2015 medicare advantage prescription drug plan h2758_salespresentation_2015 approved

2015 Medicare Advantage

Prescription Drug Plan

H2758_SalesPresentation_2015 Approved

Presentation Topics

About BeHealthy America

Medicare Eligibility Requirements

A Look at the Four Parts of Medicare (A, B, C and D)

Who is Eligible for BeHealthy America’s Plan?

Enrollment Overview

Presentation Topics

How to Enroll on BeHealthy America

How to contact BeHealthy America

What happens after an Enrollment Application is completed?

Member Rights and Safeguards

Important Disclaimer Information

Providers and BeHealthy America’s 2015 HMO Plan.

Q and A

Who is BeHealthy America?

A Medicare Advantage Prescription Drug (MAPD) Plan

Founded by local healthcare and medical professionals

Serves members in Sarasota and Manatee counties Personalized local service Located in Sarasota, Florida

Who is Eligible for Medicare?

There are 3 ways to obtain Medicare:

Turning age 65 Social Security Disability for 24 consecutive months

(eligibility begins on the 25th month) Diagnosed with End Stage Renal Disease (ESRD)

A Look at the Four Parts of Medicare

Medicare Part A Inpatient Hospital Home Health Care Skilled Nursing Hospice Care Nursing Rehabilitation Care No monthly premium for most individuals Deductibles and Cost-Sharing Apply

A Look at the Four Parts of Medicare

Medicare Part B Physician, Diagnostic, Preventive and Outpatient

Services Medical Equipment Some Drugs Deductibles and Cost-Sharing Apply Monthly premium applies, based on income level

A Look at the Four Parts of Medicare

Medicare Part C – Medicare Advantage Plans (MA) Offered through private insurance companies Includes benefits and services covered under Parts A

& B Additional Benefits that you don’t get with Original

Medicare HMO, PPO, PFFS or Cost Plans Often includes Prescription Drug coverage (MAPD)

A Look at the Four Parts of Medicare

Medicare Part D – Medicare Prescription Drug Coverage Can be offered as a stand-alone plan that goes with

original Medicare Stand Alone Prescription Drug Plans (PDP),may have

an additional monthly premium A Medicare Advantage (MA) plan can offer medical and

prescription benefits together as an Medicare Advantage Prescription Drug (MAPD) plan

Part D includes the mandatory use of a drug formulary

Who is Eligible to Join BeHealthy America’s MAPD Plan?

Medicare beneficiaries residing in our service areas Manatee County

Sarasota County

Must be enrolled in Medicare Parts A and B Medicare beneficiaries with End Stage Renal

Disease (ESRD) are not eligible to join

Important Eligibility Enrollment Dates

When to enroll and/or make a plan change for:

Initial Enrollment Period (IEP)• A seven month period when you are first eligible for

a Medicare Part A and/or B

Important Eligibility Enrollment Dates

When to enroll and/or make a plan change for:

Annual Enrollment Period (AEP)• October 15th through December 7th of each year

• For January 1st effective dates

Important Eligibility Enrollment Dates

When to enroll and/or make a plan change for:

Medicare Advantage Disenrollment Period (MADP)

• January 1st through February 14th each year

Important Eligibility Enrollment Dates

When to enroll and/or make a plan change for:

Lock-In• February 15th through December 31st each year

Important Eligibility Enrollment Dates

When to enroll and/or make a plan change for:

Special Enrollment Period (SEP)• Low Income Subsidy (LIS) eligibility

• During specific life events

How Do I Enroll?

BeHealthy America makes it easy to enroll:1. Enroll after our presentation

2. Schedule an appointment

3. Enroll by telephone at [855-522-2985]

4. Enroll online through the CMS Online Enrollment Center at www.medicare.gov

How Do I Contact BeHealthy America?

