Janis E. Carter Health Net Health Net Medicare Advantage Sales & Product Training Proprietary & Confidential, Restricted Distribution. For training purposes

Janis E. Carter

Health Net

Health Net Medicare Advantage

Sales & Product Training

Proprietary & Confidential, Restricted Distribution. For training purposes only, not to be used for Sales & Marketing activity.

Plan Year 2015

Maricopa AE /Maricopa AE Pima AE

Dionna Naugle Jeff Romero Pat Parisella

(602) 541- 6298

[email protected]

m

(602) 717-7299

Jeffrey.Q.Romero

@healthnet.com

(520) 306-7360

Patrizia.X.Parisella

@healthnet.com

E4L Maricopa Support 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)

Your Account Executives

Health NetRecognized 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

• 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

Welcome to Health Net’s2015 Product & Compliance

Training!

BROKER RESOURCES

Hours of Operation During AEP

1. Broker Services Mon-Fri 9am-6pm2. Member Services Mon-Fri 8am-5pm3. Pharmacy Dept. Mon-Fri 8am-530pm

Corporate Presentation 5

• 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 30th @ 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- [email protected]

Broker Services: AZ 1-866-459-1212([email protected])

• Help Looking up drugs on our formulary

• Questions about generic versions of brand drugs

• Questions about copays / tier classifications

• Assistance calculating approximate drug costs

Pharmacy Line 1-800-410-6565Assistance with Pharmacy/Drug-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

Member Services 1-800-977-7522

Assistance with Customer Service and Claims-Related Questions:

Pam White,Health Net

2015 Updates & Reminders

9

• 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:

No Statement of Understanding 2015

Eligibility and Enrollment

10

Sample Document

NEW

• 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.

Reminder Enrollment Form Submission


11

• 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!

NEWEnrollment Form – Health Net Office Use Only Section


12

13

- A completed application should contain the following documents:

Application Package SummaryReminder

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!


2015 Contracting

2015 Contracting Checklist

Health Net NEW Producers:

2015 Individual Producer Contract Or Appendix A (if working with Agency/GA/FMO)Completed W-9Copy of Health & Life License

2015 AHIP Exam Certificate (online)HNT 2015 Compliance Training (online) HNT 2015 Product Training (online)

***Submit all of your documents to your GA

or Broker.Contracting.Medicare

@healthnet.com

2015 Contracting Checklist

Health Net Returning Producers:

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

Plan & Network Changes Darrin Smith- Medicare Sales

Manager


2015 Plan Terminations

18

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

2015 Service Area ReductionsThe 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

19

Network Terminations– Effective 1/1/2015North South

Maricopa, Pinal Counties Pima County Banner Health Network (BHN) Direct Network in Maricopa Only

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.


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.

Statistics Impacting HN’s model for a Tailored Network

Highly Confidential & Proprietary 21

2015 Provider Specific Plans (PSPs)

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 22

2015 Provider Specific Plan (PSP) Networks

Health Net Ruby Select (HMO)

North South

Maricopa, Pinal Pima

Network Specific

Marana Health Center

Saguaro Physicians

El Rio Santa Cruz Neighborhood Health Center


Beneficiary Impact

COMMUNICATION STRATEGY

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① CMS Template Letters: Sept 18th - Oct 1st

② Health Net SAR Letter: Oct 5th

③ Outbound Call: Oct 10th -30th

Service Area

Reductions

PCP Changes

① PCP Change Letters: Oct 1st

② Health Net PCP Change Letter: Oct 5th

③ Outbound Call: (option available)

PLUS: Strong communication with our partners(Brokers, Direct sales, Inside Sales/Optum, AZPC, Member Service Team)


AZ PC Updates 2015

Janice McGill- Director of Marketing

Marie Cremisino- Director of Provider Network

*COLLABORATING FOR SUCCESS*

• Provider Contracting Updates

• Member outreach

• Website development- AZPC.com

What is in store for 2015?

Convenient

Cost effective (compared to ER copay)

STAR measures initiative

Senior discount days

Provider Search Tool Senior Advantage

Club New Partnerships

NEW WEBSITE LAUNCH

Gilbert Urgent Care Center

Casa Grande Primary Care Center

AZPC Centers

706 N. McQueen Road 1811 E. McMurray Street


**Walk-Ins, Acute Care, Immediate Care 9am – 7pm Monday – Sunday, including

holidays.

