2020...Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare...
Transcript of 2020...Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare...
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2020 Medicare Product Portfolio
2020
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TABLE OF CONTENTS
Agent Use Only. Proprietary and Confidential.
Allwell 2020 Medicare Product Portfolio
HIGHLIGHTS 2-3
CENTENE OVERVIEW 4-5
BROKER/AGENT SUPPORT 6
TRAINING AND CERTIFICATION 7
VALUE BASED ENROLLMENT 8-9
LEADERSHIP ALIGNMENT 10-11
LIS TIER INFORMATION 12
2020 MSP LEVELS 13
HIGHLIGHTS BY STATE:
ARIZONA 14
ARKANSAS 20
FLORIDA 26
GEORGIA 30
ILLINOIS 34
INDIANA 38
KANSAS 44
LOUISIANA 48
MISSISSIPPI 52
MISSOURI 56
NEVADA 60
NEW MEXICO 64
OHIO 68
PENNSYLVANIA 72
SOUTH CAROLINA 78
TEXAS 82
WISCONSIN 90
VENDOR INFORMATION 96-101
AGENT/BROKER CONTACT 102
2 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview2020 HIGHLIGHTS
Allwell is the Next Step in Medicare Coverage Your Medicare clients deserve coverage that meets their specific needs. They want a plan that helps them to live the best life they can and Allwell is the right plan to take them there. Allwell offers features such as a $0 monthly premium, comprehensive prescription drug coverage, and the option of dental and vision coverage, as well as many tailor-made health and wellness programs neatly wrapped into one package.
Allwell is a trusted health care partner in your community. By offering easy access to important benefits and provider network information, your clients are able to make their health and wellbeing a priority. Allwell’s healthy living programs assist in fostering healthy habits and exercise, adding an element of preventive care that helps your client remain happy, active and independent. Allwell is here to remove any worries your clients have about healthcare so that they can stay focused on what really matters, living the best lives they can.
Access to Health CareCaring for our members and their communities means being where they are. With the financial strength of our parent company Centene and the commitment of thousands of dedicated employees and partners, Allwell is able to create the local infrastructure needed to
better serve our members by providing access to quality personalized care in their community. Our extensive network of hospitals, primary care providers (PCPs) and specialty providers makes access to healthcare easy for your clients. We also provide in-home care, skilled nursing and, in some markets, 24-hour virtual visits.
Creating a Larger Network Centene is a leader in government-sponsored healthcare across all 50 states. We recognize that in order to better serve our members Centene must focus on continuous growth. With that in mind, Centene focuses on a combination of organic and acquisition based growth which has resulted in the creation of one of the industry’s premier healthcare organizations.
Healthcare in Your CommunityCentene’s core philosophy is that health care is best delivered locally – transforming the health of the community, one person at a time. With this in mind, when your clients choose Allwell they get access to community-based health care teams that can assist members long term with chronic conditions and also in the short term with their medical care. These teams can offer additional support with everything from education regarding healthy living to getting members to their doctor visits. It’s extra care on a local level.
3Agent Use Only. Proprietary and Confidential.
2020 HIGHLIGHTS
Help at HomeWhether helping through a member through a healing or providing assistance with everyday chores, Allwell works side-by-side with our members. Across all HMO plans Allwell offers home health services for members with certain conditions. Whether members need help around the house, bathing, exercising, or with their medications, our skilled aides will be there to assist in making members feel comfortable and cared for.
Supplemental Benefits*Vision Coverage
• Routine eye exams and eyewear allowances.
Dental Coverage
• Preventative Dental Services including oral exams, cleaning, and x-rays are offered a at low or $0 copay.
• Many plans offer additional comprehensive dental INCLUDING DENTURES, at no additional costs. Check plans for details
Over-the-Counter
• Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need either via mail or in-store.
Virtual Visits
• Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions.
Prescription Drugs
• Many of our Allwell plans offer low or $0 copays for tier 1 and 2 drugs which are the most commonly used drug tiers.
Wellness Programs
• $0 copay for Fitness program
• 24 hour nurse advice line
• Access to Personal Emergency Response System (PERS)
• Supplemental smoking and tobacco use cessations (counseling to stop smoking or tobacco use)
Allwell is proud to serve the Medicare community and you can be proud to represent Allwell. Together we can make healthcare a walk in the park for our seniors.
