mco/qhp panel...shows plans as filed with state dois (plans not yet approved; subject to change)...
TRANSCRIPT
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MCO/QHP PANEL SESSION THREE: 2PM-3:30PM*
Outreach & Enrollment Track Kentucky Primary Care Association Annual Conference 2015
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Aaron Deglow
KY ISG Sales Development Consultant
Anthem Update
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Our Vision: To be America’s valued health partner.
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We’re from here. And here is where we make a difference.
Big company advantages with a local company approach: • We live, work and raise our families in Kentucky • Celebrating over 75 years of business in Kentucky • We have more than 1,000 associates from Louisville, to
Lexington, and everywhere in-between • Local leadership with a legacy of giving • Health Plan Advisors – Licensed agents to offer support
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Last year, we committed
over $1.5 million to improving health in Kentucky.
§ Kentucky Homeplace Improving Diabetes Outcomes § Disabled Sports USA § Boys and Girls Clubs of America § American Cancer Society § American Lung Association § And many more locally focused programs impacting health
Plus countless volunteer hours from Kentucky associates giving back to their community.
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Marketing Materials
KY Individual Plan Guide
Intro to Anthem
Highlights & 2016 FAQs
2016 HMO County Map
LiveHealth Online info
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Portfolio and Plan Families
2016 Portfolio
• 6 Plans ON; 6 Plans OFF Bronze
• 7 Plans ON; 7 Plans OFF Silver
• 3 Plan ON; 3 Plan OFF Gold
• 1 Plan ON; 1 Plan OFF Catastrophic
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2016 Strategic Portfolio Changes
▪ BlueCard coverage added for all PPO Plans – out of state coverage.
▪ Added Specialist Office Visit copays to select plans .
▪ HSA plans changed from non-embedded to embedded deductibles per CMS.
▪ KY will expand the current HMO network in 2016 from 4 regions to all 8 regions
▪ Dental plans can be enrolled with Medical and the member will now receive on ID card.
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97% of hospitals
92% of physicians
382 of Fortune 500 offer a Blue health plan
1 in 3 Americans is covered by a Blue Cross Blue Shield plan
2x larger total membership than Blue’s next largest competitor
1.3 million Kentuckians are covered by Blue
Strength in numbers And when you combine that with the power of Blue, we’re virtually unstoppable
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HMO Products Individual
Hospital network: ▪ Baptist (Louisville, Lexington, Paducah) ▪ KY One (Louisville, Lexington, Central KY) ▪ University of Kentucky ▪ Norton and Kosair Childrens’ ▪ Hardin Memorial ▪ Christ Hospital (Cincinnati/northern KY physician location @ old Drawbridge Inn location)
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§ No gatekeeper, no referrals required
§ Primary care selection required
§ Locate a listing of providers within a network on Find A Doctor. • Select Kentucky and select the applicable HMO product.
HMO Products Individual
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Online Tools
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Introducing LiveHealth Online Health care where you need it, when you need it.
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Easier and less expensive than urgent care.
What is LiveHealth Online? LiveHealth Online is a convenient way for our members to interact with a doctor via live, two-way video on their computer or mobile device. LiveHealth Online: § Is available anywhere you have an internet connection
(at home, in the office or on the go) § Is available 24 hours a day/7 days a week/365 days a year § Provides access to in-network, U.S. board-certified doctors § Offers help at the same price as (or less than) a regular doctor visit § Doctors can ePrescribe to local pharmacies
(where applicable) § Takes member payments via Visa, MasterCard and Discover § Is secure, convenient and easy-to-use
LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
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.
Thank You
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Life and Disability products underwritten by Anthem Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
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KentuckyPrimaryCareAssocia3on
November12,2015
ChrisBurche>,AnthemMedicaid
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AnthemMedicaidoperatesin120coun3esofKentucky
Commonwealth’sMedicaidRegions
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AnthemMedicaidMemberCard
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MCO’sBasicHealthCoverage
• HealthInsurance(HealthCheckupsandScreenings)
• Dental–DentaQuest
• Vision-EyeQuest
• PharmacyServices–ExpressScripts
• BehavioralHealthServices
Carvedout:
• Transporta3on
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Ifcontractsarethesame…
WhatmakesAnthemdifferent?
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AnthemISDifferent!
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• NOCOPAYS
• FreeMembershiptopar3cipa3ngBoysandGirlsClubs(17loca3ons)
• FreeSportsPhysicals
• FreeCriborCarSeat–whenpregnantwomenseetheirOB’sorPCP’s73mes
• Free$25GicCardsforprenatalvisits(1stTrimestervisit)
• Free$25GicCardsforprenatalvisits(3rdTrimestervisit)
• Free$50GicCardforPostPartumVisit
• Free$50GicCard–WellChildVisits(childhastohave6visits)
• CommunityResourceGuide(English&Spanish)
• FreeSafeLinkCellPhonewithfreeminutes&texts(250minutes&unlimitedtexts)
• FreeHearingAidBa>eries(offervarioussizes)
• FreeTornadoSafetyKit
ValueAddedBenefits
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OpenEnrollmentOct.19–Dec.11,2015
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19&Growing-Lookforus!
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CareSource Just4Me™ 2016 Benef i t s
Information Confidential and Proprietary
Health insurance you can afford, understand and use
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Non-profit, founded in 1989 in Dayton, OH
Comprehensive,
member-centric health and life services
Regionally based-
serving multiple states and products
PRODUCT LINES
• Medicaid • Marketplace • Duals Demo
Medical Cost Ratio
MISSION FOCUSED:
Information Confidential and Proprietary
To make a lasting difference in our members’ lives by improving their health and well-being.
1.4M members
90%
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Our Mission
To make a lasting difference in our members’ lives by improving their health and well-being.
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Information Confidential and Proprietary
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CareSource Plans in Kentucky
Information Confidential and Proprietary
• CareSource Just4Me ™ Qualified Health Plan in 46 counties.
• Humana – CareSource® Statewide Medicaid Managed Care Organization (MCO) alliance with Humana.
• CareSource Advantage and Advantage Plus™ Medicare Advantage plans (Fall 2015).
