MT DONAHOE/Kaiser Permanente

A BETTER WAY to take care of business

kp.org/choosebetter

MT DONAHOE/Kaiser Permanente Update

Brandon Burbage, Small Group (1-50 ) Sales Executive

Agenda

1. KP Mid-Atlantic

1. National & Local Presence

2. Expansion & Growth

2. Products

1. What We Sell – A Plan for Everyone

2. Rates

3. Submission Process

4. Broker Compensation

5. Objections Impacting Quoting Activity

6. Support Resources

7. Questions


kp.org/choosebetter

KP Mid-Atlantic

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National and Local Presence

Trusted Advisors for Home Healthcare • 44-eligible home healthcare company• Group never considered Kaiser Permanente

before• Broker wasn’t as versed in specific Kaiser

Permanente details and plans• Consulted Sales Executive on the best plan

selections to meet the group’s needs• Helped position the broker as the trusted

advisor and provide the best solution for their client

• Kaiser Permanente was selected because of the quality of care, benefit designs and as the best financial solution for the group

• Our Sales Executive facilitated the enrollment meeting and consulted with members on plan options and details

• Enrolled 27 subscribers and 45 members• The group had an easy and smooth

onboarding process and renewed in 20204

“I have been working with insurance companies for a number of years. While we may have been hesitant to go with Kaiser, this was by far the easiest enrollment process I have been through.”

- Group’s senior leadership


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Quality Care at the Core


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-Our Medical Group now covers over 50 medical and surgical specialties and 1,632 physicians

-Over 1,100 board-eligible / board-certified physicians have joined us since the beginning of 2009 (Board Certification is a mark of distinction. The provider has taken the extra steps to demonstrate mastery of the latest advancements in their specialty and practice at the top of their profession).

Physicians recognized in the November 2020 “Top Doctors” issue



167 212 50Northern Virginia Magazine Washingtonian Magazine Baltimore Magazine

Top Physicians

Hiring & Retaining Top Physicians

Kaiser Permanente is the Top Rated Amongst Consumers

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Access to Care Access to Care

The Future Looks Bright

Timonium-Lutherville Medical CenterCaton Hill Medical Center

Projected opening: February 2022• New build medical center• 221,795 square-feet, five-story hub• Primary care, specialty care, Urgent Care,

Advanced Urgent Care, ancillary services

Projected opening: May 2022• New build medical center• 241,357 square-feet, five-story hub• Primary care, specialty care, behavioral health,

optometry, ASC, Urgent Care and Advanced Urgent Care, and ancillary services

• Located 3 miles from current Woodbridge Medical Center11

• Kaiser Permanente Mid-Atlantic States will spend more than $1B in capital investments across NOVA, DCSM and Baltimore over the next few years

• New facilities and expansions: Ashburn (2020), Bowie Fairwood (2021), Timonium and Caton Hill (2022)

2021 Plan Updates – Commercial Group

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Small Group:

Plan additions: VA: DHMO 8200/50/vision in bronze tier MD: $4000/40/vision DHMO and DHMO Plus in silver tier and DHMO Plus 6900/50/vision in bronze tier DC: 0/10/vision 2TPOS and 500/10/vision 2TPOS added to platinum tier

The standard non-pediatric Vision Hardware benefit has changed from a percentage (40%) discount to dollar ($) discount $125 off glasses or $25 off contacts

Embedded adult preventive and embedded cosmetic dental benefits removed to bring KP to parity with market and eliminate overlapping coverage

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NEW | Added ChoiceSimple 2 tier product that combines Kaiser Permanente's award-winning integrated care delivery system, easy member experience and unlimited access to any licensed provider nationwide.

