Welcome National Partners 2018 Market Overview Louisiana Market

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Presentation transcript:

Welcome National Partners 2018 Market Overview Louisiana Market

Louisiana Competitive Landscape Company MA Membership % Market Share Humana 156,913 62.8% Peoples 57,134 22.8% Vantage 15,319 6.1% Wellcare 12,753 5.1% Blue Cross 4,493 1.8% United Health (UHC) 1,752 0.7% Aetna 1,690

Louisiana 2017 Sales To Date Market Sales Statewide 25,993 Alexandria 871 Baton Rouge 4,268 Shreveport 2,684 New Orleans 6,888 Monroe 1,930 Lafayette 2,581 Bayou 1,274 Lake Charles 1,211 Northshore 2,646 Market Total 24,353 HMO HMO DE HMO CC LPPO RPPO 62% 17% 2% 5% 14% 93.7% Of Statewide Total

Why Humana Louisiana? Largest MA Company in state Outstanding Provider Network Broad portfolio of plans Strong brand presence starting in 2004 in La Consistent Top 10 Market in MA sales in Humana--- currently ranked #5 Plans contain many extra benefits to help our members improve overall health 5 offices statewide to support our external partners, prospects and members. Two Bold Goal markets committed to improving community health by 20% by 2020 Two neighborhood centers with education, health and fun activities daily open to the community

Louisiana HMO Parishes Green Green Green Represents $0 Premium HMO Red Represents Premium HMO

New Orleans Market Key Plans Jefferson, Orleans, St Charles H1951-038 HMO (OHS) Separate Directory—Ochsner providers only H1951-047-001 HMO H1951-044 HMO CC SNP Jefferson & Orleans Only Separate directory—Ochsner & Jencare providers only Premium $0 MOOP $6,700 Inpatient Cost Share $105 Days 1-10 $105 Days 1-10 $50 Days 1-5 PCP Co-pay Specialist Co-pay $40 $45 $25 Outpatient Surgery $175 All Locations $175 ASC /$200 Hospital $40 ASC/$50 Hospital Advanced Imaging $195 All Locations $125 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) Other Benefits: $300 Tier 4 & 5 Only $3/$10/$47/$99/27% $0/$0/$131/$287 Preventive Dental OSB Dental $22.40 Vision $0 Exam/$200 Eyewear Hearing $0 Exam/$500 per ear OTC $30 per quarter Transporation-6 one way trips $400 Tier 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 OSB Dental $21.30 Vision $0 Exam/$100 Eyewear Hearing $0 Exam/Aids Fixed Copays $0 Gap coverage for tiers 1,2,3,6 $0/$10/$47/$99/33%/$0 $0/$0/$131/$287/$0 No OSB OTC $20 per month Transporation-18 one way trips 6

Baton Rouge Market Key Plans Ascension, East Baton Rouge, Livingston, West Baton Rouge H1951-039 HMO (OHS) Not In Ascension--Separate Directory—Ochsner providers only H1951-048-001 HMO H1951-030 HMO MA Only Plus additional parishes Premium $0 MOOP $6,700 Inpatient Cost Share $130 Days 1-10 $145 Days 1-10 $110 dAys 1-10 PCP Co-pay $5 Specialist Co-pay $40 $45 $50 Outpatient Surgery $160 ASC/ $130 Hospital $125 ASC/ $160 Hospital $135 ASC /$175 Hospital Advanced Imaging $200 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) Other Benefits: $380 Tiers 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 Preventive Dental OSB Dental $22.40 Vision $0 Exam/$200 Eyewear Hearing $0 Exam/$600 per ear OTC $30 per quarter Transportation 6-one way trips $400 Tiers 4 & 5 Only $7/$15/$47/$99/25% $0/$0/$131/$287 OSB Dental $21.30 Vision $0 Exam/$100 Eyewear Hearing $0 Exam/Aids with fixed copays No RX—MA Only Plan No Preventive Dental OSB Dental Plan $14.50 7

St. Tammany & Washington Humana Gold Plus HMO H1951-028 MAPD St. Tammany & Washington Premium $28.90 MOOP $6700 Inpatient Cost Share $195 Days 1-10 PCP Co-pay $10 copay Specialist Co-pay $45 copay Outpatient Surgery $150 ASC / $195 Hospital Advanced Imaging $195 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) $400 Tiers 4 & 5 Only $7/$14/$47/$99/25% $0/$0/$131/$287 Other Benefits: Preventive Dental OSB Dental $21.30 Vision $0 Exam/$100 Eyewear Hearing $0 Exam/Hearing Aids with fixed copays OTC $30 per quarter 8