*Benefits are not offered by all plans. Members should check their plan-specific Evidence of Coverage or their Summary of Benefits for benefit offerings for their plan.
4 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview2020 HIGHLIGHTS
Centene Overview
Meet Centene
32 stateswith government sponsored healthcare programs and implementations
2 international markets
Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals.
~340 Product / Market Solutions
14.7M managed care members
15+M
5Agent Use Only. Proprietary and Confidential.
CENTENE OVERVIEW
CENTENE OVERVIEW
Who We Are
#51 FORTUNE500 (2019)
#210 FORTUNE GLOBAL 500 (2018)
$14.8B in cash and investments
$60.1B revenue for 2018
48,100 employees
$72.8 - 73.6B 2019 expected revenues
#49 on FORTUNE 100Fastest Growing Companies (2018)
Centene is deeply committed to transforming the health of the community, one person at a time, by delivering results for our stakeholders: state governments, members, healthcare providers, uninsured individuals and families, and other healthcare and commercial organizations
CENTENE’S SUCCESS IS DRIVEN BY OUR COMMITMENT TO:
Focus on Individuals
Whole Health
Active Local Involvement
#43FORBESGlobal 2000:GrowthChampions (2018)
6 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
BROKER/AGENT SUPPORT
CENTENE BROKER PORTALOnce registered and contracted, you have easy online access to the following:• Commission statements• Book of Business• Application status look-up• Training & recertification completion dates• Forms and brochure• View/print copies of member enrollment
applications
REGISTRATION:Centene distribution partners and brokers must be contracted prior to using the Broker Portal. Registering for the Broker Portal is a self-serve process that is simple and quick. Being a registered user provides easy access to pertinent information. The Broker Services Unit is available to support if assistance is needed.
2020Marketing CollateralPlease note: You may need to customize certain materials.
Agent Benefit Flyer
• 2020-HMO English Photo | English No Photo
• 2020 DSNP English Photo | English No Photo
Dental Benefits Flyer
• HMO Dental Benefits Flyer
• DSNP Dental Benefits Flyer
Event Benefit Flyers
• HMO-Event Benefits Flyer
• DSNP-Event Benefit Flyer
• Event Non-Benefit Flyer ALL English
• Event Non-Benefit Flyer ALL Spanish
• Veterans Event Flyer
Plan Highlights Brochure
• HMO Plan Highlights Brochure
• DSNP Plan Highlights Brochure
• 2020 HMO Medicare 101 Flyer
Seminar Flyer
• 2020 HMO Multi-Seminar Flyer
• 2020 HMO Seminar Flyer
• Seminar Flyer Spanish
• Med Options Seminar Flyer
• 2020 Allwell Sales Presentation Video (mp4)
• 2020 Allwell Sales presentation Slides (PDF)
7Agent Use Only. Proprietary and Confidential.
Training and Certification
Access to aDiscounted Rate
of $125
(instead of $175 full price)
Completing your 2020 AHIP Certification Trainingthrough the AllwellTraining Site will provide youwith a couple ofunique opportunities:
Reimbursement Qualifications:
• Complete 2020 AHIP Training through the Allwell Training Site
• Or submit a receipt as proof of payment of 2020 AHIP fees paid
• Must have a minimum of 5 new sales with an 1/1/2020 effective date that remain enrolled through 3/31/2020
• Must be certified and contracted to sell 2020 Allwell MA plans
Qualify forFULL REIMBURSEMENT
of 2020 AHIP Certification Training fees
(paid after meeting a few key requirements)
Allwell Training Site Link:https://allwell.cmpsystem.com
Only 1 Allwell Product Exam for all states!
2020 AHIP TrainingAvailable 6/17/2019
2020 Allwell TrainingAvailable 7/9/2019
Allwell Training Site Allwell Certification Training Allwell State Attestation
8 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
VALUE BASED ENROLLMENT PROGRAMENROLLMENT PROCEDURES
Value Based Enrollments
What is a Value Based Enrollment (VBE)?The Value Based Enrollment Program launched by Centene is a quick and easy process to helpgather health-related information and provide a smooth transition of care to your Medicare beneficiaries.
