Agents Playbook 2017 Louisiana Market September 2016
This Material Is For Educational Purposes Only This material cannot be used for marketing and sales purposes per CMS guidelines This is Humana proprietary information and cannot be shared with others outside of Humana. Please see Summary of Benefit documents for complete benefit details. Confidential Information – For Agents Only
A Message From Our Director The 2017 AEP is just around the corner. I want to thank you for your contributions to our 2016 campaign to date, which once again has Louisiana ranked in the Top 10 markets in Humana. You have accomplished much this year and I want to acknowledge your outstanding performance: AEP 13,911 sales ROY 13,141 sales Campaign to date 27,042 sales (Will be over 31,000 sales by end of 2016) Net Growth to date: 7,590 net new members as of July 1 (closest competitor 2,093) Total Membership Over 264,000 Thank you for an awesome performance. As is usual in the business, we will have some benefit and premium changes for the new year. However, we will continue to be extremely competitive in all markets in the state with HMO, Local PPO and Regional PPO plans as well as Special Needs Plans (SNP) for those with Medicare and Medicaid eligibility and a Special Needs Plan in New Orleans for Diabetes & Heart disease. We are positioned well to support you and your clients with Humana offices in New Orleans, Baton Rouge, Lafayette, Lake Charles and Shreveport. We have Humana Guidance Centers in New Orleans and Baton Rouge to support our commitment to improving health in the communities we serve with educational and interactive health and social programing. Humana represents an excellent value for your prospects and clients especially when you consider all of the unique extras that are part of being a Humana member: Local offices with in person customer service Competitive benefits Open model HMO that allows our members to see any Humana HMO provider in the state No referral needed for specialist visits 24/7 nurse hotline Meals delivered to the home following facility stay Personal health coach Incentive plan to reward members for healthy behavior Over The Counter benefit for medical supplies Best wishes for a successful new year, Cas Fitzpatrick Market Director, Humana Senior Products Confidential Information – For Agents Only
2016 Sales % Total YOUR ACCOMPLISHMENTS External Agents 15,349 51.4% All Channels 29,861
Humana Top 10 Markets Market MA Sales CTD MA Sales ROY North Carolina 47,084 15,295 Ohio 38,041 Louisiana 15,178 Puerto Rico 35,656 Greater Tampa Bay 14,748 Northeast Texas 32,856 11,779 30,280 Virginia 9,980 29,091 Tennessee 9,360 Kentucky/West Virginia 27,990 9,308 27,821 9,179 Atlanta 24,821 Dade 8,812 Indiana 24,459 KS/KC/MO 8,345
Our Values
Lead Product By Parish Green HMO Yellow LPPO Red RPPO Confidential and proprietary. For Humana internal use only. 7/26/16 (v1.0)
Your Sales Management Team Caswell Fitzpatrick, Market Director 504 615-5435 Elizabeth Gremillion Market Manager Northshore/New Orleans 504.564.3158 Steve Kent Northeast/Northwest 318.773.8858 Tim Klein Lake Charles/Alexandria 337.496.6565 Dale LaBorde Baton Rouge 504.214.9200 Miguel Delgado Lafayette 225.281.6542 Rebecca Rome New Orleans/Bayou/River Region 225.323.5020 Philippe Lannelongue Manager Sales Administration 504.667.4365 Brenda Boudreaux Marketing Support Specialist 337.288.9632 Amy Schneider 504.202.7270 8 Confidential Information – For Agents Only
Manager Territories Blue: Steve Kent Green: Tim Klein Yellow: Miguel Delgado Brown: Dale LaBorde Purple: Elizabeth Gremillion Pink: Rebecca Rome Red Dots: Career Agents Pink Star: Humana Office Purple Box: Humana Guidance Center
