rich VA Chesterfield, Colonial Heights City, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City H HMO Mid-Atlantic Tide VA Chesapeake City, Hampton City, Isle of Wight, James City, Newport News City, Norfolk City, Poquoson City, Portsmouth City, Suffolk City, Virginia Beach City, Williamsburg City, York H HMO Mid-Atlantic Tide VA Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Virginia Beach City H HMO Mid-Atlantic Roan VA Franklin, Roanoke, Roanoke City, Salem City H HMO Mid-Atlantic Roan VA Botetourt, Craig, Floyd, Montgomery, Pulaski, Radford City H HMO Mid-South SWVA VA Bristol City, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe H HMO Mid-South SWVA VA Bristol City, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe H HMO Mid-Atlantic C'ville VA Albemarle, Charlottesville City H HMO Mid-Atlantic NOVA VA Alexandria City, Arlington, Falls Church City, Fauquier, Loudoun, Manassas City, Manassas Park City, Prince William H HMO Mid-Atlantic Dela DE Kent, New Castle H HMO SNP CC H HMO SNP DE HMO SNP Mid-Atlantic Rich-Tide VA Chesapeake; Chesterfield; Colonial Heights City; Hampton; Hanover; Henrico; Hopewell City; Newport News; Norfolk; Petersburg City; Portsmouth; Richmond City; Virginia Beach Mid-South SWVA VA Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Tazewell, Washington, Wise, Wythe H HMO SNP DE H HMO SNP DE Mid-Atlantic Rich-Tide VA Chesapeake; Chesterfield; Colonial Heights City; Dinwiddie; Hampton; Hanover; Henrico; Hopewell City; Newport News; Norfolk; Petersburg City; Poquoson City; Portsmouth; Richmond City; Suffolk City; Virginia Beach Mid-Atlantic VA VA Alexandria City; Arlington; Falls Church City; Fauquier; Goochland; Loudoun; Louisa; Manassas City; Manassas Park City; Powhatan; Prince William 20

21 2017 Mid-Atlantic & Mid-South Service Area Contract PBP Prem. Prod. Reg. Mkt. St. Service Area Counties LPPO H LPPO Mid-Atlantic Rich VA Chesterfield, Colonial Heights City, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City H LPPO Mid-Atlantic Rich VA Amelia, Caroline, Cumberland, Dinwiddie, Goochland, King and Queen, Louisa, New Kent, Powhatan, Prince George, Sussex H LPPO Mid-Atlantic Tide VA Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Virginia Beach City H LPPO Mid-Atlantic Tide VA Franklin City, Gloucester, Isle of Wight, James City, Poquoson City, Southampton, Suffolk City, Surry, Williamsburg City, York H LPPO Mid-Atlantic Roan VA Bedford, Bedford City, Bland, Botetourt, Craig, Floyd, Franklin, Montgomery, Pulaski, Radford City, Roanoke, Roanoke City, Salem City H LPPO Mid-Atlantic NOVA VA Accomack, Culpeper, Essex, Fauquier, Fredericksburg City, King George, Northampton, Northumberland, Page, Rappahannock, Richmond, Spotsylvania, Stafford, Warren, Westmoreland H LPPO Mid-Atlantic NOVA VA Alexandria City, Arlington, Clarke, Falls Church City, Loudoun, Manassas City, Manassas Park City, Prince William H LPPO Mid-South SWVA VA Bristol City, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe H LPPO Mid-Atlantic Dela DE Kent, New Castle H LPPO Mid-Atlantic MD MD Garret, Washington RPPO R RPPO MA Southeast Region 7 NC, VA NC-Statewide, VA-Statewide Only R RPPO Southeast Region 7 NC, VA NC-Statewide, VA-Statewide 21

22 2017 Mid-Atlantic & Mid-South Service Area Contract PBP Prem. Prod. Reg. Mkt. St. Service Area Counties PFFS H PFFS Mid-Atlantic Virginia VA Amherst, Appomattox, Bedford, Bedford City, Bland, Botetourt, Chesapeake City, Chesterfield, Craig, Essex, Floyd, Gloucester, Goochland, Halifax, Hampton City, Hanover, Henrico, Isle of Wight, Lancaster, Middlesex, Newport News City, Norfolk City, Northumberland, Nottoway, Petersburg City, Portsmouth City, Powhatan, Prince Edward; Pulaski, Radford City, Richmond, Richmond City, Roanoke, Roanoke City, Salem City, Southampton, Suffolk City, Virginia Beach City, Williamsburg City, York H PFFS Mid-Atlantic Virginia VA Alexandria City, Bath, Brunswick, Carroll, Culpepper, Emporia City, Falls Church City, Fauquier, Fredericksburg City, Galax City, Greensville, Harrisonburg City, Highland, King George, Loudoun, Mecklenburg, Northampton, Page, Patrick, Pittsylvania, Rappahannock, Rockingham, Shenandoah, Spotsylvania, Stafford, Westmoreland H PFFS MA Only Mid-Atlantic Virginia VA Bedford, Bedford City, Bland, Botetourt, Brunswick, Buckingham, Carroll, Chesapeake City, Chesterfield, Craig, Emporia City, Essex, Floyd, Galax City, Giles, Gloucester, Goochland, Greensville, Hampton City, Hanover, Henrico, Isle of Wight, Lancaster, Middlesex, Newport News City, Norfolk City, Northumberland, Nottoway, Orange, Patrick, Petersburg City, Portsmouth City, Powhatan, Prince Edward, Radford City, Richmond, Richmond City, Roanoke, Roanoke City, Salem City, Southampton, Suffolk City, Virginia Beach City, Williamsburg City, York H PFFS Mid-South Virginia VA Bristol City, Buchanan, Dickerson, Grayson, Lee, Russell, Smyth, Tazewell, Washington, Wise, Wythe H PFFS MA Only Mid-South Virginia VA Bristol City, Buchanan, Dickerson, Grayson, Lee, Russell, Smyth, Tazewell, Washington, Wise, Wythe PDP S PDP Mid-Atlantic Region 7 VA VA-Statewide S PDP Mid-Atlantic Region 7 VA VA-Statewide S PDP Mid-Atlantic Region 7 VA VA-Statewide S PDP Mid-Atlantic Region 7 MD/DE MD/DE-Statewide S PDP Mid-Atlantic Region 7 MD/DE MD/DE-Statewide S PDP Mid-Atlantic Region 7 MD/DE MD/DE-Statewide 22

