2020...Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare...

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2020 Medicare Product Portfolio

2020

1

TABLE OF CONTENTS

Agent Use Only. Proprietary and Confidential.

Allwell 2020 Medicare Product Portfolio

HIGHLIGHTS 2-3

CENTENE OVERVIEW 4-5

BROKER/AGENT SUPPORT 6

TRAINING AND CERTIFICATION 7

VALUE BASED ENROLLMENT 8-9

LEADERSHIP ALIGNMENT 10-11

LIS TIER INFORMATION 12

2020 MSP LEVELS 13

HIGHLIGHTS BY STATE:

ARIZONA 14

ARKANSAS 20

FLORIDA 26

GEORGIA 30

ILLINOIS 34

INDIANA 38

KANSAS 44

LOUISIANA 48

MISSISSIPPI 52

MISSOURI 56

NEVADA 60

NEW MEXICO 64

OHIO 68

PENNSYLVANIA 72

SOUTH CAROLINA 78

TEXAS 82

WISCONSIN 90

VENDOR INFORMATION 96-101

AGENT/BROKER CONTACT 102

2 Agent Use Only. Proprietary and Confidential.

2020 Product Highlight Overview2020 HIGHLIGHTS

Allwell is the Next Step in Medicare Coverage Your Medicare clients deserve coverage that meets their specific needs. They want a plan that helps them to live the best life they can and Allwell is the right plan to take them there. Allwell offers features such as a $0 monthly premium, comprehensive prescription drug coverage, and the option of dental and vision coverage, as well as many tailor-made health and wellness programs neatly wrapped into one package.

Allwell is a trusted health care partner in your community. By offering easy access to important benefits and provider network information, your clients are able to make their health and wellbeing a priority. Allwell’s healthy living programs assist in fostering healthy habits and exercise, adding an element of preventive care that helps your client remain happy, active and independent. Allwell is here to remove any worries your clients have about healthcare so that they can stay focused on what really matters, living the best lives they can.

Access to Health CareCaring for our members and their communities means being where they are. With the financial strength of our parent company Centene and the commitment of thousands of dedicated employees and partners, Allwell is able to create the local infrastructure needed to

better serve our members by providing access to quality personalized care in their community. Our extensive network of hospitals, primary care providers (PCPs) and specialty providers makes access to healthcare easy for your clients. We also provide in-home care, skilled nursing and, in some markets, 24-hour virtual visits.

Creating a Larger Network Centene is a leader in government-sponsored healthcare across all 50 states. We recognize that in order to better serve our members Centene must focus on continuous growth. With that in mind, Centene focuses on a combination of organic and acquisition based growth which has resulted in the creation of one of the industry’s premier healthcare organizations.

Healthcare in Your CommunityCentene’s core philosophy is that health care is best delivered locally – transforming the health of the community, one person at a time. With this in mind, when your clients choose Allwell they get access to community-based health care teams that can assist members long term with chronic conditions and also in the short term with their medical care. These teams can offer additional support with everything from education regarding healthy living to getting members to their doctor visits. It’s extra care on a local level.

3Agent Use Only. Proprietary and Confidential.

2020 HIGHLIGHTS

Help at HomeWhether helping through a member through a healing or providing assistance with everyday chores, Allwell works side-by-side with our members. Across all HMO plans Allwell offers home health services for members with certain conditions. Whether members need help around the house, bathing, exercising, or with their medications, our skilled aides will be there to assist in making members feel comfortable and cared for.

Supplemental Benefits*Vision Coverage

• Routine eye exams and eyewear allowances.

Dental Coverage

• Preventative Dental Services including oral exams, cleaning, and x-rays are offered a at low or $0 copay.

• Many plans offer additional comprehensive dental INCLUDING DENTURES, at no additional costs. Check plans for details

Over-the-Counter

• Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need either via mail or in-store.

Virtual Visits

• Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions.

Prescription Drugs

• Many of our Allwell plans offer low or $0 copays for tier 1 and 2 drugs which are the most commonly used drug tiers.

Wellness Programs

• $0 copay for Fitness program

• 24 hour nurse advice line

• Access to Personal Emergency Response System (PERS)

• Supplemental smoking and tobacco use cessations (counseling to stop smoking or tobacco use)

Allwell is proud to serve the Medicare community and you can be proud to represent Allwell. Together we can make healthcare a walk in the park for our seniors.

*Benefits are not offered by all plans. Members should check their plan-specific Evidence of Coverage or their Summary of Benefits for benefit offerings for their plan.


2020 Product Highlight Overview2020 HIGHLIGHTS

Centene Overview

Meet Centene

32 stateswith government sponsored healthcare programs and implementations

2 international markets

Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals.

~340 Product / Market Solutions

14.7M managed care members

15+M


CENTENE OVERVIEW

CENTENE OVERVIEW

Who We Are

#51 FORTUNE500 (2019)

#210 FORTUNE GLOBAL 500 (2018)

$14.8B in cash and investments

$60.1B revenue for 2018

48,100 employees

$72.8 - 73.6B 2019 expected revenues

#49 on FORTUNE 100Fastest Growing Companies (2018)

Centene is deeply committed to transforming the health of the community, one person at a time, by delivering results for our stakeholders: state governments, members, healthcare providers, uninsured individuals and families, and other healthcare and commercial organizations

CENTENE’S SUCCESS IS DRIVEN BY OUR COMMITMENT TO:

Focus on Individuals

Whole Health

Active Local Involvement

#43FORBESGlobal 2000:GrowthChampions (2018)


2020 Product Highlight Overview

BROKER/AGENT SUPPORT

CENTENE BROKER PORTALOnce registered and contracted, you have easy online access to the following:• Commission statements• Book of Business• Application status look-up• Training & recertification completion dates• Forms and brochure• View/print copies of member enrollment

applications

REGISTRATION:Centene distribution partners and brokers must be contracted prior to using the Broker Portal. Registering for the Broker Portal is a self-serve process that is simple and quick. Being a registered user provides easy access to pertinent information. The Broker Services Unit is available to support if assistance is needed.

2020Marketing CollateralPlease note: You may need to customize certain materials.

Agent Benefit Flyer

• 2020-HMO English Photo | English No Photo

• 2020 DSNP English Photo | English No Photo

Dental Benefits Flyer

• HMO Dental Benefits Flyer

• DSNP Dental Benefits Flyer

Event Benefit Flyers

• HMO-Event Benefits Flyer

• DSNP-Event Benefit Flyer

• Event Non-Benefit Flyer ALL English

• Event Non-Benefit Flyer ALL Spanish

• Veterans Event Flyer

Plan Highlights Brochure

• HMO Plan Highlights Brochure

• DSNP Plan Highlights Brochure

• 2020 HMO Medicare 101 Flyer

Seminar Flyer

• 2020 HMO Multi-Seminar Flyer

• 2020 HMO Seminar Flyer

• Seminar Flyer Spanish

• Med Options Seminar Flyer

• 2020 Allwell Sales Presentation Video (mp4)

• 2020 Allwell Sales presentation Slides (PDF)


Training and Certification

Access to aDiscounted Rate

of $125

(instead of $175 full price)

Completing your 2020 AHIP Certification Trainingthrough the AllwellTraining Site will provide youwith a couple ofunique opportunities:

Reimbursement Qualifications:

• Complete 2020 AHIP Training through the Allwell Training Site

• Or submit a receipt as proof of payment of 2020 AHIP fees paid

• Must have a minimum of 5 new sales with an 1/1/2020 effective date that remain enrolled through 3/31/2020

• Must be certified and contracted to sell 2020 Allwell MA plans

Qualify forFULL REIMBURSEMENT

of 2020 AHIP Certification Training fees

(paid after meeting a few key requirements)

Allwell Training Site Link:https://allwell.cmpsystem.com

Only 1 Allwell Product Exam for all states!

2020 AHIP TrainingAvailable 6/17/2019

2020 Allwell TrainingAvailable 7/9/2019

Allwell Training Site Allwell Certification Training Allwell State Attestation



VALUE BASED ENROLLMENT PROGRAMENROLLMENT PROCEDURES

Value Based Enrollments

What is a Value Based Enrollment (VBE)?The Value Based Enrollment Program launched by Centene is a quick and easy process to helpgather health-related information and provide a smooth transition of care to your Medicare beneficiaries.

Why conduct a Value Based Enrollment?Value Based Enrollment allows you to support and facilitate a smooth onboarding experience for the beneficiary. It encourages a proactive beneficiary approach to healthcare through scheduling of their wellness visit and by allowing plans to learn more about the beneficiary’s needs.

Who can conduct a Value Based Enrollment?Only approved agents that have received access to Centene’s required Ascend technology platform can facilitate a Value Based Enrollment. The Ascend technology allows sales agents to submit an enrollment application and facilitate a Value Based Enrollment.

How does it work?After submitting an electronic enrollment application, the Ascend technology allows the sales agent to immediately connect the Medicare beneficiary with a plan Wellness Advocate to initiate the gathering of some health-related information and to schedule the enrollee’s Wellness Visit with their physician. Once the VBE call is initiated, the agent isrequired to leave.

Related Administration Fee to Sales AgentsAs a result, sales agents will receive a $50 administration fee for each VBE that is distinctly separate from the sales commission and associated CMS commission guidelines. This administration fee is in compliance with CMS requirements and is intended to encourage sales agents to facilitate the smooth transition of new enrollees. Value Based Enrollment will help ensure that the health care needs of new members are met.


ENROLLMENT PROCEDURES

Enrollment Mechanisms for AgentsThe following options are available for agents to submit plan enrollment applications.

Paper Enrollment Forms – Included in pre-enrollment kits and available for download from plan websites.

