Sierra Health and Life sierrahealthandlife

1. SIERRA OPTIMA Presented by”SIERRA HEALTH & LIFE INSURANCE COMPANY” Sierra Health and Life www.sierrahealthandlife.com

2. What is a Private-Fee-For-Service? • The Sierra Optima is a Medicare Advantage Plan where Medicare individuals can join and have access to any doctors, specialists and hospitals that accepts Medicare. October, 2006 1

3. Who can join the Sierra Optima Plan? • Must be enrolled in Medicare Parts A/B • ESRD (End Stage Renal Disease), individuals are not eligible to join. October, 2006 2

4. Is there Medical Underwriting? • This is a Medicare Advantage plan, and there is no Medical Underwriting. October, 2006 3

5. Does the Sierra Optima Plan include prescriptions? • The Sierra Optima plan does not cover prescriptions. • Members will be responsible for the 20% for drugs covered under Medicare Part B. (Original Medicare). • Members can elect the Sierra RX plan, or other PDP plans. October, 2006 5

6. Benefit Highlights October, 2006 7

7. Benefits Highlight Con’t October, 2006 8

8. Service Area (s) Refer to Plan Summary! October, 2006 9

9. Other Sierra Optima Plans Available! October, 2006 10

10. Marketing Guidelines: Background • The Centers for Medicare & Medicaid Services (CMS) established Marketing Guidelines. • Federal regulations • Current industry practices • Technology advancement • Interest in protecting Medicare beneficiaries. • Marketing Guideline apply to: • Medicare Advantage (MA) plans, • Medicare Advantage Prescription Drug (MA-PD) plans, • Prescription Drug Plan (PDPs). • Link to Medicare Marketing Guidelines: www.cms.hhs.gov January, 2007 11

11. Responsibility for Marketing the Sierra Plans • Plan sponsors are responsible for all of the marketing activities of third-parties contracted to carry-out Medicare health plan business including a person who is: • Is directly employed by the organization. • With which an organization contracts; and • A downstream marketing contractor. • If a state requires, plan sponsors must use only a state licensed, certified, or registered individual to perform marketing. October, 2006 12

12. Prohibited Marketing and Sales Activities • Claims of endorsement of Sierra Health & Life by CMS (Centers for Medicare and Medicaid Services). • Claims that CMS recommends enrollment. • Offers of gifts or payments to beneficiaries to influence enrollment. • Door-to-Door solicitation of members. • Alter in any fashion CMS approved materials. • Use of non-approved CMS materials. • Engaging in health screenings of prospective members. • Submission of fraudulent enrollment forms. • Solicitation of enrollment at healthcare delivery sites. • Selling leads. • Collecting enrollment applications at health fairs • Solicitation of enrollments from beneficiaries incompetent to complete and understand the Statement of Understanding from the enrollment form. October, 2006 13

13. Broker/Agent Training Updates • Broker/Agent training programs are frequently updated. • Plan sponsors often require brokers/agents to attend re-training sessions to remain certified. • Plan Sponsors: • Hold regular conference calls to reinforce information provided during training sessions, • Keep their brokers/agents informed of current issues, and; • Offer other avenues for brokers/agents to ask questions. October, 2006 14

14. Compliance with State Law • State marketing agent appointment laws do not apply to Medicare plans because the Medicare Marketing Guidelines address the use of marketing representatives. • A plan sponsor is required to use only a state licensed, registered, or certified individual to market a plan (if a state has such a requirement), CMS expects plan sponsors to comply with a reasonable request from a state insurance department (or other state department) October, 2006 15