23 2017 County and Plan Exits (plans no longer available in 2017; however, Humana has alternatives in all locations...see plan maps and service areas for alternative plans for impacted members) H HMO Fluvanna, Greene, Nelson H HMO Bedford, Bedford City H HMO-CSNP (Diabetes and Heart) Dinwiddie, Poquoson City, Suffolk City H LPPO MD: Allegany H PFFS All Counties Augusta, Danville City, Henry, Martinsville City, Staunton City, Waynesboro City H LPPO All Counties VA: Frederick, Shenandoah, Winchester City WV: Grant, Hampshire, Tucker 23

24 2017 Mid-Atlantic Region - HMO 2017 Mid-Atlantic Region - HMO-SNP 24

25 2017 Mid-Atlantic Region - LPPO 2017 Mid-Atlantic Region - RPPO 25

26 2017 Mid-Atlantic Region - PFFS MAPD 2017 Mid-Atlantic Region - PFFS MA only 26

27 Richmond Territory Field Sales Manager Contact Number Address Richmond North Doug Bradt Richmond South Errick Jones

28 Humana Gold Plus HMO H Richmond HMO Group ID: BSN: Service Area Chesterfield; Colonial Heights City; Dinwiddie; Goochland; Hanover; Henrico; Hopewell City; Louisa; Petersburg City; Powhatan; Richmond City Key Selling Points Dinwiddie, Goochland, Louisa, Powhatan should be on this plan, not eligible for H MOOP should be highlighted. Bon Secour & HCA IN Humana Pharmacy 90 Day Supply Tier 1 & 2 Premium $24 MOOP: $4,900 Plan Deductible: N/A Inpatient Cost Share $345/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $10 Spec Copay $45 Outpatient Surgery $295 at ASC or $345 at Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 at Outpatient Hospital Part D Benefit $175 Deductible (Tiers III, IV, & V only); Preferred Retail 30 Days $7/$17/$47/$97/29% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 28

29 Humana Gold Plus HMO H Richmond HMO Group ID: BSN: Service Area Chesterfield; Colonial Heights City; Hanover; Henrico; Hopewell City; Petersburg City; Richmond City Key Selling Points Bon Secour & HCA IN InPatient Cost Share Reduced Moop Should Be highlighted Humana Pharmacy 90 Day Supply Tier 1 & 2 Premium $0 MOOP: $4,900 Plan Deductible: N/A Inpatient Cost Share $345/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $0 Spec Copay $45 Outpatient Surgery $295 at ASC or $345 at Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 at Outpatient Hospital Part D Benefit $360 Deductible (Tiers IV & V only); Preferred Retail 30 Days $0/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 29

30 Humana Choice LPPO H Richmond LPPO Group ID: BSN: Service Area Chesterfield, Colonial Heights, Hanover, Henrico, Hopewell, Petersburg, Richmond City Key Selling Points Flexibility IN/OON No Deductible w/selection IN Provider OTC Benefit $30 Per Quarter Humana Pharmacy Silver Sneakers Rewards Program Preventive Screenings Premium MOOP: Plan Deductible: Inpatient Cost Share SNF PCP Copay Spec Copay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: $55 $6,700 IN/$10,000 combo $0 IN/$1,000 OON $345 days 1-5 IN/30% OON after Ded. $0 day 1-20/$ Days /30% OON $15/30% OON after Ded. $45/30% OON after Ded. $295 ASC/ $345 OP Hospital/30% OON after Ded. $295 FRF/ $345 OP Hospital/30% OON after Ded. $400 Deductible (Tiers IV & V only); Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$ days OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray; Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 30

31 Humana Choice LPPO H Richmond LPPO Group ID: BSN: Service Area Amelia, Caroline, Cumberland, Dinwiddie, Goochland, King & Queen, Louisa, New Kent, Powhatan, Prince George, Sussex Key Selling Points Flexibility IN/OON No Deductible w/selection IN Provider OTC Benefit $30 Per Quarter Humana Pharmacy Silver Sneakers Rewards Program Preventive Screenings Premium MOOP: Plan Deductible: Inpatient Cost Share SNF PCP Copay Spec Copay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: $64 $6,700 IN/$10,000 combo $0 IN/$1,000 OON $345 days 1-5 IN/30% OON after Ded. $0 day 1-20/$ Days /30% OON $15/30% OON after Ded. $45/30% OON after Ded. $295 ASC/ $345 OP Hospital/30% OON after Ded. $295 FRF/ $345 OP Hospital/30% OON after Ded. $400 Deductible (Tiers IV & V only); Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$ days OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray; Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 31

32 Humana Choice HMO H Charlottesville HMO Group ID: BSN: Service Area Albemarle, Charlottesville City Key Selling Points UVA in Network Quarterly Over the Counter Benefits Humana Pharmacy Humana Rewards Program Premium $36 MOOP: $6,700 IN/$10,000 combo Plan Deductible: $0 IN/$1,000 OON Inpatient Cost Share $345 days 1-5 IN SNF $0 day 1-20/$ Days PCP Copay $10 Spec Copay $50 Outpatient Surgery $295 at ASC or $345 at Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 at Outpatient Hospital Part D Benefit $400 Deductible (Tiers III, IV, & V only); Preferred Retail 30 Days $0/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 32