Agent Assisted On-line Enrollment – Available on the plan website, simply select, “How to Enroll”, select “Apply Now” for the desired plan and follow the prompts for an agent assisted online enrollment.

Ascend Electronic Enrollment – Ascend is now available in many of our regions and is a fast, easy and compliant way for agents to submit agent-assisted electronic and telephonic enrollments. Ascend highlights include:› Validates important data to help prevent incorrect or missing information.› Links to the provider directory and formularies to validate physician and prescriptions availability.› Scope of appointments can be documented electronically. Verify that the status is “Accepted” prior to

proceeding with the appointment.› Ascend is also the only option available for submitting Value Based Enrollments (VBEs) which allow

agents to earn an additional $50 administrative fee per enrollment!



2019 Medicare Sales Expanded National Alignment Map

Region 1 Sean Casler

Region 2Nicole Marrazzo

Region 5Don Hansford

Region 6Shaun Johnson

Region 3William Johnson

Ryan ButterfieldNational Medicare Broker Channel

Leadership Alignment


2019-2020 National Medicare Broker Channel Alignment Map

Chris Murray Ray BurrOpen Position

Ryan ButterfieldNational Medicare Broker Channel

Guy MaesStrategic Alliances and Call Centers

Leadership Alignment



LIS TIER DESCRIPTIONDrug Tier Tier Description Co-Payment and/or Co-insurance

1 Preferred Generic Drugs

$0 copay****$0 copay until total drug costs reach $4,020 and after out-of-pocket expenses reach $6,350After total drug costs reach $6,350: LIS 1 $3.60LIS 3 $0 copay, orLIS 2 $1.30LIS 4 15% of the total cost

2 Generic Drugs

LIS 3 $0 copay, orLIS 2 $1.30, orLIS 1 $3.50, orLIS 4 15% of the total cost

3 Preferred Brand Drugs

LIS 3 $0 copay, orLIS 2 $3.90, orLIS 1 $8.95, orLIS 4 15% of the total cost

4 Non-Preferred Drugs

LIS 3 $0 copay, orLIS 2 $1.30, or $3.90, orLIS 1 $3.60, or $8.95, orLIS 4 15% of the total cost

5 Specialty Tier

LIS 3 $0 copay, orLIS 2 $1.30, or $3.90, orLIS 1 $3.60, or $8.95, orLIS 4 15% of the total cost

6 Select Care Drugs

$0 copay**$0 copay until total drug costs reach $4,020 and after out of-pocket expenses reach $6,350. This does not apply to allplans. For generic drugs included in the Medicare Adherence Measures:LIS 3 $0 copayLIS 2 $0 copayLIS 1 $0 copayLIS 4 $0 copay


2020 MSP LEVELS

2020 MSP LEVELS

State2020

Contract2020 PBP

2020 Segment 2020 - Plan Type 2020 CSNP/DSNP Type Q

MB

QM

B+

SLM

B

SLM

B+

FBD

E

QD

WI

QI

AZ H5590 008 000 HMO MA-PD DSNP Non-Zero Dollar X X X

FL H5190 001 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X




GA H7173 001 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X

IN H3499 005 000 HMO MA-PD DSNP Zero-Dollar X X X X

KS H6550 004 000 HMO MA-PD DSNP Zero-Dollar X X X

LA H5117 004 000 HMO MA-PD DSNP Zero-Dollar X X

LA H5117 005 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X

MO H1664 005 000 HMO MA-PD DSNP Zero-Dollar X X

MS H9811 006 000 HMO MA-PD DSNP Zero-Dollar X X

MS H9811 007 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X

NM H2134 001 000 HMO MA-PD DSNP Zero-Dollar X X X

OH H0908 001 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X

PA H2915 001 000 HMO MA-PD DSNP Zero-Dollar X X X



SC H1436 005 000 HMO MA-PD DSNP Zero-Dollar X X

TX H5294 002 003 HMO MA-PD DSNP Zero-Dollar X X X





WI H8189 001 000 HMO MA-PD DSNP Zero-Dollar X X X


ARIZONA

1. Cochise 2. Gila 3. Graham 4. Greenlee 5. La Paz 6. Maricopa

= DSNP

= MAPD

= DSNP & MAPD

= DSNP, MAPD & CSNP

7. Pima 8. Pinal 9. Santa Cruz 10. Yavapai 11. Yuma

= New Counties*

*

1

2

3

4

5

6

7

8

9

10

11


ARIZONA


Market Highlights: • 5th largest MAPD plan

by market share, fastest growing DSNP in AZ; $0 premium plan; 3.5 Star Rating Plan(s)

RX Highlights: • No deductible and low

copays for Tier 1 and Tier 2, the most commonly used drugs

- Tier 6 $0 copay Rx

• Tier 1 & 2 coverage with 90% of generic claims on these tiers

• 8 of the top 10 most used generics are in Tier 1

Providers:• Very strong Network across

the Market; Comprehensive hospital network

Allwell Healthcare Experience:Dental Coverage

· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay

· Many plans offer additional comprehensive dental benefits for a low monthly premium

Over-the-Counter

· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail

Virtual Visits

· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions

Prescription Drugs

· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers

· Tier 6 Select Care Drugs at a $0 copay

Wellness Programs

· $0 copay for Fitness program

· 24 hour nurse advice line

· Chiropractic care

· Supplemental smoking and tobacco use cessations (counseling to

stop smoking or tobacco use)



Parent Organization: Arizona Complete Health

Medicare Product Highlights 2020

Product Type (HMO, PPO, Etc) Allwell Dual Medicare DSNP

CountiesCochise, Gila, Graham, Greenlee, La PazMaricopa, Pima, Pinal, Santa Cruz, Yuma

State/Plan/PBP AZ-H5590-008

Premium Part B Giveback

Total Premium (Part C and D) $0

In-Network Plan Deductible $0

Maximum Out of Pocket (MOOP) $6,700

Inpatient Hospital - Acute $0

PCP Office Visists $0 Copay

Specialist Office Visits $0 Copay

Over-the-Counter Items $200 Quarterly

Medically Necessary Transportation 16 one way trips

Fitness Membership Unlimited visits to Silver & Fit

Dental Benefits $3,000 Max

Vision Benefits $250 Max Benefit

Hearing Benefits $0-$1,350 (2 Aids)

Rx Deductible $0 (cost share with LIS/Medicaid is $0-$8.95)

Deductible Tiers

Tier 1: Preferred Generic Preferred Generic: $0 to $8.95

Tier 2: Generic Generic: $0 to $8.95

Tier 3: Preferred Brand Preferred Brand: $0 to $8.95

Tier 4: Preferred Drug Preferred: $0 to $8.95

Tier 5: Specialty Tier Specialty Tier: $0 to $8.95

Tier 6: Select Care Drugs Select Care Drugs: $0 to $8.95

Laboratory Services

X-Ray Services $0


ARIZONA


Product Type (HMO, PPO, Etc) Essentials HMO HMO HMO

Counties Maricopa, Pinal Pima Pima

State/Plan/PBP H5590-005-000 H9287-001-000 H0351-044-001

Premium Part B Giveback $0 $0 $0

Total Premium (Part C and D) $0 $0 $33

In-Network Plan Deductible No Deductible No Deductible No Deductible

Maximum Out of Pocket (MOOP) $3,400 $3,400 $6,700

Inpatient Hospital - AcuteDays 1-8: $180 Copay per dayDays 9-90: $0 Copay per day

Days 1-6: $175 Copay per day Days 7-90: $0 Copay per day


PCP Office Visits $0 $0 $0

Specialist Office Visits $15 $25 $50

Over-the-Counter Items $60 Quarterly $20 Per Month $60 Quarterly

Medically Necessary Transportation

Not Covered 16 one-way trips 16 one-way trips

Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit

Dental Benefits Allwell Enhanced OSB-$24 Allwell Total OSB-$27 Allwell Totalplus OSB-$32

Vision Benefits $100 Max $100 Max $250 Max

Hearing Benefits $0-$1,350 (2 Aids) Not Covered Not Covered

Rx Deductible No Deductible No Deductible $200

Deductible Tiers No Deductible No Deductible Tiers 3-5

Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $3

Tier 2: Generic Generic: $15 Generic: $7 Generic: $15

Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37 Preferred Brand: $37

Tier 4: Preferred Drug Preferred: $90 Preferred: $90 Preferred: $90

Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 29%

Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0

Laboratory Services $10 to $25 Copay $0 to $25 Copay $0 to $25 Copay

X-Ray Services $10 to $75 Copay $0 to $75 Copay $0 to $25 Copay





Product Type (HMO, PPO, Etc) HMO Essentials II HMO HMO

CountiesCochise,

Santa Cruz (New County)Maricopa, Pinal Maricopa, Pinal

State/Plan/PBP H0351-044-002 H0351-050 H0351-051


Total Premium (Part C and D) $68 $0 $38.60



Inpatient Hospital - AcuteDays 1-5: $360 Copay per day Days 6-90: $0 Copay per day



PCP Office Visits $5 Copay $0 $0


Over-the-Counter Items $60 Quarterly $60 Quarterly $60 Quarterly


16 One-Way Trips Not covered Not covered


Dental Benefits Allwell Totalplus OSB-$32 Allwell Totalplus OSB-$32 Allwell Total OSB-$27


Hearing Benefits Not Covered $0-$1,350 (2 Aids) $0-$1350 (2 Aids)

Rx Deductible $200 $50 No Deductible

Deductible Tiers Tiers 3-5 Tiers 3-5 No Deductible




Tier 4: Non-Preferred Drug Non Preferred: $90 Non Preferred: $90 Non Preferred: $90



Laboratory Services $0 to $20 Copay $10 to $25 $0

X-Ray Services $0 to $20 Copay $10 to $75 $0



ARIZONA


Product Type (HMO, PPO, Etc) HMO Essentials I HMO CSNP

Counties Yuma, Yavapai (new county)Cochise, Maricopa, Pinal, Santa Cruz, Yuma, Pima