Immediate Care Servives:Head-to-Toe ALL General X-Ray, Dexa ScanSVN Breathing Treatment, EKGOxygen ConcentratorsPropaq/Heart Monitoring IV FluidsWound Care/DressingSutures, SplintingToe nail care/removalCatheterization Vitamin B InjectionVaccines (Hep A, B, TDAP, PCV-13, Pneumovax, TB)Vitals, Incision and DrainageIV Therapy (Antibiotics, Insulin, Steroids)Durable Medical Equipment (DME)Post Hospital Visits

$0 Copay Ruby Select

Members

“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

PRIMARY FOCUS:BUILDING THE NETWORK

Over 780 Primary Care Physicians

Maricopa 740

Pinal 30

House Call PCPs 8

38 New HN Direct PCP Groups= 105

Over 1,370 Specialists & Ancillary Maricopa 1,340

Pinal 34…and counting

***2013 ONLY***

UNDERSTANDING THE NETWORKS

AE: Dionna Naugle

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

AZPC Network

Ruby Select, Ruby 1, Jade, Green,

Amber

AZPC (Specialists &

Hospitals)

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

Ruby Select, Ruby 1, JADE , GREEN

AZPC Network

Direct or AZPC (Specialists & Hospital)

“What will happen now that Banner

bought the Casa Grande 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

PINAL: Common Questions

Health Net MAPD – HMO Plans & Specialist ***PIMA COUNTY ONLY***

Carondelet NetworkMarana Health

CenterSaguaro PhysiciansEl Rio Santa Cruz

Neighborhood Health

Ruby Select Contracted Network (Specialists &

Hospitals)

RUBY 4RUBY SELECT

Marana Health Center

Saguaro Physicians

El Rio Santa Cruz Neighborhood

Health

Direct Network

Direct Network

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

Direct Network

Green & Ruby 4

Direct Network

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

Ruby 1, Ruby 4, Green

Direct Network

Direct Network

PLAN SERVICE AREA

MARICOPA

PINAL

PIMA

SANTA CRUZ

COCHISE

RUBY SELECT X X XRUBY 1 X X XRUBY 4 X X XGREEN X X X XJADE X XJADE Cardio X XAMBER Maricopa X

2015 HOSPITALS

• 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

Health Net 2015Pharmacy Enhancements

2015 AZ Medicare 43

Preferred (Low-Copay) Pharmacy Network• The preferred (low-copay) network will be published on HealthNet.com

October 1st.

• 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 (low-copay) network indicator.

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Preferential copays for Tiers 1-4

Albertson’s Osco

CVS Sam’s Club

Fry’s Xpress Care

Walmart

Plus large list of local pharmacies.

Standard copays for Tiers 1-4

Walgreens Food City

Safeway KMart

Target Basha’s

Costco

Plus large list of local pharmacies.

PreferredPharmacy examples:

StandardPharmacy examples:

Mail Order CVS Pharmacy

Health Net continues to offer copay savings for 90 day mail order fills for Tiers 1-3

HN’s RETAIL PHARMACIES*Ruby Select members have the ability

to use either Pharmacy Network*

2015 Drug Tiers

Details

Tier 1 GENERIC preferred

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

What Drugs Are in Tier 6?(Related to Star Ratings Drugs)

• 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)

2015 AZ Medicare 46

Value & Classic FormulariesCLASSIC FORMULARY VALUE FORMULARY

RUBY SELECT X

RUBY 1 X

RUBY 4 X

JADE X

JADE CARDIO X

AMBER X

Both contain a tier for certain drugs associated with Stars. These will be offered at $0 copays

47

Benefit Highlights 2015

Jeff Romero, Account Executive

On ALL of Our Plans…Benefit Member Pays

Emergency care visit $65 per visit (waived if admitted)

Urgent care visit $20 copayment

Home health care $0 copayment

Durable medical equipment 20% coinsurance

Clinical/Diagnostic lab $0 copayment

Diagnostic radiological services (CT Scans, MRI/MRA, PET Scans)