Rebecca Rome Elizabeth Gremillion Manager Territories Parish Manager Acadia Miguel Delgado Allen Tim Klein Ascension Dale LaBorde Assumption Rebecca Rome Avoyelles Beauregard Bienville Steve Kent Bossier Caddo Calcasieu Caldwell Cameron Catahoula Claiborne Concordia De Soto East Baton Rouge East Carroll East Feliciana Evangeline Franklin Grant Iberia Iberville Jackson Jefferson Elizabeth Gremillion Jefferson Davis La Salle Lafayette Lafourche Lincoln Livingston Parish Manager Madison Steve Kent Morehouse Natchitoches Orleans Rebecca Rome Elizabeth Gremillion Ouachita Plaquemines Rebecca Rome Pointe Coupee Dale LaBorde Rapides Tim Klein Red River Richland Sabine St. Bernard Elizabeth Gremillion St. Charles St. Helena St. James St. John the Baptist St. Landry Miguel Delgado St. Martin St. Mary St. Tammany Tangipahoa Tensas Terrebonne Union Vermilion Vernon Washington Webster West Baton Rouge West Carroll West Feliciana Winn Elizabeth Gremillion NOLA Zip Codes 70002 70005 70116 70117 70119 70122 70124 70126 70127 70128 70129
Louisiana MarketPOINT Retail Offices Metairie 8814 Veterans Memorial Blvd, Suite 12 Metairie, LA 70003 (504) 667-4370 Baton Rouge 10330 Airline Hwy, Suite 1-2 B Baton Rouge, LA 70816 (225) 442-6103 Lafayette 4422 Ambassador Caffery Pkwy, Suite A Lafayette, LA 70508 (337) 541-6320 Lake Charles 3625 Nelson Road, Suite B Lake Charles, LA 70605 (337) 508-3990 Shreveport 910 Pierremont Road, Suite 410 Shreveport, LA 71106 (318) 861-8609 Confidential Information – For Agents Only
Important Phone Numbers & Addresses Send Medicare Payment To: Humana Billing Department Humana Insurance Company P.O. Box 3024 Milwaukee, WI 53201-3024 If using a Money Order or Check, please include your Humana ID #. Rx Mail Order: Humana Pharmacy 800 379-0092 WalMart 800 273-3455 Mail order forms are available at: www.humana.com Silver Sneakers www.silversneakers.com Customer Service 888 423-4632 MAPD & PDP Paper Applications Humana Medicare Enrollment 2432 Fortune Drive Lexington, KY 40509 FAX: 877 889-9936 A cover sheet with your SAN# is required when faxing! Add your email address and receive a receipt email confirmation. All applications must be faxed or mailed within 24 hours. Confidential Information – For Agents Only
Ordering Sales Materials Agent Support 800-309-3163 When ordering materials, please be specific by citing the plan option number for each MAPD and Part D plan you will be selling. Emergency Supplies An emergency stock of sales materials may be obtained by contacting one of our local offices. When ordering emergency supplies, please call the local office nearest you, and request your supplies by referring to the specific plan option number for each MAPD and Part D plan for which you need supplies. 13 Confidential Information – For Agents Only
Strategic Data 2017 Plans
Statewide Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 65.2% 0.6% 21.6% 0.9% 4.2% 6.3% Net Growth 7,590 1,500 687 -422 213 2,093
Lafayette Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 76.3% 1.2% 1% 0.6% 15.3% 5.1% Includes: Acadia, Evangeline, Iberia, Lafayette, St Landry, St Martin, St Mary, Vermillion
Lake Charles/Alexandria Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 74.0% 0.0% 0.6% 3.5% 18.7% Includes: Allen, Avoyelles, Beauregard, Calcasieu, Cameron, Catahoula, Concordia, Grant Jefferson Davis, LaSalle, Rapides and Vernon
Calcasieu; Cameron; Grant; Lafayette; Rapides Humana Gold Plus HMO H1951-025 MAPD Service Area Calcasieu; Cameron; Grant; Lafayette; Rapides Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $195 copay/day Days (1-7) Preferred Hospital SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $10 Specialist Co-pay $40 Outpatient Surgery $200 ASC / $250 OP Hosp Advanced Imaging $200 copay Part D Benefit Rx Deductible $295, ICL $3700, TrOOP $4950 $10/$20/$47/$100/27% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Nursing Hotline; Fitness Program; Counseling Services; Health Education Services; Humana Pharmacy OTC; $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental High PPO OSB001/Premium $17.30 Other Value Added Services: Complimentary & Alt Med., Dental Discounts, NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at WalMart®, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 18 Confidential Information – For Agents Only
