Introducing Blue Cross d i l Medicare Advantage Plans Medicare Advantage Plans ILLINOIS

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

AGENDA Why choose Blue / Industry Trends Product Portfolio Compensation Compliance Certification Process Enrollment Process Marketing Overview Wh t does What d thi mean to this t you? ? Next Steps Questions 2

Question?

Who here is getting older?

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DID YOU KNOW ? • The 77 Million members of the “Baby Boom” generation ti b began turning t i 65 in i 2011. 2011 • The Medicare eligible population will continue t grow and to d by b the th year 2030, 2030 1 outt off every 5 Americans will be age 65 or older. • Seniors control nearly 75% of the wealth in the United States with a staggering 7 trillion dollars.

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WHY THE SENIOR MARKET?

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Customers have different needs

Blue Cross Blue Shield can provide the solutions to fit all of your customer’s needs 6

Why Blue? y

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Advantages of Blue • • • • •

Strong Product Portfolio Competitive Pricing New PDP Offerings L Low C Costt Sh Sharing i Supplemental Benefits - SilverSneakers® - Travel Benefit - Hearing

• Key Network Partners • Brand Recognition 8

Network Advantage - Blue Medicare Advantage HMO Medical Groups and Hospital Affiliation County Cook

Physician Organization Advocate Christ Hospital Physician Partners Advocate Illinois Masonic Physician Partners Advocate Lutheran General Physician Partners Advocate South Suburban Physician Partners Advocate Trinity Physician Partners Weiss Physician Group MacNeal Health Providers, Inc. Northwest Community Health Partners, IPA Presence Our Lady of Resurrection Presence Resurrection Medical Center Presence Saints Mary and Elizabeth Med Center Presence St. Francis Hospital in Evanston Presence St. St Joseph Hospital in Chicago Swedish Covenant Managed Care Alliance West Suburban Health Providers

Hospital Affiliation Advocate Christ Medical Center Advocate Illinois Masonic Medical Center Advocate Lutheran General Hospital Advocate South Suburban Hospital Advocate Trinity Hospital LOUIS A WEISS MEMORIAL HOSP MacNeal Hospital Northwest Community Hospital Our Lady of Resurrection Medical Center RESURRECTION HOSPITAL SAINTS MARY AND ELIZABETH MED CENTER ST. FRANCIS HOSPITAL in Evanston ST JOSEPH HOSPITAL in Chicago ST. Swedish Covenant Hospital West Suburban Medical Center

DuPage

Advocate Good Samaritan Physician Partners Hinsdale Physicians Healthcare Illinois Health Partners - Edward Health Partners Illinois Health Partners - DuPage Medical Group Health Partners Illinios Health Partners - Elmcare Health Partners

Advocate Good Samaritan Hospital Hinsdale Hospital Edward Hospital Edward Hospital Elmhurst Memorial Hospital

Kane

Advocate Sherman Physicians Partners Dreyer Dre er Medical Clinic Ad Advocate ocate

Sherman Hospital Rush-Copley R sh Cople Medical Center

Will

Silver Cross Managed Care Organization Presence St. Joseph Hospital in Joliet

Silver Cross Hospital St. Joseph Hospital in Joliet 9

We Need Producers / Agents to Succeed

• High Commissions • Faster Payment • Strong Market Presence • Regular R l C Communications i ti • Support Staff

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Our promise to our members is to make insurance

Simple Affordable. Simple. Affordable Accessible. Accessible

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Compensation p

MAPD & PDP

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 12

Commissions .

Individual Product Type

Policy Year

Compensation Rate

Blue Cross Medicare Advantage Initial Compensation

1

$425

Renewal

Lifetime

$213

Blue Medicare RX Initial Compensation p

1

$56

Renewal

Lifetime

$28

Initial Compensation: Subscribers identified by CMS as in their initial year of enrollment are considered to be new enrollments. HCSC will provide compensation for the initial year after receipt of the first month’s premium. The Initial Compensation amount is paid for new enrollments and enrollments into “different plan types.” Renewal Compensation: Lifetime renewals HCSC shall pay renewal compensation owed for business written with a 2014 effective date and consistent with the Agent/Broker compensation requirements in the CMS Medicare Marketing G id li Guidelines. HCSC will ill provide id compensation ti after ft receipt i t off the th first fi t month’s th’ premium. i Renewal compensation is contingent upon completion of annual training and certification requirements prior to the HCSC established deadline. 13

MAPD Products 2014

Our Medicare Advantage in 2014

Better Product in 2014 More Product Choice Network Advantage

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Medicare Product Themes for 2014 • Range of products available that can be sold to a variety of • • • • •

customers (Medicare Advantage, Prescription Drug, and Medicare Supplement S plans)) Both Medicare Advantage & PDP products will be better in 2014 Lower cost sharing g Competitive pricing Product names for each plan type Supplemental benefits • • • • • • •

Dental Vision Hearing SilverSneakers® Fitness Program Travel benefit Worldwide o d de emergency e e ge cy ca care e $0 Annual Physical Exam 16

