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2017 Utah Agent Training & Product Launch
2017 Utah Agent Training & Product Launch
We Are Here to Stay!!
#201 on the Fortune 500 List
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• National MP enrollment swells to over 12 million members
• Molina experiencing unprecedented growth from the ACA
– In 2015 we added over 750K members
• 450K from Medicaid expansion
• 250K from Marketplace growth – Molina one of the top
10 carriers in the country
• 60K growth from the Duals Demonstrations – Molina
the largest duals carrier in the country
– In 2016 we added 400k Marketplace members – Molina is
one of the top 5 carriers in the country
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Major Opportunity in Market Place
Molina Healthcare of Utah
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Molina Healthcare of Utah
Health Insurance Marketplace
3,314
2,078
871 747
0
500
1,000
1,500
2,000
2,500
3,000
3,500
SA
LT
LA
KE
UT
AH
DA
VIS
WE
BE
R
UT Enrollment by County
354
2,843
1,668
775 830
522
18 0
500
1,000
1,500
2,000
2,500
3,000
Bro
nze
Silv
er
100
Silv
er
150
Silv
er
200
Silv
er
250
Gold
Tribal
UT Enrollment by Plan
Molina Marketplace has
7,010 UT members as of
September 1, 2015.
Membership focus is the
Silver 100 plan and Silver
150 plan
2015 Utah Membership Data
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2016 Utah Membership Data
Molina an explosive 2016!
2016 Broker
Enrollment %
2015 Broker
Enrollments %
49% 29%
84% 88%
21% 16%
30% 18%
42% 19%
46% 14%
53% 17%
31% 19%
48% 26%
58% 27%
140661
Broker Non Broker Total
2495 3167
4134 11053 15187
30262 31017 61279
118768 21893
21154
3651 5096 8747
53341 63035 116376
22230 42424
263628 194253 457881
26009 22877 48886
6597 14557
State
CA
FL
MI
NM
20194
672
OH
TX
UT
WA
WI
Total
Molina’s Value Proposition Over the Competition
1. Maintain lowest priced plan in most of
our states.
2. Deductibles do not apply for MOST OP
Services on silver or gold plans.
3. Labs and Radiology services have
copays NOT Coinsurance
4. Molina does not require a PCP referral to
see a specialist
5. System enhancements to cut down on
broker time
My Molina (website for members)
Molina Healthcare Website (Has new
“Broker Feature”)
VUE Broker Portal
6. No Captive Sales Team
7. Strong broker support through our
dedicated broker support unit.
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2017 Molina Marketplace Product Designs
Molina will have 2 different Product Designs:
1. Marketplace Option Plans (Federal Standard)
2. Marketplace Consumer Choice Plans
Molina Marketplace 2017 Choice Plan Benefits At-A-Glance
2017 Molina Marketplace - Utah Choice &
Options
Bronze Silver 100 Silver 150 Silver 200 Silver 250 Gold
2017 MP ConsumerChoice 2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
Medical Deductible, Individual $6650
Combined Med/Rx
(Ded waived for Preventive
Services, Primary Care OV,
Other Practitioner OV, MH/SA
OV, Generic Drugs,
Preventive Drugs, Family
Planning, Pediatric Vision, and
Hospice.)
N/A
$500
(Applies to OP Facility and
IP services only)
$2275
(Applies to OP Facility and
IP services only)
$2400
(Applies to OP Facility and
IP services only)
$1025
(Applies to OP Facility and
IP services only)
Medical Deductible, Family
— Entire Family of 2 or more $13,300
Combined Med/Rx
(Ded waived for Preventive
Services, Primary Care OV,
Other Practitioner OV, MH/SA
OV, Generic Drugs,
Preventive Drugs, Family
Planning, Pediatric Vision, and
Hospice.)
N/A
$1000
(Applies to OP Facility and
IP services only)
$4550
(Applies to OP Facility and
IP services only)
$4800
(Applies to OP Facility and
IP services only)
$2050
(Applies to OP Facility and
IP services only)
Rx Deductible, Individual Included in
Medical deductible N/A N/A N/A N/A N/A
Rx Deductible, Family
— Entire Family of 2 or more Included in
Medical deductible N/A N/A N/A N/A N/A
OOPM, Individual $7,150 $1,250 $2,250 $5,700 $7,150 $7,150
OOPM, Family
— Entire Family of 2 or more $14,300 $2,500 $4,500 $11,400 $14,300 $14,300
EMERGENCY/URGENT SERVICES
Emergency Room
— Cost-sharing waived if admitted (Inpatient
cost-sharing applies).