Maricopa, Pinal

State/Plan/PBP H5590-004 H5590-007 H0351-038


Total Premium (Part C and D) $28 $30.90 $0




$1,000 per admission Days 1-10: $205 Copay per day

PCP Office Visits $0 $5 $0


Over-the-Counter Items $60 Quarterly Not Covered $75 Quarterly


16 One-Way Trips 16 One-Way Trips 16 One-Way Trips


Dental BenefitsBuilt in Preventative

only $1,000 MaxAllwell Wellbeing OSB-$22 Allwell Total OSB-$27

Vision Benefits Not Covered Allwell Wellbeing OSB-$22 $250 Max

Hearing Benefits Not Covered Not Covered Not Covered






Tier 4: Non-Preferred Drug Non Preferred Brand: $90 Non Preferred: $100 Non Preferred: $90



Laboratory Services $10 to $25 $20 $0 to $25 Copay

X-Ray Services $25 $25 $0 to $75 Copay



ARKANSAS

1. Baxter 2. Benton 3. Boone 4. Carroll 5. Clark 6. Clay 7. Cleburne 8. Conway 9. Craighead 10. Crawford 11. Cross 12. Franklin 13. Faulkner 14. Fulton 15. Garland

= MAPD

= New Counties

16. Hot Spring 17. Greene 18. Independence 19. Izard 20. Jackson 21. Johnson 22. Lawrence 23. Logan 24. Lonoke 25. Madison 26. Marion 27. Mississippi 28. Newton 29. Perry 30. Poinsett

31. Pope 32. Prairie 33. Pulaski 34. Randolph 35. Saline 36. Scott 37. Searcy 38. Sebastian 39. Sharp 40. Stone 41. Van Buren 42. Washington 43. White 44. Woodru� 45. Yell

*

12 34

5

6

7

8

9

10

11

12

14

13

16

17

15

18

19

2021

22

23

24

25

26

27

3031

32

28

33

2936

37

38

34

39

40

35

41

42

43 44

45

*

*

*

*

*

*

*

*

*

*

*

*

* **

**

*

**

*

*


ARKANSAS


Market Highlights: • H9630-001; 002; Most

popular plan the last 2 years in Arkansas. Strongest network. $0 premium. Strong local support team

• H9630-003: Strong additional benefits, slightly smaller network locally with access to statewide network outside of these 2 counties

• H9630-AA6: New plan to the market for 2020, great option in existing markets for those who want additional benefits and are willing to pay a premium for them

RX Highlights: • Tier 2 is $0 copay if ordered

by mail order. Tiers 1 and 6 $0 copay-most commonly used maintenance drugs. Deductible only applies to Tiers 4 & 5

Providers:• Most comprehensive

network of all plans in Arkansas. 95% of providers are participating




• Delta Dental is used for Arkansas Dental Services

Over-the-Counter


• All Arkansas plans use Walmart for their OTC Benefits with a debit card

Virtual Visits


Prescription Drugs

· Many of our Allwell plans offer $0 deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers


Wellness Programs









Product Type (HMO, PPO, Etc) HMO HMO

Counties

Benton, Carroll, Crawford, Franklin, Logan, Madison, Scott, Sebastian,

Washington, Clay, Cleburne, Cross, Fulton, Indepencence, Izard, Jackson,

Johnson, Lawrence, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph,

Searcy, Sharp, Stone, Van Buren, White, Woodruff, Yell

Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Pope,

Pulaski, Saline

State/Plan/PBP AR-H9630-001-000 AR- H9630-002-000

Premium Part B Giveback $0 $0

Total Premium (Part C and D) $0 $0

In-Network Plan Deductible $0 $0

Maximum Out of Pocket (MOOP) $5,900 $6,700

Inpatient Hospital - AcuteDays 1-6: $328 Copay per day

Day 7+: $0 Copay per dayDays 1-6: $328 Copay per day

Day 7+: $0 Copay per day

PCP Office Visists $0 $0

Specialist Office Visits $40 $40

Over-the-Counter Items $50 Quarterly $50 Quarterly

Medically Necessary Transportation Not Covered Not Covered

Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit

Dental Benefits Preventive Only $1,000 Max

Vision Benefits $200 Max $200 Max

Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)

Rx Deductible $250 $250

Deductible Tiers Tiers 4-5 Tiers 4-5

Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0

Tier 2: Generic Generic: $8 Generic: $8

Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47

Tier 4: Non-Preferred Drug Non Preferred: $100 Non Preferred: $100

Tier 5: Specialty Tier Specialty Tier: 28% Specialty Tier: 28%

Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0

Laboratory Services $0 $0

X-Ray Services $0 $0

Parent Organization: Arkansas Health and Wellness


ARKANSAS



Counties Benton, Washington Baxter, Boone, Marion

State/Plan/PBP AR-H9630-003-000 AR- H9630-004-000






Day 7+: $0 Copay per dayDays 1-6: $328 Copay per day

Day 7+: $0 Copay per day






Dental Benefits $1,000 Max $500 Max




Deductible Tiers No Deductible Tiers 4-5




Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100










Counties Baxter, Boone, Marion

Benton, Carroll, Crawford, Franklin, Logan, Madison, Scott, Sebastian, Washington,Clay, Cleburne, Cross, Fulton, Indepencence, Izard,

Jackson, Johnson, Lawrence, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph, Searcy, Sharp, Stone, Van Buren, White,

Woodruff, Yell

State/Plan/PBP AR- H9630-005-000 AR- H9630-AA6-000


Total Premium (Part C and D) 21.50 $19.50




Day 7+: $0 Copay per dayDays 1-6: $328 Copay per day Day 7+ : $0 Copay per day






Dental Benefits $1,500 Max $1,000 Max















ARKANSAS

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FLORIDA

1. Broward 2. Duval 3. Hillsborough 4. Miami-Dade 5. Orange 6. Osceola

= DSNP

= DSNP & MAPD

7. Palm Beach 8. Pinellas 9. Pasco 10. Polk 11. Seminole 12. Volusia

1

2

3

9

4

34

45

5

6

7

810

55

11

12


FLORIDA


Market Highlights: • Duval $75.00 Part B Giveback

on MAPD

• $3000 dental on DSNP

• $0 , $0 , $0 cost share

• Large Medicaid and Commercial business that has natural progression into our Medicare Product

• Great Dental and Vision and OTC benefits with Extensive Networks

RX Highlights: • $0 cost share for Tier 1 and 6

and some tier coverage during gap

Providers:• Large hospital network

• Duval – Memorial hospitals, Family Care Partners Risk Partner

• Jaycare

• IMA

• Premier Physicians - MSO

• Access/CMG

• Tampa Family Health Centers

• Orlando Family Physicians


· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at $0 copay

Over-the-Counter

· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need either via mail or in-store

Prescription Drugs

· Many of our Allwell plans offer $0 deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers.


Wellness Programs









Product Type (HMO, PPO, Etc) DSNP DSNP DSNP DSNP

Counties Duval, Volusia

Hillsborough, Orange, Osceola, Palm Beach, Pasco , Pinellas, Polk,

Seminole

Broward Miami-Dade

State/Plan/PBP FL-H5190-001 FL-H5190-002 FL-H5190-003 FL-H5190-004

Premium Part B Giveback $0 $0 $0 $0

Total Premium (Part C and D) $30.30 $30.30 $30.30 $30.30

In-Network Plan Deductible No Deductible No Deductible No Deductible No Deductible

Maximum Out of Pocket (MOOP) $3,400 $3,400 $3,400 $3,400

Inpatient Hospital - AcuteDays 1-90:

$0 Copay per dayDays 1-90:



$0 Copay per day

PCP Office Visists $0 Copay $0 Copay $0 Copay $0 Copay

Specialist Office Visits $0 Copay $0 Copay $0 Copay $0 Copay

Over-the-Counter Items $100 Monthly $100 Monthly $100 Monthly $100 Monthly


Unlimited Unlimited Unlimited Unlimited

Fitness MembershipUnlimited visits to

Silver & FitUnlimited visits to



Silver & Fit

Dental Benefits $3,000 Max $3,000 Max $3,000 Max $3,000 Max

Vision Benefits $350 Max $350 Max $350 Max $350 Max

Hearing Benefits $0 (2 Aids) $0 (2 Aids) $0 (2 Aids) $0 (2 Aids)

Rx Deductible $415 $415 $415 $415

Deductible Tiers Tiers 3-5 Tiers 3-5 Tiers 3-5 Tiers 3-5

Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $0

Tier 2: Generic Generic: $0 Generic: $0 Generic: $0 Generic: $0

Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47

Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100

Tier 5: Specialty Tier Specialty Tier: 25% Specialty Tier: 25% Specialty Tier: 25% Specialty Tier: 25%

Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0

Laboratory Services $0 $0 $0 $0

X-Ray Services $0 $0 $0 $0

Parent Organization: Sunshine Health Plan


FLORIDA


Product Type (HMO, PPO, Etc) HMO HMO HMO HMO

Counties Duval Miami-Dade Broward Palm Beach

State/Plan/PBP H9276-002 H9276-004 H9276-012 H9276-021

Premium Part B Giveback $75.00 $0 $0 $0

Total Premium (Part C and D) $0 $0 $0 $0

In-Network Plan Deductible No Deductible No Deductible No Deductible No Deductible

