new plans and new benefits for 2022
TRANSCRIPT
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New plans and new benefitsfor 2022
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2021 STAR RATING
KCA HISTORIC STAR RATING.•5 Star Rated for 5 years in a row (2017, 2018, 2019, 2020, 2021)
•Only one in 20 plans in 2020 rated 5 Stars
•The ONLY plan in Houston in rated 5 Stars for 5 CONSECATIVE
•Voted Best MA Plan in Texas by US News (2017, 2018, 2019, 2020, 2021)
MEDICARE
5 STAR RATING
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KELSEYCARE ADVANTAGE SERVICE AREA
• Austin
• Brazoria
• Chambers
• Fort Bend
• Galveston
• Grimes
• Harris
• Liberty
• Montgomery
• San Jacinto
• Waller
• Walker
• Wharton
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New clinic locations
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Number of Clinics: 22Number of Providers: 540
Number of Clinics: 29Number of Providers: 598
Number of Clinics: 38Number of Providers: 701
Number of Clinics: 43Number of Providers: 847
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New Plans = New Names
2021 Plan Names 2022 Plan Name MA Type Plan Type Service Area
- Platinum – NEW! MA-PD HMO 5 Counties
Rx Gold MA-PD HMO 5 Counties
Rx+Choice Gold Freedom MA-PD HMO-POS 5 Counties
Essential Silver MA Only HMO 5 Counties
Essential+Choice Silver Freedom MA Only HMO-POS 5 Counties
Essential Select Silver Community MA Only HMO-POS Surrounding Counties
Rx Select Gold Community MA-PD HMO-POS Surrounding Counties
5 Counties = Harris, Brazoria, Fort Bend, Galveston, MontgomerySurrounding Counties = Austin, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, Wharton
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New Plan NameMonthly Premium
Drug Coverage
Provider NetworkComprehensive
Dental
Platinum – NEW! $0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC X
Gold Freedom $0(down from $77)
XIn-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)X
Gold $0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC Only w/ add-on
Silver $0 Kelsey-Seybold Clinic: Referrals needed for outside of KSC X
Silver Freedom $0In-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)X
Silver Community
$0In-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)Only w/ add-on
Gold Community $15 XIn-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)Only w/ add-on
Quick Comparison
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New Freedom PlansGold Freedom | Silver Freedom
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You can keepyour current doctorIn addition to Kelsey-Seybold physicians, Freedom Plans allow members
to keep their out-of-network doctor with a low copay & $0 monthly premium.
Talk about a game-changer!
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Taking Advantage on In-Network Cost-Share Accessing Out-of-Network Cost-Share
Member sees aKelsey-Seybold Clinic PCP
$0Member sees an
out-of-network PCP$10
Member sees aKelsey-Seybold Clinic specialist
$25Member sees an out-of-network
specialist$35
Member sees an affiliate providercontracted with Kelsey
$25 Member sees anMD Anderson provider
40%
No referrals needed! No referrals needed!