$350 (after ded) ▲ $150 $205 $400 $400 $300
Urgent Care $75 (after ded) ▲ $15 $30 $60 $75 $60
OUTPATIENT PROFESSIONAL SERVICES ‡
Office Visit — Preventive Care
— Includes prenatal and first postpartum exam. No Charge No Charge No Charge No Charge No Charge No Charge
Office Visit — Primary Care $35 $0 $10 $20 $20 $15
Office Visit — Specialty Care $80 (after ded) ▲ $10 $30 $55 $55 $35
Office Visit — Other Practitioner Care $35 $0 $10 $20 $20 $15
Habilitative Services 40% (after ded) ▲ 10% 20% 30% 30% 20%
Rehabilitative Services
40% (after ded) ▲ 10% 20% 30% 30% 20%
Mental / Behavioral Health Services $35 $0 $10 $20 $20 $15
Substance Abuse Services $35 $0 $10 $20 $20 $15
Dental Services Related to Accidental Injury 40% (after ded) ▲ 10% 20% 30% 30% 20%
Molina Marketplace 2017 Choice Plan Benefits At-A-Glance
2017 Molina Marketplace - Texas
Choice & Options
Bronze Silver 100 Silver 150 Silver 200 Silver 250 Gold
2017 MP
ConsumerChoice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
2017 MP Consumer
Choice
Outpatient Professional & Facility
— OP Surgery
— OP Non-Surgical Services 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
Specialized Scanning Services (CT/PET Scan, MRI)
40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
Radiology Services (X-rays) $80 (after ded) ▲ $10 $30 $55 $55 $35
Laboratory Tests $35 (after ded) ▲ $10 $10 $35 $35 $15
Mental / Behavioral Health
— Outpatient Intensive Psychiatric Treatment Programs 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
INPATIENT HOSPITAL SERVICES
Medical / Surgical, Maternity, Mental/Behavioral
Health, Substance Abuse, Skilled Nursing Facility 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲
PRESCRIPTION DRUGS §
Tier 1 - Formulary Generic $33 $2 $5 $10 $10 $15
Tier 2 - Formulary Preferred Brand $65 (after ded) ▲ $15 $30 $55 $55 $50
Tier 3 - Formulary Non-Preferred Brand 50% (after ded) ▲ 20% 30% 40% 40% 30%
Tier 4 - Formulary Specialty (Oral & Injectable) 50% (after ded) ▲ 20% 30% 40% 40% 30%
Tier 5 - Formulary Preventive No Charge No Charge No Charge No Charge No Charge No Charge
ANCILLARY SERVICES
Durable Medical Equipment 40% (after ded) ▲ 10% 20% 30% 30% 20%
Home Healthcare
— Limit 20 visits per cal year. No Charge (after ded) ▲ No Charge No Charge No Charge No Charge No Charge
Emergency Medical Transportation
(Ambulance) 40% (after ded) ▲ 10% 20% 30% 30% 20%
OTHER SERVICES
Dialysis Services $80 (after ded) ▲ $10 $30 $55 $55 $35
Notes:
Green highlighting indicates that no Ded applies
▲Ded Applies. Ded is waived, except where indicated
‡ General Medical care provided by a Participating Provider
§Mail-order Rx drugs available for 2016 for tiers 1, 2, 3, and 5. For mail-order Rx, a 90-day supply is provided at twice the 30-day retail cost-sharing amount.
Referral vs. Authorization Referral • Molina Healthcare does not require referrals for contracted specialists. • In referring a patient, the PCP should forward pertinent member information and
findings to the specialist. • Some specialists may require referrals (however Molina does not)
Authorization • designed to assure the medical necessity of service, prevent unanticipated denials
of coverage, • ensure participating providers are utilized, and • all services are provided at the appropriate level of care for the member’s needs.