Maximum Out of Pocket (MOOP) $6,700 $3,400 $6,700 $6,700

Inpatient Hospital - Acute





PCP Office Visists $0 $0 $0 $0

Specialist Office Visits $40 $0 $10 $40

Over-the-Counter Items $35 Monthly $100 Monthly $80 Monthly $40 Monthly


30 one way trips 30 one way trips 30 one way trips 30 one way trips

Fitness MembershipUnlimited visits to




Silver & Fit

Dental Benefits $500 Max $1,000 max $1,000 max $500 Max

Vision Benefits $100 Max $350 Max $250 Max $150 Max

Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1580 (2 Aids)

Rx Deductible No Deductible No Deductible No Deductible No Deductible

Deductible Tiers No Deductible No Deductible No Deductible No Deductible

Tier 1: Preferred Generic Preferred Generic: $10 Preferred Generic: $10 Preferred Generic: $10 Preferred Generic: $10

Tier 2: Generic Generic: $20 Generic: $20 Generic: $20 Generic: $20

Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47

Tier 4: Non Preferred Brand Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100

Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 33%

Tier 6: Select Care Drugs: $10 Select Care Drugs: $10 Select Care Drugs: $10 Select Care Drugs: $10

Laboratory Services $0 to $100 $0 to $50 $0 to $100 $0 to $150

X-Ray Services $0 to $100 $0 to $50 $0 to $100 $0 to $150

Parent Organization: Sunshine Health Plan


GEORGIA

= DSNP

= DSNP & MAPD= New Counties*

1. Butts 2. Chattahoochee 3. Clayton 4. Cobb 5. Dawson 6. DeKalb 7. Douglas

8. Fayette 9. Forsyth 10. Fulton 11. Greene 12. Gwinnett 13. Harris 14. Heard

15. Henry 16. Lumpkin 17. Marion 18. Morgan 19. Muscogee 20. Oconee 21. Paulding 22. Pickens

23. Rabun 24. Rockdale 25. Spaulding 26. Taliaferro 27. Towns 28. Troup 29. Union 30. White

*

*

*

*

*

22

29 27

3016

5

9

720

11 262438

14

28

1525 1

13

17192

18

21 4

10 612

23


GEORGIA


Market Highlights: • $30 Part B Give back

available in the Metro Atlanta Area

• Hearing and Vision Benefits available on all products

• Worldwide Emergency coverage available on select products

RX Highlights: • $0 cost share on Tier 1 and 6

• Mail order is available

Providers:• Emory, Grady, Columbus

Regional, WellStar




Over-the-Counter


Virtual Visits


Prescription Drugs



Wellness Programs









Product Type (HMO, PPO, Etc) DSNP

CountiesButts, Chattahoochee, Clayton, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton,

Greene, Gwinnett, Harris, Heard, Henry, Lumpkin, Marion, Morgan, Muscogee, Oconee, Paulding, Pickens, Rabun, Rockdale, Spalding, Taliaferro, Towns, Troup, Union, White

State/Plan/PBP H7173-001

Premium Part B Giveback $0

Total Premium (Part C and D) $24.10

In-Network Plan Deductible No Deductible


Inpatient Hospital - Acute Days 1-90: $0 Copay per day

PCP Office Visists $0

Specialist Office Visits $15


Medically Necessary Transportation 24 -One way trips



Vision Benefits $250 Max

Hearing Benefits $0 (2 Aids)

Rx Deductible $345

Deductible Tiers Tiers 2-5

Tier 1: Preferred Generic Preferred Generic: $0

Tier 2: Generic Generic: $7

Tier 3: Preferred Brand Preferred Brand: $47

Tier 4: Non-Preferred Drug Non-Preferred: $100

Tier 5: Specialty Tier Specialty Tier: 26%

Tier 6: Select Care Drugs Select Care Drugs: $0

Laboratory Services $0

X-Ray Services 20%

Parent Organization: Peach State Health Plan


GEORGIA


Product Type (HMO, PPO, Etc) HMO HMO HMO

Counties

Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett,

Harris, Henry, Morgan, Muscogee, Oconee, Paulding,

Rockdale, Spalding, Troup

CobbDeKalb, Fulton, Greene,

Gwinnett, Muscogee

State/Plan/PBP H7173-002-000 H7173-008 H7173-007-000








PCP Office Visists $0 $0 $10


Over-the-Counter Items $70 Quarterly $60 Quartely $30 Quartely

Medically Necessary Transportation 10 one way trips Not Covered Not Covered


Unlimited visits to Silver & Fit

Unlimited visits to Silver & Fit

Dental Benefits $1,500 Max $1,500 Max $2,000 Max


Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)






Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $96



Laboratory Services $0 to $30 $0 $0 to $20

X-Ray Services $0 $0 $40

Parent Organization: Peach State Health Plan


ILLINOIS

1. Cook 2. Kane 3. Will

= MAPD Counties

21

3


ILLINOIS


Market Highlights: • Strong 4.0 Star Plan offerings

and over 30 years in the market

• Now one plan for all three counties to include low $2,700 MOOP

• $0 Premium plan with comprehensive dental embedded!

RX Highlights: • No deductible and low copays

for Tier 1 and Tier 2, the most commonly used drugs



Providers:Cook and Will Counties• U of Chicago Med Center

• Northshore

• Adventist Lagrange Memorial

• Methodist Hospital of Chicago

• Mount Sinai

• Norwegian American Hospital

• Oak Street Health Clinic

• Paios Community Hospital

• St Anthony Hospital

• Swedish Covenant

• Presence (St E’s campus, St Mary, St Joseph, Resurrection Medical Center, Presence St Joe’s, and St Francis)

Kane County• Presence Mercy Med Ctr

• Provena Health

• St Joseph Hospital




Over-the-Counter


Virtual Visits


Prescription Drugs

· Many of our Allwell plans offer $0 deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers


Wellness Programs









Product Type (HMO, PPO, Etc) HMO

Counties Cook, Kane, Will

State/Plan/PBP IL- H1475-001

Premium Part B Giveback N/A









Is this non medical Transportation? If so, Not covered


Dental Benefits $1000 Max Benefit

Vision Benefits $350 Max Benefit

Hearing Benefits $0-$1,580

Rx Deductible $0

Deductible Tiers N/A




Tier 4: Non-Preferred Drug Non-Preferred Drug: $85




X-Ray Services $0-$25

Parent Organization: Illinicare Health Plan


ILLINOIS

NOTES: ___________________________________________________________________________________________________________

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INDIANA

1. Allen 2. Boone 3. Delaware 4. Elkhart 5. Hamilton 6. Hancock 7. Hendricks 8. Howard 9. Johnson 10. Lake 11. LaPorte 12. Madison

= DSNP, MAPD & PPO

13. Marion 14. Porter 15. Posey 16. St. Joseph 17. Shelby 18. Tippecanoe 19. Tipton 20. Vanderburgh 21. Warrick 22. Wells 23. Whitley

10

188

123

6137

9 17

20 2115

19

52

22

23 1

14 1116 4


INDIANA


Market Highlights: • Very attractive $4,500

MOOP. 0/0/0/0 (Premium/PCP/Tier 1 and Tier 6 Rx) Added transportation benefits and added comprehensive dental as an OSB! Top plan on Medicare Plan Finder in 2019!

• Very attractive $5,500 IN/$9,000 OON MOOP. Top 3 on Planfinder in 2019, NEW!-copayments for OON PCP and Specialist

• Very attractive $4,100 MOOP on HMO-002

• Strong benefits, including: OTC benefit, transportation, meals, comprehensive dental

RX Highlights: • Many of our Allwell plans

offer $0 deductible and low copays for Tier 1 and 6 drugs which are the most commonly used drug tiers

Providers:• IU Health, Community

Health Network, Suburban Health Organization

• Elkhart Clinic, Beacon, Lutheran, LaPorte and Porter hospitals

• Deaconess




· To enhance the embedded Medicare benefits we offer an Optional Supplemental Benefit rider to our HMO and PPO. The OSB cost for both plans is a mere $12.80.

Over-the-Counter

· All Plans in Indiana offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail

Virtual Visits

· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions. Virtual Visits are not offered on DSNP

Prescription Drugs

· Many of our Allwell plans offer $0 deductible and low copays for Tier 1 and 6 drugs which are the most commonly used drug tiers


Wellness Programs










Counties

Allen, Boone, Delaware, Elkhart, Hamilton, Hancock, Hendricks,

Howard, Johnson, Lake, LaPorte, Marion, Madison, Porter, Posey, Shelby, St. Joseph, Tippecanoe, Tipton, Vanderburgh, Warrick,

Wells, Whitley

State/Plan/PBP IN-H3499-005-000


Total Premium (Part C and D) $31.80*







Medically Necessary Transportation 50 One-Way Trips





Rx Deductible $160









X-Ray Services $0

Parent Organization: Coordinated Care Corporation

* The member is not responsible for the $31.80 premium.


