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1 Gear Up for 2021! Camp Molina OEP Training Presented by: Casey Meehan, WA Marketplace Sales Manager
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Gear Up for 2021!
Camp Molina OEP TrainingPresented by: Casey Meehan, WA Marketplace Sales Manager
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2021 Open Enrollment Period
WA Healthplanfinder OEP ✓ November 1, 2020 – January 15, 2021
Join Camp Molina!
• Make sure you’re ready to sell in all your Molina markets
• Earn badges by attending trainings and earning bonuses!
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Agenda
1. Molina’s history and mission
2. WA Marketplace Overall
3. 2021 Product Portfolio
• Non-Standardized (Choice Plans)
• Standardized (Cascade)
4. Marketplace Enhancements
5. New Molina Marketplace Website
6. Provider Network
7. Broker Portal
8. Resources
9. Why Sell Molina
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The Molina Story
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While working as an emergency room physician,
Dr. C. David Molina saw a need to change how the health
care system cared for people on a budget.
In 1980, he opened a community clinic where caring for
people was more important than their ability to pay.
Today, the legacy of Dr. Molina lives on through Molina
Healthcare, a company that cares for more than 3.5 million
members in 15 states. Serving people with Medicare,
Medicaid, and Marketplace, Molina Healthcare remains true
to Dr. Molina’s convictions:
“treating each person like a member of the family”
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Molina Healthcare Vision
We will distinguish ourselves as the low cost, most effective and reliable health plan delivering government-sponsored care.
193Ranking
$16.8BRevenue
3.5MMembers
1Q20
15Markets
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Market Highlights: Washington
• Kitsap
• Snohomish
• Clark
• Ferry
• King
• Klickitat
• Lincoln
• Mason
• Pend Oreille
• Pierce
• Skamania
• Spokane
• Stevens
• Thurston
Current Counties:
County Expansion
Existing Footprint
Legend
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2021 State Rate Changes
LosAngeles
San Bernardino
Riverside
San Diego
Imperial
State 2021 Rate Change
CA -3.89%
FL -3.77%
MI 0.37%
MS -2.67%
NM -0.18%
OH -0.85%
SC -3.64%
TX 5.30%
UT -1.64%
WA -3.19%
WI -3.50%
National
Average
-1.51%
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2021 Washington Portfolios
LosAngeles
San Bernardino
Riverside
San Diego
Imperial
• Molina Renewal Plans (non-standardized):
2020 Plans 2021 Plans
Core Care Bronze 1 Core Care Bronze 1 (renewal)
Molina Choice Silver Constant Care Silver 1 (new)
Molina Choice Gold Molina Choice Gold (renewal)
2020 Plans 2021 Plans
n/a Molina Cascade Bronze (new)
n/a Molina Cascade Silver (new)
n/a Molina Cascade Gold (new)
• New WAHBE Cascade Plans (Standardized):
No Adult Vision option
No Adult Vision option
One Market, Two Plan Design Portfolios Same:➢ Service Area
➢ Covered Services
➢ Provider Network
Different:➢ Plan Designs
➢ Premiums
WAHBE Requires:➢ Cascade Logo on ID
Cards and Materials
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2021 Regional Rates
LosAngeles
San Bernardino
Riverside
San Diego
Imperial
Lowest Cost Bronze Non-Standard
• Snohomish, King and Clark Counties
Silver Cascade Care
• Least costly offering in most markets, including
eastside of state
WA Portfolio Rate Factors (Premium Relatives)
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Investing in our benefits in Washington (non-standardized)
Core Care Bronze Plans• $0 Deductibles
• Free Teladoc Virtual Care Services
• Low Copays for Primary and Specialty Care services
• Free Preventive Care, including:
• Annual Wellness Exams
• Preventive Prescriptions
Constant Care Silver Plans• Free Preventive Care for Adults & Children
• Free Teladoc Virtual Care Services
• Plans with Copays for Primary & Specialty Care, Mental Health, Lab and Radiology services
• Plans with Low or No Deductibles
Confident Care Gold• Comprehensive healthcare coverage for Individuals with higher incomes
• Free Teladoc Virtual Care Services
• No cost Preventive Care, and access to Primary Care without a deductible
• No Cost Virtual Care Services through Teladoc!