$125-$200

20% coinsurance for therapeutic radiology services

Part D Prescription Drug coverage (except Green)

Worldwide Emergency coverage

Health Club Benefits (SilverSneakers)

RUBY SELECT- Maricopa, Pinal (N) - Pima (S)

RUBY SELECT- BENEFITS

DETAILSR Select N - $0/mo

($3400)

Maricopa/Pinal

R Select S - $0/mo ($3800)

Pima

PCP $0 $0

SPECIALIST $20 $30

INPATIENT HOSPITAL $150/day, days 1–5 $150/day, days 1–5

Outpatient Hospital

ASC

$25 - NON surgical service

$125 - surgical service




$150- surgical service


$100- surgical service

Inpatient Mental

Health

$150/ day, days 1-5 $175/day, days 1–5

Skilled Nursing

Facility

$0/day, days 1–20;

$100/day, days 21–

100

$0/day, days 1–20;

$100/day, days 21–

100

Ambulance (land/air) $240/one-way trip $250/one-way trip

Lab/ X-rays $0/ $10 $0/ $15

PT/ Cardiac Rehab $10/ $15 $20/ $20

RUBY SELECT - Prescription Drug Benefits

Benefit (30 days supplies) Ruby Select (N)- Ruby Select (S)-

Annual Deductible $0 $0

Tier 1 – GENERIC preferred $0 $0

Tier 2 – GENERIC non-preferred $15 $12

Tier 3 – BRAND preferred $44 $44

Tier 4 – BRAND non-preferred $95 $95

Tier 5 – SPECIALTY 33% 33%

Tier 6 - some brand & generic drugs used to treat chronic conditions

$0 $0

RUBY 1- Maricopa, Pinal ($49/month)- Santa Cruz ($57/month)

RUBY 1 - BENEFITSDETAILS RUBY 1 - $49/mo ($5300)

(Maricopa, Pinal)

RUBY 1 - $57/mo ($5300) (Santa Cruz)

PCP $5 $5

SPECIALIST $35 $35

INPATIENT HOSPITAL $215/day, days 1–6 $215/day, days 1–6

Outpatient Hospital

ASC









Inpatient mental

health

(Limit 190 days

per lifetime)

$215/ day, days 1-5 $215/day, days 1–6

Skilled Nursing

Facility

(100 days /benefit

period*)

$0/day, days 1–20;

$100/day, days 21–

100

$0/day, days 1–20;

$100/day, days 21–

100

Ambulance (land/air) $285/one-way trip $270/one-way trip

Lab/ X-rays $0/ $25 $0/ $25

Therapy/Rehab $25 $25

RUBY 1 - Prescription Drug Benefits

Benefit ( 30 days supplies) Ruby 1-Preferred Ruby 1-Standard








$0 $0

RUBY 4- Pima, Cochise, & Santa Cruz

RUBY 4- BENEFITSDETAILS RUBY 4 - $0/mo ($6700)

(Pima, Cochise, Santa Cruz)

PCP $10

SPECIALIST $50

INPATIENT HOSPITAL $345/day, days 1–5

Outpatient Hospital

ASC

$35 - NON surgical service $275 - surgical service

$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) $295/one-way trip

Lab/ X-rays/ Therapy or Rehab

$0/ $35/ $40

RUBY 4 - Prescription Drug Benefit

Benefit ( 30 days supplies) Ruby 4-Preferred Ruby4-Standard








$0 $0

GREEN – MA ONLY(No prescription drug coverage)

GREEN MA - BENEFITS

DETAILS GREEN - $0/mo ($6700) (Maricopa, Pinal, Cochise, Santa Cruz)

PCP $5

SPECIALIST $35


Outpatient Hospital

ASC

$0 - NON surgical service $175 - surgical service $0 - NON surgical service $125 - surgical service

Inpatient Mental Health $175/day, days 1–8

Skilled Nursing Facility (100

days /benefit period*)

$0/day, days 1–20; $100/day, days 21–100


Lab/ X-ray $0/ $35

Therapy / Rehab $25

AMBER – Maricopa OnlyLow Income Plan (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 AMBER - D-SNP - Maricopa