IL Medicare Advantage

- MA HMO Service area will continue to be 4 counties in Chicago area (Cook, DuPage, Will and Kane)

Benefit

IL Plan Landscape Current 2013 IL HMO Plan

Comparison

Blue Cross Advantage Basic  (HMO)

Name Plan Number

Proposed 2014 IL HMO Plan

H3822‐001

H3822‐001

$0 

$0 

‐

$3,400 

$3,400 

‐

$240 Copay (days 1‐7)

$225 Copay (days 1‐7)

+

Primary Care Physician

$7 

$5 

+

Specialist

$45 

$35 

+

Hosp Outpatient

$300 

$200 

+

PT/SP Therapy

$50 

$35 

+

Cardiac/Pul Rehab

$50 

$30 

+

Ded $325 Ded $325 $3/$11/$45/$95/25%

$0‐$5/$2‐$7/$39‐$44/$85‐ $0 $5/$2 $7/$39 $44/$85 $95/33%

+

Premium MOOP Hosp Inpatient

RX (Preferred/Non‐Preferred)

New for 2014: • • • •

SilverSneakers® Fitness Program g Hearing benefit Travel benefit Worldwide emergency coverage 17

IL Medicare Advantage – More Choice

IL Plan Landscape Benefit Name Plan Number Premium

$38 

$3 800 $3,800 

$3 00 $3,500 

No OOP max OO

$250 Copay (days 1‐7)

$225 Copay (days 1‐7)

$400/day

Primary Care Physician

$10 

$5 

$75

Specialist

$45 

$40 

$75

Hosp Outpatient

$300 

$250 

40% coinsurance

PT/SP Therapy

$40 

$40 

40% coinsurance

Hosp Inpatient

Cardiac/Pul Rehab RX (Preferred/Non‐ Preferred)

$40  $40  $0‐$5/$2‐$7/$39‐$44/$85‐ $0‐$5/$2‐$7/$39‐$44/$85‐ $95/33% $95/33%

40% coinsurance N/A

$0 ((POS p plan)) – – –

•

OON Benefit on the POS  plans

$0 

MOOP OO

•

Proposed Premium HMO‐ p POS Blue Cross Medicare Blue Cross Advantage Advantage Basic Plus (POS) Premier Plus (POS) H3822‐007 H3822‐008 P Proposed HMO‐POS d HMO POS

Basic HMO network with POS option Higher out of pocket costs than HMO (escape hatch) Includes supplemental vision and hearing

$38 (POS plan) – – –

Basic HMO network with POS option Richer benefits than $0 POS (escape hatch) Includes supplemental vision, hearing and preventive dental 18

IL Medicare Advantage – Network Advantage • Key network partners, physician and system, responsible and accountable for the quality and cost of patient care.

• Physician led, patient centered care. • Integrated, team based, coordinated care services across provider specialties i lti and d settings tti anchored h db by primary i care physicians h i i meeting ti the Medicare population needs.

• Aligned incentives designed to promote delivery of cost effective care and improve health outcomes while maintaining high patient satisfaction.

• Note: Adding Hinsdale Physician Health to our MA network. Allows us to cover DuPage County more effectively than before.

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2014 PDP Products

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Overview of NEW Basic Plans and improved value and plus offerings Blue Cross MedicareRx Basic (PDP)SM •

•

(NEW PRODUCT FOR 2014)

Value Propositions: – Provides a low cost option to the healthier “Age In” population and a less expensive alternative for those that combine Part D with Medicare Supplement. Only about 40% of our Med Supp members have our Part D Benefits & Sales Stories: – Monthly premiums at about 50% of the cost of our current Basic Plan offerings; most Tier 1 & 2 drugs can be obtained for $ $2 or less;; p products to compete p with United and Humana low cost options p

Blue Cross MedicareRx Value (PDP)SM •

•

Value Propositions: – Lower cost enhanced offering with better benefits than the previous Value Plans. Offers our largest client base a product with lower deductibles, cost sharing and monthly premiums . Benefits & Sales Stories: – Monthly premiums are about $2 less than the current Value Plans; all Tier 1 & 2 drugs can be obtained for $2 or less; lower initial deductible than Value Plans in 2013

Blue Cross MedicareRx Plus ((PDP))SM •

•

Value Propositions: – Improved high end option, that provides less expensive cost sharing levels and coverage on all generics as well as some brands in the gap. Benefits & Sales Stories: – All Ti Tier 1 & 2 d drugs can b be obtained bt i d ffor $2 or lless; gap coverage extended t d d ffrom allll generics i tto iinclude l d some brands; possible to have $0 cost share until the catastrophic phase with Tier 1 drugs at Preferred Pharmacies

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Issues Addressed with the 2014 Blue Cross MedicareRx (PDP)SM Product Designs 2013 Issue or Competitive Deficiency

2014 PDP Plan Solution

No “Low Cost” option to compete with Humana and United’s Plans

HISC will offer Basic Plans that are competitive on benefits and premium to United and Humana

