Introducing Humana’s  2007 Medicare Program
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Introducing Humana’s 2007 Medicare Program. Presenters: Paul Cantrell, Peggy Taylor, Sue Suchan November 2, 2006 . Topics for Discussion Today. Our 2007 National Presence Key Dates Education and Outreach Humana’s Partners; Relationship with Wal-Mart

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Introducing Humana’s 2007 Medicare Program

Presenters: Paul Cantrell, Peggy Taylor, Sue Suchan

November 2, 2006


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Topics for Discussion Today

  • Our 2007 National Presence

  • Key Dates

  • Education and Outreach

  • Humana’s Partners; Relationship with Wal-Mart

  • Our Member Value Proposition: Benefits & Services

  • Recruiting, Selling, Enrollment and Oversight Processes

  • Humana’s Medicare Products and Benefits

  • Contacts for Ongoing Dialogue


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WA

ME

MT

ND

VT

NH

MN

OR

NY

MA

WI

SD

ID

MI

CT

RI

Milwaukee

WY

NJ

PA

Cleveland

Chicago

IA

Columbus

OH

NE

DE

Salt Lake City

Dayton

IN

NV

IL

MD

Boulder

Cincinnati

UT

Indianapolis

WV

DC

VA

Denver

Kansas City

Louisville

CO

KS

MO

Lexington

Colorado Springs

KY

St. George

CA

Raleigh

NC

Nashville

TN

AZ

Memphis

OK

SC

AR

NM

Atlanta

Phoenix

AL

GA

Dallas

MS

Shreveport

TX

LA

Jacksonville

Austin

Baton Rouge

Daytona Beach

San Antonio

Orlando

Houston

New Orleans

FL

AK

Tampa

South Florida

Corpus Christi

HI

PUERTO RICO

2007 Medicare Markets

Local PPO & HMO Markets

PDP only States

Regional PPO, PFFS & PDP States

Local PPO only Markets

PFFS, HMO, SNP & PDP Markets

PFFS & PDP States only

Local HMO only Markets

Partial county PFFS & PDP States only

Local PPO, HMO & SNP Markets




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Humana Medicare Outreach and Education

  • 8 RVs traveling through 34 states

  • Senior, civic centers and select Wal*Mart locations in both urban and rural areas

  • Prior to October 1, Humana sales associates were on hand to provide general educational information on PDP and MA plans as well as important dates related to the enrollment process and how Medicare beneficiaries can research prescription drug availability.

  • After October 1, Humana sales associates will share information about specific Humana Medicare products.


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Humana Partners

  • Co-branded partner - Wal*Mart

  • USAA

  • State Farm


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Humana - WalMart Relationship

  • Co-branded relationship since 2005

  • Humana full-service workstations in approximately 2,100 Wal-Mart/Sam’s Club stores. Manned by licensed, appointed reps who use CMS-approved materials.

  • Humana informational kiosks being piloted in 100 Wal-Mart/Sam’s Club locations with basic plan benefit information. Where possible, these will provide direct phone access to Humana licensed telephone sales reps for information and agent appointment requests.

  • Located in highly visible, general merchandise areas.

  • Both station types are clearly identified as Humana Medicare sites and those staffed with agents are available for both walk-ins and appointments.


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Adding Value to our Products

Guiding our members in using their benefits

  • New member Welcome Kit

  • Wide range of Value-Added Services

  • Local presence in most markets

  • New Member Orientations and “Re-Orientations”

  • Continuing education throughout the year; not just during open enrollment

  • Meeting beneficiaries where they are: shopping, at home, community sites, on the phone or in person


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New Member Welcome Kit

New for 2007 –Mailing a personalized package to all members to simplify and improve the new member experience. Packet includes:

  • Welcome letter

  • Copy of application

  • Summary of benefits

  • Privacy notice

  • Access to benefits instructions

  • Abridged Formulary

  • Geo-access directory (non-HMO)

  • Member handbook

  • Description of all value added services

  • RightSource (mail order) brochure

  • Humana Active Outlook brochure


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Humana – Value Added Services

Services beyond traditional benefits:

  • SilverSneakers Fitness Program

  • Humana Active Outlook Program

    • Cooking and nutrition classes

    • SilverSneakers Plus

  • Posit Science Brain Fitness Program

  • SmartSummaryRx Statements

  • MyHumana.com

  • Other value-added services and opportunities that may vary by market, region or product


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Humana PDP SmartSummary

  • Unique, monthly statement with detailed accounting of medications and prescription costs.

  • Suggestions for cost savings, including less expensive medication alternatives, mail order.

  • Educational articles about relevant chronic conditions

  • Members approaching the coverage gap also receive outbound calls to better prepare financially.


