ssm health’s range of health care assetsfeature ssm health facilities and physicians with select...

Care Delivery Health Plan Other Ancillary

• 400,000 Lives Covered in WI• 20 County Service Area• 4,500+ Plan Practitioners• 30 Plan Hospitals• 840+ PCP and Specialty Clinics

• Presence in OK, IL, MO, and WI• 24 SSM Health Hospitals • 39 Affiliate Hospitals• 110 Service Locations including urgent care

and pediatric care locations• 11,000 Providers• 40,000 Employees

• Focused on coverage outside of Wisconsin• Brand utilized for SSM Employee Coverage• ACA membership in STL

• Established in 1904 and based in Madison, WI

• PBM: Pharmacy Benefit Manager • 5.4 Million Covered Lives• National Presence• Fully Transparent, Pass-Through PBM

Do not distribute – for training purposes only – pending CMS approval

SSM Health’s Range of Health Care AssetsSSM has a unique collection of health care assets allowing us to holistically care for our patients from insurance to care delivery to pharmacy benefit management

SSM’s Health Plan Overview

BY THE NUMBERS

SSM’s Health Plan is one of the largestand most diversified regional HMOs in the Midwest, utilizing our Integrated Delivery Network consisting our Health Plan working in collaboration with our owned hospitals, medical providers and other owned assets.

$1.43 Billion Total Revenue,

2018

98.3% Retention Rate for Commercial

Groups, 2018

420K+ Total Membership (DHP/P360), 2019

1,400+Employer Groups

Insured

We offer a robust product portfolio, servicing over 459K+ members across both government and commercial business.

Membership Breakdown

Commercial BusinessLarge Group, Small Group, Individual (ACA),

Large Group ASO

Government BusinessMedicare Advantage, Medicaid,

Medicaid ASO

~184K Members Covered by a Government Plan

~274K Members Covered by a Non - Government Plan


SSM Medical Group with other select providers

Health Plan

SSM Health

Hospitals

WellFirst in St. Louis

MA Network Overview: In 2020, WellFirst Health will predominantly feature SSM Health facilities and physicians with select provider partners (i.e. Signature Medical, SLU Care, St Luke's Hospital System)

• Launched ACA individual and family plans in St Charles county, St Louis County and St Louis City

• Began administering all health benefits for SSM employees, equating to more than 40K new group members

• Built system wide networks and coordinated care model in STL

2020 Review

New for 2021

• Applying to expand our current ACA product into neighboring IL counties (Madison and St Clair counties)

• Launching only Provider Sponsored MA Plan in the STL Area

• Building new sales distribution model to be most beneficial for member, agent, and physician

• Partnering with celebrity spokesman, Ozzie Smith

MA Footprint


Achieved Success

Excellent NCQA Accreditation StatusAs assessed by the National Committee for Quality Assurance*

4.5 Out of 5 Star Ratings (Medicare Cost and MAPD)Rated by the Centers for Medicare and Medicaid Services for 2019-2020

4-Star Rating from ETFHighest quality rating scored by the State of WI Employee Trust Funds for 2019

Rated 4.5 Out of 5 Overall by NCQARated by NCQA’s Private Health Insurance Plan Ratings 2019–2020

*The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas.NCQA’s HEDIS® is the most widely used performance measurement tool in healthcare. NCQA's website (www.ncqa.org) contains information to help consumers, employers and others make informed health care choices.

Strong Quality performance for 2019-2020

Dean Health Plan, our sister company, is one of the highest-rated private health insurance plans in the nation.

NCQA’s Private Health Insurance Plan Ratings 2019-2020


WellFirst Health Product Portfolio Overview

5

• All WellFirst Health plans have a $0 premium• All WellFirst Health MAPD plans have the same cost sharing for standard Part C benefits – on par with competition:

In-Network Out-of-Network

All MAPD Plans MA-Only Plan HMO-POS Plans

Maximum Out-of-Pocket $2500 $2500 $5000

Part C Deductible $0 $0 $0

PCP Copays $0 $0 $0

Specialist Copays $35 $35 $60

Hospital Copays $325per day for days 1-7

$300per day for days 1-7

$500per day for days 1-7

Outpatient Surgery Copays

$275 in-hospital

$175 ASC

$250 in-hospital

$150 ASC20%

Telehealth Covered at same cost-share as in-person services if offered by provider

Product Objectives

• Offer Competitive Plans as a

New Market Entrant

• Promote Experience and

Member Retention

• Advance IDN Engagement and

Outcomes


WellFirst Health Product Portfolio Overview

6

SSM UnityHMO MAPD

SSM CompanionHMOMAPD

SSM IntegrityHMO-POS

MAPD

SSM HarmonyHMO-POS MA-Only

Part D Coverage -

Out-of-Network Coverage - -

Premium $0 $0 $0 $0

Part B Premium Reduction $35 - - $50

Papa Pals Benefit - -

Comprehensive Dental Benefit

All Market Parity Benefits

Differentiation across the 4-plan portfolio in 4 dimensions:


➢ Part D Coverage ➢ Out-of-Network Coverage

➢ Part B Premium Reduction

➢ Papa Pals Benefit

WellFirst Health Competitive Supplemental Benefits

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Our plans offer supplemental benefits on par with or of greater value than the current market:

$60 OTC benefit

Eyewear + $0 eye exams

Hearing aids + $0 exams

Fitness benefit

Transportation

Post-discharge meals

Market Parity: ALL PLANS

Part B Premium Reduction

• Benefit reduces premium burden for moderate income members

Comprehensive Dental

• Premier dental partnership

• Higher benefit maximum than competition

• $0 preventive + simple copay structure for comprehensive

In-Home Support & Companionship

• Address loneliness and social isolation

• Provide help in-person or virtually

• Secured 3-year benefit exclusivity in STL service area

Market-Leading: Varies by Plan



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WellFirst Health is offering plans with Part B premium reductions to reduce the economic burden for members

