Important Info on Underwriting for UHC’s AARP Med Supp Plans Eff. 1/1/2020

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As UHC kicks-off the Annual Enrollment Period, they wanted to make you aware of several key things to note to assist you in understanding the application and underwriting process for AARP® Medicare Supplement Insurance Plans, insured by UnitedHealthcare® Insurance Company.

Changes for Guaranteed Issue – Plan G
Starting with January 1, 2020 plan effective dates, Plan G (as well as Plans D and Select G if offered in the state and Extended Basic 2020 Plan in MN) will not be available without underwriting for certain previously eligible individuals with Guaranteed Issue (GI) Rights. Previously eligible individuals are those who turn 65 prior to January 1, 2020, or whose Medicare Part A plan effective date is prior to January 1, 2020.

  • Please be sure to review the “Your Guide” section within the Enrollment Kit for GI event-specific information; look for the section titled “Guaranteed Acceptance.”
  • This change does not apply to individuals in their Medicare Supplement Open Enrollment Period.
  • For newly eligible individuals (who turn 65 and have a Medicare Part A effective date on or after January 1, 2020) with GI Rights, Plans D, G and Select G will be available without underwriting.
  • If the consumer does not have guaranteed issue rights for the plan selected, and the application is accepted after going through the underwriting process, it is not considered a “guaranteed issue” application for commission purposes.

! When completing the paper application within the section labeled “Is your Acceptance Guaranteed”, complete as instructed (i.e. complete the health status questions, if required).

When completing an online enrollment application via LEAN™,  if the consumer does not have guaranteed issue rights for the plan selected or is unsure, select “no” to the question “Do you have guaranteed issue rights, as listed in the Guaranteed Acceptance section of ‘Your Guide’?”. He/she will then need to answer questions about his/her health status.

If this question is answered “yes”, LEAN, the online enrollment tool, will skip over the health status questions.  For those who respond “yes” and we are unable to confirm guaranteed issue rights for the plan selected, we will contact the consumer to answer questions about his/her health status. (Note: Plan availability varies by state.)

NOTE: If the applicant does not qualify for guaranteed issue for Plan G but would qualify for another plan, we will reach out the applicant to complete underwriting questions, or they can choose another plan.

Here to Help – For Applicants Who Do Not Have Guaranteed Acceptance
The enrollment applications for the AARP Medicare Supplement Plans offered by UnitedHealthcare include questions about medical conditions and treatments that are used to determine an applicant’s eligibility to enroll and their rate level (where applicable).

As part of UHC’s underwriting process, they review prescription drug history of the applicant because prescription drugs may indicate the presence of a medical condition listed on the application. In order to assist you in completing an application for your client, and identifying if the applicant has one of the listed conditions, please see the Partial Prescription Drug List linked below for your applicable state. This list will also be found in the appendix of your 2020 Producer Handbook, when available.

FOR ALL STATES WHERE UNDERWRITING IS APPLIED* EXCEPT: CALIFORNIA, FLORIDA, MAINE, MINNESOTA, OREGON, AND WASHINGTON

FOR ALL STATES: CALIFORNIA, FLORIDA, MAINE, MINNESOTA, OREGON, AND WASHINGTON

 

If you have any questions please contact your Cornerstone Senior Marketing representative.

Compliance Communication From Humana

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Humana has been notified of two issues with Medicare Plan Finder on Medicare.gov.  These are not limited to Humana plans and appears to impact other carriers as well.  Humana has notified CMS of the issue and are awaiting their response.  The issues are related to mail order pharmacies not displaying correctly on the Medicare Plan Finder’s newly redesigned website:

  1. Medicare.gov is not providing preferred mail order pricing or giving an option to view the preferred mail order pricing when beneficiaries click “Review Plan Details”.
  2. When a beneficiary selects that they use both retail and mail order pharmacies, mail order pharmacies do not appear in the results.

In the meantime, Humana is asking agents and prospective members to use Humana’s Rx Calculator tool for mail order pricing information found at the following URL’s:

Agent: https://drug-pricing.apps.cf.humana.com/

Prospective member: www.humana.com/medicaredrugcosts

Allwell’s New Medicare Blue Button Technology is Here!

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One small button. One big benefit.

Integrate your clients provider, pharmacy and prescription data into the Ascend online enrollment platform with the click of a button.

