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Agent Training
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Welcome
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Blues Agent Portal Training
e-Learning on the BCBSM Agent Portal
Today’s information is also available online via a new effort by the
BCBSM Sales Force Development area. In the future look for
online e-Learning modules to become your first step when
learning about new things from the Blues.
To access:
• 1. Go to bcbsm.com
• 2. Sign on to the agent portal
• 3. Click on the Education tab and click on e-Learning
• 4. Click on Click Here to Access Online Training: 4Q12 Training:
Product Updates4Q12 Training and BCN HMO HSA
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Blues Agent Portal Training
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Workshop Objectives
• What:
o Review the updates to the BCBSM/BCN products.
• Why:
o Explain the advantages and benefits of these product
updates.
• How:
o Gain a practical understanding of how the process has
changed as a result of these updates.
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4Q Product Menu Changes
• BCN HSA: – Identify individuals
eligible to participate in
HSA.
– Explain
advantages/benefits of
our HealthEquity
partner’s member and
group portals.
• Identify other BCN
menu changes.
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• Explain the new
Simply Blue tiered
copay options.
• Explain removal of
sponsored plan
requirements.
• Identify changes to
Blue Vision.
.
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HSA Basics Review
Tax Benefits
– Contributions are tax free
– Dollars grow tax free
– Dollars spent on qualified medical expenses are tax free
HSA dollars can be used to pay for:
– Medical
– Pharmacy
– Dental
– Vision
– COBRA premiums
– Long term care premiums
– Medicare premiums
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HSA Basics Review
What are the IRS guidelines for eligibility for an HSA?
• May not also be covered under any health plan that isn’t a
qualified HDHP.
• Must not be enrolled in Medicare.
• Must be covered under a qualified HDHP on the first day of
any month for which eligibility is claimed.
• May not be claimed as a dependent on another individual’s
tax return.
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BCN HMO HSA Product Features
Available October 1, 2012
Objectives: – Retain and grow BCN membership
– Meet market expectations of employer groups and agents
– Remain competitive in the market
National HSA growth increased 14.3% from 2010 to 2011
BCN goal – 35000 members in 2 years
Target market: – Groups 2+
– Houghton & Marquette groups 50+
– Health-conscious buyer
– Cost-conscious buyer
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BCN HMO HSA Product Features
• No monthly cost or set up fee.
• Low cost HMO option for employers
looking for a health savings account.
• Preventive services covered at 100%.
• Multiple high deductible and
coinsurance plan options.
• Includes integrated pharmacy benefit.
• Integrated, online health savings
account.
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BCN HMO HSA Products
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Individual / Family
Deductible
Coinsurance
After deductible
Prescriptions Drugs after
deductible
Out-of-Pocket Maximum
(include deductible)
$2000/$4000 0%
$10/$40/$80 $4000/$8000*
$2000/$4000 0%
$20/$60/50%
$80 min /$100 max $4000/$8000*
$3000/$6000 0% $10/$40/$80 $5000/$10000*
$3000/$6000 0%
$20/$60/50%
$80 min /$100 max
$5000/$10000*
$2000/$4000 20% $10/$40/$80 $4000/$8000
$2000/$4000 20%
$20/$60/50%
$80 min /$100 max $4000/$8000
$3000/$6000 20% $10/$40/$80 $5000/$10000
$3000/$6000 20%
$20/$60/50%
$80 min /$100 max $5000/$10000
$1250/$2500 20%
$15/$50/50%(
$70/$100 $2250/$4500
$1250/$2500 20% 20% coin after ded $2250/$4500
$2000/$4000 20% 20% coin after ded $4000/$8000
$3000/$6000 20% 20% coin after ded $5000/$10000
*Once deductible is met only drug copayments apply to out-of-pocket maximum
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BCN HMO HSA Product Features • 3-8% reduction in premium over comparable BCN plan
– Aggregate deductible vs. Embedded deductible
– Pharmacy applies toward deductible
– Consumerism behavior
• Products not available with HSA:
– HBL/HBLR
– Blue Elect Plus
– Medicare products
– Individual products
• The HSA cannot be wrapped
• Non-Medicare retirees are eligible
• COBRA enrollees are eligible 12
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BCN HMO HSA Product Features • Product based on new High Deductible Health Plan (HDHP)
certificate
• HDHP will have an aggregate and integrated deductible
– Aggregate
• Family contract deductible must be met prior to medical and/or pharmacy
coverage. Collective family deductible – benefits are payable once the entire family
deductible is met by one or more family members
– Integrated
• Deductible accumulates all medical and pharmacy costs
• Plan cannot pay capitation for PCP and other captiated services
• Product is based on calendar year
• No 4th quarter carryover
• PDC
– From qualified HSA plan only
– Credit deductible back to January
• No deductible carryover from a BCN deductible product
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BCN HMO HSA Targets
• Groups currently purchasing a low premium, high deductible
plan looking for an opportunity to allow employees to enjoy
lower out-of-pocket costs by allowing deductible expense to
flow through HSA accounts using pre-tax dollars.