MEDICAL COPAYS $0

PRESCRIPTION DRUG COPAYS

LIS copays (LIS 2) $1.20/$3.60 & (LIS 1)

$2.65/$6.60

DENTAL (PPO)

$0 Deductible $0 Preventive/Diagnostic

$2,000 Annual Maximum Benefit

VISION $100 allowable Frames/Contacts / 2 yrs

HEARING

$1000 Allowance on pair of hearing aids/3 yrs $0 Annual Routine Hearing Exam

$0 Fittings / 3 yrs

TRANSPORTATION $0 copay – 24 one-way trips

HEALTH CLUB BENEFITS $0 – Silver Sneakers

CASE MANAGEMENT Case Management assistance

2015 Amber Plan - Benefit Highlights

Dental Plan

Dental PPO

Network

Maximum allowable

(calendar year)

Deductible

(calendar year)

Preventive and diagnostic

Comprehensive services

Major dental

services

$2,000 in-network and out-of-network

combined

$0 in-network and out-of-network combined

In-network: Mbr pays $0 Out-of-network: Mbr pays

20%

In-network: Mbr pays 50% Out-of-network: Mbr pays

50%

In-network: Mbr pays 50% Out-of-network: Mbr pays

50%

Vision

Exam – Routine (refractive) (1

per year)

Frame (standard) (every 2 years)

Lens (standard) (every 2 years)

Contacts (every 2 years)

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

Jade- Special Needs Plan Maricopa & Pinal Counties

• Diabetes • Chronic Heart Failure• Cardiovascular Disorders

Jade CardioMaricopa, Pinal

CHRONIC CONDITIONS:

1. Cardiac Arrhythmias2. Coronary Artery Disease3. Peripheral Vascular Disease4. Chronic Venous Thromboembolic Disorder

*Must be one of these specific cardiovascular diseases to be eligible

JadeMaricopa, Pinal

CHRONIC CONDITION:

Diabetes (Type I or type II; Do not have to be insulin/medication

dependent)

AND/OR

Chronic Heart Failure (Must specifically have CHF)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.

A046672

Ruby Select North (H0351-040) will also be available in Pinal county for 2014. Pending CMS approval of our expansion request. Ruby Select south (H0351-041) will have additional providers in the network (El Rio for sure - need to confirm with Jacque as to any other providers).

JADE/JADE CARDIOVASCULAR C-SNP DETAILS

JADE / JADE C - $0/mo ($3400) (Maricopa, Pinal)

PCP $0

SPECIALIST $20


Outpatient Hospital

ASC

$25 - NON surgical service $175 - surgical service $0 - NON surgical service $150 - surgical service

Inpatient Mental Health $175/day, days 1–8

Skilled Nursing Facility (100 days /benefit period*)

$0/day, days 1–20; $100/day, days 21–100


Lab/ X-ray (Flat Film) $0/ $25

Cardiac/ PT Therapy $0/ $10

Oxygen Copay $0

JADE / JADE CARDIO - Part D

Benefit ( 30 days supplies)Jade/Cardio-

PreferredJade/Cardio-

Standard








$0 $0

Example SNP Pre-Qualification FormMember must indicate what Dr diagnosed them with

disease. If the chronic condition cannot be verified, the member

will be enrolled two months after the effective date with SEP eligibility to enroll in another plan.

67

Transportation Benefits

TOTAL TRANSIT # 877-986-7419

AMBER – 24 one-way trips

JADE PLANS – 6 one-way trips

• 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


Gold Buy-Up Options

Optional Supplemental BenefitsRuby 1, Ruby 4, Ruby Select, Green, Jade and Jade Cardiovascular members

Gold Option 1 $49/mo

Dental (PPO) (Major Dental

Services Included)

Vision ($250 eyewear allowance/2

yrs)

Chiropractic / Acupuncture (24 visits/year

@ $15 copay/visit)***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

Gold Option 2 $25/mo

Dental (PPO) (Basic /

Comprehensive ONLY)

Vision ($100 eyewear allowance/2

yrs)

A046672

Ruby Select North (H0351-040) will also be available in Pinal county for 2014. Pending CMS approval of our expansion request. Ruby Select south (H0351-041) will have additional providers in the network (El Rio for sure - need to confirm with Jacque as to any other providers).

