Broker/Agent Product Training Coventry Health Care of Texas Medicare Advantage (MA) Coordinated Care Plans (CCP) 2014 Data Classification: INTERNAL USE – BROKER/AGENT ONLY © 2013Coventry Health Care, Inc. 2 2014 MAPD Product Training Before we begin… Reminders: • Silence Your Phone • Handling Questions • Complete all 2014 Requirements PRIOR to Selling Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 3 Agenda • • • • • • • Service Area Value Proposition Ready to Sell Product Servicing Your Clients Compliance Additional Resources Data Classification: INTERNAL USE – BROKER/AGENT ONLY 4 2014 MAPD Product Training Data Classification: INTERNAL USE – BROKER/AGENT ONLY 5 2014 MAPD Product Training Provider Network Highlights Coventry Health Care of Texas Houston Metro Memorial Hermann System Methodist System Christus St. John Hospital Cypress Fairbanks Medical Center Houston Northwest Medical Center Park Plaza Hospital San Antonio Metro Baptist Health Systems Medina Community Hospital Beaumont Metro Christus Dubois Hospital Christus St. Elizabeth Hospital Christus St. Mary Hospital The Medical Center of SE Texas El Paso Metro Providence Memorial Sierra Medical Center Sierra Providence East University Medical Center Texarkana Christus St. Michael Wadley Regional Corpus Christi Christus Spohn Hospitals Weatherford Weatherford Regional Hospital Data Classification: INTERNAL USE – BROKER/AGENT ONLY 6 2014 MAPD Product Training Value Proposition Coventry Health Care of Texas • Local presence and understanding • National experience and infrastructure • Products that are relevant and valuable to the beneficiary • High quality network • History of provider collaboration • Patient-centered care model & case management • Local Texas team for both members and agents/brokers Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 7 What’s New for 2014 $0 PCP Co-Pay $0 Co-Pay for Tier 1 Prescriptions HMO product in 10 counties Gap coverage Tiers 1 & 2 {HMO Only} Co-Branding with Baptist Hospital Systems in San Antonio • Expanded networks in many markets • • • • • Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 8 How to Be ‘Ready to Sell’ for 2014 • Complete the online AHIP/Coventry training and testing at www.coventry-medicare.com • Complete local health plan product training and testing for all service areas you plan to sell in – Contact your up-line, BSD, or local health plan to ensure you are properly contracted and certified for the service area you intend to represent • New Brokers must complete your online Coventry “Contract Package” • Must have State Appointment – in each state where you are licensed and the state(s) where a prospective member resides. • Receive “Ready to Sell” notification from Coventry and your Agent Writing Number (AWN) ID Card for 2014. (Via Email) • Must have up to date Errors & Omissions coverage on file • Contact the Broker Service Department (BSD) if you have not received your AWN ID Card (E-Mail) before you intend to present Coventry to a prospective member If you sell Coventry Products without completing the steps above you WILL NOT receive commission payments and you will be non-compliant. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 9 2014 MAPD Product Training Local Health Plan Training & Testing • A local health plan test must be successfully completed • 20 multiple choice questions • Must achieve a 90% or better • Can complete the test online, by email, face to face or fax – If by email check your spam folder! • Tests that are not taken online can be turned in to your local Medicare sales team or faxed to the test center via toll-free number • Completed test will be kept for 10 years by Coventry Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 Product Information 10 11 2014 MAPD Product Training Product Strengths • True balanced product portfolio with $0 premium HMO and PPO plans offered • Access to a very broad network of quality hospitals and physicians for 2014. • Get the best value for your health care dollar with premium stability- we have offered $0 PPO plans for several years • Full access to any Health Club facility in the network with no co-payments for club membership • Prescription drug coverage is included on all plans Data Classification: INTERNAL USE – BROKER/AGENT ONLY 12 2014 MAPD Product Training Comparison Grid • Your Coventry Product Sales Tool! • Let’s take a tour of the Comparison Grid Data Classification: INTERNAL USE – BROKER/AGENT ONLY 13 2014 MAPD Product Training Prescription Drug Coverage Stage 1 Yearly Deductible Stage Stage 2 Initial Coverage Stage Stage 3 Coverage Gap Stage Stage 4 Catastrophic Coverage Stage Member will pay 100% of the cost of drugs until the plan deductible is met. The deductible for 2014 is $310.00. During this stage, the plan pays its share of the cost of drugs and the member pays their share of the cost. Members pay 47.5% of negotiated drug cost for brand and 72% of negotiated drug cost for generics. Members pay $2.55 for generics and $6.35 for brand or 5% (whichever is greater). *Some plans have coverage in the gap. If so, members pay a copayment