Value Plans are not competitive in terms of premium

For 2014 there will be an inexpensive Basic offering and the Value Plans will be about $2 cheaper per month with better benefits than 2013

Opportunity for members to fill prescriptions at a preferred pharmacy for a discount

Members will save at least $5 per 30 day on Tiers 1-4 at CVS, Wal-Mart/Sam’s Club, a local grocer andd an independent i d d t pharmacy h group

Robust offering of Tier 1 generics and deductible only counting on Tiers 3-5, were not as beneficial as anticipated

The Basic offerings have a deductible on all tiers and Value/Plus Plans have narrower Tier 1 formulary; similar to competitor’s offerings 22

New Preferred Network Pharmacies for All States in 2014 • The preferred network option has no impact on whether a member can fill at any of the 63,000+ network pharmacies nationwide • Members can save at least $5 per 30 day fill on all three PDP Plans, if they fill at a preferred pharmacy versus any other network pharmacy • Tier 1 & 2 drugs on all three PDP Plans can be obtained for $2 or less at a preferred pharmacy p y during g the initial coverage g p period ((OK is $ $4 or less on the Basic Plan)) • Discounts not applicable to deductibles, but do apply to gap coverage on the Plus Plans

Preferred Network Pharmacies for 2014: CVS

Wal-Mart/Sam’s Club

SuperValu (Jewel/Osco), HEB & Albertson Albertson’ss

Good Neighbor Independent Pharmacies and PPOK

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Blue Cross MedicareRx Basic (PDP)SM Offering g Details for 2014 • We currently don’t have a plan that competes with the price point of the AARP United and Humana Wal-Mart Plans • New N ffor 2014 HISC will ill b be iintroducing t d i a llow costt option ti th thatt will ill compete t wellll iin th the marketplace with existing “low cost” plans – Meets the needs of a wider spectrum of the over 65 population – Matches United's and beats Humana’s Tier 1 & 2 p pricing g at Preferred Pharmacies – Premium range from $14 to $26 for 2014, which is in line with other similar offerings

Highlights and Sales Points on the New Blue MedicareRx Basic Plan in Illinois: Most premiums are in the low to mid $20’s, in line with United and Humana Basic Plan Offerings; NM is $14.90 $14 90

Provides another option to use in tandem sales with Medicare Supplement pp Offerings g

Members can obtain Tier 1 & 2 drugs for $2 or under at Preferred Pharmacies; in OK it is for $4 or under

Provides alternative to the healthier Age-In population that had been unaddressed

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Changes to Blue Cross MedicareRx Value (PDP)SM in 2014 2013 Value Plan • $325 deductible only counts towards Tiers 3-5 • Tier 1 drugs were $3 and Tier 2 were $10-$14 $10 $14 at any Pharmacy • No discounted cost sharing for Preferred Pharmacies • No Insulin option on Tier 1 or 2 • Premiums in high $30’s to low $40’s in all States • Broad range of generics on Tier 1

2014 Value Plan • $200 or $275 ddeductible d tibl only l counts towards Tiers 3-5 • Tier 1 drugs are $0 and Tier 2 are $$2 at Preferred Pharmacies • Out of Preferred Pharmacies, Tier 1 is only $5 and Tier 2 is $7 • Insulin option available on Tier 2 • Premiums around $2 cheaper per month in all States • Narrow, more focused set of generics i on Ti Tier 1

• With the addition of the Blue Cross MedicareRx Basic (PDP)SM Plan, the Value plan is now an “Enhanced Alternative” under CMS guidelines

• Members will not be moved if they are currently a part of the Value Plan • Deductible is $200 in NM and TX and $275 in IL and OK 25

Changes to Blue Cross MedicareRx Plus (PDP)SM in 2014 2013 Plus Plan • All generics covered in the gap • Tier 1 drugs were $3 and Tier 2 were $10 at any Pharmacy • No discounted cost sharing for Preferred Pharmacies • No Insulin option on Tier 1 or 2 • Premiums under $100 in all States • Broad range of generics on Tier 1

2014 Plus Plan • All generics i andd some brands b d covered in the gap • Tier 1 drugs are $0 and Tier 2 are $$2 at Preferred Pharmacies • Out of Preferred Pharmacies, Tier 1 is only $5 and Tier 2 is $7 • Insulin option available on Tier 2 • Premiums around $100 in all States, with better benefits • Narrow, more focused set of generics i on Ti Tier 1

• Since there will be two “Enhanced Alternatives” in 2014, the Plus Plan now includes coverage of some brand drugs in addition to all generics in the coverage gap

• Tier 1 generics are now more narrowly focused on major CMS disease states for both the Plus and Value Plans 26

The SilverSneakers® Experience Health plan members can experience SilverSneakers® in various ways:  Work out and take classes at any of more than 11,000 fitness locations  Use SilverSneakers® Steps at home or on the go  Participate in SilverSneakers® FLEX classes and activities at local venues  Go G online li

