MCO/QHP PANEL...Shows plans as filed with state DOIs (plans not yet approved; subject to change) Your Kentucky Individual Sales Team Andrea Fowler- Field Sales Rep KY, IN, OH, and

MCO/QHP PANEL SESSION THREE: 2PM-3:30PM*

Outreach & Enrollment Track Kentucky Primary Care Association Annual Conference 2015

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Aaron Deglow

KY ISG Sales Development Consultant

Anthem Update

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Our Vision: To be America’s valued health partner.

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We’re from here. And here is where we make a difference.

Big company advantages with a local company approach: •  We live, work and raise our families in Kentucky •  Celebrating over 75 years of business in Kentucky •  We have more than 1,000 associates from Louisville, to

Lexington, and everywhere in-between •  Local leadership with a legacy of giving •  Health Plan Advisors – Licensed agents to offer support

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Last year, we committed

over $1.5 million to improving health in Kentucky.

§  Kentucky Homeplace Improving Diabetes Outcomes §  Disabled Sports USA §  Boys and Girls Clubs of America §  American Cancer Society §  American Lung Association §  And many more locally focused programs impacting health

Plus countless volunteer hours from Kentucky associates giving back to their community.

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Marketing Materials

KY Individual Plan Guide

Intro to Anthem

Highlights & 2016 FAQs

2016 HMO County Map

LiveHealth Online info

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Portfolio and Plan Families

2016 Portfolio

•  6 Plans ON; 6 Plans OFF Bronze

•  7 Plans ON; 7 Plans OFF Silver

•  3 Plan ON; 3 Plan OFF Gold

•  1 Plan ON; 1 Plan OFF Catastrophic

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2016 Strategic Portfolio Changes

▪  BlueCard coverage added for all PPO Plans – out of state coverage.

▪  Added Specialist Office Visit copays to select plans .

▪  HSA plans changed from non-embedded to embedded deductibles per CMS.

▪  KY will expand the current HMO network in 2016 from 4 regions to all 8 regions

▪  Dental plans can be enrolled with Medical and the member will now receive on ID card.

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97% of hospitals

92% of physicians

382 of Fortune 500 offer a Blue health plan

1 in 3 Americans is covered by a Blue Cross Blue Shield plan

2x larger total membership than Blue’s next largest competitor

1.3 million Kentuckians are covered by Blue

Strength in numbers And when you combine that with the power of Blue, we’re virtually unstoppable

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HMO Products Individual

Hospital network: ▪  Baptist (Louisville, Lexington, Paducah) ▪  KY One (Louisville, Lexington, Central KY) ▪  University of Kentucky ▪  Norton and Kosair Childrens’ ▪  Hardin Memorial ▪  Christ Hospital (Cincinnati/northern KY physician location @ old Drawbridge Inn location)

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§  No gatekeeper, no referrals required

§  Primary care selection required

§  Locate a listing of providers within a network on Find A Doctor. •  Select Kentucky and select the applicable HMO product.

HMO Products Individual

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Online Tools

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Introducing LiveHealth Online Health care where you need it, when you need it.

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Easier and less expensive than urgent care.

What is LiveHealth Online? LiveHealth Online is a convenient way for our members to interact with a doctor via live, two-way video on their computer or mobile device. LiveHealth Online: §  Is available anywhere you have an internet connection

(at home, in the office or on the go) §  Is available 24 hours a day/7 days a week/365 days a year §  Provides access to in-network, U.S. board-certified doctors §  Offers help at the same price as (or less than) a regular doctor visit §  Doctors can ePrescribe to local pharmacies

(where applicable) §  Takes member payments via Visa, MasterCard and Discover §  Is secure, convenient and easy-to-use

LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.

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.

Thank You

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Life and Disability products underwritten by Anthem Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

KentuckyPrimaryCareAssocia3on

November12,2015

ChrisBurche>,AnthemMedicaid

AnthemMedicaidoperatesin120coun3esofKentucky

Commonwealth’sMedicaidRegions

AnthemMedicaidMemberCard

MCO’sBasicHealthCoverage

•  HealthInsurance(HealthCheckupsandScreenings)

•  Dental–DentaQuest

•  Vision-EyeQuest

•  PharmacyServices–ExpressScripts

•  BehavioralHealthServices

Carvedout:

•  Transporta3on

Ifcontractsarethesame…

WhatmakesAnthemdifferent?

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AnthemISDifferent!

•  NOCOPAYS

•  FreeMembershiptopar3cipa3ngBoysandGirlsClubs(17loca3ons)

•  FreeSportsPhysicals

•  FreeCriborCarSeat–whenpregnantwomenseetheirOB’sorPCP’s73mes

•  Free$25GicCardsforprenatalvisits(1stTrimestervisit)

•  Free$25GicCardsforprenatalvisits(3rdTrimestervisit)

•  Free$50GicCardforPostPartumVisit

•  Free$50GicCard–WellChildVisits(childhastohave6visits)

•  CommunityResourceGuide(English&Spanish)

•  FreeSafeLinkCellPhonewithfreeminutes&texts(250minutes&unlimitedtexts)

•  FreeHearingAidBa>eries(offervarioussizes)

•  FreeTornadoSafetyKit

ValueAddedBenefits

OpenEnrollmentOct.19–Dec.11,2015

19&Growing-Lookforus!

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CareSource Just4Me™ 2016 Benef i t s

Information Confidential and Proprietary

Health insurance you can afford, understand and use

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Non-profit, founded in 1989 in Dayton, OH

Comprehensive,

member-centric health and life services

Regionally based-

serving multiple states and products

PRODUCT LINES

•  Medicaid •  Marketplace •  Duals Demo

Medical Cost Ratio

MISSION FOCUSED:


To make a lasting difference in our members’ lives by improving their health and well-being.

1.4M members

90%

Our Mission

To make a lasting difference in our members’ lives by improving their health and well-being.

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CareSource Plans in Kentucky


•  CareSource Just4Me ™ Qualified Health Plan in 46 counties.

•  Humana – CareSource® Statewide Medicaid Managed Care Organization (MCO) alliance with Humana.

•  CareSource Advantage and Advantage Plus™ Medicare Advantage plans (Fall 2015).