Humana Gold Plus HMO H1951-024 MAPD Tangipahoa Premium $61 MOOP $6700 Inpatient Cost Share $200 Days 1-7 Preferred Hospital $275 Days 1-7 Non-Preferred Hospital PCP Co-pay $5 Specialist Co-pay $45 Outpatient Surgery $200 copay ASC / $250 Hospital Advanced Imaging $250 copay all locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) $320 Tiers 4 & 5 Only $5/$12/$47/$99/26% $0/$0/$131/$287 Other Benefits: Preventive Dental Vision $0 Exam/$100 Eyewear Hearing $0 Exam/Hearing Aids with fixed copays OTC $30 per quarter 14

Assumption, Lafourche, St James, St John the Baptist, Terrebonne 2018 Humana Gold Plus HMO H1951-047-002 MAPD Assumption, Lafourche, St James, St John the Baptist, Terrebonne Premium $25 MOOP $6700 Inpatient Cost Share $150 Days 1-10 PCP Co-pay $5 Specialist Co-pay $50 Outpatient Surgery $175 ASC /$200 Hospital Advanced Imaging $195 copay all locations Part D Benefits Deductible Preferred Retail (30) Preferred Mail Order $400 Tiers 4 &5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 Other Benefits: Preventive Dental OSB Dental $21.30 Vision $0 Exam/$100 Eyewear Hearing $0 Exam/Aids with fixed copays OTC $30 per quarter Transportation 6-one way trips 14

East Feliciana, Iberville, Pointe Coupee, St. Helena, West Feliciana Humana Gold Plus HMO H1951-048-002 MAPD East Feliciana, Iberville, Pointe Coupee, St. Helena, West Feliciana Premium $26 MOOP $6700 Inpatient Cost Share $150 Days 1-10 PCP Co-pay $5 Specialist Co-pay $50 Outpatient Surgery $135 ASC /$175 Hospital Advanced Imaging $225 copay all locations Part D Benefits Deductible Preferred Retail (30) Preferred Mail Order $400 Tiers 4 &5 Only $7/$15/$47/$99/25% $0/$0/$131/$287 Other Benefits: Preventive Dental OSB Dental $21.30 Vision $0 Exam/$100 Eyewear Hearing $0 Exam/Aids with fixed copays OTC $30 per quarter Transportation 6-one way trips 14

HMO Service Area: Lafayette, St Landry, St Martin Lafayette Market HMO Service Area: Lafayette, St Landry, St Martin H1951-049-002 HMO H5216-064 LPPO Premium $0 $49 MOOP $6,700 $6,700/$10,000 Plan Deductible $1,000 OON Only Inpatient Cost Share $215 1-8 $225 1-7 PCP Co-pay $5 Specialist Co-pay $40 $45 Outpatient Surgery $250 ASC/$275 Hospital $175 ASC/$225 Hospital Advanced Imaging $250 All Locations $195 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) Other Benefits: $200 Tiers 4 & 5 Only $6/$10/$47/$99/29% $0/$0/$131/$287 Preventive Dental No OSB Vision $0 Exam/$100 Eyewear Hearing Aids—Fixed Copayments OTC $30 per quarter $400 Tiers 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 OSB Vision $15.30 Vision $0 Exam/$40 max Hearing Aids---Fixed Copayments OTC $25 per quarter 12

Lake Charles & Alexandria Market Service Area: Calcasieu, Cameron, Grant, Rapides H1951-049-001 HMO H5216-064 LPPO Plan LPPO Plan Available in Grant & Rapides Premium $0 $49 MOOP $6,700 $6,700/$10,000 Plan Deductible $1,000 OON Only Inpatient Cost Share $225 Days 1-8 $225 Days 1-7 PCP Co-pay $15 $5 Specialist Co-pay $45 Outpatient Surgery $225 ASC/$275 Hospital $175 ASC/ $225 Hospital Advanced Imaging $250 All Locations $195 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) Other Benefits: $200 Tiers 4 & 5 Only $6/$10/$47/$99/29% $0/$0/$131/$287 Preventive Dental Vision $0 Exam/$100 eyewear No OSB Vision Hearing Aids-Fixed Copayments OTC $30 per quarter $400 Tiers 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 Vision $0 Exam/$40 max OSB Vision $15.30 Hearing Aids---Fixed Copayments OTC $25 per quarter 13