• Groups interested in a healthier work force encouraging
healthy lifestyles through consumerism and the opportunity for
HSA account growth for future medical expense planning.
• High earning professional groups that are looking for the
advantages of tax free savings.
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BCN HSA Partner – HealthEquity
• BCN will partner with leading CDH vendor: HealthEquity Web link from MiBCN.com member site to HealthEquity
– Single sign-on available in 2013
– Debit card
– Dual logo – BCN and HealthEquity
• HealthEquity provides 24/7 customer service.
• Customized phone number for BCN members:
1-877-219-4506
• Online statements with current account balance.
• Personalized group enrollment.
• HealthEquity member and group portals.
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Member Home Page
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My Account
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My Account
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My Money
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My Money
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My Money
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My Money
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My Money
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My Money
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My Toolkit
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My Profile
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Employer Portal Home Page
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Employer Information
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Insurance Information
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Manage Money
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Manage Money
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Manage Money
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Company Detail
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• Employee Account Summary – Summary of data displayed
on home page of employer portal.
• Contributions (Tax Year) – Contribution summary report by
member for the tax year.
• Contributions (Calendar Year) – Contribution summary report
by member for the calendar year.
• Potential Over Contributions – Report of any member that
may be in a potential over contribution status.
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Available HSA Reports
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Resources
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BCN HSA/HealthEquity Facts
• BCN will not need Notice of New CDH Business.
• BCN created a new certificate for the HDHP.
• Forms & Docs page will be available on the HealthEquity portal.
• Member experience with HealthEquity is the same across the
enterprise.
• HealthEquity website will be customized for BCN.
• HealthEquity will not be used for BCN HRA.
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BCN HSA/HealthEquity Facts
• BCN has one file for group and member information.
• BCN configuration supports standard HealthEquity
interface requirements.
• BCN will use standard HealthEquity documents.
• Member welcome kit contains:
• Debit card
• Debit card mailer
• Tri-fold welcome letter
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BCN HSA/HealthEquity Facts • Lead Time – 45 days
• BCN Coverage Agreement
– Parts A, B and C for New Business
– Part C for Group Wide Change
• Group Set-Up
– Two classes will be established
• HDHP with HSA
• HDHP only
• Enrollment Data
– Enrollment/Change of Status Form
• Indicator to be checked if contract enrolls in HSA
– eMCS
• Provide indicator to be checked if contract enrolls in HSA
– Electronic Enrollment
• Group will provide enrollment by class using Facets set-up 38
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• All documents required to enroll a group are located on the
secure agent portal.
• CDH Administration, after receiving the Notice of New Business
Form, assigns an analyst to support implementation activities.
• All communications or questions related to implementation can
be directed to CDH Administration.
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BCBSM CDH Implementation Guide
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BCN $4,000 Deductible Plan with 0% Coinsurance
• On the 2+ portfolio, but is also available to groups 50+.
BCN Drug Plans
• New $10/$40/$80 plan added to the menu.
Removal of Two BCN’s HRA Options
• Removal of HRA options for the $5000 and $7500 deductibles options,
with 20% coinsurance and 30% coinsurance.
