Plan Year 2015
Janis E. Carter
Health Net
Proprietary & Confidential, Restricted Distribution. For training purposes only, not to be used for Sales & Marketing activity.

Maricopa AE /Maricopa AE Pima AE
Dionna Naugle
(602) 541- 6298
Dionna.M.Naugle@healthnet.com
E4L
Jeff Romero
(602) 717-7299
Jeffrey.Q.Romero
@healthnet.com
Maricopa Support
Pat Parisella
(520) 306-7360
Patrizia.X.Parisella
@healthnet.com
P4P
Call Your Account Executive if You Need SALES Support :
• Product training / sales tools and resources to help you sell
• Benefits training / answers to advanced benefits questions
• Answers to product / network clarification (not provider searches)
• Marketing ideas / Business strategies
• CMS-approved marketing toolkit / generic marketing material development)

Recognized Leader in Health Care
• Health Net is among the nation’s largest publicly traded managed health care companies with offices in Arizona, California, Washington, Oregon
• Health Net provides health benefits to more than 5.4 million people nationwide
• Strategic repositioning based on financial performance
• Local presence- Easily accessible to our partners and members
(Local Sales Team and Local Advocate Team/ Case Management)
• Strong member satisfaction (Members stay with HN on average 7 years)
3

2015
• Broker Resources
• 2015 Contracting
• Beneficiary Reminders
• Network Partner Updates
• Understanding Our Networks
• Benefits and Market-Specific Information
• Optional Gold Buy-Up Plans
• Website Enhancements
• Commission Updates

1. Broker Services
2. Member Services
3. Pharmacy Dept.
Mon-Fri
9 am-
6 pm
Mon-Fri 8 am -5 pm
Mon-Fri 8 am -530 pm
5 Corporate Presentation

1-866-459-1212
• Health Net Contracting (accessing AHIP website / Compliance Training)
• Medicare eligibility (Part A & Part B confirmation) / LIS / AHCCCS eligibility
• Ordering Supplies- Broker Pick Up (Approx Sept 30 th @ Health Net)
• Looking up a provider and Network affiliation
• Benefit questions / Clarification on copays, etc.
• Broker change of address or name change
THESE CALLS WILL BE REDIRECTED :
 Confirmed Enrollment ---Email Broker Services
 Ordering a New Health Net card for a member- Call MEMBER SERVICES
 Commission inquiries- Broker.Commission@healthnet.com

1-800-410-6565
Assistance with Pharmacy/Drug-Related Questions
• Help Looking up drugs on our formulary
• Questions about generic versions of brand drugs
• Questions about copays / tier classifications
• Assistance calculating approximate drug costs

1-800-977-7522
Assistance with Customer Service and Claims-Related Questions:
• This is the number members can call for assistance.
• You CAN do a 3-way call with the member, and if the member provides permission, you can assist with their inquiries.
• Assistance with claims information, changing a PCP, etc.
• Member Assistance – claims information, referrals, etc. (NOTE:
You will need to have a HIPPA form on file
• Ordering a New Health Net Card

Pam White,
Health Net
9

Eligibility and Enrollment
2015
• The Statement of Understanding (SOU) form is not going to be available in 2015.
• A new broker checklist will be in the enrollment kit. Example:
10

Eligibility and Enrollment
• Health Net prefers paper applications faxed to 1-877-693-2202.
• AMBER APPLICATION ENROLLMENT FAX: 855-795-7575
• You can submit an online application. Contact Broker Services for a online link.
Reminder Online submission allowed for in person enrollment.
(Confirmation of receipt will be sent to broker on application within 48 hours, call broker services if confirmation was not received. )
• Enrollment applications will be pended for a maximum of 21 days or
until the end of the month if the beneficiaries’ Part A and Part B cannot be verified through MARx and we cannot reach the beneficiary by phone. If the beneficiary doesn’t submit a copy to HN within the pended time frame, the application will be cancelled .
11

