Agent Guide for selling Journey Rx

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Welcome to the MII Life Insurance, Inc. (MII) team! This guide provides licensed agents, brokers, producers and call center representatives (hereinafter referred to as “agent”) with information about how to sell Journey Rx™. You will learn:

• How to get certified and appointed to sell Journey Rx

• How to enroll beneficiaries

• How to manage your book of business

• Journey Rx product information

Contact information

MII has contracted with your managing or general agent (hereinafter referred to as “general agent”) to sell Journey Rx. Contact your general agent to:

• Contract to sell Journey Rx

• Research questions about plan benefits

• Request approved marketing materials

• Get answers to commission-related questions

If you are contacted by a member who has questions that you are unable to answer, refer the member to the post-enrollment customer service line. You may also use these numbers if you have post-enrollment questions about Journey Rx.

Journey Rx

1-877-690-8196 (TTY users call: 711)

October 1 – March 31: 8 a.m. to 8 p.m., local time, seven days a week

April 1 – September 30: 8 a.m. to 8 p.m., local time, Monday through Friday

Welcome

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Journey Rx (pdp)

Journey Rx is a stand-alone, low-premium PDP that features two coverage options. See page 5 for product details.

ClearStone Solutions and MII

ClearStone Solutions (ClearStone), is an independent company providing Part D administrative services and is the national administrator of MII Part D plans and your primary contact. ClearStone provides Part D administrative services for more than 300,000 members across the United States.

MII is a Medicare contractor and underwriter for Journey Rx.

Organizational overview

Organization structure

ClearStone Solutions(Plan administrator)

MII Life Insurance, Inc.(Plan sponsor)

Journey Rx(PDP product)

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Before you can begin selling Journey Rx, there are some required steps that must be completed. This checklist will help ensure that you are qualified to sell the plans. Additional information about each checklist item can be found throughout the remainder of this section.

Checklist for agent onboardingn Get approval for appointment with

general agent

n Complete Medicare certification training

n Get appointed with MII

n Confirm qualified agent status

n Set up account on TMG Health (TMG) Portal for agents

Get approval for appointment with general agent

You must be contracted with a general agent that is contracted with MII to be eligible for appointment with MII. Before you begin the MII appointment process, you must get approval from your general agent to do so. If you are not currently contracted with a general agent, please contact a participating general agent to initiate the process. Contracting with a general agent is a separate process from the appointment with MII.

Complete Medicare certification training

Agents are required to complete Medicare certification training to be eligible for appointment with MII. The following training courses are required:

• Medicare Basics

• Medicare Parts C and D Compliance and Fraud, Waste, and Abuse (FWA) training

• Product training

If you have been approved to sell MII plans, you will receive an email with instructions about how to access the training courses. Each course must be completed on an annual basis for you to remain eligible to receive commission and/or commission renewal payments. If you are not actively selling Journey Rx but hold a book of business, you are required to be certified annually to receive commissions.

Medicare Basics training can be completed through Pinpoint Global for a small fee. If you complete Medicare Basics and/or Medicare Parts C and D Compliance and Fraud, Waste, and Abuse training through another accepted provider (e.g. AHIP or Gorman Core), the training fee will be waived. You will need to upload the certificate of completion into the training system to receive credit.

There is no cost to agents for Journey Rx training. The required pass rate is 85 percent and the training module takes approximately 20 to 30 minutes to complete.

Get appointed with MIIAfter you complete all required training, MII will appoint you to sell with the state in which your general agent has requested for you to sell. Depending on state requirements, the timing for completion of the appointment will vary. Typically, it is an overnight process. You will need to complete this training on an annual basis to maintain appointment with MII and to continue to receive commission payments.

Confirm qualified agent statusYou will receive a ready-to-sell notification when your qualified agent status has been confirmed. If you are expecting a ready-to-sell notification but haven’t received one, please contact your general agent to determine the status.

Preparing to sell Journey Rx

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Set up account on TMG Health (TMG) Portal for agents

You can easily check your book of business and access member and other information online using the TMG Portal for agents. TMG is MII’s contracted post-enrollment customer service vendor and manages the TMG Portal. You should set up your TMG Portal account as soon as possible after being appointed with MII.

Only agents who have completed onboarding, Medicare certification training and who have been appointed with MII can access this portal. It is your responsibility to set up an account through the TMG Portal. You can only set up your portal access after you have received your ready-to-sell notification. Your general agent does not have access to this portal.