Why conduct a Value Based Enrollment?Value Based Enrollment allows you to support and facilitate a smooth onboarding experience for the beneficiary. It encourages a proactive beneficiary approach to healthcare through scheduling of their wellness visit and by allowing plans to learn more about the beneficiary’s needs.
Who can conduct a Value Based Enrollment?Only approved agents that have received access to Centene’s required Ascend technology platform can facilitate a Value Based Enrollment. The Ascend technology allows sales agents to submit an enrollment application and facilitate a Value Based Enrollment.
How does it work?After submitting an electronic enrollment application, the Ascend technology allows the sales agent to immediately connect the Medicare beneficiary with a plan Wellness Advocate to initiate the gathering of some health-related information and to schedule the enrollee’s Wellness Visit with their physician. Once the VBE call is initiated, the agent isrequired to leave.
Related Administration Fee to Sales AgentsAs a result, sales agents will receive a $50 administration fee for each VBE that is distinctly separate from the sales commission and associated CMS commission guidelines. This administration fee is in compliance with CMS requirements and is intended to encourage sales agents to facilitate the smooth transition of new enrollees. Value Based Enrollment will help ensure that the health care needs of new members are met.
9Agent Use Only. Proprietary and Confidential.
ENROLLMENT PROCEDURES
Enrollment Mechanisms for AgentsThe following options are available for agents to submit plan enrollment applications.
Paper Enrollment Forms – Included in pre-enrollment kits and available for download from plan websites.
Agent Assisted On-line Enrollment – Available on the plan website, simply select, “How to Enroll”, select “Apply Now” for the desired plan and follow the prompts for an agent assisted online enrollment.
Ascend Electronic Enrollment – Ascend is now available in many of our regions and is a fast, easy and compliant way for agents to submit agent-assisted electronic and telephonic enrollments. Ascend highlights include:› Validates important data to help prevent incorrect or missing information.› Links to the provider directory and formularies to validate physician and prescriptions availability.› Scope of appointments can be documented electronically. Verify that the status is “Accepted” prior to
proceeding with the appointment.› Ascend is also the only option available for submitting Value Based Enrollments (VBEs) which allow
agents to earn an additional $50 administrative fee per enrollment!
10 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
2019 Medicare Sales Expanded National Alignment Map
Region 1 Sean Casler
Region 2Nicole Marrazzo
Region 5Don Hansford
Region 6Shaun Johnson
Region 3William Johnson
Ryan ButterfieldNational Medicare Broker Channel
Leadership Alignment
11Agent Use Only. Proprietary and Confidential.
2019-2020 National Medicare Broker Channel Alignment Map
Chris Murray Ray BurrOpen Position
Ryan ButterfieldNational Medicare Broker Channel
Guy MaesStrategic Alliances and Call Centers
Leadership Alignment
12 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
LIS TIER DESCRIPTIONDrug Tier Tier Description Co-Payment and/or Co-insurance
1 Preferred Generic Drugs
$0 copay****$0 copay until total drug costs reach $4,020 and after out-of-pocket expenses reach $6,350After total drug costs reach $6,350: LIS 1 $3.60LIS 3 $0 copay, orLIS 2 $1.30LIS 4 15% of the total cost
2 Generic Drugs
LIS 3 $0 copay, orLIS 2 $1.30, orLIS 1 $3.50, orLIS 4 15% of the total cost
3 Preferred Brand Drugs
LIS 3 $0 copay, orLIS 2 $3.90, orLIS 1 $8.95, orLIS 4 15% of the total cost
4 Non-Preferred Drugs
LIS 3 $0 copay, orLIS 2 $1.30, or $3.90, orLIS 1 $3.60, or $8.95, orLIS 4 15% of the total cost
5 Specialty Tier
LIS 3 $0 copay, orLIS 2 $1.30, or $3.90, orLIS 1 $3.60, or $8.95, orLIS 4 15% of the total cost
6 Select Care Drugs
$0 copay**$0 copay until total drug costs reach $4,020 and after out of-pocket expenses reach $6,350. This does not apply to allplans. For generic drugs included in the Medicare Adherence Measures:LIS 3 $0 copayLIS 2 $0 copayLIS 1 $0 copayLIS 4 $0 copay
13Agent Use Only. Proprietary and Confidential.