Freedom in action
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MEDICAL+DRUGCOVERAGE
Gold (HMO) 5 core counties
Gold Freedom (POS) 5 core counties
Gold Community (POS) 8 outlier counties
Platinum (HMO) NEW! 5 core counties
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MAPD w/Drug Coverage / Value-Added Benefits
Platinum Gold Gold Freedom Gold Community (outlier counties)
IP Hospital $350/stay $375/stay $375/stay $375/stay
T2 Drug $0/$15 $0/$15 $0/$15 $0/$15
DentalComprehensive with
$1,500 limitPreventive + option to purchase
supplemental ($32.80)Comprehensive with
$1,500 limit
Preventive + option to purchase supplemental
($32.80)
COVID-19Benefit
Yes Yes Yes Yes
OTC $25 monthly $25 quarterly $25 monthly $25 quarterly
Wellness Benefit
Yes No Yes No
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MEDICAL COVERAGE ONLY
Silver (HMO) 5 core counties
Silver Freedom (POS) 5 core counties
Silver Community (POS) 8 outlier counties
1313
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MA Only Value-Added Benefits
Silver Silver Freedom Silver Community(outlier counties)
IP Hospital $325/stay $325/stay $325/stay
DentalComprehensive with
$1,500 limitComprehensive with
$1,500 limitPreventive + option to purchase
supplemental ($32.80)
COVID-19Benefit
Yes Yes Yes
OTC $50 quarterly $50 quarterly $25 quarterly
Vision Allowance
$125 $125 $75
Wellness Benefit Yes Yes No
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Morechangesfor 2022
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Comprehensive dental*With $1,500 allowance
Plus …
• $0 copay for Tier 1 & 2 drugs*
• Increased vision allowance*
• Wellness benefit* –up to $100 a year in gift card rewards
• COVID-19-related care and waiver of IP copay
• Simplified in-hospital stay copays
• Monthly and/or quarterly OTC allowances*
* Available in specific plans
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2022 PART D SUMMARY
MAPD w/ DRUG COVERAGE MA ONLYOUTLIER COUNTIES (MA/MAPD-POS)
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO
(001)Silver Freedom
POS (003)Silver Community
POS (007)
Gold Community POS (008)
$15 premium
Part D Deductible $100 (T3, T4, T5) $100 (T3, T4, T5) $100 (T3, T4, T5)
No Drug CoverageNo Drug
Coverage
$100 (T3, T4, T5)
T1 Drug $0/$3 $0/$3 $0/$3 $0/$3
T2 Drug $0/$15 $0/$15 $0/$15 $0/$15
T3 Drug $40/$45 $40/$45 $40/$45 $40/$45
T4 Drug $80/$90 $80/$90 $80/$90 $80/$90
T5 Drug 31% 31% 31% 31%EXCLUDED drugs covered
Generic Viagra with QL 6/30days
Generic Viagra with QL 6/30days
Generic Viagra with QL 6/30days
Generic Viagra with QL 6/30days
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VALUE ADDED BENEFITS: DENTAL BENEFITS
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO (001)
Silver Freedom POS (003)
Silver Community POS (007)
Gold Community POS (008)
Embedded Preventive Dental (mandatory) + Optional Buy-Up (Supplemental)
Prev Included + Option to
Purchase Supp($32.80
premium)
No No No No
Prev Included + Option to
Purchase Supp ($32.80
premium)
Prev Included + Option to
Purchase Supp($32.80
premium)
Comprehensive included in plan (mandatory)
No$1,500 Comp
Included$1,500 Comp
Included$1,500 Comp
Included$1,500 Comp
IncludedNo No
$25 per visit copay*
Once the member reaches the $1,500 threshold everything else is their responsibility, which is 0%/0% for the preventive and diagnostic services and 50% coinsurance for each of those comprehensive procedures listed
in the Dental EOC. Product doesn’t have a per visit copay it has per procedure coinsurance.
$25 per visit copay*
$25 per visit copay*
*Covers certain preventative services: Oral exam, Comprehensive oral exam, Adult Cleaning – prophylaxis, Intraoral-Complete Series of Radiographic Images, Bitewings (2 or 4) 18
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VALUE ADDED BENEFITS CONTINUED
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO (001)
Silver Freedom POS (003)
Silver Community POS (007)
Gold Community POS (008)
Vision Allowance contacts/glasses
$75 $125 $125 $125 $125 $75 $75
OTC Monthly Benefit
-- $25 $25 -- -- -- --
OTC Quarterly Benefit
$25 -- -- $50 $50 $25 $25
Up to $100/yrWellness Benefit (based on health actions)
Not Offered Yes Yes Yes Yes Not Offered Not Offered
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VALUE ADDED BENEFITS CONTINUED
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO (001)
Silver Freedom POS (003)
Silver Community POS (007)
Gold Community POS (008)
Hearing Aid Allowance
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
Inpatient Cost Share waived with COVID19 diagnosis, all testing and related visits as well as Meal Delivery post discharge (w/ covid diagnosis) 2 meals per day for 7 days*
Yes Yes Yes Yes Yes Yes Yes
20 one-way trips to medical appointments
Yes Yes Yes Yes Yes Not Covered Not Covered
*EGWPs not covered20
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Thank you!