You can access this portal at https://agentportal-bbr.tmghealth.com/portal

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Prescription drug costs are not covered by Original Medicare and without coverage, these costs can add up quickly for beneficiaries. Journey Rx may be a good fit for beneficiaries who:

• Are eligible for a Medicare Part D plan

• Currently take prescription drugs, or may need to in the future

• May need to fill prescriptions while traveling in the U.S.

• Want a low-premium prescription drug plan

• Want to avoid the Part D late enrollment penalty

• Are enrolled in, or plan to enroll in, a Medicare Supplement Insurance (Medigap) plan

It’s important to consider plan suitability when assisting a beneficiary who is looking for prescription drug coverage.

About the plan

Members of Journey Rx can choose between two low-premium prescription drug plan options that feature reliable, nationwide coverage. You can review all current plan details for your coverage area at JourneyRxMedicare.com.

Nationwide pharmacy network

Journey Rx has a nationwide network with more than 67,000 pharmacies with each one offering either preferred or standard cost sharing. Members will pay less when using an network pharmacy offering preferred cost sharing. All members get preferred cost sharing at more than 9,800 CVS and Target pharmacies. Standard plan members additionally get preferred cost sharing at more than 36,000 pharmacies including retailers like Costco, Kroger, Walmart and more.

Drug list

The drug list, or formulary, shows members which prescription drugs are covered by the plan. Journey Rx and a team of health care professionals create the list by selecting drugs that provide the best value and effectiveness. The drug list covers around 3,000 prescription drugs and features five tiers, or levels:

• Preferred generic

• Generic

• Preferred brand

• Non-preferred drug

• Specialty

The drug list can change throughout the year, and the fastest way to check the latest information is to use the online drug search tool.

Help members look up the drug list at JourneyRxMedicare.com/members/drug-list-information

Journey Rx product overview

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Agents should follow the guidelines set by the Centers for Medicare & Medicaid Services (CMS) when selling and enrolling members in Journey Rx. This ensures that you receive credit for the sale and that you are in compliance with applicable rules and regulations. The information and resources outlined in this section will help you sell Journey Rx.

Scope of appointment form

Before meeting with a beneficiary, make sure to complete a scope of appointment (SOA) form. When possible, complete the SOA form in advance of the appointment. In some instances, for example, when meeting with a walk-in, it is acceptable to fill out the SOA form at the time of the appointment. If you have an SOA form completed and the beneficiary asks to discuss additional products during the appointment, document a second SOA form for the additional product type to continue the appointment.

CMS requires that you retain a copy of the SOA form for 10 years plus the current year, regardless of whether an application is taken during the appointment. SOAs must be made available to CMS and MII upon request.

You may use the SOA form provided by your general agent, or you can access MII-provided SOA forms online.

Journey Rx SOA form: JourneyRxMedicare.com/agents

Sales events

If you are interested in presenting Journey Rx at a formal or informal sales and/or marketing event, you must first notify your general agent. Do not begin marketing or advertising the event or your participation in an event until you have approval from your general agent to do so. Your general agent is required to report all event-related activities to MII.

Review the CMS Medicare Communications and Marketing Guidelines and your Medicare certification training to learn more about the requirements for hosting a sales and/or marketing event.

Advertising and marketing activities

Producers should not engage in advertising or marketing activities that promote Journey Rx without express permission to do so. If you become aware of an advertising or marketing opportunity, please share it with your general agent.

Advertising and marketing activities include, but are not limited to:

• Billboard and other environmental advertisements

• Email marketing

• Digital advertisements

• Paid search marketing

• Print advertisements

• Social media marketing

Approved marketing materials

ClearStone manages the creation and approval processes for all MII marketing materials. You can request marketing materials from your general agent. The following materials are typically readily available:

• Pre-enrollment guide (print and digital)

• Presentation templates (digital)

• Product and premium benefit overview (print and digital)

Making the sale

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Pre-enrollment guide for prospective members

Each product has its own pre-enrollment guide which includes details about the annual deductible, monthly premium amounts, cost-sharing information and a paper enrollment form with a pre-paid postage return envelope. The pre-enrollment guide is updated and redistributed annually. You may use and/or reference this when discussing the plans with beneficiaries.