2020 MSP LEVELS
2020 MSP LEVELS
State2020
Contract2020 PBP
2020 Segment 2020 - Plan Type 2020 CSNP/DSNP Type Q
MB
QM
B+
SLM
B
SLM
B+
FBD
E
QD
WI
QI
AZ H5590 008 000 HMO MA-PD DSNP Non-Zero Dollar X X X
FL H5190 001 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
FL H5190 002 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
FL H5190 003 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
FL H5190 004 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
GA H7173 001 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
IN H3499 005 000 HMO MA-PD DSNP Zero-Dollar X X X X
KS H6550 004 000 HMO MA-PD DSNP Zero-Dollar X X X
LA H5117 004 000 HMO MA-PD DSNP Zero-Dollar X X
LA H5117 005 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
MO H1664 005 000 HMO MA-PD DSNP Zero-Dollar X X
MS H9811 006 000 HMO MA-PD DSNP Zero-Dollar X X
MS H9811 007 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
NM H2134 001 000 HMO MA-PD DSNP Zero-Dollar X X X
OH H0908 001 000 HMO MA-PD DSNP Non-Zero Dollar X X X X X X X
PA H2915 001 000 HMO MA-PD DSNP Zero-Dollar X X X
PA H2915 002 000 HMO MA-PD DSNP Zero-Dollar X X X
PA H2915 007 000 HMO MA-PD DSNP Zero-Dollar X X X
SC H1436 005 000 HMO MA-PD DSNP Zero-Dollar X X
TX H5294 002 003 HMO MA-PD DSNP Zero-Dollar X X X
TX H5294 002 002 HMO MA-PD DSNP Zero-Dollar X X X
TX H5294 002 004 HMO MA-PD DSNP Zero-Dollar X X X
TX H5294 007 000 HMO MA-PD DSNP Zero-Dollar X X X
TX H5294 009 000 HMO MA-PD DSNP Zero-Dollar X X X
WI H8189 001 000 HMO MA-PD DSNP Zero-Dollar X X X
14 Agent Use Only. Proprietary and Confidential.
ARIZONA
1. Cochise 2. Gila 3. Graham 4. Greenlee 5. La Paz 6. Maricopa
= DSNP
= MAPD
= DSNP & MAPD
= DSNP, MAPD & CSNP
7. Pima 8. Pinal 9. Santa Cruz 10. Yavapai 11. Yuma
= New Counties*
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15Agent Use Only. Proprietary and Confidential.
ARIZONA
2020 Product Highlight Overview
Market Highlights: • 5th largest MAPD plan
by market share, fastest growing DSNP in AZ; $0 premium plan; 3.5 Star Rating Plan(s)
RX Highlights: • No deductible and low
copays for Tier 1 and Tier 2, the most commonly used drugs
- Tier 6 $0 copay Rx
• Tier 1 & 2 coverage with 90% of generic claims on these tiers
• 8 of the top 10 most used generics are in Tier 1
Providers:• Very strong Network across
the Market; Comprehensive hospital network
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
16 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Parent Organization: Arizona Complete Health
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) Allwell Dual Medicare DSNP
CountiesCochise, Gila, Graham, Greenlee, La PazMaricopa, Pima, Pinal, Santa Cruz, Yuma
State/Plan/PBP AZ-H5590-008
Premium Part B Giveback
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $6,700
Inpatient Hospital - Acute $0
PCP Office Visists $0 Copay
Specialist Office Visits $0 Copay
Over-the-Counter Items $200 Quarterly
Medically Necessary Transportation 16 one way trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $3,000 Max
Vision Benefits $250 Max Benefit
Hearing Benefits $0-$1,350 (2 Aids)
Rx Deductible $0 (cost share with LIS/Medicaid is $0-$8.95)
Deductible Tiers
Tier 1: Preferred Generic Preferred Generic: $0 to $8.95
Tier 2: Generic Generic: $0 to $8.95
Tier 3: Preferred Brand Preferred Brand: $0 to $8.95
Tier 4: Preferred Drug Preferred: $0 to $8.95
Tier 5: Specialty Tier Specialty Tier: $0 to $8.95
Tier 6: Select Care Drugs Select Care Drugs: $0 to $8.95
Laboratory Services
X-Ray Services $0
17Agent Use Only. Proprietary and Confidential.