INDIANA



Counties

Existing: Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Marion, Madison, Shelby, Tippecanoe,

Tipton, Consolidation: Posey, Vanderburgh, Warrick

Existing: Allen, Elkhart, St. Joseph, Wells, Whitley Consolidation: Lake, LaPorte, Porter

State/Plan/PBP IN-H3499-001-000 IN-H3499-002-000





Inpatient Hospital - AcuteDays 1-6: $295.00 Copay per day Days 7-90 $0.00 Copay per day

Days 1-6: $295.00 Copay per day Days 7-90 $0.00 Copay per day




Medically Necessary Transportation 30 One-Way Trips 30 One-Way Trips


Dental Benefits $1,000 Max** $1,000 Max**



Rx Deductible $200 No deductible

Deductible Tiers Tiers 4-5 No deductible








X-Ray Services $0-$35 $0-$25

**Dental benefits on both HMO’s are OSB. This is an optional add on for a premium and not included in the base HMO.




Product Type (HMO, PPO, Etc) PPO PPO

CountiesBoone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Marion, Madison, Shelby, Tippecanoe, Tipton

Allen, Elkhart, St. Joseph, Wells, Whitley
















Rx Deductible $200 No deductible

Deductible Tiers Tiers 4-5 No deductible







Laboratory Services $5-$15 $5


Parent Organization: Coordinated Care Corporation

**Dental benefits on both HMO’s are OSB. This is an optional add on for a premium and not included in the base PPO.


INDIANA


Product Type (HMO, PPO, Etc) PPO PPO

Counties Posey, Vanderburgh, Warrick Lake, LaPorte, Porter
















Rx Deductible No deductible No deductible

Deductible Tiers No deductible No deductible









**Dental benefits on both HMO’s are OSB. This is an optional add on for a premium and not included in the base PPO.


KANSAS

1. Allen 2. Butler 3. Bourbon 4. Cherokee 5. Crawford

= DSNP & MAPD

6. Douglas 7. Harvey 8. Johnson 9. Leavenworth 10. Linn

= New Counties* 11. Miami 12. Sedgwick 13. Sumner 14. Woodson 15. Wyandotte

14 1 3

512

7

13

2

4

11

10

6 8

9

*

* **

*

*

15


KANSAS


Market Highlights: • $0 Premium with a $5,000

MOOP; $3,400 for D-SNP

• $0 PCP Visits

• $0 Labs

• $0 Diabetic Supplies

• Preventive Dental

• $0-$1580 Copay for Hearing Aids

• $50-$325 OTC Benefit/Quarter

• A big benefit highlight for Kansas is QMBs will be excepted for our DSNP Plan

• Silver and Fit Gym Benefit

And

• Chiropractic visits per year: 6 visits for HMO MAPD 001 & 12 visits for HMO D-SNP 004; 003 follows Medicare-covered services

• Transportation - 24 one way trips; D-SNP only

• Meals – 2 per day/14 days

• Dental benefits - $1,000 HMO MAPD-$2,000 HMO D-SNP, including dentures

• Vision Benefit - $100 for HMO MAPD-$450 for HMO D-SNP including eyewear

RX Highlights: • $0 Rx Deductible, $0 Tier 1 Rx

copay,$0 Tier 6 Rx copay

Providers:• Large Provider Network,

including University of Kansas Health System




Over-the-Counter


Prescription Drugs



Wellness Programs










CountiesJohnson, Leavenworth, Miami, Wyandotte

Douglas, LinnAllen, Bourbon, Cherokee, Crawford,

Sedgwick, Sumner, Woodson

State/Plan/PBP KS-H6550-001 H6550-003














Hearing Benefits $0 to $1,580 (2 Aids) $0 to $1,580 (2 Aids)

Rx Deductible No Deductible No Deductible

Deductible Tiers No Deductible No Deductible







Laboratory Services $0 to $10 $0 to $10


Parent Organization: Sunflower Health Plan


KANSAS



CountiesAllen, Bourbon, Butler, Cherokee, Crawford, Douglas, Harvey, Johnson,

Leavenworth, Linn, Miami, Sedgwick, Sumner, Woodson Wyandotte

State/Plan/PBP H-6550-004














Rx Deductible $205









X-Ray Services $0

Parent Organization: Sunflower Health Plan


LOUISIANA

1. Acadia 2. Ascension 3. East Baton Rouge 4. Iberville 5. Je�erson 6. Lafayette

= DSNP

= MAPD

= DSNP & MAPD= New Counties

7. Livingston 8. Orleans 9. Pointe Coupee 10. St. James 11. St. Landry12. St. Martin

*

13. St. Tammany 14. Tangipahoa 15. Washington 16. West Baton Rouge

11 9 14

15

13

12

73

16

1 6 4 2

1048 8

5

* *


LOUISIANA


Market Highlights: • $0 premium in St. Tammany

• Top plan in Tangipahoa

• Very competitive plan design

• Plan for Full Duals- QMB, QMB+ only

• Plan for Partial duals

RX Highlights: • No deductible, zero copay

Tiers 1 and 6

• Over 3,000 maintenance drugs covered on Tier 6 at $0 copay

• Wide network of pharmacies

• LIS Level will dictate copays

Providers:• Baton Rouge Clinic in

network

• Strong relationships with FQHC’s

• LHCC well known in market

• Solid network




Over-the-Counter


Prescription Drugs

· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers.


Wellness Programs









Product Type (HMO, PPO, Etc) DSNP DSNP

CountiesAscension, E. Baton Rouge, W. Baton Rouge,

Livingston, Pointe Coupee, Tangipahoa, Washington, St. Tammany, Jefferson, Orleans

Ascension, E. Baton Rouge, W. Baton Rouge, Livingston, Pointe Coupee, Tangipahoa,

Washington, St. Tammany, Jefferson, Orleans

State/Plan/PBP LA- H5117-004 LA-H5117-005



In-Network Plan Deductible $0 Medicare Defined Part B


Inpatient Hospital - Acute $0 Days 1-8: $75 Copay per day Days 9-90: $0 Copay per day





Fitness Membership Unlimited Visits to Silver & Fit Unlimited Visits to Silver & Fit



Hearing Benefits $0 (2 Aids) $0 (2 Aids)






Tier 4: Non-Preferred Drug Non-Preferred Drug: $100 Non-Preferred Drug: $100





Parent Organization: Louisiana HealthCare Connections


LOUISIANA



CountiesAcadia, Lafayette, St. Landry, St. Martin, Ascension, East Baton Rouge, Iberville), Livingston,

Pointe Coupee, St. James, Tangipahoa, Washington, West Baton Rouge, St. Tammany

State/Plan/PBP LA- H5117-003-000

Premium Part B Giveback N/A






Specialist Office Visits $40 copay



Fitness Membership Unlimited Visits to Silver & Fit


Vision Benefits $ 200 max


Rx Deductible $0

Deductible Tiers No Deductible




Tier 4: Non-Preferred Drug Non-Preferred Drug: $90




X-Ray Services $40

Parent Organization: Louisiana HealthCare Connections


MISSISSIPPI

1. DeSoto 2. George 3. Hancock 4. Harrison 5. Hinds 6. Jackson 7. Lafayette

= MAPD

= DSNP & MAPD

= New Counties

8. Madison 9. Panola 10. Rankin 11. Stone 12. Tate

*

1

9 7

8

105

34 6

11 2

12

*


MISSISSIPPI


Market Highlights: • H9811-AA7: Partial dual plan.

Transportation, hearing, dental, OTC all included.

• H9811-006: Full dual plan. QMB, QMB+ only. Strong benefit design

• H9811-001, 005: Dental added at $0 premium

RX Highlights: • H9811-AA7, 006: LIS Level

will dictate copays

• H9811-001, 005: $0 copay for Tiers 1 & 6. Most common maintenance medications in these tiers

Providers:• H9811-AA7, 001 and 00:

Solid network, addition of Memorial on the coast

• H9811-005: Baptist System in network including Memphis



Over-the-Counter


Virtual Visits


Prescription Drugs



Wellness Programs










CountiesGeorge , Harrison, Hinds, Jackson, Madison , Rankin, Stone, Hancock

George, Harrison, Hinds, Jackson, Madison, Rankin, Stone, Hancock

State/Plan/PBP MS-H9811-006-000 MS-H9811-007-000


Total Premium (Part C and D) $26.90 $25

In-Network Plan Deductible $0 Standard Medicare Part B










Hearing Benefits $0-$1,580 (2 Aids) $0- $1,350










X-Ray Services 20% $10

Parent Organization: Magnolia Health Plan


MISSISSIPPI



CountiesGeorge, Harrison, Hinds, Jackson, Madison, Rankin, Stone, Hancock

DeSoto, Lafayette, Panola, Tate

State/Plan/PBP MS-H9811-001-000 MS-H9811-005-000














Hearing Benefits Not Covered Not Covered











Parent Organization: Magnolia Health Plan


MISSOURI

1. Barry 2. Cass 3. Christian 4. Clay 5. Crawford 6. Dallas 7. Franklin

= DSNP & MAPD= New Counties

8. Greene 9. Jackson 10. Jasper 11. Je�erson 12. Laclede 13. Lawrence 14. Lincoln

*

15. McDonald 16. Newton 17. Platte 18. Polk 19. St. Charles 20. St. Louis 21. St. Louis City

22. Stone 23. Taney 24. Warren 25. Washington 26. Webster 27. Wright

17 4

9

2

10

16

15

13

1

18

8

2

23

26 27

126

11

255

7

14

24 1920

22

21* *

*

*

**



Market Highlights: • We’re expanding into 6 new counties

including St. Louis City and County with lower MOOPs and cost sharing. We added gap coverage for T1 & T6 and comprehensive dental coverage to all plans. We eliminated deductibles on Part D in all markets

• When we get the opportunity, we’re selling in Jasper, Newton, McDonald counties due to having strong networks in these areas

• DSNP opportunities love that the Comprehensive Dental benefit includes dentures! Excited about PERS system as well

• We’ve had constant positive feedback about our Member Services team providing excellent service to our members!

RX Highlights: • Many of our Allwell plans offer $0

deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers

· Tier 6 Select Care Drugs at a $0 copay.

• $0 on Tier 1 and Tier 6 at preferred pharmacies (this includes our gap coverage) and $0 Tier 2 copays at Mail-order

Providers:• Mercy Health Systems, Freeman Health

Systems, Ozark Community Hospital, Select Specialty Hospital, Citizen’s Memorial Hospital, Cass Regional Medical Center, Belton Regional Medical Center, Truman Hospital, Lee’s Summit Medical Center, SSM Health System, Saint Luke’s Des Peres Episcopal Presbyterian and more…



· All Missouri plans offer additional comprehensive dental benefits

Over-the-Counter


Virtual Visits


Wellness Programs



· Chiropractic care (MAPD Only)

· Supplemental smoking and tobacco use cessations (counseling to stop smoking or tobacco use)

• Additional DSNP benefits: PERS, non-emergency

transportation

MISSOURI





Counties

Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson,

Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, Warren,

Washington, Webster, St. Louis, St. Louis City, Stone, Taney, Wright

State/Plan/PBP H1664-005-000


Total Premium (Part C and D)$0 or $32

Based on member’s level of eligibility.