2018 Humana Gold Plus HMO H1951-013 Bossier, Caddo, Webster Premium $29 MOOP $6700 Inpatient Cost Share $175 copay/day Days (1-10) PCP Co-pay $5 Specialist Co-pay $40 Outpatient Surgery $250 copay in Free Standing $275 copay in Hospital Advanced Imaging $225 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) $400 Tiers 4 & 5 Only $6/$15/$47/$99/25% $0/$0/$131/$287 Other Benefits: Preventive Dental OSB Dental Plan $22.40 Vision $0 Exam OSB Vision Plan $15.30 OTC $30 Per quarter Hearing Aids-Fixed Copayments 14

Caldwell, Morehouse, Ouachita Monroe Market Caldwell; Catahoula; East Carroll; Franklin; Jackson; Lincoln; Madison; Morehouse; Ouachita; Richland; Tensas; Union; West Carroll H1951-049-003 HMO H5216-064 LPPO Plan Caldwell, Morehouse, Ouachita Premium $0 $49 MOOP $6,700 $6,700/$10,000 Plan Deductible $1,000 OON Only Inpatient Cost Share $215 Days 1-8 $225 Days 1-7 PCP Co-pay $15 $5 Specialist Co-pay $45 Outpatient Surgery $250 ASC/$275 Hospital $175 ASC/ $225 Hospital Advanced Imaging $250 All Locations $195 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) Other Benefits: $200 Tiers 4 & 5 Only $6/$10/$47/$99/29% $0/$0/$131/$287 Preventive Dental Vision $0 Exam/$100 eyewear No OSB Vison Hearing Aids-Fixed Copayments OTC $30 per quarter $400 Tiers 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 Vision $0 Exam/$40 max OSB Vision $15.30 Hearing Aids---Fixed Copayments OTC $25 per quarter 15

LPPO Parishes

Humana Choice Local PPO (LPPO) Three Plans With Different Service Areas But Same Benefits H5216-064 H5216-135 H5525-015 Premium $49 MOOP $6,700/$10,000 Plan Deductible $1,000 OON Only Inpatient Cost $225 Days 1-7 PCP Co-pay $5 Specialist Co-pay $45 Outpatient Surgery $175 ASC/ $225 Hospital $175 ASC/$225 Hospital Advanced Imaging $195 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail Order (90) Other Benefits: $400 Tiers 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 Preventative Dental Vision $0 Exam -$40 Max OSB Vision Plan $15.30 Hearing Aids-Fixed Copayments OTC $25 per quarter 17

Humana Choice Regional PPO-Statewide R0110-003 (old plan R526-011) PASSIVE PPO R0110-001 (old plan R5826-068) R0110-002 (old plan R5826-078) Premium $89 $0 $55 MOOP $6,700/$10,000 Plan Deductible $1,000 OON Only $1,000 OON Only then 30% Inpatient Cost Share $275 1-7 $195 1-6 PCP Co-pay $15 $10 Specialist Co-pay $50 $35 Outpatient Surgery $225 ASC $275 OP $145 ASC $195 OP Advanced Imaging $225 All Locations $150 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail (90) Other Benefits: $400 Tiers 4 & 5 Only $6/$15/$47/$99/25% $0/$0/$131/$287 Preventive Plus Dental OSB Dental Plan $20.20 Vision $0 Exam OSB Vision Plan $15.30 Hearing Aids-Fixed Copayments OTC $25 per quarter No Rx—MA Only OTC $30 per quarter $300 Tiers 3,4 & 5 $1/$15/$47/$100/27% $0/$0/$131/$290 OSB Dental Plan $17.10 OSB Vision Plan $15.30 18

Humana Choice Regional PPO Versus Local PPO R0110-003 (old plan R526-011) PASSIVE PPO H5216-064 R0110-002 (old plan R5826-078) Premium $89 $49 $55 MOOP $6,700/$10,000 Plan Deductible $1,000 OON Only $1,000 OON Only then 30% Inpatient Cost Share $275 Days 1-7 $225 Days 1-7 $275 Days 1-7 PCP Co-pay $15 $5 Specialist Co-pay $50 $45 Outpatient Surgery $225 ASC/$275 Hospital $175 ASC/$225 Hospital Advanced Imaging $225 All Locations $195 All Locations Part D Benefit Deductible Preferred Retail (30) Preferred Mail (90) Other Benefits: $400 Tiers 4 &5 Only $6/$15/$47/$99/25% $0/$0/$131/$287 Preventive Plus Dental OSB Dental Plan $20.20 Vision $0 Exam OSB Vision Plan $15.30 Hearing Aids-Fixed Copayments OTC $25 per quarter $400 Tiers 4 & 5 Only $5/$15/$47/$99/25% $0/$0/$131/$287 Preventative Dental Vision $0 Exam -$40 Max $300 Tiers 4 & 5 Only $1/$15/$47/$100/27% $0/$0/$131/$290 OSB Dental Plan $17.10 OSB Vision Plan $15.30 19

Dual Eligible SNP Parishes

Dual Eligible SNP Plan Members on this Dual Eligible SNP will not be responsible for medical copayments, medical coinsurances, or medical deductibles on this plan. They are cost share protected by the State Medicaid Office because of their dual eligible status. Providers may not balance bill these members for any Cost sharing. Providers must bill the state for reimbursement of member cost share. Advise members to show both their Humana ID card and Medicaid ID card to Providers. Refer to Medicare Special Needs Plans Overview document in Mentor for additional information on cost share and benefits the member may receive.

