© 2011 Coventry Health Care, Inc.CONFIDENTIAL

Broker/Agent Product Training

PersonalCare Insurance of Illinois

Medicare Advantage (MA) Coordinated Care Plans (CCP) 2012

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AGENDA

• Top Performers Presentation• 2012 Product Review• Servicing the Member• Servicing our Partners• Q & A Review

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Before we begin…

Reminders:

• Silence Your Phone

• Handling Questions

• Complete all 2012 Requirements PRIOR to Selling

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PERSONALCARE IS GOING…

GREEN!

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PersonalCare’s Value Proposition

• Local presence and understanding• National experience and infrastructure• Products that are relevant and valuable to

YOUR clients• High quality network• History of provider collaboration• Patient-centered care model & case

management• Local and personalized for both members AND

brokers• Fastest growing MAPD in our service area for

the past 3 years…and #1 in Coventry AEP sales 2011!

• 4-Star rated plans

2012 Product Information

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Service AreasService Areas2012 Counties:Adams, Boone, Brown, Champaign, Coles, Douglas, Marshall, McLean, Moultrie, Ogle, Peoria, Piatt, Sangamon, Stark, Stephenson, Tazewell, Vermillion, Winnebago, Woodford

Network Highlights*:Rockford Memorial & Swedish American Hospital (includes Coventry Total Care)

Freeport Memorial Hospital

Peoria Methodist Medical Center & Proctor Hospital

Pekin Memorial Hospital

BroMenn Hospital Bloomington

Advocate Eureka Hospital

Kirby Hospital Monticello

Provena Covenant and Carle Hospitals in Urbana

United Samaritan Medical Center

Sarah Bush Lincoln Health Center

Blessing Hospital Quincy

St. John’s Hospital & Memorial Medical Center in Springfield

* Service area network only

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Product Details - 2012Product Details - 2012

Benefit Original Medicare (2011) Advantra PPO Total Care HMO

Monthly Premium $96.40/$110.50 $13 $0

MOOP N/A$3,315 IN

$5,100 IN & OON $3,300

Inpatient Hospital

$1,100 for days 1-60 $275 for days 61-90 $550 for days 91-50

$180/day Days 1-10$0/day Days 11-90

$175/day Days 1-10$0/day Days 11-90$1,750 max/stay

Out-of-Network N/A 30% NONE

PCP 20% Coinsurance $10 $5

Specialist 20% Coinsurance $35 $25

Skilled Nursing$0 Days 1-20

$137.50 Days 21-100

$0 Days 1-20$117/day Days 21-48

$0 Days 49-100

$0 Days 1-20$100/day Days 21-53

$0 Days 54 -100

Outpatient Mental Health 40% Coinsurance $40 $40

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Product Details – 2012Product Details – 2012…continued…continued

Benefit Original Medicare (2011) Advantra PPO Total Care HMO

Preventive Services Annual Physicals 0 - 20% Coinsurance

$0 (office visit copay may apply)

$0 (office visit copay may apply)

Immunizations$0 Flu, Pneumonia

20% Hepatitis B$0 Flu, Pneumonia,

Hepatitis B$0 Flu, Pneumonia,

Hepatitis B

Gyn Exams

20% Coinsurance$0 Pap, Exam 20%

Coinsurance$0

Pap $0$0

Pap $0

Mammograms 20% Coinsurance $0 $0

Bone Mass 20% Coinsurance $0 $0

Colorectal & Prostate Screenings 20% Coinsurance $0 $0

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Product Details – 2012Product Details – 2012…continued…continued

Benefit Original Medicare (2011) Advantra PPO Total Care HMO

Outpatient Surgery 20% Coinsurance 20% Coinsurance 20% coinsurance

Urgent Care 20% Coinsurance $35 $35

ER20% Coinsurance for BOTH

Doctor and facility$65

Waived if admitted$65

Waived if admitted

X-Rays/DiagnosticRadiology/TherapeuticRadiology

20% Coinsurance fordiagnostic tests, x-rays,

diagnostic radiology

20% Coinsurance forx-ray

$150 copay fordiagnostic

20% Coinsurance forx-ray

$150 copay fordiagnostic

Labs 20% Coinsurance$20

$0 if preventive$10

$0 if preventive

Physical Therapy 20% Coinsurance $35 $25

Cardiac/PulmonaryRehab 20% Coinsurance $0 $0

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Product Details – 2012Product Details – 2012…continued…continued