Eligibility and Enrollment
Enrollment Form –
Health Net Office Use Only Section
• This section MUST be filled out correctly and legibly. Illegible information might delay commission payment.
• Labels are optional but strongly suggested. Ask you General Agency for Label assistance.
• If labels are to include your NPN number: NEW!
12

- A completed application should contain the following documents:
1. Batch (fax) cover sheet
2. Scope of Appointment (we accept all carriers’/generic SOAs)
3. Completed Application
4. Completed Prequalification Form (For Chronic SNP plans)
Be sure to submit the application to Health Net within 24 hours of the broker received date!
13

Pam White,
Health Net
2015

 2015 Individual Producer Contract

***Submit all of your
Or Appendix A
(if working with Agency/GA/FMO)
 Completed W-9 or
 Copy of Health & Life License
Broker.Contracting.Medicare
@healthnet.com
 2015 AHIP Exam Certificate (online)
 HNT 2015 Compliance Training (online)
 HNT 2015 Product Training (online)

 AHIP (online)
 AHIP Compliance & FWA (online)
 HNT 2015 Product Training- HN.com
***NOTE***
Brokers will need to be in good standing (AHIP-certified, product trained and currently licensed in
Arizona) to receive renewals for sales from 2009–2014.
Deadline to be in good
standing: December 31, 2014

Corporate Presentation 17


The following plans will be terminated in the counties referenced.
Members of the following plans will receive a non-renewal letter:
 Ruby 4 plan in Maricopa and Pinal Counties
 Ruby 1 plan in Pima County

The following plans will not be offered in the counties referenced.
Members who reside in these counties will receive a non-renewal letter.
 Green (MA Only)
- Non-renewed in Pima County
 Jade & Jade Cardio
- Non-renewed in Pima County
18

North
Maricopa, Pinal Counties
 Banner Health Network (BHN)
 Direct Network in Maricopa Only
South
Pima County
 Arizona Community Physicians (ACP)
Members currently enrolled with the above providers will not be disenrolled from their plan due to the providers being terminated.
Members will receive a letter from Health Net that explains their options:
 No Action – during AEP member will automatically be moved to a different PPG and/or PCP but will remain on currently elected plan.
 Action – the member has the option to change their PPG and/or PCP to one different than the one assigned to him/her.
 Disenroll – the member can disenroll from Health Net .
19

Claims Incurred Jan – July 2014
 Inpatient Acute Statewide:
Only 13% of all inpatient acute admissions took place at a Banner facility in 2013
 Maricopa county:
Only 23% of inpatient acute admits took place at a Banner facility
 Pinal county:
39% of inpatient acute admits took place at a Banner facility.
 73% of the Banner admits for Maricopa members were admitted via the ER
.
 72% of the Banner admits for Pinal members were admitted via the ER
Corporate Presentation 20

What is a Provider Specific Plan?
 A provider specific plan is a Medicare Advantage (MA) plan that limits plan members to a subset of contracted providers from our full provider network located in the plan's service area
 PSPs must pass the CMS network adequacy requirement to ensure availability of providers including: PCPs, specialists, labs, hospital facilities, etc.
 PCPs may only refer members to other providers or facilities affiliated within the PPG
Highly Confidential & Proprietary 21

Health Net Ruby Select (HMO)
North
Maricopa, Pinal
South
Pima
Network
Specific
Marana Health Center
Saguaro Physicians
El Rio Santa Cruz
Neighborhood Health Center
Highly Confidential & Proprietary 22

Pam White,
Health Net

Service
Area
Reductions
①
CMS Template Letters: Sept 18 th - Oct 1 st
②
Health Net SAR Letter: Oct 5 th
③
Outbound Call: Oct 10 th -30 th
PCP
Changes
① PCP Change Letters: Oct 1 st
②
Health Net PCP Change Letter: Oct 5 th
③
Outbound Call: (option available)
(Brokers, Direct sales, Inside Sales/Optum, AZPC, Member Service Team)
24

