Broker/Agent Product Training
2014 Product Overview
CONFIDENTIAL: Trade Secret/Competitive Advantage
© 2013 Coventry Health Care, Inc.
Before we begin…
Reminders:
• Silence Your Phone
• Handling Questions
• Complete all 2014 Requirements PRIOR to
Selling
For broker use only. Not for distribution to beneficiaries.
Coventry data classification: Trade Secret/Competitive
Advantage Plan benefits may vary by Service Area. Benefits
and pricing are not final until CMS approved.
2
Agenda
• 2014 Product Review
• Servicing the member
• Compliance Review
• Supporting our Partners
•Q&A
3
2014 Product Information
2014 PDP Product Overview


Moving from 4 plans to 3
Premier is being renamed, the PBPs are not being withdrawn
2013
2014
First Health Part D Premier Plus
First Health Part D Premier Plus
First Health Part D Value Plus
First Health Part D Value Plus
First Health Part D Premier
First Health Part D Essentials
First Health Part D Essentials
5
2014 PDP Plans
- First Health Part D Value Plus
First Health Part D Value Plus
– Consumer ONLY Product for 2014
• Brokers can not refer this
product in 2014!!!
– First dollar coverage with no
deductibles
– Copays as low as $3 dollars at
Preferred Pharmacies
– First Health Part D Value Plus members get a no-cost
quarterly voucher to purchase select vitamins and
supplements at our preferred pharmacies
6
2014 PDP Products – First Health Part D Essentials
First Health Part D Essentials (PDP) - Low
copays and a low monthly plan premium, plus:
• Low, fixed cost for preferred generics
• Additional savings at thousands of preferred pharmacies
nationwide
• Convenient mail-order service at no extra charge
• Healthy Rewards member incentive program lets members
earn up to $30 to spend at Walmart
• Available in all 50 states and the District of Columbia
• Greater savings and lower copays with preferred pharmacies
and mail-order
7
2014 PDP Products – First Health Part D Essentials
NEW FOR 2014
Essentials Value-Added Items & Services
• Walmart gift card program – new for 2014.
• Members who qualify will receive a $10 gift card that is redeemable at any
Walmart store
• Members qualify by participating in two or more healthy activities per offer
period (three offer periods in 2014)
– Once confirmed, “Healthy Reward” gift card is mailed to member
• Members can choose from numerous activities –participation in a
pharmacy survey, reading health articles, medication adherence (including
high risk meds and use of generics), participation in MTM programs, Optin to receive health/wellness messages via email and/or mobile, etc.
8
2014 PDP Plans
- First Health Part D
Premier Plus
First Health Part D Premier Plus (PDP) - Our highest
level of medication coverage and choice, offering:
• NO deductible - your clients get first-dollar coverage
• Low copays for preferred generic medications
• Comprehensive coverage in the gap with low
copays/coinsurance in Tiers 1,3 & 4
• Extensive formulary
• Even more saving through mail-order delivery
• Discounted membership at local fitness center, including
Bally®, Curves®, Lifetime® and YMCA®
• Extensive formulary that includes a $1 copay for all
generic preferred drugs
9
2014 PDP Plans
- First Health Part D
Premier Plus
First Health Part D Premier Plus
5-Tier Design
•
•
•
•
•
Tier 1 - Preferred generics
Tier 2 - Non-Preferred generics
Tier 3 - Preferred brands (contains both brand
and generics)
Tier 4 - Non-preferred brands (contains both brand and
generics)
Tier 5 - Specialty Drugs are equal to or greater than
$600 in cost for a 30 days supply (generics and brands,
may be oral or injectables)
Formularies are “closed”
– New drugs are reviewed and may or may not be
added to the formulary
10
2014 PDP Plans
- First Health Part D
Premier Plus Excluded Drug List
• Coverage of CMS Excluded
Drugs applies to First
Health Part D Premier
Plus only
FOLIC ACID
(1 mg)
• Enhanced drugs are
limited to 30 day supply.
• Removing benzodiazepines
and barbiturates and
adding to formulary
• Brand enhanced drugs are
covered for a Tier 3
copayment for 2014
• Does not count towards
total drug spend or
TrOOP.
• Quantity limits may apply
VITAMIN
DEFICIENCY
TIER
1, QL
30/30
days
LEVITRA
mg; 5 mg;
mg; 20 mg)
ERECTILE
DYSFUNCTION
TIER
3, QL
4/30
days
MEPHYTON*
(5 mg)
BLOOD
DISORDERS
VITAMIN D
(50,000
units)*
VITAMIN
DEFICIENCY
TIER
3,
10/30
days
TIER
11
2014 PDP Plans
- First Health Part D
Premier Plus
NEW FOR 2014
Value Plus Value-Added Items & Services
• Low cost memberships at a comprehensive Silver&Fit-contracted
network of fitness facilities and exercise centers.