Call Us Customer Service

Toll-free telephone [855-522-2870] or TDD/TYY [855-522-2973]

We are open:

• October 1 to February 14: Monday through Sunday, 8:00 am – 8:00 pm

• February 15 to September 30: Monday through Friday, 8:00 am – 8:00 pm

Visit Our Office We are conveniently located in Lakewood Ranch at:

6948 Professional Parkway EastSarasota, FL 34240

What Happens After an Enrollment Application is Completed?

1. Completed enrollment applications are sent to BeHealthy for review

2. The Centers for Medicaid and Medicare Services (CMS) must approve all enrollment applications

3. Outbound Enrollment Verification call or letter

4. Confirmation Letter

New Member Enrollment Package The BeHealthy America Identification Card The Evidence of Coverage (EOC) Provider and Pharmacy Directory Drug Formulary Additional Information

What Happens After an Enrollment Application is Completed?

Member Rights and Safeguards

You always have the right to appeal any denial of coverage or payment for any benefits or services you believe should be covered

You can file a grievance if you are not satisfied with our benefits or services

Please refer to BeHealthy America’s Evidence of Coverage or you can contact our Customer Service team for more

detailed information

Disclaimers

BeHealthy America, Inc. is an HMO plan with a Medicare contract. Enrollment in BeHealthy America, Inc. depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan.

Limitations, co-payment, and restrictions may apply.

Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change on January 1 of each year.

You must continue to pay your Medicare Part B premium.

Disclaimers

This information is available for free in other languages. Please contact the customer service number at 855-522-2780 or TDD/TTY relay 855-522-2973 Monday – Friday from 8:00 AM to 8:00 PM. From October 1 – February 14, we’re available seven days a week from 8:00 AM to 8:00 PM.

Other Pharmacies, Physicians and Providers are available in our network. Medicare beneficiaries may also enroll in BeHealthy America through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Contracted Hospitals

Blake Medical Center Doctors Hospital of Sarasota Englewood Community Hospital Lakewood Ranch Medical Center Manatee Memorial Hospital

Contracted Providers

MAXhealth

21st Century Oncology

Sarasota Arthritis Center

Sarasota Vascular Specialists

Gulf Coast Medical Group

Kennedy-White Orthopedic Group

The Eye Associates

West FL Physician Network

Manatee Cardiology

Manatee Cardiologists

HCA – Healthcare America

HCA – Pinnacle Medical Group

Coastal Orthopedics and Sports Medicine of SW FL

North River Family Center

Cortez Foot & Ankle Specialists

BeHealthy America has contracts with the following medical provider groups in Sarasota and Manatee counties:

And many more quality medical providers

Why Choose BeHealthy America’s Medicare Advantage Part D (MAPD) Plan?

[$0] Monthly Plan Premium [$0] Copay for Primary Care Office Visits [$0] Copay for Tier One Generic Medications Prescription Drug Coverage in Gap Dental, Vision and Hearing Services Health Club Membership Transportation Service

Why Choose BeHealthy America’s Medicare Advantage Part D (MAPD) Plan?

Over the Counter (OTC) Allowance 24/7 Nurse Hotline Smoking Cessation Assistance Preventive Services and Screenings Over 500 Doctors from which to Choose Friendly Local Service

BeHealthy America’s 2015 Benefit Overview

Benefit Member Responsibility

Monthly Plan Premium [$0]

Annual Deductible [$0]

Maximum Out of Pocket (MOOP) [$4,500]

PCP Visit [$0]

Specialist Visit [$35]

Annual Wellness Exam [$0 copay]

Preventive Screenings and Immunizations

[$0 copay]

Silver and Fit Gym Membership [100% covered by the plan]

BeHealthy America’s 2015 Benefit Overview

Benefit Member Responsibility

Hospital Inpatient [ $125/day (Days 1-7); $0/day (days 8-90) ]

Ambulance [$150 copay]

Urgent Care [$35 Copay]

Emergency Room [ $65 copay ]

