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Carrier Updates

Plus an 87 county expansion for HMO and DSNP plans! AND brand NEW STATE OF THE ART benefits! The plans to look at are Mediblue Preferred, Mediblue Extra (New plan for those on LIS), Mediblue DSNP.

Mediblue Essentials is STILL available. There is NO SERVICE AREA REDUCTION. This plan IS NOT going away. There are NO active outbound call campaigns or direct mail campaigns on behalf Anthem BCBS to try and promote changing plans to the Preferred or Extra HMOs. If your client would like to switch, you can take a new application  (preferred method). Please be advised that per CMS, a new application must be taken and telephonic enrollments take at least 45 minutes to complete. If your member is looking to change, I would highly recommend taking a paper application.

As of 10/15 Anthem's Agent of Record policy was updated. Anthem is no longer taking a form letter. The member must submit a hand written note that includes their name, member ID and date of birth.

Essentials Extras – These are the brand new benefits that no other carrier has including adult daycare and home aids.

Anthem is pleased to announce that they will be holding one hour webinars to discuss in detail the new Essentials/Everyday Extras that are a part of the 2019 Medicare Advantage plans.  These webinar will go into detail on how to sell this benefit portfolio, how the member enrolls in their benefit selection and answer general questions. Please take an hour out of your busy day attend one of meetings that are scheduled at varying times of the day/week throughout the rest of the year. Register at http://brokertraining.anthem.com

*This information is not anything you can learn just by reading the enrollment kit! Please plan to attend one session.

As of 10/1/18 you can now take a Scope of Appointment at the time of the appointment! It is highly suggested going 100% digital and using the mproducer.anthem.com website for ALL Medicare application submissions.

New Medicare Supplement commissions for 2019! There is also a NEW Field Underwriting Guide for you!

University of Cincinnati main campus, COPC and Aultman are in network.  Ohio State University, including Arthur James Cancer & Wexner, are part of Anthem's Medicare Advantage network. Click here to view the provider listing PDF for your reference. 2019 HMO plans no longer have a referral required.

Expansion Information

There is major expansion in the Kentucky and Indiana markets.  If you sell in these markets, please reach out to Chuck Brawner at [email protected] for Kentucky.  If you're in Indiania, reach out to Craig Ruble at [email protected] for more details.

Other Information

To qualify for Anthem Medicare Megastar status for 2020, you will need 19 new to Anthem Med Advantage submissions for a 1/1 effective date.

Provider and Drug Searches 

  • The ONLY website you should be using is shop.anthem.com/medicare. If you find a provider that is part of a major hospital system and does not appear, please email their full contact info to Kim Kirn at [email protected] so that she can verify it for you.
  • When searching for FACILITIIES/HOSPITALS, there are 86 hospitals that are part of the Medicare Select Supplement network that are located on the website search engine. These hospitals will show TWO hits at a minimum. One will be for the Select Supplements and will show the Advantage out of network. The other will show the Advantage plans in network and the Select out. These hospitals are IN NETWORK FOR BOTH Select and Advantage plans. 
  • The main difference between Prime Select and the other HMOs is that Prime is ONLY Cleveland Clinic and Akron General networks
  • There is no network limitation between the LPPO and RPPO plans. They BOTH have access to the 37 state in network benefits. 
  • To look up out of state providers: Https://provider.bcbs.com
    • Your Plan: Select Plan > select by plan name> Medicare Advantage PPO > Ohio
    • Then enter in zip of where you want to search and other info

Adding Optional Supplemental Benefits (Dental and Vision)

Hearing Benefit – 

  • $3000 first dollar coverage on Preferred, Extra and DSNP plans, newer technology including iPhone and Bluetooth compatible devices, 30 day free trial, 1 year warranty, and 12 months of free batteries!
  • The 2019 carrier will be Hearing Care Solutions and their website to search for providers ishttp://www.hearingcaresolutions.com/locations/
  • Click here for reference sheets
    • Member calls 800 number to locate provider and schedule appointment
    • They must use an in network provider

Personal Emergency Response System (Like Life Alert)

  • HMO Essential, Prime and DSNP have this benefit.
  • No cost for set up or monthly fees!
  • 3 different units to choose from and anyone can request, no medical necessity required

Meals after Inpatient Hospital

  • 2 meals a day for 10 days after EVERY inpatient hospital stay
  • Discharge must be from hospital to home
  • Benefit is triggered by case manager who contacts Anthem

Silver Sneakers is on all Medicare Advantage and Medicare Supplement plans!