Marie Cremisino- Director of Provider Network
*COLLABORATING FOR SUCCESS*
Corporate Presentation 25

• Provider Contracting Updates
• Member outreach
• Website development- AZPC.com

 Convenient
 Cost effective (compared to ER copay)
 STAR measures initiative
 Senior discount days





Gilbert Urgent Care
Center
Casa Grande
Primary Care Center
706 N. McQueen Road 1811 E. McMurray Street

$0 Copay
Ruby Select
Members
Immediate Care Servives:
Head-to-Toe ALL General X-Ray, Dexa Scan
SVN Breathing Treatment, EKG
Oxygen Concentrators
Propaq/Heart Monitoring
IV Fluids
Wound Care/Dressing
Sutures, Splinting
Toe nail care/removal
Catheterization Vitamin B Injection
Vaccines (Hep A, B, TDAP, PCV-13, Pneumovax, TB)
Vitals, Incision and Drainage
IV Therapy (Antibiotics, Insulin, Steroids)
Durable Medical Equipment (DME)
Post Hospital Visits
**Walk-Ins, Acute Care, Immediate Care
9am – 7pm Monday – Sunday, including holidays.
Corporate Presentation 30

“I always like to look on the optimistic side of life, but I am realistic enough to know that life is a complex matter.”
Walt Disney

Over 780 Primary Care Physicians
Maricopa 740
Pinal
House Call PCPs
30
8
38 New HN Direct PCP Groups= 105
Over 1,370 Specialists & Ancillary
Maricopa 1,340
Pinal 34
and counting

AE: Dionna Naugle
***2013 ONLY***

Health Net MAPD – HMO Plans & Specialist
***MARICOPA COUNTY ***
Ruby Select, Ruby 1 ,
Jade, Green, Amber
(Specialists & Hospitals)

Health Net MAPD – HMO Plans & Specialist
***PINAL COUNTY ***
Ruby Select, Ruby 1 , JADE , GREEN
AZPC Network
(Specialists & Hospital)

• Members have the ability to go to the Casa Grande Hospital
• ELECTIVE surgery CAN be conducted at the Casa Grande Hospital
• Worldwide Coverage Emergency Coverage

Health Net MAPD – HMO Plans & Specialist
***PIMA COUNTY ONLY***
Carondelet Network
Marana Health Center
Saguaro Physicians
El Rio Santa Cruz
Neighborhood Health
Marana Health
Center
Saguaro Physicians
El Rio Santa Cruz
Neighborhood
Health
Direct
Network
Ruby Select
Contracted
Network
(Specialists & Hospitals)

Health Net MAPD – HMO Plans & Specialist
***COCHISE COUNTY ***

Health Net MAPD – HMO Plans & Specialist
***SANTA CRUZ COUNTY***

SANTA CRUZ COCHISE
RUBY
SELECT
RUBY 1
RUBY 4
GREEN
JADE
JADE Cardio
AMBER
Maricopa
MARICOPA PINAL
X
X
X
X
X
X
X
X
X
X
X
PIMA
X
X
X
X
X
X
X

• AZ Heart Hospital
• AZ Orthopedic Surgical Hospital
• AZ Spine & Joint Hospital
• Arrowhead Community Hospital
• Chandler Regional Center
• John C Lincoln – Deer Valley
• John C Lincoln – North Mountain
• Maryvale Hospital
• Mercy Gilbert Medical Center
• Mountain Vista Medical Center
• Paradise Valley Hospital
• Phoenix Baptist Hospital
• St Joseph’s Hospital
• St Luke’s Medical Center
• Surgical Specialty Hospital of AZ
• Tempe St. Luke’s Medical Center
• West Valley Hospital
• Wickenburg Community Hospital
• OASIS
• Oro Valley Hospital
• Northwest Medical Center
• Tucson Medical Center
• University Physicians Hospital
• University Medical Center
• St Mary’s Hospital
• Benson Hospital
• Bisbee Hospital
• Southeast Arizona Medical
• Sierra Vista Regional Center
• Northern Cochise Hospital
• Casa Grande Medical Center
• Carondelet Holy Cross Hospital