for covered drugs. During this stage, the plan will pay most of the cost of the member’s drugs for the rest of the calendar year (through December 31,2014) If the plan does not have Member stay in this a deductible member will stage until their year-tobegin in Stage 2 date “total drug costs” (member’s payments plus any plan’s payments) total$2850.00. Members stay in this stage until member’s year-to-date “out-ofpocket costs”(member’s payments)reach a total of $4550.00. This amount and rules for counting costs toward this amount have been set by Medicare. Note- LIS members will pay the lessor of the plan member cost share or their CMS defined LIS copayments Data Classification: INTERNAL USE – BROKER/AGENT ONLY 14 2014 MAPD Product Training 2014 Pharmacy Benefits Comparison Outpatient Rx Cost-Sharing Information Network 30-Day Supply at Network Pharmacy Preferred Pharmacies Tier 1: $0 copay Tier 2: $3 copay Tier 3: $35 copay Tier 4: $70 copay Tier 5: 33% Nonpreferred Pharmacies Tier 1: $3 copay Tier 2: $10 copay Tier 3: $45 copay Tier 4: $95 copay Tier 5: 33% Note- LIS members will pay the lessor of the plan member cost share or their CMS defined LIS copayments Data Classification: INTERNAL USE – BROKER/AGENT ONLY 15 2014 MAPD Product Training Coventry Preferred Pharmacies! More ways for your clients to save money with Coventry! A “Preferred Pharmacy” is one that’s within our overall pharmacy network where we’ve negotiated lower cost-sharing levels (pricing) for Coventry members. Prescriptions can still be filled at any network pharmacy, but your clients can save even more money by using a preferred pharmacy. Any pharmacy in our network not listed here as a Preferred Pharmacy is a Non-Preferred Pharmacy (CVS, Safeway, Costco, etc.) -Walgreens -Wal-Mart {Sams} -Kroger -Medicine Shoppe -Target -LeaderNET Pharmacy Network Data Classification: INTERNAL USE – BROKER/AGENT ONLY 16 2014 MAPD Product Training HMO & PPO Additional Value Benefits • Health Club membership – available on all plans through contracted facilities • Dental Benefits – available on select plans as a reimbursement • Vision Benefits – available on all plans Data Classification: INTERNAL USE – BROKER/AGENT ONLY 17 2014 MAPD Product Training Selling Coventry Medicare Advantage •Coventry is now an Aetna owned Fortune 53 company •Coventry leads the Industry in Broker Support •Coventry’s reputation with customer service to their membership is industry leading •Coventry’s home grown model of care and care coordination for your clients differentiates them from other companies •Coventry maintains a high member retention rate •Coventry pays 10 year renewals Data Classification: INTERNAL USE – BROKER/AGENT ONLY Servicing Your Clients 18 2014 MAPD Product Training 19 Outbound Education and Verification Calls What Happens After an application is submitted? • A Coventry Health Care Representative will call your client within 10 days of receiving an Enrollment Form to: 1. Confirm their enrollment in the Coventry plan of their choice. • 2. Review the plan rules and make sure they understand how their new plan works. Coventry Health Care will make three attempts to reach your client by phone. If we are unable to speak with them after the second attempt, they will receive a letter outlining the plan rules. • Both the telephone calls and letters will cover the same information that your client has in their enrollment kit. Please contact Alexis Horton or Kenna Rickett for a copy of the verification call script. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 20 Servicing The Member ID Cards and New Member Kits • Member will receive an ID Card – • Members will also receive an Enrollment Confirmation letter than may be presented as proof of enrollment New member kits will be mailed within 10 days of receipt of CMS confirmation of enrollment or by the last day of the month prior to the effective date, whichever is later. The new member kit contains: – Welcome letter – Evidence of Coverage (EOC)- Gives members the details about their Medicare health care and prescription drug coverage for the plan year. The EOC explains how to get coverage for Medicare health care services and prescription drugs – Formulary drug list- Lists the covered drugs selected by the plan in consultation with a team of health care providers. It indicates drug information such as the therapeutic class of drugs, drug tier, and special requirements that may apply like Prior Authorization and Step Therapy. Members can review it to see if the medications they take are covered by the plan. – Provider/Pharmacy directory- Provides a list of participating network providers (physicians, hospitals, skilled nursing facilities, urgent care centers or other duly licensed institutions or health professionals) and pharmacies. – Other health-related informational flyers NOTE: If a member requires assistance regarding their membership/member ID, the member MUST call Customer Service. • Newsletters to help members learn how to use their plan, including education on specific health-related topics. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 21 2014 MAPD Product Training Care Coordination Programs Coventry cares about your client’s health and wants to ensure they are receiving the most appropriate and highest quality care possible. • Disease Management Programs Diabetes Heart Disease COPD Heart Failure Disease Management • Outreach Calls for Preventive/Wellness Services • Member Health Support Center • Social Services Coordination • Member Health Assessments from Matrix Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training Diabetic Clients - Glucometer Information • One Touch ® LifeScan blood glucose monitoring system (one per member) • Only LifeScan brand test strips are covered at a $0 copay under the Part B pharmacy benefit • All other brands covered at 20% copay • The member must call CSO directly to enroll. CSO will set them up with Health Services to insure they get the correct meter Data Classification: INTERNAL USE – BROKER/AGENT ONLY 23 2014 MAPD Product Training Altegra Formerly known as Social Services Coordinators • Coventry Members will be screened to determine eligibility for extra help • Helps button up the sale to solidify Coventry’s desire to ensure they get what they deserve • May be used to screen for Special Election Period Data Classification: INTERNAL USE – BROKER/AGENT ONLY 24 2014 MAPD Product Training BenefitsCheckUp www.BenefitsCheckUp.org/Coventry One-stop resource for determining eligibility for programs that can help members with all types of expenses, including health care, prescriptions, taxes, utilities and more! Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 25 Servicing The Member Member Resources Customer Service is open: • 10/1/2013- 2/14/2014 – • 7 days a week- 8 am – 8 pm (local region time zone) 2/15/2014-9/30/2014 – Monday- Friday 8 am- 8 pm (local region time zone) • Telephone number on back of the member’s ID Card • Thanksgiving and Christmas days – voicemail available Customer Service for Pharmacy (Express Scripts) is open: • 24 hours/day, 7 days/week • Telephone number on back of ID Card Website: www.coventry-medicare.com • My Online Services (MOS) • Access to important plan information such as: • Evidence of Coverage, Summary of Benefits, Formulary, Provider/Pharmacy directory Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 26 Servicing The Member Appeals & Grievances • The member's treating provider can make a coverage request by contacting the number on the back of the member's ID card (called an Initial Coverage Determination). • An “appeal” – is when a member disagrees with decision their plan made to deny a request for coverage of health care services or prescription drugs or payment for services or drugs you already received. • A “grievance” – a type of complaint a member makes about their plan or one of their plan’s network providers or pharmacies, including a complaint concerning the quality of your care. This type of complaint does not involve coverage or payment disputes. • Detailed information on the initial coverage determination, appeal and grievance processes can be found in the member's Evidence of Coverage. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 Compliance Review 27 2014 MAPD Product Training 28 Scope of Appointment (SoA) • • • • • • Scope of Appointment (SoA) is required for any personal or individual marketing appointment (this excludes attendees at formal and informal marketing/sales events). CMS-approved Scope of Appointment Forms (CMS model & Coventry non-model) can be found on the Broker Portal. Agents may not market any health care related product during a marketing appointment beyond the scope that the beneficiary agreed before the meeting with that individual. SoA’s must be documented before the appointment (48 hours in advance when practical). If this is not feasible, agent may have beneficiary sign SoA at the beginning of the marketing appointment. • Explanation must be documented directly on the SoA in the area provided why SoA was not obtained 48 hours in advance. Distinct lines of plan business include MA, MAPD, PDP and Cost Plan products. If the beneficiary requests to discuss other products, agent must document a second scope of appointment for the additional product type to continue the marketing appointment. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 29 Scope of Appointment – contd. • • • Agents cannot record SoA’s. SoA’s must be secured on a CMSapproved SoA form. A beneficiary may set a SoA at a marketing/sales event for a future appointment. Agents must attach a copy of the signed SoA to any application received from a personal/individual appointment before submitting the application to Coventry Health Care of Texas. • Agents may not: discuss plans options not agreed by the beneficiary, ask for referrals, market non-health care products (such as annuities or life insurance), solicit/accept enrollment applications for a Jan 1 effective date prior to the start of AEP unless the beneficiary is entitled to another enrollment period, provide meals or have meals subsidized, or market through unsolicited contacts. • All SoA must be