PRODUCT TRAINING

2020

• History / Values• Plan Offerings• Providers• Healthcare Concierge• Agent Concierge• Enrollment Process/Application Submission

• Agent Oversight• Agent Compensation• Important Information• Wrap Up

Certification Overview

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Hello and welcome to the 2020 Care N’ Care Agent Certification module. My name is Tana Kersten, Senior Manager of Sales. This training module will help you learn about Care N’ Care and what sets us apart from other Medicare Advantage companies.

With your help, we anticipate 2020 a banner year and look forward to a mutually rewarding relationship.

Introduction

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Care N’ Care is a local Medicare Advantage plan created in 2008 by local doctors committed to giving seniors in North Texas sensible, affordable alternatives that improve and simplify Medicare coverage. Proudly headquartered in Fort worth, offering our friends and neighbors HMO and PPO Medicare Advantage plans with exceptional benefits and delivering outstanding member service with local hospitality.

The Mission of Care N’ Care:

“To be the most loved health plan in the communities we serve”

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Coverage Area• Collin County• Dallas County• Denton County• Hood County • Johnson County• Parker County• Rockwall County• Tarrant County• Wise County

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• Cooke- New for 2020• Somervell- New for 2020• Erath- New for 2020• Palo Pinto- New for 2020

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• Predictable copayments and low annual out-of-pocket maximums• A $0 premium option is available• Preventive dental, eyewear coverage and hearing aids all included in base benefits

with no extra premium!• Optional dental rider that covers comprehensive dental benefits for additional

monthly premium• Included fitness benefit through SilverSneakers™

Care N’ Care is an affordable alternative to Medicare Supplement insurance and other types of Medicare health plans. To assist its members in living healthier and happier lives, the health plans provide the following benefits to eligible Medicare beneficiaries:

PPO

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• Predictable copayments and low annual out-of-pocket maximums• $0 premium, $0 deductible, $0 PCP Copay, and $0 Tier 1 Prescription Copay• Enrollees must select an In-Network Primary Care Physician, which will work closely

with members to meet healthcare needs and coordinate plan benefits, such as referrals to specialists, medication refills and other needed services

• Optional dental rider that covers comprehensive dental benefits for additional monthly premium

• Fitness membership through SilverSneakers™

HMO

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• Embedded Vision benefits provided by EyeMed Vision− Over 4,000 in-network locations

• Embedded Dental benefits provided by FCL Dental− All plans cover cleanings, exams and x-rays

• Embedded Hearing benefits provided by TruHearing− Offering two options for hearing aids

• Fitness benefit through SilverSneakers• Post-discharge meal benefit included in all plans from Mom’s Meals• Part D Drugs in Tier 1 will have gap coverage on all MAPD plans• Part D COPD Medications on Tier 2 and 3 will also have gap coverage on all MAPD plans• OTC (over the counter) card on ALL plans

Learn more about our great benefits for 2020, make plans to attend our Pre-AEP Kickoff meeting in August.

Details coming soon!

New for 2020, Some great benefits and more!

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Dental Rider:

Optional Dental Rider

• At Care N' Care, we believe our members’ dental health can have a direct impact on their overall health and well-being, and may have an influence on the development of certain conditions such as diabetes and heart disease.

• For 2020, we maintained our dental benefits included in all plans.

Plan Highlights (Refer to benefits for complete details)

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Plan Highlights (Refer to benefits for complete details)

Optional Dental Rider (cont.)

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Choosing an In-Network ProviderChoosing the right physician can greatly influence many factors in our lives. At Care N’ Care, quality of care is an important focus. Choosing in-network providers can help:

•Lower copayments and out of pocket costs for members•Ensure that plan benefits are properly coordinated, to

provide a seamless continuation of care

•Ensure that plan providers follow plan processes to

minimize billing errors

•Members properly and effectively manage challenging and

costly chronic health conditions

•Assist in working towards higher STARS Ratings

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Provider Selection

Locate Providers On Website

Find Providers at www.cnchealthplan.com/search

• On the Provider Network Page click “find a provider” located at the bottom of the page• Select 2019 Find a Provider located on the left

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Care N’ Care’s Website (cont.)

1. Select PPO or HMO2. Search by:

• Provider Last Name• Practice Name

OR• Provider Type• Zip Code• Miles Radius

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The Care N’ Care Provider Search Tool is updated every 24 hours to reflect

network changes.

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Healthcare Concierge

At Care N’ Care, we work hard to provide our membersexcellent member service. Whenever a member has a question, we are always just a phone call or email away.

The Healthcare Concierge is the member’s single point of contact and trusted partner committed to working with them throughout the entire healthcare experience. They are here to help navigate the member’s personal health plan benefits, while providing the best member experience with the utmost courtesy and respect.

