2016 Broker Training Presentation - 10-22-15

2016Meritus Broker Training 2016

2 Together for better health

> We serve your community:Meritus is a locally owned and operated health plan. Located in Tempe, our Customer Care Representatives know Arizona. Want to come visit us, it’s a short drive away. > Benefits for your lifestyle:Naturopathy, acupuncture and therapeutic massage available on all of the Meritus “Plus” plans (all PPO plans, and the Gold and Platinum HMO). > Access medical care your way:Access to CVS Minute Clinics at the office visit copay, as well as a Telemedicine benefit at a $0 copay(MeMD) on every Meritus product. > Ready to hit the gym:$25 monthly reimbursement on qualified gym memberships on all of our PPO plans and the Platinum and Gold level HMO plans. > Copay first, deductible second:On all of our HMO and PPO plans(excluding our HSA plans, and the Pharmacy benefit), the copay comes first, the deductible comes second! Whenever there is a copay benefit, you do not have to satisfy the plan deductible before the copay benefit kicks in.

The Meritus Difference


>Meritus is a Qualified Health Plan (QHP) >Meritus is required to maintain 500% risk based capital –

higher than other the 300% minimum required by the AZ DOI>Meritus is supported by a $90 million loan from CMS>Meritus has reinsurance coverage from Federal government

for claims up to $250K per claim>Meritus has commercial reinsurance for claims in excess

of the federal limits

Meritus Financial Information


Recognized for Innovation

“Congratulations for trying to make a difference in this very staid and stodgy business.

I know Meritus will be successful at your direction.”Broker Partner

What’s New for 2016


What’s New for 2016


2016 Product Offering by County*

• Pinal County HMO Expansion – Complete and Banner HMO Networks

• Mohave County – Narrow Network Name Change from “Mohave” to “WARMC”

• Mohave County – Adding Complete HMO Network


• Maricopa County• Pima County • Santa Cruz County• Mohave County – 2016

• Pinal County – 2016

Meritus Complete HMO Network


Maricopa County>Meritus HMO Abrazo network>Meritus HMO Banner network>Meritus HMO MIHS network

Pima & Santa Cruz County>Meritus HMO Pima network

Mohave County>Meritus HMO WARMC network

Pinal County - 2016>Meritus HMO Banner network

Meritus Narrow HMO Networks


2016 Individual Products


2016 Individual Rates

HMO Average 2016 Rate Increase – 23.5%

26 Individual Plans: 10.5% – 27.6%

PPO/HSA Average 2016 Rate Increase* - 30.1%

4 Individual Plans: 26.9% – 31.3% *Off Exchange Only


2016 Small Group Rates

HMO Average 2016 Rate Increase – 14.6%24 Group Plans: 5.1% – 21.1%

PPO/HSA Average 2016 Rate Increase – 13.8%

6 Group Plans: 10.5% – 14.5%


2016 Benefit Modifications


2016 Pharmacy BenefitsNew Meritus 6-tier Formulary from CVS/CareMark

Tier 0 – ACA Preventive DrugsTier 1 – Adherence Generic DrugsTier 2 – Other Generic DrugsTier 3 – Preferred Brand DrugsTier 4 – Non-Preferred Brand DrugsTier 5 – Preferred Specialty DrugsTier 6 – Non-Preferred Specialty Drugs

Adherence Generics are those medications that promote Heart health, treat High Blood Pressure, High Cholesterol, along with Oral Diabetic medications.

