Agents Playbook 2017 Louisiana Market September 2016 This
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. 2 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 3 Confidential Information – For Agents Only
YOUR ACCOMPLISHMENTS 2016 % Sales Total External Agents 15, 349 51. 4% All Channels 29, 861 4
Humana Top 10 Markets Market MA Sales CTD Market MA Sales ROY North Carolina 47, 084 North Carolina 15, 295 Ohio 38, 041 Louisiana 15, 178 Puerto Rico 35, 656 Greater Tampa Bay 14, 748 Northeast Texas 32, 856 Northeast Texas 11, 779 Greater Tampa Bay 30, 280 Virginia 9, 980 Louisiana 29, 091 Tennessee 9, 360 Kentucky/West Virginia 27, 990 Puerto Rico 9, 308 Virginia 27, 821 Kentucky/West Virginia 9, 179 Atlanta 24, 821 Dade 8, 812 Indiana 24, 459 KS/KC/MO 8, 345 5
Our Values 6
Lead Product By Parish Green HMO Yellow LPPO Red RPPO Confidential and proprietary. For Humana internal use only. 7/26/16 (v 1. 0)
Your Sales Management Team Caswell Fitzpatrick, Market Director 504 615 -5435 Elizabeth Gremillion Market Manager Northshore/New Orleans 504. 564. 3158 Steve Kent Market Manager Northeast/Northwest 318. 773. 8858 Tim Klein Market Manager Lake Charles/Alexandria 337. 496. 6565 Dale La. Borde Market Manager Baton Rouge 504. 214. 9200 Miguel Delgado Market Manager Lafayette 225. 281. 6542 Rebecca Rome Market Manager 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 Marketing Support Specialist 504. 202. 7270 8 Confidential Information – For Agents Only
Manager Territories Blue: Steve Kent Green: Tim Klein Yellow: Miguel Delgado Brown: Dale La. Borde Purple: Elizabeth Gremillion Pink: Rebecca Rome Red Dots: Career Agents Pink Star: Humana Office Purple Box: Humana Guidance Center 9
Manager Territories Parish Acadia Allen Ascension Assumption Avoyelles Beauregard Bienville Bossier Caddo Calcasieu Caldwell Cameron Catahoula Claiborne Concordia De Soto East Baton Rouge East Carroll East Feliciana Evangeline Franklin Grant Iberia Iberville Jackson Jefferson Davis La Salle Lafayette Lafourche Lincoln Livingston Manager Miguel Delgado Tim Klein Dale La. Borde Rebecca Rome Tim Klein Steve Kent Tim Klein Steve Kent Dale La. Borde Miguel Delgado Steve Kent Tim Klein Miguel Delgado Dale La. Borde Steve Kent Rebecca Rome Elizabeth Gremillion Tim Klein Miguel Delgado Rebecca Rome Steve Kent Dale La. Borde Parish Madison Morehouse Natchitoches Manager Steve Kent Rebecca Rome Orleans Elizabeth Gremillion Ouachita Steve Kent Plaquemines Rebecca Rome Pointe Coupee Dale La. Borde Rapides Tim Klein Red River Steve Kent Richland Steve Kent Sabine Steve Kent St. Bernard Elizabeth Gremillion St. Charles Rebecca Rome St. Helena Dale La. Borde St. James Rebecca Rome St. John the Baptist Rebecca Rome St. Landry Miguel Delgado St. Martin Miguel Delgado St. Mary Miguel Delgado St. Tammany Elizabeth Gremillion Tangipahoa Elizabeth Gremillion Tensas Steve Kent Terrebonne Rebecca Rome Union Steve Kent Vermilion Miguel Delgado Vernon Tim Klein Washington Elizabeth Gremillion Webster Steve Kent West Baton Rouge Dale La. Borde West Carroll Steve Kent West Feliciana Dale La. Borde Winn Steve Kent Elizabeth Gremillion NOLA Zip Codes 70002 70005 70116 70117 70119 70122 70124 70126 70127 70128 70129 10
Louisiana Market. POINT 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 11 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 Wal. Mart 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. 12 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 15
Lafayette Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage 76. 3% 1% 0. 6% 15. 3% 5. 1% 1. 2% Includes: Acadia, Evangeline, Iberia, Lafayette, St Landry, St Martin, St Mary, Vermillion 16
Lake Charles/Alexandria Market Share Humana Blue Cross Peoples Aetna Wellcare Vantage 74. 0% 0. 6% 3. 5% 18. 7% 0. 0% Includes: Allen, Avoyelles, Beauregard, Calcasieu, Cameron, Catahoula, Concordia, Grant Jefferson Davis, La. Salle, Rapides and Vernon 17