ARIZONA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) Essentials HMO HMO HMO
Counties Maricopa, Pinal Pima Pima
State/Plan/PBP H5590-005-000 H9287-001-000 H0351-044-001
Premium Part B Giveback $0 $0 $0
Total Premium (Part C and D) $0 $0 $33
In-Network Plan Deductible No Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $3,400 $3,400 $6,700
Inpatient Hospital - AcuteDays 1-8: $180 Copay per dayDays 9-90: $0 Copay per day
Days 1-6: $175 Copay per day Days 7-90: $0 Copay per day
Days 1-5: $360 Copay per day Days 6-90: $0 Copay per day
PCP Office Visits $0 $0 $0
Specialist Office Visits $15 $25 $50
Over-the-Counter Items $60 Quarterly $20 Per Month $60 Quarterly
Medically Necessary Transportation
Not Covered 16 one-way trips 16 one-way trips
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits Allwell Enhanced OSB-$24 Allwell Total OSB-$27 Allwell Totalplus OSB-$32
Vision Benefits $100 Max $100 Max $250 Max
Hearing Benefits $0-$1,350 (2 Aids) Not Covered Not Covered
Rx Deductible No Deductible No Deductible $200
Deductible Tiers No Deductible No Deductible Tiers 3-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $3
Tier 2: Generic Generic: $15 Generic: $7 Generic: $15
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37 Preferred Brand: $37
Tier 4: Preferred Drug Preferred: $90 Preferred: $90 Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 29%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $10 to $25 Copay $0 to $25 Copay $0 to $25 Copay
X-Ray Services $10 to $75 Copay $0 to $75 Copay $0 to $25 Copay
Parent Organization: Arizona Complete Health
18 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO Essentials II HMO HMO
CountiesCochise,
Santa Cruz (New County)Maricopa, Pinal Maricopa, Pinal
State/Plan/PBP H0351-044-002 H0351-050 H0351-051
Premium Part B Giveback $0 $0 $0
Total Premium (Part C and D) $68 $0 $38.60
In-Network Plan Deductible No Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $6,700 $4,250 $3,400
Inpatient Hospital - AcuteDays 1-5: $360 Copay per day Days 6-90: $0 Copay per day
Days 1-6: $295 Copay per day Days 7-90: $0 Copay per day
Days 1-8: $150 Copay per day Days 9-90: $0 Copay per day
PCP Office Visits $5 Copay $0 $0
Specialist Office Visits $50 $35 $15
Over-the-Counter Items $60 Quarterly $60 Quarterly $60 Quarterly
Medically Necessary Transportation
16 One-Way Trips Not covered Not covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits Allwell Totalplus OSB-$32 Allwell Totalplus OSB-$32 Allwell Total OSB-$27
Vision Benefits $250 Max $250 Max $100 Max
Hearing Benefits Not Covered $0-$1,350 (2 Aids) $0-$1350 (2 Aids)
Rx Deductible $200 $50 No Deductible
Deductible Tiers Tiers 3-5 Tiers 3-5 No Deductible
Tier 1: Preferred Generic Preferred Generic: $3 Preferred Generic: $5 Preferred Generic: $0
Tier 2: Generic Generic: $15 Generic: $15 Generic: $15
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non Preferred: $90 Non Preferred: $90 Non Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 32% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 to $20 Copay $10 to $25 $0
X-Ray Services $0 to $20 Copay $10 to $75 $0
Parent Organization: Arizona Complete Health
19Agent Use Only. Proprietary and Confidential.