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SilverSneakers® Fitness Locations Venue-based Program Component Fitness membership includes: q p and amenities included  Use of all equipment in a basic fitness membership  Access to more than 11,000 fitness locations nationwide  SilverSneakers® classes taught by certified instructors  A SilverSneakers® Program AdvisorSM f guidance for id and d assistance i t  Fun social activities  Health education seminars

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SilverSneakers® Steps Self-directed Program Component  Non-venue based physical activity program  Convenient alternative for members without easy access to a full-service location  Choice of four fitness kits with tools to use at home or on the go  Kit choices (one per member): • General fitness • Strength • Walking • Yoga g instructions at  Information and kit ordering silversneakers.com

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General Fitness

Strength

Walking

Yoga

SilverSneakers® FLEX Outside the Gym  Classes and activities offered in parks, recreation centers, churches and other l local l venues

 Examples: tai chi, yoga, walking groups  Led by certified instructors  Offerings and easy online enrollment available at my.silversneakers.com

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SilverSneakers® Online Web-based Program Component Offers members a secure, easy-to-use website where they can:  Find fitness locations by ZIP code  Enroll p member ID card  Order replacement

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Compliance p

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 32

Medicare Marketing Do’s

• Do only use materials available on the Producer portal after successful completion p of 2014 Producer Certification Requirements

• Do market only within Blue Cross Medicare Products service i areas

• Do complete a Scope of Appointment (SOA) form 48 hours before each face to face appointment and retain hard copy in your records for 11 years (current year plus 10 years)

• Do clearly mark “optional” on any sign-in sheets used at sales events

• Do clearly describe eligibility requirements, benefits, premiums, network use, premiums use enrollment periods periods, lock in periods and extra help to every enrollee 33

Medicare Marketing Do’s the Blue Access for • Do file and report all sales events through th

Producers portal no later than the 15 of each month for the following month and follow CMS requirements for cancelling any previously month, scheduled events

• Do submit your client’s enrollment form within 48 hours of producer receipt and keep all records relating to your client for 11 years (current year plus 10 years)

• Do be familiar with producer responsibilities when performing sales and educational d ti l events, t iincluding l di understanding d t di allll requirements i t outlined tli d iin the Compliance Program (which can be found at HISCCompliance.com)

• Do report any suspected violations to the Fraud Line at 1.800.838.2552, anonymous and d available il bl 24 h hours a d day

• Do familiarize yourself with the 2014 Medicare Marketing Guide available on the Blue Access for Producers website portal

• Do indicate at all sales and/or educational events that you are a licensed agent of BCBS of IL/OK/TX/NM (as applicable) 34

Medicare Marketing Don’ts

• Don’t create any marketing or enrollment materials on your own

• Don’t engage in door-to-door marketing or sales • Don’t engage in outbound telemarketing, e-mail campaigns or calls to those in the process of voluntarily disenrolling for the purpose of retaining membership Don’tt discuss other health products unless stated in • Don advance on the Scope of Appointment form g g in activities that intentionally y mislead or • Don’t engage confuse beneficiaries

• Don’t engage in discriminatory activities such as conditional diti l enrollment ll t based b d on physical h i l or mental t l ill illness, claims experience or disability 35

Medicare Marketing Don’ts

• Don’t serve meals at sales events or host them in a health care setting that is not a common area such as a cafeteria or auditorium p an enrollment form p prior to the client’s • Don’t accept enrollment period (and hold it until they are eligible)

• Don’t offer inducement, monetary or otherwise, to enroll or switch it h tto a Bl Blue C Cross M Medicare di product d t

• Don’t engage in “high pressure” sales tactics, make absolute statements, use superlatives or provide personal opinions when discussing Blue Cross Medicare products

• Don’t pressure attendees at sales events to complete sign-in sheets 36

Monitoring & Oversight Program The monitoring and oversight program consists of the following:

• Monthlyy and qquarterlyy reviews of various marketingg activities including, g but not limited to: • Confirmation of certification status, including status at time of a submitted enrollment • Disenrollment trends • Scope of Appointment form use and retention • Sales event monitoring (submission of events and onsite observation) • Advertising gp placements ((via clipping pp g service)) • Enrollment submission and retention of paper form • Secret Shopping • Review of Producer complaints received internally and from CMS 37

Certification Process

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 38

Why Certify Now? In accordance with the guidelines established by the Centers for Medicare and Medicaid Services (CMS), all agents must be trained and certified annually in order to market, sell and/or d/ service i PDP and d MAPD products. d CMS guidance states that an agent must be certified in order to receive renewal compensation for policies sold after the 2008 plan year. Failure to complete 2014 HCSC/HISC Producer Training & Certification requirements by deadline will result in: •

Blue Cross MedicareRx and Blue Cross Medicare Advantage (where applicable) Book of Business for CYs 2009 and forward being moved to an HISC House Account.

•

Blue Cross MedicareRx and Blue Cross Medicare Advantage (where applicable) Book of Business is NOT returned if certification occurs after December 6 6, 2013 deadline or in a subsequent year.