Humana Gold Plus HMO H 1951 -025 MAPD Service Area Calcasieu; Cameron; Grant; Lafayette; Rapides Premium $0 MOOP Plan Deductible Inpatient Cost Share SNF $6700 N/A $195 copay/day Days (1 -7) Preferred Hospital $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $10 $40 $200 ASC / $250 OP Hosp PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $200 copay Rx Deductible $295, ICL $3700, Tr. OOP $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: My. Option Dental High PPO OSB 001/Premium $17. 30 Other Value Added Services: Complimentary & Alt Med. , Dental Discounts, Nutri. Systems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at Wal. Mart®, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 18 Confidential Information – For Agents Only
Humana Gold Plus HMO H 1951 -042 MAPD Service Area Acadia; Caldwell; Catahoula; East Carroll; Franklin; Iberia; Jackson; Lincoln; Madison; Morehouse; Ouachita; Richland; St. Landry; St. Martin; Tensas; Union; Vermilion; West Carroll Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $0 $6700 N/A $215 copay/day Days (1 -8) $0 copay/day Days (1 -20)/ $164. 50 copay/day Days (21 -100) $15 copay $50 copay $250 ASC $275 OP Hosp $250 copay RX $200; ICL $3700; Tr. OOP $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; Humana. First; Humana Wellness; Life. Synch; Quit. Net 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, Life. Card Plans, Dental, Vision & Hearing Discounts, Lifeline Program, Nutri. Systems 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
Humana Choice PPO (Louisiana) H 6609 -104 MAPD Service Area Calcasieu; Caldwell; Cameron; La Salle; Lafayette; Morehouse; Ouachita; St. Landry; St. Martin; St. Mary; Washington Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging $47 $6700 $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. $225 copay/day Days (1 -7) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $5 copay $50 copay $175 ASC $225 OP Hosp $175 copay Part D Benefit Rx Deductible $400, ICL $3700, Tr. OOP $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 : My. Option Dental –High PPO My. Option Plus My. Option Vision $17. 30 $17. 70 $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 72. 3% 0. 0% 1. 7% 0. 0% 20. 8% 0. 0% Includes: Bienville, Bossier, Caddo, Claiborne, De Soto, Jackson, Lincoln, Natchitoches, Red River, Sabine, Webster and Winn 21
Humana Gold Plus HMO H 1951 -013 MAPD Service Area Bossier; Caddo; Webster Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: $37 $6700 N/A $175 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $5 $50 $250 ASC/$275 OP Hosp $225 copay Rx Deductible $400, ICL $3700, Tr. OOP $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) 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: My. Option Enhanced Dental HMO OSB 008/Premium $24. 10 My. Option Vision OSB 004/Premium $15. 30 Other Value Added Services: Complimentary & Alt Med. , Dental Discounts, Nutri. Systems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at Wal. Mart®, Jenny Craig Please refer to plan Summary of Benefits and EOC for full explanation of benefits 22 Confidential Information – For Agents Only
Humana Choice PPO H 5525 -015 MAPD Service Area Bienville; Claiborne; De Soto; Natchitoches; Red River; Sabine; Winn Premium MOOP Plan Deductible $47 $6700. 00 $750. 00 Inpatient Cost Share SNF $185 copay/day Days (1 -7) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $5 copay $50 copay $135 ASC $185 OP Hosp $175 copay PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Rx Deductible $400, ICL $3700, Tr. OOP $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: My. Option Dental - High PPO OSB 001/Premium $17. 30 Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutri. Systems Discount, Rx Discount, Vision Discount, Hearing Discount , Vitality Healthy Food Discount at Wal. Mart®, Jenny Craig 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 38. 0% 0. 1% 0. 0% 61. 2% 0. 0% Includes: Caldwell, East Carroll, Franklin, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll 24
Humana Gold Plus HMO H 1951 -042 MAPD Service Area Acadia; Caldwell; Catahoula; East Carroll; Franklin; Iberia; Jackson; Lincoln; Madison; Morehouse; Ouachita; Richland; St. Landry; St. Martin; Tensas; Union; Vermilion; West Carroll Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $0 $6700 N/A $215 copay/day Days (1 -8) $0 copay/day Days (1 -20)/ $164. 50 copay/day Days (21 -100) $15 copay $50 copay $250 ASC $275 OP Hosp $250 copay RX $200; ICL $3700; Tr. OOP $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; Humana. First; Humana Wellness; Life. Synch; Quit. Net 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, Life. Card Plans, Dental, Vision & Hearing Discounts, Lifeline Program, Nutri. Systems 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 59. 4% 35. 9% 0. 7% 3. 1% 0. 2% 0. 3% Includes: Assumption, Jefferson, Lafourche, Orleans, Plaquemines, St Charles, St James, St John, Terrebonne 26