Our Plans


Group - 4 HMO, 3 PPO, 3 HSAIndividual - 7 HMO, 2 PPO, 2 HSA *PPO & HSA are OFF Market only

> Healthy Lifestyle Benefits on all PPO plans & all Gold/Platinum HMO plans> No pediatric dental for all 2016 plans *excluding the three 2014 carry-over plans

Meritus Plans


Lifestyle Benefits/ Plus Plans


MeMD - Telemedicine


CVS Minute Clinic – In Store Health Care Clinic

Our Networks


PPO – Based on Arizona Foundation for Medical Care

Meritus Arizona PPO Network


HMO – Meritus Complete

HMO network(Includes Maricopa, Pinal,

Pima, Santa Cruz and Mohave Counties)

> Meritus HMO Abrazo> Meritus HMO Banner > Meritus HMO MIHS> Meritus HMO Pima > Meritus HMO WARMC

Meritus Arizona HMO Networks

PPO Network Contracted Hospitals in Maricopa

Meritus Complete HMO Network in Maricopa

Meritus Complete HMO Network in Pinal

Meritus HMO Abrazo Network

Meritus HMO Banner Network

Meritus HMO Banner Network cont..

Meritus HMO MIHS Network

PPO Network Contracted Hospitals in Pima and Santa Cruz Counties

Meritus Complete HMO NetworkIn Pima and Santa Cruz Counties

Meritus HMO Pima and Santa Cruz Network

Meritus HMO Complete Network - Mohave

Meritus HMO WARMC Network


Meritus Pharmacies

For more information on our contracted pharmacies

and their drug formularies go to meritusaz.com

Please note: No Walgreens!

Helping You Find the Right Doctor

Helping You Find the Right Doctor

Individual Enrollment


Meritus Online Individual Enrollment


Meritus Broker Sales PortalLog into your customized

Broker Sales Portal at

MeritusAZ.com


Meritus Broker Sales Portal

Enter your User Name and

Password. Note: These are case

sensitive.



Now you are able to create quotes. It is

recommended that you click on Tools and then on the

ACA Individual Calculator.


Fill in the information and then click Next to see all of the plans that your client may qualify for. Note: If the zip code on an HMO plan is outside of our 4 counties, then no plans will show as being available. Now click Next.



Meritus Broker Sales PortalHere is a snapshot of any tax credits or cost share

reductions (CSR), if either apply; and what the

projected tax penalty would be if no plan is selected.

Click Get a Quote to continue.


You can narrow down your plan choices by selecting options in

the left-hand column. Let’s choose to look at only PPO plans

for this demonstration.


You can select up to 4 plans to compare at one time. Click on Select on the right, and then click

on Compare on the upper right side.


Meritus Broker Sales PortalYou can also select to see each plan’s

Summary of Benefits, Provider

Networks and Limitations and

Exclusions. Select Show Plan Details on the lower left side

to see more information.



You can fill in the client’s information and email all the options to them. You can also edit out plans which you don’t want to

send.

It is VERY important to type their name into the

Optional Proposal Name filed and then click Save.

Let’s click to Start Application



Each plan and each quote has the option to go directly to the application.

Click on Start Application and fill

in all required information. Click Complete this

Section.


The application is almost complete. Now you can change the plan if needed, save it for later, email it to the client or click on Finalize and Sign.



Your client would need to E-Sign in the Enter your name* field and then click on Continue To Payment Options.



Your client has 4 payment options: Credit Card, Prepaid Card, Bank Account or by Mail. Click on Continue and application is finalized. PLEASE NOTE: Payment is pulled immediately



> Streamlines FFM qualifications and applications

> Verify Marketplace Eligibility without going to Healthcare.gov

>Complete enrollment on Meritus site- Average Individual Enrollment takes 20 minutes

> Submit your completed FFM Cert of Completion to [email protected]

Meritus Direct Enrollment


> Streamlines FFM qualifications and applications

> Verify Marketplace Eligibility without going to Healthcare.gov

>Complete enrollment on Meritus site- Average Individual Enrollment takes 20 minutes

> Submit your completed FFM Cert of Completion to [email protected]

Meritus Direct Enrollment


> Members and group must log in make payments

> Members should contact Customer Care to add their email address and or/update their password

> Group admins should contact Sarah Gollwitzer, the Group Account Manger.

> Members can set up autopay with a debit or credit card.ACH/Bank Draft is coming soon!