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55

CareSource Just4Me™ Qualified Health Plan


2016 Just4Me Counties

6


CareSource Just4Me™ Offers

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1.  Affordable insurance 2.  Plans are easy and simple to use 3.  Robust network 4.  Multiple payment options for ease of

payment

2016 vs 2015 Plan Design Changes

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ENHANCEMENTS •  Gold & Silver will have $0 copay for PCP •  Gold & Silver will have $0 copay for Retail Clinics •  Gold & Silver will have $0 copay for Physical

Therapy & Occupational Therapy

•  Silver 73% (Silver 1) $40 copay Preferred Brand Prescriptions

2016 vs 2015 Plan Design Changes

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CHANGES •  Gold goes to 20% coinsurance •  Gold, Silver (No CSR, 1, 2) & Bronze moves to 50% for

Non-Preferred Specialty High Cost Rx •  Silver 3 moves to $300 deductible •  Silver 3 moves to 35% for Non-Preferred Specialty High

Cost Rx •  Bronze moves to $6650 deducible, 40% coinsurance,

and $6850 Max. OOP •  Catastrophic moves to $6850 deductible & Max OOP

Two Ways to Reduce Cost

1. Advanced Premium Tax

Credit

2. Cost Sharing Reductions

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2172


CareSource Just4Me™

Health insurance you can afford, understand and use

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Appendix


Types of Plans


•  Catastrophic Coverage Plans –  3 primary care visits per year –  Low premiums, high out of pocket costs and deductibles – Provide only for emergency care

•  HMO (Health Maintenance Organization) –  Use closed-network benefit model –  Referrals required for specialist care – Benefits not available if care given out of network unless it is emergency

•  POS (Point of Service) –  Uses a network benefit model similar to HMO –  Higher out of pocket costs if care given out of network – May require referrals for specialist care

•  HSA (Health Savings Accounts) – tied to high deductible plan which features

•  lower premiums •  higher out of pocket costs

– Savings account that allows tax advantage dollars to be put away to pay for qualified medical expenses

•  PPO (Preferred Provider Organizations) –  Use open network benefit model that allows for out of network services at a

higher out of pocket cost –  Referrals not needed to see specialists –  Premiums are typically higher than HMO’s

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This is a solicitation for health insurance. *Some exclusions and limitations may apply. Benefits and costs vary by plan. See the CareSource Just4Me Evidence of Coverage or Schedule of Benefits document for details at CareSourceJust4Me.com. CareSource Just4Me does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. CareSource Just4Me is a Qualified Health Plan issuer in the Kentucky Health Benefit Exchange.

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KY-EXCM-118a Information Confidential and Proprietary

GrowingYourBusiness:2016OpenEnrollment

42 Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)

YourKentuckyIndividualSalesTeam

AndreaFowler-FieldSalesRepKY,IN,OH,andWV(502)[email protected]/WV(855)305-4950jhasman@humana.comBrianBagan-RegionalSalesManager-IndependentAgentChannelIN,KY,OH,PA,VA,WVandNortheaststates

Ifyoudidn’thavehealthinsurancein2015,you’llpaythehigherofthesetwo

amounts:

•  $325perpersonfortheyear($162.50perchildunder18).Themaximumpenaltyperfamilyusingthismethodis$975

•  2%ofyouryearlyhouseholdincome.• Onlytheamountofincomeabovethetaxfilingthreshold,about$10,150foranindividual,isusedtocalculatethepenalty.

•  ThemaximumpenaltyisthenadonalaveragepremiumforaBronzeplan.

Ifyoudon’thavehealthinsurancein2016,you’llpaythehigherofthesetwo

amounts:

•  $695perperson($347.50perchildunder18)Themaximumpenaltyperfamilyusingthismethodis$2,085.

•  2.5%ofyouryearlyhouseholdincome• Onlytheamountofincomeabovethetaxfilingthreshold,about$10,150foranindividualin2014,isusedtocalculatethepenalty.

•  ThemaximumpenaltyisthenadonalaveragepremiumforaBronzeplan.

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TaxPenaltyUpdates

Source:hgps://www.healthcare.gov/fees-exempdons/fee-for-not-being-covered/

2016ProductFootprintandEnrollmentDates

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Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)

2016OpenEnrollmentEffecdveDateChart

IssueDate EnrollmentPeriod 2016Effec3veDates11/1/15-12/15/15 OpenEnrollment 1/1/201612/16/15-1/15/16 OpenEnrollment 2/1/20161/16/16-1/31/16 OpenEnrollment 3/1/2016

•  From2/1/16-10/31/16,customerscanenrollinHealthPlansiftheyhaveexperienceda“QualifiedLifeEvent”(QLE)thatwouldqualifythemforaSpecialElecdonPeriod.

•  TheEffecdveDatesforyourcustomersthatexperiencesaQLEwillbedictatedbythenatureoftheQLE

•  On-ExchangeDentalmustbesoldinconjuncdonwithanOn-ExchangeMedicalPlan

Confidential/ For Agent Use Only

PlanEnhancements

56


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Key2016GuidingPrinciplesforProductchanges

•  EncouragecorrectusageofplansbyMembers– Encouragemember/PCPreladonship;Reducenon-emergencyERudlizadon

– Directmemberstomostappropriateplaceoftreatment– Encourageproacdvecareandmedadherence:EnhancedaffordabilityforPCPvisits,retailclinics,Rxcopays,$0Rxdeducdble.

Confidendal-InternalUseOnly–ShowsplansasfiledwithstateDOIs(plansnotyetapproved;subjecttochange)

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2016MedicalProducts–Enhancements

•  LowerMedicalDeduc3bles:–  SilverHUMx/EPOx/PPOxHighValueNetworksandHMOPremiercopayplanhasaded.of$3,800(was$4,600in2015)*

–  GoldPlanhasaded.of$2250(was$2,500in2015)*

•  FamilyplansinALLstatesin2016willhaveIndividualProtec3on–  Embeddeddeducdbleonallplansfor2016

•  NOTE:thisisanimprovementformembersontheCatastrophic,BronzeHDHPandSilverHDHPplans(in2015theseplanshadonlyaggregatefamilydeducdbles)

LowerDeduc+blesin2016’sformostSilverandGoldplans

Nowallplanshaveindividualmemberprotec+on

q BroadNetworksareHumana/ChoiceCare,NPOSandCPOSq HighValueNetworksareHMOx,EPOxorPPOx

*SimilarEnchantmentsforsomeplansavailableinGAandMS



•  SilverandGoldCopayPlanenhancement:•  $0RxDeduc3ble:Improvesaccesstomedicadonsincebenefitswillbegin

immediatelyforcovereddrugs.

•  SilverCostShareReducdonCopayplans:–  LowerRxcopays:tohelpmemberswithaccessibilitytomedicadon(all

networks,allstates)–  LowerPCPcopays:ThePCPisalwaysthefirstchoiceoftreatmentfor

padents,andwewanttomakesurethatitisaccessibleandaffordableformembers.(allnetworks,allstates)

•  RetailClinicsandUrgentCareCenters–  Noreferralsrequiredforin-networkretailclinicsandurgentcarecenters,

foreasieraccesstoarer-hoursandweekendcare(newforHMOxplansmid2015)

–  CVSMinuteClinicandConcentraUrgentCareCentersinnetworknadonwidewhereavailable*•  QuestandLabcorpinnetworknadonwidewhereavailable*

Improvementstoprovideeasyaccesstonon-ERcare

ImprovementstoprovideeasyaccesstoPCPsandRX



NEWin2016 SilverBase CSR200-250%FPL

CSR150-200%FPL

CSR100-150%FPL

PCPCopay $20 $15 $10 $5

RetailCliniccopay $30 $25 $20 $10

UrgentCareCopay $40 $30 $25 $15

ER(copay+ded+coins)

$250copay+ded+coins

$200copay+ded+coins

$200copay+ded+coins

$150copay+ded+coins

Tier1&2Rx $10/$20 $5/$15 $5/$10 $4/$8

Tier3,4,5Rx $50/50%/50% $45/50%/50% $35/50%/50% $25/50%/50%

Example:HMOxSilvercopayplan

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2016MedicalProducts–Changes

•  New2016EmergencyRoomChangesforcopayplans•  Benefitsummarieswillstate:

–  “Youpay20%coinsurancea3era$250copaypervisitanddeduc9ble”

–  “…youpaya$250copayforeveryemergencyroomvisit.Youalsopayallemergencyroomchargesun9lyoureachyourdeduc9ble.Onceyoureachyourdeduc9ble,youpay20%coinsuranceun9lyoureachyourmaximumout-of-pocket.