Service Area Humana Gold Plus HMO H1951-042 MAPD Acadia; Caldwell; Catahoula; East Carroll; Franklin; Iberia; Jackson; Lincoln; Madison; Morehouse; Ouachita; Richland; St. Landry; St. Martin; Tensas; Union; Vermilion; West Carroll Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $215 copay/day Days (1-8) SNF $0 copay/day Days (1-20)/ $164.50 copay/day Days (21-100) PCP Co-pay $15 copay Specialist Co-pay $50 copay Outpatient Surgery $250 ASC $275 OP Hosp Advanced Imaging $250 copay Part D Benefit RX $200; ICL $3700; TrOOP $4950.00 $10/$15/$47/$100 - 29% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order cost Sharing 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision & Hearing Services; Silver Sneakers; HumanaFirst; Humana Wellness; LifeSynch; QuitNet Smoking Cessation; Independent Living System; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complementary & Alternative Medicine, LifeCard Plans, Dental, Vision & Hearing Discounts, Lifeline Program, NutriSystems Discount, Rx Discount, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 19 Confidential Information – For Agents Only
Service Area Humana Choice PPO (Louisiana) H6609-104 MAPD Calcasieu; Caldwell; Cameron; La Salle; Lafayette; Morehouse; Ouachita; St. Landry; St. Martin; St. Mary; Washington Premium $47 MOOP $6700 Plan Deductible $750.00 All services received from in network providers are excluded from the combined deductible. Services not covered by Original Medicare, Ambulance services, Emergency room services, Urgently Needed Care, Immunizations (Flu & Pneumonia) received from out-of network providers are also excluded from the combined deductible. Inpatient Cost Share $225 copay/day Days (1-7) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $5 copay Specialist Co-pay $50 copay Outpatient Surgery $175 ASC $225 OP Hosp Advanced Imaging $175 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 - Preferred Mail Order 90 day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental; Vision & Hearing Services; Nursing Hotline; Humana Wellness; Health Education Services; Silver Sneakers; Humana Vitality; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental –High PPO $17.30 MyOption Plus $17.70 MyOption Vision $15.30 Please refer to plan Summary of Benefits and EOC for full explanation of benefits 20 Confidential Information – For Agents Only
Northwest Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 72.3% 0.0% 1.7% 20.8% Includes: Bienville, Bossier, Caddo, Claiborne, De Soto, Jackson, Lincoln, Natchitoches, Red River, Sabine, Webster and Winn
Bossier; Caddo; Webster Humana Gold Plus HMO H1951-013 MAPD Service Area Bossier; Caddo; Webster Premium $37 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $175 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $5 Specialist Co-pay $50 Outpatient Surgery $250 ASC/$275 OP Hosp Advanced Imaging $225 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Nursing Hotline; Fitness Program; Counseling Services; Health Education Services; Humana Pharmacy OTC; $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: MyOption Enhanced Dental HMO OSB008/Premium $24.10 MyOption Vision OSB004/Premium $15.30 Other Value Added Services: Complimentary & Alt Med., Dental Discounts, NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at WalMart®, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 22 Confidential Information – For Agents Only
Bienville; Claiborne; De Soto; Natchitoches; Red River; Sabine; Winn Humana Choice PPO H5525-015 MAPD Service Area Bienville; Claiborne; De Soto; Natchitoches; Red River; Sabine; Winn Premium $47 MOOP $6700.00 Plan Deductible $750.00 Inpatient Cost Share $185 copay/day Days (1-7) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $5 copay Specialist Co-pay $50 copay Outpatient Surgery $135 ASC $185 OP Hosp Advanced Imaging $175 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 - Preferred Mail Order 90-day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Fitness Program; Health Education Services; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: Other Value Added Services: Complimentary & Alt Medici ne, De ntal Discounts , NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount ,Vitality Healthy Food Discount at WalMart® , Jenny Craig MyOption Dental - High PPO OSB001/Premium $17.30 Please refer to plan Summary of Benefits and EOC for full explanation of benefits 23 Confidential Information – For Agents Only
Northeast Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 38.0% 0.0% 0.1% 61.2% Includes: Caldwell, East Carroll, Franklin, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll
Service Area Humana Gold Plus HMO H1951-042 MAPD Acadia; Caldwell; Catahoula; East Carroll; Franklin; Iberia; Jackson; Lincoln; Madison; Morehouse; Ouachita; Richland; St. Landry; St. Martin; Tensas; Union; Vermilion; West Carroll Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $215 copay/day Days (1-8) SNF $0 copay/day Days (1-20)/ $164.50 copay/day Days (21-100) PCP Co-pay $15 copay Specialist Co-pay $50 copay Outpatient Surgery $250 ASC $275 OP Hosp Advanced Imaging $250 copay Part D Benefit RX $200; ICL $3700; TrOOP $4950.00 $10/$15/$47/$100 - 29% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order cost Sharing 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision & Hearing Services; Silver Sneakers; HumanaFirst; Humana Wellness; LifeSynch; QuitNet Smoking Cessation; Independent Living System; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complementary & Alternative Medicine, LifeCard Plans, Dental, Vision & Hearing Discounts, Lifeline Program, NutriSystems Discount, Rx Discount, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 25 Confidential Information – For Agents Only
New Orleans Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 59.4% 0.3% 35.9% 0.7% 3.1% 0.2% Includes: Assumption, Jefferson, Lafourche, Orleans, Plaquemines, St Charles, St James, St John, Terrebonne
Service Area Humana Total Care Advantage HMO H1951-038 MAPD This Plan Has A Separate HMO Network Directory Members Must Use Only Those Providers Service Area Jefferson; Orleans; St. Charles Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $105 copay/day Days (1-10) SNF $0 copay/day Days (1-20): $164.50 copay/day Days (21-100) PCP Co-pay $0 copay Specialist Co-pay $45 copay Outpatient Surgery $175 copay Advanced Imaging $195 copay ASC & OP Hosp Part D Benefit Rx Deductible $350, ICL $3700, TrOOP $4950 $10/$20/$47/$100/26% Standard Retail 30-Day supply $0/$0/$131/$287 - Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, Hearing Services; Independent Living System; Silver Sneakers; Humana Pharmacy OTC $30 maximum benefit coverage amount per month for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary and Alternative Medicine, Dental Discounts, Nutrisystem Discounts, Jenny Craig Discounts, Vision Discounts, Hearing Discounts, Rx Discounts, Lifeline Program Please refer to plan Summary of Benefits and EOC for full explanation of benefits 27 Confidential Information – For Agents Only
Humana Gold Plus HMO H1951-044 MAPD SNP CVD/CHF/DB Service Area This Plan Has A Separate HMO Network Directory Members Must Use Only Those Providers Service Area Jefferson; Orleans Premium $0 MOOP $3400.00 Services not covered by Original Medicare and part D prescription drugs do not apply to the in-network or out-of-network MOOP. Plan Deductible N/A Inpatient Cost Share $25 copay/day Day (1-5) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $0 copay Specialist Co-pay $27 copay Outpatient Surgery OV copay if in PCP or spec office / $100 if in ASC or OP Hosp Advanced Imaging $100 ASC & OP Hosp Part D Benefit Rx Deductible $0, ICL $3700, TrOOP $4950 $0/$15/$47/$100/33%/$0 Standard Retail 30-Day supply $0/$0/$131/$287/NA/$0 - Preferred Mail Order 90 day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Silver Sneakers; Health & Nutrition Education Services; Independent Living System; Humana Vitality; Humana Wellness; Humana Pharmacy OTC $20 maximum benefit coverage amount per month for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary & Alt Medicine, Dental Discount, Nutrisystem Discount, Rx Discount, Vision Discount, Jenny Craig, Lifeline, Life Fitness, Vitality Healthy Food Discount at WalMart®, Seattle Sutton Healthy Eating, Biggest Looser Resort Please refer to plan Summary of Benefits and EOC for full explanation of benefits 28 Confidential Information – For Agents Only