ARIZONA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO Essentials I HMO CSNP
Counties Yuma, Yavapai (new county)Cochise, Maricopa, Pinal, Santa Cruz, Yuma, Pima
Maricopa, Pinal
State/Plan/PBP H5590-004 H5590-007 H0351-038
Premium Part B Giveback $0 $0 $0
Total Premium (Part C and D) $28 $30.90 $0
In-Network Plan Deductible No Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $6,700 $6,700 $3,400
Inpatient Hospital - AcuteDays 1-5: $360 Copay per day Days 6-90: $0 Copay per day
$1,000 per admission Days 1-10: $205 Copay per day
PCP Office Visits $0 $5 $0
Specialist Office Visits $50 $50 $15
Over-the-Counter Items $60 Quarterly Not Covered $75 Quarterly
Medically Necessary Transportation
16 One-Way Trips 16 One-Way Trips 16 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental BenefitsBuilt in Preventative
only $1,000 MaxAllwell Wellbeing OSB-$22 Allwell Total OSB-$27
Vision Benefits Not Covered Allwell Wellbeing OSB-$22 $250 Max
Hearing Benefits Not Covered Not Covered Not Covered
Rx Deductible $200 $290 No Deductible
Deductible Tiers Tiers 3-5 Tiers 2-5 No Deductible
Tier 1: Preferred Generic Preferred Generic: $3 Preferred Generic: $0 Preferred Generic: $5
Tier 2: Generic Generic: $15 Generic: $20 Generic: $15
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $47 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non Preferred Brand: $90 Non Preferred: $100 Non Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 27% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $10 to $25 $20 $0 to $25 Copay
X-Ray Services $25 $25 $0 to $75 Copay
Parent Organization: Arizona Complete Health
20 Agent Use Only. Proprietary and Confidential.
ARKANSAS
1. Baxter 2. Benton 3. Boone 4. Carroll 5. Clark 6. Clay 7. Cleburne 8. Conway 9. Craighead 10. Crawford 11. Cross 12. Franklin 13. Faulkner 14. Fulton 15. Garland
= MAPD
= New Counties
16. Hot Spring 17. Greene 18. Independence 19. Izard 20. Jackson 21. Johnson 22. Lawrence 23. Logan 24. Lonoke 25. Madison 26. Marion 27. Mississippi 28. Newton 29. Perry 30. Poinsett
31. Pope 32. Prairie 33. Pulaski 34. Randolph 35. Saline 36. Scott 37. Searcy 38. Sebastian 39. Sharp 40. Stone 41. Van Buren 42. Washington 43. White 44. Woodru� 45. Yell
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21Agent Use Only. Proprietary and Confidential.
ARKANSAS
2020 Product Highlight Overview
Market Highlights: • H9630-001; 002; Most
popular plan the last 2 years in Arkansas. Strongest network. $0 premium. Strong local support team
• H9630-003: Strong additional benefits, slightly smaller network locally with access to statewide network outside of these 2 counties
• H9630-AA6: New plan to the market for 2020, great option in existing markets for those who want additional benefits and are willing to pay a premium for them
RX Highlights: • Tier 2 is $0 copay if ordered
by mail order. Tiers 1 and 6 $0 copay-most commonly used maintenance drugs. Deductible only applies to Tiers 4 & 5
Providers:• Most comprehensive
network of all plans in Arkansas. 95% of providers are participating
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
• Delta Dental is used for Arkansas Dental Services
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
• All Arkansas plans use Walmart for their OTC Benefits with a debit card
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer $0 deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
22 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties
Benton, Carroll, Crawford, Franklin, Logan, Madison, Scott, Sebastian,
Washington, Clay, Cleburne, Cross, Fulton, Indepencence, Izard, Jackson,
Johnson, Lawrence, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph,
Searcy, Sharp, Stone, Van Buren, White, Woodruff, Yell
Clark, Conway, Craighead, Faulkner, Garland, Greene, Hot Spring, Lonoke, Pope,
Pulaski, Saline
State/Plan/PBP AR-H9630-001-000 AR- H9630-002-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $5,900 $6,700
Inpatient Hospital - AcuteDays 1-6: $328 Copay per day
Day 7+: $0 Copay per dayDays 1-6: $328 Copay per day
Day 7+: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $40
Over-the-Counter Items $50 Quarterly $50 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits Preventive Only $1,000 Max
Vision Benefits $200 Max $200 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $250 $250
Deductible Tiers Tiers 4-5 Tiers 4-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $8 Generic: $8
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non Preferred: $100 Non Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 28% Specialty Tier: 28%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Arkansas Health and Wellness
23Agent Use Only. Proprietary and Confidential.