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A Healthcare Concierge can help:

• Assistance with finding a physician, and scheduling appointments

• Plan and benefit questions

• Assistance with special healthcare needs

• Prescription drug assistance

• Claims questions and billing resolution

Welcome CallAs part of its quality assurance process, Care N’ Care completes a welcome call with each new enrollee. The purpose is to confirm the accuracy of the information on the enrollment form, ensure that the enrollee understands the plan and wants to enroll in the Care N’ Care Medicare Advantage plan.

The agent should cover the purpose of the welcome call during enrollment process.

During the member’s initial Welcome Call, the Healthcare Concierge will cover the following:

• Verification of plan selection as well as any optional supplemental benefits if applicable.

• Verification of Primary Care Physician (PCP) selection and if they selected an Out-Of-Network provider, the Healthcare Concierge will cover the benefits of utilizing an IN-Network provider.

*If the member enrolls in HMO, an In-Network PCP has to be selected.

• Reminder of the Welcome to Medicare Preventive Visit or Annual Wellness Visit.

• Payment method for enrollment in plans with premiums.

• Emergency contact information and who member would like as their HIPAA contact.

• Address any additional questions the member may have about their plan and welcome them to Care N’ Care.

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• Check Application Status

• Check Enrollment Status

• Check Eligibility

• Answer Benefit Questions (this does not guarantee coverage)

• Product Certification

• Answer Commission Questions

• Provide Enrollment Kits & Supplies

• Online Application Support

Our Agent Concierge team is dedicated to assist contracted Care N’ Care agents throughout the sales and enrollment process and continues as long as that member is enrolled with Care N’ Care. The Agent Concierge team is available from 8 AM to 5 PM, Monday through Friday.

For Assistance:Phone: (855) 547-0345 | Email: agentsupport@cnchealthplan.com

An Agent Concierge Can Help:

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Agent Concierge

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Enrollment Process

1. Determine eligibility

2. Identify the election period. Make sure you submit the attestation form along with the application as proof of the eligibility

3. Select a plan

4. Explain the MAPD monthly premium amount and supplemental coverage

5. Select a payment option

6. Explain OEP (Open Enrollment Period) process

7. Explain the Welcome Call

8. Submit the enrollment form along with Attestation Form (Preferred method is via our web electronic enrollment)

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Care N’ Care Application – Page 1

• Plan selection

• Beneficiary full name (including middle initial), birth date, sex and contact information such as home phone number, and/or cell phone number

• Permanent residence street address (PO Box can only be used for mailing address) and need to include mailing address if different than permanent address

• Include an emergency contact with contact phone number

• In addition to contact information enter E-mail address if provided, indicate if none

• Enter Medicare number and Part A and B effective dates

• Double check spelling and other pertinent information as noted on the beneficiary’s Medicare card

• Write legibly with a black ball point pen24

Payment Options – Page 2 Monthly Invoice

Electronic funds transfer (EFT) from bank account each month

Automatic deduction from monthly Social Security/Railroad Retirement Board (RRB) benefit check

• If you select this option: The Social Security/Railroad Retirement Board deduction may take two or more months to begin after Social Security/RRB approves the deduction. In most cases, if Social Security or RRB accepts the request for automatic deduction, the first deduction from the Social Security or RRB benefit check will include all premiums due from the enrollment effective date up to the point withholding begins. If Social Security or RRB does not approve the request for automatic deduction, we will send a paper bill for the monthly premiums.

Note: if member does not wish to select a payment option for any reason Care N’ Care will automatically send a monthly invoice. To change this payment option, beneficiary can call the Health Care Concierge.

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PCP Selection - Page 3

• Make sure to answer questions 1-5• Enter the beneficiary’s chosen PCP

* All HMO applications require an In-Network Provider

• Select the option for other than English language format

• Read the important information

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Broker Information - Page 4

Signatures and dates from either the beneficiary or an authorized representative

To ensure proper commission credit, the Agent/Broker assisting must provide their name, plan selected, effective date of coverage, election period, and the NPN number.

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Scope of Appointment (SOA)

A beneficiary or existing Member must agree on the SOA prior to the agent scheduling in-person presentation, other than a community sales meeting.

Agents must have a signed CMS-approved SOA form prior to any in-person meeting. SOA is required for all such meetings with current or new clients to discuss Medicare Advantage or PDP products.

Agent must disclose all product types to be discussed (i.e. MA, MAPD, PDP) during the appointment by securing a SOA prior to the meeting.

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Scope of Appointment (SOA) (cont.)

Exception Policy: if it is not feasible to obtain the SOA Form prior to the appointment, the agent may have the beneficiary sign the form at the beginning of the appointment.

• Agent must record in writing and maintaindocumentation on why it was not feasible to obtain the SOA prior to the appointment.CMS expects Care N’ Care to record and maintain this documentation, and upon request, must be able to produce it.