Enrollment Kits, Marketing, and more

  • You may only use currently CMS approved documents when working with MA-PD and PDP beneficiaries. Materials are updated yearly unless otherwise noted.
    • There are two HMO Preferred kits –
  • 2019 MAPD Kit - Anthem MediBlue Preferred (HMO) Max 50 - Service Area: Adams, Allen, Ashland, Ashtabula, Auglaize, Champaign, Clark, Clermont, Clinton, Crawford, Cuyahoga, Darke, Defiance, Erie, Fairfield, Fayette, Franklin, Fulton, Geauga, Hancock, Highland, Huron, Jefferson, Lake, Lawrence, Licking, Lorain, Madison, Marion, Medina, Mercer, Morrow, Ottawa, Pickaway, Richland, Ross, Sandusky, Scioto, Seneca, Van Wert, Warren, Washington, Wayne, Williams, Athens, Coshocton, Gallia, Guernsey, Hardin, Harrison, Henry, Hocking, Holmes, Jackson, Logan, Meigs, Monroe, Morgan, Noble, Paulding, Perry, Pike, Putnam, Vinton, Wyandot
  • 2019 MAPD Kit - Anthem MediBlue Plus Preferred (HMO)Max 50 - Service Area: Belmont, Brown, Butler, Carroll, Columbiana, Delaware, Greene, Hamilton, Lucas, Mahoning, Miami, Montgomery, Muskingum, Portage, Preble, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Wood
  • If you need to download the electronic files of anything Medicare related, like the Summary of Benefits or Applications, please visit shop.anthem.com/medicare. You will find the files you need under Plan Documents under each product.
  • Please visit Custom Point to order Enrollment Kits, Directories and more. 
    • Make sure you order and use the correct Enrollment Kit for the county you are working. You cannot cross-reference kits please.
    • Please look at the description for each kit and it will list for you the counties that are applicable for that kit.
    • If you do not have your Custom Point ID and password, please email [email protected] and they will provide it to you. The Account is wpss.
  • 2019 Marketing Catalog and Promotional Items – Can be found on Custom Point. These now include pieces that can have your picture on them.
    • This year, there are customizable brochures for the Special Needs Plans, presentations, and Plan Highlight Guides.
    • Please take the time to click through each of the different headings as there are so many new pieces for you to choose from.
    • Click on “Sales Toolkit”
      • Click on My Profile and set up your defaults.
      • On the top right corner is a link to download the training materials.
      • When customizing a piece, select electronic delivery for your PDF. You will get the file within 15 minutes or less.
        • If you are doing a mailer, send that file to your printer or contact TargetLeads – Michelle Bardin at 469-402-0251 regarding fulfillment processing for you. (This obtaining a mailing list, printing and mailing of the piece). You can also send to FedEx Kinko’s as you get a discount with them.
  • Sales Presentations – There are CMS approved Sales presentations available for you to use under the Sales Toolkit on Custom Point

COMPLIANCE

Sales Events

  • If you are meeting with a group of people and want to hand out business cards, information on plans and products, or collect lead cards, you MUST file this with us and with CMS. This is considered a Sales event.

o   Sales events do NOT need to be you lecturing to a group of people in a formal setting. There are several other different types of sales events than this.

o   To file an event, please log your events with us online by clicking on the underlined words. It will take you to the correct website.

o   Please click on the Sales Event Filing tab.

o   You must file your event at least 11 days prior to the scheduled date.

o   THESE CAN AND WILL BE AUDITED. 

  • If you are working a Retail Store, ALL activity within the store must be filed as a Sales Event.

o   To file an event, please log your events with us online by clicking on the underlined words. It will take you to the correct website.

o   You must file your event at least 11 days prior to the scheduled date.

o   THESE CAN AND WILL BE AUDITED. 

o   Once filed, you can hand out any CMS approved marketing material, business cards, collect lead cards, and sign members up on the spot (after 10/15)

  • If you are meeting with beneficiaries in an assisted living or nursing home, please make sure to follow the instructions above and be sure to have the meeting in a common area like a cafeteria or event room.

