HumanaOne health plans for individuals and families

1
HumanaOne health plans for individuals and
families
2
Product Portfolio Map

• HumanaOne New Business States

WI
MI
NE
OH
IL
IN
NV
UT
VA
CO
MO
KS
KY
NC
TN
SC
OK
AZ
NM
AR
AL
GA
MS
LA
TX
FL
Old Plans
New Plans
Association States AZ, FL, MI, WI
3
Portability

• If a client has a child who attends college in
  another state, that child will receive in-network
  benefits by seeing an in-network provider
• If a client moves to another state they can take
  their policy with them even if HumanaOne is not
  sold in that state
• This is not the case for new sales in FL Open
  Access counties, WI Coalition Counties and GA
  policies

4
HumanaOne Individual Health Plans (OLD PRODUCTS)
Alabama, Arkansas, Illinois, Indiana, Kansas,
Kentucky, Mississippi, Missouri, Nebraska,
Nevada, New Mexico, North Carolina, Ohio,
Oklahoma, South Carolina, Tennessee and Virginia
5
PORTRAIT Share 80 Plus Rx Unlimited

• 80 coinsurance
• Deductibles
• single 1,000 2,500
• family 2,000 5,000
• Unlimited doctor visits
• Separate 500 Rx deductible
• 0 Rx deductible buy-up option

6
AUTOGRAPH Share 80 Plus Rx

• 80 coinsurance
• Deductibles
• single 3,500 5,000 6,000
• family 7,000 10,000 12,000
• Six office visits, then 80 after deductible
• Separate 1,000 Rx deductible
• 500 Rx deductible buy-up option
• 35 reduction in premium over Portrait!

7
Rx benefit for Portrait and Autograph Plans

• Level 1 15 copay ONLY
• no deductible
• 38 of Rx claims fall into Level 1
• Separate 500 (Portrait) or 1,000 (Autograph)
  deductible then copay
• Level 2 35 copay
• Level 3 55 copay
• Level 4 25 copay (Up to 2,500 maximum
  out-of-pocket per person per calendar year)
• Option to buy up to a 0 deductible on Portrait
  or a 500 deductible on Autograph.

8
Office Visit Co-pay

• Doctor visits for injuries / illnesses
• UNLIMITED Office Co-pays (Portrait) or 6 Co-pays
  per person (Autograph Share 80 Plus Rx)
• 35 co-pay for primary care physician
• 50 co-pay for specialist
• 200 allowance for diagnostics and labs at 100
  before deductible

9
AUTOGRAPH Total Plus Rx / HSA

• HSA-Qualified
• 100 coinsurance
• Deductibles
• single 1,500, 2,500, 3,500 5,000
• family 3,000, 5,000, 7,000, 10,000
• Rx expenses integrated with medical deductible

10
AUTOGRAPH Total / HSA

• 100 coinsurance
• Deductibles
• single 2,000, 3,000, 4,000 5,200
• family 4,000, 6,000, 8,000, 10,400
• No Rx benefit but discount card
• Use HSA to fund discounted prescriptions
• Allows for favorable UW and rate-ups are avoided
• Does not cover mental health (except where
  mandated by the state)

11
MONOGRAM Total Plus Rx

• 100 coinsurance
• Deductibles
• single 7,500
• family 15,000
• Separate 1,000 Rx deductible
• Same Rx tier structure with slightly higher
  copays on tiers 2-4 (see your benefit summary)

Monthly premium for a 25 year old male 51.72
12
Back by popular demand - Share 70 Plus Rx

• 70 coinsurance
• Deductibles
• Single 2,500 or 5,000
• Family 5,000 or 10,000
• Out-of-pocket maximum coinsurance
• Single 3,000
• Family 6,000
• Separate 1,000 Rx deductible
• Available in CO, FL, GA, MI, TX, WI

12
13
Important Notes
Applicants Who Are Not Replacing Coverage

• If an applicant has not had coverage in the last
  63 days
• Earliest effective date is 30 days from the date
  of complete application
• UW will complete a not replacing questionnaire
• If an applicant has not had coverage in the last
  2 years
• Underwriting will require the applicant to have a
  physical examination prior to application