4
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CareSource Just4Me™ Qualified Health Plan
Information Confidential and Proprietary
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2016 Just4Me Counties
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Information Confidential and Proprietary
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CareSource Just4Me™ Offers
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Information Confidential and Proprietary
1. Affordable insurance 2. Plans are easy and simple to use 3. Robust network 4. Multiple payment options for ease of
payment
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2016 vs 2015 Plan Design Changes
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Information Confidential and Proprietary
ENHANCEMENTS • Gold & Silver will have $0 copay for PCP • Gold & Silver will have $0 copay for Retail Clinics • Gold & Silver will have $0 copay for Physical
Therapy & Occupational Therapy
• Silver 73% (Silver 1) $40 copay Preferred Brand Prescriptions
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2016 vs 2015 Plan Design Changes
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Information Confidential and Proprietary
CHANGES • Gold goes to 20% coinsurance • Gold, Silver (No CSR, 1, 2) & Bronze moves to 50% for
Non-Preferred Specialty High Cost Rx • Silver 3 moves to $300 deductible • Silver 3 moves to 35% for Non-Preferred Specialty High
Cost Rx • Bronze moves to $6650 deducible, 40% coinsurance,
and $6850 Max. OOP • Catastrophic moves to $6850 deductible & Max OOP
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Two Ways to Reduce Cost
1. Advanced Premium Tax
Credit
2. Cost Sharing Reductions
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Information Confidential and Proprietary
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Information Confidential and Proprietary
CareSource Just4Me™
Health insurance you can afford, understand and use
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Appendix
Information Confidential and Proprietary
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Types of Plans
Information Confidential and Proprietary
• Catastrophic Coverage Plans – 3 primary care visits per year – Low premiums, high out of pocket costs and deductibles – Provide only for emergency care
• HMO (Health Maintenance Organization) – Use closed-network benefit model – Referrals required for specialist care – Benefits not available if care given out of network unless it is emergency
• POS (Point of Service) – Uses a network benefit model similar to HMO – Higher out of pocket costs if care given out of network – May require referrals for specialist care
• HSA (Health Savings Accounts) – tied to high deductible plan which features
• lower premiums • higher out of pocket costs
– Savings account that allows tax advantage dollars to be put away to pay for qualified medical expenses
• PPO (Preferred Provider Organizations) – Use open network benefit model that allows for out of network services at a
higher out of pocket cost – Referrals not needed to see specialists – Premiums are typically higher than HMO’s
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This is a solicitation for health insurance. *Some exclusions and limitations may apply. Benefits and costs vary by plan. See the CareSource Just4Me Evidence of Coverage or Schedule of Benefits document for details at CareSourceJust4Me.com. CareSource Just4Me does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. CareSource Just4Me is a Qualified Health Plan issuer in the Kentucky Health Benefit Exchange.
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KY-EXCM-118a Information Confidential and Proprietary
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GrowingYourBusiness:2016OpenEnrollment
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42 Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
YourKentuckyIndividualSalesTeam
AndreaFowler-FieldSalesRepKY,IN,OH,andWV(502)[email protected]/WV(855)305-4950jhasman@humana.comBrianBagan-RegionalSalesManager-IndependentAgentChannelIN,KY,OH,PA,VA,WVandNortheaststates
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Ifyoudidn’thavehealthinsurancein2015,you’llpaythehigherofthesetwo
amounts:
• $325perpersonfortheyear($162.50perchildunder18).Themaximumpenaltyperfamilyusingthismethodis$975
• 2%ofyouryearlyhouseholdincome.• Onlytheamountofincomeabovethetaxfilingthreshold,about$10,150foranindividual,isusedtocalculatethepenalty.
• ThemaximumpenaltyisthenadonalaveragepremiumforaBronzeplan.
Ifyoudon’thavehealthinsurancein2016,you’llpaythehigherofthesetwo
amounts:
• $695perperson($347.50perchildunder18)Themaximumpenaltyperfamilyusingthismethodis$2,085.
• 2.5%ofyouryearlyhouseholdincome• Onlytheamountofincomeabovethetaxfilingthreshold,about$10,150foranindividualin2014,isusedtocalculatethepenalty.
• ThemaximumpenaltyisthenadonalaveragepremiumforaBronzeplan.
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TaxPenaltyUpdates
Source:hgps://www.healthcare.gov/fees-exempdons/fee-for-not-being-covered/
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2016ProductFootprintandEnrollmentDates
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Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
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2016OpenEnrollmentEffecdveDateChart
IssueDate EnrollmentPeriod 2016Effec3veDates11/1/15-12/15/15 OpenEnrollment 1/1/201612/16/15-1/15/16 OpenEnrollment 2/1/20161/16/16-1/31/16 OpenEnrollment 3/1/2016
• From2/1/16-10/31/16,customerscanenrollinHealthPlansiftheyhaveexperienceda“QualifiedLifeEvent”(QLE)thatwouldqualifythemforaSpecialElecdonPeriod.
• TheEffecdveDatesforyourcustomersthatexperiencesaQLEwillbedictatedbythenatureoftheQLE
• On-ExchangeDentalmustbesoldinconjuncdonwithanOn-ExchangeMedicalPlan
Confidential/ For Agent Use Only
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PlanEnhancements
56
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
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57
Key2016GuidingPrinciplesforProductchanges
• EncouragecorrectusageofplansbyMembers– Encouragemember/PCPreladonship;Reducenon-emergencyERudlizadon
– Directmemberstomostappropriateplaceoftreatment– Encourageproacdvecareandmedadherence:EnhancedaffordabilityforPCPvisits,retailclinics,Rxcopays,$0Rxdeducdble.
Confidendal-InternalUseOnly–ShowsplansasfiledwithstateDOIs(plansnotyetapproved;subjecttochange)
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58
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
2016MedicalProducts–Enhancements
• LowerMedicalDeduc3bles:– SilverHUMx/EPOx/PPOxHighValueNetworksandHMOPremiercopayplanhasaded.of$3,800(was$4,600in2015)*
– GoldPlanhasaded.of$2250(was$2,500in2015)*
• FamilyplansinALLstatesin2016willhaveIndividualProtec3on– Embeddeddeducdbleonallplansfor2016
• NOTE:thisisanimprovementformembersontheCatastrophic,BronzeHDHPandSilverHDHPplans(in2015theseplanshadonlyaggregatefamilydeducdbles)
LowerDeduc+blesin2016’sformostSilverandGoldplans
Nowallplanshaveindividualmemberprotec+on
q BroadNetworksareHumana/ChoiceCare,NPOSandCPOSq HighValueNetworksareHMOx,EPOxorPPOx
*SimilarEnchantmentsforsomeplansavailableinGAandMS
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59 Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
2016MedicalProducts–Enhancements
• SilverandGoldCopayPlanenhancement:• $0RxDeduc3ble:Improvesaccesstomedicadonsincebenefitswillbegin
immediatelyforcovereddrugs.
• SilverCostShareReducdonCopayplans:– LowerRxcopays:tohelpmemberswithaccessibilitytomedicadon(all
networks,allstates)– LowerPCPcopays:ThePCPisalwaysthefirstchoiceoftreatmentfor
padents,andwewanttomakesurethatitisaccessibleandaffordableformembers.(allnetworks,allstates)
• RetailClinicsandUrgentCareCenters– Noreferralsrequiredforin-networkretailclinicsandurgentcarecenters,
foreasieraccesstoarer-hoursandweekendcare(newforHMOxplansmid2015)
– CVSMinuteClinicandConcentraUrgentCareCentersinnetworknadonwidewhereavailable*• QuestandLabcorpinnetworknadonwidewhereavailable*
Improvementstoprovideeasyaccesstonon-ERcare
ImprovementstoprovideeasyaccesstoPCPsandRX
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60 Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
2016MedicalProducts–Enhancements
NEWin2016 SilverBase CSR200-250%FPL
CSR150-200%FPL
CSR100-150%FPL
PCPCopay $20 $15 $10 $5
RetailCliniccopay $30 $25 $20 $10
UrgentCareCopay $40 $30 $25 $15
ER(copay+ded+coins)
$250copay+ded+coins
$200copay+ded+coins
$200copay+ded+coins
$150copay+ded+coins
Tier1&2Rx $10/$20 $5/$15 $5/$10 $4/$8
Tier3,4,5Rx $50/50%/50% $45/50%/50% $35/50%/50% $25/50%/50%
Example:HMOxSilvercopayplan
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61
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
2016MedicalProducts–Changes
• New2016EmergencyRoomChangesforcopayplans• Benefitsummarieswillstate:
– “Youpay20%coinsurancea3era$250copaypervisitanddeduc9ble”
– “…youpaya$250copayforeveryemergencyroomvisit.Youalsopayallemergencyroomchargesun9lyoureachyourdeduc9ble.Onceyoureachyourdeduc9ble,youpay20%coinsuranceun9lyoureachyourmaximumout-of-pocket.