• Avoid higher emergency room costs with Primary Care, Urgent Care at PCP Copay
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Plan Highlights: Washington Bronze
Plan Name Core Care Bronze 1Deductible $0
Max OOP $8,550
PCP Copay $60
Specialist Copay $150
Urgent Copay $60
Teladoc Virtual Care $0
Inpatient Copay$1,500 / Day
2 copay Max
Prescription
Drug Deductible$3,000
Rx Tier 1 $27
Rx Tier 2 $130
Rx Tier 3 50% after deductible
Rx Tier 4 50% after deductible
Adult Vision Option No
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Plan Highlights: Washington Silver
Plan Name Constant Care Silver 1 (100) Constant Care Silver 1 (250)Deductible $0 $0
Max OOP $1,200 $8,150
PCP Copay $0 $30
Specialist Copay $10 $60
Urgent Copay $0 $30
Teladoc Virtual Care $0 $0
Inpatient Copay$600/day
2 copay max
$1,200 / Day
2 copay MaxPrescription
Drug Deductible$0 $800
Rx Tier 1 $0 $20
Rx Tier 2 $10 $60
Rx Tier 3 10% after deductible 40% after deductible
Rx Tier 4 10% after deductible 40% after deductible
Adult Vision Option No No
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Plan Name Confident Care Gold 1
Deductible $2,925
Max OOP $6,500
PCP Copay $10
Specialist Copay $50
Urgent Copay $10
Teladoc Virtual Care $0
Inpatient Copay 20% after deductible
Prescription
Drug DeductibleIncluded in medical deductible
Rx Tier 1 $10
Rx Tier 2 $50
Rx Tier 3 30% after deductible
Rx Tier 4 30% after deductible
Adult Vision Option No
Plan Highlights: Washington Gold
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Cascade Care (SB 5526) Overview
Response to rising premiums and deductibles and declining enrollment in the individual market and failure to enact reinsurance
Three Main Parts:
1. Standard Plans: Goal to make care more accessible by lowering deductibles, making cost-sharing more transparent, and providing more services before the deductible
2. Public Option Plans: Goal to make more affordable (lower premium) options available across the state, that also include additional quality and value requirements
3. Subsidy Study: Goal to develop and submit a plan for implementing premium subsidies through Exchange for individuals up to 500% FPL (report due Nov. 15, 2020)
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Plan Highlights: Standard Plan (Cascade Care) Silver and Bronze
Plan Name Cascade Silver Cascade Bronze
Deductible $2,000 $6000
Max OOP $7,800 $8,550
PCP Copay $25 $50
Specialist Copay $60 $100 after deductible
Urgent Copay $60 $100
Teladoc Virtual Care $0 $0
Inpatient Copay$800/day after deductible
5 copay max40% after deductible
Prescription Drug Deductible
Combined Med/RX Combined Med/RX
Rx Tier 1 $20 $32
Rx Tier 2 $70 40% after deductible
Rx Tier 3 $250 after deductible 40% after deductible
Rx Tier 4 $250 after deductible 40% after deductible
Adult Vision Option No No
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Plan Name Cascade Gold
Deductible $500
Max OOP $5,250
PCP Copay $15
Specialist Copay $40
Urgent Copay $35
Teladoc Virtual Care $0
Inpatient Copay$525/day
(limit 5 days)
Prescription
Drug DeductibleIncluded in medical deductible
Rx Tier 1 $10
Rx Tier 2 $60
Rx Tier 3 $100
Rx Tier 4 $100
Adult Vision Option No
Plan Highlights: Standard Plan (Cascade Care) Gold
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Hospitals – Washington State Marketplace
Clark County:
• PeaceHealth Medical Center
Ferry County:
• Ferry County Memorial Hospital
Lincoln County:
• Lincoln County Hospital
• Odessa Memorial Hospital
King County:
• Snoqualmie Valley Hospital
• Swedish/Issaquah Hospital
• Valley Medical Center
• Harborview Medical Center
• St Elizabeth Hospital
• Overlake Hospital Medical Ctr
• Highline Medical Center
• Univ. Of Washington Medical Center