48 One-Way Trips





Rx Deductible $0, $89 or $250 Based on member’s level of eligibility









X-Ray Services $0

Parent Organization: Home State Health Plan


MISSOURI


Product Type (HMO, PPO, Etc) HMO HMO HMO

Counties

Barry, Christian, Dallas, Greene, Jasper, Laclede,

Lawrence, McDonald, Newton, Polk, Webster, Stone, Taney,

Wright

Cass, Clay, Jackson, Platte

Crawford, Franklin, Jefferson, Lincoln, St. Charles, Warren,

Washington, St. Louis City, St. Louis

State/Plan/PBP H1664-001-000 H1664-002-000 H1664-004-000



In-Network Plan Deductible $0 $0 $0


Inpatient Hospital - AcuteDays 1-5: $300 copay per day Days 6-90: $0 copay per day

Days 1-6: $300 copay per day Days 7-90: $0 copay per day

Days 1-7: $275 copay per day Days 8-90: $0 copay per day





Not Covered Not Covered Not Covered


Dental Benefits $1,000 Max $1,000 Max $1,000 Max


Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)

Rx Deductible No Deductible No Deductible No Deductible

Deductible Tiers No Deductible No Deductible No Deductible







Laboratory Services $0 to $35 $0 $0 to $30

X-Ray Services $0 to $35 $50 $0 to $30

Parent Organization: Home State Health Plan


NEVADA

1. Clark 2. Nye

= MAPD= New Counties*

*

*

2

1


NEVADA


Market Highlights: • New Market Opportunity with

Allwell; Strong Network, Rich Benefits, an MAPD HMO plan under two strong networks





Providers:• Strong Network of Drs —

associated with P3 and USHS



· Comprehensive Dental, Vision, Meals, Fitness, Hearing and more included

Over-the-Counter

· Plan offers a competitive quarterly OTC benefit.

Virtual Visits


Prescription Drugs



Wellness Programs










Counties Clark, Nye






Inpatient Hospital - Acute Days 1-6: $0 Copay per dayDays 7-90: $0 Copay per day









Rx Deductible No Deductible









X-Ray Services $0

Parent Organization: Silver Summit


NEVADA

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NEW MEXICO

1. Bernalillo 2. Cibola 3. Dona Ana 4. Luna 5. McKinley

= DSNP= New Counties*

*

6. San Juan 7. Sandoval 8. Santa Fe 9. Torrance 10. Valencia

6

75

10

12

8

9

34

*

**

* *

*


NEW MEXICO


Market Highlights: • Considered new Market Plan

(2nd year), Very Rich benefits, Western Sky Community Care and Allwell DSNP awarded Medicaid & DSNP Contracts by the State of New Mexico





Providers:• Strong provider network


· Very Competitive Preventive & Comprehensive Dental Benefits

Over-the-Counter

· Competitive Quarterly OTC benefit

Virtual Visits


Prescription Drugs



Wellness Programs




· Supplemental smoking and tobacco use cessations (counseling to stop smoking or tobacco use)

• Transportation benefits





CountiesBernalillo, Cibola, Dona Ana, Luna, McKinley, San Juan, Sandoval,

Santa Fe, Torrance, Valencia

State/Plan/PBP NM-H2134-001



In-Network Plan Deductible No deductible


Inpatient Hospital - Acute Days 1-6: $0 Copay per dayDays 7-90: $0 Copay per day





Fitness Membership Unlimited visits to Silver and Fit



Hearing Benefits 2 Hearing Aids Per Year

Rx Deductible No deductible after cost share


Tier 1: Preferred Generic Preferred Generic: $0-$3.80

Tier 2: Generic Generic: $0-$3.80

Tier 3: Preferred Brand Preferred Brand: $0-$8.50

Tier 4: Non-Preferred Drug Non-Preferred: $0-8.50

Tier 5: Specialty Tier Specialty Tier: $0-$8.50



X-Ray Services $0

Parent Organization: Western Sky Community Care


NEW MEXICO

NOTES: ___________________________________________________________________________________________________________

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OHIO

1. Adams 2. Allen 3. Ashland 4. Ashtabula 5. Auglaize 6. Brown 7. Butler 8. Carroll 9. Champaign 10. Clark 11. Clermont 12. Clinton 13. Columbiana 14. Coschocton 15. Crawford

16. Cuyahoga 17. Darke 18. De�ance 19. Delaware 20. Erie 21. Fair�eld 22. Fayette 23. Franklin 24. Fulton 25. Geauga 26. Greene 27. Guernsey 28. Hamilton 29. Hancock 30. Hardin

= DSNP

= DSNP and MAPD

= MAPD

= New Counties*

31. Harrison 32. Henry 33. Highland 34. Hocking 35. Holmes 36. Huron 37. Jackson 38. Je�erson 39. Lake 40. Logan 41. Lorain 42. Lucas 43. Madison 44. Mahoning 45. Medina 46. Meigs

47. Mercer 48. Miami 49. Monroe 50. Montgomery 51. Morgan 52. Morrow 53. Noble 54. Ottawa 55. Paulding 56. Perry 57. Pickaway 58. Pike 59. Portage 60. Preble 61. Putnam 62. Sandusky

63. Seneca 64. Shelby 65. Stark 66. Summit 67. Trumbull 68. Tuscarawas 69. Van Wert 70. Vinton 71. Warren 72. Wayne 73. Williams 74. Wood 75. Wyandot

DSNP only: MonroeJacksonJe�ersonDarkeAshland

73 24 4254

20 4116

39 4

25

6759664536

62

63

75 15 3 72

35

65

44

13

8

743218

55

692

47

1748

50

919

23

2157

10

1228

1122

43

34

4637

70

58

26

1

33

6

7 71

60

5

64 40

30

52

1468

27

4951

5356

3138

61 29

*

*

*

*

*


OHIO


Market Highlights: • Strong product, robust

network, backed by Centene, dedicated agent force, experienced management team. DSNP takes Full and Partial Duals, $0 premium plan, $1,000 built in comprehensive dental

• For 2019 there are four HMO’s and for 2020 three of the four are being cross walked into one and we are adding a great Veterans play with a MA only which will cover the same territory as the HMO (22 counties)

RX Highlights: • $50 deductible and $0 copays

for tiers 1 and 6

• $125 deducible and $0 copays for tiers 1 and 6

Providers:• Comprehensive hospital

network



Over-the-Counter

· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need either via mail or in-store

Prescription Drugs



Wellness Programs









Product Type (HMO, PPO, Etc) DSNP HMO

Counties

Adams, Allen Ashland, Ashtabula, Auglaize, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana,

Coschocton, Crawford, Cuyahoga,Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Fulton, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson,

Lake, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan,

Morrow, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Sandusky, Seneca, Shelby,

Stark, Summit,Trumbull, Tuscarawas, Van Wert, Vinton, Warren, Wayne, Williams, Wood, Wyandot

Butler, Columbiana, Cuyahoga, Delaware, Franklin, Farirfield, Fulton,

Greene, Hamilton, Lake, Lorain, Lucas, Mahoning, Montgomery,

Ottawa, Stark, Summit, Trumbull, Wood

State/Plan/PBP H0908-001-000 H-0724-001


Total Premium (Part C and D) $0 - $31.60* $0

In-Network Plan Deductible No Deductible $0





Over-the-Counter Items $60 Monthly $60 Quarterly

Medically Necessary Transportation 50 One-Way Trips Not Covered




Hearing Benefits $0 (2 Aids) $0-$1,580 (2 Aids)











Parent Organization: Buckeye Health Plan

* Depending on what MSP level and what LIS Tier depends what you will pay. Most Medicaid recipients will pay $0


OHIO

Parent Organization: Buckeye Health Plan



Counties

Butler, Columbiana, Cuyahoga, Delaware, Fairfield, Franklin, Fulton, Greene,

Hamilton, Lake, Lorain, Lucas, Mahoning, Montgomery, Ottawa, Stark, Summit,

Trumbull, Wood







PCP Office Visists $0 copay

Specialist Office Visits $35 copay


Medically Necessary Transportation Not Covered

Fitness Membership Unlimited visits to Silver and Fit


Vision Benefits $100 max

Hearing Benefits Not Covered

Rx Deductible Not Covered

Deductible Tiers Not Covered

Tier 1: Preferred Generic Not Covered

Tier 2: Generic Not Covered

Tier 3: Preferred Brand Not Covered

Tier 4: Non-Preferred Drug Not Covered

Tier 5: Specialty Tier Not Covered

Tier 6: Select Care Drugs Not Covered

Laboratory Services $0 copay

X-Ray Services $0-$25


PENNSYLVANIA

1. Adams 2. Allegheny 3. Armstrong 4. Beaver 5. Bedford 6. Berks 7. Blair 8. Bradford 9. Bucks 10. Butler 11. Cambria 12. Cameron

= DSNP

= DSNP & MAPD

= New Counties

13. Carbon 14. Centre 15. Chester 16. Clarion 17. Clear�eld 18. Clinton 19. Crawford 20. Cumberland 21. Dauphin 22. Delaware 23. Elk 24. Erie

25. Fayette 26. Forest 27. Franklin 28. Fulton 29. Greene 30. Huntingdon 31. Indiana 32. Je�erson 33. Juanita 34. Lackawanna 35. Lancaster 36. Lawrence 37. Lebanon