maintained for 10 years and available upon CMS or Coventry’s request. This includes initial and second SoA’s obtained at the same appointment Data Classification: INTERNAL USE – BROKER/AGENT ONLY 30 2014 MAPD Product Training How do you stay informed as to what the rules are so that your marketing activities are in compliance with CMS? • Monitor the release of new CMS regulations by signing up for the Federal Register List at http://www.gpoaccess.gov/fr/index.html • CMS marketing guidance can be found at cms.gov and: http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketi ngGuidelines.asp • Watch for Coventry bulletins (Compliance Connection and/or Broker Flash emails) that includes guidance such as any new updates on Medicare Marketing Guidelines. Check Broker Portal “Recent Field Communications”. • Adhere to Coventry CMS-approved Sales Presentation! Data Classification: INTERNAL USE – BROKER/AGENT ONLY 31 2014 MAPD Product Training Sales Presentation Materials The following materials must be provided to each beneficiary at the time of the presentation: • Formulary- Lists the covered drugs selected by the plan in consultation with a team of health care providers. It indicates drug information such as the therapeutic class of drugs, drug tier, and special requirements that may apply like Prior Authorization and Step Therapy. Members can review it to see if the medications they take are covered by the plan • Summary of Benefits- Lists important plan benefits. Beneficiaries can use the SB to compare benefits. • Multilanguage Insert- provides member in various language instructions for seeking interpreter services • Plan Stars Rating information- CMS rating of the plan’s quality and performance. These ratings help the beneficiary to know how the plan is doing and allows them to compare our plan's performance to other plans. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 32 Applications Do’s and Don’t DO: • • • • • • • • • • • Submit applications to the RIGHT fax number (i.e. fax MAPD applications to the MAPD fax number and Part D applications to the Part D fax number). Use the Coventry Enrollment /First Health Part D Fax Coversheet when faxing enrollment application. If using paper applications, be sure to use the application provided in the presales kit. Use Ascend, the Coventry iPad application, for paperless sales presentations and electronic application submission. Complete the Scope of Appointment section of the application. Submit Scope of Appointments with all paper applications. Use, and submit, the Coventry Enrollment Checklist for ALL non-AEP applications. Write the FULL NAME of provider and appropriate Physician I.D. for ALL plans requiring the selection of a PCP. Select a premium payment method (even for plans with $0 monthly premium). Date the application when you receive it. Complete the requested effective date (note effective date may be modified in accordance with CMS requirements) Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 33 Applications Do’s and Don’t DON’T: • • • • • • • Submit applications to the Broker Services Department this will delay application processing. Use the Consumer Enrollment Website, found by clicking “Enroll Now” on the health plan websites, to submit applications. (May assist the beneficiary in their completion of the on-line enrollment but cannot do it yourself.) Download and use the application in PDF available on the health plan websites. Copy the paper applications for use with different beneficiary. Enter any information or notes in the “Internal Use Only” section. Submit an application without the actual Medicare coverage dates. “Applied for” will not allow the application to process. Forget to complete the Medicare Part A and B effective dates on the application. Data Classification: INTERNAL USE – BROKER/AGENT ONLY 34 2014 MAPD Product Training IMPORTANT! Completed Enrollment Applications must be received by Coventry Within 2 Calendar Days!! You can submit enrollment applications • Fax (a preferred method) or overnight to the designated Health Plan contact as listed in the Health Plan Application Contacts section, under Agent Resources heading towards the end of this module. Paper applications MUST be received by Coventry Health Care/First Health Part D within 2 calendar days of agent’s receipt of signed enrollment application or agent’s completion of an electronic application effectuated through a Coventry approved electronic application. • IPAD App(a preferred method) – faster, real time submission of the enrollment application Data Classification: INTERNAL USE – BROKER/AGENT ONLY 35 2014 MAPD Product Training Expanding Our Service to YOU! THE Ascend iPAD APPLICATION! • Capture client information. • Conduct PAPERLESS Sales Presentations. • Easily utilize the Coventry Sales Presentation Video • Take and submit enrollment applications in REAL TIME (eliminate turn around time issues). • Decrease application pending issues Data Classification: INTERNAL USE – BROKER/AGENT ONLY 36 2014 MAPD Product Training Broker Services Department Our dedicated Medicare Broker Services