medigap & medplus trainingfirst mailer from silversneakers, the initial member engagement touch...

CareFirst MedPlus is the business name of First Care, Inc., which is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association.

SilverSneakers is a product owned by Healthways, Inc., an independent company that is solely responsible for their products and provides services to CareFirst MedPlus members. Healthways does not sell BlueCross or BlueShield products. Healthways, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Healthways, Inc. and/or its subsidiaries. SilverSneakers is not a benefit

guaranteed through your Medigap insurance Policy. It is, however, a health program option made available outside of the Policy to CareFirst MedPlus members.

PROPRIETARY AND CONFIDENTIAL

Medigap & MedPlus Training

Consumer Direct Brokers

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June 2016


Maryland Medicare Supplemental (Med Supp) Background

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Competitive Issues in Maryland Medigap Product space historically: Uncompetitive Rates Locked into 5 year Age Bands for some plans Few Discounts Less strict underwriting than competitors

What is CareFirst doing to be more competitive in Maryland? Initiating 8 products in Maryland to be sold under the existing legal entity First Care,

Inc. that is currently inactive and previously used for Medicare Part D business. Key features which will include:

– All Plans with 1 Year Age Bands– More competitive rates– Ability to offer more Discounts– SilverSneakers– Tightening up Medical Underwriting Guidelines

When? Launching July 24th for August 1, 2016 effective dates in Maryland Future plans to launch in DC & VA will be announced soon


Current Medigap vs. MedPlus in Maryland

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Features Current Plans MedPlus

All Plans 1 Year Age Bands

EFT / Autopay Discount

Annual Pay Discount (under MedPlusmember chooses between the

EFT/Autopay OR the Annual Discount

Household Discount

SilverSneakers Fitness Program

Geographical Rating

8 Plans Offered – A, B, F, High Deductible F, G, L, M, & N


MedPlus Maryland Discount Information

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Available Discounts Household Discount EFT (Electronic Funds Transfer) Or Annual Payer

Where will members see the discount Print On Demand Book Broker iStore and Portal Application Pre-Sale Brochures


MedPlus

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Household Discount - Where is the discount? In the Print On Demand Books:

o In the cover lettero In the Why Choose CareFirst sectiono In the Apply Today section


MedPlus

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EFT OR Autopay Discount - Where is the discount? In the pre-sale brochures:

o In the cover lettero In the Why Choose CareFirst sectiono In the Apply Today section


MedPlus - Discounts

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Discounts are also described on the Broker iStore• The quoted rate will

always reflect the base rate.

• They will see any discounts they qualify for in their first invoice.


Additional Information

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Geographical Rating 4 Geographic Rating Areas: Baltimore Metropolitan Area, Eastern & Southern

Maryland (E&S), Washington D.C. Metropolitan Area and Western Maryland Having the ability to Geographically Rate allows CareFirst more flexibility in

market growth and with future business

Dental and Vision Plans are Available Dental

o Dental plans can be added to MedPlus Coverage at an additional cost. Vision

o A vision plan can be added to MedPlus Coverage at an additional cost.


MedPlus

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Medigap UW Matrix The system will Medically Underwrite people who move into a “richer” plan. For MD, people moving from GHMSI or CFMI Legal Entity into a new First Care Legal Entity shall be

Medically Underwritten, unless they qualify for the Open Enrollment/Guarantee Issue. For MD, a person moving from a GHMSI or CFMI Legal Entity into First Care Legal Entity must reapply

for Vision benefit if it existed on the current plan. For DC and VA, a person moving from Grandfathered Plan into Actively Sold 2012 Plan shall be

Medically Underwritten. For DC and VA, a person moving from a Grandfathered Plan into Actively Sold 2012 Plan shall retain

his/her Vision coverage if it existed on the Grandfathered Plan.

Move within MedPlus (MD) or Current Plans (DC/VA): To

From High Ded F Plan A Plan N Plan L Plan B Plan M Plan G Plan F

High Ded F N/A Yes Yes Yes Yes Yes Yes YesPlan A No N/A Yes Yes Yes Yes Yes YesPlan N No No N/A No Yes Yes Yes YesPlan L No No No N/A Yes Yes Yes YesPlan B No No No No N/A No Yes YesPlan M No No No No No N/A Yes YesPlan G No No No No No No N/A YesPlan F No No No No No No No N/A


MedPlus ID Cards

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<Client Logo Here>

Healthways SilverSneakers® Fitness

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SSFPBNAT_48 8.14

Agenda

SilverSneakers ValueMember EngagementAcquisition and Retention

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SilverSneakers Value

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SSFPBNAT_48 8.14

Member Experience

Based upon 35,908 SilverSneakers enrollees experience with SilverSneakers:

67%73%68%54%

Stated they are more likely to stay with their health plan because of SilverSneakers.

