Humana Confidenal Page 1 2018 Humana MAPD and PDP Plan Summary Nebraska Market Please note: The informaon included in this document is for training purposes only and is not approved for public distribuon. The following pages are summaries of the 2018 MAPD and PDP plan highlights. For more complete benefit informaon, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage. External Agent Version ALL 2018 PLANS ARE PENDING CMS APPROVAL. BENEFITS RELEASED 10/01/2017
Transcript
Humana Confidential Page 1
2018 Humana MAPD and PDP Plan Summary Nebraska Market
Please note: The information included in this document is for training purposes only and is not approved for public
distribution. The following pages are summaries of the 2018 MAPD and PDP plan highlights. For more complete
benefit information, please refer to the appropriate Summary of Benefits and/or Evidence of Coverage.
External Agent Version
ALL 2018 PLANS ARE PENDING CMS APPROVAL. BENEFITS RELEASED 10/01/2017
Humana Confidential Page 1
Nebraska
BIO Local Contact
I’m Sandy Robar, the Sales Manager for Humana in
South Dakota, Nebraska, and NW Iowa. I live in Sioux
Falls, SD, and have worked for Humana for ten years.
I work in conjunction with Todd Koland and Richard
Collier from the FMO channel, and Bryan Rizzo and
Courtney Sweet from the Independent channel.
We’re excited about the 2018 benefits and look for-
ward to doing business with you this AEP. I can help
you with items such as MAPA, provider look-up, cus-
tomer service, and supplies.
We are offering a new LPPO in SD that includes a
$3000 MOOP, $100 per admit hospitalization, $0 PCP,
and $25 Specialist. We have added Minnehaha in our
HMO footprint and reduced the PCP visit to $0 and
RX deductible to $150.00. One other new addition is
our DE-SNP HMO in Minnehaha County that will give
the member a potential $0 premium along with many
$0 copays for medical benefits.
This will be an excellent selling season; please contact
No premium, no referral required, dental, vision, hearing aid benefit, Go365 Rewards Program, silversneakers, OTC quarterly benefit
Highlights
Premium $0
Plan Deductible: $0
PCP copay $0
Specialist Copay $45
Inpatient Cost Share $350 copay/day Days 1-5
Outpatient Surgery $300—$450 copay
Part D Benefit
Tier 1: $0 (90 Day Supply via Humana Mail Order)
Tier 2: $0 (90 Day Supply via Humana Mail Order)
$150 RX Deductible Tiers 3, 4, 5 ($47/50%/30%)
NEW for 2018: lowered PCP copay to $0, lowered specialists to $45, removed referrals to see a specialist, lowered RX deductible $150 (tiers 3-5), lowered INP hospital to $350 days 1-5, added hearing aid benefit, add-ed 30 new counties to the service area in South Dakota (Minnehaha County) & Iowa
Key Selling Points
For Agent Training Use Only
2018 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits***
ALL 2018 PLANS ARE PENDING CMS APPROVAL. BENEFITS RELEASED 10/01/2017
Humana Confidential Page 5
Humana Gold Plus SNP-DE HMO Douglas County, NE
H0028-007
SERVICE AREA
NEBRASKA Douglas County
Robust Network, Preventive dental, No Referral required, Silversneakers, OTC
Highlights (All COPAYS & COINSURANCE IS BASED ON ASSISTANCE LEVEL)
Premium $0
PCP $0
Specialist $0 (NO REFERRAL REQUIRED—NEW FOR 2018)
Inpatient Cost Share $0
SNF $0 copay/day Days 1-20; $167.50 copay/day Days 21-100
Outpatient Surgery $0
Advanced Imaging $0
Plan Deductible Part B $183 (Depends on assistance level)
Part D Benefit Deductible may vary based on level of assistance
* $0 copay for 90 Day Supply of Tier I & II from Humana Pharmacy
Other Benefits: $35 OTC per quarter (3 months), 10 Well Dine meals after hospitalization, Nursing Hotline, Healthy rewards Incentive Program through GO365
Key Selling Points
For Agent Training Use Only
2018 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits***
ALL 2018 PLANS ARE PENDING CMS APPROVAL. BENEFITS RELEASED 10/01/2017
Humana Confidential Page 6
HumanaChoice LPPO
H5216-085
SERVICE AREA
NEBRASKA Cass, Dodge, Douglas, Lancaster, Sar-py, Saunders, Washington
IOWA Pottawattamie
Robust network, can use in or out of network benefits, silversneakers, GO365 rewards program , meal pro-gram for post hospitalizations
Highlights
Premium $110
Plan Deductible: $0
Inpatient Cost Share $454 copay/day Days 1-4
PCP Copay $15
Spec Copay $50
Outpatient Surgery In-Network $450/ Out of Network 50% of the cost
Part D Benefit
Tier 1: $0 (90 Day Supply via Humana Mail Order)
Tier 2: $0 (90 Day Supply via Humana Mail Order)
$399 RX Deductible Tiers 3, 4, 5 ($47/50%/30%)
Key Selling Points
For Agent Training Use Only
2018 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits***
ALL 2018 PLANS ARE PENDING CMS APPROVAL. BENEFITS RELEASED 10/01/2017
Humana Confidential Page 7
HumanaChoice MA Only LPPO
H5216-086 Service Area
NEBRASKA
Cass, Dodge, Douglas, Lancaster, Sarpy, Saunders, Washington
IOWA
82 counties
SOUTH DAKOTA
32 counties
Robust Network, Preventive dental, can use in or out of network benefits, Silversneakers, OTC
Highlights
Premium $0
Plan Deductible: $0
PCP $10
Specialist $45
MOOP $6700
Inpatient Cost Share $295/Day (1-6)
Outpatient Surgery In-Network $360/ Out of Network 50% of the cost
Advanced Imaging $300 Free Standing and $360 Outpatient Hospital
Other Benefits: $75 OTC per quarter (3 months), 10 Well Dine meals after hospitalization, Nursing Hotline, Healthy rewards Incentive Program through GO365
Key Selling Points
For Agent Training Use Only
2018 Plan Summary Outline ***Please refer to plan Summary of Benefits and EOC for full explanation of benefits***
ALL 2018 PLANS ARE PENDING CMS APPROVAL. BENEFITS RELEASED 10/01/2017
The Agent Retail Service Ops. Support mailbox has been created to support member escalations or issues that arise within a Humana enrollment post sale. The process is designed to create one avenue for you to get your questions answered related to “Medicare” or “Individual” members.