•  ERCopaypordonisgenerally$250(butSilvercopayCSRplansthatwillhavelowerlevels)

•  Note:ERcopaypordonnotwaivedifmemberadmigedtohospital

ERcopayPor3on

SilverBase CSR200-250%FPL

CSR150-200%FPL

CSR100-150%FPL

$250 $200 $200 $150

NewERBenefitisthe

combinadonofERCopay,Deduc3ble,

andCoinsurance

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2016MedicalProducts

Afewindividualmedicaldeduc3bleswentup.

•  ’16SilverHDHPded.of$4125(was$3650in‘15).

•  ’16Basicplanded.of$6850(was$6600in‘15)

•  ’16Bronzeplanded.of$6450(was$6300in‘15).


NewH1HumanaVitality®Benefit**•  Samefootprintas2015;willincludemendoninbenefitsummaryandagentgrid.

•  HumanaVitalityDescripdon:-  EnhancedHumanaVitalityHealthyFoodbenefitatWalmart

–  Blue=0%savings*–  Bronze=5%savings–  Silver=10%savings–  Gold=25%savings–  Pladnum=50%savings(Maxsavings=$600perfamilyperyear)

–  VitalityBucksnolongerapartoftheprogram**

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2016MedicalProducts–Changes


Jan–June2016promodon:25%savingsforbronzestatus

(JustdothehealthscreeningandrequesttheHealthFoodscard)

**Thenon-grandfatheredplansandgrandfatheredplansfor2016willsdllhavethe2015HumanaVitalitybenefit(withbucks)

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MyVitalityMobileApp

65


2016MedicalProducts

•  New2016MemberIDCardDesign

-IDcardswillnowshowtheERCopayaswellasstatethatdeducdbleandcoinsuranceapply:

Exampleof2016IDCardDesign:

66


MyHumanaMobileApp

LowerDeducdblesformostSilverPlans

LowerDeducdblesformostGoldPlans

LowerPCPCopaysandRXDeducdble

forCSRPlans

EmbeddedProtecdononAll

PlansNewERbenefit ChangestoRx

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ProductEnhancementSummary

HowHumanaSupportsYourClients


Cashpaymentopdonfeatures

Humanaassignsbarcodenumbers Membertakes

invoicewithbarcodetoretailer

Memberpaysatretailerbyprovidingbarcode

Memberreceivesareceiptforpayment

Whatisit?•  AbarcodebasedsoludonprovidingHumanamemberswhohaveindividualmedicaland/or

dentalplansinapprovedstates(currentlyAL,CO,FL,GA,IL,LA,KY,MI,MS,MO,OH,TN,TX,andUT)anopdontopaytheirpremiumswithcashthroughabill-payserviceatCVS/pharmacyorDollarGenerallocadons.

•  Availabletoon-exchangeandselectoff-exchangeindividualmedicaland/ordentalplans

Howdoesitwork?•  Humanamemberswithindividualmedicaland/ordentalplansinapprovedstateswillreceivea

barcodeontheirinvoice•  MembertakestheinvoiceandpaymenttoapardcipadngCVS/pharmacyorDollarGeneral

locadons•  Storeassociatescansthebarcode,acceptsthecash,andgivesthememberareceiptindicadng

thepremiumhasbeenpaid•  Memberkeepsreceiptasproofofpayment


Cashpaymentopdonfeatures

HowdoIusethisnewcashpaymentop3onasasellingtool?Thebestwayformemberstokeeptheirpolicyinforceiswithrecurringmonthlyautomatedpayment.Ifaprospectdoesnothaveabankaccountorcredit/debitcardandneedstheflexibilitytopaytheirpremiumsusingcash,younowhaveanalternatecashpaymentmethod.

Wherewillthisbeavailable?•  Memberswithindividualmedicaland/ordentalplansinAlabama,Florida,Georgia,

Kentucky,Michigan,Mississippi,Missouri,Ohio,Tennessee,Texas,Utah,Illinois,andLouisianacanusethebarcodeateitherCVS/pharmacyorDollarGeneralstores.

•  MemberswhoreceiveapaperinvoiceinColoradowillbeginseeingthecashpaymentopdonstardngwiththeirApril2015invoice.DollarGeneralistheonlyretailerpar3cipa3ngintheprograminColorado

Howdoesamembergetabarcodeatenrollment?AgentsenrollingOn-Exchange:-  Ifthememberwantstopaythefirstmonth’spremiumpaymentorrecurringpaymentswith

cash,theyshouldselect“check,moneyorderorcash”whichwillgenerateabarcodedpaperinvoice


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SmartChoiceDental

11/18/15

ThankYou!

2016OpenEnrollment

AetnaKentuckyHealthNetworkOnlyOpenAccess

Availablein10coundesfor2016:Boone,Kenton,Campbell;Fayege,Madison;Owen,Henry,Jefferson,OldhamandTrimble

ExchangeHighlightsMostcompe33vely-pricedonBronzeplansinLouisvilleandLexington

Lowest-pricedcarrierofallofthebrokercommissionableplansinNorthernKentucky

•  OpenAccessHMOProduct

–  NoPCPselecdonrequired–  Noreferralsneeded.–  Nocoverageforoutofnetwork,otherthanforemergencycare

•  Narrownetworkwithnooutofstateproviderspardcipadng–  NKYnetworkisbuiltaroundtheSt.ElizabethHospitalsystem–  LexingtonthenetworkisbuiltaroundtheBapdstandUKHealthcarehospitalsystems–  LouisvillethenetworkisbuiltaroundtheBapdsthospitalsystem

•  Fiveplandesignsoffered–  Gold$10Copay–  Silver$10Copay–  Bronze$15Copay–  BronzeDeducdbleOnlyHSAEligibleplan–  Catastrophicplanforthoseunderage30orhardshipexempdonwaiverobtained

Typeofproductssoldontheexchange

76

Pla3num–90%

Gold–80% Silver–70%

Bronze–60%

CatastrophicplanThisproductisavailabletoindividualsunder30yearsofageorthoseexemptfromtheindividualmandatebecausenoaffordableplanisavailabletothemorbecauseofahardship

“Nowrongdoor”TheexchangewillinformindividualsofeligibilityrequirementsfortheMedicaidprogram,theChildren’sHealthInsuranceProgram(CHIP),oranyapplicablestateorlocalpublicprogram

DentalplanExchangesmaysellstand-alonedentalplansiftheyofferpediatricdentalbenefitsmeedngtherequirementsoftheACA

Aplanwillprovidealevelofcoveragethatisdesignedtoprovideessendalbenefitsthathaveanactuarialvalueof:

Metallicexchangeproducts

Otherexchangeofferings

AspartofHealthCareReform,bothon-andoff-exchange,productsforindividualsandsmallgroupemployersmustadheretometalliclevel

requirementsbasedonactuarialvalue.