• A new SOA form is required if the beneficiary has requested to discuss another MA or PDP product type during an appointment. However, a new appointment is not required. The additional product can be discussed as soon as the beneficiary request is documented.

NOTE: CMS requires SOA to be retained for 10 years. 29

Online Applications (Preferred Method)Applications can be submitted online using the Web App. If you need assistance with this process, please contact your Agent Concierge.

Web AppEnrollment link can be found at www.cnchealthplan.com under the Agents section under Sales Tools OR contact your Agent Concierge for the link.

Paper ApplicationsPaper applications may be dropped off at the Care N’ Care office or faxed. Applications may be faxed to any of the following fax numbers.

Fax Number:817-529-9157 (Preferred Fax Number)877-799-5669

For Assistance:Phone: (855) 547-0345 | Email: agentsupport@cnchealthplan.com

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Submitting Applications

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Oversight of Agent/Broker Sales & Marketing

To maintain Compliance oversight and monitoring of agent/broker sales activities:

• Care N’ Care will monitor and track all agent/broker sales and marketing activities and respond to all issues or complaints related to member dissatisfaction or misrepresentation, including those requested by the Texas Department of Insurance (TDI) and CMS.

• Activities that are monitored may include, but are not limited to:

• Enrollments, cancellations, and disenrollments, including rapid disenrollment

• Sales and surveillance activities, including presentations and SOA’s

• Complaints against an agent and/or inappropriate identified behaviors (e.g., suspicious application signatures, etc.)

• Training and testing• Data submission/reporting of agent complaints to CMS

annually• State licensing and appointment requirements, including

reporting terminations• Compensation structures

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Agent/Broker Complaints Tracking

• The Senior Manager Of Sales will track complaints from beneficiaries or their representatives regarding the agent/broker on an ongoing basis. Complaints may come in from, but are not limited to, the following sources:

• The CMS Complaints Tracking Module (CTM) in HPMS• The CMS Regional Office• The Member Service call center

• When a complaint is received by Care N’ Care involving an agent/broker, The Compliance Department will contact the Senior Manager Of Sales who will then contact the agent/broker and request statements of account for the complaint.

• Agent compliance will be tracked using a scoring system that assigns points to complaints based on the severity of the complaint. Agents crossing the threshold will be referred to the Agent Oversight Committee.

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Agent/Broker Complaints Tracking (cont.)

• The agent/broker’s cooperation with Care N’ Care is required by Care N’ Care during the investigation of the complaint, as well as during the implementation of any Corrective Action Plan (CAP) developed in response to such complaint

• Corrective Action(s) may include the following:

• Focus training; monitoring sessions• Full re-training and re-testing• Termination and prohibition from selling Care N’ Care plans

• Failure to respond within the required timeframe to any of Care N’ Care’s requests during the investigation or corrective action phase will result in suspension or termination of the agent/broker’s ability to market, sell and receive commissions.

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Agent Termination

Care N’ care is required by CMS to report the termination of any agent, and the reasons for the termination, to the state where the agent is appointed and to CMS, where required. The same applies for all contracted distribution partners. When a Care N’ Care agent is terminated, the agent cannot market our products.

**Code of Ethics for Professionalism:

Brokers are required to maintain highest levels of professionalism at all times when interacting with potential beneficiaries, other brokers, FMO (if applicable), and all plan employees.

Agent of Record (AOR) During the Annual Enrollment Period, if we get multiple applications for a beneficiary, we

recognize the AOR as the agent associated with the most recent application on file. If a member does a plan-to-plan change, the existing AOR on the policy will remain and

commissions will not be paid for that change. Renewals will be unaffected. Plan change is considered a change from one PPO plan to another PPO plan If a change is made from PPO to HMO or vice versa, this is considered a product

change and a new application is needed and AOR will be whomever completed that new application.

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Agent/Broker Compensation

Compensation Rate Adjustment for CY 2020

As provided in 42 C.F.R. §§422.2274(b)(1) and 423.2274(b), the compensation amount paid to an independent agent or broker for an enrollment must be at or below the fair market value (FMV) cut-off amounts published yearly by CMS.

NOTE: The FMV amounts for CY 2020 are rounded to the nearest dollar. The Initial Year amount is the maximum allowable to be paid for enrollments during compensation cycle-year 1. The 2 renewal amount is the maximum allowable to be paid for enrollments during compensation cycle-years 2 and beyond.

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Setting Expectations Early On

It is important as an agent with both your reputation and the company’s reputation on the line to communicate accurate information beginning with your first interaction/visit with the beneficiary. This will help eliminate any future complaints/grievances against both you and the plan in the future.

The following are helpful items that may assist you with some of the questions you will be faced with during an appointment.