*

*

38. Lehigh39. Luzerne 40. Lycoming 41. McKean 42. Mercer 43. Mi�in 44. Monroe 45. Montgomery 46. Northampton 47. Perry 48. Philadelphia 49. Pike 50. Potter 51. Schuykill

52. Snyder 53. Somerset 54. Sullivan 55. Susquehanna 56. Tioga 57. Union 58. Venango 59. Warren 60. Washington 61. Wayne 62. Westmoreland 63. Wyoming 64. York

*

*

*

*

***

*

***

*

*

*

*

*

**

*

*

*

1959 41 5650 8 55

61

3463

3944

544018

122326

5842

36 10

16

3

3217

14 57 13

51 4638

9

45

6

221535

3721

52

47

3343

641

20

27

30

71131

28553

62

2

4

60

2529

49

24

48*

*

*

*

*

*

*

*

*

*

*


PENNSYLVANIA


Market Highlights: • Expansion into 30

Counties

• $0 Premium / $0 PCP copay/ $0 generics HMO

• Great Value-Add Benefits

• $50 quarterly OTC benefit – HMO

• $325 quarterly OTC benefit – DSNP*

• Transportation on HMO and DSNP*

• Acupuncture Coverage in some areas

• Comprehensive Dental with $500 max – HMO

• $1,500-$2,500 max dental benefit dentures included – DSNP only

• $0 Copay for 2 Hearing Aids per ear per year- DSNP only

*Benefit varies by county

RX Highlights: • $0 Deductible

• $0 Copay Tier 1

• $0 Copay Tier 6 Select Care Drugs

Providers:• SW/NW PA Counites:

• Butler Health System

• Monongahela Valley Hospital

• Uniontown Hospital

• UPMC- Multiple Locations




Over-the-Counter


Virtual Visits


Prescription Drugs



Wellness Programs




· Supplemental smoking and tobacco use cessations (counseling to stop smoking or

tobacco use)

• Washington Hospital

• Excela Health Network

• Heritage Valley

• SE PA Counties:

• Temple Hospital & Provider Network

• University of Pennsylvania Hospital & Provider Network

• Crozer Hospital System

• Delaware County Memorial

• Suburban Community Hospital

• Doylestown Hospital

• Central PA Counties:

• UPMC Pinnacle Health Hospitals*

• Penn State Milton Hershey Hospitals

• Lancaster General

• Lehigh Valley Hospital*

• Wellspan Hospital*

• St. Joe’s

• Susquehanna Hospital

• Guthrie Hospital

• Good Samaritan

• Wayne Memorial

*DSNP Only Network





Counties

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette Forest, Greene,

Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren,

Washington, Westmoreland

Bucks, Chester, Delaware, Montgomery, Philadelphia

State/Plan/PBP PA-H2915-001-000 PA-H2915-002-000





Inpatient Hospital - Acute $0 $0





Fitness Membership Unlimited Visits to Silver and Fit Unlimited Visits to Silver and Fit


Vision Benefits $250 Max $250 max



Deductible Tiers NA NA

Tier 1: Preferred Generic Preferred Generic: 25% Preferred Generic: 25%

Tier 2: Generic Generic: 25% Generic: 25%

Tier 3: Preferred Brand Preferred Brand: 25% Preferred Brand: 25%

Tier 4: Non-Preferred Drug Non Preferred: 25% Non Preferred: 25%


Tier 6: Select Care Drugs Select Care Drugs: 25% Select Care Drugs: 25%



Parent Organization: Pennsylvania Health and Wellness


PENNSYLVANIA



Counties

Adams, Berks, Bradford, Carbon, Centre, Clinton, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juanita, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union,

Wayne, Wyoming, York

State/Plan/PBP PA-H2915-007-000










Fitness Membership Unlimited Visits to Silver and Fit




Rx Deductible $435

Deductible Tiers NA

Tier 1: Preferred Generic Preferred Generic: 25%

Tier 2: Generic Generic: 25%

Tier 3: Preferred Brand Preferred Brand: 25%

Tier 4: Non-Preferred Drug Non-Preferred: 25%


Tier 6: Select Care Drugs Select Care Drugs: 25%


X-Ray Services $0







Counties

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette,

Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter,

Somerset, Venango, Warren, Washington, Westmoreland,

Bradford, Bucks, Centre, Chester, Cumberland, Dauphin, Delaware, Fulton,

Huntingdon, Juniata, Lackwanna, Lancaster, Lebanon, Lycoming, Mifflin, Montgomery, Perry, Philadelphia Berks, Snyder, Sullivan, Susquehanna, Tioga,

Union, Wayne, Wyoming

State/Plan/PBP PA-H2915-003-000 PA-H2915-006-000











Fitness Membership Unlimited Visits to Silver and Fit Unlimited Visits to Silver and Fit

Dental Benefits $500 Max $500 Max










Tier 6: Select Care Drugs $0 $0

Laboratory Services $0 $0-$20

X-Ray Services $0 $0-$40


PENNSYLVANIA

NOTES: ___________________________________________________________________________________________________________

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SOUTH CAROLINA

1. Abbeville 2. Allendale 3. Anderson 4. Bamberg 5. Barnwell 6. Beaufort 7. Berkeley 8. Calhoun 9. Charleston 10. Cherokee

= DSNP AND MAPD

11. Chester 12. Chester�eld 13. Clarendon 14. Colleton 15. Dillon 16. Edge�eld 17. Fair�eld 18. Florence 19. Georgetown 20. Greenville

21. Greenwood 22. Hampton 23. Jasper 24. Kershaw 25. Laurens 26. Lee 27. Lexington 28. Marion 29. Marlboro 30. McCormick

31. Newberry 32. Oconee 33. Orangeburg 34. Pickens 35. Richland 36. Saluda 37. Spartanburg 38. Union 39. Williamsburg

372034

32

3 25

1

10

1138

31

21

3036

16

17 24

12 29

15

2635 18

28

27

8

33

5 4

2

2214

236

9

7

1339

19

*

*

*

*


SOUTH CAROLINA

Market Highlights: • 4 New county expansions

• 4 New major hospitals acquired in-network

• Improved and expanded MAPD and D-SNP benefit offerings

RX Highlights: • $0 Co-pay for Tier 1 and Tier

6 Meds

• No Rx Deductible

Providers:• New Major Hospitals in

Market:

o Lexington Medical Center

o Spartanburg Regional Healthcare System

o McLeod Regional Medical Center

o Providence Health



· Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay

Over-the-Counter


Virtual Visits


Prescription Drugs

· 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers


Wellness Programs

· $0 copay for fitness program


· Chiropractic care (DSNP Only)





Counties

Abbeville, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Chester, Chesterfield, Cherokee, Clarendon, Colleton, Dillon, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Jasper, Kershaw, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda,

Spartanburg, Union, Williamsburg

State/Plan/PBP H1436-005-000



In-Network Plan Deductible No Deductible








Dental Benefits $2,500



Rx Deductible Medicaid RX Cost Sharing

Deductible Tiers Medicaid RX Cost Sharing

Tier 1: Preferred Generic Medicaid RX Cost Sharing

Tier 2: Generic Medicaid RX Cost Sharing

Tier 3: Preferred Brand Medicaid RX Cost Sharing

Tier 4: Non-Preferred Drug Medicaid RX Cost Sharing

Tier 5: Specialty Tier Medicaid RX Cost Sharing

Tier 6: Select Care Drugs Medicaid RX Cost Sharing


X-Ray Services $0

Parent Organization: Absolute Total Care


SOUTH CAROLINA



Counties

Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton,

Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee,

Marion, Marlboro, McCormick, Newberry, Orangeburg, Union, Williamsburg

Anderson, Greenville, Pickens, Spartanburg, Lexington, Oconee, Calhoun, Fairfield,

Kershaw, Richland, Saluda

State/Plan/PBP H1436-002-000 H1436-004-000



In-Network Plan Deductible No Deductible No Deductible







Medically Necessary Transportation (Ambulance covered) Not Covered

Fitness Membership Unlimited visits to Silver and Fit Unlimited visits to Silver and Fit

Dental Benefits $1,500 $1,500

Vision Benefits $200 $200

Hearing Benefits $0 - $1,580 (2 Aids) $0 - $1,580 (2 Aids)





Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand:$47






Parent Organization: Absolute Total Care


TEXAS

1. Aransas 2. Bexar 3. Cameron 4. Collin 5. Comal 6. Dallas

= DSNP

= DSNP & MAPD

= New Counties

7. Denton 8. El Paso 9. Fort Bend 10. Guadalupe 11. Hidalgo 12. Jim Wells

*

*

13. Lubbock 14. Montgomery 15. Nueces 16. Rockwall 17. Starr

13

8

2510

19

18 6

47

16

1711

3

151

9

14

12

18. Tarrant 19. Wilson

*

*

*

*


TEXAS

Market Highlights: • H5294-002: Strong benefit

design. Well known in the market. Very strong Medicaid presence. Unlimited transportation (Lyft)

• H5294-BB9: New to market. Superior has the Medicaid plan to support this

• H0062-001: Dental, vision, transportation, OTC all included at a $0 premium. Spec. copay $35

• H0062-002, 003: Dental, vision, OTC all included at a $0 premium. Spec. copay $30

• H0062-009: Preventive dental, vision, transportation, OTC all included at a $0 premium. Spec. copay $35

RX Highlights: • H0062-001, 002, 003, 009: No

deductible. $0 copay for Tier 6 drugs

• H5294 002, 003, 004, 007, BB9: LIS levels will determine copays

Providers:• H5294-002, H0062-003: Strong

provider network, all hospitals in network

• H5294-003, H0062-002: University, Methodist systems in network

• H5294-004,H0062-001: San Antonio network is strong, all hospitals are PAR. El Paso is growing, all hospitals PAR. Aransas, Comal & Jim Wells new counties for 2020