Benefit Original Medicare (2011) Advantra PPO Total Care HMO

Diabetic Supplies 20% Coinsurance 20% Coinsurance$0 strips, shoes,

inserts

Vision 20% Coinsurance

$0 copay

$10-$35 for additionalservices

$0 copay

$5-$25 for additionalServices

ONE pair of glassesevery (2) years

Hearing 20% Coinsurance $35 copay $25 copay

Dental N/A

$0 copay includes:1 oral exam/year1 cleaning/year

1 x-ray/year

$500 annual limit

$35 copay forMedicare-covered

$0 copay includes:1 oral exam/year1 cleaning/year

1 x-ray/year

$500 annual limit

$35 copay forMedicare-covered

Fitness N/A Silver & Fit Silver & Fit

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Outpatient Rx Benefit Information

Part D Prescription Drug Plan included in all products! Still No deductible – first dollar coverage!

Tier 1: Preferred Generics with a 90-day supply available through

mail-order at discount

Tier 2: Generics with 90-day supply available through mail-order at discount

Tier 3: Non-Preferred Brand, Non-Preferred Generic with 90-day supply available

Tier 4: Specialty Drugs - Mail order not available for Tier 4

• Pharmacy network made up of over 60,000 contracted retail pharmacies across the United States. Large national and regional chains plus local pharmacies

• Pharmacy network includes:• Retail, Mail Order, LTC• Home Infusion• Indian Tribes and Tribunal Organizations and Urban Indian Organizations (I/T/U)

Product InformationProduct Information

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Outpatient Rx Benefit Information

Product InformationProduct Information

The OTC Medications we cover as part of Step Therapy with no

copay are as follows:

Loratadine, 10mg Tablets (Claritin)

Loratadine, 5mg/5ml Syrup

Loratadine-D, 12 Hour Tablets

Loratadine-D, 24 Hour Tablets

Cetirizine, 5 & 10 mg Tablets and Chewable Tablets (Zyrtec)

Cetirizine, 1 mg/ml Syrup

Cetirizine-D, 5mg, 12 Hour Tablets

Physician written prescription is needed for covered OTC drugs

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Product Details – 2012Product Details – 2012……RxRx

Benefit Original Medicare (2011) Advantra PPO Total Care HMO

Tier 1:Preferred Generic N/A

$5 copay$12.50 copay for 90

days through mail order

$5 copay$12.50 copay for 90

days through mail order

Tier 2:Preferred Brand Name N/A

$40 copay$90 copay for 90 days

through mail order

$40 copay$90 copay for 90 days

through mail order

Tier 3:Non-Preferred BrandNon-Preferred Generic N/A $80 copay $79 copay

Tier 4:Specialty N/A 33% Coinsurance 33% Coinsurance

Coverage Gap N/A

(On brand name drugs) 86% of

the plan’s costs for generic drugs

(On brand name drugs) 86% of

the plan’s costs for generic drugs

Outpatient Part B N/A 20% 20%

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PersonalCare’s Value Proposition- Product Design 2012

• PPO – Advantra Silver®

– Available in all 19 counties of the PersonalCare service area.

– Designed to give the most provider freedom available for those who need a wide network.

– Perfect for Medicare Supplement members who are tired of high premiums but want access freedom.

– Offers BOTH financial freedom AND protection.

– Everything in ONE package for one LOW price.

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PersonalCare’s Value Proposition- Product Design 2012

• HMO – Coventry Total Care®

– Available in Winnebago and Boone counties ONLY

– Partnership with SwedishAmerican Hospital.• Co-branded – Coventry Total Care (HMO): A

Partnership with Swedish American– Patient-centered care model/case

management • Primary Care Physician becomes the member’s

“Quarterback” of their health care team.– Designed to improve the overall quality and

efficiency of care received by the member.• i.e. – keep the member healthy• Improved efficiencies mean lower costs for the

member.

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PRODUCT INFORMATIONPRODUCT INFORMATIONValue Added

• PersonalCare is backed by the strength and stability of Coventry Health Care

• Designed to save money – compare us to a Medicare Supplement and see how much money can be saved!

• NO DEDUCTIBLES!

• Rx Coverage included

• Vision, Hearing, Fitness AND Dental!

• Coordination with Illinois CaresRx

• The AMA ranked Coventry #1 in the country in Claims Processing Accuracy in its 2010 and 2011 National Health Insurer Report Card (NHIRC)

• Our support to you and your clients…local plan staff with proven commitment to helping you grow your business and support your needs.

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Selling Medicare Advantage

When Comparing When Comparing PersonalCare to Other Plans…to Other Plans…

• APPLES to APPLES

• Do the Math – how do the premiums and main copays impact the prospect financially for the YEAR.

• Deductibles?

• Network comparison – HMO/PPO

• Financial protection?