Durable Medical Equipment [20% coinsurance]

Diabetic Supplies [$0/monitoring supplies; $10 Copay/Orth Shoes or Inserts]

Diagnostic X-Rays and Routine Lab [$0 Copay]

BeHealthy America’s 2015 Benefit Overview

Additional Benefits

Podiatry Services Dental

Chiropractic Services Vision

Hearing 24 hour Nurse Hotline

Over the Counter (OTC) Allowance Transportation

Smoking Cessation Local Customer Service

BeHealthy America’s 2015 Prescription Drug Benefit Overview

Benefit Member Responsibility

Tier 1 Drugs - Preferred Generics [$0 Copay]

Tier 2 Drugs - Non-Preferred Generics [$7 Copay]

Tier 3 - Preferred Brand [$25 Copay]

Tier 4 - Non-Preferred Brand [$55 Copay]

Tier 5 - Specialty Drugs [33% Coinsurance]

Part B Drugs and Home Infusion Drugs [20% (Part B Drugs) / $0 Copay (Home Infusion Drugs)]

BeHealthy America Drug Formulary. This formulary will be distributed and can also be found at www.BeHealthyus.com.

Tier 1 generic prescriptions are covered 100%

Different out-of-pocket costs may apply for members who:

Have limited income

Live in long term care facilities

Access to Indian/Tribal/Urban (Indian Health Services) providers

Some medications may have quantity limits or they may need authorization from a medical provider

BeHealthy offers national in-network prescription coverage

BeHealthy America’s 2015 Prescription Drug Benefit Overview

BeHealthy America’s 2015 Prescription Drug Benefit Overview

Stage 1Yearly Deductible Stage

Stage 2Initial Coverage Stage

Not Applicable Members stay in this stage their year-to-date “total drug costs” reach [$2,960].

BeHealthy America’s 2015 Prescription Drug Benefit OverviewStage 3

Coverage Gap StageStage 4

Catastrophic Coverage Stage

Members pay either:

• a [$0] copay OR

• [65%] for covered generic drugsOR

• [45%] of covered brand drugs.

Members stay in this stage until their year-to-date costs reach [$4,700].

Members pay the greater of:

• [5%] of the cost of the drug, OR

• a [$2.65] copay for generic (including brand drugs treated as generic)

• a [$6.60] copay for all other drugs.

Understanding Drug Formulary Terms

Formulary Exception: Members can ask the plan to make an exception to the coverage rules

Transition Process: A newly eligible member, switching plans or having a change in level of health care, can receive a one-time 30-day supply of their current medication(s). Members in a long-term care will receive a 31-day supply

Cost Tiers: Each drug is categorized by Tier. These Tiers determine how much members will pay for that drug

Restrictions: Some drugs have Prior Authorization, Quantity Limits and/or Step Therapy requirements

Network: Extensive network of participating pharmacies and well as mail order options for long term medications

Understanding Drug Formulary Terms

Part D Late Enrollment Penalty

What is it? Are there exceptions?

Yes, if you have creditable drug coverage or you qualify for Extra Help, you will not pay a penalty

Help With Medicare Costs

Beneficiaries may qualify for extra help to pay prescription drug premiums and costs

Beneficiaries can call Medicare to see if they qualify for extra help:

1-800-MEDICARE (1-800-633-4227)

or

TDD/TTY relay users should call 1-877-486-2048,

24 hours a day/7 days a week

Help With Medicare Costs

Beneficiaries can also check with the following resources to see if they may quality for “extra help”

Contact the Social Security Office at 1-800-722-1213

between 7 AM and 7 PM, Monday through Friday

TDD/TTY Relay users should call 1-800-325-0778

Or call the Florida Medicaid Office at 1-866-762-2237

Review of BeHealthy America’s Summary of Benefits

Q & A Session

Thank you for considering BeHealthy America for your Medicare Advantage

PrescriptionDrug (MAPD) plan option!