Other Notes

• Integrated 4th Quarter deductible carry-over on
  non-HSA plans
• 90 day wait period for preventive care
• Optional Benefits covered in next section with
  New Plan Designs
• Dental, Term Life and Supplemental Accident
  Coverage

14
HumanaOne Individual Health Plans (NEW PRODUCTS)
Arizona, Colorado, Florida, Georgia, Louisiana,
Michigan, Texas, Utah and Wisconsin
15
Enhanced Copay 80 (Similar to Portrait)

• 80 coinsurance
• Deductibles
• Single 500, 1,000, 1,500, 2,000, 2,500,
  3,500, 5,000
• Family Once three family members meet their
  single deductibles, the family deductible will be
  met for all other family members
• Out-of-pocket maximum coinsurance
• Single 2,500 / Family 5,000
• Unlimited doctor office visits35 copay primary
  care physician/60 copay specialist
• 60 copay for an urgent care visit
• Separate 500 Rx deductible (buy-up to 150)

In-network coinsurance and deductibles are shown
16
Copay 80 (Similar to Autograph Share 80 Plus Rx )

• 80 coinsurance
• Deductibles
• Single 3,500, 5,000
• Family Once three family members meet their
  single deductibles, the family deductible will be
  met for all other family members
• Out-of-pocket maximum coinsurance
• Single 3,500 / Family 7,000
• Six doctor office visits
• 35 copay primary care physician /60 copay
  specialist
• 60 copay for an urgent care visit
• After six visits then 80 after deductible
• Separate 700 Rx deductible (buy-up to 300)

In-network coinsurance and deductibles are shown
17
Copay 70 (Similar to the Autograph Share 70)

• 70 coinsurance
• Deductibles
• Single 1,500, 2,500, 5,000
• Family Once three family members meet their
  single deductibles, the family deductible will be
  met for all other family members
• Out-of-pocket maximum coinsurance
• Single 5,000 / Family 10,000
• Three doctor office visits 35 copay primary care
  physician /60 copay specialist
• 60 copay for an urgent care visit
• After 3 visits then 70 after deductible
• Separate 1,000 Rx deductible (buy-up to 500)

In-network coinsurance and deductibles are shown
18
Value 100 (Similar to Monogram)

• 100 coinsurance
• Deductibles
• Single 5,000, 7,500
• Family Once three family members meet their
  single deductibles, the family deductible will be
  met for all other family members
• Separate 1,000 Rx deductible
• Perfect plan for first time insurance buyers and
  those not yet eligible for Medicare

In-network coinsurance and deductibles are shown
19
Prescription benefit Rx4

• Level 1 15 copay (No deductible applies- copay
  only)
• 50 of all Rx claims fall into Level 1
• Level 2 35 copay (40 copay for Copay 70 and
  Value 100)
• 40 of all Rx claims fall into Level 2
• Level 3 60 copay (65 copay for Copay 70 and
  Value 100)
• 10 of all Rx claims fall into Level 3
• Level 4 35 copay
• Up to 5,000 copay maximum, level 4 only
  out-of-pocket expense per person per calendar
  year
• No maximum that Humana will dispense
• Less than 1 of all Rx claims fall into Level 4

Separate prescription deductible applies for
Levels 2 through 4
20
Enhanced HSA 100 (Similar to Autograph Total
Plus Rx HSA)

• 100 coinsurance
• Deductibles
• Single 1,500, 2,500, 3,500, 5,000, 5,950
• Family Benefits will be paid once the family
  deductible is met, regardless of the number of
  members on the plan
• Rx expenses integrated with medical deductible

21
HSA 100 (Similar to Autograph Total/HAS)

• Deductibles
• Single 1,500, 2,500, 3,500, 5,000, 5,950
• Family Benefits will be paid once the family
  deductible is met, regardless of the number of
  members on the plan
• No Rx benefit discount card available at up to
  25 savings
• Does NOT cover mental health (except where
  mandated by state)
• Applicants will NOT be rated up for current Rx
  medications
• Coverage for spinal manipulations, adjustments
  and modalities is not included (except where
  mandated by the state)