Actuarialvalueisthepercentageofthetotalcoveredexpensesthatahealthplancovers.

CoventryCaresManagedCare

CoventryCaresofKentuckyservicesMedicaideligibleindividualsinall120Kentuckycoun3esWeemployapproximately250locally-basedstaff,includingindividualswholiveandworkineachoftheeightMedicaidregionsWewerepurchasedbyAetnainMay2013

2016Migra3onDate

Effec3veFebruary1,2016

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2016OpenEnrollment

•  RunsOctober19throughDecember19•  WewillbeCoventryCaresofKentuckyforOpenEnrollment

•  NewenrolleesduringOpenEnrollmentwillreceiveaCoventryCaresMemberIDCardandCoventryCaresNewMemberMaterialsinJanuary2016

•  NewAetnaBegerHealth®ofKentuckyMemberIDCardswillbemailedtoallmembersinFebruary

ReducedCo-Paysfor2016

80

NewcopayscheduledesignedtohelpourmemberslivehealthierlivesNOCopaysforPhysiciansoffice(PCPorspecialists)visitsNOCopaysforPreventadveCareservicesNOCopaysforUrgentCarevisitsNOCopaysforGenericandPreferredPrescripdonDrugsNOCopaysforDentalservicesNOCopaysforMaternityservicesNOCopaysforOutpadentHospital/AmbulatorySurgicalCenterNOCopaysforPodiatryservicesNOCopaysforDMENOCopaysforProsthedcDevicesNOCopaysforPT/OT/STNOCopaysforOutpadentMentalHealth/SubstanceUseServicesNOCopaysforLabs,DiagnosdcandRadiologyServices$25CopayforAcuteInpadentHospitalServices–IncludingMentalHealthandSubstanceAbuseServices(Previously$50)$4CopayforNon-PreferredPrescripdonDrugs(Previously$8)

MemberBenefitsfor2016Casemanagementanddiseasemanagementprograms(Adult,PediatricandPerinatal)Diabetes,congesdveheartfailure,asthma,COPDBehavioralHealthservicesDental,vision,homehealth,pharmacyandotherancillaryservicesEPSDT-Monthlypostcardmailing&remindercallsWellWoman-MonthlybirthdaycardmailingMemberAdvocatesPreven3onandWellnessPa3entCenteredMedicalHomesReadmissionPreven3onEDu3liza3on,inpa3entadmission&readmissionreports

ExpandedDrugFormularyfor2016

•  Ourdrugformularywillexpandtoincludemorepreferreddrugs– Begerserviceforourmembersandprescribers– Reducedpharmacywaitdmes– Getdoctor-prescribedmedicadonsinmembers’handsquickly

IncreasedMemberIncendvesfor2016•  DocBearClubforKids•  24-HourNurseLine•  CribIncen3veProgram•  PromiseRewardsProgram

–  MemberscanearnaPromiseRewardsspecialgirarertheirbabyisborn.TheywillearnafreeDiaperbagwhichincludescommonbabyitemsandagircardiftheycompletethefollowing:

•  Completethepost-partumvisit.Thisvisitmustbewithin21–56daysarerthebabyisborn.

•  AsktheObstetricalprovidertocompletethePromiseRewardsform**andreturnittoCoventryCaresofKentucky.

•  **PromiseRewardsformtobesubmiSedforcommonwealthapproval•  CoventryCaresBe>erWaytoHealthIncen3veProgram

–  Memberscanearngircardsarertheycompletethefollowingcheckups:•  $10gircardforcompledngaLeadScreeningtestforchildrenpriortotheir2nd

birthday•  $10gircardforcompledngadiabedcrednaleyeexamforadults18–75yearsold•  $10gircardforcompledngspirometrytesdngformembers42yearsorolderwith

COPD•  $20gircardforcompledngafollow-upvisitwithamentalhealthpracddoner

within7daysofdischargearerahospitalizadonformentalillness(6yearsofageorolder)

IntegratedBehavioralHealth•  MobileCrisis

•  Asser3veCommunityTreatment(ACT)

•  PeerSupport

•  CrisisInterven3on

•  IntensiveOutpa3entTreatment

•  Par3alHospitaliza3onProgram

•  Addi3onalcodesforassessment,screening,andtreatmentplanning

•  Allindependentlylicensedprac33onersarenoweligibleMedicaidBehavioralHealthproviders,includingLCSW,LPCC,LMFT,&PhDs

•  GroupsoftherapyprovidersareeligibletobecontractedasMul3-SpecialtyGroupsandcanprovideafullarrayofbehavioralhealthservices

ImprovedCoverageforSubstanceAbuse•  Detoxifica3on

•  Residen3alTreatment

•  IntensiveOutpa3entTreatment

•  Par3alHospitaliza3onProgram

•  Rou3neOutpa3entTherapy(individual,family,groupcounseling)

•  PeerSupport

•  Addi3onalcodesforassessment,screening,andtreatmentplanning

Ourmembersarealwaysthecenterofwhatwedo

MemberOpera3ons&Enrollment

MemberServices&MemberAdvocates

QualityManagement

ProviderRela3ons&ProviderNetwork Appeals&

Grievances

MedicalManagement

Collabora3veServices

86

MemberServices•  MemberServicescanbereachedat1-855-300-5528

•  MemberServicesstaffwillbelocatedinKentuckyfor2016

•  OurMemberServicesstaff:»  Provideinformadononeligibilityandbenefits»  Assistproviderswithnon-compliantmembersand/ordischarges

»  Assistmemberswithavailableprogramsandresources»  Assistmemberinfindingproviders»  Assistmembersinfilinggrievancesorappeals

87

CommunityOutreach

•  AetnaBegerHealthofKentuckyhasdedicatedCommunityOutreachstaffacrossthestate,whoworktobevisibleandaccessiblelocalresourcesforourmembers,potendalmembersandcommunitypartners

•  CommunityOutreachstaff:─  Presentcurriculumonavarietyofsubjectsincludingpersonalhygiene(adaptedtobeage-appropriateinschools),bullyingprevendon,oralhealth,nutridon,andothers

─  AreCerdfiedPresentersinChronicDiseasemanagementandNurturingFamiliestraining

─  Pardcipateincommunityevents,organizadonsandmeedngsthatreachmembers,potendalmembersandcommunitypartners

─  Provideeducadonandanswersaboutourmemberbenefits─  Areapointofcontactformemberconcerns

88

ProviderRela3ons•  AetnaBegerHealthofKentuckyhasdedicatedProviderReladonsstaff•  ProviderReladonsstaffwillvisitproviderofficesregularlythroughouttheyeartoensureAetnaismeedngtheirneedsandaddressingconcerns

•  ProviderReladonswill:−  Provideeducadontoproviderofficesonavarietyoftopics−  ProvidesupportonMedicaidpoliciesandprocedures−  Provideprovidercontractclarificadon−  Assistwithdemographicchanges,terminadons,andinidadonofcredendaling

−  MonitorcompliancewithapplicableCommonwealthandFederalagencies

−  ConductannualProviderSadsfacdonSurvey−  Conductmembercompliantinvesdgadon−  Maintaintheproviderdirectory−  Beapointofcontactforproviderconcerns

ProviderRela3onscanbereachedat1-855-454-006189

THANKYOU

Presented by: Dana Moody Director of Community Engagement

Kentucky Primary Care Association Conference

Outreach and Education Track

WHAT IS PASSPORT HEALTH PLAN?