71

2015 Gold Option #1 - Benefit Highlights

Dental plan

Dental PPO Network

(in-and out-of-network benefits)

Maximum allowable (calendar year)

Deductible (calendar year) *

Preventive and diagnostic services

General comprehensive/Basic services

Major dental services (oral surgery, endodontics, prosthodotics, crowns, dentures, etc)

$1,000 in-network and out-of-network combined

$50 in-network AND $100 out-of-network

In-network: Mbr pays $0 Out-of-network: Mbr pays 20%

In-network: Mbr pays 20% Out-of-network: Mbr pays 40%


Vision

Exam - Routine (refraction)

(1 per year)

Frames, lens and lens options package

(every 2 years)

Contacts

(every 2 years)


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

Chiropractic

Acupuncture

Office visitVisit limits (Chiro and acupuncture combined)

$15 per visit24 visits per calendar year

$49 monthly premium

• Deductible applies to ALL services; in- and out-of-network..

72

2015 Gold Option #2 - Benefit Highlights$25 monthly premium

• Deductible applies to ALL services; in- and out-of-network.

Dental plan

Dental PPO Network (in- and out-of-network benefits)

Maximum allowable (calendar year)

Deductible (calendar year)

Preventive and diagnostic services

Comprehensive services

Periodontal services

Major dental services (oral surgery, endodontics, prosthodotics, crowns, dentures, etc)

$1,000 in-network and out-of-network combined

$50 in-network and out-of-network combined

In-network: Mbr pays $0 Out-of-network: Mbr pays 20%



NOT COVERED

Vision

Exam – routine (refractive) (1 per year)

Frame (standard)

(every 2 years)

Lens (standard)

(every 2 years)

Contacts

(every 2 years)


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

Darren M Wozniak

en dash

Darren M Wozniak

fix leading

SilverSneakers FitnessVenue-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 AdvisorSM 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

SilverSneakers® Fitness is Included FREE on Every

2015 Health Net Plan!

Geoffrey GomezHealth Net

Healthnet.com

Provider Search and Online Enrollment

September 9, 2014

Jocelyn Weiss

Manager, Web Solutions

Agenda

76

① You Spoke, We Listened: Provider Search Enhancements

② Making Your Job Easier: Online Enrollment Tools

Provider Search: What you told us

77

Let me search by more than just location

• During AEP, filter by plan year for accurate results.

Provider Search: We listened

78

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


79

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.


80

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


81

The list of available plans is based on the location entered. Only those plans offered in that area will be shown in the list.


82

All filters should be on one page.


83

All filters will be on one page instead of three.

We also highlighted top search bar to make it easier to use


84

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

85

Users will be able to choose to view Medical Group results based on Servicing Location or Physical Location. Default will be Servicing Location



86

•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


87

Simplify how we select a plan – there are just too many in the drop down list


88

We will add a filter for Plan Type

Standard Medical PlansMedicare PlansState Health PlansExchange Plans

Selecting the Medicare Plans filter will only display Medicare Plans in the drop down.

Provider Search: Timeline

89

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

Online Enrollment

90

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

Online Enrollment

91

To access the online enrollment tool

From healthnet.com hover over “Shoppers” and select “Plans for Medicare Beneficiaries” from the fly out menu

Online Enrollment

92


Then select “Medicare Advantage Plans”

Online Enrollment

93


Verify your zip codeDuring AEP, verify your plan yearSelect one of the menu items to view available plans

Online Enrollment

94


From the plan results,click on the Apply Nowbutton to go to the Online Enrollment form.

Online Enrollment

95

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 needsto be with you to use theonline enrollment tool

Online Enrollment

96

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

Commission Updates 2015

Darrin Smith- Sales Manager

97

Broker UpdatesInitial MA Enrollment $408Renewal MA Enrollment $204

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.

Thank You Health Net Partners!

Documents

Janis E. Carter Health Net Health Net Medicare Advantage Sales & Product Training Proprietary & Confidential, Restricted Distribution. For training purposes