• ERCopaypordonisgenerally$250(butSilvercopayCSRplansthatwillhavelowerlevels)
• Note:ERcopaypordonnotwaivedifmemberadmigedtohospital
ERcopayPor3on
SilverBase CSR200-250%FPL
CSR150-200%FPL
CSR100-150%FPL
$250 $200 $200 $150
NewERBenefitisthe
combinadonofERCopay,Deduc3ble,
andCoinsurance
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62
2016MedicalProducts
Afewindividualmedicaldeduc3bleswentup.
• ’16SilverHDHPded.of$4125(was$3650in‘15).
• ’16Basicplanded.of$6850(was$6600in‘15)
• ’16Bronzeplanded.of$6450(was$6300in‘15).
Confidendal-InternalUseOnly–ShowsplansasfiledwithstateDOIs(plansnotyetapproved;subjecttochange)
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NewH1HumanaVitality®Benefit**• Samefootprintas2015;willincludemendoninbenefitsummaryandagentgrid.
• HumanaVitalityDescripdon:- EnhancedHumanaVitalityHealthyFoodbenefitatWalmart
– Blue=0%savings*– Bronze=5%savings– Silver=10%savings– Gold=25%savings– Pladnum=50%savings(Maxsavings=$600perfamilyperyear)
– VitalityBucksnolongerapartoftheprogram**
63
2016MedicalProducts–Changes
Confidendal-InternalUseOnly–ShowsplansasfiledwithstateDOIs(plansnotyetapproved;subjecttochange)
Jan–June2016promodon:25%savingsforbronzestatus
(JustdothehealthscreeningandrequesttheHealthFoodscard)
**Thenon-grandfatheredplansandgrandfatheredplansfor2016willsdllhavethe2015HumanaVitalitybenefit(withbucks)
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64
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
MyVitalityMobileApp
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65
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
2016MedicalProducts
• New2016MemberIDCardDesign
-IDcardswillnowshowtheERCopayaswellasstatethatdeducdbleandcoinsuranceapply:
Exampleof2016IDCardDesign:
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66
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
MyHumanaMobileApp
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LowerDeducdblesformostSilverPlans
LowerDeducdblesformostGoldPlans
LowerPCPCopaysandRXDeducdble
forCSRPlans
EmbeddedProtecdononAll
PlansNewERbenefit ChangestoRx
67
Confidential 2016 Individual Product Strategy- Internal Use Only – Shows plans as filed with state DOIs (plans not yet approved; subject to change)
ProductEnhancementSummary
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HowHumanaSupportsYourClients
Confidential/ For Agent Use Only
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Cashpaymentopdonfeatures
Humanaassignsbarcodenumbers Membertakes
invoicewithbarcodetoretailer
Memberpaysatretailerbyprovidingbarcode
Memberreceivesareceiptforpayment
Whatisit?• AbarcodebasedsoludonprovidingHumanamemberswhohaveindividualmedicaland/or
dentalplansinapprovedstates(currentlyAL,CO,FL,GA,IL,LA,KY,MI,MS,MO,OH,TN,TX,andUT)anopdontopaytheirpremiumswithcashthroughabill-payserviceatCVS/pharmacyorDollarGenerallocadons.
• Availabletoon-exchangeandselectoff-exchangeindividualmedicaland/ordentalplans
Howdoesitwork?• Humanamemberswithindividualmedicaland/ordentalplansinapprovedstateswillreceivea
barcodeontheirinvoice• MembertakestheinvoiceandpaymenttoapardcipadngCVS/pharmacyorDollarGeneral
locadons• Storeassociatescansthebarcode,acceptsthecash,andgivesthememberareceiptindicadng
thepremiumhasbeenpaid• Memberkeepsreceiptasproofofpayment
Confidential/ For Agent Use Only
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Cashpaymentopdonfeatures
HowdoIusethisnewcashpaymentop3onasasellingtool?Thebestwayformemberstokeeptheirpolicyinforceiswithrecurringmonthlyautomatedpayment.Ifaprospectdoesnothaveabankaccountorcredit/debitcardandneedstheflexibilitytopaytheirpremiumsusingcash,younowhaveanalternatecashpaymentmethod.
Wherewillthisbeavailable?• Memberswithindividualmedicaland/ordentalplansinAlabama,Florida,Georgia,
Kentucky,Michigan,Mississippi,Missouri,Ohio,Tennessee,Texas,Utah,Illinois,andLouisianacanusethebarcodeateitherCVS/pharmacyorDollarGeneralstores.
• MemberswhoreceiveapaperinvoiceinColoradowillbeginseeingthecashpaymentopdonstardngwiththeirApril2015invoice.DollarGeneralistheonlyretailerpar3cipa3ngintheprograminColorado
Howdoesamembergetabarcodeatenrollment?AgentsenrollingOn-Exchange:- Ifthememberwantstopaythefirstmonth’spremiumpaymentorrecurringpaymentswith
cash,theyshouldselect“check,moneyorderorcash”whichwillgenerateabarcodedpaperinvoice
Confidential/ For Agent Use Only
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71
SmartChoiceDental
11/18/15
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ThankYou!
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2016OpenEnrollment
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AetnaKentuckyHealthNetworkOnlyOpenAccess
Availablein10coundesfor2016:Boone,Kenton,Campbell;Fayege,Madison;Owen,Henry,Jefferson,OldhamandTrimble
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ExchangeHighlightsMostcompe33vely-pricedonBronzeplansinLouisvilleandLexington
Lowest-pricedcarrierofallofthebrokercommissionableplansinNorthernKentucky
• OpenAccessHMOProduct
– NoPCPselecdonrequired– Noreferralsneeded.– Nocoverageforoutofnetwork,otherthanforemergencycare
• Narrownetworkwithnooutofstateproviderspardcipadng– NKYnetworkisbuiltaroundtheSt.ElizabethHospitalsystem– LexingtonthenetworkisbuiltaroundtheBapdstandUKHealthcarehospitalsystems– LouisvillethenetworkisbuiltaroundtheBapdsthospitalsystem
• Fiveplandesignsoffered– Gold$10Copay– Silver$10Copay– Bronze$15Copay– BronzeDeducdbleOnlyHSAEligibleplan– Catastrophicplanforthoseunderage30orhardshipexempdonwaiverobtained
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Typeofproductssoldontheexchange
76
Pla3num–90%
Gold–80% Silver–70%
Bronze–60%
CatastrophicplanThisproductisavailabletoindividualsunder30yearsofageorthoseexemptfromtheindividualmandatebecausenoaffordableplanisavailabletothemorbecauseofahardship
“Nowrongdoor”TheexchangewillinformindividualsofeligibilityrequirementsfortheMedicaidprogram,theChildren’sHealthInsuranceProgram(CHIP),oranyapplicablestateorlocalpublicprogram
DentalplanExchangesmaysellstand-alonedentalplansiftheyofferpediatricdentalbenefitsmeedngtherequirementsoftheACA
Aplanwillprovidealevelofcoveragethatisdesignedtoprovideessendalbenefitsthathaveanactuarialvalueof:
Metallicexchangeproducts
Otherexchangeofferings
AspartofHealthCareReform,bothon-andoff-exchange,productsforindividualsandsmallgroupemployersmustadheretometalliclevel
requirementsbasedonactuarialvalue.
