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2018 Market Benefit Highlights
2018 Market Benefit Highlights
Organization Chart
Frankie Isla Market Manager
Palm Beach 954-261-9176
Edwin Davis Market Director
954-846-2055 x 2226
Art Coton Market Manager
Broward 954-816-0979
Sharon Rodgers Manager Sales Administration
954-846-2055 x 2259
Carolina Naranjo Sales and Marketing
Support Executive 954-846-2055 x 2255
CarePlus Dade Office Managers
CarePlus Dade Office 11430 NW 20th St Suite 300, Doral, FL 33172
305-441-9400
Dereck Aponte 305-766-9497
Richard Mesa 305-323-1636
Nery Linares 786.315.8400
Our Story….
We are a Florida-based company with more than 17 years specializing in Medicare and helping seniors with their health care needs.
Financial Stability • Owned by a Fortune 100 Company • Awarded the Medicare Risk Contract in
1998 Statewide Coverage • Providing Medicare HMO benefit plans in
several counties throughout the State of Florida: Miami-Dade, Broward, Palm Beach, Hillsborough, Pinellas, Pasco, Polk, Brevard, Indian River, Martin, Orange, Osceola, Seminole, Lake, Marion, Sumter and Duval
• More than 110,000* Medicare Advantage plan members
*The Centers for Medicare & Medicaid Services (CMS) Medicare Advantage (MA) Membership Reports August 2017.
The Centers for Medicare and Medicaid (CMS) wants to make sure that we are taking care of our members, and doing what we can to keep them happier and healthier. That’s why
every year , Medicare rates Medicare Advantage plans based on member surveys and other health-related categories such as:
CMS Star Rating
The ratings are given to every Medicare Advantage plan, and offer members an impartial way to compare different health plans. You can get more information on Medicare Star
Ratings at www.medicare.gov.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
5 stars = Excellent
4 stars = Above Average
3 stars = Average
2 stars = Below Average
1 star = Poor
For 2017 CarePlus was awarded an overall Star Rating of:
4 Stars
2018 CMS Star Rating
CarePlus 2018 Sales Presentation
• Fall 2017/ROY 2018
CarePlus 2018 Sales Presentation Videos
English Spanish
Creole
English Sales Presentation: http://www.vsbrooks.com/portal/?c=294&k=b04c9ee2fc
Spanish Sales Presentation: http://www.vsbrooks.com/portal/?c=289&k=335cd80917
Creole Sales Presentation: http://www.vsbrooks.com/portal/?c=292&k=6d9e1a1955
*internet connection is required to download video presentations
CarePlus 2018 Sales Presentations (video links*)
CarePlus 2018 Sales Presentation (download instructions)
Step One: Click link: http://www.vsbrooks.com/portal/?c=288&k=55bd3d5dfa
Step Two: Click icon:
Step Three: Click “Download”
Step Four: Click “Save”
CarePlus 2018 Sales Presentation (download instructions cont’d)
Step Five: Click “Save As”
Step Six: Save file to your “Desktop” and name file “2016 Sales Presentation Link”
File will take about 8 minutes to download.
Use MAPA for CarePlus Enrollments
Delegate Agents MUST FAX all their sales documents – SOAs, Paper Applications and Chronic Condition Forms to:
855-819-8679 (cover sheet must be included)
Paper Application and SOA Submission
CarePlus Enrollment Materials Ordering Site
• Fall 2017/ROY 2018
Enrollment Materials Ordering Site
CarePlus has made it easier for you to order your enrollment materials by building an online ordering site for your use at:
www.carepluskits.com
Agencies only need to enter a SAN number
If you encounter an error message when logging in, it may mean that there is an issue with your certification or appointment with CarePlus. Please contact a Sales Manager or ASU.
Enrollment Materials Ordering Site
Once information has been entered and your information verified, the user will proceed to the storefront and the quick access menu which will provide links to all the markets.
Enrollment Materials Ordering Site
The site has been broken down by market for ease of navigation. You will be able to access either plan specific, or new for this year dynamic kits for each market by navigating to “dynamic kits” as shown above.
Please note, the plans shown on the site are subject to change up until September. CarePlus reserves the right to substitute materials if orders are placed for discontinued plans.
The plan specific kits will include: • Sales brochure • Summary of Benefits for one specific product • Benefits Overview • PrescribeIt OTC catalog/form • PrescribeIt OTC envelope • Stars Ratings Form
The dynamic kits will include: • Sales brochure • All Summary of Benefits available in your market • Benefits Overview • PrescribeIt OTC catalog/form • PrescribeIt OTC envelope • Stars Ratings Form
Enrollment Materials Ordering Site
PLEASE NOTE: The items below will NOT be included as part of your kits, and will need to be ordered as loose items:
– Enrollment Applications
– SOA forms
– MAPA receipt booklets
– Provider Directories
Please contact CarePlus Marketing at [email protected] if you have any questions on the site.