• Seattle Children's Hospital
• St Francis Hospital
• Swedish Medical Center
• MultiCare Auburn Medical Center
• MultiCare Covington Medical Center
• Northwest Hospital
Kitsap County:
• Harrison Medical Center
Klickitat County:
• Klickitat Valley Health
• Skyline Hospital
Mason County:
• Mason General Hospital
Pend Oreille County:
• Newport Community Hospital
Pierce County:
• Good Samaritan Hospital
• St Clare Hospital
• St Joseph Medical Center
• Tacoma General Allenmore Hospital
• Mary Bridge Children's Hospital
• St Anthony Hospital
Snohomish County:
• Providence Everett
Spokane County:
• St Luke's Rehabilitation Institute
• Providence Sacred Heart Medical Center
• MultiCare Deaconess Hospital
• Shriners Hospitals For Children
• Providence Holy Family Hospital
• MultiCare Valley Hospital
Stevens County:
• Providence St. Joseph Hospital
• Providence Mount Carmel Hospital
• St Joseph Hospital of Chewelah
Thurston County:
• Providence St Peter Hospital
• Capital Medical Center
Oregon:
• Providence Hood River
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Major Provider Groups – Washington State Marketplace
Puget Sound Region
UW, Providence, Harborview, MultiCare,
Franciscan, Everett Clinic, Mason General,
Swedish
Pediatric
Seattle Children’s, Mary Bridge, Shriners
SW Washington
Vancouver Clinic, PeaceHealth (SW WA only),
Northshore Medical Group
Eastside
Providence, MultiCare
FQHC’s
Peninsula Community, SeaMar, HealthPoint,
CHAS Health, CHC Snohomish, NewHealth
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$0 Telehealth Benefit for 2021
Virtual medical visits via Teladoc
• Easy access – Register once, three ways to engage
• Convenient – 24/7/365 – visit with doctors in 45 secs
• Affordable – Co-pays waived for Molina members
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COVID-19 Resources for Molina Marketplace Members
• Waiving ALL out-of-pocket expenses related to the treatment of COVID-19 for all
Marketplace, Medicare, and Medicaid members through December 31, 2020
• Waiving ALL cost-shares associated with COVID-19 testing in 2020
• Waiving ALL Teladoc service cost-sharing fees for members
• Free access to a 24-hour Nurse Advice Line:
• English: (888) 275-8750
• Spanish: (866) 648-3537
• Free home Rx delivery through CVS Pharmacy
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Premium Payment Methods
MolinaPayment.comOne time payment option via ‘Pay Now’
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Premium Billing Member Notifications
1. AutoPay Notices
• Confirmation
• Cancellation Letter
• Non-Sufficient Funds
• Disabled
2. Grace Period Notices
• Past Due
• Termination for Non-Payment
3. Refund Notices
• Full
• Partial
• Denied
4. Notice of Enrollment Separation (Binder Cancellation Notice)
• Cancellation occurs one month after the coverage effective date
• Notice is triggered once cancellation is processed
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Member ID Cards
• Hard Plastic ID cards sent to all members
• PCP name will not be on the physical card
• Electronic version of ID Card on My Molina portal and Molina Mobile app will continue to show PCP name
• ID cards will now be color coded for line of business
Timing
• New Members - Sent once full binder payment
is received and processed
• Active Renewals – Sent as members actively
renew during Open Enrollment
• Passive Renewals – Sent in early January
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New Website and Member Materials
• Brand new
MolinaMarketplace.com site for brokers, members and
providers
• Broker pages rolling out 10/1
• Redesigned, user-friendly,
health literate coverage
documents
• First ever Member Handbook
coming soon!