• Optional programs such as senior-based exercise classes including
varying levels of intensity, including Zumba Gold ® dance, yoga,
strength training, aqua exercise, fall prevention, and tai chi exercise
for seniors, and a Fitness Advisor at some of the fitness clubs.
• The Silver&Fit Home Exercise Program for those who are unable to
participate at a fitness facility or prefer to work out at home.
• SilverandFit.com, a website with a variety of health tools and
resources
• The Silver Slate®, a quarterly newsletter.
• A toll-free customer service hotline to answer questions about the
program
12
National Fitness Club & Exercise Center Network
1
13
2014 First Health Part D
Preferred Networks
• Preferred Pharmacies are network pharmacies where
members may pay lower out-of-pocket costs (i.e.
copayment or coinsurance). These are pharmacies that
have an agreement with the Part D Plan to charge less.
• Lower cost-sharing available for Value Plus & Essentials at
preferred pharmacies
• The 2014 Preferred Network Pharmacies vary by Region
and can include Walmart, Walgreens, Target, the Kroger
Family of Pharmacies, and others.
14
More 2014 First Health Part D
Product Information
CETIRIZINE TABLETS: 30 tablets per 30
days
CETIRIZINE SYRUP: 300ml per 30 days
CETIRIZINE CHEWABLE TABLETS:
10mg and 5mg chewable tablets are
covered up to 30 chewable tablets per
30 days
CETIRIZINE-D: 60 tablets per 30 days
LORATADINE: 30 tablets per 30 days
Allergy OTC
•
The OTC medications to the left are
available to members in 2014 for a $0
co-pay with a prescription
•
Applies to all Part D formularies
•
Does not count towards total drug
spend or TrOOP
•
90-day maintenance supplies are
allowed for these medications
(*ESI/Medco MO does not break
packages)
•
Strengths and Quantity Limits apply
LORATIDINE DISPERSIBLE TABLETS:
1 tablet per day up to 90 days
LORATADINE 12-HR: 60 tablets per 30
days
LORATADINE 24-HR: 30 tablets per 30
days
15
2014 Plan Summary
Value Plus
Essentials
Premier Plus
# of Regions
32
34
34
Type of Plan
Enhanced Plan
Actuarially Equivalent Plan
Enhanced Plan
Premium
$36.90 - $58.40
$21.30 - $60.70
$77.60 - $123.90
# of Stages
3: Initial Coverage, Coverage Gap,
Catastrophic Coverage
4: Deductible, Initial Coverage,
Coverage Gap, Catastrophic
Coverage
3: Initial Coverage, Coverage
Gap, Catastrophic Coverage
Deductible
$0
$310
$0
Preferred
Pharmacies
Non-Preferred
Pharmacies
Preferred
Pharmacies
Non-Preferred
Pharmacies
Preferred or Non-Preferred
Pharmacies
Tier 1
$3
$10
$1
$3
$1
Tier 2
$11
$33
14 or 15%
15-18%
$25
Tier 3
$37
$45
35-47%
38-48%
25%
Tier 4
$88
$95
N/A
40-50%
Tier 5
33%
33%
N/A
33%
No Gap Coverage
Some Coverage in Gap,
Benefits Vary
Gap
>$2,850 Drug
Spend
Catastrophic
>$4,550 Mbr OOP
Retail 90 Day
Mail Order 90 Day
No Gap Coverage
$2.55 Generic or Preferred Multi-Source Drugs; $6.35 Other
3x Cost Sharing for Tiers 1-4
Tier 5 N/A
3x Cost-Sharing
No Mail Order Benefit
3x Preferred Pharmacy Cost-Share
for all Network Pharmacies
3x Cost Sharing for Tiers 1-4
Tier 5 N/A
2.5x Cost Sharing for Tiers 1-4
16
Tier 5 N/A
Servicing the Member
Servicing The Member
Member Resources
• Customer Service for Rx (Medco) is open…
– 24 hours/day, 7 days/week
– Telephone number on back of ID Card
• Information:
– Explanation of Benefits (EOB) when the member has activity
• Mailing Address:
– P.O. Box 7763,London, KY 40742-9831
• Website: www.FirstHealthPartD.com
– My Online Services
– Up-to-date provider directories
– Current formularies
18
Servicing The Member
ID Cards and New Member Kits
•
ID Cards will be mailed to the member’s home within 2 to 3 weeks of the date the
application is received.