•  Local, Kentucky-based •  Community Health Plan •  Provider-Sponsored

•  Nonprofit •  Mission-Driven

Passport named Top Medicaid Plan in Kentucky by NCQA

NCQA ACCREDITATION SURVEY RESULTS

CAUSE-RELATED ADVOCACY

94

REGIONAL FOCUS

“MOVING THE NEEDLE”

•  24-HourHotlines

•  Collaboradonwithadvocatesand

agencies

•  CareCoordinadon

•  InsidePassport

•  ProviderNetworkManagement

•  MommySteps&SpecialPrograms

•  Disease&CaseManagement

HealthEducadon

•  EmbeddedCaseManagement

•  MemberEducadonSessions

•  CommunityEvents&HealthFairs

•  Added additional dental screening for adults (2 per year)

•  Over the Counter Medications •  90-day supply maintenance

medications •  Rx Copay

•  $2 preferred brand •  $4 non-preferred •  $0 generic medications

•  MemberIncendvePrograms

2016 BENEFITS

VALUE OF A MEDICAL HOME

98

At Passport we feel our members are best served with a primary home for care and oversight, thus the Primary Care Provider is responsible for coordinating the member’s health care. This ensures the member’s PCP is aware of all aspects of the patient’s care and can mange their overall health. We want all of our members to have a “Medical Home!” Our mission is to improve the health and quality of life of our members.

QUESTIONS?

2016 Individual Exchange Kentucky

Not for Consumer Use

The Marketplace and helping consumers choose a plan

101

Help individuals to choose a plan

102

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Add up the points and go to the next page to see the results: pts.

Ask individuals the three questions below to help find the plan that might be right for them

Metallic plan recommendations*

103


Based on total points, they might like:

*Every metallic level plan includes access to the same doctors and medications.

Video to support plan choice

104


Help individuals learn more about choosing a health plan

Share the Choosing a Plan

video from uhc.com

Video steps consumers through the three main considerations when

choosing a plan

Available in English now and Spanish in

November

UnitedHealthcare health insurance plans: 2016 overview

105

Here’s where to find our plans in your state

106


On Exchange plan availability

UnitedHealthcare Insurance Company of Kentucky, Ltd.

Our company name in your Marketplace:

Plans at a glance

107


Getting care in our network

108


Network Name: UnitedHealthcare® Compass Balanced

Members must:

Choose a primary care provider in the service area.

Get a referral before they see a specialist to receive the highest level of benefit.

In-network coverage only.

Note

Provider search can be done in

Spanish

Provider Search

uhc.com/docfind


Sample ID Card

109


UnitedHealthcare tools to help manage health care and costs

110

24/7 access anytime or anywhere when members register at myuhc.com

111


Choose how they want to get information – online, mail, email,

text

Available in Spanish

Access health resources and cost decision tools

Health4Me mobile app

Virtual Visits

NurseLine

myHealthcare Cost Estimator

myClaims Manager

Health4Me™ app helps you where you are

112


“There’s a convenienc

e clinic nearby”

“Doctor, can I get the MRI at

the clinic instead of the

hospital?”

From home, work or on the go, members can easily:

Share their ID card

Find and price care

Check claim status

Manage OptumRx prescriptions

FitBit connectivity

Note

Although Health4Me is not available in

Spanish, information can be accessed by

calling Customer Service

Tools to help manage health care

113


Virtual Visits

Health4Me app

myuhc.com

For members enrolled in UnitedHealthcare plans

Secure, online 24-hour access to physicians using mobile phone, tablet or computer

See and speak with a doctor

Get diagnosis and prescriptions for minor medical needs

Get list of participating virtual-visit providers using UnitedHealthcare’s

Health4Me™ mobile app or myuhc.com

Members pay a flat fee for each virtual visit


Decide if you should see a doctor, go to an urgent care center or emergency room, or treat yourself at home Find a doctor or hospital Answer questions about an illness or injury Give you support on caring for a chronic health problem, like diabetes Understand your medications

114


Registered nurses, with an average 15 years

of experience, are available 24 hours a day,

365 days a year

Call the number on the back of the ID card

NurseLine 24/7 nurse support

Nurses are supported by Spanish language

interpreters

PLAN TIPS Call a nurse wherever you are. This 24/7 service is part of your health plan at no additional cost.


115


Source4Women®

myuhc.com

Monthly interactive seminars

Tips, recipes, guidelines and checklists

Blog health topics important to the whole family

Interactive quizzes and health assessments

Where to find more information

116

Assister resources on dedicated website

117


Materials are on the Assister Resources site:

uhc.com/assisters

Slides

Assister newsletter

Hotline 1-866-698-1739

Material available on your website Collateral to provide information on

UnitedHealthcare Marketplace products and services

Consumer Guide

Marketplace FAQ

Subsidy Chart

Mini Brochure Network Flier

118


uhc.com/assisters

Hotline 1-866-698-1739

Summary of resources in Spanish

119


Personalized enrollment support is available at our fully-staffed bilingual

(Spanish-English) direct sales and enrollment Call Center

(800-985-3859)

Provider search with Spanish language indicator

Latino Health Solutions bilingual website at uhclatino.com

myuhc.com is in Spanish, including myClaims Manager

Once a member has enrolled, Customer Service is available in

Spanish with full member support

Latino Health Solutions

120


Bilingual health information center with medical terms and descriptions of laboratory tests

and common illnesses

Bilingual health education fliers, brochures, and other health

maintenance materials

Valuable educational videos in both Spanish and English at

uhclatino.com

How insurance works, What are HSAs, What are “Life Events,” What are the

Penalties for not enrolling, etc.

Health and fitness topics and recipes

Award-winning fotonovelas

uhclatino.com Spanish website

About UnitedHealthcare

121

About UnitedHealthcare

122


Consumers choose UnitedHealthcare based on the stability of our national size, our focus on quality improvement, and the value of our better approach to health engagement

Our Quality Our Value Our Tools

Our market leadership is a result of the unmatched quality for our members, customers, and providers

Using better analytics, we provide a better approach

to members that leads them to better health

engagement

With innovative tools we provide members help to

better manage their health care

Why UnitedHealthcare?