33 Roanoke Territory Field Sales Manager Contact Number Address Roanoke Dale Ellis Roanoke Dale Ellis

34 Humana Gold Plus HMO H Roanoke HMO Group ID: BSN: Service Area Franklin; Roanoke; Roanoke City; Salem City Key Selling Points Carillion & HCA Health System IN Humana Pharmacy $0 Tiers 1 & 2 (90 day supply) Relaxed referral rules Premium $14.90 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $325/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $10 Spec Copay $50 Outpatient Surgery $275 at ASC or $325 at Outpatient Hospital Advanced Imaging $275 at Free-Standing or $325 at Outpatient Hospital Part D Benefit $175 Deductible (Tiers III, IV, & V only); Preferred Retail 30 Days $7/$17/$47/$97/29% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 34

35 Humana Gold Plus HMO H Roanoke HMO Group ID: BSN: Service Area Botetourt; Craig; Floyd; Montgomery; Pulaski; Radford City Key Selling Points Carillion & HCA Health System IN Humana Pharmacy $0 Tiers 1 & 2 (90 day supply) Relaxed referral rules Premium $25 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $325/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $10 Spec Copay $50 Outpatient Surgery $275 at ASC or $325 at Outpatient Hospital Advanced Imaging $275 at Free-Standing or $325 at Outpatient Hospital Part D Benefit $175 Deductible (Tiers III, IV, & V only); Preferred Retail 30 Days $7/$17/$47/$97/29% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 35

36 Humana Choice LPPO H Roanoke LPPO Group ID: BSN: Service Area Bedford, Bedford City, Bland, Botetourt, Craig, Floyd, Franklin, Montgomery, Pulaski, Radford City, Roanoke, Roanoke City, Salem City Key Selling Points National PPO Network OON Flexibility MDLive Web/Phone Technology available Premium $70 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 IN/$500 OON Inpatient Cost Share $345 days 1-5 IN/30% OON SNF $0 day 1-20/$ Days /30% OON PCP Copay $15/30% OON after Ded. Spec Copay $45/30% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/30% OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/30% OON Part D Benefit $245 Ded. Tier 3-5; std; $10/20/47/100/28% Preferred Retail 30 days: $8/20/47/99/28% Preferred Mail Order 90 days: $0/0/131/287 Other Benefits: OTC: $30 per Qtr; $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 36

37 Tidewater Territory Field Sales Manager Contact Number Address Roanoke Dale Ellis Tidewater Christian Carpenter

38 Humana Gold Plus HMO H Tidewater HMO Group ID: BSN: Service Area Chesapeake; Hampton; Newport News; Norfolk City; Portsmouth; Virginia Beach Key Selling Points $0 Premium $0 PCP Copay JenCare + extensive network (check Physician Finder for Dr. participation) Premium $0 MOOP: $4,500 Plan Deductible: N/A Inpatient Cost Share $345/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $0 Spec Copay $45 Outpatient Surgery $295 at ASC or $345 at Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 at Outpatient Hospital Part D Benefit $360 Deductible (Tiers IV & V only); Preferred Retail 30 Days $0/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 38

39 Humana Gold Plus HMO H Tidewater HMO Group ID: BSN: Service Area Chesapeake; Hampton; Isle of Wight; James City; Newport News; Norfolk; Poquoson; Portsmouth; Suffolk; Virginia Beach; Williamsburg, York Key Selling Points Sell based on network vs. H Generally used in counties where H is not available Premium $25 MOOP: $4,900 Plan Deductible: N/A Inpatient Cost Share $345/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $10 Spec Copay $45 Outpatient Surgery $295 at ASC or $345 at Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 at Outpatient Hospital Part D Benefit $175 Deductible (Tiers III, IV, & V only); Preferred Retail 30 Days $7/$17/$47/$97/29% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 39

40 Humana Choice LPPO H Tidewater LPPO Group ID: BSN: Service Area Chesapeake; Hampton; Newport News; Norfolk City; Portsmouth; Virginia Beach Key Selling Points Flexibility for using national PPO Choice Network Higher premium than HMO for greater provider choice nationally Premium $57 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 IN/$1000 OON Inpatient Cost Share $345 days 1-5 IN/30% OON SNF $0 day 1-20/$ Days /30% OON PCP Copay $15/30% OON after Ded. Spec Copay $45/30% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/30% OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/30% OON Part D Benefit $400 Ded. Tier 4-5; std; $10/20/47/100/25% Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 40

41 Humana Choice LPPO H Tidewater LPPO Group ID: BSN: Service Area Franklin City, Gloucester, Isle of Wight, James City, Poquoson City, Southampton, Suffolk City, Surry, Williamsburg City, York Key Selling Points Flexibility for using national PPO Choice Network Higher premium than HMO for greater provider choice nationally Premium $59 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 IN/$1000 OON Inpatient Cost Share $345 days 1-5 IN/30% OON SNF $0 day 1-20/$ Days /30% OON PCP Copay $15/30% OON after Ded. Spec Copay $45/30% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/30% OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/30% OON Part D Benefit $400 Ded. Tier 4-5; std; $10/20/47/100/25% Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 41

42 42

43 Northern Virginia Territory Field Sales Manager Contact Number Address Roanoke Dale Ellis Northern VA Jose Cabrera

44 Humana Gold Plus HMO H NOVA HMO Group ID: BSN: Service Area Alexandria City; Arlington; Falls Church City; Fauquier; Loudoun; Manassas City; Manassas Park City; Prince William Key Selling Points Privia Health in network Quarterly Over the Counter Benefit Integrated Health Care Model with PCP Doctor involvement Premium $37 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $345/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $5 Spec Copay $45 Outpatient Surgery $295 at ASC or $345 at Outpatient Hospital Advanced Imaging $295 at Free-Standing or $345 at Outpatient Hospital Part D Benefit $400 Deductible (Tiers IV & V only); Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 44