SERVICE AREAS 2018 GOLD PLUS HMO DE SNP H1951-032 EXTRA BENEFITS TRANSPORTATION- 48 one way trips PREVENTIVE DENTAL ROUTINE VISION -$0 copay exam $200 Eyewear HEARING SERVICES-$0 copay $1,000 per ear/year OTC- $75 per month WELL DINE- $0 copay 2 meals per day/5 days ENHANCED NUTRITION THERAPY SESSIONS SMOKING CESSATION COUNSELING PHILIPS LIFELINE $0 copay for fall detection device WIGS-$500 per year due to Chemo hair loss WEIGHT MANAGEMENT- Jenny Craig Initial Enrollment Fee waived 22

SERVICE AREAS 2018 GOLD PLUS HMO DE SNP H1951-033 EXTRA BENEFITS TRANSPORTATION- 48 one way trips PREVENTIVE DENTAL ROUTINE VISION -$0 copay exam $200 Eyewear HEARING SERVICES-$0 copay $1,000 per ear/year OTC- $50 per month WELL DINE- $0 copay 2 meals per day/5 days ENHANCED NUTRITION THERAPY SESSIONS SMOKING CESSATION COUNSELING PHILIPS LIFELINE $0 copay for fall detection device WIGS-$500 per year due to Chemo hair loss WEIGHT MANAGEMENT- Jenny Craig Initial Enrollment Fee waived 23

SERVICE AREAS 2018 GOLD PLUS HMO DE SNP H1951-034 EXTRA BENEFITS TRANSPORTATION- 48 one way trips PREVENTATIVE DENTAL ROUTINE VISION -$0 copay exam $200 Eyewear HEARING SERVICES-$0 copay $1,000 per ear/year OTC- $75 per month WELL DINE- $0 copay 2 meals per day/5 days ENHANCED NUTRITION THERAPY- $0 copay up to 4 one-hour sessions per 12 months SMOKING CESSATION- $0 copay for up to 4 sessions per year PHILIPS LIFELINE $0 copay for fall detection device WIGS-$500 per year due to Chemo hair loss 24

SERVICE AREAS 2018 GOLD PLUS HMO DE SNP H1951-041 EXTRA BENEFITS TRANSPORTATION- 48 one way trips PREVENTATIVE DENTAL ROUTINE VISION -$0 copay exam $300 Eyewear HEARING SERVICES-$0 copay $1,000 per ear/year OTC- $75 per month WELL DINE- $0 copay 2 meals per day/5 days ENHANCED NUTRITION THERAPY- $0 copay up to 4 one-hour sessions per 12 months SMOKING CESSATION COUNSELING PHILIPS LIFELINE $0 copay for fall detection device LIF003 WIGS-$500 per year due to Chemo hair loss 25

2018 Changes For All Plans Member cost or location of service change on all plans Emergency Room: $75 to $80 Skilled Nursing Facility: Days 21-100 $164.50 (some 2017 plans were already at this level) Diabetic Supplies: 2017 $0 Preferred DME Provider/20% Non-Preferred DME/10%Pharmacy 2018 $0 Preferred Diabetic Supplier/20% Diabetic Supplier/10% Pharmacy Available On all plans: $0 copayment for Tier 1 & 2 through Humana Pharmacy Mail Order 24/7 Nursing Hotline Go365 Rewards for Healthy Behaviors Meals at home after Hospital Stay No Longer Available Removed Counseling Service (MAP) Removed Smoking Cessation Except DE SNP plans Removed Health Education (Personal Coach) Humana MarketPOINT Internal Use Only - For Training Purposes ONLY (Not CMS Approved) 11/10/2018

Humana Louisiana 2018 Benefits Humana MarketPOINT Internal Use Only - For Training Purposes ONLY (Not CMS Approved)

Louisiana Market Managers Steve Kent 318-773-8858 Dale LaBorde 504-214-9200 Elizabeth Gremillion 504-564-3158 Bonnie Lee 337-540-0002 Rebecca Rome 225-323-5020 Joseph Ewell External Channel 504-218-6490