TX HealthSpring MedicareProgram TrainingJanuary 1, 2014—Go Live

Agenda

Overview of Plans Medicare Plans & Benefits Member ID Cards Complaints and Appeals Questions

Overview of Plans – High Level

Cigna-HealthSpring offers 13 Medicare Advantage dental plans that have been filed as part of their Texas market with CMS. HealthSpring categorizes the plans by Contract ID.

All Medicare plans are effective 1/1/2014

All Medicare plans operate on a calendar year January 2014 – December 2014

Some of the Medicare plans have out-of-network benefits

Some of the Medicare plans have co-insurance

None of the Medicare plans require authorization or UM review

Overview of PlansWhat types of dental plans are

offered? HealthSpring’s Medicare Advantage dental plans are similar

to commercial insurance plans. There are 4 different benefit sets that members can choose to buy based on where they live:

Preventive Plan

Preventive + Out-of-Network Plan

Preventive & Comprehensive Plan

Preventive & Comprehensive Optional Supplemental Plan

Overview of Plans

The plans with the same benefits are rolled up into the same exhibits in the ORM. The subgroup names are listed below by plan category:

Preventive Plans TX HS Preferred Advantage Medicare TX HS Preferred AR Medicare

Preventive + Out-of-Network Plan TX HS Preferred Advantage Medicare (50% Co-Ins)

Preventive & Comprehensive Plan TX HS Preferred TotalCare Medicare

Preventive & Comprehensive Optional Supplemental Plans TX HS Preferred TX/AR Medicare (Opt Supp) HS Preferred AR Medicare (Opt Supp)

Preventive PlanDentaQuest Subgroups: TX HS Preferred Advantage Medicare, TX HS Preferred AR Medicare

Covered Plans and Counties:H4528-001 Cigna-HealthSpring Preferred (HMO) Service Area: Bexar, Collin, Dallas, Denton, Ellis, El Paso, Hood, Johnson, Parker, Rockwall, Tarrrant, Wise, TXH2165-018 Cigna-HealthSpring Preferred (HMO) Service Area: Cherokee, Grayson, Gregg, Hale, Henderson, Hockley, Lubbock, Rains, Rusk, Smith, Upshur, Van Zandt, Wood, TXH4513-009 Cigna-HealthSpring Advantage (HMO) Service Area: Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston*, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller, Willacy, Webb, TXH4528-016 Cigna-HealthSpring Advantage (HMO) Service Area: Bexar, Collin, Dallas, Denton, Ellis, El Paso, Hood, Johnson, Parker, Rockwall, Tarrrant, Wise, TXH6972-001 Cigna-HealthSpring Preferred (HMO) Service Area: Yell, Sebastian, Scott, Pope, Logan, Johnson, Franklin, Crawford, Conway, AR

Preventive Benefits     Preventive Dental Benefits

Code Description Frequency Co-Pay

Diagnostic

D0120 Periodic Oral Evaluation one every 6 months $0

D0140 Limited Oral Evaluation One per Calendar year(s) Per patient $0

D0150 Comprehensive Oral Evaluation - new or established

One per Calendar year(s) per patient. One every 36 months per provider per tax id number

$0

D0210 Intraoral - Complete Series (including bitewings)

One of (D0210 or D0330) every 36 months $0

D0220 Intraoral - Periapical first film One every Calendar Year $0

D0230 Intraoral - Periapical each additional film One every Calendar Year $0

D0272 Bitewing, two films One every Calendar Year $0

D0274 Bitewing, four films One every Calendar Year $0

D0330 Panoramic Film One of (D0210 or D0330) every 36 months $0

Preventive

D1110 Prophylaxis - Adult one every 6 months $0

Preventive + OON Benefits PlanDentaQuest Subgroup: TX HS Preferred Advantage Medicare (50% Co-Ins)

Covered Plans and Counties:H7787-001 Cigna-HealthSpring Preferred (PPO) Service Area: Cherokee, Collin, Dallas, Denton, Grayson, Gregg, Hale, Henderson, Hockley, Johnson, Kaufman, Lubbock, Rockwall, Smith, Tarrant, Rains, Rusk, Upshur, Van Zandt, WoodH7787-002 Cigna-HealthSpring Advantage (PPO) Service Area: Cherokee, Collin, Dallas, Denton, Grayson, Gregg, Hale, Henderson, Hockley, Johnson, Kaufman, Lubbock, Rockwall, Smith, Tarrant, Rains, Rusk, Upshur, Van Zandt, Wood

Preventive + OON Benefits     Preventive Dental Benefits

Code Description Frequency Co-Pay

Diagnostic

D0120 Periodic Oral Evaluation one every 6 months $0

D0140 Limited Oral Evaluation One per Calendar year(s) Per patient $0

D0150 Comprehensive Oral Evaluation - new or established

One per Calendar year(s) per patient. One every 36 months per provider per tax id number

$0

D0210 Intraoral - Complete Series (including bitewings)

One of (D0210 or D0330) every 36 months $0

D0220 Intraoral - Periapical first film One every Calendar Year $0

D0230 Intraoral - Periapical each additional film One every Calendar Year $0

D0272 Bitewing, two films One every Calendar Year $0

D0274 Bitewing, four films One every Calendar Year $0

D0330 Panoramic Film One of (D0210 or D0330) every 36 months $0

Preventive

D1110 Prophylaxis - Adult one every 6 months $0

• Members have the option of going Out-of-Network to receive the preventive services on this plan. If members receive services from a non-participating (Out-of-Network) dentist they will be responsible for 50% of the dentist’s charges for services (50% co-insurance).