• H5294-BB9: New for 2020. University system is the network. Only the DSNP for 2020





Over-the-Counter


Virtual Visits


Prescription Drugs



Wellness Programs




· Supplemental smoking and tobacco use cessations (counseling

to stop smoking or tobacco use)




Product Type (HMO, PPO, Etc) DSNP DSNP DSNP

Counties Cameron, Hidalgo, StarrDallas, Tarrant, Denton, Collin,

Rockwall

Bexar, Guadalupe, Nueces, Wilson, Aransas, Comal, Jim

Wells, El Paso

State/Plan/PBP TX-H5294-002-002 TX-H5294-002-003 TX-H5294-002-004



In-Network Plan Deductible $0 $0 $0


Inpatient Hospital - Acute $0 $0 $0





Unlimited One-Way Trips 30 One-Way Trips Unlimited One-Way Trips


Dental Benefits $3,000 Max $1,500 Max $,3000 Max


Hearing Benefits $0 (2 Aids) $0 (2 Aids) $0 (2 Aids)

Rx Deductible $155 $155 $155

Deductible Tiers Tiers 2-5 Tiers 2-5 Tiers 2-5







Laboratory Services $0 $0 $0

X-Ray Services $0 $0 $0

Parent Organization: Superior Health Plan


TEXAS

Medicare Product Highlights


Counties Fort Bend, Montgomery Lubbock

State/Plan/PBP TX-H5294-007-000 TX-H5294-BB9-000





Inpatient Hospital - Acute $0 $0





Fitness Membership Unlimited visits to Silver &Fit Unlimited visits to Silver & Fit



















CountiesBexar, Guadalupe, Wilson,Nueces, El Paso,

Aransas, Comal, Jim WellsCollin, Dallas, Denton, Rockwall, Tarrant

State/Plan/PBP TX-H0062-001 TX-H0062-002-000










Medically Necessary Transportation 10 One-Way Trips Not Covered

















TEXAS



Counties Cameron, Hidalgo, Starr Fort Bend, Montgomery

State/Plan/PBP TX-H0062-003-000 TX-H0062-009-000












Dental Benefits $1,000 Max Preventive Only

















TEXAS

NOTES: ___________________________________________________________________________________________________________

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__________________________________________________________________________________________________________________


WISCONSIN

1. Adams 2. Brown 3. Calumet 4. Clark 5. Columbia 6. Dodge 7. Fond du Lac

= DSNP and HMO MA

8. Green Lake 9. Je�erson 10. Kenosha 11. Kewaunee 12. Langlade 13. Lincoln 14. Manitowoc

15. Marathon 16. Marinette 17. Marquette 18. Menominee 19. Milwaukee 20. Oconto 21. Outagamie

22. Ozaukee 23. Portage 24. Racine 25. Shawano 26. Sheboygan 27. Taylor 28. Walworth

29. Washington 30. Waukesha 31. Waupaca 32. Waushara 33. Winnebago 34. Wood

16

2713 12

201815

25

11221312334

4

1 32 32 3 14

267817

9

282410

5 6 29

3019

22


WISCONSIN

Market Highlights: • Vision-Routine Covered

Services

• PERS- Personal Emergancy Response System

• Gym Membership-Silver and Fit

• OTC Benefits Available

• MA is a totallly new policy for Wisconsin

RX Highlights: • $0 Cost Share for Tier 1 and

Tier 6 Meds

Providers:Northern Counties (North of Milwaukee - Fond du Lac, Outagamie and Winnebago)• ThedaCare

• Agnesian Health Care

• Affinity Health System (Ascension)

North to Northeast (Brown, Manitowoc, Marinette and Oconto)• Aurora

• Bellin Health Care System

• Northshore Health Network

• Holy Family Medical Center

North Central (Marathon, Lincoln, Portage and Wood)• Aspirus

• Ministry Healthcare (Ascension)

Kenosha County• United Hospital Systems

(Froedtert South)




Over-the-Counter


Wellness Programs



• Kenosha Community Health Center

Milwaukee County • Aurora

• Froedtert

• Medical College of WI

• ProCare

• Isaac Coggs

• Sixteenth St. Clinic

• Ascenscion (Columbia St. Mary’s and Wheaton Franciscan)

Waukesha County • Aurora

• ProHealth Care





Counties

Adams, Brown, Calumet, Clark, Columbia, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette,

Menominee, Milwaukee, Oconto, Oytagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waupaca, Waukesha, Waushara,

Winnebago, Wood

State/Plan/PBP WI-H8189-001


Total Premium (Part C and D) $40.80






Over-the-Counter Items $120 Monthly






Rx Deductible $175









X-Ray Services $0

Parent Organization: MHS Health Wisconsin


WISCONSIN



Counties

Adams, Brown, Calumet, Clark, Columbia, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, ManiItowoc, Marathon, Marinette, Marquette,

Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waupaca, Waukesha, Waushara,

Winnebago, Wood

State/Plan/PBP WI-H8189-003













Hearing Benefits Not Covered

Rx Deductible Not Covered

Deductible Tiers Not Covered

Tier 1: Preferred Generic Preferred Generic: Not Covered

Tier 2: Generic Generic: Not Covered

Tier 3: Preferred Brand Preferred Brand: Not Covered

Tier 4: Non-Preferred Drug Non-Preferred: Not Covered

Tier 5: Specialty Tier Specialty Tier: Not Covered

Tier 6: Select Care Drugs Select Care Drugs: Not Covered


X-Ray Services $0

Parent Organization: MHS Health Wisconsin



NOTES: ___________________________________________________________________________________________________________

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NOTES: ___________________________________________________________________________________________________________

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__________________________________________________________________________________________________________________

WISCONSIN



VENDOR INFORMATION

101100 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.

2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS

Vendor Information

4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers

instead of vendor4 PBPs with coverage covered by DBP for Dental

5 Health plan covered by International Fitness for Fitness

6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit

card option through Walmart

State Health Plan CAM Dental Fitness Hearing MealsAdvice

LineOTC PERS Telehealth Vision Dental Dental

Contract Vendor gAcu. Chiro. Naturo.

AR H9630 4 4 4 4 47 4 4 4

AZ

H03514 4 4 41 41 4 41 4 4

H559042 41 41 4 4 42 4 42

H92874 4 4 4 4 4 4

FL

H5190 4 4 4 4 4 4

H9276 4 4 4 4 4 4

GA H7173 4 4 4 4 4 4

IL H1475 4 4 4 4 4 4 4

4

GA Foods

GA Foods

GA Foods

97Agent Use Only. Proprietary and Confidential. 101100 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.


Vendor Information









AR H9630 4 4 4 4 47 4 4 4

AZ

H03514 4 4 41 41 4 41 4 4

H559042 41 41 4 4 42 4 42

H92874 4 4 4 4 4 4

FL

H5190 4 4 4 4 4 4

H9276 4 4 4 4 4 4

GA H7173 4 4 4 4 4 4

IL H1475 4 4 4 4 4 4 4

4

GA Foods

GA Foods

GA Foods



VENDOR INFORMATION



Vendor Information









IN

H3499 4 4 4 42 4 4 4 41 4

H6348 4 4 4 4 4 4 4

KS H6550 4 4 4 4 4 4 42 4

LA H5117 4 4 4 4 4 4 4

MS H9811 4 4 42 4 4 42 4 4

MO H1664 4 4 4 4 4 4 42 4 4

NM H2134 42

OH

H0724 4 4 4 4 4 4

H0908 4 4 4 4 4 4 4 4

41



Vendor Information









IN

H3499 4 4 4 42 4 4 4 41 4

H6348 4 4 4 4 4 4 4

KS H6550 4 4 4 4 4 4 42 4

LA H5117 4 4 4 4 4 4 4

MS H9811 4 4 42 4 4 42 4 4

MO H1664 4 4 4 4 4 4 42 4 4

NM H2134 42

OH

H0724 4 4 4 4 4 4

H0908 4 4 4 4 4 4 4 4

41



VENDOR INFORMATION



Vendor Information









PA H2915 4 4 4 42 4 4 4

SC H1436 4 4 4 4 4 42 4 4

TX

H0062 4 4 4 4 4 41 4 4

H5294 4 4 4 4 4 4 4

WI H8189 4 4 4 4 4 4 4



Vendor Information









PA H2915 4 4 4 42 4 4 4

SC H1436 4 4 4 4 4 42 4 4

TX

H0062 4 4 4 4 4 41 4 4

H5294 4 4 4 4 4 4 4

WI H8189 4 4 4 4 4 4 4



2020 AGENT/BROKER RESOURCES AGENT/BROKER SUPPORT Broker Services Member Services

Contact Information Phone:844-202-6811

Email:[email protected]

Phone:Refer to the health plan website

TTY users should dial 711

Hours of Operation October 15 – December 7:• 9:00 a.m. to 7:00 p.m.

Monday – Friday (excluding holidays)• 9:00 a.m. to 1:00 p.m.

Saturday

December 8 – October 14:• 9:00 a.m. to 5:00 p.m.

Monday – Friday (excluding holidays)

October 1 – March 31:• 8:00 a.m. to 8:00 p.m.

7 days a week (excluding certain holidays)

April 1 – September 30:• 8:00 a.m. to 8:00 p.m.

Monday – Friday• Automated phone system on

weekends and on federal holidays

Support Receive help with:

• Contracting & Commission Inquiries

• Member Eligibility Verification

• Verifying PCP/PPG Affiliation

• Ordering Sales Material

Receive help with:

• Claims questions

• Changing a provider

• Referrals

• Formulary questions

• Appeals and Grievances


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allwell.com

Date post:	08-Aug-2020
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2020...Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare...

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