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BCN Product Updates
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3-Jul-12 41
New Group 2+ (Page 1)
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3-Jul-12 42
New Group 2+ (Page 2)
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3-Jul-12 43
New Group 50+ (Page 1)
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New Group 50+ (Page 2)
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3-Jul-12 45
New Group 50+ (Page 3)
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ECOS (Page 1)
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3-Jul-12 47
ECOS (Page 3)
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Removal of Sponsored Plan
Requirements- BCBSM and BCN
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• Effective 10/1/12, groups will no longer be required to be sponsored
through a chamber or association in order to have access to all of
our small group products.
• Groups may still be sponsored, but are not required to be.
• Applies to all medical, dental and vision plans.
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Simply Blue tiered copay riders are a new option for Simply Blue
that offers different levels of copayments for primary care office
visits, specialist visits, urgent care visits, and emergency room
visits. Tiered copays encourage appropriate use of each of these
services to avoid unnecessary expenses.
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Simply Blue Tiered Copay Options
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Target Market
• Businesses that are cost-conscious buyers, needing affordable,
yet comprehensive coverage.
• Simply Blue groups who want to further lower their premiums.
• Groups that have been dropping employer-sponsored health care
coverage opting for individual coverage.
• Groups in Community BlueSM and Flexible BlueSM plans seeking
to lower costs.
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Scenario
• The customer is a Benefits Manager for a BCBSM group of 62
employees. The group just received a BCBSM 10/1/12 renewal-
13% increase over last year’s rate.
• Last year the group saved money by moving from Community
Blue 4 to Simply Blue 500. They made that change because they
did not want to raise employee deductibles or change their
prescription benefits. They felt that those two plan components
were the most visible to employees and would have been met
with the most resistance.
• Although employees have since become accustomed to the
difference in medical benefits between Community Blue and
Simply Blue, the group is hesitant to make a big benefit change
again this year.
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Simply Blue Tiered Copay Options
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• Delivers ambulatory care.
• Is offered outside of hospital emergency rooms.
• Is offered on a walk-in basis without a scheduled appointment.
• Offers evaluation and treatment for a sudden illness or injury that needs immediate medical attention, but is not an emergency.
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What Is Urgent Care?
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Simply Blue Tiered Copay Options
Cost Savings
Current
Standard Tiered Copay Optional Rider 1 Tiered Copay Optional Rider 2
OV ER OV Spec UC ER OV Spec UC ER
SB 250 20 150 20 40 60 150 40 60 60 250
SB 500 20 150 20 40 60 150 40 60 60 250
SB 1000 30 150 30 50 60 150 40 60 60 250
SB1500 30 150 30 50 60 150 40 60 60 250
SB 2500 30 150 30 50 60 150 40 60 60 250
SB 4000 30 150 30 50 60 150 40 60 60 250
SB HRA 1000 30 150 30 50 60 150 40 60 60 250
SB HRA 1500 30 150 30 50 60 150 40 60 60 250
SB HRA 2500 30 150 30 50 60 150 40 60 60 250
SB HRA 4000 30 150 30 50 60 150 40 60 60 250
Cost difference vs
standard
SB 250 -1.1% -4.5%
SB 500 -1.2% -4.9%
SB 1000 -1.4% -4.2%
SB1500 -1.5% -4.6%
SB 2500 -1.8% -5.4%
SB 4000 -2.2% -6.8%
SB HRA 1000 -1.2% -3.8%
SB HRA 1500 -1.3% -4.0%
SB HRA 2500 -1.5% -4.7%
SB HRA 4000 -1.8% -5.6%
Average -1.5% -4.9%
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Revised Simply Blue Fact Sheets
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55
Simply Blue Tiered Copay Options
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Dental Claim Comparison
PPO dentist Blue Par Select
dentist
Non-participating
dentist
Dentist’s fee $1,200 $1,200 $1,200
We approve $650 $650 $650
We pay $325 $325 $325
Member copay $325 $325 $325
Member total out-
of-pocket cost $325 $575 $875
Comments Dentist accepts our PPO fee
as full payment for covered
services. Member has 50%
copayment, so member
owes $325.
Dentist accepts our Blue Par
Select fee as full payment
for covered services.