It’s quick. It’s easy. It’s accurate.
As you enroll your clients using Asend this AEP, you will have access to the Medicare Blue Button technology. This technology reduces enrollment time and increases the accuracy of your clients enrollment information. Your clients can import the following personal information directly from CMS:

• Provider Information
• Prescriptions and Dosages
• Pharmacy Information

During the enrollment process you will have the ability to have your client access their data by using their mymedicare.gov username and password. If they don’t have their username and password with them simply have your clients retrieve their information by logging on to MyMedicare.Gov or, if they don’t have an account you can help them create an account, which is quick and easy to do.

Keep a Look Out – More Information on Administrative Payment and Training to Come

Blue Button data integration is an option for your client, it is not a requirement to enroll.

Sales agents will receive a $30 administration fee paid to the broker that is distinctly separate from the sales commission and associated CMS commission guidelines. Agents will recieve the $30 if they are able to click the button in Ascend AND the member has an account set up  on Medicare.gov. This administration fee is in compliance with CMS requirements and is intended to encourage sales agents to facilitate the smooth transition of new enrollees.

 

If you have any questions, please contact your Cornerstone Senior Marketing representative 

Humana Benefits At A Glance Error

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Important AEP Notice!

Humana identified an issue associated with the Benefits-At-A-Glance (BAAG) document included within the enrollment packet.  This error does not impact Care Plus BAAGs.

Specifically, in an effort to eliminate possible member confusion, additional information was added to the benefits grid to provide clarity surrounding member cost-share.  However, due to an error in the coding logic used to populate plan specific information, member cost-share was erroneously listed as $0 in the column labeled “With Medicare and State Cost-Share Protection.”  In response, this information has been corrected and new BAAGs are being printed. See below for details:

Old Version

New Corrected Version

What Does this Mean for External Agents?

You will be receiving new Benefit at a Glance documents associated with the 228 plans linked below.  Please tear out the old version found in the sales kit, and if desired, print the new version to replace it.  We ask that you discontinue use of the old BAAG document immediately.  Note that the Benefits at a Glance document is not required as part of the sales kit or the sales presentation; you can continue to use the Summary of Benefits.  When you re-order sales kits, the new version will be included.

IMPORTANT:  When using one of the previously printed all-in-one books from a Contract/PBP/Segment listed in the link below, the existing BAAG (with the error) should be torn out of the book and the separate new BAAG, if desired, should be used during prospect appointments.

 

Click Here to Access the New BAAG’s

Anthem Medicare 2020: Important Info & Updates

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Anthem is hosting a few more 2020 Product Training sessions below!

10/8/2019 10 am 2020 Product Training Click Here to Join
10/9/2019 9 am 2020 Product Training Click Here to Join

To RSVP for an event or if you have questions, please contact your Regional Sales Manager below or reach out to our Agent Services Team. Just call 1-800-633-4368 or email medicareagentsupport@anthem.com.  Learn more about the variety of broker events and networking opportunities near you by visiting www.anthembrokerconnection.com.*

Anthem 2020 Important Updates 

DSNP-HMO MAPD Updates and Reminders:

  • New Brokers will have the ability to validate DSNP eligibility from within mProducer.
  • New Added 4 New Essential Extras Benefits (See Below / Attachment)
  • New Minimal Plan Changes but huge addition of Ingenio RX (See Below)
  • Hearing Benefit
    • You sell this on the following: $3000 first dollar coverage on HMO and DSNP plans, newer technology including iPhone and Bluetooth compatible devices, 30 day free trial, 1 year warranty, and 12 months of free batteries!
    • The 2020 carrier will be Hearing Care Solutions and their website to search for providers is http://www.hearingcaresolutions.com/locations/
    • Member calls 800 number to locate provider and schedule appointment
    • They must use an in-network provider

Personal Emergency Response System

  • HMO and DSNP have this benefit.
  • No cost for set up or monthly fees!
  • GPS enabled device available
  • 3 different units to choose from and anyone can request, no medical necessity required

 

  • Meals after Inpatient Hospital Stay
  • 2 meals a day for 10 days after EVERY inpatient hospital stay
  • Discharge must be from hospital to home
  • Benefit is triggered by case manager who contacts Anthem

 

  • OTC

New OTC catalogs will be sent with OTC card. Existing members will also receive a new OTC card and catalog.

 Silver Sneakers is on all Medicare Advantage and Medicare Supplement plans!!