Actuarialvalueisthepercentageofthetotalcoveredexpensesthatahealthplancovers.
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CoventryCaresManagedCare
CoventryCaresofKentuckyservicesMedicaideligibleindividualsinall120Kentuckycoun3esWeemployapproximately250locally-basedstaff,includingindividualswholiveandworkineachoftheeightMedicaidregionsWewerepurchasedbyAetnainMay2013
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2016Migra3onDate
Effec3veFebruary1,2016
78
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2016OpenEnrollment
• RunsOctober19throughDecember19• WewillbeCoventryCaresofKentuckyforOpenEnrollment
• NewenrolleesduringOpenEnrollmentwillreceiveaCoventryCaresMemberIDCardandCoventryCaresNewMemberMaterialsinJanuary2016
• NewAetnaBegerHealth®ofKentuckyMemberIDCardswillbemailedtoallmembersinFebruary
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ReducedCo-Paysfor2016
80
NewcopayscheduledesignedtohelpourmemberslivehealthierlivesNOCopaysforPhysiciansoffice(PCPorspecialists)visitsNOCopaysforPreventadveCareservicesNOCopaysforUrgentCarevisitsNOCopaysforGenericandPreferredPrescripdonDrugsNOCopaysforDentalservicesNOCopaysforMaternityservicesNOCopaysforOutpadentHospital/AmbulatorySurgicalCenterNOCopaysforPodiatryservicesNOCopaysforDMENOCopaysforProsthedcDevicesNOCopaysforPT/OT/STNOCopaysforOutpadentMentalHealth/SubstanceUseServicesNOCopaysforLabs,DiagnosdcandRadiologyServices$25CopayforAcuteInpadentHospitalServices–IncludingMentalHealthandSubstanceAbuseServices(Previously$50)$4CopayforNon-PreferredPrescripdonDrugs(Previously$8)
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MemberBenefitsfor2016Casemanagementanddiseasemanagementprograms(Adult,PediatricandPerinatal)Diabetes,congesdveheartfailure,asthma,COPDBehavioralHealthservicesDental,vision,homehealth,pharmacyandotherancillaryservicesEPSDT-Monthlypostcardmailing&remindercallsWellWoman-MonthlybirthdaycardmailingMemberAdvocatesPreven3onandWellnessPa3entCenteredMedicalHomesReadmissionPreven3onEDu3liza3on,inpa3entadmission&readmissionreports
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ExpandedDrugFormularyfor2016
• Ourdrugformularywillexpandtoincludemorepreferreddrugs– Begerserviceforourmembersandprescribers– Reducedpharmacywaitdmes– Getdoctor-prescribedmedicadonsinmembers’handsquickly
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IncreasedMemberIncendvesfor2016• DocBearClubforKids• 24-HourNurseLine• CribIncen3veProgram• PromiseRewardsProgram
– MemberscanearnaPromiseRewardsspecialgirarertheirbabyisborn.TheywillearnafreeDiaperbagwhichincludescommonbabyitemsandagircardiftheycompletethefollowing:
• Completethepost-partumvisit.Thisvisitmustbewithin21–56daysarerthebabyisborn.
• AsktheObstetricalprovidertocompletethePromiseRewardsform**andreturnittoCoventryCaresofKentucky.
• **PromiseRewardsformtobesubmiSedforcommonwealthapproval• CoventryCaresBe>erWaytoHealthIncen3veProgram
– Memberscanearngircardsarertheycompletethefollowingcheckups:• $10gircardforcompledngaLeadScreeningtestforchildrenpriortotheir2nd
birthday• $10gircardforcompledngadiabedcrednaleyeexamforadults18–75yearsold• $10gircardforcompledngspirometrytesdngformembers42yearsorolderwith
COPD• $20gircardforcompledngafollow-upvisitwithamentalhealthpracddoner
within7daysofdischargearerahospitalizadonformentalillness(6yearsofageorolder)
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IntegratedBehavioralHealth• MobileCrisis
• Asser3veCommunityTreatment(ACT)
• PeerSupport
• CrisisInterven3on
• IntensiveOutpa3entTreatment
• Par3alHospitaliza3onProgram
• Addi3onalcodesforassessment,screening,andtreatmentplanning
• Allindependentlylicensedprac33onersarenoweligibleMedicaidBehavioralHealthproviders,includingLCSW,LPCC,LMFT,&PhDs
• GroupsoftherapyprovidersareeligibletobecontractedasMul3-SpecialtyGroupsandcanprovideafullarrayofbehavioralhealthservices
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ImprovedCoverageforSubstanceAbuse• Detoxifica3on
• Residen3alTreatment
• IntensiveOutpa3entTreatment
• Par3alHospitaliza3onProgram
• Rou3neOutpa3entTherapy(individual,family,groupcounseling)
• PeerSupport
• Addi3onalcodesforassessment,screening,andtreatmentplanning
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Ourmembersarealwaysthecenterofwhatwedo
MemberOpera3ons&Enrollment
MemberServices&MemberAdvocates
QualityManagement
ProviderRela3ons&ProviderNetwork Appeals&
Grievances
MedicalManagement
Collabora3veServices
86
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MemberServices• MemberServicescanbereachedat1-855-300-5528
• MemberServicesstaffwillbelocatedinKentuckyfor2016
• OurMemberServicesstaff:» Provideinformadononeligibilityandbenefits» Assistproviderswithnon-compliantmembersand/ordischarges
» Assistmemberswithavailableprogramsandresources» Assistmemberinfindingproviders» Assistmembersinfilinggrievancesorappeals
87
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CommunityOutreach
• AetnaBegerHealthofKentuckyhasdedicatedCommunityOutreachstaffacrossthestate,whoworktobevisibleandaccessiblelocalresourcesforourmembers,potendalmembersandcommunitypartners
• CommunityOutreachstaff:─ Presentcurriculumonavarietyofsubjectsincludingpersonalhygiene(adaptedtobeage-appropriateinschools),bullyingprevendon,oralhealth,nutridon,andothers
─ AreCerdfiedPresentersinChronicDiseasemanagementandNurturingFamiliestraining
─ Pardcipateincommunityevents,organizadonsandmeedngsthatreachmembers,potendalmembersandcommunitypartners
─ Provideeducadonandanswersaboutourmemberbenefits─ Areapointofcontactformemberconcerns
88
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ProviderRela3ons• AetnaBegerHealthofKentuckyhasdedicatedProviderReladonsstaff• ProviderReladonsstaffwillvisitproviderofficesregularlythroughouttheyeartoensureAetnaismeedngtheirneedsandaddressingconcerns
• ProviderReladonswill:− Provideeducadontoproviderofficesonavarietyoftopics− ProvidesupportonMedicaidpoliciesandprocedures− Provideprovidercontractclarificadon− Assistwithdemographicchanges,terminadons,andinidadonofcredendaling
− MonitorcompliancewithapplicableCommonwealthandFederalagencies
− ConductannualProviderSadsfacdonSurvey− Conductmembercompliantinvesdgadon− Maintaintheproviderdirectory− Beapointofcontactforproviderconcerns
ProviderRela3onscanbereachedat1-855-454-006189
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THANKYOU
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Presented by: Dana Moody Director of Community Engagement
Kentucky Primary Care Association Conference
Outreach and Education Track
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WHAT IS PASSPORT HEALTH PLAN?