• The preferred (low-copay) network will be published on HealthNet.com
October 1 st .
• Members will also learn about the preferred (low-copay) network in the information they receive after choosing Health Net during open enrollment.
• Members will receive a pharmacy directory which contains all network retail pharmacies. Preferred pharmacies will have a preferred (lowcopay) network indicator.
2015 AZ Medicare 43

Preferred
Pharmacy examples :
Standard
Pharmacy examples:
Preferential copays for Tiers 1-4
Albertson’s Osco
CVS
Fry’s
Sam’s Club
Xpress Care
Walmart
Standard copays for Tiers 1-4
Walgreens Food City
Safeway
Target
KMart
Basha’s
Costco
Plus large list of local pharmacies.
Mail Order CVS
Pharmacy
Plus large list of local pharmacies.
Health Net continues to offer copay savings for 90 day mail order fills for Tiers 1-3
44

Details
Tier 1 GENERIC preferred
What Drugs Are in Tier 6?
(Related to Star Ratings Drugs)
Tier 2 GENERIC non-preferred
Tier 3 BRAND preferred
Tier 4 BRAND non-preferred
Tier 5 SPECIALTY drugs retail
Tier 6
$0 copay!
SELECT CARE drugs retail includes some brand & generic drugs used to treat specific chronic conditions
• Sulfonylureas ** (ex: GLIPIZIDE ER)
• Meglitinide Analogues ** (ex: NATEGLINIDE)
• Insulin Sensitizing Agents ** (ex: PIOGLITAZONE
HCL)
• Incretin Mimetic Agents (GLP-1 Receptor
Agonists)** (ex. BYDUREON)
• HMG CoA Reductase Inhibitors ** (ex.
ATORVASTATIN CALCIUM)
• Dipeptidyl Peptidase-4 (DPP-4) Inhibitors ** (ex.
TRADJENTA)
• ACE Inhibitors ** (ex. BENAZEPRIL HCL)
• Angiotensin II Receptor Antagonists ** (ex:
CANDESARTAN CILEXETIL)
• Alpha-Glucosidase Inhibitors ** (e: ACARBOSE)
• Antidiabetic Combinations ** (ex:
GLIPIZIDE/METFORMIN HCL)
• Antihypertensive Combinations ** (ex:
AMLODIPINE BESYLATE/BENAZEPRIL
HYDROCHLORIDE)
• Biguanides ** (ex: METFORMIN HCL)

CLASSIC FORMULARY VALUE FORMULARY
RUBY SELECT
RUBY 1
RUBY 4
JADE
JADE CARDIO
X
X
X
X
X
AMBER
X
Both contain a tier for certain drugs associated with Stars.
These will be offered at $0 copays
2015 AZ Medicare 46

47

Benefit
Emergency care visit
Urgent care visit
Home health care
Durable medical equipment
Member Pays
$65 per visit (waived if admitted)
$20 copayment
$0 copayment
20% coinsurance
Clinical/Diagnostic lab $0 copayment
Diagnostic radiological services
$125-$200
(CT Scans, MRI/MRA, PET Scans)
20% coinsurance for therapeutic radiology services
Part D Prescription Drug coverage (except Green)
Worldwide Emergency coverage
Health Club Benefits (SilverSneakers)

PCP
DETAILS
R Select N - $0/mo
($3400)
R Select S - $0/mo
($3800)
Maricopa/Pinal Pima
$0 $0
SPECIALIST $20 $30
INPATIENT HOSPITAL
Outpatient Hospital
ASC
Inpatient Mental Health
$150/day, days 1–5
$25 - NON surgical service
$125 - surgical service
$0 - NON surgical service
$75 - surgical service
$150/ day, days 1-5
$150/day, days 1–5
$25 - NON surgical service
$150- surgical service
$0 - NON surgical service
$100- surgical service
$175/day, days 1–5
Skilled Nursing Facility
Ambulance (land/air)
Lab/ X-rays
PT/ Cardiac Rehab
$100/day, days 21–100
$240/one-way trip
$0/ $10
$10/ $15
$100/day, days 21–100
$250/one-way trip
$0/ $15
$20/ $20

