2014 Medicare Advantage Group Awareness Training CBIA Brokers. October 2013

Transcription

1 2014 Medicare Advantage Group Awareness Training CBIA Brokers October 2013

2 Presenters Matthew Gallagher Director, Medicare Sales David Pallotta Medicare Group Specialist 2

3 Agenda CBIA Medicare Advantage Group Plan Enrollment Member Services Important Reminders Q & A 3

4 CBIA Medicare Advantage Group Plan

5 CBIA Plan Highlights Comprehensive lower cost alternative for a monthly premium of $ Available to all CBIA Employer Groups Medicare-eligible Retirees (residing anywhere in the US) Medicare-eligible Employees Actively Working / Working Aged (For groups <20 employees) Medicare Advantage Point-of-Service plan Benefits are the same for In and Out of Network Maximum Out-of-Pocket: $3,400. Financial protection for members Worldwide Emergency / Urgent Care = up to $50,000 annually 3% Commissions Effective January 1, 2014 Highly Rated Medicare Advantage plan in CT for Health Plan Quality 4 out of 5 STARs by CMS 5

6 CBIA Plan Highlights Open Part D formulary A Preferred / Non-Preferred pharmacy network will be utilized for 2014 Different formulary from ConnectiCare Commercial and Individual Medicare products National provider network Open Access = No referrals required Prior Authorization is required on some services Comprehensive Annual Physical (not covered by Original Medicare or Supplement plans) SilverSneakers Fitness Program now included Vision discount program that offers discounts of 25% to 30% on frames, lenses, prescription contact lenses, and sunglasses when using participating optical providers ConnectiCare Touchpoints access to health & wellness resources and services Case Management COPD, Diabetes, Heart Disease, and Cancer Treatment Decision Support Important Health Reminders immunization and medication reminders 6

7 CBIA - Medical Benefit Monthly Premium Maximum Out-of-Pocket Annual Physical Exam PCP Office Visit Specialist Office Visit Routine Hearing and Vision Exams Lab and X-Ray Services Diagnostic Radiology Therapeutic Radiology Ambulance Worldwide Emergency / Urgent Care $50,000 limit outside the U.S. Outpatient Surgery: Ambulatory Surgical Center Hospital In-Network & Out-of-Network $ $3,400 $0 $15 $30 $30 $0 $0 $0 $0 $0 $200 $300 7

8 CBIA Prescription Drug Benefit 30-Day Supply 90-Day Supply Supply Retail and Mail Order (*) Preferred (*) / Non-Preferred Retail Pref / Non-P Mail Order Preferred Only Tier 1: Generic $5 / $10 $15 / $30 $10 Tier 2: Preferred Brand $35 / $40 $105 / $120 $88 Tier 3: Non-Preferred Brand $75 / $80 $225 / $240 $188 Tier 4: Specialty $75 / $80 $225 / $240 $188 Catastrophic Drug Coverage After member cost exceeds $4,550 The greater of: $2.55 or 5% for generic drugs $6.35 or 5% for all other drugs 8

9 Network More than 27,000 fully-credentialed health care providers All Hospitals in Connecticut (except CT Children s Medical Center) Different network from ConnectiCare Commercial The POS plan offers the flexibility to seek services from any Medicare-approved provider in the United States and its territories Participating In-Network Providers outside CT Westerly Hospital, RI New York providers Massachusetts providers National Pharmacy network Preferred Pharmacy network includes: Right Aid, Wal-Mart, Target, Costco, Stop and Shop Provider Directory available online at 9

10 Enrollment

11 Pre-Enrollment Materials Prior to enrollment, brokers should provide the following: Pre-enrollment Letter Enrollment form Benefit Summary Access to: Formulary Provider Directory All materials available on CBIA website (cbia.com/medicare) 11

12 Post Enrollment Materials Newly enrolled beneficiaries will receive the following new member materials: ID card Evidence of Coverage Benefit Summary Provider Directory (if they do not opt out) Formulary 12

13 Enrollment Process Eligible applicants must complete the Enrollment form Applicant submits directly to Broker (or employer) Broker (or employer) submits to CBIA Must be signed by applicant no later than December 31, 2013 CBIA enters the enrollment into their system CBIA sends an electronic enrollment file to ConnectiCare ConnectiCare submits enrollment to CMS for approval 13

14 Communications after Enrollment Acknowledgement of Receipt of Enrollment Application (Intent Letter) Notice to Confirm Enrollment (CMS approval) Member ID card - Medical and Rx on same card Welcome Kit separate mailing from ID card Health Risk Assessment Call Connextions In-Home Health Assessment Inspiris Member Outreach Program Call Optum Premium Payment Assistance Call to determine qualification for Extra Help Altegra 14

15 Member Services

16 Member Services Member Service Representatives will be available seven days per week 8:00 am to 8:00 pm EST ConnectiCare VIP Medicare (1-800-CCI-CARE) TTY/TTD users may dial

17 Important Reminders

18 Why ConnectiCare VIP Medicare? Significant cost-savings with low $ monthly premium Broker commissions = 3% of premium Highly ranked Medicare Advantage plan in CT 4 out of 5 STARs for Health Plan Quality in 2014 Excellent comprehensive medical and prescription coverage Flexibility to use any Medicare-approved provider in the United States or its territories Worldwide coverage for emergency and urgent care Financial protection with low $3,400 MOOP SilverSneakers Fitness Program Vision Discounts of 25-30% on frames and lenses Quality Disease & Care Management Programs through Touchpoints 18

19 Next Steps CBIA Website (cbia.com/medicare) Enrollment Form Benefit Summary Link to ConnectiCare website: Online Provider search Provider Directory PDF Formulary PDF Claim reimbursement forms: Medical Pharmacy Mailing to all current CBIA Medicare Supplement members Mailing to all current CBIA Employer Groups Contact your CBIA Sales Representative for additional information 19

20 Q & A 20