• Local, Kentucky-based • Community Health Plan • Provider-Sponsored
• Nonprofit • Mission-Driven
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Passport named Top Medicaid Plan in Kentucky by NCQA
NCQA ACCREDITATION SURVEY RESULTS
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CAUSE-RELATED ADVOCACY
94
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REGIONAL FOCUS
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“MOVING THE NEEDLE”
• 24-HourHotlines
• Collaboradonwithadvocatesand
agencies
• CareCoordinadon
• InsidePassport
• ProviderNetworkManagement
• MommySteps&SpecialPrograms
• Disease&CaseManagement
HealthEducadon
• EmbeddedCaseManagement
• MemberEducadonSessions
• CommunityEvents&HealthFairs
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• Added additional dental screening for adults (2 per year)
• Over the Counter Medications • 90-day supply maintenance
medications • Rx Copay
• $2 preferred brand • $4 non-preferred • $0 generic medications
• MemberIncendvePrograms
2016 BENEFITS
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VALUE OF A MEDICAL HOME
98
At Passport we feel our members are best served with a primary home for care and oversight, thus the Primary Care Provider is responsible for coordinating the member’s health care. This ensures the member’s PCP is aware of all aspects of the patient’s care and can mange their overall health. We want all of our members to have a “Medical Home!” Our mission is to improve the health and quality of life of our members.
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QUESTIONS?
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2016 Individual Exchange Kentucky
Not for Consumer Use
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The Marketplace and helping consumers choose a plan
101
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Help individuals to choose a plan
102
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Add up the points and go to the next page to see the results: pts.
Ask individuals the three questions below to help find the plan that might be right for them
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Metallic plan recommendations*
103
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Based on total points, they might like:
*Every metallic level plan includes access to the same doctors and medications.
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Video to support plan choice
104
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Help individuals learn more about choosing a health plan
Share the Choosing a Plan
video from uhc.com
Video steps consumers through the three main considerations when
choosing a plan
Available in English now and Spanish in
November
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UnitedHealthcare health insurance plans: 2016 overview
105
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Here’s where to find our plans in your state
106
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
On Exchange plan availability
UnitedHealthcare Insurance Company of Kentucky, Ltd.
Our company name in your Marketplace:
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Plans at a glance
107
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Getting care in our network
108
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Network Name: UnitedHealthcare® Compass Balanced
Members must:
Choose a primary care provider in the service area.
Get a referral before they see a specialist to receive the highest level of benefit.
In-network coverage only.
Note
Provider search can be done in
Spanish
Provider Search
uhc.com/docfind
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Not for Consumer Use
Sample ID Card
109
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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UnitedHealthcare tools to help manage health care and costs
110
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24/7 access anytime or anywhere when members register at myuhc.com
111
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Choose how they want to get information – online, mail, email,
text
Available in Spanish
Access health resources and cost decision tools
Health4Me mobile app
Virtual Visits
NurseLine
myHealthcare Cost Estimator
myClaims Manager
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Health4Me™ app helps you where you are
112
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
“There’s a convenienc
e clinic nearby”
“Doctor, can I get the MRI at
the clinic instead of the
hospital?”
From home, work or on the go, members can easily:
Share their ID card
Find and price care
Check claim status
Manage OptumRx prescriptions
FitBit connectivity
Note
Although Health4Me is not available in
Spanish, information can be accessed by
calling Customer Service
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Tools to help manage health care
113
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Virtual Visits
Health4Me app
myuhc.com
For members enrolled in UnitedHealthcare plans
Secure, online 24-hour access to physicians using mobile phone, tablet or computer
See and speak with a doctor
Get diagnosis and prescriptions for minor medical needs
Get list of participating virtual-visit providers using UnitedHealthcare’s
Health4Me™ mobile app or myuhc.com
Members pay a flat fee for each virtual visit
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Tools to help manage health care
Decide if you should see a doctor, go to an urgent care center or emergency room, or treat yourself at home Find a doctor or hospital Answer questions about an illness or injury Give you support on caring for a chronic health problem, like diabetes Understand your medications
114
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Registered nurses, with an average 15 years
of experience, are available 24 hours a day,
365 days a year
Call the number on the back of the ID card
NurseLine 24/7 nurse support
Nurses are supported by Spanish language
interpreters
PLAN TIPS Call a nurse wherever you are. This 24/7 service is part of your health plan at no additional cost.
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Tools to help manage health care
115
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Source4Women®
myuhc.com
Monthly interactive seminars
Tips, recipes, guidelines and checklists
Blog health topics important to the whole family
Interactive quizzes and health assessments
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Where to find more information
116
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Assister resources on dedicated website
117
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Materials are on the Assister Resources site:
uhc.com/assisters
Slides
Assister newsletter
Hotline 1-866-698-1739
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Material available on your website Collateral to provide information on
UnitedHealthcare Marketplace products and services
Consumer Guide
Marketplace FAQ
Subsidy Chart
Mini Brochure Network Flier
118
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
uhc.com/assisters
Hotline 1-866-698-1739
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Summary of resources in Spanish
119
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Personalized enrollment support is available at our fully-staffed bilingual
(Spanish-English) direct sales and enrollment Call Center
(800-985-3859)
Provider search with Spanish language indicator
Latino Health Solutions bilingual website at uhclatino.com
myuhc.com is in Spanish, including myClaims Manager
Once a member has enrolled, Customer Service is available in
Spanish with full member support
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Latino Health Solutions
120
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Bilingual health information center with medical terms and descriptions of laboratory tests
and common illnesses
Bilingual health education fliers, brochures, and other health
maintenance materials
Valuable educational videos in both Spanish and English at
uhclatino.com
How insurance works, What are HSAs, What are “Life Events,” What are the
Penalties for not enrolling, etc.
Health and fitness topics and recipes
Award-winning fotonovelas
uhclatino.com Spanish website
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About UnitedHealthcare
121
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About UnitedHealthcare
122
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Consumers choose UnitedHealthcare based on the stability of our national size, our focus on quality improvement, and the value of our better approach to health engagement
Our Quality Our Value Our Tools
Our market leadership is a result of the unmatched quality for our members, customers, and providers
Using better analytics, we provide a better approach
to members that leads them to better health
engagement
With innovative tools we provide members help to
better manage their health care
Why UnitedHealthcare?