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Milestone Dates  December 3, 2013 - 2014 HCSC/HISC Certification closes for sub producers at 11:59 p.m.

 December 6, 2013 - 2014 HCSC/HISC Certification closes for all i di id l producers individual d and d agency principles i i l

 Januaryy 4,, 2014 - 2014 HCSC/HISC Certification reopens p • Applicable for February 2014 effective dates and beyond • Certification on or after this date does not result in reinstatement of lost Blue Cross MedicareRx/Blue Cross Medicare Advantage Book of Business

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Access Training  Go to Blue Access for Producers (BAP); click li k C Certify tif tto S Sellll 2014 P Products d t lilink k OR Access certification link via Certification L Launch h emailil

 If you have never accessed training as an individual: • Use 9-digit HCSC assigned Producer ID #, which is also the same number used to login to BAP.

 If accessing training as an agency: • Use 9-digit g HCSC assigned g Agency g y ID # Note: Do not use your Social Security # or Tax ID # as login. If unsure of your HCSC assigned Producer or Agency ID #, call the Producer Service Center at 1-855-782-4272 for help. 41

Password

• If you have never accessed Knowledgewire, your initial password is your 9-digit HCSC Producer number • You will be then prompted to create a new password

• If you have h previously i l accessed Knowledgewire, use established password

• Keep password in an easily accessible location • If you need help with resetting a forgotten password, please contact the HCSC Helpdesk at 1-888-706-0583

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2014 Courses and Exams Individual Producer     

Annual Information Form

 Annual Information Form

Sales Agent Requirements

 Sales Agent Requirements

Medicare Basics course

 Medicare Basics course

Medicare Basics exam

 Medicare Basics exam

Medicare Marketing Rules & Regulations course

 Medicare Marketing Rules & Regulations exam

     

Sub Producer

PDP/MAPD Product course

 Medicare Marketing Rules & Regulations course

 Medicare M di Marketing M k ti R Rules l & Regulations exam

PDP/MAPD Product exam

 PDP/MAPD Product course

FWA course

 PDP/MAPD P Product d t exam

FWA exam

 FWA course

Certification Form

 FWA exam

M di Medicare A Amendment d

 Certification Form Note: Subagents are not deemed certified until the Agency Principal completes the agency certification requirements

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2014 Courses and Exams AHIP Individual Producer or Sub Producer  Annual Information Form  Sales Agent Requirements  PDP/MAPD Product course  PDP/MAPD Product exam  FWA course  FWA exam  Certification Form  Medicare Amendment (applicable to

Agency Principal  Annual Information Form  Sales Agent Requirements  Medicare Marketing Rules &     

Regulations R l i course Medicare Marketing Rules & Regulations exam FWA course FWA exam Certification Form Medicare Amendment

producers)) individual p Note: Principal must complete all Producer courses and exams in order to market, sell and/or service PDP and MAPD products. products

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Exams • Passing score is 85% on all exams per CMS g p guidelines

• Three attempts per exam (4 exams) • No lockout period p • Can re-take exam immediately after a failed attempt

• Exam qquestions are randomlyy selected;; not all questions are the same for each attempt

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Continuing Education Credits • Illinois: • 4 credits approved for individual producers/subagents • 2 credits approved for AHIP producers/subagents in Illinois

• New N M Mexico, i Okl Oklahoma h and d Texas T • 4 credits approved for individual producers/subagents • 2 credits approved for AHIP producers/subagents

• Upon successful completion of all 2014 requirements, HCSC will submit credits to the respective DOI. Producers should confirm with Department of Insurance to confirm credits are applied.

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Communications Curriculum Completion • Confirms completion of all 2014 HCSC/HISC Producer Training & Certification R Requirements i t and d iincludes l d lilink k tto access supplies li • Notice received Incomplete Curriculum • States there are outstanding items for 2014 HCSC/HISC Producer Training & C tifi ti Requirements Certification R i t • One task on the to-do list must be completed to alert a notice • Notice received approximately 7 days after user begins training Agency Amendment Execution • Confirms at least one subagent has completed their 2014 HCSC/HISC Producer Training & Certification requirements • Outlines principal’s 2014 HCSC/HISC Producer Training & Certification requirements • Requires completion within 2 weeks of notification • Emailed approximately 1-3 business days after at least one subagent completes their 2014 HCSC/HISC Producer Training & Certification requirements Failed Exams • Informs producer they failed one of the exams after three attempts thus failing the certification 47

Enrollment Process

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 48

Enrollment Process – Key Dates Key Dates

Once Certified….

October 1st

Begin accepting IEP and SEP enrollments which allow for January 1st effective ff ti dates d t  Extended hours of operation begin for customer service: 8 a.m. – 8 p.m., 7 days a week, including holidays. Note: Customer service will be closed on Thanksgiving and Christmas.