Department (BSD) will assist you with questions pertaining to: – Commissions / contracting questions – Broker portal, website support – Please do not call Broker Services for product or benefits questions. For those questions you may call Customer Service at (866) 731-9570 BSD Contact Information: – Phone- (866) 714-9301 • 8am– 6pm Eastern Time, Monday-Friday – Email - Brokersupport@cvty.com – Broker Portal: https://broker.cvty.com Data Classification: INTERNAL USE – BROKER/AGENT ONLY 37 2014 MAPD Product Training Producer Manual • Producer Manual can be found on the Broker Portal at: http://coventrymedicare.coventryhealthcare.com/web /groups/public/@cvty_medicare_coventrymedicare/do cuments/webcontent/c062429.pdf • Will answer most of your questions! • Renewals upon your death? • Commission Charge Backs? • Agent of Record? • Ctrl F = Find what you are looking for Data Classification: INTERNAL USE – BROKER/AGENT ONLY 38 2014 MAPD Product Training Coventry Local Resources Manager Of Sales Don Hansford 3900 Rogers Rd San Antonio, TX 78251 210-366-6294 dbhansford@cvty.com Broker Manager Alexis Horton 3900 Rogers Rd San Antonio, TX 78251 210-346-2146 aahorton@cvty.com Broker Manager Kenna Rickett 3900 Rogers Rd San Antonio, TX 78251 210-346-2175 kprickett@cvty.com Data Classification: INTERNAL USE – BROKER/AGENT ONLY 39 2014 MAPD Product Training The WHO, WHY, and HOW to Contact List WHO WHY How Customer Service General questions regarding medical benefits, claims, prior authorization status/requirements, Part B Issues, explanation of benefits, verification of premium receipt, coupon book issues, ID cards, and new member kit request 866-731-9570 Express Scripts Medicare Advantage Part D questions including prior authorization & Step Therapy. NOT PART B ISSUES. (Diabetic supplies are Part B) 866-295-4119 MHNet All Questions regarding mental health services. Including any questions regarding prior authorizations and participating doctors. 800-336-2030 Health Services Providers ONLY should call this number to obtain Prior Authorizations for medical services. (all Part D questions including authorizations should go through Express Scripts- See number above) 888-651-1802 First Health Part D First Health Part D Questions ONLY. Prior Authorizations, step therapy, premium payments, ID cards, Etc. 888-736-0486 Life Scan Questions regarding diabetic monitors. 800-227-8862 Ordering a LifeScan monitor 800-227-8862 Data Classification: INTERNAL USE – BROKER/AGENT ONLY 40 2014 MAPD Product Training Continued WHO WHY How Broker Services Department (BSD) Contracting issues and questions, License updates, E&O updates, changes to agent contact information, commission questions, broker portal or ACOM questions including password resets. (866) 714-9301 BSD Fax Sending E&O license updates, or other requested information or updates to broker services. EXCEPTION: All contracting must go through NO MORE FORMS via the Broker Portal. (Broker Portal can be accessed via the below website (724) 741-7285 Website Broker Portal access, online provider searches, my online services, (for member use only), claim forms, online formulary search, EFT forms, and much more. www.coventry-medicare.com IPAD Enrollment the only acceptable way for a broker or captive to submit an electronic application is through the iPad Application tool. To Receive Permission to access the application for IPAD enrollments please call the BSD 866-714-9301 Data Classification: INTERNAL USE – BROKER/AGENT ONLY 41 2014 MAPD Product Training Continued WHO WHY How Premium Payment EFT Request (must send EFT form: which is available on our website) Accounts Receivable Department Coventry Health Care PO Box 6411 Carol Stream, IL 60197 Pharmacy Claims (claim forms are available online) Express Scripts PO Box 14711 Lexington, KY 40512 Medical Claims (no Claim Form Needed) CHC of Texas PO Box 7154 London, KY 40742 This includes standard and expedited appeals Advantra Attn: Medicare Medical Appeals and Grievance Department PO Box 7776 London, KY 40742 This includes standard and expedited appeals Advantra Attn: Medicare Part D Appeals and Grievance Department PO Box 7773 London, KY 40742 Important Addresses Part C Appeal & Grievances (A&G) Pharmacy Appeals & Grievance Data Classification: INTERNAL USE – BROKER/AGENT ONLY 42 2014 MAPD Product Training Local Presence LOCAL PLAN OFFICES Coventry Health Care of Texas 3900 Rogers Road San Antonio, TX 78251 Coventry Health Care {Customer Service} 14955 Heathrow Forest Houston, TX 77032 Data Classification: INTERNAL USE – BROKER/AGENT ONLY 2014 MAPD Product Training 43 Broker Next Steps • • • • • • Score 90%+ on the Product Exam Supplies Sales Presentation ANOC/Retention Referrals Marketing Now go get some sales!! Data Classification: INTERNAL USE – BROKER/AGENT ONLY Thank you for attending the 2014 Kick-Off Training Class! Don’t Forget to make sure all Testing and Contracting has been completed! Coventry Health Care of Texas Medicare Advantage (MA) Coordinated Care Plans (CCP) 2014 Data Classification: INTERNAL USE – BROKER/AGENT ONLY © 2013Coventry Health Care, Inc.