RUBY SELECT Prescription Drug Benefits
Benefit (30 days supplies)
Annual Deductible
Tier 1 – GENERIC preferred
Tier 2 – GENERIC non-preferred
Tier 3 – BRAND preferred
Tier 4 – BRAND non-preferred
Tier 5 – SPECIALTY
Tier 6 - some brand & generic drugs used to treat chronic conditions
Ruby Select (N)Ruby Select (S)-
$0
$0
$15
$44
$95
33%
$0
$0
$12
$44
$95
33%
$0 $0

RUBY 1
DETAILS
PCP
SPECIALIST
INPATIENT HOSPITAL
Outpatient Hospital
ASC
(Maricopa, Pinal)
$5
$35
$215/day, days 1–6
$25 - NON surgical service
$200 - surgical service
$0 - NON surgical service
$175 - surgical service
(Santa Cruz)
$5
$35
$215/day, days 1–6
$0 - NON surgical service
$175 - surgical service
$0 - NON surgical service
$125 - surgical service
$215/day, days 1–6
(Limit 190 days per lifetime)
(100 days /benefit period*)
Ambulance (land/air)
Lab/ X-rays
Therapy/Rehab
$100/day, days 21–100
$285/one-way trip
$0/ $25
$25
$100/day, days 21–100
$270/one-way trip
$0/ $25
$25

RUBY 1 Prescription Drug Benefits
Benefit ( 30 days supplies)
Annual Deductible
Tier 1 – GENERIC preferred
Tier 2 – GENERIC non-preferred
Tier 3 – BRAND preferred
Tier 4 – BRAND non-preferred
Tier 5 – SPECIALTY
Tier 6 - some brand & generic drugs used to treat chronic conditions
Ruby 1-Preferred Ruby 1-Standard
$0
$2
$15
$35
$85
33%
$0
$7
$20
$45
$95
33%
$0 $0

4

DETAILS
PCP
SPECIALIST
INPATIENT HOSPITAL
Outpatient Hospital
4
RUBY 4 - $0/mo ($6700)
(Pima, Cochise, Santa Cruz)
$10
$50
$345/day, days 1–5
$35 - NON surgical service
$275 - surgical service
ASC
$0 - NON surgical service
$250 - surgical service
Inpatient mental health
(Limit 190 days per lifetime)
$285/day, days 1–6
Skilled Nursing Facility
$0/day, days 1–20;
$100/day, days 21–100
Ambulance (land/air)
Lab/ X-rays/ Therapy or Rehab
$295/one-way trip
$0/ $35/ $40

RUBY 4 Prescription Drug Benefit
Benefit ( 30 days supplies)
Annual Deductible
Tier 1 – GENERIC preferred
Tier 2 – GENERIC non-preferred
Tier 3 – BRAND preferred
Tier 4 – BRAND non-preferred
Tier 5 – SPECIALTY
Tier 6 - some brand & generic drugs used to treat chronic conditions
Ruby 4-Preferred Ruby4-Standard
$0
$0
$15
$35
$85
33%
$0
$0
$5
$20
$45
$95
33%
$0

PCP
SPECIALIST
INPATIENT HOSPITAL
Outpatient Hospital
ASC
DETAILS
GREEN - $0/mo ($6700)
(Maricopa, Pinal, Cochise, Santa Cruz)
$5
$35
$195/day, days 1–8
$0 - NON surgical service
$175 - surgical service
$0 - NON surgical service
$125 - surgical service
$175/day, days 1–8
Inpatient Mental Health
Skilled Nursing Facility
(100 days /benefit period*)
$100/day, days 21–100
Ambulance (land/air)
Lab/ X-ray
Therapy / Rehab
$300/one-way trip
$0/ $35
$25

(Medicare/AHCCCS)
FULL DUAL ONLY!
SLMB and QI1 CANNOT join the Amber Plan.

