agent use only humanaone health plans for individuals and families

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HumanaOne health plans for individuals and families

AGENT USE ONLY

Product Portfolio Map

• HumanaOne New Business States

TX

AZ*

CO

IL

FL*

GA

LA

MOKS

NEIN

WI*

MS

SC

NC

OH

MI*

AR

KY

TN

UTNV

OK

AL

VA

Old Plans

NM

New Plans

* Association States – AZ, FL, MI, WI

AGENT USE ONLY

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

AGENT USE ONLY

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

AGENT USE ONLY

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

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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!

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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.

AGENT USE ONLY

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

AGENT USE ONLY

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

AGENT USE ONLY

AUTOGRAPH Total / HSA


• 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)

AGENT USE ONLY

MONOGRAM Total Plus Rx


• Deductibles:

– single: $7,500

– family: $15,000


– 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

AGENT USE ONLY12

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


• Available in CO, FL, GA, MI, TX, WI

AGENT USE ONLY

Important Notes

• 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

Applicants Who Are Not Replacing Coverage

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

AGENT USE ONLY

HumanaOne Individual Health Plans(NEW PRODUCTS)

Arizona, Colorado, Florida, Georgia, Louisiana, Michigan, Texas, Utah and Wisconsin

AGENT USE ONLY

In-network coinsurance and deductibles are shown

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 visits$35 copay primary care physician/$60 copay specialist

– $60 copay for an urgent care visit

• Separate $500 Rx deductible (buy-up to $150)

AGENT USE ONLY


Copay 80% (Similar to Autograph Share 80 Plus Rx )

• 80% coinsurance

• Deductibles

– Single: $3,500, $5,000



• Six doctor office visits

– $35 copay primary care physician /$60 copay specialist


– After six visits then 80% after deductible

• Separate $700 Rx deductible (buy-up to $300)

AGENT USE ONLY


Copay 70% (Similar to the Autograph Share 70)

• 70% coinsurance

• Deductibles

– Single: $1,500, $2,500, $5,000



• Three doctor office visits $35 copay primary care physician /$60 copay specialist


– After 3 visits then 70% after deductible

• Separate $1,000 Rx deductible (buy-up to $500)

AGENT USE ONLY


Value 100% (Similar to Monogram)


• Deductibles

– Single: $5,000, $7,500



• Perfect plan for first time insurance buyers and those not yet eligible for Medicare

AGENT USE ONLY

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%)


• Level 3: $60 copay ($65 copay for Copay 70% and Value 100%)


• 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:

AGENT USE ONLY

Enhanced HSA 100% (Similar to Autograph Total Plus Rx HSA)


• 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

AGENT USE ONLY

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)

AGENT USE ONLY

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

AGENT USE ONLY

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!

AGENT USE ONLY

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

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

AGENT USE ONLY

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

AGENT USE ONLY

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

AGENT USE ONLY

New plan enhancements

• 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 don’t 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

Rate classes HumanaOne offers three competitive rate classes for its medical products. These classes are:

AGENT USE ONLY

New plan enhancements

• 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

Sickness effective date

Applicants will have peace of mind knowing they are covered for an injury immediately after policy issue

AGENT USE ONLY

Underwriting

AGENT USE ONLY

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

AGENT USE ONLY

When do we need requirements?

• Medical Records (<15%):

– Not replacing coverage & recent medical care

– Chronic type conditions

– Information obtained from 3rd party data

• Parameds (<10%):

– Applicant is close to 50% ratable or declinable build

– Information obtained from 3rd party data

• Additional Information

– Blood Pressure/Cholesterol Readings (when applicants’ answer “don’t know”).

– Test Results

– Physician or treatment information.

– Third Party Data review/validation

AGENT USE ONLY

Opportunity – Financial Protection Products

AGENT USE ONLY

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

AGENT USE ONLY

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.

AGENT USE ONLY

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


AGENT USE ONLY

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)


AGENT USE ONLY

Quoting

Quoting and Enrollment

AGENT USE ONLY


• To create a quote go to humanaoneagentquote.com

• Enter Humana Agent SAN and click Next.

www.Humanaoneagentquote.com• Use for quoting and enrollment only

• Agent can not reassig the quote to another agent

AGENT USE ONLY


Your Humana Agent number is required forregistration and can be found:– On your welcome letter after appointment– On your commission statement– From the Agent Service Center

www.humana.comSimple Registration Process!

Agent Workbench

AGENT USE ONLY

Accessing Agent Workbench

• Log onto www.humana.com

• Enter your username and password

• Click Log In

AGENT USE ONLY


AGENT USE ONLY


• 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

AGENT USE ONLY

Generate a Quote Agent Workbench or humanaoneagentquote.com

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Generate a Quote

AGENT USE ONLY

Generate a Quote

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

AGENT USE ONLY

Application Methods

AGENT USE ONLY

How Can Clients Apply?

Clients can apply two different ways:

1. Agent Initiated Application (AIA) – Online with your assistance

2. Agent Online Application (AOA) – Online, on their own

AGENT USE ONLY

Agent Initiated Application

AGENT USE ONLY


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

AGENT USE ONLY


AGENT USE ONLY


• 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

AGENT USE ONLY


AGENT USE ONLY


• 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.

AGENT USE ONLY

Signing an Agent Initiated App

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E-Signature Process

AGENT USE ONLY

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.

AGENT USE ONLY

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.

AGENT USE ONLY

E-Signature Process

AGENT USE ONLY

Track Quotes and ApplicationsAgent Workbench

AGENT USE ONLY

Track Quotes and Applications

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

AGENT USE ONLY

Track Quotes and Applications

• Enter your search criteria

• Search results can also be exported into excel

• Status Information

AGENT USE ONLY

Issued Business Tab

AGENT USE ONLY

agent use only humanaone health plans for individuals and families

Documents

family deductible

agent use

rx deductible buy

rx deductible available

coinsurance deductibles

single deductibles

medical deductible slide

rx unlimited