Jefferson; Orleans; St. Charles Humana Gold Plus HMO H1951-047-001 MAPD Service Area Jefferson; Orleans; St. Charles Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $105 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $10 Specialist Co-pay $50 Outpatient Surgery $175 ASC & $200 OP Hosp Advanced Imaging $195 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90 Day Supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Fitness Program; Health Education Services; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter on select OTC health and wellness products. Optional Supplemental Benefits: My Option Dental – High PPO OSB001 $17.30 Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount , Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 29 Confidential Information – For Agents Only
Humana Gold Plus HMO H1951-047-002 MAPD Service Area Assumption; Lafourche; Plaquemines; St. James; St. John the Baptist; Terrebonne Premium $33 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $150 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.5 copay/day Days (21-100) PCP Co-pay $5 Specialist Co-pay $50 Outpatient Surgery 175 ASC & $200 if in OP Hosp Advanced Imaging $195 copay Part D Benefit Rx Deductible $400 ICL $3310, TrOOP $4850 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Fitness Program; Health Education Services; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter on select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental – High PPO OSB001 $17.30 Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount , Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 30 Confidential Information – For Agents Only
Northshore Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 64.9% 0.9% 31.1% 0.8% 1.6% 0.2% Includes: St Tammany & Washington
St. Tammany; Washington Humana Gold Plus HMO H1951-028 MAPD Service Area St. Tammany; Washington Premium $28.90 MOOP $6700.00 Plan Deductible N/A Inpatient Cost Share $195 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $10 copay Specialist Co-pay $50 copay Outpatient Surgery $150 ASC / $195 OP Hosp Advanced Imaging $195 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$19/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 - Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Nursing Hotline; Fitness Program; Counseling Services; Health Education Services; Humana Pharmacy OTC; $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental High PPO OSB001/Premium $17.30 Other Value Added Services: Complimentary & Alt Med., Dental Discounts, NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at WalMart®, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 32 Confidential Information – For Agents Only
Tangipahoa Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 64.6% 0.0% 32.2% 0.5% 1.9%
Service Area Humana Gold Plus HMO H1951-024 MAPD Tangipahoa Premium $61 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $200 copay/day Days (1-7) Preferred Hospital $275 copay/day Days (1-7) Non-Preferred Hospital SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $5 Specialist Co-pay $45 Outpatient Surgery $200 ASC / $250 OP Hosp Advanced Imaging $250 copay Part D Benefit Rx Deductible $320, ICL $3700, TrOOP $4950 $10/$17/$47/$100/26% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Nursing Hotline; Fitness Program; Counseling Services; Health Education Services; Humana Pharmacy OTC; $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary & Alt Med., Dental Discounts, NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at WalMart®, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits Confidential Information – For Agents Only
Baton Rouge Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage Market Share 73.3% 1.3% 16.1% 6.2% 0.3% Includes: Ascension, East Baton Rouge, East Feliciana, Iberville, Livingston, Pointe Coupee, St Helena, West Baton Rouge, West Feliciana Confidential Information – For Agents Only
Service Area Humana Total Care Advantage HMO H1951-039 MAPD This Plan Has A Separate HMO Network Directory Members Must Use Only Those Providers Service Area East Baton Rouge; East Feliciana; Iberville; Livingston; St. Helena; West Baton Rouge Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $145 copay/day Days (1-10) SNF $0 copay/day Days (1-20): $164.50 copay/day Days (21-100) PCP Co-pay $0 copay Specialist Co-pay $45 copay Outpatient Surgery $160 ASC & OP Hosp Advanced Imaging $200 copay Part D Benefit Rx $350 Deductible, ICL $3700, TrOOP $4950 $10/$20/$47/$100/26% Standard Retail 30-Day supply $0/$0/$131/$287 - Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision & Hearing Services; Independent Living System; Silver Sneakers; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary and Alternative Medicine, Dental Discounts, Nutrisystem Discounts, Jenny Craig Discounts, Vision Discounts, Hearing Discounts, Rx Discounts, Lifeline Program Please refer to plan Summary of Benefits and EOC for full explanation of benefits 36 Confidential Information – For Agents Only