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123
Load834inUHCSystemsthroughinvoicegeneradonwithin24
hours
Note:Pre-auditfilesare3dayTATforsystemloadthroughinvoice
generadon
Incompleteinformadonfallstoerrorprocessing
Welcomeemailsent
(ifapplicable)
Days 4-7
PendedsubscriberssenttoFiServovernightbatch
Memberhasinhand:• Welcomee-mail
(ifapplicable)• Inidalinvoice&
Onboardingchecklist
• AcdvadonFlyer&InidalIDCard
Ini3alIDcard+s3cker&ac3va3onflyergenerated&mailedAveragemail9meis2-3days(firstclass)
Day 3 Day 2 Day 1
Pre-Effectuation Timeline In 2015 materials were received on average 30-45 days after coverage effective date
Enroll
Currently receiving e-mail addresses for 20% of enrollees through exchange on
initial enrollment file
Enrollment Summary
Ini3alInvoice&Onboardingchecklistgenerated/mailedAveragemail9meis2-3days(firstclass)
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124
• Welcome email sent when email is included on file from exchange
Confirmation of Action(s):
Enroll Days 1 & 2
Welcome e-mail
Approximately 72% of e-mails are opened
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Confirmation and Welcome Email/Letter
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
125
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126
Days 4-7 Day 3
Memberhasinhand:
• Welcomee-mail(ifapplicable)
• InidalinvoicewithOnboardingchecklist
• AcdvadonFlyer&InidalIDCard
Enroll Days 3+
Initial ID Card, activation sticker, & activation flyer (gated and non-gated versions)
Ini3alIDcard+s3cker&ac3va3onflyergenerated&mailed
Averagemail9meis2-3days(firstclass)
Gated versions
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Welcome Kit - Envelope, Folder, Welcome Letter
127
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Not for Consumer Use
Thank you!
128
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Assister website: uhc.com/assisters
Thank you for
taking the time
to learn more about
UnitedHealthcare!
Questions: Navigator Hotline
1-866-698-1739
!
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2016 WellCare of Kentucky Benefit Overview
November 2015
THIS AREA CAN BE LEFT BLANK or ADD A PICTURE
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WellCare Health Plans, Inc.
At WellCare, our members are our reason for being.
We work each day to enhance our members’
health and quality of life.
Emphasis on lower income populations and value-focused benefit design
Community-based solutions to close gaps in the social safety net
Focus on preventive care including regular doctor visits
Communication among members and providers to improve outcomes
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Serving Kentucky
Fulton CallowayHickman MonroeSimpsonClintonAllen
Cum
berlandGravesCarlisle
BellMcCreary WhitleyWayneTrigg HarlanKnox
Marshall Todd LoganChristian BarrenLyon Metcalfe RussellWarrenBallard LetcherAdair LeslieLaurelPulaski ClayCaldwell
ButlerMuhlenberg Hart
GreenTaylor KnottOwsleyCrittenden Casey
HopkinsJacksonGrayson LincolnWebster McLean BreathittBoyle Lee
MarionLarueOhio
PikeFloydEstill Wolfe
Union MadisonDaviessPowell
MartinMercerHenderson Nelson JohnsonHardinBreckinridge
MenifeeClark MorganBullitt AndersonSpencer
Woodford Fayette
ElliottLawrenceBathShelby BourbonFranklin
Jefferson RowanScott Carter BoydOldham FlemingHarrisonHenry Robertson LewisOwen GreenupCarroll
MasonGrantK
entonC
ampbell
Boone
WellCare’s economic impact on the Commonwealth of Kentucky is $36 million annually. *
In Kentucky, WellCare:
• Serves 457,000 members across the state.
• Has a local presence with seven office locations.
• Employs 230 people.
CoundeswithWellCareoffices
*Basedona2011studycommissionedbyWellCareandconductedbyJamesV.Koch,Ph.D.,Economics,BoardofVisitorsProfessorofEconomicsandPresidentEmeritusatOldDominionUniversity.
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Data is per the last reported quarter, ending June 30, 2015 All numbers are approximated. Updated: September 18, 2015
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Health Care Quality and Access
Access
Provider Access:
• 4,800 primary care providers.
• 17,400 specialists.
• 1,300 behavioral health and substance abuse providers.
Facilities Access:
• 110 hospitals.
• 170 federally qualified health centers.
• 175 community mental health centers.
Geographic Access:
• One primary care provider and hospital within 30 minutes for urban counties and 45/60 minutes for rural counties.
Quality
• Focused on preventive health, wellness, chronic diseases and care management.
• An enhanced case management model helps to more effectively serve the most medically complex members.
• The model leverages both field-based and telephonic resources using state-specific, multi-disciplinary care teams.
Process: • The National Committee for Quality
Assurance (NCQA) awarded WellCare of Kentucky’s Medicaid plan an accreditation status of Commendable and an Accredited designation for its Medicare Advantage and Health Insurance Marketplace plans in the state.
Technology: • Company-wide, more than $60 million
has been invested for information technology to support quality.
WellCare is committed to continually improving the quality of care and service that we provide to our members.