45 Humana Choice LPPO H Northern Virginia LPPO Group ID: BSN: SEE BELOW 001 Service Area GR: BSN: 001 Culpeper, Fauquier, Page, Rappahannock, Warren GR: BSN: 001 Accomack, Essex, Northampton, Northumberland, Richmond, Westmoreland GR: BSN: 001 King George, Spotsylvania, Stafford, Fredericksburg City Key Selling Points UVA in Network Flexibility to go in or out of Network National Network Mary Washington Hospital and Mary Washington Health Alliance is now in network Premium $80 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 IN/$500 OON Inpatient Cost Share $345 days 1-5 IN/30% OON after Ded SNF $0 day 1-20/$ Days /30% OON after Ded PCP Copay $15/30% OON after Ded. Spec Copay $45/30% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/30% OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/30% OON after Ded. Part D Benefit $400 Ded. Tier 4-5; std; $10/20/47/100/25% Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: OTC: $30 per Qtr; Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 45

46 Humana Choice LPPO H Northern Virginia LPPO Group ID: BSN: Service Area Alexandria City, Arlington, Clarke, Falls Church City, Loudoun, Manassas City, Manassas Park City, Prince William Key Selling Points UVA In Network Flexibility to go In or Out of Network National Network Privia Medial Group In Network Premium $66 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 Inpatient Cost Share $345 days 1-5 IN/40% OON SNF $0 day 1-20/$ Days /40% OON PCP Copay $15/40% OON after Ded. Spec Copay $45/40% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/40% OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/40% OON Part D Benefit $400 Ded. Tier 4-5; std; $10/20/47/100/25% Preferred Retail 30 Days $7/$17/$47/$97/29% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: OTC: $30 per Qtr; Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 46

47 Southwest Virginia Territory Field Sales Manager Contact Number Address Southwest VA Richie Gallimore Southwest VA Richie Gallimore

48 Humana Gold Plus HMO H Tri-Cities HMO Group ID: BSN: Service Area Bristol City, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe Key Selling Points $50 OTC benefit quarterly No referrals for specialists LifePoint, Mountain States, Wellmont All IN Network Exclusive providers: HMG, Royal Oaks Medical Associates Premium $27 MOOP: $5900 Plan Deductible: $0 In network Inpatient Cost Share $275 copay daily days 1-7 SNF $0 days 1-20; $150 days PCP Copay $5 PCP; Spec Copay $35 specialist (no referral required) Outpatient Surgery $225 ASC; $250 OP Hospital Advanced Imaging $225 Freestanding Radiology Facility (FRF); $250 OP Hospital Part D Benefit $320 Deductible (Tiers IV & V only); Preferred Retail 30 Days $7/$17/$47/$97/26% Preferred Mail Order 90 Days: $0/$0/$131/$ days Other Benefits: Vision: 1 exam, $100 Eyewear allowance from EyeMed: $50 per quarter OTC benefit ; Silver Sneakers; Humana Wellness and Go 365 Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 48

49 Humana Gold Plus HMO H Tri-Cities HMO Group ID: BSN: Service Area Bristol City, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe Key Selling Points $0 Hospital Inpatient Co-pay No referrals for specialists LifePoint, Mountain States, Wellmont All IN Network Exclusive providers: HMG, Royal Oaks Low OP surgical/imaging co-pays Premium $97 MOOP: $5900 IN Plan Deductible: $0 Inpatient Cost Share $0 Co-Pay per Admission! SNF $0 day 1-20/$150 Days PCP Copay $5 Spec Copay $30 Outpatient Surgery $200 ASC/ $200 OP Hospital Advanced Imaging $150 FRF/ $150 OP Hospital Part D Benefit $200 Deductible (Tiers IV & V only); Preferred Retail 30 Days $5/$15/$47/$97/29% Preferred Mail Order 90 Days: $0/$0/$131/$ days Other Benefits: OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray; Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 49

50 Humana Choice LPPO H Tri-Cities LPPO Group ID: BSN: Service Area Bristol City, Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe Key Selling Points National PPO network More flexibility to visit OON providers Premium MOOP: Plan Deductible: Inpatient Cost Share SNF PCP Copay Spec Copay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: $61 $6,700 IN/$10,000 combo $0 IN/$750 OON $265 days 1-7 IN/30% OON after Ded. $0 day 1-20/$ Days /30% OON $15/30% OON after Ded. $35/30% OON after Ded. $225 ASC/ $250 OP Hospital/30% OON after Ded. $150 FRF/ $200 OP Hospital/30% OON after Ded. $360 Deductible (Tiers IV & V only); Preferred Retail 30 Days $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$ days OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray; Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 50

51 Delaware Territory Field Sales Manager Contact Number Address Roanoke Dale Ellis Delaware Jose Cabrera

52 Humana Gold Plus HMO H Delaware HMO Group ID: BSN: Service Area Kent County and New Castle County Key Selling Points Christiana Health System IN Newly expanding into Kent Co. in 2017! Premium $27 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $279/day (days 1-7); $0 (days 8-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $10 Spec Copay $50 Outpatient Surgery $229 at ASC or $279 at Outpatient Hospital Advanced Imaging $229 at Free-Standing or $279 at Outpatient Hospital Part D Benefit $280 Deductible (Tiers III, IV, & V only); Preferred Retail 30 Days $7/$12/$47/$95/27% Preferred Mail Order 90 Days: $0/$0/$131/$275 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 52

53 Humana Choice LPPO H Delaware LPPO Group ID: BSN: Service Area Kent County and New Castle County Key Selling Points Flexibility to go OON Humana National PPO network Ability to travel and find IN network providers nationally Premium $72 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 IN/$1000 OON Inpatient Cost Share $345 days 1-5 IN/30% OON after Ded. SNF $0 day 1-20/$ Days /30% OON after Ded. PCP Copay $15/30% OON after Ded. Spec Copay $45/30% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/30% OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/30% OON Part D Benefit $400 Ded. (Tier III, IV, & V); std; $10/20/47/100/25% Preferred Retail 30 Days $9/$20/$47/$100/25% Preferred Mail Order 90 Days: $0/$0/$131/$290 Other Benefits: OTC: $30 per Qtr; Dental: 1 exam, cleaning bitewing X-ray Vision: 1 exam, $100 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 53