123

Load834inUHCSystemsthroughinvoicegeneradonwithin24

hours

Note:Pre-auditfilesare3dayTATforsystemloadthroughinvoice

generadon

Incompleteinformadonfallstoerrorprocessing

Welcomeemailsent

(ifapplicable)

Days 4-7

PendedsubscriberssenttoFiServovernightbatch

Memberhasinhand:•  Welcomee-mail

(ifapplicable)•  Inidalinvoice&

Onboardingchecklist

•  AcdvadonFlyer&InidalIDCard

Ini3alIDcard+s3cker&ac3va3onflyergenerated&mailedAveragemail9meis2-3days(firstclass)

Day 3 Day 2 Day 1

Pre-Effectuation Timeline In 2015 materials were received on average 30-45 days after coverage effective date

Enroll

Currently receiving e-mail addresses for 20% of enrollees through exchange on

initial enrollment file

Enrollment Summary

Ini3alInvoice&Onboardingchecklistgenerated/mailedAveragemail9meis2-3days(firstclass)

124

•  Welcome email sent when email is included on file from exchange

Confirmation of Action(s):

Enroll Days 1 & 2

Welcome e-mail

Approximately 72% of e-mails are opened

Confirmation and Welcome Email/Letter


125

126

Days 4-7 Day 3

Memberhasinhand:

•  Welcomee-mail(ifapplicable)

•  InidalinvoicewithOnboardingchecklist

•  AcdvadonFlyer&InidalIDCard

Enroll Days 3+

Initial ID Card, activation sticker, & activation flyer (gated and non-gated versions)

Ini3alIDcard+s3cker&ac3va3onflyergenerated&mailed

Averagemail9meis2-3days(firstclass)

Gated versions

Welcome Kit - Envelope, Folder, Welcome Letter

127



Thank you!

128


Assister website: uhc.com/assisters

Thank you for

taking the time

to learn more about

UnitedHealthcare!

Questions: Navigator Hotline

1-866-698-1739

!

2016 WellCare of Kentucky Benefit Overview

November 2015

THIS AREA CAN BE LEFT BLANK or ADD A PICTURE

129

WellCare Health Plans, Inc.

At WellCare, our members are our reason for being.

We work each day to enhance our members’

health and quality of life.

Emphasis on lower income populations and value-focused benefit design

Community-based solutions to close gaps in the social safety net

Focus on preventive care including regular doctor visits

Communication among members and providers to improve outcomes

130

Serving Kentucky

Fulton CallowayHickman MonroeSimpsonClintonAllen

Cum

berlandGravesCarlisle

BellMcCreary WhitleyWayneTrigg HarlanKnox

Marshall Todd LoganChristian BarrenLyon Metcalfe RussellWarrenBallard LetcherAdair LeslieLaurelPulaski ClayCaldwell

ButlerMuhlenberg Hart

GreenTaylor KnottOwsleyCrittenden Casey

HopkinsJacksonGrayson LincolnWebster McLean BreathittBoyle Lee

MarionLarueOhio

PikeFloydEstill Wolfe

Union MadisonDaviessPowell

MartinMercerHenderson Nelson JohnsonHardinBreckinridge

MenifeeClark MorganBullitt AndersonSpencer

Woodford Fayette

ElliottLawrenceBathShelby BourbonFranklin

Jefferson RowanScott Carter BoydOldham FlemingHarrisonHenry Robertson LewisOwen GreenupCarroll

MasonGrantK

entonC

ampbell

Boone

WellCare’s economic impact on the Commonwealth of Kentucky is $36 million annually. *

In Kentucky, WellCare:

•  Serves 457,000 members across the state.

•  Has a local presence with seven office locations.

•  Employs 230 people.

CoundeswithWellCareoffices

*Basedona2011studycommissionedbyWellCareandconductedbyJamesV.Koch,Ph.D.,Economics,BoardofVisitorsProfessorofEconomicsandPresidentEmeritusatOldDominionUniversity.

131

Data is per the last reported quarter, ending June 30, 2015 All numbers are approximated. Updated: September 18, 2015

Health Care Quality and Access

Access

Provider Access:

•  4,800 primary care providers.

•  17,400 specialists.

•  1,300 behavioral health and substance abuse providers.

Facilities Access:

•  110 hospitals.

•  170 federally qualified health centers.

•  175 community mental health centers.

Geographic Access:

• One primary care provider and hospital within 30 minutes for urban counties and 45/60 minutes for rural counties.

Quality

•  Focused on preventive health, wellness, chronic diseases and care management.

•  An enhanced case management model helps to more effectively serve the most medically complex members.

• The model leverages both field-based and telephonic resources using state-specific, multi-disciplinary care teams.

Process: •  The National Committee for Quality

Assurance (NCQA) awarded WellCare of Kentucky’s Medicaid plan an accreditation status of Commendable and an Accredited designation for its Medicare Advantage and Health Insurance Marketplace plans in the state.

Technology: •  Company-wide, more than $60 million

has been invested for information technology to support quality.

WellCare is committed to continually improving the quality of care and service that we provide to our members.

132

o  Fayette o  Jessamine o  Clay o  Leslie o  Harlan o  Laurel

Kentucky QHP Presence

•  Medicaid Plans and Medicare Prescription Drug Plans are available statewide. •  Medicare Advantage Plans are available in Boone, Bourbon, Bullitt, Campbell, Carroll,

Clark, Fayette, Gallatin, Grant, Jefferson, Kenton, Owen, Pendleton, and Scott counties. •  Individual Exchange Plans are available in 12 counties including:

o  Warren o  Jefferson o  Bullitt o  Boone o  Kenton o  Campbell

10

Marketplace QHP Network

Extensive network of 8162 providers (Hospitals, Ancillaries, FQHCs and RHCs, Dental, Vision, Behavioral Health and Pharmacy providers) including:

•  2899 PCPs

•  2365 Specialists

•  221 FQHCs and RHCs

•  142 Behavioral Health Specialists

•  21 Hospital Systems

134

Physician Network

Major Physician group networks:

•  Kentucky Primary Care Association

•  The Association of Primary Care Physicians

•  Baptist Physician Group

•  Kentucky Medical Services Foundation – UK HealthCare

•  Saint Elizabeth Physicians and the Summit Medical Group

•  Norton Physician Group

135

Hospital Network

Hospital Network Includes:

•  Baptist Health Hospital System

•  Norton Health System

•  Kosair Children’s Hospital

•  University of Kentucky Health System

•  Saint Elizabeth Health System

•  Pineville Community Hospital

•  Knox County Hospital

136

2016 Plan Changes

•  Bronze Plan Introduced

•  Re-designed Silver & Gold Plans

o  First three PCP visits Free - No cost share

o  Waived Deductible on Key Benefits

137

2016 Plan Changes

•  Waived Deductible on Key Benefits (all plans except Catastrophic)

o  PCP Office Visits

o  Specialist Office Visits

o  Outpatient Mental Health & Substance Abuse

o  Physical, Occupational, and Speech Therapy

o  Generic Drugs

•  Pharmacy Formulary

o  Changed from four-tier to five-tier formulary:

•  Tier 1: Generic Drugs

•  Tier 2: Preferred Brand Drugs

•  Tier 3: Non-Preferred Brand Drugs

•  Tier 4: Preferred Specialty Drugs

•  Tier 5: Non-Preferred Specialty Drugs

138

Plan Offerings - Catastrophic

Metal Level Catastrophic Individual Deductible $6,850

Family Deductible $13,700

Note Medical and Rx Combined

Individual Max Out-of-Pocket $6,850

Family Max Out-of-Pocket $13,700


Medical Inpatient Hospital Care $0 after Ded

Emergency Care $0 after Ded

Urgent Care $0 after Ded

Outpatient Hospital Services $0 after Ded

X-Rays/Labs $0 after Ded

Advanced Imaging $0 after Ded

PCP Visits 1-3: $0 (Ded Waived) Visits 4+: $0 after Ded

Specialist $0 after Ded

Other Services Dental – Pediatric ü 

Vision – Pediatric ü 

Pharmacy Generic $0 after Ded

Preferred Brand $0 after Ded

Non-Preferred Brand $0 after Ded

Preferred Specialty $0 after Ded

Non-Preferred Specialty $0 after Ded 17

Plan Offerings – Bronze Plan

Metal Level Bronze Individual Deductible $6,500 Medical / $300 Rx

Family Deductible $13,000 Medical / $600 Rx

Note -




Medical Inpatient Hospital Care $0 after Ded

Emergency Care $0 after Ded

Urgent Care $80 after Ded

Outpatient Hospital Services $0 after Ded

X-Rays/Labs Basic Lab: $40 (Ded Waived) X-Ray: $0 after Ded

Advanced Imaging $0 after Ded

PCP $40 (Ded Waived)

Specialist $80 (Ded Waived)

Other Services Dental – Pediatric ü 

Vision – Pediatric ü 

Pharmacy Generic $15 (Ded Waived)

Preferred Brand $75 (Ded Waived)

Non-Preferred Brand $125 after Ded

Preferred Specialty 35% after Ded

Non-Preferred Specialty 40% after Ded 18

Plan Offerings - Silver

Metal Level Silver Silver 73 Silver 87 Silver 94 Individual Deductible $2,800 $2,800 $800 $0

Family Deductible $5,600 $5,600 $1,600 $0

Note Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined

Individual Max Out-of-Pocket $6,600 $5,300 $1,650 $975

Family Max Out-of-Pocket $13,200 $10,600 $3,300 $1,950

Note Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined

Medical

Inpatient Hospital Care 30% after Ded 30% after Ded $300 after Ded $175 Copay

Emergency Care 30% after Ded 30% after Ded $200 after Ded $150 Copay

Urgency Care $45 after Ded $45 after Ded $20 after Ded $15 Copay

Outpatient Hospital Services 20% after Ded 20% after Ded 10% after Ded 10%

X-Rays/Labs 20% after Ded 20% after Ded 10% after Ded 10%

Advanced Imaging 20% after Ded 20% after Ded 10% after Ded 10%

PCP $15 (Ded Waived) $15 (Ded Waived) $5 (Ded Waived) $0

Specialist $45 (Ded Waived) $45 (Ded Waived) $20 (Ded Waived) $15

Other Services

Dental – Pediatric ü  ü  ü  ü 

Vision – Pediatric ü  ü  ü  ü 

Pharmacy

Generic $5 (Ded Waived) $5 (Ded Waived) $5 (Ded Waived) $0

Preferred Brand $40 after Ded $40 after Ded $30 after Ded $20

Non-Preferred Brand $100 after Ded $100 after Ded $70 after Ded $45

Preferred Specialty 35% after Ded 35% after Ded 35% after Ded 35%

Non-Preferred Specialty 40% after Ded 40% after Ded 40% after Ded 40%

19

Plan Offerings - Gold

Metal Level Gold Individual Deductible $1,500 Family Deductible $3,000





Medical Inpatient Hospital Care 20% after Ded Emergency Care 20% after Ded Urgent Care $35 after Ded

Outpatient Hospital Services 20% after Ded

X-Rays/Labs 20% after Ded Advanced Imaging 20% after Ded PCP $20 (Ded Waived) Specialist $35 (Ded Waived)

Other Services Dental – Pediatric ü  Vision – Pediatric ü 

Pharmacy Generic $0 (Ded Waived) Preferred Brand $25 after Ded Non-Preferred Brand $100 after Ded Preferred Specialty 35% after Ded

Non-Preferred Specialty 40% after Ded 20

Wellness Discounts

143

•  Online education tools. •  Up to 30% discount on CAM

providers like acupuncture, chiro, diet/supplement advisors, exercise/movement, massage and relaxation.

•  Additional discounts for Jenny Craig, eyeglasses, hearing screening and hearing aids, dental insurance and more.

Community Assistance Line

•  Transportation Homeless Services

•  Food Assistance Education Assistance

•  Financial Assistance Respite Care

•  (Utility, Rent)

•  Support Groups Other

•  Disability-related Services

Refer any WellCare member in need of community-based social services

Get connected with the right social services.

CALL

KY CommUnity Assistance Line (CAL) 1-866-775-2192 Video Relay 1-855-628-7552

Free for WellCare of Kentucky members.

23

New Member On Boarding

•  New member kits sent out 5 days after receiving a completed enrollment.

•  Members will receive their first bill within several days of enrollment. After the

first payment is received, a payment book will be mailed to subscriber on the

account.

•  Members will need to select a Primary Care Physician (PCP), if not selected it

will be assigned. Members can change their PCP at any time.

•  ID Cards will be mailed within 7 days of effectuated enrollment.

•  Health Risk Assessment initiated to new members after effective date

(telephonic).

145

Kentucky’s Choice for Medicaid

33%ofKYMedicaidMemberschooseWellCare

OEP

0

50000

100000

150000

200000

250000

300000

350000

400000

450000

500000

SumofWellCare SumofAnthem SumofAetna(Coventry) SumofHumana SumofCentene SumofPassport

KentuckySpiritExit

ACABeginsOEP OEP

Region3

Medicaid - Benefits

NO CHANGE FROM 2015

TWO COPAYS •  $4 Non-Preferred Brand Medications

•  $8 Non-Emergent ER Visits

147

Medicaid – Extra Benefits

o Expanded benefits are effective tools used to enhance our member’s health and their quality of life.

o The benefits are designed to address members needs and help to remove barriers to care.

o We believe these benefits deliver meaningful, lasting improvements to our members, thereby delivering value to our providers and state partners.

148

Extra Benefit Overview

Benefit BenefitDescrip3on EligiblePopula3on CostShare/Copay

MealProgram Eligiblemembersdischargedfrominpadenthospital,rehabilitadonorskillednursingfacilityreceive10mealspostdischarge(priorauthorizadonrequired..

MembersonatreatmentplanwithaCaseorDiseaseManagerthataredischargedwithintwoweeksfromaninpadentfacility

$0

HealthyRewardsProgram Membersarerewardedfortakingstepsthathelpthemtoliveahealthylife(i.e.,annualwellnessvisits,prenatalvisits,diabedcscreenings).