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o Fayette o Jessamine o Clay o Leslie o Harlan o Laurel
Kentucky QHP Presence
• Medicaid Plans and Medicare Prescription Drug Plans are available statewide. • Medicare Advantage Plans are available in Boone, Bourbon, Bullitt, Campbell, Carroll,
Clark, Fayette, Gallatin, Grant, Jefferson, Kenton, Owen, Pendleton, and Scott counties. • Individual Exchange Plans are available in 12 counties including:
o Warren o Jefferson o Bullitt o Boone o Kenton o Campbell
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Marketplace QHP Network
Extensive network of 8162 providers (Hospitals, Ancillaries, FQHCs and RHCs, Dental, Vision, Behavioral Health and Pharmacy providers) including:
• 2899 PCPs
• 2365 Specialists
• 221 FQHCs and RHCs
• 142 Behavioral Health Specialists
• 21 Hospital Systems
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Physician Network
Major Physician group networks:
• Kentucky Primary Care Association
• The Association of Primary Care Physicians
• Baptist Physician Group
• Kentucky Medical Services Foundation – UK HealthCare
• Saint Elizabeth Physicians and the Summit Medical Group
• Norton Physician Group
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Hospital Network
Hospital Network Includes:
• Baptist Health Hospital System
• Norton Health System
• Kosair Children’s Hospital
• University of Kentucky Health System
• Saint Elizabeth Health System
• Pineville Community Hospital
• Knox County Hospital
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2016 Plan Changes
• Bronze Plan Introduced
• Re-designed Silver & Gold Plans
o First three PCP visits Free - No cost share
o Waived Deductible on Key Benefits
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2016 Plan Changes
• Waived Deductible on Key Benefits (all plans except Catastrophic)
o PCP Office Visits
o Specialist Office Visits
o Outpatient Mental Health & Substance Abuse
o Physical, Occupational, and Speech Therapy
o Generic Drugs
• Pharmacy Formulary
o Changed from four-tier to five-tier formulary:
• Tier 1: Generic Drugs
• Tier 2: Preferred Brand Drugs
• Tier 3: Non-Preferred Brand Drugs
• Tier 4: Preferred Specialty Drugs
• Tier 5: Non-Preferred Specialty Drugs
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Plan Offerings - Catastrophic
Metal Level Catastrophic Individual Deductible $6,850
Family Deductible $13,700
Note Medical and Rx Combined
Individual Max Out-of-Pocket $6,850
Family Max Out-of-Pocket $13,700
Note Medical and Rx Combined
Medical Inpatient Hospital Care $0 after Ded
Emergency Care $0 after Ded
Urgent Care $0 after Ded
Outpatient Hospital Services $0 after Ded
X-Rays/Labs $0 after Ded
Advanced Imaging $0 after Ded
PCP Visits 1-3: $0 (Ded Waived) Visits 4+: $0 after Ded
Specialist $0 after Ded
Other Services Dental – Pediatric ü
Vision – Pediatric ü
Pharmacy Generic $0 after Ded
Preferred Brand $0 after Ded
Non-Preferred Brand $0 after Ded
Preferred Specialty $0 after Ded
Non-Preferred Specialty $0 after Ded 17
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Plan Offerings – Bronze Plan
Metal Level Bronze Individual Deductible $6,500 Medical / $300 Rx
Family Deductible $13,000 Medical / $600 Rx
Note -
Individual Max Out-of-Pocket $6,800
Family Max Out-of-Pocket $13,600
Note Medical and Rx Combined
Medical Inpatient Hospital Care $0 after Ded
Emergency Care $0 after Ded
Urgent Care $80 after Ded
Outpatient Hospital Services $0 after Ded
X-Rays/Labs Basic Lab: $40 (Ded Waived) X-Ray: $0 after Ded
Advanced Imaging $0 after Ded
PCP $40 (Ded Waived)
Specialist $80 (Ded Waived)
Other Services Dental – Pediatric ü
Vision – Pediatric ü
Pharmacy Generic $15 (Ded Waived)
Preferred Brand $75 (Ded Waived)
Non-Preferred Brand $125 after Ded
Preferred Specialty 35% after Ded
Non-Preferred Specialty 40% after Ded 18
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Plan Offerings - Silver
Metal Level Silver Silver 73 Silver 87 Silver 94 Individual Deductible $2,800 $2,800 $800 $0
Family Deductible $5,600 $5,600 $1,600 $0
Note Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined
Individual Max Out-of-Pocket $6,600 $5,300 $1,650 $975
Family Max Out-of-Pocket $13,200 $10,600 $3,300 $1,950
Note Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined Medical and Rx Combined
Medical
Inpatient Hospital Care 30% after Ded 30% after Ded $300 after Ded $175 Copay
Emergency Care 30% after Ded 30% after Ded $200 after Ded $150 Copay
Urgency Care $45 after Ded $45 after Ded $20 after Ded $15 Copay
Outpatient Hospital Services 20% after Ded 20% after Ded 10% after Ded 10%
X-Rays/Labs 20% after Ded 20% after Ded 10% after Ded 10%
Advanced Imaging 20% after Ded 20% after Ded 10% after Ded 10%
PCP $15 (Ded Waived) $15 (Ded Waived) $5 (Ded Waived) $0
Specialist $45 (Ded Waived) $45 (Ded Waived) $20 (Ded Waived) $15
Other Services
Dental – Pediatric ü ü ü ü
Vision – Pediatric ü ü ü ü
Pharmacy
Generic $5 (Ded Waived) $5 (Ded Waived) $5 (Ded Waived) $0
Preferred Brand $40 after Ded $40 after Ded $30 after Ded $20
Non-Preferred Brand $100 after Ded $100 after Ded $70 after Ded $45
Preferred Specialty 35% after Ded 35% after Ded 35% after Ded 35%
Non-Preferred Specialty 40% after Ded 40% after Ded 40% after Ded 40%
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Plan Offerings - Gold
Metal Level Gold Individual Deductible $1,500 Family Deductible $3,000
Note Medical and Rx Combined
Individual Max Out-of-Pocket $3,000
Family Max Out-of-Pocket $6,000
Note Medical and Rx Combined
Medical Inpatient Hospital Care 20% after Ded Emergency Care 20% after Ded Urgent Care $35 after Ded
Outpatient Hospital Services 20% after Ded
X-Rays/Labs 20% after Ded Advanced Imaging 20% after Ded PCP $20 (Ded Waived) Specialist $35 (Ded Waived)
Other Services Dental – Pediatric ü Vision – Pediatric ü
Pharmacy Generic $0 (Ded Waived) Preferred Brand $25 after Ded Non-Preferred Brand $100 after Ded Preferred Specialty 35% after Ded
Non-Preferred Specialty 40% after Ded 20
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Wellness Discounts
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• Online education tools. • Up to 30% discount on CAM
providers like acupuncture, chiro, diet/supplement advisors, exercise/movement, massage and relaxation.
• Additional discounts for Jenny Craig, eyeglasses, hearing screening and hearing aids, dental insurance and more.
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Community Assistance Line
• Transportation Homeless Services
• Food Assistance Education Assistance
• Financial Assistance Respite Care
• (Utility, Rent)
• Support Groups Other
• Disability-related Services
Refer any WellCare member in need of community-based social services
Get connected with the right social services.
CALL
KY CommUnity Assistance Line (CAL) 1-866-775-2192 Video Relay 1-855-628-7552
Free for WellCare of Kentucky members.
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New Member On Boarding
• New member kits sent out 5 days after receiving a completed enrollment.
• Members will receive their first bill within several days of enrollment. After the
first payment is received, a payment book will be mailed to subscriber on the
account.
• Members will need to select a Primary Care Physician (PCP), if not selected it
will be assigned. Members can change their PCP at any time.
• ID Cards will be mailed within 7 days of effectuated enrollment.
• Health Risk Assessment initiated to new members after effective date
(telephonic).
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Kentucky’s Choice for Medicaid
33%ofKYMedicaidMemberschooseWellCare
OEP
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
500000
SumofWellCare SumofAnthem SumofAetna(Coventry) SumofHumana SumofCentene SumofPassport
KentuckySpiritExit
ACABeginsOEP OEP
Region3
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Medicaid - Benefits
NO CHANGE FROM 2015
TWO COPAYS • $4 Non-Preferred Brand Medications
• $8 Non-Emergent ER Visits
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Medicaid – Extra Benefits
o Expanded benefits are effective tools used to enhance our member’s health and their quality of life.
o The benefits are designed to address members needs and help to remove barriers to care.
o We believe these benefits deliver meaningful, lasting improvements to our members, thereby delivering value to our providers and state partners.
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Extra Benefit Overview
Benefit BenefitDescrip3on EligiblePopula3on CostShare/Copay
MealProgram Eligiblemembersdischargedfrominpadenthospital,rehabilitadonorskillednursingfacilityreceive10mealspostdischarge(priorauthorizadonrequired..