Because plan payment is
based on the PPO fee,
member owes difference
between PPO fee and Blue
Par Select fee—$250—
along with a 50% copayment
of $325.
Dentist doesn’t accept our
fee as payment in full.
Member is responsible for
difference between plan
payment and dentist’s fee—
$550—along with a 50%
copayment of $325.
58
Scenario
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61
Blue Vision Expanded VSP Network
Go where you want. When you want.
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Summary
What:
• Review the updates to the BCBSM/BCN products.
Why:
• Explain the advantages and benefits of these product updates.
How:
• Gain a practical understanding of how the process has changed
as a result of these updates.
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Fourth Quarter 2012
Rate Exhibits
63 63
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Small Group Rate Changes
Area 1 2 3 4 5 6 7 8 9 All
LOB Southeast Lansing KalamazooGrand
RapidsSaginaw Flint
Traverse
City
Upper
PeninsulaSouthwest Statewide
Medical 8.9% 7.5% 6.5% 9.6% 6.9% 8.9% 13.0% 17.2% 4.5% 9.0%
Drug 13.7% 16.2% 16.9% 11.6% 14.4% 9.6% 8.9% -8.0% 12.9% 12.2%
Dental 2.8% 1.8% 2.8% 1.6% 3.3% 3.8% 1.5% 2.4% 2.2% 2.5%
Vision 7.6% 8.3% 8.2% 8.4% 7.6% 9.9% 9.0% 8.2% 5.4% 8.0%
Total 9.6% 8.8% 8.2% 9.8% 8.1% 8.8% 11.9% 12.2% 5.7% 9.4%
Area 1 2 3 4 5 6 7 8 9 All
LOB Southeast Lansing KalamazooGrand
RapidsSaginaw Flint
Traverse
City
Upper
PeninsulaSouthwest Statewide
Medical 5.8% 1.1% 0.4% 5.3% 3.8% 5.9% 14.5% 12.7% 5.6% 5.7%
Drug 21.1% 20.0% 23.6% 18.6% 15.9% 15.0% 19.4% 2.6% 20.2% 18.9%
Dental 5.0% 4.6% 4.8% 2.8% 3.0% 4.5% 3.4% 3.8% -1.7% 4.1%
Vision 8.3% 7.1% 7.7% 10.2% 8.1% 12.3% 10.6% 7.8% 4.5% 8.7%
Total 8.0% 4.0% 3.3% 7.0% 5.5% 7.1% 14.7% 11.1% 7.0% 7.5%
Area 1 2 3 4 5 6 7 8 9 All
LOB Southeast Lansing KalamazooGrand
RapidsSaginaw Flint
Traverse
City
Upper
PeninsulaSouthwest Statewide
Medical 8.3% 6.7% 5.9% 8.8% 6.5% 8.4% 13.1% 16.5% 4.6% 8.4%
Drug 14.7% 16.6% 17.5% 12.5% 14.5% 10.2% 9.9% -6.8% 13.6% 13.0%
Dental 3.1% 2.0% 3.0% 1.9% 3.2% 4.0% 1.8% 2.4% 2.0% 2.7%
Vision 7.7% 8.0% 8.1% 8.8% 7.7% 10.5% 9.2% 8.1% 5.3% 8.1%
Total 9.3% 8.2% 7.7% 9.3% 7.8% 8.6% 12.2% 12.0% 5.8% 9.1%
Reform
Non Reform
Total Small Group
64
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Historical Rate Changes by Area Reform and Non-Reform
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Rate Change History Reform Groups
0%
2%
4%
6%
8%
10%
12%
14%
2006 2007 2008 2009 2010 2011 2012
Rate
In
cre
ase
Year
Rate Change HistoryReform Groups
First Quarter Second Quarter Third Quarter Fourth Quarter
66
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Rate Change History Non-Reform Groups
0%
5%
10%
15%
20%
25%
2006 2007 2008 2009 2010 2011 2012
Rate
In
cre
ase
Year
Rate Change HistoryNon Reform Groups
First Quarter Second Quarter Third Quarter Fourth Quarter
67
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BCN Rate Changes
68
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BCN Historical Rate Changes
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Questions
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