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What You Should Know about the Enrollment Process

  • Sales Agent presentation with application

    • Paper application

    • Electronic enrollment using a digital signature

    • Telephonic enrollment

  • On-line application through our website – www.Humana.com

  • On-line application through the CMS at the Medicare website – www.Medicare.gov


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What You Should Know About Humana Sales Agents

  • All agents—both employed and independent--are state licensed, certified, registered and appointed.

  • All agents selling Medicare products required to attend sales and ethics training prior to the sale of our products.

  • Background check conducted on all agents appointed to sell Medicare products.

  • Required testing and certification for all agents prior to selling – initially and annually thereafter. Must sign Code of Conduct.

  • Allegations of agent misconduct or misrepresentation are thoroughly investigated pursuant to rigorous policies and procedures.

  • Agent conduct monitored. Consequences for founded violations of company policy and/or regulations can include disciplinary corrective action and contract termination.


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What You Should Know about the Sales Presentation

Sales presentation includes:

  • Specific plan information including all Humana MA, MAPD and PDP products

  • Full disclosure of all enrollment options

  • Marketing materials that follow CMS requirements; are filed and approved by CMS prior to their use

  • Information about enrollment considerations including a beneficiary needs analysis and suitability assessment

  • Enrollment applications clearly identify the type of product and product name

  • A non-sales associate-initiated telephonic or written verification process is conducted to determine the enrollee’s understanding of the product purchased


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Medicare Advantage Plan Options in [state]

Humana Gold Choice PFFS Low Option - Premium Range: $0

Primary Care Physician OV – $[15] copay

Specialty Physician OV - $[30] copay

Outpatient Hospital – [20%] coinsurance

Inpatient Hospital – $[550] per stay

Humana Gold Choice PFFS High Option - Premium Range: $20

Primary Care Physician OV – $[15] copay

Specialty Physician OV - $[30] copay

Outpatient Hospital – $[0-100] copay

Inpatient Hospital – $[180/day for days 1-5]

HumanaChoice Regional PPO - Premium $69

Primary Care Physician OV – $[10] copay for network / $[35] copay for non-network

Specialty Physician OV - $[30] copay for network / $[35] copay for non-network

Outpatient Hospital – $[50-95] copay for network / [30%] coinsurance for non-network

Inpatient Hospital – $[550] per stay for network / $[750-$800] per stay non-network*

* $[750] if pre-certified; $[800] if not pre-certified


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Humana Gold Choice Private-Fee-For-Service

Defining a Medicare Advantage Private Fee-For-Service (PFFS) Plan:

  • Includes the same basic Medicare Part A & B benefits and payments as Original Medicare; generally, lower out of pocket costs overall.

  • Unlike Original Medicare, it is administered by a private insurance company like Humana.

  • Usually includes value-added services that are not part of Original Medicare.

  • May have Part D Prescription Drug coverage included.


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More on Private Fee-For-Service

Plan and provider reimbursements:

  • Medicare pays Humana a monthly, fixed payment for each Medicare-eligible enrolled in the plan.

  • Humana then pays the doctor, hospital or other providers for services rendered to its members.

  • Humana’s PFFS plan pays 100% of Medicare allowable, less any applicable member copay or coinsurance amount.


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More on Private-Fee-For-Service

How does a PFFS plan work?

  • There is no doctor or hospital “network” or directory for medical care.

  • PFFS members, however, do receive a pharmacy directory and must use a network pharmacy to obtain prescription drugs.

  • Providers must be licensed and eligible to receive Medicare plan payments.

  • Providers must agree to Humana’s terms and conditions, including acceptance of payment from Humana and agreement not to balance bill patients for Medicare-covered services if accepting Medicare assignment.

  • Providers who don’t accept Medicare assignment may bill the patient up to the limiting charge.


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More on Private Fee-For-Service

What if a member finds his/her doctor or hospital does not accept Humana’s PFFS plan?

  • Physician and hospital participation is voluntary

  • Medicare beneficiaries are encouraged to contact their providers to determine if their doctors and hospitals accept or will accept Humana’s PFFS payment.

  • Humana provides outreach and education to help physicians and hospitals understand the PFFS billing process and how the plan works.

  • Members can request that a Humana Provider Relations Representative contact their health care providers to encourage their acceptance of the plan.


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Ongoing Dialogue

Establish an ongoing dialogue:

  • Updates on new information

  • Questions

  • Issue resolution

    Regulatory Compliance Contact:

    Sue Suchan

    Phone: [386] 676-1831

    Fax: [904] 376-7798 E-mail: ssuchan@humana.com

    Government Relations Contact:

    Harry Spring

    Phone: [850] 224-9996

    Fax: [850] 224-9998 E-mail: hspring@humana.com