Ascension; East Baton Rouge; Livingston; Humana Gold Plus HMO H1951-048-001 MAPD Service Area Ascension; East Baton Rouge; Livingston; West Baton Rouge Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $145 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.5 copay/day Days (21-100) PCP Co-pay $10 Specialist Co-pay $50 Outpatient Surgery $125 ASC $1 OP Hosp Advanced Imaging $200 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day Supply $0/$0/$131/$287 Preferred Mail Order 90 Day Supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Fitness Program; Health Education Services; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter on select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental – High PPO OSB001 $17.30 Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount , Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 37 Confidential Information – For Agents Only
East Feliciana; Iberville; Pointe Coupee; St. Helena; West Feliciana Humana Gold Plus HMO H1951-048-002 MAPD Service Area East Feliciana; Iberville; Pointe Coupee; St. Helena; West Feliciana Premium $36 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $150 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.5 copay/day Days (21-100) PCP Co-pay $10 Specialist Co-pay $50 Outpatient Surgery $135 ASC $175 OP Hosp Advanced Imaging $225 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90 Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Fitness Program; Health Education Services; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter on select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental – High PPO OSB001 $17.30 Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount , Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 38 Confidential Information – For Agents Only
Service Area Humana Gold Plus HMO H1951-030 MA Ascension; East Baton Rouge; East Feliciana; Iberville; Livingston; Pointe Coupee; St. Helena; West Baton Rouge; West Feliciana Premium $0 MOOP $6700 Plan Deductible N/A Inpatient Cost Share $110 copay/day Days (1-10) SNF $0 copay/day Days (1-20) $164.50 copay/day Days (21-100) PCP Co-pay $5 Specialist Co-pay $50 Outpatient Surgery $135 ASC / $175 OP Hosp Advanced Imaging $200 copay Part D Benefit Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation Services; HumanaFirst 24 Nurseline; Fitness Program; Health & Nutrition Education Services; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental - High PPO OSB001 $17.30 Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , Nu triSystems Discount, HealthyFood Discount, Lifeline Program, Vision Discount, Hearing Discount, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 39 Confidential Information – For Agents Only
2017 Regional PPO Plans Louisiana & Mississippi
Louisiana & Mississippi Statewide Humana Choice RPPO R5826-011 MAPD Service Area Louisiana & Mississippi Statewide Premium $0 MOOP $6700.00 Plan Deductible $1,000 Inpatient Cost Share $195 copay / Days (1-6) SNF $0 copay /day Days (1-20); $164.50 copay/day Days (21-100) PCP Co-pay $15 copay Specialist Co-pay $35 copay Outpatient Surgery $145 ASC $195 OP Hosp Advanced Imaging $150 copay Part D Benefit Rx Deductible $400, ICL $3700, TrOOP $4950 $10/$20/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$287 Preferred Mail Order 90-Day supply (DEDUCTIBLE APPLIES ONLY TO TIERS 4 & 5) Other Benefits: Dental, Vision, & Hearing Services; Nursing Hotline; Fitness Program; Health Education Services; Humana Pharmacy $30 maximum benefit coverage amount per quarter for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , NutriSystems Discount, Rx Discount, Vision Discount, Hearing Discount , Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 41 Confidential Information – For Agents Only