Presentation templates

You may request the Journey Rx PowerPoint template from your general agent. Please do not modify the logo or any other brand-related elements within the template. Contact your general agent if you have any questions or issues with the template.

Product and premium benefit overview

Each product has its own benefit overview which includes details such as annual deductible, monthly premium and cost-sharing information and a short FAQ section. The benefit overview is updated and redistributed annually. You may use and/or reference this when discussing the plan with beneficiaries.

Agent Alerts

Agent Alerts are email communications that you will receive from your general agent on an as-needed basis. You should carefully review these communications as they arrive as they may contain important plan information, formulary updates, AEP-readiness details and other information. If you are not receiving Agent Alerts but believe you should be, contact your general agent.

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After completing the Medicare certification training and appointment process, you will receive a ready-to-sell notification. Once you receive the notification, you are qualified to enroll beneficiaries in Journey Rx. When you’re ready to enroll a beneficiary, you may choose one of two methods for completing the enrollment: Online or paper. You will need your national producer number (NPN) available to earn credit for your enrollments regardless of which method you use.

Online enrollment (including call center agents)

This is the preferred enrollment method, and the fastest. To complete an online enrollment, follow these steps:

• Visit the website for the plan in which the beneficiary is enrolling: JourneyRxMedicare.com

• Select the “Enroll” tab and follow the steps

• Under “Agent Signatures,” individual agents select “Enrollee is present” or “Agent has signed paper enrollment form in hand”

– “Enrollee is present”: Select this option only if the enrollee is physically present at the time of enrollment

– “Agent has signed paper enrollment form in hand”: Select this option only if the enrollee signed the paper form and checked the box giving the agent permission to enter the form online

• For call center agents only: Select “Enrollee is present” for telephonic enrollments, then check “I am a call center agent”

Paper enrollment

Paper applications must be submitted within four business days of the agent’s signature date, per CMS guidelines. You or your general agent should send completed paper enrollment forms via fax or overnight mail to TMG, MII’s contracted post-enrollment customer experience vendor:

TMG Health fax: 1-855-382-6680

TMG Health 25 Lakeview Drive Jessup, PA 18434

Enrolling beneficiaries

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Member communication timeline

MII will send members plan communications throughout the year. Each communication outlined below is required by the government and helps members better understand their coverage and get the most out of their plan. It’s important for members to review these mailings

as they arrive, as they often contain important, timely information. If you receive questions from members about any mailings they receive from the plan, please encourage them to call the customer service line for the product in which they are enrolled.

The member experience

What When Why

Confirmation letter and member ID card

Within 10 days after you are enrolled

Confirms your plan membership and includes your member ID card

Coordination of benefits (COB) verification letter

Within 30 days after your enrollment, and as needed in following years

To find out if you have any other insurance

Part D explanation of benefits Once per month (if you have a claim)

Provides details about your prescription drug costs and benefits used

First premium bill The month after enrollment, if you elected to receive a billing statement

Explains what is owed for the monthly premium and when to pay

Surveys Throughout the year To improve member experience

Annual Notice of Changes By September 30 each year Describes the plan changes for the upcoming year

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Member ID card

Members will receive a member ID card for the plan in which they are enrolled within 10 calendar days after being enrolled in the plan. Remind members to use this card whenever they visit a pharmacy to fill a prescription or use the CVS Caremark* Mail Order Pharmacy to have a prescription mailed to their home. This ID card is separate from the one the member received for Original Medicare (Part A and/or Part B) and it will not change unless they switch to a different prescription drug plan.

If a newly enrolled member has not yet received their ID card but needs to fill a prescription, remind the member that the acknowledgment, confirmation or welcome letter can be used as proof of valid enrollment until the ID card arrives in the mail.

Coverage during special circumstances

When members travel, encounter an unexpected situation or experience a federal or state emergency, they may be able to use their benefits. Encourage members to contact customer service if they have questions about any of the situations outlined below.

Coverage while traveling

Members who travel within the U.S. and need to fill a prescription along the way may use the online pharmacy locator or call customer service to find an in-network pharmacy nearby.

Members who travel outside of the U.S., will need to pay the full cost of the prescription. MII cannot pay for or make reimbursements for any prescription drugs purchased outside of the U.S.