Thank you for your valued partnership!
If you need to pick up sales materials* (kits) from our (county) office, please call a Sales Manager before stopping by the office.
We have to verify you are certified to sell first!
Art Cotton: 954-816-0979
Frankie Isla: 954-261-9176
*Limited supplies are available at the Market Offices, for larger quantities please use the ordering website. Please note that in our Broward office, we have Broward & Palm Beach kits. In our Palm Beach office, we only have Palm Beach kits.
IMPORTANT: Picking up Sales Materials
Broward Office 13680 NW 5th Street Suite 200
Sunrise, FL 33325
Palm Beach Office 2056 Vista Pkwy Suite 120 West Palm Beach, FL 33411
ACCESS (DIRECT): 844-722-2347 • To validate applicants status in Gov’t programs • Assist with Gov’t program applications for potential members • Eligibility Requirements – Medicaid and LIS • Social Services for referrals of Gov’t assistance programs
Agent Support Unit (ASU): 800-309-3163 • Appointment and Certification Inquiries • Product and Plan Inquiries • Application and Enrollment Status • Commission Inquires • MAPA Install and trouble shooting – PC Version Only
IVR SOA: 888-685-8606 • Complete a SOA over the phone
Important Telephone Numbers
Member Contact Numbers • CarePlus Member Services (Customer Service): 800-794-5907
• Transportation for Members: 866-956-5635
• PrescripIt (Preferred Mail Order Rx): 800-526-1490
• Beacon Health (Mental Health Services): 800-221-5487
• Silver Sneakers/Healthways: 888-423-4632
CarePlus Website – www.careplushealthplans.com • Check plan benefits
• Physician Search – most updated
• Download Summary of Benefits and Formularies (PDF documents)
• Prescription Calculator
Important Contacts – Member
• Signed SOA 48 hours in advance, conduct NEADS Analysis, Give Approved CarePlus Sales Presentation (DVD Preferred), Explain Summary of Benefits, Star Rating and Brochure, Complete Application, leave Copy of Application or MAPA receipt and Provider Directory. Formulary will be mailed. (This process will change soon. Will not have to leave Directory)
• CMS 2018 CarePlus Approved Presentation – DVD (Preferred Method)
– Power Point Presentation
– Flip Chart
• Delegated agents are responsible for the following: – Leave the new member a carbon copy of application or MAPA receipt, sales kit
to include Summary of Benefits, brochure with all product specific information, Star Rating, Provider Directory and disclosures.
– Fax all documents to Market Office within 24 hours, including weekends
– Maintain original applications and documents for 10 years
– Paper SOA’s and Applications are bar-coded (No Copies)
Things to Remember
Marketing Material Samples
• Fall 2017/ROY 2018
Marketing Materials Samples
Benefit Catch all External Flyer
Marketing Materials Samples
Delegated CareNeedsPlus Mailer
Marketing Materials Samples
LIS Delegated Flyer
Marketing Materials Samples
Medi Medi External Flyer
Marketing Materials Samples
Situational External Flyer
2018 Benefits Overview
• Fall 2017/ROY 2018
Product Offering Highlights Broward
CareOne
H1019-001 Premium: $0 MOOP: $3,400* PCP/SPEC: $0/$5* Inpatient: $0 OTC: $50* Emergency: $100 Ambulance: $200* Rx: Initial Coverage $3,750 $0/$0/$20/$85/33%* Dental: 2 Cleanings per year 2 Fillings per year 3 Extractions per year 1 Deep Cleaning per year Complete Dentures 1 every 5 years, Partial Dentures 1 every 5 years*
HMO
CareFree H1019-06
Premium: $0/ $75 Part B* Premium Reimbursement MOOP: $3,400* PCP/SPEC: $0/$40 Inpatient: $225 (Days 1-8) OTC: $25 Ambulance: 200 Emergency: $100 Rx: Initial Coverage $3,750 $0/$7/$47/$97/31% Dental: 2 Cleanings per year 1 Fillings per year 1 Extractions per year
HMO
* Benefit Improvement
Product Offering Highlights Broward
CareNeeds H1019-081
Premium: $0 MOOP: $3400 PCP/SPEC: $0/$0 Inpatient: $0 OTC: $50* Emergency: $100 Ambulance: $100* Rx: Initial Coverage $3,750
Generics $0/$3.30/15%; All Others $0/$8.25/15% Dental: 2 Cleanings per year 2 Fillings per year 3 Extractions per year 1 Deep Cleaning per year Complete Dentures 1 every 5 years, Partial Dentures 1 every 5 years*
HMO
CareNeeds Plus H1019-023
Premium: $0 MOOP: $3400 PCP/SPEC: $0/$0 Inpatient: $0 OTC: $100* Emergency: $100 Ambulance: $50* Rx: Initial Coverage $3,750