22
Reform Changes to Benefits

• Plans sold on or after Sept. 23, 2010 (excluding
  HumanaOne Short Term Medical plans) will have the
  following benefit changes
• Plans will have an unlimited lifetime maximum
  benefit
• Plans will cover in-network preventive care
  services at 100 percent, and there will be no
  dollar limit on coverage for in-network
  preventive care services
• Plans will have no limit on coverage for
  ambulance services
• Plans will have no dollar limit on coverage for
  mental health care

23
Supplemental Accident Benefit option

• 1,000 or 2,500 benefit choice is provided for
  accidental injuries only
• - Old product has 500 or 1,000 benefit
• Treatment must be administered within 90 days of
  the accident
• Not subject to deductible or coinsurance - first
  dollar coverage administered before applicable
  co-pays
• After benefit amount is exhausted, remaining
  charges are applied to the medical policy
  provisions
• No limit on number of accidents per year
• Ideal supplemental benefit to add on to higher
  deductible plans!

24
Dental Traditional Plus

• Preventive Services Plan pays 100 no deductible
• Oral exams
• Routine cleanings
• X-rays
• Basic Services Plan pays 50 after deductible
• Emergency exams
• Composite fillings
• Oral surgery
• Major services Plan pays 50 after deductible
• Crowns
• Root Canals
• Dentures
• Other benefits Orthodontia discount

Waiting periods, limitations and exclusions may
applySee your benefit summary for complete
details and covered services
25
Dental Preventive Plus

• Preventive Services Plan pays 100 no deductible
• Oral exams
• Routine cleanings
• X-rays
• Sealants and fluoride treatments
• Basic Services Plan pays 50 after 50
  deductible (six-month waiting period applies)
• Extractions
• Space maintainers
• Composite fillings
• Oral surgery
• Annual Maximum (excludes discount services)
  1,000
• Discount services
• Receive a discount on services not covered under
  this plan. Savings average 27 nationwide on
  in-network services including Orthodontia
  services
• Checkbox add-on in AZ, CO, MI, UT, WI

Please refer to your state specific summary as
benefits may vary
26
Term Life option

• Simple, convenient process
• Amounts start at 25,000 up to 150,000
• Combined Medical/Life Application - If your
  clients are approved for a health plan they are
  approved for life as well (up to 150K)
• 10, 15, and 20-year level premiums
• Rates are guaranteed for the full term of the
  policy
• Renewable to age 95 after the level premium
  period

27
New plan enhancements
Rate classes
HumanaOne offers three competitive rate classes
for its medical products. These classes are

• Preferred rating our best rate for applicants
  who are in good health overall, take no current
  medication (except birth control), and who have
  had major medial coverage within the past 63 days
  (proof may be required)
• Standard rating applicants who dont qualify for
  the preferred rating and/or have minor ongoing
  medical conditions
• Stardard rating applicants who are in fair
  health and require additional rating due to
  moderate medical conditions

28
New plan enhancements
Sickness effective date
Applicants will have peace of mind knowing they
are covered for an injury immediately after
policy issue

• No longer moving the effective date forward 30
  days
• Applicants will start with a plan (injury)
  effective data and a sickness effective date
• If applicant had a least 63 days of prior
  coverage at time of application, the sickness
  effective date will not apply
• Sickness effective date is the 15th day after the
  policy effective date for bodily injury
• Sickness effective date is issued at the member
  level

29
Underwriting
30
Other Important Notes

• Eligible Ages
• 2 weeks to 64 ½ years old
• No Child Only Applications
• Effective Dates
• Any day of the month including the day they apply
• Up to 45 days in advance
• Special rules for those not replacing coverage

31
When do we need requirements?

• Medical Records (lt15)
• Not replacing coverage recent medical care
• Chronic type conditions
• Information obtained from 3rd party data
• Parameds (lt10)
• Applicant is close to 50 ratable or declinable
  build
• Information obtained from 3rd party data
• Additional Information
• Blood Pressure/Cholesterol Readings (when
  applicants answer dont know).
• Test Results
• Physician or treatment information.
• Third Party Data review/validation

32
Opportunity Financial Protection Products
33
Humana Financial Protection products

• Further diversify your product portfolio
• Wider selection of products to offer your clients
  based on their varying budgets and needs
• Our consumer-focused products are simple to
  understand, easy to obtain, affordable, and
  transparent
• Cross sell huge potential for consumers to
  purchase multiple products
• With health reform, consumers will be considering
  added protection for their personal and financial
  health