There is also additional information on what you can do as an agent to communicate with the member on what to expect and some options available to them. The discussions around some of these items can help with our overall STARS rating which in the end effects both you and the member’s experience since the STARS rating can effect the benefits from year to year.

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Medication Therapy Management (MTM)

• Members may be automatically enrolled in Care N’ Care’s MTM program if they meet 3 criteria (have the ability to opt-out)

• Members must meet three criteria in order to be selected for the program • Fill at least eight Part D medications per month• Accumulate at least $1063.75 in medication costs in the previous quarter• Have at least three of the following conditions:

• Diabetes• High Cholesterol• Osteoporosis• High Blood Pressure • COPD

• The plan, in conjunction with our PBM (Pharmacy Benefit Management), Envision, determines who is eligible for the program based on Part D claims

• If determined to be eligible, Envision will notify the member of enrollment in the MTM program

• The program consists of two elements; 1) a detailed comprehensive medication review by either a pharmacist or nurse (can opt-out) or 2) a “targeted medication review” which identifies medications the member should be on, based on medical guidelines and member’s medical conditions (can’t opt-out)

• Please encourage members to complete the medication review when Envision notifies them • MTM is a STAR measure and is used to calculate the overall STAR rating for CNC

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Surveys

CMS requires health plans to administer two surveys each year:• A third party vendor is delegated to administer the surveys (SPH Analytics)• If selected, the member will receive a survey from SPH in March or April • Though long, the survey results are very important to the overall STAR rating for CNC• Please encourage members to complete the surveys and return them by the deadline

CAHPS survey (Consumer Assessment of Health Plan Satisfaction):• Will ask members about their satisfaction with the health plan and their physician

STAR related measures are:

• Getting needed care• Getting appointments and care quickly• Customer service• Overall rating of health care quality• Overall rating of plan • Care coordination• Rating of drug plan • Getting needed prescription drugs• Getting information from the plan about prescription drug coverage and

cost • Annual flu vaccine

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Surveys (cont.) HOS survey (Health Outcomes):• Will ask members about their health status• STAR related measures are:

• Improving or maintaining physical health • Improving or maintaining mental health • Monitoring physical activity• Improving bladder control • Reducing the risk of falling

Preventative Screenings, Management of Conditions and Medication Utilization:

• CMS “grades” Care N’ Care on how many of our members get screenings, how well they manage their conditions and how well they fill their medications

• Care N’ Care will routinely reach out to members to encourage them to get screenings, manage conditions, take medications

• Encourage members to cooperate with requests for screenings

Screenings include:• Breast Cancer Screening• Colorectal Cancer Screening • Adult BMI (Ht and Wt)• Bone Density Screening (It is vital that after a woman has a fracture she gets a bone

density screening (has to be done within 6 months of fracture)42

Surveys (cont.) Managing Conditions:

Diabetes:• Diabetics need to get a retinal eye exam • Diabetics need to make sure that their hbA1c is in control • Diabetics need to get a Nephropathy screening

High Blood Pressure:• Members need to make sure that their BP stays in control

Rheumatoid Arthritis:• If a member has Rheumatoid Arthritis they need to take an Anti-Rheumatic drug

Medications:• Members prescribed high blood pressure medication need to fill all scripts written by

doctor• Members prescribes cholesterol medication need to fill all scripts written by doctor• Members prescribed diabetes medication need to fill all scripts written by doctor

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ID Cards:New Care N’ Care members are expected to have their ID cards within 15 days of enrollment in the plan.

Handling of Out-Of-Network Medical Claims:Every doctor is different on how they may choose to handle Care N’ Care patients as Out-of-Network. It is important that your beneficiary understand that even though we are a PPO, there may be some Primary Care Physicians, Specialists, or Facilities who will not accept Care N’ Care patients. We are willing to work with any Out-of-Network doctors/facilities to help facilitate that claims process. In many instances, your beneficiary may be expected to pay the entire bill up front and would thensubmit that receipt with all the billable codes listed to their Healthcare Concierge for the reimbursable amount. That amount is based on the Medicare Allowable MINUS any applicable Out-of-Network copay. It is best to have your beneficiary check with the doctor’s office in advance of appointment to understand what they will be responsible for paying at the time of visit to avoid any confusion.

Handling of Out-Of-Network Dental Currently, if a member decides to go Out-of-Network for a procedure, they may ask the dental office to send FCL Dental the claims directly and the member must pay the out-of-pocket expenses at the time of services. However, the members will be responsible to pay the full out-of-pocket expenses.

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Final Thoughts

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Wrapping Up

Hi again! Now you know about Care N’ Care Medicare Advantage Plans.

Now that you’ve viewed each slide of the presentation, you may proceed to the 2020 Care N’ Care Medicare Advantage Certification Exam.

You will have three attempts to successfully pass the exam with a minimum score of 85%.

Good luck!

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