HumanaOne Benefits
Humana
Jeremy Stanly
Verification of Benefits Training Agenda
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Landing Page
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Affordable Care Act compliant – what does that mean
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Essential Health Benefits
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Benefit Grids
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Vision
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Dental
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PCP
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ID Card
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Cost Sharing
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Deductibles
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Common Transfer Numbers
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Humana One – Individual Line of Business
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What is it- HumanaOne is for individuals who purchase their
own insurance. They are not affiliated with a group or programs
such as Medicaid.
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Landing Page
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The landing page is the first place you will be taken when
receiving a member call.
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The next slide will show what the Landing Page looks like.
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Landing Page
Screen shot and circle or highlight
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Affordable Care Act Compliant
What does this mean?
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The benefits that you will be quoting are plans that went
into effect on or after 1/1/14 is considered to be ACA
compliant.
There are 10 essential health benefits that must be
included in all of these plans.
Mentor Doc: Essential Health Benefits Overview
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Affordable Care Act Compliant
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The ACA compliant plans fall under one of four metallic tiers,
and are named as such:
 Platinum
 Gold
 Silver
 Bronze
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An example plan name would be: FL HMO Premier 80 IMM
Silver 1 Connect Silver
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Terms
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Deductible- The portion of the covered member’s health care
expenses that must be paid out of pocket before the member’s plan
begins paying its share
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Coinsurance- A percentage of health care costs for which the member
is responsible under the member’s health benefit policy. For example,
a member might pay for 20 percent of the cost of a service, with the
health coverage policy paying the remaining cost
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Copayment-A fixed amount of health care costs for which the member
is responsible under the member’s health benefit policy. For example,
a member might pay $15 for each visit to a physician, with the health
coverage policy paying the remaining cost.
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Terms
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Maximum Out of Pocket-The amount a member is required to
pay for treatment or services.
Example: You will see something like this maybe $5000/$6500
The $5000 is the deductible and the $6500 is the Maximum Out of
Pocket (Moop)
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Cost Sharing- The portion of the deductible or out of pocket that
the member may get a reduction on due to income levels.
Example: A member may have a deductible of $5,000, but receive
a cost share discount to bring their deductible down to $3500
based off of their income level.
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Benefit Grids
Benefit grids are where the member’s benefit information
comes from.
• To populate these grids, in CCP click the benefits tab:
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Benefit Grids
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Benefit Grids
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The slide prior shows what the benefit tab looks like.
The grid then will populate in mentor:
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Benefit Grids
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The name of the member’s plan is the hyperlink that you
actually click to get into the grid:
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Benefit Grids
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On the bottom there are tabs where the medical benefits
and the Pediatric Vision benefits are available.
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The benefit tab is what is used most often, unless the
member has a question about Pediatric Vision
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Benefit Grids
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Deductibles
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Some members may have their deductibles populate for you in
CCP on the benefits tab:
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Deductibles
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Some members may qualify for cost share through the federal
government.
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Cost share is where the government picks up a portion of the
members deductible. For example if the plan calls for a $4600
deductible, with cost sharing it may drop it to $2500.
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To locate the cost share go back to the landing page and hover
over the member details button at the top. A drop down will
appear and click on Cost Share.
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Locating Cost Share
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Locating Cost Share
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Pediatric Vision
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Pediatric Vision
For questions regarding Pediatric Vision:
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Use the benefit grid the same way you learned how to quote the
medical benefits.
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Dental
Some members may have a dental benefit.
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To find if a member has one of these you would check on the
Member tab of CCP.
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Dental
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This plan has a CB next to it, so that would be a warm transfer to
the Dental CompBenefits area at 855-204-4929.
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For Dental Plans that do not have a CB, warm transfer to 877282-5654
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PCP
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To verify who a member’s PCP is (primary care physician)
go to the benefits tab again.
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Click the PCP tab:
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The types of providers that can be PCPs are; Family
Practice, General Practitioners, OBGYN’s, Internal Medicine
and Pediatricians
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PCP Changes
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PCP Changes
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To assist a member with a PCP change go to the PCP tab on the
benefits screen
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Go to physician finder and make sure the PCP is in network.
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To get the physician ID click on the physician’s name
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Then click on the hyperlink that says “more” under Locations and
Affiliations.
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The PCP number appears.
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The following slides will show you the process.
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If the member is a 1/1/14 effective date you can backdate the PCP
effective date. The change will take 24 hours to take effect in CCP.
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PCP Changes
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PCP Changes
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PCP Changes
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PCP Change
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If for some reason the change doesn’t work in CCP then follow the
below process:
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All Primary Care Physician (PCP) Changes should be made in
CCP. NOTE: If the network says FL HMO Premier, it is not a true HMO
and does not require a PCP.
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If you are unable to update the PCP in CCP because the system is
giving you an error message, please use the following scripting.
Scripting:
“I’ll send a request for your PCP change now, you will be getting a new
ID in an estimated 10-14 business days. What is the best number to
reach you at if we have any additional questions or concerns with your
new choice?”
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PCP Change
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Then please document your inquiry with the following information and send it to the tank
below.
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Please include in your notes the following information, all of which can be found in
Physician Finder Plus (PFP) except for the member’s phone #:

Physician’s Name:
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Physician’s Address:
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CAS #:
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Member’s Call Back Phone #:
After filling out the above information, send your inquiry to:
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Service Center: Green Bay
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Department: INDALLS Calls
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Team: PCP Update
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User: Blank
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ID Cards
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For ID card orders please advise the member to go to
Humana.com and they can view or print their ID Cards.
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If they are having problems doing this assure them that their
cards are on the way.
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In the mean time double check the member’s effective date to
be 1/1/14.
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Also inform them of their member ID and their Group #. Those
are what they will need to attain care from their provider.
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ID Cards
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Transfer Types
Some calls may require you to transfer to other departments:
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For more in depth medical benefit or referral questions please
cold transfer to HumanaOne claims and benefits at 855-4772418
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For any pharmacy claim and benefit questions transfer to 877832-4229
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For member calls where they have a procedure scheduled and
want to know if authorization is needed, transfer to our Clinical
Intake Team (CIT) 800-523-0023
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Call Logging
When logging the benefits please copy verbatim from the grid, and paste
the benefit into your free text. If multiple benefits are given then paste all
the benefits into one CCP Inquiry.
• Your CRD’s for the call will be:
Category- VOB
Reason- (type of benefit) such as Preventive
Disposition- (what you did) such as info given
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Call Logging
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Technology Errors
If for some reason there is an error in CCP or Mentor where the
information is not populating or you get an actual error of some
kind.
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Please send a screen shot as well as a description of the error to
Dana Vandenlangenberg (Dvandenlangenberg@humana.com)
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Questions???
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