 

mProducer Updates- https://mproducer.anthem.com

  1. Can obtain a paper application and submit later on mProducer, eliminating fax and email.  This process will save you time and energy during AEP.
  2. New Short applications will be available via mProducer for Anthem’s existing clients.  The system will automatically recognize the members MBI and will result in less fields to be completed by the agent.  Optional Supplemental Benefits can be added on this form.  Like to like plan changes only, MAPD to MAPD, Medicare Supplement not included.
  3. New MBI “checker” is now embedded in mProducer.  If your entry does not match the correct format you will get a notification and will not be able to proceed.  This will drastically reduce pended applications due to incorrect information.  HICN will no longer be acceptable on applications for 2020 effective dates.
  4. New DSNP eligibility will also include the last time the member used LIS as their SEP to change products.  No more guessing if the member has a SEP available for the current quarter, just login to mProducer and check.
  5. New MACRA-Applicants who are not eligible for the Plan F in 2020 will not be able to be submitted via mProducer.  The system will implement CMS rules and prevent you from applying for members who are not eligible.
  6. New Application Status Tracker – Will provide start to finish updates on all applications submitted.  Submitted status all the way through Welcome Kit and ID card being sent can be tracked.  Missing information from applications can be uploaded directly from the tracker if application was submitted electronically.  MAPD products only, Med Supp coming 2/1/2020.

Why submit Electronic Enrollments with mProducer?

  1. Efficiency (increasing your capacity)
  2. Reduced Processing Time
  3. Fewer Errors
  4. Doctor Finder Embedded
  5. DSNP Eligibility Verification

 

10 Essential Extras (All HMO/DSNP products)  

  1. Selection Form will be included on the application, member does not have to select at point of sale but is highly recommended.
  2. Current members will automatically retain the same benefit from 2019, if they would like to change have them contact customer support number on the back of their card.
  3. If the benefit overlaps with a plan benefit the member will exhaust the plans benefit first, i.e. transportation.
  4. Member can change benefits one time annually as long as they have not utilized the benefit.
  5. Retaining the six current EE offerings; adding four more to make it give the member the choice of 10 options
    1. Healthy Food Deliveries- 16 meals for 4 months, total of 64 meals for the year. BMI >25, BMI < 18.5 or A1C > 9 to qualify.  GA Foods is the vendor.
    2. Transportation- 60 one-way trips per year.  Will transport to all plan covered benefits, Silver Sneakers locations, pharmacy, or any other benefit included in the plan.
    3. Personal Home Helper- up to 124 hours per year.  Non skilled services only not medical professionals.  Cooking, cleaning and personal care duties are most common.
    4. Assistive Devices-$500 allowance from catalog, administered through Walmart.  Can be ordered on CustomPoint.  https://custompoint.rrd.com/xs2/prelogin?CMPID=1064&qwerty=19091802
    5. Day Center Visits- 1 day per week, up to 8 hours per day.  Member must lack at least 2 ADLs.  Reimbursement of up to $80 per day.
    6. Alternative Medicine- Therapeutic massage or acupuncture, up to 24 visits per year.  Members must utilize ASH network, provider search link below:  https://www.ashlink.com/ASH/public/applications/providersearch/default.aspx

If you have a provider interested in being added to the network please have them contact ASH at (800)-972-4226.

    1. New Healthy Nutrition- Up to 8 dietary consultations to educate members on proper nutrition.  Will lead to specific food being delivered to the member that fits their health needs.  Will be shipped directly from Kroger.  Groceries will not be fresh foods that have short shelf life. Examples include; pasta, granola bars and other nonperishable items. Member must need a change in diet to improve health to qualify.  Anthem may communicate with member’s physician if needed.
    2. New Service Dog Support- $500 annual allowance.  Food and supplies for ADA service dogs.  Administered by Walmart via catalog or online.  Will not include vet costs, dog training costs, and the actual cost of the dog.
    3. New Pest Control- Quarterly routine preventive or 1-time eradication of infestation.  Terminex is the vendor.  Must qualify for 1/15 Chronic conditions.  Document attached to better explain.
    4. New Active Lifestyle & Wellness Device- 1 device every other year.  A Fitbit type of device to track and promote healthy lifestyle.  No precertification required.