October 15th

Begin accepting Annual Election Period (AEP) enrollments for January effective dates  CMS does NOT allow any AEP enrollments to be accepted by producers prior to thi d this date t ((e.g. cannott acceptt ffrom b beneficiary fi i and dh hold ld th the application li ti tto submit b it th on the 15 )

December 7th

Last day to receive AEP enrollments

January 1st

AEP enrollments effective and new benefits begin

February 14th

Last day of extended hours for customer service  Resume operating 8 a a.m. m – 8 p.m., p m Monday through Friday Friday, with alternate technologies (e.g. voice mail) available on weekends and holidays.

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Enrollment Process Elements Required to Consider the Enrollment Complete • The Centers for Medicare and Medicaid Services (CMS) requires the following elements be provided to consider the enrollment complete:        

Plan Selection Beneficiary Name Beneficiary Date of Birth Beneficiary Gender Permanent Residence Address (cannot be P.O. Box) Beneficiary Medicare Number For MAPD, ESRD question Beneficiary Signature (or Authorized Representative Signature, if signed by someone other than the beneficiary)  If signed by an Authorized Representative, all contact information fields

• Notes:  Form CMS-1696 may not be used to appoint an authorized representative for the purposes of enrollment and disenrollment. This form is solely for use in the claims information and appeals.  Producers should not include any y of their information in the Authorized Representative p sections of the enrollment form, nor sign as the Authorized Representative, unless they have been legally appointed as the beneficiary’s legal guardian, Power of Attorney, etc.  The above items are the only ones for which the enrollment can be pended or put in “Request for Information (RFI)” status, if not provided on the enrollment mechanism.  CMS has separate timeframes for submission and notifications to the beneficiary only when one of these elements is missing from the enrollment request; however, CMS still counts these towards compliance with enrollment timeliness standards. 

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Enrollment Process Elements Required to Consider the Enrollment Complete • If any of the CMS-required fields are incomplete, the “RFI” (Request for Information) process begins:  Conduct 3 outbound phone calls  Send “RFI” letter to beneficiary requesting missing information  Allow the extended timeframe (21 days or the end of the calendar month; or in the case of an initial enrollment period submitted early, early up to the last day of the month prior to the Medicare Part D eligibility date)  If the required information is not received within required timeframe, enrollment is denied

• If information related to other fields or qquestions on the enrollment mechanism are not provided, the enrollment cannot be pended. These fields, include, but are not limited to:  premium payment option  other coverage information  long-term l t care information i f ti  enrollment period and associated date (if applicable)  producer-related fields

• Enrollments missing any information other than the required elements elements, as defined by CMS CMS, MUST be submitted to CMS within 7 calendar days. 51

Enrollment Process – Election Periods (AEP/IEP/SEP) • Although CMS requires we validate the member is enrolling during an allowable election period, the enrollment period is not an element required to consider an enrollment complete. p

• We must make the determination of whether the member is enrolling during a valid election period based on the information provided on the enrollment mechanism, and/or our validation of the member’s Part D eligibility and/or Low-Income Subsidy status (IEP or SEP for LIS). LIS)  This determination must be made within 7 days of the producer’s receipt of the enrollment form, so we can meet the requirement of submitting to CMS within 7 days  For enrollments that are denied due to not being able to confirm a valid election period, the denial letter must be mailed within 10 days of receipt

• If an election period or required date associated with an election period is missing:  Maximum of two outbound calls are made on the day the enrollment is processed  If we are unable to reach beneficiary/producer and/or no response received, the enrollment is denied

• It is especially important the producer ensure the appropriate election period is selected on the enrollment mechanism - and for those that require q a date,, the date is also p provided - to prevent enrollments from being denied.

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Enrollment Process Timeframes •

The “Application Date” related to those enrollments facilitated by producers is defined by CMS as follows: “For requests submitted to sales agents, including brokers, the application date is the date the agent/broker receives (accepts) the enrollment request and not the date the sponsor receives the enrollment request from the agent/broker. For purposes of enrollment, receipt by the agent or broker employed p y by y or contracting g with the sponsor, p is considered receipt p by y the p plan, thus all CMS required q timeframes for enrollment processing begin on this date.”

•

The date the producer receives the form from the client is the date from which all CMS requirements are measured:

 Submission to CMS within 7 calendar days  Acknowledgment letter, Request for Information Letter, or Denial letter mailed within 10 calendar days

•

It is imperative producers submit all enrollments within 24 hours of receipt to ensure compliance with these mandated timeframes.