54 54

55 Maryland Territory Field Sales Manager Contact Number Address Roanoke Dale Ellis Maryland Jose Cabrera

56 Humana Choice LPPO H Western Maryland LPPO Group ID: BSN: Service Area Garret, Washington Key Selling Points Humana Choice NATIONAL PPO network One of few MA options in area Premium $74 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 Inpatient Cost Share $345 days 1-5 IN/30% OON SNF $0 day 1-20/$ Days /30% OON PCP Copay $15/30% OON after Ded. Spec Copay $45/30% OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/30% OON Advanced Imaging $295 FRF/ $345 OP Hospital/30% OON Part D Benefit $390 Ded. Tier 3-5; std; $10/20/47/100/25% Preferred Retail 30 Days: $9/20/47/100/25% Preferred Mail Order 90 Days: $0/0/131/290 Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; $30 OTC Quarterly Allowance; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 56

57 2017 PFFS 57

58 58

59 Humana PFFS H Virginia PFFS Group ID: BSN: Service Area Amherst, Appomattox, Bedford, Bedford City, Bland, Botetourt, Chesapeake City, Chesterfield, Craig, Essex, Floyd, Gloucester, Goochland, Halifax, Hampton City, Hanover, Henrico, Isle of Wight, Lancaster, Middlesex, Newport News City, Norfolk City, Northumberland, Nottoway, Petersburg City, Portsmouth City, Powhatan, Prince Edward, Pulaski, Radford City, Richmond, Richmond City, Roanoke, Roanoke City, Salem City, Southampton, Suffolk City, Virginia Beach City, Williamsburg City, York Key Selling Points Alternative to RPPO in counties listed Allows for some provider choice flexibility IN/OON copays mostly same after OON deductible Premium $67 MOOP: $6700 IN/OON combined Plan Deductible: $0 IN/$500 OON Inpatient Cost Share $345 days 1-5 IN no Ded./ OON after Ded. SNF $0 day 1-20/$ Days No Ded./ OON after Ded. PCP Copay $15 IN no Ded./ OON after Ded. Spec Copay $45 IN no Ded./ OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital IN no Ded./ OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital IN no Ded./ OON after Ded. Part D Benefit $400 Ded. Tier 4-5; std; $10/$20/$47/$100/25% Preferred Retail 30 Days: $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: OTC: $30 per Qtr; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 59

60 Humana PFFS H Virginia PFFS Group ID: BSN: Service Area Key Selling Points Alexandria City, Bath, Brunswick, Carroll, Culpeper, Emporia City, Falls Church City, Fauquier, Fredericksburg City, Galax City, Greensville, Harrisonburg City, Highland, King George, Loudoun, Mecklenburg, Northampton, Page, Patrick, Pittsylvania, Rappahannock, Rockingham, Shenandoah, Spotsylvania, Stafford, Westmoreland Alternative to RPPO in counties listed Allows for some provider choice flexibility IN/OON copays mostly same after OON deductible Premium $83 MOOP: $6700 IN/OON combined Plan Deductible: $0 IN/$450 OON Inpatient Cost Share $345 days 1-5 IN no Ded./ OON after Ded. SNF $0 day 1-20/$ Days No Ded./ OON after Ded. PCP Copay $15 IN no Ded./ OON after Ded. Spec Copay $45 IN no Ded./ OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital IN no Ded./ OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital IN no Ded./ OON after Ded. Part D Benefit $400 Ded. Tier 4-5; std; $10/$20/$47/$100/25% Preferred Retail 30 Days: $7/$17/$47/$97/25% Preferred Mail Order 90 Days: $0/$0/$131/$281 Other Benefits: OTC: $30 per Qtr; Vision: 1 exam Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 60

61 Humana PFFS H Virginia PFFS Group ID: BSN: Service Area Key Selling Points Bristol City, Buchanan, Dickenson, Grayson, Lee, Russell, Smyth, Tazewell, Washington, Wise, Wythe Generally a grandfathered plan Current members should move to HMO, LPPO, or PFFS MA only + PDP Premium $86 MOOP: $6700 IN/OON combined Plan Deductible: $0 IN/$750 OON Inpatient Hospital Cost Share $295 days 1-6 IN No Ded./ 35% OON after Ded. SNF $0 day 1-20/$150 Days No Ded./ 35% OON after Ded. PCP Copay $15 IN No Ded./ 35% OON after Ded. Spec Copay $40 IN No Ded./ 35% OON after Ded. Outpatient Surgery 20% ASC/25% OP Hospital IN No Ded./ 35% OON after Ded. Advanced Imaging 20% FRF/ 25% OP Hospital IN No Ded./ 35% OON after Ded. Part D Benefit $400 Ded. Tier 4-5; Standard: $10/$20/$47/$100/25% Preferred Retail 30 Days: $7/$17/$47/$100/25% Preferred Mail Order 90 Days: $0/$0/$131/$290 Other Benefits: OTC: $10 per Month Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 61

62 Humana PFFS H Virginia PFFS MA Only Group ID: BSN: Service Area Bedford, Bedford City, Bland, Botetourt, Brunswick*, Buckingham, Carroll*, Chesapeake City, Chesterfield, Craig, Emporia City*, Essex, Floyd, Galax City*, Giles, Gloucester, Goochland, Greensville*, Hampton City, Hanover, Henrico, Isle of Wight, Lancaster, Middlesex, Newport News City, Norfolk City, Northumberland, Nottoway, Orange, Patrick*, Petersburg City, Portsmouth City, Powhatan, Prince Edward, Radford City, Richmond, Richmond City, Roanoke, Roanoke City, Salem City, Southampton, Suffolk City, Virginia Beach City, Williamsburg City, York Key Selling Points Benefits same OON as IN AFTER Deductible Flexible to sell with ANY stand alone PDP MA + PDP alternative to RPPO in counties listed totals lower premium New offering in Brunswick, Carroll, Emporia City, Galax, Greensville, and Patrick * Underlined Counties are expanded Counties for 2017 Premium $33 MOOP: Plan Deductible: Inpatient Cost Share SNF PCP Copay Spec Copay Outpatient Surgery Advanced Imaging Part D Benefit $6700 IN/OON combined $0 IN/$500 OON $345 days 1-5 IN no Ded./ OON after Ded. $0 day 1-20/$ Days No Ded./ OON after Ded. $20 IN no Ded./ OON after Ded. $50 IN no Ded./ OON after Ded. $295 ASC/ $345 OP Hospital IN no Ded./ OON after Ded. $295 FRF/ $345 OP Hospital IN no Ded./ OON after Ded. N/A Other Benefits: OTC: $30 per Qtr Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 62