FULL DUAL – SNP
You Must Complete an AHCCCS Status Verification prior to submission
BENEFITS- $4100 MOOP
MEDICAL COPAYS
PRESCRIPTION DRUG COPAYS
DENTAL (PPO)
VISION
HEARING
TRANSPORTATION
HEALTH CLUB BENEFITS
CASE MANAGEMENT
AMBER - D-SNP - Maricopa
$0
LIS copays
(LIS 2) $1.20/$3.60 & (LIS 1) $2.65/$6.60
$0 Deductible
$0 Preventive/Diagnostic
$2,000 Annual Maximum Benefit
$100 allowable Frames/Contacts / 2 yrs
$1000 Allowance on pair of hearing aids/3 yrs
$0 Annual Routine Hearing Exam
$0 Fittings / 3 yrs
$0 copay – 24 one-way trips
$0 – Silver Sneakers
Case Management assistance

Dental Plan
Maximum allowable $2,000 in-network and out-of-network combined
(calendar year)
Dental PPO
Network
$0 in-network and out-of-network combined
(calendar year)
Preventive and diagnostic
In-network: Mbr pays $0 Out-of-network: Mbr pays 20%
Comprehensive services
In-network: Mbr pays 50% Out-of-network: Mbr pays 50%
Major dental services
In-network: Mbr pays 50% Out-of-network: Mbr pays 50%
Exam – Routine (refractive)
(1 per year)
In-network: $10 per visit Out-of-network: $35 allowable
Vision
Frame (standard)
(every 2 years)
In-network: $100 allowance; 20% off balance over $100
Out-of-network: $45 allowable
Lens (standard)
(every 2 years) $0 copay
Contacts (every 2 years) Conventional in-network – $100 allowance;
15% off balance over $100
Disposable in-network – $100 allowance; then balance over $100
Out-of-network:
Conventional OR disposable – $80 allowance

Maricopa, Pinal
CHRONIC CONDITION:
Maricopa, Pinal
CHRONIC CONDITIONS:
(Type I or type II; Do not have to be insulin/medication dependent)
AND/OR
Chronic Heart Failure
(Must specifically have CHF)
2. Coronary Artery Disease
3. Peripheral Vascular Disease
4. Chronic Venous
Thromboembolic Disorder
*Must be one of these specific cardiovascular diseases to be eligible
An attestation form is submitted to the member’s PCP as we need to obtain verification of the condition(s) on a post-enrollment basis .

PCP
SPECIALIST
INPATIENT HOSPITAL
Outpatient Hospital
ASC
JADE/JADE CARDIOVASCULAR C-SNP
DETAILS
JADE / JADE C - $0/mo ($3400)
(Maricopa, Pinal)
Inpatient Mental Health
$0
$20
$175/day, days 1–8
$25 - NON surgical service
$175 - surgical service
$0 - NON surgical service
$150 - surgical service
$175/day, days 1–8
(100 days /benefit period*)
Ambulance (land/air)
Lab/ X-ray (Flat Film)
Cardiac/ PT Therapy
Oxygen Copay
$100/day, days 21–100
$350/one-way trip
$0/ $25
$0/ $10
$0

JADE / JADE CARDIO Part D
Benefit ( 30 days supplies)
Annual Deductible
Tier 1 – GENERIC preferred
Tier 2 – GENERIC non-preferred
Tier 3 – BRAND preferred
Tier 4 – BRAND non-preferred
Tier 5 – SPECIALTY
Tier 6 - some brand & generic drugs used to treat chronic conditions
Jade/Cardio-
Preferred
$0
$0
$15
$35
$85
33%
$0
Jade/Cardio-
Standard
$0
$5
$20
$45
$95
33%
$0