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Enrollment Process Methods to Submit Enrollment Enrollment Method

Requirements

How to Submit:

Health Plan Online Enrollment (BAP)

Must have signed paper enrollment on file

Access through Blue Access for Producers (BAP)

Retention: current calendar year plus 10 years Paper Enrollment

Retention: current calendar year plus 10 years



Image of paper enrollment form and/or scope of appointment form f may be uploaded with the electronic submission

MAPD:

Blue Cross Medicare Advantage P.O. Box 4555 Scranton, PA 18505 Fax: 1.855.895.4747

PDP:

Blue Cross MedicareRx P.O. Box 3897 Scranton, PA 18505 Fax: 1.855.297.4245

Overnight: 25 Lakeview Dr. Jessup, PA 18434 Telephone Enrollment

Enrollment area keeps telephone recording for current calendar year plus 10 years

MAPD: 1-888-657-4164

Producer may not be on the phone or physically present with beneficiary) Can only be completed based on inbound call – cannot transfer from an outbound tb d callll tto an iinbound b d callll

PDP: 1-888-657-1215

To check on enrollment status, please call the Producer Help Desk: 1-888-723-7423 54

Enrollment Process Health Plan Online •

Must use health plan online enrollment link through Blue Access for Producers (BAP) to be paid the appropriate compensation

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Use of the Direct Consumer Health Plan Online Enrollment available through our websites (vs. BAP) will prevent any producer-specific information from being captured and commissions will not be paid.

•

2014 Enrollment Forms will be available October 15

•

Submission through the Health Plan Online Enrollment process is the most timely and efficient method:

• •

Eliminates any potential mailing delays associated with paper enrollments Reduces risk off producer information f or election period information f not being captured appropriately during telephone enrollments as a result of information provided (or not provided) by the beneficiary. 55

Enrollment Process – Paper • Ensure the correct Election Period is selected, and an associated date is provided if needed (as designated next to the option selected):

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Enrollment Process – Paper • Ensure the producer attestation questions are answered completely and accurately. Note: If face-to-face appointment was conducted, the producer should have a scope of appointment form on file

• It is important the producer fully explain the items listed in the last question, most of which are also contained in the Decision Guide

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Enrollment Process – Paper • Ensure the selling producer completes the producer-related fields on both copies of the paper enrollment form prior to submitting for processing.

• Ensure the selling producer enters his/her unique identification number in the “Writing Writing Agent ID#” field. In the case of producers that report up to an agency, etc. this should NOT be the number of the agency and/or entity to which commissions may be paid, but the Unique ID # of the selling producer (normally 5 or 6 digits, digits proceeded by zeros, zeros not the tax ID #) The agency information should be included in the “Agency Name” and “Agency Number” fields, if applicable

• Ensure the selling producer signs and dates the form, as the signature date is the date used as the “application received date.”

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Enrollment Process Telephone •

Phone enrollments are an option, however, the producer may not be present on the phone or physically present with the member during the telephone enrollment: The sponsor must ensure that the telephonic enrollment request is effectuated entirely by the beneficiary or his/her authorized representative, and that the plan representative, sales agent or broker is not physically present with the beneficiary or present on the phone at the time of the request

•

Telephone enrollments may only be completed during an inbound phone call.

•

The caller will be asked to confirm the producer is not on the line or physically present in order to complete the telephone enrollment enrollment.

• The beneficiary, or the agent, prior to transferring the beneficiary, will need to provide the relevant selling producer information (name and ID number) for the producer to receive the appropriate i t credit dit ffor the th enrollment. ll t

•

Telephone enrollments will take approximately 20 – 30 minutes to complete.

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Enrollment Process – Tips for Effective Processing and Avoiding Grievances Do:

 Ensure all CMS-required fields are complete  Ensure the appropriate election period is selected As the paper forms only offer a subset of the possible election periods, if the applicable enrollment period is not listed, use the “Plan Use” only section of the form to indicate the SEP reason

 Use the “Plan Use” section of the enrollment form to indicate the requested effective date on the model paper enrollment forms Note: only certain SEPs allow for future effective dates; many enrollment periods require the effective date to be the first of the month following receipt of the enrollment

 Submit enrollment forms within 24 hours of receipt  Ensure all fields on the enrollment form are completed prior to the beneficiary signing the enrollment form

 Provide the client with the entire Decision Guide and a copy of their enrollment form

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Enrollment Process – Tips for Effective Processing and Avoiding Grievances Don’t:  Solicit enrollments from members just becoming eligible for Medicare PRIOR to their receipt of notification of the Medicare eligibility and Medicare number from SSA (e (e.g. g do not assume what the Medicare # will be) This results in not being able to confirm the Medicare eligibility and pending the application for up to 3 months prior to the member’s eligibility date, which impacts CMS required enrollment timeliness standards t d d

 Hold applications in an effort to get a preferred effective date for the client for those SEPs that become effective the first of the month after receipt This results in being out of compliance with CMS required notifications and submissions submissions, as the date the producer receives the form is the date from which timeliness is measured

 Select the “I am new to Medicare” election period for beneficiaries just becoming eligible for Medicare Part B and enrolling in Blue Cross MedicareRx For example, member works until age 68; then retires, loses and/or gives up their group coverage and enrolls in Medicare Part B. This member is not “new to Medicare” as he/she would have been eligible for Medicare Part A and/or Part D when reaching age 65. The election period in these cases is normally either involuntarily losing creditable coverage due to retiring and/or making a change during th EGHP election the l ti period i d when h their th i employer l allows ll them th to t disenroll, di ll etc. t

 Use current year enrollment materials to enroll members for effective dates in the following year 61

Enrollment Process Outbound Enrollment Verification Calls (OEV) •

Upon processing the enrollment request, CMS requires outbound enrollment verification (OEV) calls be made to all beneficiaries enrolled through a producer.