Servicing the Member

Your Medicare Advantage Solutions

© 2011 Coventry Health Care, Inc.Y0022_2011_6002_092a_FINAL9 CMS Approval Date: 04/14/2011

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The use of Coventry’s Sales Presentation, including the notes section, is MANDATORY for all sales events involving Coventry products. This includes Face-to-Face Meetings and Marketing/Sales Seminars. Latest version dated 8.15.11

Display Recommendations• Sales Seminar: print copies without notes for audience, with notes for presenter.• Face-to-Face Meeting: Use the presentation in a flip chart format by placing thevisual slide facing the prospect and the notes facing the presenter (you).

Notes Pages Instructions•To view the notes pages go to the PowerPoint menu bar, click on "View," and select "Notes Page."•To print the PowerPoint so that it displays the notes, click on "Print" and on the bottom left you will see "Print What" with a drop down underneath. Select "Notes" and your print out will display both the slides and notes.

SERVICING THE MEMBERSales Presentation – How To Use

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• Do You Qualify?• Understanding Your Needs• Who We Are• How Medicare Works• Plan Benefits• Network• Member Rights/Responsibilities• Plan Value• Enrollment• What Happens Next (if you enroll)

SERVICING THE MEMBERSales Presentation - Agenda

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Physician number needed for ALL

HMO/HPN applications:

PCP ONLY

No Physician # = Pended App.

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Servicing The Member

Outbound Education and Verification Calls

What Happens After an application is submitted?

• A Coventry Health Care Representative will call your client within 10 days of receiving the completed Enrollment Form to:

1. Confirm their enrollment in the Coventry plan of their choice.

2. Review the plan rules and make sure they understand how their new plan works.

• Coventry Health Care will make three attempts to reach your client by phone. If we are unable to speak with them after the first attempt, they will receive a letter outlining the plan rules.

• Both the telephone calls and letters will cover the same information that your client has in their enrollment kit.

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Servicing The Member

• Customer Service is open…– 7 am – 7 pm Central, 7 days/week– Closed Holidays– Telephone number on back of ID Card – (866-784-4916)

• Customer Service for Rx (Medco) is open…– 24 hours/day, 7 days/week– Telephone number on back of ID Card

• We will have extended hours during 2012 AEP

• Website: www.coventry-medicare.com– My Online Services– Up-to-date provider directories– Current formularies

Member Resources

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Servicing The Member

• ID Cards will be mailed to the member’s home within 2 to 3 weeks of the date the application is received.NOTE: If a member requires assistance regarding their

membership/member ID, the member MUST call Member Services.

• New member kits will be mailed within 10 days of verification of eligibility by CMS. The new member kit contains:– Welcome letter.– Evidence of Coverage (gives members detailed information about the

plan’s policies, procedures and benefits).– Formulary drug list.– Other health-related informational flyers.– Does NOT include a provider directory. Please leave a provider directory

at the point of sale.

• Newsletters to help members learn how to use their plan, including education on specific health-related topics.

ID Cards and New Member Kits

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Servicing The Member

Appeals & Grievances

• The member's treating provider can make a coverage request by contacting the number on the back of the member's ID card (called an Initial Coverage Determination).

• An “appeal” is a type of complaint requesting us to reconsider and change a decision we have made about what services are covered for a particular member or what we will pay for (i.e. denied request for a Part D drug the member thinks should be covered, early discharge from the hospital, etc.).

• A “grievance” is a type of complaint the member can make if they have any other type of problem with Coventry Advantra or one of our plan providers (i.e. quality of care, accessibility issues, involuntary disenrollment, etc.).

• Detailed information on the initial coverage, appeal and grievance processes can be found in the member's Evidence of Coverage.

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www.BenefitsCheckUp.org/Coventry

One-stop resource for determining eligibility for programs that can help with all types of expenses, including health care,

prescriptions, taxes, utilities and more!

Servicing Our Partners

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Broker Servicing Department• A dedicated Broker Servicing

Department (BSD) in our operations department that will assist you with questions pertaining to:– Commissions / contracting questions,

including attestation– Broker portal, website support

• BSD Contact Information:– (866) 714-9301– Brokersupport@cvty.com– 7am–7pm Central Time, Monday-Friday

• Broker Portal: broker.cvty.com

Please check here regularly

for updated information

and resources

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Broker ResourcesCertification Process – Steps to become “Ready-to-Sell”

• Complete the online AHIP Medicare Marketing Training and Test– Minimum passing score is 90% within 3 attempts

• Successfully complete the Coventry Advantra CCP Overview Training and Test– Minimum passing score is 90% within 3 attempts

• Successfully complete the PersonalCare Specific PowerPoint and complete the online attestation.– No test component but you must attest that you reviewed the health

plan specific presentation for EACH Coventry plan you wish to sell.• Must have State appointment –each state where you are licensed.