Member must indicate what Dr diagnosed them with disease.
67

877-986-7419
• To / from medical appointments
• Will stop at Pharmacy; not counted as additional trip
• Family member / caregiver can accompany member and is not counted as an additional trip
• Members should call 72 HRS in advance
• English & Spanish speakers

Pam White,
Health Net
Ruby 1, Ruby 4, Ruby Select, Green,
Jade and Jade Cardiovascular members

Dental (PPO)
(Major Dental Services Included)
Vision
($250 eyewear allowance/2 yrs)
Chiropractic / Acupuncture
(24 visits/year @ $15 copay/visit)
Dental (PPO)
(Basic / Comprehensive ONLY)
Vision
($100 eyewear allowance/2 yrs)
***NO CHANGES FROM LAST YEAR***
ENROLLMENT: NEW MEMBERS: within the first month of enrollment (use app form)
EXISTING MEMBERS: can only add during Oct 15 – Jan 31;
(Jan or Feb 1 eff)
DISENROLLMENT: ALL MEMBERS: Members can disenroll at any time of the year by sending a signed, dated letter to Member Services

$49 monthly premium
Dental plan
Maximum allowable (calendar year)
Deductible (calendar year) *
$1,000 in-network and out-of-network combined
$50 in-network AND $100 out-of-network
Dental PPO
Network
(in-and out-ofnetwork benefits)
Preventive and diagnostic services
General comprehensive/Basic services
Major dental services (o ral surgery, endodontics, prosthodotics, crowns, dentures, etc)
Exam - Routine (refraction)
(1 per year)
Vision
Chiropractic
Acupuncture
Frames, lens and lens options package
(every 2 years)
Contacts
(every 2 years)
Office visit
Visit limits (Chiro and acupuncture combined)
In-network: Mbr pays $0 Out-of-network: Mbr pays 20%
In-network: Mbr pays 20% Out-of-network: Mbr pays 40%
In-network: Mbr pays 30% Out-of-network: Mbr pays 50%
In-network: $10 per visit Out-of-network: $45 allowable
In-network: $250 allowance ; 20% off balance over $250
Out-of-network: $250 allowance; then 100% of balance
Conventional – in-network: $250 allowance
15% off balance over $250
Disposable – in-network: $250 allowance; then balance over $250
Conventional and disposable – out-of-network:
$250 allowance; then balance over $250
$15 per visit
24 visits per calendar year
71 • Deductible applies to ALL services; in- and out-of-network.
.

$25 monthly premium
Dental plan
Maximum allowable ( calendar year)
Deductible (calendar year)
$1,000 in-network and out-of-network combined
$50 in-network and out-of-network combined
Dental PPO Network
(in- and out-ofnetwork benefits)
Preventive and diagnostic services
Comprehensive services
Periodontal services
In-network: Mbr pays $0 Out-of-network: Mbr pays 20%
In-network: Mbr pays 20% Out-of-network: Mbr pays 40%
In-network: Mbr pays 20% Out-of-network: Mbr pays 40%
•
Vision
Major dental services (o ral surgery, endodontics, prosthodotics, crowns, dentures, etc)
Exam – routine (refractive) (1 per year)
Frame (standard)
(every 2 years)
Lens (standard)
(every 2 years )
Contacts
(every 2 years)
Deductible applies to ALL services; in- and out-of-network.
NOT COVERED
In-network: $10 per visit Out-of-network: $35 allowable
In-network: $ 100 allowance ; 20% off balance over $100
Out-of-network: $45 allowable
$0 copay
Conventional in-network – $100 allowance;
15% off balance over $100
Disposable in-network – $ 100 allowance; then balance over $100
Out-of-network: Conventional OR disposable – $80 allowance
72

®
Venue-Based Program Component
Fitness membership that includes:

Access to over 12,000 fitness locations nationwide
 SilverSneakers classes taught by certified instructors
 A Home-based Fitness Program (Silver Steps)

A SilverSneakers Program Advisor SM for guidance and assistance

New health plan members will receive their personalized membership card to be used to enroll in the program