Preventive & Comprehensive PlanDentaQuest Subgroup: TX HS Preferred TotalCare Medicare

Covered Plan and Counties:H4513-001 Cigna-HealthSpring Preferred (HMO) Service Area: Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston*, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller, Willacy, WebbH4513-010 Cigna-HealthSpring TotalCare (HMO SNP) Service Area: Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston*, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller, Willacy, WebbH4528-002 Cigna-HealthSpring TotalCare (HMO SNP) Service Area: Bexar, Collin, Dallas, Denton, Ellis, El Paso, Hood, Johnson, Parker, Rockwall, Tarrrant, WiseH2165-019 Cigna-HealthSpring TotalCare (HMO SNP) Service Area: Cherokee, Grayson, Gregg, Hale, Henderson, Hockley, Lubbock, Rains, Rusk, Smith, Upshur, Van Zandt, Wood

Preventive & Comprehensive Plan Benefits

    Preventive Dental Benefits

Code Description Frequency Co-PayDiagnostic

D0120 Periodic Oral Evaluation one every 6 months $0D0140 Limited Oral Evaluation One per Calendar year(s) Per patient $0D0150 Comprehensive Oral Evaluation - new or

establishedOne per Calendar year(s) per patient. One every 36 months per provider per tax id number

$0

D0210 Intraoral - Complete Series (including bitewings)

One of (D0210 or D0330) every 36 months $0

D0220 Intraoral - Periapical first film One every Calendar Year $0D0230 Intraoral - Periapical each additional film One every Calendar Year $0D0272 Bitewing, two films One every Calendar Year $0D0274 Bitewing, four films One every Calendar Year $0D0330 Panoramic Film One of (D0210 or D0330) every 36 months $0

PreventiveD1110 Prophylaxis - Adult one every 6 months $0

• Members are entitled to the covered preventive benefits above, plus a Calendar Year Maximum of $1,000 towards comprehensive services including:• Restorative care• Periodontics• Prosthodontics• Oral surgery

• Diagnostic and preventive services above do not count towards annual coverage limit.

• Full list of covered codes can be found in the ORM.

Optional Supplemental Benefits Plan: Preventive & ComprehensiveDentaQuest Subgroups: TX HS Preferred TX/AR Medicare (Opt Supp), TX HS Preferred AR Medicare (Opt Supp)

Covered Plan and Counties:H2676-001 Cigna-HealthSpring Preferred (PPO) Service Area: Bowie, Cass, Titus, TX and Miller, ARH4871-001 Cigna-HealthSpring Preferred (PPO) Service Area: Howard, AR

Optional Supplemental Benefits

    Preventive Dental Benefits

Code Description Frequency Co-PayDiagnostic

D0120 Periodic Oral Evaluation one every 6 months $0D0140 Limited Oral Evaluation One per Calendar year(s) Per patient $0D0150 Comprehensive Oral Evaluation - new or

establishedOne per Calendar year(s) per patient. One every 36 months per provider per tax id number

$0

D0210 Intraoral - Complete Series (including bitewings)

One of (D0210 or D0330) every 36 months $0

D0220 Intraoral - Periapical first film One every Calendar Year $0D0230 Intraoral - Periapical each additional film One every Calendar Year $0D0272 Bitewing, two films One every Calendar Year $0D0274 Bitewing, four films One every Calendar Year $0D0330 Panoramic Film One of (D0210 or D0330) every 36 months $0

PreventiveD1110 Prophylaxis - Adult one every 6 months $0

• Members can decide to opt up to an enhanced dental benefit package at any time during the year.

• Members are entitled to the covered preventive benefits above, plus a Calendar Year Maximum of $800 towards comprehensive services including:• Restorative care• Periodontics• Prosthodontics• Oral surgery

Optional Supplemental Benefits Continued…  

•Diagnostic and preventive services above do not count towards annual coverage limit.

•Full list of covered codes can be found in the ORM.

•Members have the option of going Out-of-Network to receive services on these plans. If members receive services from a non-participating (Out-of-Network) dentist they will be responsible for 50% of the dentist’s charges for services (50% co-insurance).

•Both in and out-of-network services apply to the annual maximum of $800.

ID Cards & Welcome Letters The DentaQuest ID card will be printed at the bottom of the Member

Welcome Letter.

The ID card will include the HealthSpring product name & the DentaQuest subgroup name. The purpose of this is to ensure that all parties know the name of the plans (member, provider, DQ staff, HS staff). Example:

HealthSpring product name: H2165019 - Cigna-HealthSpring TotalCare (HMO SNP) DentaQuest subgroup name: TX HealthSpring Preferred TotalCare Medicare

If a member has been active < 89 days they are considered “reinstated”. Reinstated members will only receive a new ID card/welcome letter.

If lapse in coverage is > 90 days, they are treated as new members. New members receive an ID card/welcome letter, member handbook & EOC document.

Sample ID Cards

DentaQuest is Primary for Member Services DentaQuest HealthSpring Medicare Member

Services 855-343-7341

For reference: HealthSpring Medicare Member Services

866-288-1573

DentaQuest is Primary for Provider Services 888-308-9345 (Dedicated TX MCO Line)

Member/Provider Services

DentaQuest will not handle HealthSpring Medicare member complaints. HealthSpring members should contact

HealthSpring member services to file a complaint.

DentaQuest will not handle HealthSpring Medicare member appeals. HealthSpring members should contact

HealthSpring member services to file an appeal.

Member Complaints & Appeals

Provider Complaints & Appeals

DentaQuest will handle HealthSpring Medicare provider complaints and appeals. Providers should follow the standard

TX process to file complaints or appeals with DentaQuest.

Questions?