(Illinois is not an appointment state.)• Must Have Errors & Omissions Insurance• New Agents: Complete your online Coventry “contract package”• Receive “Ready to Sell” notification from Coventry and your Agent

Writing Number (AWN) ID Card for the benefit year.

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• The beneficiary must agree to the scope of products to be presented to them prior to the appointment date.

• The agent must secure the Scope of Appointment documentation prior to the appointment. If it is not feasible for the scope of appointment form to be executed prior to the appointment, an agent may have the beneficiary sign the form at the beginning of the marketing appointment. However, CMS expects plans to record and maintain documentation on why it was not feasible to obtain the scope of appointment prior to the appointment.

• A new Scope of Appointment form is required if the beneficiary has requested to discuss another MA or PDP product type during a personal/individual appointment. However, a new appointment is not required. The additional product can be discussed as soon as the beneficiary request is documented.

• Per CMS< Agents cannot record Scope of Appointment. Only plan sponsors can record the Scope of Appointment.

• If the beneficiary requests another line of business to be discussed during a personal/ individual appointment (i.e., Med Supp, Long Term Care), agent may leave product information, excluding Enrollment Application, and a follow-up appointment cannot be scheduled until at least 48 hours after the initial appointment (cooling-off period).

• The Scope of Appointment form should be documented with a CMS-approved Scope of Appointment form (either model or non-model);

• Please include the completed scope of appointment form with the paper enrollment application when submitted to PersonalCare®.

Scope of Appointment

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Directories

•PPO Physician Directory

•PPO Facilities Directory

•HMO Physicians Directory

•HMO Facilities Directory

Forms

•2011 Disenrollment Form

•EFT Form

•LifeScan Form

•MEDCO Part D Reimbursement

•Member Designated Form

•Marketing Submission Form

•Scope of Appointment

Other Helpful Tools

•CCP Fax Cover Sheet

•FAQ

•Prior Authorization List

•Who To Contact

Sales Presentations

•Broker ONLY Version w/Notes

•Prospect Version

•PowerPoint for Group Settings

Tutorials and Procedures

•How to Use Apptracker

•Reading Your Commission Statements

•Seminar Cancellation Procedures

•Broker Training Presentation

Broker ResourcesTools at Your Disposal…

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• Monitor the release of new CMS regulations by signing up for the Federal Register List at http://www.gpoaccess.gov/fr/index.html.

• CMS marketing guidance can be found at http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp.

• Watch for Coventry bulletins that include new guidance such as any updates on Medicare Marketing Provisions. Once published, bulletins will be posted on the Broker Portal.

• Broker Portal

• Adhere to Coventry Sales Presentation

How do you stay informed as to what the rules are so that your marketing activities are in compliance with CMS?

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After Completion of Each Application

- Within 24 Hours -Coventry Advantra has made it easy to meet the 24 hour time restraint

Applications can be delivered to PersonalCare in the following ways:

1) ON-LINE: www.coventry-medicare.com (Select Enroll Now)Use CAPS & Tab Key

2) Fax: 866-669-23443) Deliver to PersonalCare Office: 2110 Fox Drive, Suite A Champaign4) Self-Addressed, postage-paid envelope from enrollment kit5) Scan and email application to IllinoisMAPDSales@cvty.com

IMPORTANT!

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PersonalCare Insurance of IllinoisMedicare Sales & Marketing Department

Medicare Sales Manager Broker SpecialistTodd Brooks Karen Bidner309-686-3861 (office) 866-765-7658 (office)309-791-2808 (cell) 217-552-9814 (cell)twbrooks@cvty.com kmbidner@cvty.com

Broker SpecialistAngela Hauser866-765-7658 (office)815-922-7577 (cell)ashauser@cvty.com

Coventry Local ResourcesCoventry Local Resources

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Q & AQuestions on:Questions on:- Scope Of Appointment?- SEP/ADP?- Premium Payment Methods- Referrals?- Member Materials (ID Cards, etc.)?- Marketing?- Seminars – Formal/Informal Sales Meetings

- Member Meetings- Diabetic Supplies/DME?- Getting Supplies?

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COMING 2012COVENTRY HEALTH CARE

OFILLINOIS

Same great company with a new name!

Thank you for attending the 2012Kick-Off Training Class!

Don’t Forget to make sure all Testing and Contracting has been

completed online!