 3 call attempts are made within 15 days of producer’s receipt of the enrollment form  If 1st call unsuccessful, an OEV letter is sent  Call script and letter are model language provided by CMS  These calls occur concurrently with any RFI calls  There is a ‘separate’ p cancellation timeframe associated with OEV calls/letters ((vs. the other allowable cancellation timeframe where the beneficiary may verbally request the enrollment be cancelled prior to the effective date) 

For OEV cancellations of enrollments, beneficiaries may request their enrollment be cancelled during the OEV call call, and/or within seven (7) calendar days from the date of the letter or call call, or the last day of the month in which the enrollment request was received, whichever is later.



For AEP enrollment requests, enrollments may be cancelled within seven (7) calendar days from the date of the letter or call, or by December 7, whichever is later.



Cancellation of enrollments unrelated to the OEV process can be requested up to the day prior to the member’s effective date.

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Marketing Overview  g

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 63

Overview

• • • •

Marketing Lessons Learned Summary 2014 Timeline & Key Messages 2014 Collateral Overview 2014 Advertising Overview

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Marketing Effectiveness The Marketing Team leveraged insight from key research projects and 2013 campaign p g p performance metrics to inform marketing g mix and optimize p content.

Lessons Learned Collateral  • Updated collateral material to include  more educational information • Used more charts, graphs, and basic  l language

Advertising • Cable more efficient than spot TV • Pre‐printed Business Response Cards  (BRCs) with prospects information • Incorporate positive headlines

• Redesigned Decision Guides and Welcome  Kits

• Developing new graphic TV spot and  refreshed direct mail creative

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2014 Collateral Overview 

Key Marketing Messages The AEP campaign consists of cohesive cross-channel messaging

• Key marketing messages: • Highlight new benefits, services and products for MAPD and new low-cost Part D plan • Include a sense of urgency for AEP deadline (Dec. 7) • C Continue ti Bl Blue C Cross M Medicare di O Options ti portfolio tf li messaging i and d co-marketing Med Supp and Part D

September Generate PreAEP awareness & soften the market

October 1 AEP Marketing Begins

October 15 AEP Begins

October 15 AEP Begins TV Strong CTA

November 25 Digital Message Increased Sense of Urgency

December 7 AEP ends Marketing activity ends close of day

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AEP Direct To Consumer Collateral • Collateral consists of: • Sales kit contents: enrollment forms, forms decision guides, formularies, etc… • Presentations • Product brochures

• All marketing collateral is designed to be consistent with advertising.

• Goals • Recognize HCSC branded materials • Easy to understand • Provide options for enrolling

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2013 Sales Kits Content Blue Cross Medicare Advantage (MAPD)

Blue Cross MedicareRx (PDP)

Blue Medicare Supplement

Enrollment Forms

Enrollment Forms

Enrollment Forms

Decision Guide

Decision Guide

Decision Guide

Summary of Benefits

Summary of Benefits

Outlines of Coverage

(included multi-language insert)

(included multi-language insert)

Formulary (will be removed in Jan.)

Formulary (will be removed in Jan.)

CMS Choosing A Medigap Policy Booklets

B i Business R Reply l Envelope E l

B i Business R Reply l Envelope E l

B i Business R Reply l Envelope E l

Blue Medicare Options

Decision Guide

MAPD Provider directories will NOT be included in the MAPD kits, but can b ordered be d d as stand t d alone l it items

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Online Tools

Online Supply Portal - Collateral

• Think Blue Ambassadors, producers p and other internal employees are to order sales kits and event supplies from: www yourcmsupplyportal com www.yourcmsupplyportal.com

• Houses the most up to date materials •

Blue Cross MedicareRx

•

Blue Cross Medicare Advantage

•

Event Materials

•

Presentations

• Usage and Inventory Tracking

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Online Supply Portal – Advertising Templates 2014 Advertising Templates Available 10/1 for all products

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Provider Finder Tool

 Access via the Microsite: http://www bcbsil com/medicare http://www.bcbsil.com/medicare

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What does this mean to you and your customers?

• Year round enrollment opportunities. • A portfolio of health care solutions to meet y your customer’s needs. • One of the most recognized brands, serving seniors in the Medicare market. • Dedicated marketing and training resources. g commitment. • Local advertising

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WHAT ARE THE NEXT STEPS ? • We’re looking for a select group of agents who will complement our organization and offer innovative ideas to their clients. • We’re looking g for agents g with a great g attitude, patience, p persistence, passion, commitment and the willingness to work as a TEAM player! • • • •

Contracted? If not please contact your Sales Rep. or affiliated FMO Complete Certification Requirements AHIP / Knowledge Wire Order Supplies Sell, Sell, Sell!

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•Questions? Q ti ?

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