 

Medicare Community Resource Support Benefit

A telephone based program used to identify needs, leverage resources and coordinate services for members and providers by providing specific medical or health related education and leveraging local community based services.   This benefit can help members with non-health related needs such as paying a utility bill, household expenses, legal aid and much more.  If your member is having trouble with any aspect of their life, they can reach out to our customer service team and get connected with help from their local community through Anthem’s partnerships.

 

New Medicare Community Resource Outreach

An in-person, community-based program that hosts new member orientations, benefit training sessions and other events where we can assist members directly. Members can learn about community resources available and meet new people.   They also will have the opportunity to access individual support needed.  To access this benefit, Members can call Customer Service at the number listed on the back of their ID card and ask for information about MCRO events in their area.   They may also receive notification about events in their area through the contact information they have provided us.

Ingenio RX-Replacing Express Scripts for 2020

  1. Improves affordability for our members.
  2. Provides a more seamless member experience.  Anthem will leverage our provider relationships to ensure confident, informed decision making which will lead to better health of your members.
  3. Simplified, consistent, and coordinated experience for the member.
  4. Will help in keeping MAPD benefits consistent by driving total costs down.
  5. 24/7 access pharmacy via toll free number on the back of their membership card.
  6. Electronic Prior Authorizations.
  7. Active mail-order and specialty scripts will automatically transfer 1/1/2020. Member’s will need to update is their financial information.  Anthem is not legally able to transfer this information. Communications will go out to members.
  8. Stand-alone PDP products offered as low as $18.90 monthly.  Lowering the premiums on existing PDP products offered.

Medicare Supplement

  1. Will continue to provide full  Silver Sneakers program.
  2. Discounts up to $48 per year for EFT or annual payment.
  3. Household discount of 5% available.
  4. 21% commission for years 1-6.
  5. Aggressive bonus program, increasing for first quarter of 2020.

Monthly bonus. Great to utilize in renewing your current clients and resetting that clock or for all of those 1/1 effectives during AEP. Do as many as you can in 1 month and earn major bucks.  (Flier attached to email)

3-4 sales $150 extra per application

5-9 sales $200 extra per application

10+ sales $250 extra per application (no cap)

  1. Great brand recognition, stable and realistically priced.  Don’t be fooled by companies offering premiums that are not sustainable for your members.  Poor pricing will lead to drastic increasing forcing a tough decision down the road for you and your member.
  2. Ingenio RX will offer a package deal for your MS clients.  We all know most clients prefer simple, so one carrier will deliver that in 2020.
  3. No aging increase at renewal for members who are 81+.

Provider Finder Tips

  1. Use the “shop” website for the most updated version. https://shop.anthem.com/medicare/standalonetools/find-doctor?state=IN&brand=ABCBS&role=consumer&locale=en_US
  2. The  Search Radius has been expanded to 25 Miles.  This will cast a bigger net, making sure you don’t miss any contracted doctors. You still have the option to narrow the radius or expand it to 50 miles.
  3. Change “Provider Specialty” = “All Specialties”.  This will ensure you search all contracted doctors.  Sometimes doctors can be listed under different categories than your client is referencing.
  4. Updated to recognize names that sound familiar to your search.  This is a positive change that will help you find doctors when your clients may be pronouncing them incorrectly.
  5. Please send us any provider recommendations.  It is our goal to keep our Doctor Finder as up-to-date as possible but I need your help.  I am asking for your help in this category so we can offer not only a competitive product but also a very robust network.
  6. HMO members are allowed to utilize KY, IN and OH HMO providers. The Ohio hospital flier is attached. All state hospital fliers can be found in CustomPoint.

Miscellaneous

  1. 2020 marketing pieces are available to order in the Sales Toolkit. These pieces are available to you in quantities of 200 each per month at no cost. Personalize each piece by uploading your photo and contact information.
  2. New A Temporary Proof of Membership form is provided in the Sales Kit after the application. The form includes RX bin information and can be left with the soon-to-be new member. The back of the form provides helpful contact numbers. Please note that enrollment is subject to Medicare approval.

Dental Care Plus AEP Broker Bonus Program

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Dental Care Plus is offering a broker bonus program just in time for AEP! Sell individual dental plans between 11/1/19 and 2/1/2020 and get a cash bonus!!

CLICK HERE FOR MORE INFO

JUST A REMINDER…. DCP OFFERS BROKERS:

  • 10% commission on new sales and renewals.
  • Email notifications on new sales and renewals.
  • Designated individual product consultants to handle questions.