Medical emergency

Members who experience a medical emergency may need to have a prescription filled at an out-of-network pharmacy. In this situation, the member will typically pay for the entire cost of the prescription then submit a claim for reimbursement. The member may be responsible for paying the difference between the in-network and out-of-network costs.

Federal or state emergency

Members who live in a county designated as a federal (as declared by the Federal Emergency Management Agency) or state (as declared by the member’s state’s governor) disaster area can refill or replace medications lost due to the disaster. Members can get the maximum extended supply available at the time of refill.

Emergency procedures remain in effect for 60 days from the initial declaration unless an end date to the disaster period is announced by FEMA, the member’s state’s governor or CMS. Details about what assistance is available to members in the event of a disaster will be communicated via Agent Alerts (see page 7 to learn more).

* CVS Caremark Part D Services is an independent company providing pharmacy benefit management services.

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Fraud, Waste and Abuse (FWA): Protect your identityIdentity theft impacts Medicare and can lead to higher health care costs. Don’t let anybody steal your identity.

Make sure you:• Never give out your Social Security number,

health plan number, Medicare number or banking information to someone you don’t know

• Always review your Explanation of Benefits (EOB) to make sure you received the service or medication

• Remember that free services do not require you to give your persoanl information

• Contact us if you have questions

If you have FWA concerns, call 1-877-376-2185 (TTY 711) 24 hours a day, seven days a week.

For more information on FWA schemes, go to JourneyRxMedicare.com, select the “LEARN” tab and go to Fraud, Waste & Abuse.

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Code of conduct

You should review the MII code of conduct annually. You can access the most current version of the code of conduct at JourneyRxMedicare.com.

Reporting fraud, waste and abuse (FWA)

You are required to promptly report any suspicions about fraud, waste and abuse (FWA) to MII. FWA suspicions and violations can be reported in any of the following ways:

• Compliance hotline

– Available 24 hours a day, seven days a week 1-866-311-4229

• Compliance officer

– 1-651-662-1900

• Ethics, compliance and privacy officer

– P.O. Box 50821 Mendota, MN 55150-0821

• Send a secure email

– clearstone.solutions.compliance@ clearstonesolutions.com

MII is committed to providing simple ways to report violations of law or the code of conduct. MII strictly prohibits intimidation or retaliation of any kind against anyone who reports violations in good faith, participates in an investigation of alleged violations or files charges external from MII. Reports are kept confidential and those who report violations may remain anonymous. When reporting any FWA, please include all imperative information, including, but not limited to:

• A description of the activity or situation

• Who the alleged parties are

• Disciplinary action taken, if any

Program integrity

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Frequently asked questions

Questions Answers

How do I get appointed? You must first get approval from your general agent. Next, you must complete all onboarding steps. After you have completed all applicable steps and required training, you will be eligible for appointment with MII. See page 3.

When can I begin selling? You can begin making sales after MII notifies you of your ready-to-sell status. This ensures that you are active on all MII systems. Contact your general agent if you have any questions about obtaining your ready-to-sell status.

How do I get a new link for Medicare certification training?

If you have been approved to sell Journey Rx, you will receive an email with instructions about how to access the training courses.

If you are expecting this email but don’t receive it, please first check your junk or spam folder. If you are certain you should have received an email but did not, contact your general agent to have the certification email resent.

Who do I contact with questions or concerns about commission payments?

Contact your general agent for all commission-related questions.

What happens if I enrolled a member with an incorrect spelling of the member’s name or address?

Typically, CMS corrects the enrollment information through the verification process. Members can call customer service at 1-877-690-8196 to verify the spelling of these items and update them if necessary.

How do I verify that a member is enrolled in Journey Rx and/or in electronic funds transfer (EFT)?

You can see if a member’s enrollment status is active and/or how the member’s billing preference was set up via the TMG Portal. See page 4.

How can I get physical or digital copies of approved marketing materials?

You can request these materials from your general agent. Not all materials are available in a printed format. Digital copies are available on the specific product’s website.

MII Life Insurance, Inc. is the underwriter for Journey Rx, a prescription drug plan with a Medicare contract. Enrollment in Journey Rx depends on contract renewal. Journey Rx is a trademark of MII Life Insurance, Inc.

Journey Rx Value plan’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of IA, MI, MN, MT, ND, NE, SD and WY. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call Journey Rx at 1-888-575-7530 (TTY: 711) or consult the online pharmacy directory at JourneyRxMedicare.com.

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