• Updates to Molina Mobile App
and My Molina portal
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Online Provider Search
providersearch.molinahealthcare.com
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Pharmacy Services and Prescriptions
You can find a list of our contracted pharmacies in your area here:
http://www2.caremark.com/micro/asset/mp_ca_pharmloc.htm
Molina contracts our pharmacies through CVS/Caremark
http://www2.caremark.com/micro/asset/mp_ca_pharmloc.htm
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Molina Broker Portal
Easy Access to Broker Support Tools
You can create or reset your password by using this link, your username is your Molina agent number (AAXXXX)
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Book of Business Search
Book of Business
Filter your Molina BOB Search by Effective Date, Grace Period Status, or Paid Thru Date
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Book of Business
Book of Business, Member Payment info and Grace Period Status
Joe Molina
CAEXXXXXXXXX
CAEXXXXXXXXX
CAEXXXXXXXXX
CAEXXXXXXXXX
CAEXXXXXXXXX
CAEXXXXXXXXX
CAEXXXXXXXXX
Joe Molina
Joe Molina
Joe Molina
Joe Molina
Joe Molina
Joe Molina
Joe Molina
AA1234
AA1234
AA1234
AA1234
AA1234
AA1234
AA1234
LAST NAME, FIRST NAME
LAST NAME, FIRST NAME
LAST NAME, FIRST NAME
LAST NAME, FIRST NAME
LAST NAME, FIRST NAME
LAST NAME, FIRST NAME
LAST NAME, FIRST NAME
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Lean On Molina Marketing Campaign
• Continuing our successful
“Lean On Molina”
marketing campaign from
2020
• 3X increase in marketing
budget for 2021 over 2020
• Focus on targeted digital
marketing and streaming
platforms
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Why Sell Molina?
Compensation
• Enhanced New and Renewal business bonuses
• Raising commissions in 2021
• Grandfathering renewal commissions to 2021 rates
Member Ease of Use
• Free Teledoc Virtual Care Services
• Molina does NOT require referrals for specialist visits
• Digital ID card, take control through MyMolina and Molina Mobile app
• Mail Order Pharmacy, free delivery
MolinaCares Accord
• $150 Million initial contribution for positive change in racial disparities affecting access and
delivery of care, opioid use, rural access to health care, social determinants of health and care
for elderly
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Broker Services Team
Phone: 855-885-3179
Broker Services - # 1
• General inquiries, account access issues, member EOC/SBC questions
Broker Care Team- # 2
• Member access to care issues, billing discrepancies, terminations in error
Commission Team- # 3
• Broker Book of Business reconciliation for unpaid policies
Contracting Inquiries - # 4
• Appointment requests, E&O/license/contact information updates
Monday through Friday – 7:00 AM to 6:00 PM (MT)32
• Access to Care• Billing Issue• Claims• Enrollment• Member Services• Prior Authorization
Status Review
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Your WA Molina Marketplace Sales Manager
Casey Meehan(360) [email protected]
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Washington
MSM: Casey Meehan
Email: [email protected]
Phone: (360) 764-6816
California
Director: Amy DeMarco
Email: [email protected]
Phone: (657) 243-7461
New Mexico & Utah
MSM: Adam Grimaldo
Email: [email protected]
Phone: (818) 428-9205
Texas
MSM: Gabriel A. Arguello
Email: [email protected]
Phone: (210) 517-4814
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Molina State Field Reps
Michigan, Ohio & Wisconsin
MSM: Kahassai Tafese
Email: [email protected]
Phone: (614) 623-8267
North Florida & Mississippi
MSM: Denis Pujals
Email: [email protected]
Phone: (786) 299-9818
South Florida & South Carolina
MSM: Tina Martinez
Email: [email protected]
Phone: (786) 837-4844
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]
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Thank you for attending!
Questions?
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