Questions? Reach out to your Cornerstone Senior Marketing representative today

Medical Mutual Advantage Plan Webinars

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Join MMO for a webinar highlighting key selling points for  2020 Medicare Advantage plans. They will discuss MMO’s continued commitment to meeting the needs of Ohioans in 83 of the 88 counties and cover the following topics:

 

Service Area Expansions Region 1: Muskingum and Tuscarawas counties
Region 2: Gallia county
New HMO Plan MedMutual Advantage Secure HMO now available in Cuyahoga, Medina and Summit counties
$0 Premium Plan Available in all 83 counties
Generic Rx Copays Tier 1: $0 copay
Additional Benefits New transportation benefit

 

 MMO will be offering three webinars. Please click the corresponding link below to register and join the meeting.

Tuesday, Sept. 24, 2019, at 10:00 a.m.
Click Here to Join the Meeting

Tuesday, Sept. 24, 2019, at 1:30 p.m.
Click Here to Join the Meeting

Wednesday, Sept. 25, 2019, at 10:00 a.m.
Click Here to Join the Meeting

Anthem 2020 Enrollment Freeze Update

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No Enrollment Freeze for KY or WI for 2020 with Anthem!

Cornerstone Senior Marketing recieved confirmation there will NOT be an enrollment freeze in Kentucky or Wisconsin for plan year 2020.

Quick Reminder: Anthem is expanding into 17 NEW KY Counties for 2020! Carroll, Estill, Floyd, Fulton, Hickman, Larue, Letcher, Martin, Mason, Metcalfe, Morgan, Nicholas, Owsley, Pike, Simpson, Trimble, and Union.

 

If you have any questions please contact your Cornerstone Senior Marketing representative. 

Humana’s NEW Medicare Supplement Product: ACHIEVE

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Introducing Humana Achieve: premium coverage that’s affordably-priced.

Humana’s Achieve is a plan that offers many of the same benefits as Humana’s premier line of products at a great value!

Approved States:

New business will be accepted for Georgia and South Carolina effective immediately with an effective date of October 1 or later. This will be available via the Humana Fast App for business submission and agents holding appointments in these states can begin ordering supplies. Below you will find the Outline of Coverage available for download for both Georgia and South Carolina.

As new states become available (OH & KY), Humana will notify agents in those states and update the Humana Achieve Medicare Supplement coverage maps.

Georgia Application

 

Georgia Outline of Coverage

 

South Carolina Application

 

South Carolina Outline of Coverage

If you have any questions please contact your Cornerstone Senior Marketing representative

West Virginia University To Acquire The Health Plan

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WVU Health System’s acquisition to make it an integrated financing/delivery network

West Virginia University Health System is taking the first steps toward becoming an integrated health care financing and delivery system with Tuesday’s announcement it would merge with a Wheeling, West Virginia-based insurer.

Financial terms of the deal between WVU Health System, also known as WVU Medicine, and managed-care provider The Health Plan, weren’t disclosed. The Health Plan would become a subsidiary of WVU Health System as a nonprofit corporation.

An integrated financing and delivery system puts under one system both the payor and provider of health care similar in structure to UPMC, which owns its own insurance division, as well as Highmark Health, which owns insurer Highmark and the Allegheny Health Network. It’s a model that is increasingly employed elsewhere in the country, including Geisinger in the central part of Pennsylvania.

“By aligning and integrating our two organizations and by leveraging our respective expertise in a more coordinated fashion, we can deliver better outcomes to the people of West Virginia,” said WVU Health System President and CEO Albert L. Wright Jr. in a statement Tuesday. “The Health Plan will also continue to build collaborative, value-based partnerships with other health systems and independent providers in West Virginia.”

WVU Medicine is a powerhouse in West Virginia, based in Morgantown and including hospitals throughout West Virginia. It’s also is in the midst of a growth spurt, including the building of a new children’s tower and other facilities in Morgantown, and it’s expanding in Pennsylvania, including a facility just over the border into Waynesburg as well as a potential affiliation with Uniontown Hospital.

The Health Plan began operations in 1979 and has licenses in West Virginia’s 55 counties as well as a 36-county area in Ohio. As of 2017, it had 400 employees and four offices in Ohio and West Virginia. It offers a wide range of insurance options, including HMOs, PPOs, point-of-service and self-funded health plans. The Health Plan’s market share in group health in West Virginia was 7 percent with coverage of 20,024 lives, according to a West Virginia state report in 2017.