AllMembers

$0

SportsPhysical Membersage6-18receiveone(1)sportsphysicalperyear,providedbyaPCP,forchildrenage6-18.

Membersage6-18

$0

Over-the-Counter(OTC)Items

$120infreeOTCitemseachyeararemailedtomembershomes.Memberschoosefromover150items,likediapers,readingglasses,handsoap,dentaltravelkit,lodons,painrelieversandmore.

Allmembers

$0

GEDTes3ng Membersage16andup,withoutahighschooldiplomareceivepre-paidvoucherstotaketheGEDtest.

Membersage16andup

$0

149

Extra Benefit Overview Cont.

150

Benefit BenefitDescrip3on EligiblePopula3on CostShare/Copay

BabyShower Localbabyshowersareheldinthecommunitywherememberscananagend.Membersreceiveagirbasketanddpsandrecommendadonstokeepthemandtheirbabyhealthy.

Expectantmembers $0

Text4Baby® Text4baby,allowsmemberstogetcridcalhealthandsafetydpsdmedtotheirbaby’sageupundlbaby’sfirstbirthday.

Allmembers $0

Meals Program

We understand the transition from a hospital setting back home can be challenging. Individuals often need additional support related to an underlying illness, recent surgery,

wound healing, or ongoing symptoms to avoid a return visit to the hospital.

151

Members in Care Management can receive 10 meals delivered to their home within 14 days of discharge from hospital, rehabilitation or skilled nursing facility.

FREE Sports Physical

A Sports Physical helps determine whether it's safe for children to participate in a particular sport. Most states actually require that kids and teens have a sports physical before they

can start a new sport or begin a new competitive season.

152

OneFREESportsPhysicalforschool-agedchildren,annually.

Healthy Behaviors Program

The Healthy Behaviors program will reward members who complete specific preventive health, wellness, and engagement milestones.

Enrollees will receive a reloadable Visa Debit Card or Gift Card.

153

OurHealthyRewardsProgramisdesignedtopromoteahealthierlifestyle

Popula3onSegment FocusArea Ac3vityCriteria Incen3veType Incen3veValue

Children'sHealth

0-15months WellChildvisitperperiodicityschedule(6visits) DebitCard $10visitsforatotalof$60

3-6years AnnualCheck-up DebitCard $20

7-21years AnnualCheck-up DebitCard $20

HealthyPregnancy

PrenatalCareVisits Agend6prenatalvisitsbeforethebirthofthebaby DebitCard $50

PostpartumCareVisits Agend1postpartumvisit21-56daysarerthebirthofthebaby

DiapersandDebitcard

6packsofdiapers

plus$20

Diabetes Diabetes

Completeeyeexam(Memberswithdiabetes18-75)DebitCard

$20

CompleteHgbA1C(Memberswithdiabetes18-75)DebitCard

$20

WellWomen

CervicalCancerScreening

Completeofofficevisitforcervicalcancerscreening(papsmear)(ages21-64)

DebitCard

$20

ScreeningMammogram

CompledonofScreeningmammogram–(ages40-65)

DebitCard

$20

AdultHealth AnnualAdult Completeannualadultscreening(WellnessVisit-members>21yrsold)

DebitCard

$20

Dental PreventadveDentalVisit

AnyprevendvedentalvisitforallWellCaremembersage5andup

DebitCard

$20

154

Over-The- Counter (OTC)

The OTC benefit promotes self-directed prevention, maintenance and on-going medical management.

Items offered not only include traditional products (e.g. diapers, pain relievers, vitamins) but also eyeglass kits, reading glasses, and assistive aid devices such as pill containers or

magnifying glasses to improve adherence to medication usage and to avoid errors in taking their medications which could result in hospitalization.

155

Memberscanorder$10inOTCitemspermonth,perhousehold

GED Program

WellCare recognizes the importance of education for the overall health and wellness of our enrollees. We believe in empowering our enrollees and providing them access to knowledge

that will help them improve their health and quality of life. The GED exam benefit supports this belief by ensuring that our enrollees receive the

education needed to initiate this foundation of awareness.

156

Throughthisbenefit,WellCarewillcoverthecostforthefourrequiredexams.

Community Baby Showers

WellCare members who are expecting are invited to a community baby shower. Baby Showers are a way to give our expecting members tips for staying healthy and a gift basket

of helpful items.

157

Through this program we are able to celebrate and educate our members.

Text4Baby®

WellCare recognizes the importance of educating our members. Text4baby, allows members to get critical health and safety tips timed to their baby’s age up until baby’s first

birthday.

158

Text4babyisFreeevenifmembersdon’thaveafreetextmessagingplan.**MemberswithaTracfonemustconfirmwiththeircarrier**

Text4Baby® Cont.

Who is Eligible? All WellCare members

159

How Does the Program Work? Topardcipateintheprogramallmembersneedtodoissendatextto,BABY(orBEBEforSpanish)511411.Whenpromptedmembersentertheirduedateandzipcode.MemberscancancelthisserviceatanydmebytexdngSTOP;fortechnicalassistancemembershouldtextHELP.MemberscanalsoTextUPDATEtochangetheirduedateorbaby'sbirthday.

Extra Benefits - Community Assistance Line

•  Transportation Homeless Services

•  Food Assistance Education Assistance

•  Financial Assistance Respite Care

•  (Utility, Rent)

•  Support Groups Other

•  Disability-related Services

Refer any WellCare member in need of community-based social services

Get connected with the right social services.

CALL

KY CommUnity Assistance Line (CAL) 1-866-775-2192 Video Relay 1-855-628-7552

Free for WellCare of Kentucky members.

48

Community Relations and Focused Giving

The WellCare Community Foundation Established in 2010, it is a non-profit, private foundation with a mission to foster and promote the health, wellbeing and quality of life for the poor, distressed and other medically underserved populations – including, those who are elderly, young and indigent – and the communities in which they live.

Employee Volunteerism WellCare encourages volunteerism to support children and seniors, and those who are low-income or underserved. Employees work in their local communities to raise much-needed funds and to support organizations that offer valuable support to those in need.

Community Relations

The Community Relations program educates and advocates for WellCare members and the community. Through it, we proactively facilitate communications with providers, members and the community to inform, educate, address health issues and encourage preventive health care.

WellCarestrivestohelpourmembersandtheircommuni3es,leadbe>erandhealthierlives.

In Kentucky, WellCare supports the work of community organizations and initiatives, including:

American Diabetes Association

American Red Cross

Coalition for the Homeless

Community Farm Alliance

Community Farmers Market

Community Ministries

HOTEL INC Homeless Outreach

Family and Children’s Place

Mama to Mama

Owensboro Regional Suicide Prevention Coalition

Volunteers of America of Kentucky

West Care

YMCA

161

Questions

QUESTIONS?

Outreach & Enrollment Track Kentucky Primary Care Association Annual Conference 2015

Documents

MCO/QHP PANEL...Shows plans as filed with state DOIs (plans not yet approved; subject to change) Your Kentucky Individual Sales Team Andrea Fowler- Field Sales Rep KY, IN, OH, and