Part B Premium Reduction – featured on 2 plans:

SSM Unity Plan (HMO) $35 per month

SSM Harmony Plan (HMO-POS) MA-Only $50 per month


• Members in $0 MA plans still pay $144.60 Part B premium (expected to increase for 2021)

• States cover Part B premium for low income beneficiaries

• Benefit reduces premium burden for moderate income members

• Members will automatically see increase in their Social Security check equal to the amount of the premium reduction

Also Known As:

• Part B Buy-Back

• Part B Buy-Down

• Part B Give Back

• Part B Rebate


Comprehensive Dental

9

WellFirst Health has partnered with Delta Dental of Wisconsin to build an exclusive Medicare Advantage network of dentists in the St. Louis market

Preventive & Diagnostic Services

$0 copay per visit

Two routine preventive dental exams and cleanings per calendar year.

One x-ray and fluoride treatment per calendar year.

Comprehensive Services

$45 copay per procedure

Periodontal ServicesGum disease maintenance and bridge/implants/dentures repairs.


Restorative ServicesFillings, gum disease treatment, and extractions.


EndodonticsRoot canals, bridges, implants, dentures, and crowns.

Maximum Coverage/Year

$1500

Waiting Periods

None

Deductible

$0

Coinsurance

Copays only

Additional Benefits

Members will also have access to Delta Dental’s evidence-based dentistry. People with certain health conditions may be eligible for up to two additional cleanings and one fluoride treatment per calendar year.

Conditions include:• Cancer therapy• Gum disease• Diabetes• High-risk cardiac conditions• Weakened immune systems• Kidney failure or dialysis

Featured Benefit on

ALL PLANS


In-Home Support & Companionship: Papa Pals

10Do not distribute – for training purposes only – pending CMS approval

WellFirst Health has partnered with Papa to offer in-person and virtual services.Papa pairs older adults and families with Papa Pals for companionship and assistance with everyday tasks.

Papa Pals In-Home Support & Companionship

Featured on:SSM Companion Plan (HMO)SSM Harmony Plan (HMO-POS) MA-Only

Benefit 10 hours per month

Family On-Demand Assistance from a Distance

CompanionshipPlay board games, watch a movie, take a walk

TechnologyHow to use computers, smart phones, software, telehealth

House HelpLight cleaning, meal prep, organizing, pet help

TransportationDoctor appointments/pharmacy, grocery shopping, errands

Papa Pals• Enthusiastic and Compassionate• Strict vetting process

• Background checks• Covered by liability insurance

&

Part D Pharmacy Benefit

11Do not distribute – for training purposes only – pending CMS approval

WellFirst Health plans provide comprehensive prescription drug coverage. Our drug formulary covers a wide-ranging list of generic, brand name and specialty drugs with manageable copays and no deductibles.

Part DCost Sharing

Preferred Pharmacy

Standard Retail Pharmacy

Deductible $0 $0

30 day 90 day 30 day 90 day

Tier 1 $0 $0 $7 $7

Tier 2 $5 $10 $12 $24

Tier 3* $40 $100 $47 $117.50

Tier 4 $90 $270 $100 $300

Tier 5 33% 33%

Vaccine Tier(Incl. Coverage Gap)

$0 $0

Preferred Pharmacy Network

• Walmart, CVS, Target, Dierbergs, Schnucks, Medicine Shoppe, and many other local pharmacies

• SSM pharmacies

Standard Retail Pharmacy Network

• Most national pharmacy chains, including Walgreens• Many retail and grocery store pharmacies• Mail order pharmacy through Costco

Senior Savings Program Pilot: Insulin Savings

$30 copays for 30-day insulin prescriptions • Phase 1: Deductible• Phase 2: Pre-ICL• Phase 3: Coverage Gap (Donut Hole)

$30 fills at preferred pharmacy and $35 at standard retail pharmacy locations

WellFirst Health Product Portfolio Strategy

12

Best Plan Fit

Recommendation

Market-Leading Benefits

Dental Premium Reduction

Papa Pals

Out-of-Network

HMO or HMO-POS

Part D

MAPD or MA-Only

Do you need Part D pharmacy benefits?

Do you seek the flexibility to visit out-of-network

providers?

Would you prefer a premium reduction

or Papa Pals benefit?

SSM Unity HMO MAPD

SSM Companion HMO MAPD

HMO-POS has only the dental leading

benefit

SSM Integrity HMO-POS

MAPD

MA-Only has POS benefit

MA-Only has all leading benefits

SSM Harmony HMO-POS MA-Only


MAPD

Premium Reduction

HMO

MA-Only

HMO-POS

Papa Pals

Premium Reduction

Dental

HMO-POS

Key DecisionPoints

• Product portfolio thought process

• Recommended workflow with prospective members

WellFirst Health & Plan Advisors

13


To get appointed with WellFirst Health Medicare plans,complete your request for contracting at

planadvisorsfirst.com/wellfirst

Think Plan Advisors first when you want to offer your clients better plan options through WellFirst Health!

At Plan Advisors, our focus is on your business, partnering with you for success. We leverage our knowledge, expertise, and brand to provide you with the support you need to grow your business. Whether it’s agent onboarding, marketing initiatives, or preferred vendor pricing on lead generation and technology tools, we want you to think of Plan Advisors first!

ssm health’s range of health care assetsfeature ssm health facilities and physicians with select...

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