Agent Process
Send email to Agent Retail Service Ops. Support mailbox: [email protected]
Use template below to provide as much information as possible (including correct subject line).
If the request is unclear or insufficient, it may be returned with a request for additional details.
An acknowledgement email will be sent to the requestor advising that the issue is currently being reviewed. Additional updates will be sent to the sender throughout review period, until final resolution is confirmed. Unless otherwise advised, there will be an update sent every five business days.
Note:
Turnaround time will depend on resource availability and may change during peak business seasons.
All email responses will be sent secure so you will be required to create an account/login to see the response.
Agent Template
A standard Subject heading:
[Member Last Name], [Member First Name] [Medicare OR HumanaOne]
NOTE: do not send Medicare and Individual issues in the same email nor more than one issue per email.
The Body should include the following:
Agent Name: (Required)
Agent SAN: (Required)
Member ID #: (Required)
Member Name in question: (Required)
Reference #: (If applicable)
Summary of issue: (Required)
Issues that are out of Scope, and shouldn’t be sent to RSOS mailbox:
DE SNP—Stands for Dual Eligible Special Needs Plan. These plans can be sold to beneficiaries who are entitled to both Medicare A&B and certain levels of Medicaid. They will offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid.
Note: This is not a chronic SNP. Qualification for this plan is not derived from the beneficiary’s health.
Dual Eligible SNP JOB AID What is a DE SNP?
What makes a DE SNP different than a regular plan?
There are no co-pays, and extra benefits included. Please see plan document for full list.
What Medicaid levels qualify member for Humana DE SNP in SC?
Have member information ready: Either their Medicaid Member ID # or their SSN and DOB
Call Humana Agent Support at: 1-800-309-3163, and follow the prompts for Medicaid Eligibility Verification. Be sure the call rep gives you the actual level of eligibility (all numbers and letters), and then use the guide above to determine if their level of eligibility qualifies them to be placed on the DE SNP Plan.
How can you find out what level of Medicaid a member has?
QMB or QMB+
PCAT-32 QMB
PCAT-80 SSI
PCAT-32 (not listed as QMB) may possibly qualify but read the following note:
SPECIAL NOTE: If your member has a Medicaid eligibility level of PCAT-32 they may be able to be accepted into a Humana DE SNP Plan. Unfortunately, the only way to know if they qualify for the plan is to complete an application and submit it to Humana. At that time a special team manually checks the record to see if the member is able to be enrolled into the DE SNP plan. If they qualify they will be enrolled. If they do not, they will be sent a rejection letter.
This manual process can take up to two weeks to complete. Because of that, if you are in the second half of the month and your member has a PCAT-32 (not listed as QMB) eligibility level it may be in their best inter-est to first enroll them into a regular HMO plan (if it meets their needs, and their provider is in network). Submit that application, and wait at least a day (to ensure wires don’t get crossed in the Enrollment Dept.) and then take an application for the DE SNP and submit it. Following this process will ensure that even if the member is denied for the DE SNP they will at least have a plan (the regular HMO) at the start of the following month.
**For Agent Use Only, Not for Public Distribution**
Humana Confidential Page 16
Midwest South HMO Referral JOB AID
Referral/Authorization system sends notification to PCP of referral/
authorization to secondary specialist
Humana’s new Referral/Authorization System
PCP selects service to be rendered
Selects specialist from “preferred provider list”
If PAL applies—request routes to approval authority (e.g. CIT, MSO, Orthonet, etc.) PCP is advised.
Critical Elements of New Model
1.PCP retains oversight
2.PAL review/approval enabled
3.Specialists have some freedom to evaluate & treat
6.System tool simplifies creation of referral/authorization
Referral/Authorization sent to specialist
Referral/Authorization sent to secondary specialist
Diagnostic Center
Humana’s new Referral/Authorization System
Specialist selects service to be rendered
Selects secondary specialist from “preferred provider list”
If PAL applies—request routes to approval authority (e.g. CIT, MSO, Orthonet, etc.) Specialist is advised.
**For Agent Use Only, Not for Public Distribution**
Secondary Specialist
(same network)
Secondary Specialist
(diff. network)
Primary Care
Physician
Specialist
Referral Requirement - A referral from the member's Primary Care Physician must be obtained prior to member seeing an In-Network Specialist. Failure to obtain a referral prior to seeing a specialist will result in the member being responsible for the full costs of seeing the specialist. Refer to plan documents for further information.