Stated they are more likely to recommend their health plan to family or friends as a result of their participating in the program.

Rated their health plan a 9 or 10 on a scale of 1 to 10, with an average rating of 8.8 (10 being the best)

Indicated they would likely switch plans if SilverSneakers were no longer offered.

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Source: Healthways 2014 National Annual Participant Survey Data

SSFPBNAT_48 8.14

FLEX

Older AdultWellbeing

GETTING STARTED ACTIVE ATHLETE

Shared Components / Common Elements / Progression

Programming for Everyone

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SSFPBNAT_48 8.14

Class Programming

SIGNATURE CLASSES

• SilverSneakers Classic

• SilverSneakers Circuit

• SilverSneakers CardioFit

• SilverSneakers Yoga

• SilverSneakers Splash

EXPANDED FITNESS CHOICES

• Tai Chi• Pole Walking• Zumba• and more!

NEXT GENERATION

FITNESS

• BOOM Move It ™

• BOOM Mind ™

• BOOM Muscle ™

GYM CLASSES

• Les Mills• Pilates• Spin• Jazzercise• Tabata• BodyFlow• Barre• and more!

®

®

®

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SSFPBNAT_48 8.14

Diverse Nationwide Coverage

13,000+ LOCATIONSNATIONAL RECIPROCITY

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SSFPBNAT_48 8.14

Member Engagement

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SSFPBNAT_48 8.14

How Health Plan Members Enroll

Members are encouraged to enroll and participate in SilverSneakers through health plan communications and targeted marketing.

New health plan members receive their first mailer from SilverSneakers, the Initial Member Engagement Touch (IMET), shortly after joining the plan.

SilverSneakers members may request a replacement ID card and print a temporary card at silversneakers.com, or they can call customer service at 1-888-423-4632 to request a card. The permanent card will be mailed to the member’s home.

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SSFPBNAT_48 8.14

Self-Directed Member Experience

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MEMBER WEB

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21PROPRIETARY AND CONFIDENTIAL

Medigap Refresher


Medigap Refresher: CareFirst’s Portfolio

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CareFirst sells 8 of the 11 Standardized Plans:

A B F HI-F G L M N

New-ish!Most Popular

G, L and M: Lower-cost plans launched in 2012• Added premium options for prospects at different price points • More people, especially in small groups, have HSA funds that can be used to pay for

Medigap cost sharing upon retirement• Boomers are accustomed to plans with more cost sharing

35% increase in Enrollment

nationally(2011-2012)3

3: AHIP, “Trends in Medigap Coverage and Enrollment, 2012” May 2013 http://www.ahip.org/Trends-Medigap-Coverage-Enroll2012/

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What Medicare Does Not Pay:

With Original

Medicare alone,

You Pay:

Choose Medigap

Plan A and You Pay:

Choose Medigap

Plan B and You Pay:

Choose Medigap

Plan F and You Pay:

Choose Medigap Plan

High Deductible F* and You Pay:

Choose Medigap

Plan G and You Pay:

Choose Medigap

Plan L** and You Pay:

Choose Medigap

Plan M and You Pay:

Choose Medigap

Plan N and You Pay:

Inpatient hospital deductible $1,288 $1,288 $0 $0$0 after plan deductible $0

25%(or $322)

50%(or $644) $0

Hospital days 61-90 $322/day $0 $0 $0$0 after plan

deductible $0 $0 $0 $0

Hospital days 91-150 (lifetime reserve) $644/day $0 $0 $0

$0 after plan deductible $0 $0 $0 $0

365 days after hospital benefits stop $0/day $0 $0 $0$0 after plan

deductible $0 $0 $0 $0

Skilled nursing facility days 21-100 $161/day $161/day $161/day $0$0 after plan

deductible $0 $40.25/day $0 $0

Medical expense deductible $166 $166 $166 $0$0 after plan

deductible $166 $166 $166 $166

Medical expenses after deductible 20% $0 0% $00% after plan

deductible $0 5% $0Office Visit: Up to $20; ER visit: Up

to $50

Excess charges above Medicare approved amounts 100% 100% 100% $0

0% after plan deductible $0 100% 100% 100%

Foreign country emergency care (up to $50,000 lifetime max) 100% 100% 100%

$250 deductible, then 20%

$250 deductible after plan deductible,then 20%

$250 deductible, then 20% 100%



Dollar amounts shown are the 2016 deductibles, copayment and coinsurance. These amounts may change on January 1, 2017.*With High-Deductible Plan F, there is an annual plan deductible of $2,180 ; after you meet the $2,180 annual plan deductible, you pay $0.**With Plan L, there is an Out-of-Pocket limit of $2,480; After you meet $2,480 in out-of-pocket expenses, you pay $0.