Louisiana & Mississippi Statewide Humana Choice RPPO R5826-068 Service Area Louisiana & Mississippi Statewide Premium $0 MOOP $6,700 IN / $10,000 I&ON Plan Deductible $1,000 Inpatient Cost Share $195 copay/day Days (1-6) SNF $0 copay/day Days (1-20); $164.50 copay/day Days (21-100) PCP Co-pay $10 copay Specialist Co-pay $35 copay Outpatient Surgery $145 ASC $195 OP HOSP Advanced Imaging $150 copay Part D Benefit N/A Other Benefits: Dental, Vision & Hearing; Independent Living System; QuitNet; SilverSneakers; HumanaFirst; Humana Wellness; Humana Medicare Rewards; Humana Pharmacy OTC $30 maximum benefit coverage amount per quarter for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complementary & Alternative Medicine, LifeCard Plans, Lifeline Program, NutriSystems Discount, Dental, Vision & Hearing Discounts, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 42 Confidential Information – For Agents Only
Louisiana & Mississippi Statewide Humana Choice RPPO R5826-078 PPO MA Service Area Louisiana & Mississippi Statewide Premium $47 MOOP $6,700 Plan Deductible $1000 Inpatient Cost Share $275 copay/day Days (1-7) SNF $0 copay/day Days (1-20); $164.50 copay/day Days (21-100) PCP Co-pay $15 copay Specialist Co-pay $50 copay Outpatient Surgery $275 ASC & OP Hosp Advanced Imaging $225 copay Part D Benefit RX $400; ICL $3700; TrOOP $4950 $5/$12/$47/$100/25% Standard Retail 30-Day supply $0/$0/$131/$290 Preferred Mail Order—90-Day supply Other Benefits: SilverSneakers; HumanaFirst; Humana Pharmacy $25 maximum benefit coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: MyOption Dental-High PPO $19.10/Month Other Value Added Services: Complementary & Alternative Medicine, Humana Medicare Rewards, Lifeline Program, Humana Pharmacy, Independent Living, Humana Wellness, Dental, Vision & Hearing Discounts. Please refer to plan Summary of Benefits and EOC for full explanation of benefits 43 Confidential Information – For Agents Only
2017 Dual Eligible SNP Plans
Available to dual eligible individuals who are SLMB+, QMB Plus and QMB Humana Gold Plus HMO H1951-041 SNP DE MAPD (Include H1951-035 Service Area) Available to dual eligible individuals who are SLMB+, QMB Plus and QMB The individuals who qualify will not be responsible for cost sharing of plan benefits Service Area Bossier; Caddo; Calcasieu; Caldwell; Cameron; East Carroll; Franklin; Grant; Jackson; Lafayette; Lincoln; Madison; Morehouse; Ouachita; Rapides; Richland; Tensas; Union; West Carroll Premium $0 MOOP Plan Deductible Inpatient Cost Share $300 copay/day Days (1-3) / $0 copay/day Days (4-90) SNF $0 copay/day Days (1-20)/$160 copay/day Days (21-100) PCP Co-pay 0% coinsurance Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Rx Deductible $200, ICL $3700,TrOOP $4950 $0 - 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision & Hearing; QuitNet; Silver Sneakers; HumanaFirst; Humana Wellness; Humana Pharmacy $25 maximum benefit coverage amount per month for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary and Alternative Medicine, Dental Discounts, Nutrisystem Discounts, Jenny Craig Discounts, Vision Discounts, Hearing Discounts, Rx Discounts, Lifeline Program, Vitality Healthy Food Discount at Wal-Mart Please refer to plan Summary of Benefits and EOC for full explanation of benefits 45 Confidential Information – For Agents Only
Available to dual eligible individuals who are SLMB+, QMB Plus and QMB Humana Gold Plus HMO H1951-032 SNP DE MAPD Available to dual eligible individuals who are SLMB+, QMB Plus and QMB The individuals who qualify will not be responsible for cost sharing of plan benefits Service Area Ascension; East Baton Rouge; East Feliciana; Iberville; Livingston; Pointe Coupee; St. Helena; West Baton Rouge; West Feliciana Premium $0 MOOP Plan Deductible Inpatient Cost Share $0 copay/day Days (1-3) $0 copay/day Days (4-90) SNF $0 copay/day Days (1-20) $160 copay/day Days (21-100) PCP Co-pay 0% coinsurance Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Rx Deductible $0, ICL $0, TrOOP $0 $0 - Preferred Mail Order 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; HumanaFirst 24 Nurseline; Fitness Program; Health & Nutrition Education Services; Humana Pharmacy $25 maximum benefit coverage amount per month for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutrisystem Discount, HealthyFood Discount, LifeLine Program, Rx Discount, Vision Discount, Hearing Discount, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 46 Confidential Information – For Agents Only