63 Humana PFFS H Virginia PFFS MA Only Group ID: BSN: Service Area Bristol City, Buchanan, Dickenson, Grayson, Lee, Russell, Smyth, Tazewell, Washington, Wise, Wythe Key Selling Points IN/OON flexibility Flexibility to pair with any stand alone PDP Premium MOOP: Plan Deductible: Inpatient Cost Share SNF PCP Copay Spec Copay Outpatient Surgery Advanced Imaging Part D Benefit $0 $6700 IN/OON combined $0 IN/$500 OON $295 days 1-6 IN no Ded./ 35% OON after Ded. $0 day 1-20/$150 Days / OON after Ded. $15 IN no Ded./ 35% OON after Ded. $40 IN no Ded./ 35% OON after Ded. 20% ASC/ 25% OP Hospital IN no Ded./ 35% OON after Ded. $245 FRF/ $245 OP Hospital IN no Ded./ OON after Ded. N/A Other Benefits: OTC: $30 per Qtr Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 63

64 64

65 2017 RPPO 65

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67 Humana RPPO R Virginia/ North Carolina RPPO Group ID: BSN: Service Area State of North Carolina* and Virginia *must have special NC Medicare license to sell to NC residents* Key Selling Points Equal IN/OON cost share after OON Ded. National PPO Network Available statewide in VA (see non-commissionable counties) Premium $81 MOOP: $6700 IN/$10,000 combo Plan Deductible: $0 IN/$500 OON Inpatient Cost Share $345 days 1-5 IN no Ded./OON after Ded SNF $0 day 1-20/$160 Days /OON after Ded PCP Copay $15 IN / $15 OON after Ded. Spec Copay $45/ $45 OON after Ded. Outpatient Surgery $295 ASC/ $345 OP Hospital/OON after Ded. Advanced Imaging $295 FRF/ $345 OP Hospital/OON after Ded. Part D Benefit $325 Ded. Tier 3-5 only; std; $10/$20/$47/$100/26% Preferred Retail 30 Days: $9/$20/$47/$99/26% Preferred Mail Order 90 Days: $0/$0/$131/$28 Other Benefits: OTC: $30 per Qtr; Vision: 1 exam, $130 eyewear allowance; Silver Sneakers fitness Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 67

68 Humana RPPO R Virginia/ NC RPPO MA only Group ID: BSN: Service Area State of North Carolina* and Virginia *must have special NC Medicare license to sell to NC residents* Key Selling Points $0 MA only plan Good for Veterans who use V.A. for Rx CANNOT combine with stand alone PDP Low hospital admit co-pay Premium MOOP: $4,900 combo Plan Deductible: $0 Inpatient Cost Share $695/admit IN/$1,195 per admit OON SNF $0 day 1-20/$160 Days /OON PCP Copay $10 IN / 20% OON Spec Copay $35/ 20% OON Outpatient Surgery $200 ASC/ $250 OP Hospital/ 20% OON Advanced Imaging $200 FRF/ $250 OP Hospital/ 20% OON Part D Benefit None: Compliance Note cannot sell combined with PDP stand-alone plans. Selling to someone with a stand-alone PDP will dis-enroll them from PDP (does not effect Vet Admin. Drug coverage) Other Benefits: $0 OTC: $30 per Qtr; Dental: 1 exam, bitewing x-rays, cleaning; Vision: 1 exam, Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 68

69 Non-Commissionable Counties For R The counties below have either HMO, LPPO, or PFFS options which are better value propositions with similar or equal networks as the RPPO. For that reason, sales of R will not be eligible for commission payment if sold to residents of these counties: Alexandria City Franklin Louisa Roanoke City Amelia Fredericksburg City Manassas City Salem City Arlington Gloucester New Kent Spotsylvania Botetourt Goochland Newport News City Stafford Caroline Hampton City Norfolk City Suffolk City Chesapeake City Hanover Petersburg City Surry Chesterfield Henrico Poquoson City Sussex Clarke Hopewell City Portsmouth City Virginia Beach City Colonial Heights City Isle of Wight Powhatan Warren Clarke James City Prince George Williamsburg City Cumberland King and Queen Prince William York Dinwiddie King George Richmond City Fauquier Loudon Roanoke 69

70 70

71 2017 PDP 71

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73 Walmart PDP S Virginia Walmart PDP Group ID: BSN: Service Area State of Virginia Key Selling Points Low Premium PDP Wal-Mart and Sam s Preferred Pharmacy Premium $17.00 Plan Deductible: $400 for Tiers 3-5 only Part D Benefit: $0 co-pay 90 days Tier 1 Mail order; $8 Tier 2 30 day supplies below: Tier 1 Preferred: $1 Tier 2 Preferred: $4 Tier 3 Preferred: 20% Tier 4 Preferred: 35% Tier 5 Preferred: 25% Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 73

74 Enhanced PDP S Virginia Enhanced PDP Group ID: BSN: Service Area State of Virginia Key Selling Points No Deductible PDP No Commission Paid Premium $62.80 Plan Deductible: $0 Part D Benefit: $0 co-pay 90 days Tier 1 & 2 Mail order 30 day supplies below: Tier 1 Preferred: $3 Tier 2 Preferred: $7 Tier 3 Preferred: $42 Tier 4 Preferred: 44% Tier 5 Preferred: 33% Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 74