Other Expenses

What You Pay with Original Medicare vs. What You Pay with CareFirst Medigap plans

Hospital Services (Part A)

Medical Expenses (Part B)

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What Medicare Does Not Pay:

With Original

Medicare alone,

You Pay:

Choose Medigap Plan

High Deductible F* and You Pay:

Choose Medigap

Plan L** and You Pay:

Choose Medigap

Plan N and You Pay:

Choose Medigap

Plan A and You Pay:

Choose Medigap

Plan M and You Pay:

Choose Medigap

Plan B and You Pay:

Choose Medigap

Plan G and You Pay:

Choose Medigap

Plan F and You Pay:

Hospital Services (Part A)

Inpatient hospital deductible $1,288$0 after plan deductible

25%(or $322) $0 $1,288

50%(or $644) $0 $0 $0

Hospital days 61-90 $322/day$0 after plan

deductible $0 $0 $0 $0 $0 $0 $0

Hospital days 91-150 (lifetime reserve) $644/day

$0 after plan deductible $0 $0 $0 $0 $0 $0 $0

365 days after hospital benefits stop $0/day$0 after plan

deductible $0 $0 $0 $0 $0 $0 $0

Skilled nursing facility days 21-100 $161/day$0 after plan

deductible $40.25/day $0 $161/day $0 $161/day $0 $0

Medical Expenses (Part B)

Medical expense deductible $166$0 after plan

deductible $166 $166 $166 $166 $166 $166 $0

Medical expenses after deductible 20%0% after plan

deductible 5%Office Visit: Up to $20; ER visit: Up

to $50 $0 $0 0% $0 $0

Excess charges above Medicare approved amounts 100%

0% after plan deductible 100% 100% 100% 100% 100% $0 $0

Other Expenses

Foreign country emergency care (up to $50,000 lifetime max) 100%

$250 deductible after plan deductible,then 20%

100%$250 deductible,

then 20% 100%$250 deductible,

then 20% 100%$250 deductible,

then 20%$250 deductible,

then 20%

Dollar amounts shown are the 2016 deductibles, copayment and coinsurance. These amounts may change on January 1, 2017.*With High-Deductible Plan F, there is an annual plan deductible of $2,180 ; after you meet the $2,180 annual plan deductible, you pay $0.**With Plan L, there is an Out-of-Pocket limit of $2,480; After you meet $2,480 in out-of-pocket expenses, you pay $0.

What You Pay with Original Medicare vs. What You Pay with CareFirst Medigap plans

Lower Priced Moderately Priced Higher Priced

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Key Plan Differences:

Plan G gives members comprehensive coverage similar to Plan F at a lower cost—members are just responsible for paying the Part B deductible. As with Plan F, it provides coverage for Balance Billing (coverage for the extra charges for doctors who do not accept Medicare allowance).

Plan M is a moderately priced plan with coverage similar to Plan G, except members must also pay 50% of the Part A deductible and balance billing charges. As with Plan G, the member is responsible for the Part B deductible.

Plan L is one of the lower priced Medigap options covering most basic benefits at 75%, including the Part A deductible. Yet Plan L still provides for 100% hospitalization after the Part A deductible. As with Plans G and M, the member is responsible for the Part B deductible.

Medigap Refresher: Medigap Plans G, L, and M

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All Members who apply for a plan change that requires medical underwriting must be informed of the following:1. The potential outcomes of medical underwriting: so the member can decide

whether to continue pursuing a plan change.a) Based upon medical underwriting, the plan the member is coming from, and

the plan selected, the member may get a lower rate, a higher rate, or be “denied” for the new Medigap Plan (under the new rating methodology)

2. The member should NOT terminate their original coverage until the results of medical underwriting for the new plan are known.

3. The member ALWAYS has the right to remain in his/her original plan:a) If the member is denied coverage under medical underwriting, he or she will

remain in their original coverage. b) Once the new coverage has been approved by medical underwriting, the

member is termed from his/her original coverage. If the member wants to remain in his/her original coverage (e.g., the rate for the new plan is higher), the member has 30 days from the effective date of the new policy to contact Customer Service and request to be placed back into his/her original policy/coverage.