Available to dual eligible individuals who are SLMB+, QMB Plus and QMB Humana Gold Plus HMO H1951-033 SNP DE MAPD Available to dual eligible individuals who are SLMB+, QMB Plus and QMB The individuals who qualify will not be responsible for cost sharing of plan benefits Service Area Assumption; Jefferson; Lafourche; Orleans; Plaquemines; St. Charles; St. James; St. John the Baptist; Terrebonne Premium $0 MOOP Plan Deductible Inpatient Cost Share $0 copay/day Days (1-3) $0 copay/day Days (4-90) SNF $0 copay/day Days (1-20) $160 copay/day Days (21-100) PCP Co-pay 0% coinsurance Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Rx Deductible $0, ICL $0, TrOOP $0 $0 - Preferred Mail Order 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; HumanaFirst 24 Hotline; Fitness Program; Health & Nutrition Education Services; Humana Pharmacy $20 maximum benefit coverage amount per month for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , NutriSystems Discount, Rx Discount, Lifeline Program, Vision Discount, Hearing Discount, HealthyFood Discount at Walmart, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 47 Confidential Information – For Agents Only
Available to dual eligible individuals who are SLMB+, QMB Plus and QMB Humana Gold Plus HMO H1951-034 SNP DE MAPD Available to dual eligible individuals who are SLMB+, QMB Plus and QMB The individuals who qualify will not be responsible for cost sharing of plan benefits Service Area St. Tammany; Washington Premium $0 MOOP Plan Deductible Inpatient Cost Share $0 copay/day Days (1-3) $0 copay/day Days (4-90) SNF $0 copay/day Days (1-20); $160 copay/day Days (21-100) PCP Co-pay 0% coinsurance Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Rx Deductible $0, ICL $0,TrOOP $0 $0 - 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; HumanaFirst 24 Nurse Line; Silver Sneakers; Health & Nutrition Education Services; Humana Pharmacy $25 maximum benefit coverage amount per month for OTC health and wellness products. Optional Supplemental Benefits: N/A Other Value Added Services: Complimentary and Alternative Medicine, Dental Discounts, Nutrisystem Discount, Jenny Craig Discounts, Vision Discounts, Hearing Discounts, Rx Discounts, Lifeline Program, HealthyFood Discount at Wal-Mart, QuitNet Please refer to plan Summary of Benefits and EOC for full explanation of benefits 48 Confidential Information – For Agents Only
Benefit Year 2017 Humana, Inc. - Louisiana Benefit Year 2017 HMO New Orleans Baton Rouge Northshore H1951-047-001 - $0 H1951-048-001- $0 H1951-028 - $28.90 Jefferson St Charles Ascension Livingston H1951-034 (DE SNP)- $0 Orleans East Baton Rouge West Baton Rouge St. Tammany H1951-047-002- $33 H1951-048-002- $36 Washington Assumption St James East Feliciana St Helena Lafourche St John The Baptist Iberville West Feliciana Tangipahoa Shreveport Plaquemines Terrebonne Pointe Coupee H1951-024 - $61.00 H1951-013 - $37.00 Bossier Caddo Webster H1951-033 (DE SNP)- $0 H1951-030- $0 and H1951-032 (DE SNP)- $0 St. Charles St. James East BR St. John Baptist LPPO H6609-104 -$47 New Orleans H1951-044 Diabetes & Heart CC SNP- $0 Southwest/Central Calcasieu Ouachita H1951-025 - $0 Caldwell St. Landry Ochsner Only Plans H1951-041 DE SNP- $0 Cameron St. Martin H1951-038 (NO) - $0 H1951-039 (BR) - $0 Lafayette St. Mary La Salle Grant Morehouse LPPO H5525-015 - $47 Rapides Bienville Red River St. Helena H1951-042 (LA Crossroads) - $0 Claiborne Sabine West BR Acadia DeSoto Winn H1951-041 (LA Crossroads DE SNP)- $0 Natchitoches Madison Catahoula Richland East Carrol Franklin Iberia Tensas Jackson Union Lincoln Vermillion West Carrol RPPO Plans PDP PLANS RX Enhanced (Passive) RX Standard MA Only Preferred Rx (NEW) Enhanced Rx Walmart Rx Plan R5826-011 - $77 R5826-078 - $47 R5826-068 - $0 S5884-108 -$27.90 S5884-019-$67.90 S5884-167-$17.00 LA Statewide
Have a great AEP!