75 Preferred PDP S Virginia Preferred PDP Group ID: BSN: Service Area Key Selling Points State of Virginia This is the PDP option to sell to LIS beneficiaries (LIS Levels 1-6 pay $0 premium, BUT DO NOT QUOTE THIS) Low copays after deductible Premium $28.10 Plan Deductible: $400 for ALL TIER LEVELS Part D Benefit: $0 co-pay 90 days Tier 1 and Tier 2 Mail Order (Humana Pharmacy) 30 day supplies below: Tier 1 Preferred: $0 Tier 2 Preferred: $1 Tier 3 Preferred: 20% Tier 4 Preferred: 35% Tier 5 Preferred: 25% Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 75

76 Walmart PDP S DC, DE, & MD Walmart PDP Group ID: BSN: Service Area District of Columbia, State of Delaware, State of Maryland Key Selling Points Low Premium PDP Wal-Mart and Sam s Preferred Pharmacy Premium $17.00 Plan Deductible: $400 for Tiers 3-5 only Part D Benefit: $0 co-pay 90 days Tier 1 Mail Order, $8 Tier 2 30 day supplies below: Tier 1 Preferred: $1 Tier 2 Preferred: $4 Tier 3 Preferred: 20% Tier 4 Preferred: 35% Tier 5 Preferred: 25% Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 76

77 Enhanced PDP S DC, DE, & MD Enhanced PDP Group ID: BSN: Service Area District of Columbia, State of Delaware, State of Maryland Key Selling Points No Deductible PDP Premium $66.20 Plan Deductible: $0 Part D Benefit: $0 co-pay 90 days Tier 1 & 2 Mail order 30 day supplies below: Tier 1 Preferred: $3 Tier 2 Preferred: $7 Tier 3 Preferred: $42 Tier 4 Preferred: 44% Tier 5 Preferred: 33% Tier 5 Preferred: 25% Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 77

78 Preferred PDP S DC, DE, & MD Preferred PDP Group ID: BSN: Service Area District of Columbia, State of Delaware, State of Maryland Key Selling Points This is the PDP option to sell to LIS beneficiaries (LIS Levels 1-6 pay $0 premium, BUT DO NOT QUOTE THIS) Low copays after deductible Premium $29.30 Plan Deductible: $400 for ALL Tiers Part D Benefit: $0 co-pay 90 days Tier 1 & 2 Mail order AFTER Deductible 30 day supplies below: Tier 1 Preferred: $2 Tier 2 Preferred: $3 Tier 3 Preferred: 25% Tier 4 Preferred: 40% Tier 5 Preferred: 25% Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 78

79 Dual Eligible SNP Job Aid What is a DE SNP? DE SNP Stands for Dual Eligible Special Needs Plan. These plan(s) can be sold to beneficiaries entitled to both Medicare A & B and certain levels of Medicaid. They will offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid. Note: This is NOT a chronic SNP. Qualification for this plan is NOT derived from the beneficiary s health. What makes a DE-SNP different than a regular plan? There are no co-pays, and extra benefits included. Please see plan document for full list. What Medicaid levels qualify member for Humana DE SNP in VA for 2017? QMB SLMB+ Proposed new level of eligibility in VA in 2017, wait for guidance and further training FBDE Proposed new level of eligibility in VA in 2017, wait for guidance and further training QMB+ (Only in these counties for H : Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Tazewell, Washington, Wise, Wythe) In all other counties in VA, agents must refer QMB+ prospects to Maximus for their Commonwealth Coordinated Care options: Maximus: State Enrollment Broker How can you find out what level of Medicaid a member has? (Have member information ready: Either their Medicaid Member ID# OR their SSN And DOB) Call a local Humana office: Richmond (Monday Friday: 8 AM 5 PM) Roanoke (Monday Friday: 8 AM 5 PM) Call Humana Agent Support: Follow prompts for Eligibility Verification, Medicaid. Be sure the call rep gives you the actual level of eligibility (Letters and/or plus +), and use the guide above to determine if you may sell them a VA DE-SNP or if you need to refer to Maximus for the CCC plan in VA 79

80 Chronic Condition SNP Job Aid What Counties Have CC Plans: Chesapeake City Chesterfield Colonial Heights City Dinwiddie Hampton City Hanover Henrico Hopewell City, Newport News City Norfolk City, Petersburg City Poquoson City, Portsmouth City Richmond City Virginia Beach City Enrollment Opportunity When can a beneficiary enroll in a Chronic Condition SNP (CSNP)? Beneficiaries who have been diagnosed with a qualifying condition (Cardiovascular Disorders, Chronic Heart Failure, and/or Diabetes) have a continuous Special Enrollment Period (SEP- CHR) to join a CSNP at any time, but is locked in to the CSNP after selection, like any other MAPD plan, until the next AEP. Pre-Qualification Form What methods do I have to collect the Pre-Qualification form? The member can fill-out a paper copy (available for order from VSO) or the agent can fill-out the CLINICAL TAB in MAPA. What happens if the member submits an incomplete Pre-Qualification form or does not submit the Pre-Qualification form with their enrollment application? If the member submits an incomplete Pre- Qualification form or does not submit the Pre- Qualification form with their enrollment application, the enrollment application is considered incomplete. What happens if the member does not submit the Pre-Qualification form within the member s incomplete grace period? If a completed Pre-Qualification form is not submitted to Humana within the member s incomplete grace period, the enrollment application would be denied. 80