Medigap Refresher: Medical Underwriting

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Medigap: Updated Rating Methodology StructureKey Changes MD: All Plans (MedPlus) DC and VA: All Plans

Household Discount Yes No

Geographical Rating Yes No

SilverSneakers Fitness Program Yes No

Age Bands 1 Year

Pre-Existing Waiting Period No

Guaranteed Acceptance Only during Open Enrollment or Guaranteed Issue Period

Medical Underwriting(if outside Open Enrollment/ Guaranteed Issue Period)

Yes

Gender Rating Yes

Tobacco Rating (if outside Open Enrollment/ Guaranteed Issue Period)

Yes

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Medigap Open EnrollmentThe best time for a beneficiary to sign up is during their Medigap open enrollment period.The Medigap Open Enrollment Period lasts for 6 months, beginning the 1st day of the month when an individual is both:

65 years old or older, and Enrolled in Medicare Part B

Note: If an individual was born on the first date of any month, he or she is considered to have turned 65 on the first of the previous month. For example, if an individual’s birthday is February 1st, he or she is deemed to have turned 65 on January 1st.

For an individual under age 65 and disabled, the Open Enrollment Period begins when the individual enrolls in Medicare Part B. These members are only eligible to purchase Plan A.

Delaying Part BSome Medicare beneficiaries automatically get Part A and Part B upon turning 65. However, they have the option to delay enrollment in Part B. For example, a beneficiary may still be getting benefits through their or their spouse’s employer.

Once the employment or coverage ends, a beneficiary has 8 months to sign up for Part B without a penalty. This is regardless of whether they choose COBRA or not. They still need to sign up for Part B within 8 months to avoid the penalty.

Once they enroll in Part B, their Medigap open enrollment will start.

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ACA and MedicareIf an ACA member becomes eligible for Medicare (for example, when they turn 65): They have the option to stay in their ACA plan, however, they will lose any

subsidy they are currently receiving. It is in their best interest to sign up for Medicare when first eligible to avoid late

enrollment penalties Similarly, beneficiaries want to act quickly if they want to buy a Medigap plan,

as they risk higher premiums or denial of coverage if they do not sign up during open enrollment. If the ACA member purchased on the exchange, they will have to go back to

the exchange to disenroll. Any dependents on the ACA plan would have to sign up for a new plan and would be able to reapply for any subsidy. Notices will be sent to ACA members approaching age 65 that explains their

options.If someone is eligible for Medicare, they cannot buy an ACA plan

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Reminder…Medigap has different business rules than ACA.• No initial payment is required• Effective date cutoff is at the end of the month


CareFirst MedPlus Marketing Strategy

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2016 MedPlus Marketing Plan Overview

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Important dates and things to remember: 6/20 is the cutoff date for MG – Maryland MediGap-65.

o If an individual wants to apply after 6/20 for a 7/1 effective date, he/she needs to go online.

7/24 CareFirst MedPlus (MD) will launch for 8/1 effective and backlogs will be released.

DC and Virginia will remain business as usual at this time. SUD – DC Supplement-65 SUV – Virginia Supplement-65

Medigap activity (e.g. research, quote, buy) spikes 3 months out from an individual’s 65th birthday

Shopping habits center around 1) friends & family, 2) Internet, 3) Mail; After talking with friends/family, 70% read direct mail and 48% attend a seminar


Applications and Pre-Sale Brochure

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CareFirst MedPlus (MD) – Geo Rating

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Geo-rating will be introduced in Maryland for Over-65.

(Same geo-areas as ACA Maryland)


MedPlus Maryland Application Changes

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This section will be used to collect data for the new 10% household discount.

New CareFirst MedPlus logo and First Care, Inc. legal entity.


MedPlus Application Changes

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Billing frequency was added (monthly or annually).

Other notable changes: Waiting period language removed

Health Evaluation section updated by

Medical Underwriting

MIB language removed

CareFirst MedPlus replaced

CareFirst BlueCross BlueShield

language


Sales Materials

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Additional MedPlus Marketing Materials

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The following marketing materials have been updated for MedPlus and will be ready for use in Maryland-only in July (pending MIA approval).

Please note: these materials will be updated and reprinted once MedPlus has been approved in DC and VA (dates TBD).

Medicare Made Simple Guide (GMED) Educational resource about Medicare for

seniors for sales and broker useMedicare Supp Insurance Solutions Postcard Quick reference guide and sell sheet

highlighting CareFirst’s 8 Medigap plans for sales and broker use

Broker Retiree Flyer Provides an overview of Medigap plans,

CareFirst MedPlus advantages, and quick tips for retirees; designed for brokers to give to employer groups to distribute to retirees

Medicare Made Simple Guide

Medicare Supp Insurance Solutions Postcard

Broker Retiree Flyer


New Marketing Materials – Broker Retiree Flier

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This flier will be provided to Brokers so that personalized contact information can be added.


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medigap & medplus trainingfirst mailer from silversneakers, the initial member engagement touch...

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