Educational Events

  • You c give out business cards to beneficiaries.

o   You cannot have a table with Medicare Advantage or PDP materials there

o   You can ONLY use approved for educational use only materials

o   You can have a beneficiary fill out a lead card or schedule an appointment

o   You can use carrier branded signage and tablecloths.

o   You can answer general “What is Medicare” questions

Sales Effort Information

  • You may discuss changes with your current clients but you CANNOT conduct any new sales until October 15th.
  • 2019 Medicare Part B premiums and A & B coverage levels have not been released yet. I will let you know when they are available.
  • The 2019 Medicare and You book is out! Please download your copy - https://www.medicare.gov/sites/default/files/2018-09/10050-medicare-and-you.pdf
  • I have attached a copy of the Scope of Appointment form for you to use. They will also be in the Enrollment Kits.  There is no longer a 48 hour prior requirement on the Scope of Appointment!
  • We request that you use our Scope with our applications but will take any SOA.  
  • I suggest taking a moment when you get your Enrollment Kits and fill out the Agent section of the applications. This is a best practice that several of you use and THANK YOU for sharing.
  • You can order new Medicare Supplement kits in Custom PointThey will be listed under 2018 Medicare Supplements. Rates change July 1st.

 

Anthem BCBS Agent Business cards

Anthem Giveaways and Apparel

  • Check out this website: Anthem Promo Store
  • You will be able to browse before purchasing. However, it is suggested that you set up a profile before you shop.  To do so, click on the link “My Account” to set up your profile.
  • Please use your initials as the purchase order number

Product Information

  • Preferred Pharmacies for 2018 in Ohio – CVS, Giant Eagle, Wal-Mart/Sam’s Club, Target, Kroger, *****NEW FOR 2019*** 155 Independent pharmacies! Others that are found in the pharmacy directory are considered Standard.
  • Use shop.anthem.com/medicare for all Provider, Pharmacy, and drug searches please. It is updated every few days and is the best place to verify.
    • Click on details to get PCP information. It will be under the headings for Hospitals or Medical Group.
  • Injectable drugs are now in tiers 1-4 for MA-PD plans and in tiers 3-4 for PDP plans. Specialty is Tier 5, and  tier 6 is called Select Care.
  • Select Care medications are $0 Co-pay on all MAPD plans and in the gap, regardless of how they fill the prescription!
    • Hypertension Drugs:
      • Benazepril HCL
      • Enalapril Maleate
      • Enalapril Hydrochlorothiazide
      • Lisinopril
      • Lisinopril Hydrochlorothiazide
      • Losartan Potassium
      • Losartan Hydrochlorothiazide
    • Cholesterol Drugs: 
      • Atorvastatin Calcium
      • Lovastatin
      • Pravastatin Sodium
      • Simvastatin
    • Diabetes Drugs:
      • Glimepiride
      • Glipizide
      • Glipizide ER
      • Metformin HCL
      • Metformin HCL ER
    • Osteoporosis
      • Alendronate Sodium
  • $0 Co-pay on Routine podiatry on ALL plans
  • Worldwide ER coverage is on ALL plans!
  • Live Health Online and Silver Sneakers are also on ALL plans!

Network Information

  • OSU is in the Medicare Advantage network.
  • Cleveland Clinic IS in the Medicare Advantage network.
  • Christ Hospital and University of Cincinnati are in-network.
  • HMO network is STATEWIDE, plus Indiana AND Kentucky.
  • We ask that you enter a PCP on the applications (after Oct. 15th) but if you do not, we will auto-assign a PCP to the member. They can call to change it at any time.

Other Updates

  • Welcome Kits are big BLUE books that contain a formulary and the Evidence of Coverage (EOC). Provider directories will only be mailed upon request.
    • If the member wants a full directory they can call Member Services, although online is the most current.
  • ID cards will be sent out  mid-November and then more frequently after that date.
  • OTC cards will be sent out in December
  • Essential Extras Selection Forms will be mails in December and can be submitted at any time.
  • The outbound verification calls are no longer taking place. There is a letter that will be sent stating we show enrollment in a given plan and if this is not what they wanted to please call.
  • For those who need “Extra Help,” regardless of whether it’s for LIS, Medicaid, and any other special assistance, visit http://www.ohiobenefits.org