34
Life coverage Memorial Fund

• A whole life plan to offset final expenses
  available in benefit amounts from 1,000 -
  25,000
• Offers a graded death benefit with level premiums
  for prospects with health issues (becomes level
  after the third policy year)
• Guaranteed cash value
• Coverage for issue age is 45 - 80 (nearest age)
• Premium options are life pay or 10-year pay

Product availability will vary by state.
35
Health coverage Critical Illness Cash plan

• Pays lump-sum cash benefits for critical
  illnesses such as heart attack, stroke, and
  cancer
• Benefit amount from 5,000 - 50,000
• Same lump-sum amount paid for all covered family
  members
• Issue ages 0 - 69 (may vary by state)
• Pays in addition to any benefits client already
  has
• Guaranteed renewable
• 30-day free look
• Optional Return of Premium rider

Product availability will vary by state.
36
Health coverage Hospital Cash plan

• Provides lump-sum benefits directly to client
  for
• Hospital confinement
• Outpatient surgery
• Accidental injury or sickness
• Issue ages 0 - 69 (may vary by state)
• Guaranteed renewable to age 70
• Lump-sum hospital confinement from 250 - 2,000
• Maximum coverage 2,000 for all in-force policies
• 150 lump-sum accidental injury and sickness
  benefit per emergency room visit
• 150 lump-sum outpatient surgery benefit
• Optional hospital confinement daily benefit
  rider 50 (200 ICU) 100 (400 ICU 200 (800
  ICU)

Product availability will vary by state.
37
Quoting and Enrollment
Quoting
38
Quoting and Enrollment
www.Humanaoneagentquote.com

• To create a quote go to humanaoneagentquote.com
• Enter Humana Agent SAN and click Next.

• Use for quoting and enrollment only
• Agent can not reassig the quote to another agent

39
Quoting and Enrollment
Agent Workbench
www.humana.com Simple Registration Process!
Your Humana Agent number is required
for registration and can be found On your
welcome letter after appointment On your
commission statement From the Agent Service
Center
40
Accessing Agent Workbench

• Log onto www.humana.com
• Enter your username and password
• Click Log In

41
Accessing Agent Workbench
42
Accessing Agent Workbench

• To begin a quote, hover over Generate a New Quote
  in either of the two locations and select a
  product
• Medical (Health and STM)
• Stand Alone Dental and Vision
• Supplemental Insurance
• Stand Alone Life

43
Generate a Quote Agent Workbench or
humanaoneagentquote.com
44
Generate a Quote
45
Generate a Quote
46
Generate a Quote
47
Generate a Quote

• Once the quote is saved, the quote can be
  printed, e-mailed or applied for.

48
Application Methods
49
How Can Clients Apply?

• Clients can apply two different ways
• Agent Initiated Application (AIA) Online with
  your assistance
• Agent Online Application (AOA) Online, on their
  own

50
Agent Initiated Application
51
Agent Initiated Application

• On the agent disclaimer screen, the agent must
  read and agree to all statements by checking the
  boxes.

52
Agent Initiated Application
53
Agent Initiated Application

• Enter the information for all applicants on the
  applicant details screen.
• Select which signature type the client wishes to
  use e-signature or wet-signature. Click Next

54
Agent Initiated Application
55
Agent Initiated Application
56
Agent Initiated Application

• The application is now ready to send to the
  client. In order to provide your client with a
  link to review and sign their documents, the
  agent must click Send E-mail.

57
Signing an Agent Initiated App
58
E-Signature Process
59
E-Signature Process

• Your client will need to click on the link within
  the email. A new browser window will open.
• The application number will pre-populate. Your
  client will enter the required information and
  click Next.

60
E-Signature Process

• The applicant(s) are required to read and agree
  to the Online Service Agreement and the Notice of
  Privacy Practices.
• They should review each document and click the
  checkboxes next to their name. Click Next.

61
E-Signature Process
62
Track Quotes and ApplicationsAgent Workbench
63
Track Quotes and Applications

• Agents can access Track Quotes and Applications
  to view status up to the point of payment
  verification.

64
Track Quotes and Applications

• Enter your search criteria
• Search results can also be exported into excel
• Status Information

65
Issued Business Tab
66
(No Transcript)