Out-of-Network Benefit Design

Unlimited medical services and Rx fills/refills

PCP Office VisitPreventive Care

Specialty Office VisitOutpatient Mental Health

PT/OT/STLabs/X-Rays

Deductible20% or 30%

Coinsurance in ML1

RXGeneric

Preferred BrandNon-Preferred Specialty


Coinsurance in ML1

InpatientOutpatient surgery

Skilled nursing facilitiesMaternity

Prenatal care


Coinsurance in ML1

Product Highlight:• The same comprehensive coverage as KP’s traditional

HMO in-network, with unlimited routine care out-of-network

A great fit for groups new to KP and seeking to:• Experience integrated care from KP but still have

provider choice• Transition from a similar POS plan with another carrier• Maintain their relationship with an existing provider • Have options for employees that live on the outskirts of KP

service area

Market and Price Competitive:• Priced competitively compared to Flexible Choice• Combines KP quality with provider choice• Enhanced consumer and employer experience

Availability:• Available now in Mid-Large all jurisdictions• Available now in Small group

• Off-exchange Maryland (3) and Virginia (3)• On-exchange for DC (5), on-exchange for MD (1)

14Notes: 1. Specific plan designs for SG with coinsurance varying between 20%-40%

A BETTER WAY to take care of businessHMO Plus and DHMO Plus

Product Highlight• The same comprehensive coverage as KP’s traditional HMO and

DHMO in-network, with limited routine care out-of-networkTarget groups will be new to KP and seeking to:

•Lower costs, but still have provider choice•Transitioning from a POS or PPO plan with another carrier•Maintain their relationship with an existing provider •Have options for employees that travel frequently

Availability•9/1/2018 in Mid-Large all jurisdictions, and Small group off-exchange Maryland and Virginia•1/1/2019 for Small group DC on-exchange

Market and Price Competitive•The Plus plans are approximately 4% higher than their equivalent HMO and DHMO plans•Currently no other products like this in the market

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Plus Out-of-Network Benefit Design

Limited to 10 medical services and 5 Rx fills per year

PCP Office VisitSpecialty Office Visit

Outpatient Mental Health

PT/OT/STLabs/X-Rays

$20 higher co-pay or 10% higher co-

insurance than in-network

RXGeneric

Preferred BrandNon-Preferred Specialty

$20 higher co-pay or 10% higher co-

insurance than in-network

Inpatient, outpatient surgery, skilled nursing

facilities, maternity, prenatal care,

chiropractic, acupuncture, dental, and vision

Not Covered Out-of-Network

The innovative HMO and DHMO Plus products combine Kaiser Permanente's award-winning integrated care delivery system and price stability with limited access to any licensed provider nationwide.

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FLEX CHOICE (3TPOS) Kaiser Permanente


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Common Objections

Common Objections

Most Common Objections Employees can’t keep their own doctor/narrow network

My employee’s family member/friend had a bad experience with Kaiser

Kaiser is great for certain blue collar, local industries

Responses to Objections Kaiser offers several options (plans) for employees to

keep their own providers AND enjoy significant cost savings (review plan options in this deck)

It’s unfortunate the employee had a bad experience (can’t minimize someone’s experience)- but Kaiser consistently ranks as the highest quality of healthcare provider according to the NCQA (independent, non profit, no industry influence) and 3rd party ratings

Because of Kaiser Permanente’s consistently high quality of care ratings, plans that allow flexible access to non-Kaiser providers in/out of service area, affordability and commitment to investing in resources (Wellness, Telehealth) that allow groups to contribute to the health of their employees- Kaiser Permanente is best solution for ANY group seeking quality of care, access flexibility and significant cost savings.

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Highly Competitive Rates Across All Jurisdictions

Approved DC 2021Small Group rate position by metal tier

DC

Preliminary 2021

$45

$33

$3

-$37

DC

KP lowest price plan

KP 2nd lowest price plan

Positive values represent rate advantage.

42%

39%

16%

2%Silver Bronze

Platinum

Gold

APPROVED MD 2021 (DC Metro)Small Group rate position by metal tier

MD

Preliminary 2021

$35

-$6

$10

-$1

MD




Platinum14%

Gold26%Silver

52%

Bronze7%

#3

APPROVED VA 2021Small Group rate position by metal tier

VA

2021

$44

$13

$8

-$34

VA




Platinum20%

Gold46%

Silver26%

Bronze8%


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Small Group Submission Process

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Small Group Enrollment Check List Enrollment


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Broker Compensation

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Broker Compensation Small Group Fall Broker Bonus Extended

Year End Agency Bonus

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Medical Financial Assistance (MFA) Program

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Documents

MT DONAHOE/Kaiser Permanente