81 Chronic Condition SNP Job Aid (cont.) Verification of Chronic Condition Form When does Verification of Chronic Condition form have to be returned to Humana? The member has until the last day of their effective month to return the Verification of Chronic Condition form per CMS guidelines. Can an agent provide the Verification of Chronic Condition form to a member at the time of the sale? The Verification of Chronic Condition form cannot be provided to the member at the time of sale because it comes prepopulated with plan information that is often found to be inaccurate if the member was allowed to complete the form themselves, which resulted in terminations. It is important that the agent stresses to the member how they ll receive the Verification of Chronic Condition form in the mail along with their acknowledgement of enrollment materials and the next steps they ll need to take to verify their condition and complete the enrollment process. Does the member have to provide a specific diagnosis code in order to enroll? Members do not have to have any specific diagnosis code in order to enroll; they simply need the verification from their doctor that they have one of the conditions included in the Verification of Chronic Condition form. What happens if the member does not return the Verification of Chronic Condition form? If the member does not return the Verification of Chronic Condition form by the last day of the member s effective month, the member s plan will be termed for the last day of the second month of enrollment and the member will be sent an involuntary termination letter. What happens if a member is terminated from their plan for failure to return a Verification of Chronic Condition form? If a member is terminated from their plan for failure to return a Verification of Chronic Condition form within the allotted time period, the member is eligible for a SEP. Members whose plan is terminated because they failed to verify their chronic condition receive a Special Election Period (SEP) that begins the month of disenrollment and continues for two months. 81

82 VA Dual Eligible Medicare/Medicaid Program October 1, 2014 Virginia Medallion 3.0 Managed Care Regions Virginia s Proposed Medicare/Medicaid Alignment Demonstration For Dual Eligibles January 1,

83 Humana Gold Plus HMO-SNP DE H Tri-Cities HM0-SNP DE Group ID: BSN: Service Area Buchanan, Dickenson, Grayson, Lee, Norton City, Russell, Scott, Tazewell, Washington, Wise, Wythe Key Selling Points Call Agent support for qualification $0 cost share for Medicaid/Medicare benefits Premium $0 Members on this Dual Eligible SNP will not be responsible for medical copayments, medical coinsurances, or Medical deductibles on this plan. They are cost share protected by the State Medicaid Office because of their dual eligible status. Providers may not balance bill these members for any cost sharing. Providers must bill the state for reimbursement of member cost share. Advise members to show both their Humana ID card and Medicaid ID card to Providers. Please note: The information included in this document is for training purposes only and is not approved or public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 83

84 Humana Gold Plus HMO SNP CC H Richmond-Tidewater HMO SNP CC Group ID: BSN: SEE BELOW 001 Service Area Key Selling Points GR: BSN: 001 Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, Virginia Beach City GR: BSN: 001 Chesterfield, Hanover, Henrico, Colonial Heights City, Hopewell City, Petersburg City, Richmond City Ability to sell year round to eligible beneficiaries Special programs for diabetes and heart disease Premium $12.90 MOOP: $6,700 Plan Deductible: N/A Inpatient Cost Share $325/day (days 1-5); $0 (days 6-90) SNF $0 (days 1-20); $164.50/day (days ) PCP Copay $0 Spec Copay $45 Outpatient Surgery $275 at ASC or $325 at Outpatient Hospital Advanced Imaging $275 at Free-Standing or $325 at Outpatient Hospital Part D Benefit $400 Deductible (Tiers IV & V only); Preferred Retail 30 Days $0/$17/$47/$97/25%/0 (VI) Preferred Mail Order 90 Days: $0/$0/$131/$281/0 (VI) Other Benefits: Routine Eye Exam $0; Eyewear Allowance $100; OTC Quarterly Allowance; Meal Benefit; Humana Wellness, Fitness Program Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 84

85 Humana Gold Plus HMO-SNP DE H Richmond-Tidewater HMO-SNP DE Group ID: BSN: SEE BELOW 001 Service Area GR: BSN: 001 Chesterfield, Dinwiddie, Hanover, Henrico, Colonial Heights City, Hopewell City, Petersburg City, Richmond City GR: BSN: 001 Chesapeake City, Hampton City, Newport News City, Norfolk City, Poquoson City, Portsmouth City, Suffolk City, Virginia Beach City Key Selling Points Ability to sell year round to qualified Medicare/ Medicaid Dual eligible Cost sharing protection for Medicare and Medicaid covered services when receiving care in the HMO SNP network. Premium $0.00 Members on this Dual Eligible SNP will not be responsible for medical copayments, medical coinsurances, or Medical deductibles on this plan. They are cost share protected by the State Medicaid Office because of their dual eligible status. Providers may not balance bill these members for any cost sharing. Providers must bill the state for reimbursement of member cost share. Advise members to show both their Humana ID card and Medicaid ID card to Providers. Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 85

86 Humana Gold Plus HMO-SNP DE H NOVA HMO-SNP DE Group ID: BSN: SEE BELOW 001 Service Area GR: BSN: 001 Arlington, Fauquier, Loudoun, Prince William, Alexandria City, Falls Church City, Manassas City, Manassas Park City GR: BSN: 001 Goochland, Louisa, Powhatan Key Selling Points Ability to sell year round to qualified Medicare/ Medicaid Dual eligible Cost sharing protection for Medicare and Medicaid covered services when receiving care in the HMO SNP network. Premium $0.00 Members on this Dual Eligible SNP will not be responsible for medical copayments, medical coinsurances, or Medical deductibles on this plan. They are cost share protected by the State Medicaid Office because of their dual eligible status. Providers may not balance bill these members for any cost sharing. Providers must bill the state for reimbursement of member cost share. Advise members to show both their Humana ID card and Medicaid ID card to Providers. Please note: The information included in this document is for training purposes only and is not approved for public distribution. The following pages are summaries of the 2017 MAPD and PDP plan highlights. For more complete benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage 86

87 2017 Mid-Atlantic Region - HMO 87

88 2017 Mid-Atlantic Region - HMO-SNP 88

89 2017 Mid-Atlantic Region - LPPO 89

90 2017 Mid-Atlantic Region - RPPO 90

91 2017 Mid-Atlantic Region - PFFS MAPD 91

92 2017 Mid-Atlantic Region - PFFS MA Only 92

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