Meritus Billing/Payment System

Small Group Enrollment


Small Group Underwriting Guidelines

>Minimum of 2 eligible employees

>70% participation excluding valid waivers(Except 11/15/15 – 12/15/15)

>75% Employees must reside in Meritus service area

>Employer must contribute 50% of premium cost for all plans

>Meritus offers all FFM-SHOP group plans OFF Market>Meritus will accept Husband/Wife Groups as long as they meet the requirements found on page 78 of broker handbook >Meritus offers up to 3 plan options on any size group>Meritus offers composite or age rates on any size group


Creating Small Group QuotesSend census to [email protected] or

Use Meritus “self service” quoting tool


Small Group Enrollment Guide


To quote a group, click on the Group tab and select New Quote. Fill in the information and click Next.



This is where you will enter the employee census information or import the census you created from the Meritus census form. If you want to import the census, click Import from the drop down box from the Add Employee box.



Sample Census File


Choose your census file to import or if you need a blank census file, click on the green “sample” link to get the census spreadsheet. Once you have chosen a file, click Import.



This is where you will see the list of employees that have been imported or entered.



Click on the Medical button – it will turn orange when selected, and then click Next.



Click on the Member Level button – it will turn orange when selected, and then click Next



Enter the employer contribution amount. You can switch from a Percentage to a Dollar amount by clicking the orange button. Once complete, click Next.



Here you can select a few plans to quote or you can Select All Plans to quote. Once plans are selected, click Continue.



Review the proposal and edit any information if necessary.



Proposal review continued. At this point, if the information looks correct, either Save As PDF, Email to Employer or click Apply. If you click Apply, make sure that you have selected no more than three (3) plans that the

employer will offer their employees.



To email the proposal to your client, complete the missing fields. You may edit the Subject and Message fields to fit your needs. If you would like to copy yourself or another party on the proposal email, click the small up-arrow

in the bottom right corner of the Send button. Once complete, click Send.



This is the Group Application – this is the first screen you will see when you click Apply at the bottom of the Proposal Review screen. Enter the information requested, then click Next to take you to the next page.



If any information is incomplete, you will see a red box and be able to edit the information.



Once all the information is completed, select the Submit button. Meritus will review the information and either approve, ask for additional information or reject the application within 24-48 hours.





Easy Online Small Group Open Enrollment


Employee Emails are Generated for Enrollment


> Employee Receives O/E Notice

> Shop and Review PlanOption(s)

> Adds/Removes any dependents

> Verify Personal Information> Provide Electronic Signature> Enrollment Complete

Employee Enrollment Steps


> Employer can monitor open enrollment status through employer portal

> Once open enrollment completed by each employee, employer reviews and approves all employee enrollment

> Employer then submits completed enrollment to Meritus

> Employer is directed to payment screen where they arrange payment of first month’s premium

Employer Enrollment to Complete

Partner with Meritus


Changing everything means supporting brokers by making it easy and providing helpful support !!

Why Meritus?

> Responsive and friendly broker support> Market friendly and competitive plan benefits> Competitive commissions

6% first year and then 4% ongoing for Individual plans

4% for all groups *Commissions are paid on the 10th of the month following the effective date as long as group/member is paid to date

> Innovative Enrollment Technology > Meritus Authorized broker Logo* *Logo be used on your website, business cards, flyers, for trade shows etc. Please follow guidelines to utilize the Authorized Logo and the two versions available.


Meritus Sales Team

Individual Sales

Kristi DeWitt-Quintero, Account Executive

Justin Heubach, Account Executive

Kevin May, Account Coordinator

Group Sales

Aubrey Bloom, Account Executive

Sarah Gollwitzer, Account Manager

April Schwab, Account Coordinator

Deseri Fisher, Account Coordinator

Kelly Schoonmaker, Director, Sales and Product Management

Broker Commissions

Stephanie McCulla, Commissions


Questions

Documents

2016 Broker Training Presentation - 10-22-15