Humana Total Care Advantage HMO H 1951 -038 MAPD This Plan Has A Separate HMO Network Directory Members Must Use Only Those Providers Service Area Jefferson; Orleans; St. Charles Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $0 $6700 N/A $105 copay/day Days (1 -10) $0 copay/day Days (1 -20): $164. 50 copay/day Days (21 -100) $0 copay $45 copay $175 copay $195 copay ASC & OP Hosp Rx Deductible $350, ICL $3700, Tr. OOP $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 H 1951 -044 MAPD SNP CVD/CHF/DB This Plan Has A Separate HMO Network Directory Members Must Use Only Those Providers Service Area Jefferson; Orleans Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging $0 $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. N/A $25 copay/day Day (1 -5) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $0 copay $27 copay OV copay if in PCP or spec office / $100 if in ASC or OP Hosp $100 ASC & OP Hosp Part D Benefit Rx Deductible $0, ICL $3700, Tr. OOP $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 Wal. Mart®, 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
Humana Gold Plus HMO H 1951 -047 -001 MAPD Service Area Jefferson; Orleans; St. Charles Premium MOOP Plan Deductible Inpatient Cost Share SNF $0 $6700 N/A $105 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $10 $50 $175 ASC & $200 OP Hosp $195 copay Rx Deductible $400, ICL $3700, Tr. OOP $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 OSB 001 $17. 30 Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutri. Systems 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 H 1951 -047 -002 MAPD Service Area Assumption; Lafourche; Plaquemines; St. James; St. John the Baptist; Terrebonne Premium MOOP Plan Deductible Inpatient Cost Share SNF $33 $6700 N/A $150 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 5 copay/day Days (21 -100) PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $5 $50 175 ASC & $200 if in OP Hosp $195 copay Rx Deductible $400 ICL $3310, Tr. OOP $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: My. Option Dental – High PPO OSB 001 $17. 30 Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutri. Systems 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 64. 9% 31. 1% 0. 8% 1. 6% 0. 2% 0. 9% Includes: St Tammany & Washington 31
Humana Gold Plus HMO H 1951 -028 MAPD Service Area St. Tammany; Washington Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery $28. 90 $6700. 00 N/A $195 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $10 copay $50 copay $150 ASC / $195 OP Hosp Advanced Imaging Part D Benefit $195 copay Rx Deductible $400, ICL $3700, Tr. OOP $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: My. Option Dental High PPO OSB 001/Premium $17. 30 Other Value Added Services: Complimentary & Alt Med. , Dental Discounts, Nutri. Systems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at Wal. Mart®, 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 64. 6% 32. 2% 0. 5% 0. 0% 1. 9% 0. 0% 33
Humana Gold Plus HMO H 1951 -024 MAPD Service Area Tangipahoa Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery $61 $6700 N/A $200 copay/day Days (1 -7) Preferred Hospital $275 copay/day Days (1 -7) Non-Preferred Hospital $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $5 $45 $200 ASC / $250 OP Hosp Advanced Imaging Part D Benefit $250 copay Rx Deductible $320, ICL $3700, Tr. OOP $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, Nutri. Systems Discount, Rx Discount, Vision Discount, Hearing Discount, Vitality Healthy Food Discount at Wal. Mart®, 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 73. 3% 16. 1% 1. 3% 6. 2% 0. 3% 1. 3% Includes: Ascension, East Baton Rouge, East Feliciana, Iberville, Livingston, Pointe Coupee, St Helena, West Baton Rouge, West Feliciana 35 Confidential Information – For Agents Only