Access to www.SilverSneakers.com
for facility locations and comprehensive, easy-to-use wellness resources.
73

Geoffrey Gomez
Health Net
Provider Search and
Online Enrollment
September 9, 2014
Jocelyn Weiss
Manager, Web Solutions

Agenda
①
You Spoke, We Listened:
Provider Search Enhancements
② Making Your Job Easier:
Online Enrollment Tools
76

Provider Search: What you told us
Let me search by more than just location
•
During AEP, filter by plan year for accurate results.
77

Provider Search: We listened
You will be able to search by location and plan year (during AEP) as well as filter by provider name, provider ID or plan name
78

Provider Search: We listened
Location searches will have multiple options
– Address, Zip Code, City, County or State.
If an address is entered, we ask for a radius selection. If any other location is entered we will not.
79

Provider Search: We listened
After entering a location and plan year, the user may also add one of three filter types
–
Provider Name, Provider ID or Plan Name
80

Provider Search: We listened
The list of available plans is based on the location entered. Only those plans offered in that area will be shown in the list.
81

Provider Search: We listened
All filters should be on one page.
82

Provider Search: We listened
All filters will be on one page instead of three.
We also highlighted top search bar to make it easier to use
83

Provider Search: What you told us
Should have an option to view Medical Group results based on where affiliated physicians are located (servicing location) rather than where the medical group is physically located.
Users will be able to choose to view Medical Group results based on Servicing Location or
Physical Location. Default will be Servicing Location
Default will be Servicing Location
84

Provider Search: We listened
Users will be able to choose to view Medical Group results based on Servicing Location or
Physical Location. Default will be Servicing Location
85

Provider Search: What you told us
•Fix print results/plan providers – don’t make me wait hours for a PDF to be sent via email
•Print Results and Print Plan Providers will display a printable web page instead of a PDF
•It will be available immediately (although large result sets may take a few minutes to)
•Email Results will email a link to the web page, not a PDF
86

Provider Search: What you told us
Simplify how we select a plan
– there are just too many in the drop down list
87

Provider Search: We listened
We will add a filter for Plan Type
Standard Medical Plans
Medicare Plans
State Health Plans
Exchange Plans
Selecting the Medicare Plans filter will only display Medicare Plans in the drop down.
88

Provider Search: Timeline
All of these changes will go live the night of Thursday, October 23
Until then, the current Provider Search tool will be available, although updated to include all the 2015 provider networks
Broker Services will provide more communications, including a detailed training presentation, as we get closer to implementation
89

Online Enrollment
Did you know….
You can enroll members online using your laptop or tablet?
Using the online tool
• Promotes accuracy
• Ensures all required data is captured
• Results in faster application processing
90

Online Enrollment
To access the online enrollment tool
From healthnet.com hover over “Shoppers” and select “Plans for
Medicare Beneficiaries” from the fly out menu
91

Online Enrollment
To access the online enrollment tool
Then select “Medicare Advantage Plans”
92

Online Enrollment
To access the online enrollment tool
Verify your zip code
During AEP, verify your plan year
Select one of the menu items to view available plans
93

Online Enrollment
To access the online enrollment tool
From the plan results, click on the Apply Now button to go to the
Online Enrollment form.
94

Online Enrollment
The first step is to identify that you are a Sales Producer and complete the information that allows us to tie you to the sale.
Tip: The applicant needs to be with you to use the online enrollment tool
95

Online Enrollment
Then the online tool walks you through each step of the enrollment process, providing a progress bar so you can always see where you are:
The screens are tailored to the plan and mirror the printed forms
The tool allows you to upload required documents and provides error messaging when you miss a required field or provide data in a bad format
– helping ensure complete and accurate forms are submitted
96

97



Commissions for 1/1/15 effective policies will be paid out approximately January 10th
Legacy commissions – plans that were written prior to 2009. Commissions will be paid out the month after the anniversary month of enrollment.
Plans written in 2009 and forward, will be paid out around the second week of February 2014.