NOTE: If a member requires assistance regarding their membership/member ID, the member
MUST call Member Services.
•
New member kits will be mailed within 10 days of verification of eligibility by CMS.
The new member kit contains:
– Welcome letter.
– Evidence of Coverage (gives members detailed information about the plan’s policies,
procedures and benefits).
– Formulary drug list.
– Other health-related informational flyers.
– Does NOT include a provider directory. Please leave a provider directory at the point of
sale.
•
Newsletters to help members learn how to use their plan, including education on
specific health-related topics.
19
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 a type of complaint requesting us to reconsider and change a
decision we have made about what services are covered for a particular member
or what we will pay for (i.e. denied request for a Part D drug the member thinks
should be covered, early discharge from the hospital, etc.).
•
A “grievance” is a type of complaint the member can make if they have any other
type of problem with Coventry Advantra or one of our plan providers (i.e. quality of
care, accessibility issues, involuntary disenrollment, etc.).
•
Detailed information on the initial coverage, appeal and grievance processes can be
found in the member's Evidence of Coverage.
20
2014 Compliance
Scope of Appointment
•
The beneficiary must agree to the scope of products to be presented to them prior to the
appointment date.
•
The agent must secure the Scope of Appointment documentation prior to the appointment. If it
is not feasible for the scope of appointment form to be executed prior to the appointment, an
agent may have the beneficiary sign the form at the beginning of the marketing appointment.
However, CMS expects plans to record and maintain documentation on why it was not feasible
to obtain the scope of appointment prior to the appointment.
A new Scope of Appointment form is required if the beneficiary has requested to discuss
another MA or PDP product type during a personal/individual appointment. However, a new
appointment is not required. The additional product can be discussed as soon as the beneficiary
request is documented.
•
•
Per CMS< Agents cannot record Scope of Appointment. Only plan sponsors can record the
Scope of Appointment.
•
If the beneficiary requests another line of business to be discussed during a personal/ individual
appointment (i.e., Med Supp, Long Term Care), agent may leave product information, excluding
Enrollment Application, and a follow-up appointment cannot be scheduled until at least 48
hours after the initial appointment (cooling-off period).
•
The Scope of Appointment form should be documented with a CMS-approved Scope of
•
Please include the completed scope of appointment form with the paper enrollment
application.
Appointment form (either model or non-model);
22
Staying Informed
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
http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketingG
uidelines.asp.
•
Watch for Coventry bulletins that include new guidance such as any updates
on Medicare Marketing Provisions. Once published, bulletins will be posted
on the Broker Portal.
•
Adhere to Coventry Sales Presentation
23
IMPORTANT!
Submit Completed Apps
Within 2 calendar days!!
First Health Part D has made it easy to meet the 2 day requirement
1) Faxed to application fax line: 866-415-2232
2) Complete an Online Enrollment through the Coventry Medicare website
24
An Alternative Way to Contract With
Coventry
Don’t want to sell? REFER instead!
No Certification Required &
Fast Contracting Approval
Refer both Medicare Advantage Products &
Part D products
Contact our Broker Service Department today for more
information.
25
Coventry Supports - YOU
Additional information and materials are available on the
Coventry Broker Portal located at: broker.cvty.com.
Resources available include:
• Low Income Subsidy Brainshark
• Ordering Sales Supplies
• Coventry’s Mandatory Sales Presentation
• Compliance Updates
• Referral flyer for those who don’t want to sell
• Application Tracker
• 2014 Sales materials will be available prior to October 1
• Much, much more…
26
Steps for Success:
How to Be ‘Ready to Sell’ for 2014
• Complete the online training and testing at www.coventrymedicare.com.
• Must have State Appointment – in each state where you are
licensed.
• Complete your online Coventry “contract package”
• Receive “Ready to Sell” notification from Coventry and your Agent
Writing Number (AWN) ID Card for the benefit year.
• Must have up to date E&O on file
• You may not market or sell prior to official notification from
Coventry.
27
Broker Servicing Department
• A dedicated Broker Servicing Department
(BSD) in our operations department that
will assist you with questions pertaining
to:
– Commissions / contracting questions,
including attestation
– Broker portal, website support
• BSD Contact Information:
– (866) 714-9301
– Brokersupport@cvty.com
– 8am–8pm Eastern Time, Monday-Friday
• Broker Portal: broker.cvty.com
28
Thank you for attending the 2014
Kick-Off Training Class!
Don’t Forget to make sure all Testing and
Contracting has been completed!
If you have any further questions,
please email your questions to
Broker Support at
BrokerSupport@cvty.com