Humana Total Care Advantage HMO H 1951 -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 MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $0 $6700 N/A $145 copay/day Days (1 -10) $0 copay/day Days (1 -20): $164. 50 copay/day Days (21 -100) $0 copay $45 copay $160 ASC & OP Hosp $200 copay Rx $350 Deductible, ICL $3700, Tr. OOP $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
Humana Gold Plus HMO H 1951 -048 -001 MAPD Service Area Ascension; East Baton Rouge; Livingston; West Baton Rouge Premium MOOP Plan Deductible Inpatient Cost Share SNF $0 $6700 N/A $145 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 5 copay/day Days (21 -100) PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $10 $50 $125 ASC $1 OP Hosp $200 copay Rx Deductible $400, ICL $3700, Tr. OOP $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 OSB 001 $17. 30 Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutri. Systems 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
Humana Gold Plus HMO H 1951 -048 -002 MAPD Service Area East Feliciana; Iberville; Pointe Coupee; St. Helena; West Feliciana Premium MOOP Plan Deductible Inpatient Cost Share SNF $36 $6700 N/A $150 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 5 copay/day Days (21 -100) PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $10 $50 $135 ASC $175 OP Hosp $225 copay Rx Deductible $400, ICL $3700, Tr. OOP $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 OSB 001 $17. 30 Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutri. Systems 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
Humana Gold Plus HMO H 1951 -030 MA Service Area Ascension; East Baton Rouge; East Feliciana; Iberville; Livingston; Pointe Coupee; St. Helena; West Baton Rouge; West Feliciana Premium MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: $0 $6700 N/A $110 copay/day Days (1 -10) $0 copay/day Days (1 -20) $164. 50 copay/day Days (21 -100) $5 $50 $135 ASC / $175 OP Hosp $200 copay N/A Dental, Vision, & Hearing Services; Smoking Cessation Services; Humana. First 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: My. Option Dental - High PPO OSB 001 $17. 30 Other Value Added Services: Complimentary & Alt Medicine, Dental Discounts, Nutri. Systems Discount, Healthy. Food 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
Humana Choice RPPO R 5826 -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, Tr. OOP $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, Dental Discounts, Nutri. Systems 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
Humana Choice RPPO R 5826 -068 Service Area Louisiana & Mississippi Statewide Premium $0 MOOP Plan Deductible Inpatient Cost Share SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: $6, 700 IN / $10, 000 I&ON $1, 000 $195 copay/day Days (1 -6) $0 copay/day Days (1 -20); $164. 50 copay/day Days (21 -100) $10 copay $35 copay $145 ASC $195 OP HOSP $150 copay N/A Dental, Vision & Hearing; Independent Living System; Quit. Net; Silver. Sneakers; Humana. First; 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, Life. Card Plans, Lifeline Program, Nutri. Systems 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
Humana Choice RPPO R 5826 -078 PPO MA Service Area Louisiana & Mississippi Statewide Premium MOOP Plan Deductible Inpatient Cost Share SNF $47 $6, 700 $1000 $275 copay/day Days (1 -7) $0 copay/day Days (1 -20); $164. 50 copay/day Days (21 -100) PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $15 copay $50 copay $275 ASC & OP Hosp $225 copay RX $400; ICL $3700; Tr. OOP $4950 $5/$12/$47/$100/25% Standard Retail 30 -Day supply $0/$0/$131/$290 Preferred Mail Order— 90 -Day supply Silver. Sneakers; Humana. First; Humana Pharmacy $25 maximum benefit Other Benefits: coverage amount per quarter (3 months) for select OTC health and wellness products. Optional Supplemental Benefits: My. Option 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
Humana Gold Plus HMO H 1951 -041 SNP DE MAPD (Include H 1951 -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 MOOP Plan Deductible Inpatient Cost Share $0 $0 $0 $300 copay/day Days (1 -3) / $0 copay/day Days (4 -90) SNF PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit $0 copay/day Days (1 -20)/$160 copay/day Days (21 -100) 0% coinsurance Rx Deductible $200, ICL $3700, Tr. OOP $4950 $0 - 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision & Hearing; Quit. Net; Silver Sneakers; Humana. First; 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