MembersonatreatmentplanwithaCaseorDiseaseManagerthataredischargedwithintwoweeksfromaninpadentfacility
$0
HealthyRewardsProgram Membersarerewardedfortakingstepsthathelpthemtoliveahealthylife(i.e.,annualwellnessvisits,prenatalvisits,diabedcscreenings).
AllMembers
$0
SportsPhysical Membersage6-18receiveone(1)sportsphysicalperyear,providedbyaPCP,forchildrenage6-18.
Membersage6-18
$0
Over-the-Counter(OTC)Items
$120infreeOTCitemseachyeararemailedtomembershomes.Memberschoosefromover150items,likediapers,readingglasses,handsoap,dentaltravelkit,lodons,painrelieversandmore.
Allmembers
$0
GEDTes3ng Membersage16andup,withoutahighschooldiplomareceivepre-paidvoucherstotaketheGEDtest.
Membersage16andup
$0
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Extra Benefit Overview Cont.
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Benefit BenefitDescrip3on EligiblePopula3on CostShare/Copay
BabyShower Localbabyshowersareheldinthecommunitywherememberscananagend.Membersreceiveagirbasketanddpsandrecommendadonstokeepthemandtheirbabyhealthy.
Expectantmembers $0
Text4Baby® Text4baby,allowsmemberstogetcridcalhealthandsafetydpsdmedtotheirbaby’sageupundlbaby’sfirstbirthday.
Allmembers $0
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Meals Program
We understand the transition from a hospital setting back home can be challenging. Individuals often need additional support related to an underlying illness, recent surgery,
wound healing, or ongoing symptoms to avoid a return visit to the hospital.
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Members in Care Management can receive 10 meals delivered to their home within 14 days of discharge from hospital, rehabilitation or skilled nursing facility.
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FREE Sports Physical
A Sports Physical helps determine whether it's safe for children to participate in a particular sport. Most states actually require that kids and teens have a sports physical before they
can start a new sport or begin a new competitive season.
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OneFREESportsPhysicalforschool-agedchildren,annually.
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Healthy Behaviors Program
The Healthy Behaviors program will reward members who complete specific preventive health, wellness, and engagement milestones.
Enrollees will receive a reloadable Visa Debit Card or Gift Card.
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OurHealthyRewardsProgramisdesignedtopromoteahealthierlifestyle
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Popula3onSegment FocusArea Ac3vityCriteria Incen3veType Incen3veValue
Children'sHealth
0-15months WellChildvisitperperiodicityschedule(6visits) DebitCard $10visitsforatotalof$60
3-6years AnnualCheck-up DebitCard $20
7-21years AnnualCheck-up DebitCard $20
HealthyPregnancy
PrenatalCareVisits Agend6prenatalvisitsbeforethebirthofthebaby DebitCard $50
PostpartumCareVisits Agend1postpartumvisit21-56daysarerthebirthofthebaby
DiapersandDebitcard
6packsofdiapers
plus$20
Diabetes Diabetes
Completeeyeexam(Memberswithdiabetes18-75)DebitCard
$20
CompleteHgbA1C(Memberswithdiabetes18-75)DebitCard
$20
WellWomen
CervicalCancerScreening
Completeofofficevisitforcervicalcancerscreening(papsmear)(ages21-64)
DebitCard
$20
ScreeningMammogram
CompledonofScreeningmammogram–(ages40-65)
DebitCard
$20
AdultHealth AnnualAdult Completeannualadultscreening(WellnessVisit-members>21yrsold)
DebitCard
$20
Dental PreventadveDentalVisit
AnyprevendvedentalvisitforallWellCaremembersage5andup
DebitCard
$20
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Over-The- Counter (OTC)
The OTC benefit promotes self-directed prevention, maintenance and on-going medical management.
Items offered not only include traditional products (e.g. diapers, pain relievers, vitamins) but also eyeglass kits, reading glasses, and assistive aid devices such as pill containers or
magnifying glasses to improve adherence to medication usage and to avoid errors in taking their medications which could result in hospitalization.
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Memberscanorder$10inOTCitemspermonth,perhousehold
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GED Program
WellCare recognizes the importance of education for the overall health and wellness of our enrollees. We believe in empowering our enrollees and providing them access to knowledge
that will help them improve their health and quality of life. The GED exam benefit supports this belief by ensuring that our enrollees receive the
education needed to initiate this foundation of awareness.
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Throughthisbenefit,WellCarewillcoverthecostforthefourrequiredexams.
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Community Baby Showers
WellCare members who are expecting are invited to a community baby shower. Baby Showers are a way to give our expecting members tips for staying healthy and a gift basket
of helpful items.
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Through this program we are able to celebrate and educate our members.
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Text4Baby®
WellCare recognizes the importance of educating our members. Text4baby, allows members to get critical health and safety tips timed to their baby’s age up until baby’s first
birthday.
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Text4babyisFreeevenifmembersdon’thaveafreetextmessagingplan.**MemberswithaTracfonemustconfirmwiththeircarrier**
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Text4Baby® Cont.
Who is Eligible? All WellCare members
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How Does the Program Work? Topardcipateintheprogramallmembersneedtodoissendatextto,BABY(orBEBEforSpanish)511411.Whenpromptedmembersentertheirduedateandzipcode.MemberscancancelthisserviceatanydmebytexdngSTOP;fortechnicalassistancemembershouldtextHELP.MemberscanalsoTextUPDATEtochangetheirduedateorbaby'sbirthday.
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Extra Benefits - Community Assistance Line
• Transportation Homeless Services
• Food Assistance Education Assistance
• Financial Assistance Respite Care
• (Utility, Rent)
• Support Groups Other
• Disability-related Services
Refer any WellCare member in need of community-based social services
Get connected with the right social services.
CALL
KY CommUnity Assistance Line (CAL) 1-866-775-2192 Video Relay 1-855-628-7552
Free for WellCare of Kentucky members.
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Community Relations and Focused Giving
The WellCare Community Foundation Established in 2010, it is a non-profit, private foundation with a mission to foster and promote the health, wellbeing and quality of life for the poor, distressed and other medically underserved populations – including, those who are elderly, young and indigent – and the communities in which they live.
Employee Volunteerism WellCare encourages volunteerism to support children and seniors, and those who are low-income or underserved. Employees work in their local communities to raise much-needed funds and to support organizations that offer valuable support to those in need.
Community Relations
The Community Relations program educates and advocates for WellCare members and the community. Through it, we proactively facilitate communications with providers, members and the community to inform, educate, address health issues and encourage preventive health care.
WellCarestrivestohelpourmembersandtheircommuni3es,leadbe>erandhealthierlives.
In Kentucky, WellCare supports the work of community organizations and initiatives, including:
American Diabetes Association
American Red Cross
Coalition for the Homeless
Community Farm Alliance
Community Farmers Market
Community Ministries
HOTEL INC Homeless Outreach
Family and Children’s Place
Mama to Mama
Owensboro Regional Suicide Prevention Coalition
Volunteers of America of Kentucky
West Care
YMCA
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Questions
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QUESTIONS?
Outreach & Enrollment Track Kentucky Primary Care Association Annual Conference 2015