Generics $0/$3.30/15%; All Others $0/$8.25/15% Dental: 2 Cleanings per year 2 Fillings per year 3 Extractions per year 1 Deep Cleaning per year Complete Dentures 1 every 5 years, Partial Dentures 1 every 5 years*
HMO
* Benefit Improvement
Broward Market Highlights
• $0 Premium • Plans includes Dental, Hearing, & Vision benefits • 4 star plans • $50 Over the Counter (OTC) Benefits on our HMO products • Transportation benefits • Silver Sneakers – free fitness and gym membership • Tier 3 & 4 Rx Benefits discounts if member uses Prescribit Mail order for 90 day supply
Benefit Highlights
• Major Hospitals systems including HCA, 1 Memorial Hospital in network. Tenet’s Florida Memorial • Strong Relationships with Providers
Network Highlights
• 14,500 Members • Strong Brand Recognition In Market • Commitment to Grassroots and numerous Events in the community • Relentless focus on LIS/ Medicaid Social Services Referrals • Local Market office and Support Team • Year Round Selling opportunities with 2 Dual Eligible Plans
Competitive Advantages
Network
Broward Hospitals: • Broward Health Coral Springs • Broward Health Imperial Point • Broward Health Medical Center • Broward Health North • Holy Cross Hospital • Memorial Hospital Pembroke Pines • North Shore Medical Center Fmc Campus • Northwest Medical Center • Plantation General Hospital • University Hospital • University Hospital & Medical Center • Westside Regional Medical Center
Product Offering Highlights Palm Beach
CareFree H1019-06
Premium: $0/ $75 Part B* Premium Reimbursement MOOP: $3,400* PCP/SPEC: $0/$40 Inpatient: $225 (Days 1-8) OTC: $25 Ambulance: 200 Emergency: $100 Rx: Initial Coverage $3,750 $0/$7/$47/$97/31% Dental: 2 Cleanings per year 1 Fillings per year 1 Extractions per year
HMO
* Benefit Improvement
Product Offering Highlights Palm Beach
CareNeeds H1019-081
Premium: $0 MOOP: $3400 PCP/SPEC: $0/$0 Inpatient: $0 OTC: $50* Emergency: $100 Ambulance: $100* Rx: Initial Coverage $3,750
Generics $0/$3.30/15%; All Others $0/$8.25/15% Dental: 2 Cleanings per year 2 Fillings per year 3 Extractions per year 1 Deep Cleaning per year
Complete Dentures 1 every 5 years, Partial Dentures 1 every 5 years*
HMO
CareNeeds Plus H1019-023
Premium: $0 MOOP: $3400 PCP/SPEC: $0/$0 Inpatient: $0 OTC: $100* Emergency: $100 Ambulance: $50* Rx: Initial Coverage $3,750
Generics $0/$3.30/15%; All Others $0/$8.25/15% Dental: 2 Cleanings per year 2 Fillings per year 3 Extractions per year 1 Deep Cleaning per year
Complete Dentures 1 every 5 years, Partial Dentures 1 every 5 years*
HMO
* Benefit Improvement
Palm Beach Market Highlights
• $0 Premium, $75 Part B Reimbursement • Plans includes Dental, Hearing, & Vision benefits • 4 star plans • $25 Over the Counter (OTC) Benefits on our HMO products • Transportation benefits • Silver Sneakers – free fitness and gym membership • $0 Tier 1 & 2 Rx Benefits if member uses Prescribit Mail order for 90 day supply
Benefit Highlights
• In network Hospitals include HCA, independents, and will shortly include Tenet, which makes up half of the hospitals in Palm Beach. • Strong Relationships with Providers
Network Highlights
• 5,880 Members • Strong Brand Recognition In Market • Commitment to Grassroots and numerous Events in the community • Relentless focus on LIS/ Medicaid Social Services Referrals • Local Market office and Support Team • Year Round Selling opportunities with 2 Dual Eligible Plans
Competitive Advantages
Network
Palm Beach Hospitals: • Bethesda Hospital Inc. • Bethesda Memorial Hospital • Bethesda West Hospital • Delray Medical Center • Good Samaritan Hospital • JFK Medical Center • Jupiter Medical Center • Lakeside Medical Center • Palm Beach Gardens • Palms West Hospital • St Mary’s Hospital • Wellington Medical Center • West Palm Hospital
2018 Benefits Roll-Out Training Broward County
2018 Benefits Roll-Out Training Palm Beach County
Certification & Upcoming Classes
PLEASE DO NOT WRITE ANY BUSINESS UNTIL YOU ARE CERTAIN THAT YOU ARE CERTIFIED
WITH HUMANA & CAREPLUS!
It takes at least 2 business days from the day of the class for the certification to go through our system. We highly recommend you call the Agent Support Unit line to
confirm you are certified to sell prior to writing any business.
Agent Support Unit (ASU): 800-309-3163
Please contact a Sales Manager for the dates of upcoming certification classes*
*Pre-course work is required prior to attending a certification class
Thank you!!!!!
Questions?