Humana Gold Plus HMO H 1951 -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 MOOP Plan Deductible Inpatient Cost Share $0 $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) 0% coinsurance PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Rx Deductible $0, ICL $0, Tr. OOP $0 $0 - Preferred Mail Order 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Humana. First 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, Healthy. Food Discount, Life. Line 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
Humana Gold Plus HMO H 1951 -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 MOOP Plan Deductible Inpatient Cost Share $0 $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) 0% coinsurance Rx Deductible $0, ICL $0, Tr. OOP $0 $0 - Preferred Mail Order 30 day supply $0 - Preferred Mail Order 90 day supply PCP Co-pay Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit Other Benefits: Optional Supplemental Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Humana. First 24 Hotline; Fitness Program; Health & Nutrition Education Services; Humana Pharmacy $20 maximum benefit coverage amount per month for OTC health and wellness products. N/A Other Value Added Services: Complimentary & Alt Medicine, De ntal Discounts , Nutri. Systems Discount, Rx Discount, Lifeline Program, Vision Discount, Hearing Discount, Healthy. Food 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
Humana Gold Plus HMO H 1951 -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 MOOP Plan Deductible Inpatient Cost Share $0 $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 Specialist Co-pay Outpatient Surgery Advanced Imaging Part D Benefit 0% coinsurance Rx Deductible $0, ICL $0, Tr. OOP $0 $0 - 30 day supply $0 - Preferred Mail Order 90 day supply Other Benefits: Dental, Vision, & Hearing Services; Smoking Cessation; Humana. First 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, Healthy. Food Discount at Wal-Mart, Quit. Net 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 H 1951 -047 -001 - $0 H 1951 -048 -001 - $0 H 1951 -028 - $28. 90 Jefferson St Charles Orleans H 1951 -047 -002 - $33 Ascension Livingston H 1951 -034 (DE SNP)- $0 East Baton Rouge West Baton Rouge St. Tammany H 1951 -048 -002 - $36 Washington East Feliciana St Helena St John The Baptist Iberville West Feliciana Tangipahoa Shreveport Terrebonne Pointe Coupee H 1951 -024 - $61. 00 H 1951 -013 - $37. 00 Tangipahoa Bossier Assumption St James Lafourche Plaquemines H 1951 -033 (DE SNP)- $0 H 1951 -030 - $0 and H 1951 -032 (DE SNP)- $0 Caddo Webster Assumption St. Charles Ascension Pointe Coupee Jefferson St. James East BR St Helena Lafourche St. John Baptist East Feliciana West Baton Rouge Orleans Terrebonne Iberville West Feliciana Plaquemines Livingston New Orleans H 1951 -044 Diabetes & Heart CC SNP- $0 Jefferson Southwest/Central Orleans H 1951 -025 - $0 Ochsner Only Plans LPPO H 6609 -104 -$47 Calcasieu Ouachita Caldwell St. Landry St. Martin H 1951 -041 DE SNP- $0 Cameron H 1951 -038 (NO) - $0 H 1951 -039 (BR) - $0 Calcasieu Lafayette St. Mary Jefferson East BR Cameron La Salle Washington Orleans East Feliciana Grant Morehouse St. Charles Iberville Lafayette Livingston Rapides Bienville Red River St. Helena H 1951 -042 (LA Crossroads) - $0 Claiborne Sabine West BR LPPO H 5525 -015 - $47 H 1951 -041 (LA Crossroads DE SNP)- $0 Acadia Morehouse De. Soto Winn Caldwell Ouachita Natchitoches Bossier Madison Catahoula Richland Caddo Morehouse East Carrol St. Landry Caldwell Ouachita Franklin St. Martin East Carrol Richland Iberia Tensas Franklin Tensas Jackson Union Lincoln Vermillion Lincoln West Carrol Madison West Carrol PDP PLANS RPPO Plans RX Enhanced (Passive) RX Standard MA Only R 5826 -011 - $77 R 5826 -078 - $47 R 5826 -068 - $0 LA Statewide Preferred Rx (NEW) S 5884 -108 -$27. 90 LA Statewide Enhanced Rx S 5884 -019 -$67. 90 LA Statewide Walmart Rx Plan S 5884 -167 -$17. 00 LA Statewide 49
Have a great AEP!
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