Agenda Rocky Mountain Health Plans RMHP Dual Care

Agenda • Rocky Mountain Health Plans (RMHP) Dual Care Plus • What are Dual Special Needs Plans (D-SNP) • How to Qualify • D-SNP from RMHP • D-SNP Benefits • Additional Benefits • RMHP 1: 1 Visit • D-SNP ID Cards • D-SNP Eligibility Check • Get Help 2

RMHP Dual. Care Plus Rocky Mountain Health Plans offers a new Dual Special Needs Plan called RMHP Dual. Care Plus in Mesa County. 3

What are Dual Special Needs Plans? Dual Special Needs Plans, also called D-SNPs, provide the same benefits Members get from Original Medicare and have many additional benefits. Dual Special Needs Plans: • are designed for people who may need extra help because of disabilities, age, and/or health conditions • offer more benefits than Original Medicare • come with no additional costs • are offered by private insurance companies with a Medicare contract, like RMHP 4

The Advantages Dual Special Needs Plans include: + Hospital stays • Skilled nursing • Home health + Doctor Visits • Outpatient care • Screenings and shots • Lab tests + Prescription drug coverage Additional benefits like • Hearing • Vision • Dental • Health products catalog • Fitness 5

How to Qualify If individuals can answer “yes” to the four questions below, there’s a good chance they may qualify for a Dual Special Needs Plan. Do they qualify for Colorado Medicaid Benefits? • they are under the age 65 and qualify on the basis of disability or other special situation • they are at least 65 years old and receive extra help or assistance from the state • they must have full Medicaid benefits to qualify for RMHP Dual. Care Plus Do they have Medicare Parts A and B? • they are at least 65 years old, or they’re under 65 and qualify on the basis of disability or other special situations AND • they are a United States citizen or a legal resident who has lived in the United States for at least five consecutive years Do they live in RMHP’s Dual. Care Plus service area? They must live in Mesa County to qualify for RMHP Dual. Care Plus plan. Do they meet the health requirements? This plan is generally NOT available to people who have end-stage kidney failure, also called end-stage renal disease (ERSD). 6

Get More with RMHP With an RMHP Dual. Care Plus plan, RMHP combines Medicare and Medicaid coverage into one plan. Members receive: Additional benefits beyond Original Medicare Access to a local network of doctors and pharmacies A coordinated care experience Wellness support Answers to Medicare, Medicaid, prescription, and other benefit questions by calling one phone number Local coordination of Medicaid benefits by the same RMHP team 7

Understanding RMHP Dual. Care Plus D-SNP Benefits With a Dual Special Needs Plan, Members will receive all their Medicare and Medicaid benefits plus additional benefits listed below, at no additional cost. If the plan has a premium, they may also qualify for low‑income subsidies. What they may have now What they could have Medicaid benefits Hospital stays Doctor and outpatient care Prescription drugs + + Additional benefits 8

Additional Member Benefits with RMHP Dual. Care Plus Dental Coverage: $500 annual benefit. OTC Debit Card: Up to $50/quarter - $200/year on an over -the-counter (OTC) debit card. (Expires annually) Fitness Benefit: A fitness program for body and mind with access to participating gym and fitness centers at no extra cost. Hearing Coverage: Annual hearing exam and $2, 000 credit every two years for hearing devices. Vision Coverage: Biannual exam and $200 credit every two years for eyewear. Personal Emergency Response System: Members are connected to trained operators in any emergency situation 24 hours a day Foot Care: Four visits per year at $0 copay. • Benefit limitations and exclusions apply. 9

RMHP Care. Calls • 1: 1 in-home visit with RMHP D-SNP Member • A local provider from the clinic at The Center for Living Your Best (operated by Hope West) performs the home visit. Information is shared with the members primary care provider Offers Members one-on-one time for 45 -60 minutes. The visit focuses on key areas and impacted quality measures, which may include these elements: Physiological Psychosocial/Behavioral Functional Medication Review Environmental 10

RMHP Dual. Care Plus D-SNP ID Cards Medicare Advantage Plan; administered by Rocky Mountain Health Plans Medicare Advantage Contract and Program Benefit Plan Dual Care Plus Plan Name Group Name: 00250 • Sample ID cards are for illustration only. Actual cards may vary. 11

Serving RMHP Dual Care D-SNP Members Before providing services, please verify member eligibility and benefits. Check eligibility on the RMHP Provider portal, access. RMHP Call RMHP Provider Services at the number on the member’s RMHP Dual. Care Plus ID card Members can enroll, disenroll or switch plans once per calendar quarter during the first nine months of the year by following the Centers for Medicare & Medicaid Services (CMS) regulatory requirements. • Sample ID cards are for illustration only. Actual cards may vary. 12

Get Help from RMHP Customer Service 970 -248 -5036 or 800 -854 -4558 8 a. m. – 5 p. m. , local time, Monday-Friday • Claims, including status and coordination of benefits • Eligibility, benefit and co-pay questions • Provider participation status inquiries • Remittance questions • Preauthorization status questions RMHP Provider Relations 970 -244 -7798 • Contract issues, including concerns regarding incorrect reimbursement • Credentialing • Electronic claims transmission • Practice changes, such as location change • Complex claims questions Visit rmhp. Dual. Care. org 13

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