Notification • Notifications is required by Molina Healthcare for specified services as long as:
The requirement complies with Federal or State regulations, and the Molina Healthcare Hospital or Provider Services Agreement
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Pharmacy Highlights 1. New Mail Order Benefit
Improves affordability and access
Applies to Tiers 1,2,3, and 5
(Specialty Drugs excluded)
Easy On-line Ordering
2. Low Copay for Generics Removes financial barriers to care
3. Rx tier for Preventive Drugs
available at $0 copay Helps members know which
prescriptions are No Charge
4. New Expedited Review for Non-
Formulary Drugs Decision must be provided within 72
hours for standard requests and
within 24 hours for urgent requests
Improves member access to non-
formulary drugs
5. Prior authorization may be required
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Welcome to MolinaHealthcare.com
Ways to Pay MORE THAN 400
walk-in locations
statewide that
take CASH
To find a MoneyGram
location near you, Click
Here. Please take the
information below with
you to your MoneyGram
Location
Check MoneyGram
website for
acceptable payment
BILLER NAME : Molina
Healthcare of WI
Receive Code : 14360
No
feesWalk-in locations
nationwide
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Online Provider Search
www.molinahealthcare.com
or directly at
https://eportal.molinahealthcare.com/Provider/ProviderSearch?RedirectFrom=MolinaStaticWeb
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Provider Services - MarketPlace Provider Network
• University of Utah (4 Hospitals) 1,200 Physicians
• HCA/MountainStar
• Lakeview
• Lone Peak
• Mountain View - Payson
• Ogden Regional
• St. Mark’s
• Timpanogos
• Brigham Hospital
• IASIS
• Davis Hospital and Medical Center
• Jordan Valley Medical Center
• Jordan Valley West
• Mountain Point Medical Center
• Salt Lake Regional Medical Center
Hospital Network
Broker Portal
Broker Portal Log In
• Log in to VUE Broker portal (Password resets in 60 Days)
https://molina.vuesoftware.com/PORTAL.STS/Pages/_Default/Login.aspx
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Home Page:
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Book of Business: - Click the purple “Search” icon
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Health Sherpa Prospect Management HealthSherpa HealthSherpa link is for enrolling the new members
Marketplace Broker Support
Phone #: 1.855.885.3179 Broker Services - Option 1 • Provide Support and Education on:
– Agency/Agent Portal/Book of Business/Prospect Management/Direct Enrollment (DE)/SEP's (Special Enrollment Period)/CIC (Change in Circumstance)/Yearly Renewal enrollment submission
– Plan Benefit - all states - all metals
– Molina Website
• MyMolina
• Payment Options
• Provider Search
• Mobile Apps Commission Recon Team- Option 3 • Provides research and resolution to commission inquiries
• Provides research for missing clients from your Book of Business
• Processes Agent of Record Updates Contracting Inquiries - Option 4 • Agency Contracting
• Agent Onboarding
• Maintenance of E&O/Licenses/Yearly Certifications
[email protected] [email protected] [email protected]
Broker Support Unit “BSU Team”
Phone #: 1.855.885.3179 • CARE Team – Option 2 (Marketplace Broker Communication And Resolution Experts Team!)
• Access to Care
– If your Molina client is seeking immediate medical services and/or medications, you, the agent may contact the
MP CARE Team. (Please note: The CARE Team does not take member calls. Member should always reach
out to Member Services)
• Billing Issue:
– Invoice Regeneration
– Non-Applied Payment
– Refund
– Update Accounts/Receivable (A/R)
– Update Payment Application
– Binder Payment & Pending Termination Restriction Removal
• Enrollments:
– APTC Adjustment
– Eligibility
– Missing Dependent
– No Member profile
– Restriction Removal
– Voluntary Cancellation
Broker Support Unit “BSU Team”
My Molina
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© 2013 Molina Healthcare, Inc.
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© 2013 Molina Healthcare, Inc.
11111111
Mickey Mouse
11111111
Donald Duck
Daisy Duck
Daisy,
Marketplace Materials
Molina Marketplace – Co-Branded Collateral
Brochure
with BAAG
Benefits
At-A-Glance
Brochure with
Lead Card
Lead Card
2017 Open Enrollment Period
• Marketplace open enrollment dates:
November 1, 2016 – January 31, 2017
• Molina’s website www.MolinaHealthcare.com will provide 2017 plan information starting October 1, 2016
• Someone who enrolls by December 15, 2016 will have a January 1, 2017 effective date
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Questions
Broker Support Unit Phone #: 1.855.885.3179 (New number) Broker Services - Option 1 CARE Team- Option 2 Commission Recon Team - Option 3 Contracting Team – Option 4 [email protected] [email protected] [email protected] [email protected]
Contact information
Adam Grimaldo, Broker Channel Manager Phone: (818) 428-9205 Email: [email protected]
Customer Support Phone: (888) 295-7651
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