ARKANSAS
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties Benton, Washington Baxter, Boone, Marion
State/Plan/PBP AR-H9630-003-000 AR- H9630-004-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $6,300 $6,700
Inpatient Hospital - AcuteDays 1-6: $328 Copay per day
Day 7+: $0 Copay per dayDays 1-6: $328 Copay per day
Day 7+: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $40
Over-the-Counter Items $50 Quarterly $50 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max $500 Max
Vision Benefits $200 Max $200 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $0 $250
Deductible Tiers No Deductible Tiers 4-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $8 Generic: $8
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 28%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Arkansas Health and Wellness
24 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties Baxter, Boone, Marion
Benton, Carroll, Crawford, Franklin, Logan, Madison, Scott, Sebastian, Washington,Clay, Cleburne, Cross, Fulton, Indepencence, Izard,
Jackson, Johnson, Lawrence, Mississippi, Newton, Perry, Poinsett, Prairie, Randolph, Searcy, Sharp, Stone, Van Buren, White,
Woodruff, Yell
State/Plan/PBP AR- H9630-005-000 AR- H9630-AA6-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) 21.50 $19.50
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $6,700 $6,700
Inpatient Hospital - AcuteDays 1-6: $328 Copay per day
Day 7+: $0 Copay per dayDays 1-6: $328 Copay per day Day 7+ : $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $35
Over-the-Counter Items $65 Quarterly $65 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,500 Max $1,000 Max
Vision Benefits $250 Max $250 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $250 $250
Deductible Tiers Tiers 4-5 Tiers 4-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $8 Generic: $8
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 28% Specialty Tier: 28%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Arkansas Health and Wellness
25Agent Use Only. Proprietary and Confidential.
ARKANSAS
NOTES: ___________________________________________________________________________________________________________
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26 Agent Use Only. Proprietary and Confidential.
FLORIDA
1. Broward 2. Duval 3. Hillsborough 4. Miami-Dade 5. Orange 6. Osceola
= DSNP
= DSNP & MAPD
7. Palm Beach 8. Pinellas 9. Pasco 10. Polk 11. Seminole 12. Volusia
1
2
3
9
4
34
45
5
6
7
810
55
11
12
27Agent Use Only. Proprietary and Confidential.
FLORIDA
2020 Product Highlight Overview
Market Highlights: • Duval $75.00 Part B Giveback
on MAPD
• $3000 dental on DSNP
• $0 , $0 , $0 cost share
• Large Medicaid and Commercial business that has natural progression into our Medicare Product
• Great Dental and Vision and OTC benefits with Extensive Networks
RX Highlights: • $0 cost share for Tier 1 and 6
and some tier coverage during gap
Providers:• Large hospital network
• Duval – Memorial hospitals, Family Care Partners Risk Partner
• Jaycare
• IMA
• Premier Physicians - MSO
• Access/CMG
• Tampa Family Health Centers
• Orlando Family Physicians
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at $0 copay
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need either via mail or in-store
Prescription Drugs
· Many of our Allwell plans offer $0 deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers.
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
28 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP DSNP DSNP DSNP
Counties Duval, Volusia
Hillsborough, Orange, Osceola, Palm Beach, Pasco , Pinellas, Polk,
Seminole
Broward Miami-Dade
State/Plan/PBP FL-H5190-001 FL-H5190-002 FL-H5190-003 FL-H5190-004
Premium Part B Giveback $0 $0 $0 $0
Total Premium (Part C and D) $30.30 $30.30 $30.30 $30.30
In-Network Plan Deductible No Deductible No Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $3,400 $3,400 $3,400 $3,400
Inpatient Hospital - AcuteDays 1-90:
$0 Copay per dayDays 1-90:
$0 Copay per dayDays 1-90:
$0 Copay per dayDays 1-90:
$0 Copay per day
PCP Office Visists $0 Copay $0 Copay $0 Copay $0 Copay
Specialist Office Visits $0 Copay $0 Copay $0 Copay $0 Copay
Over-the-Counter Items $100 Monthly $100 Monthly $100 Monthly $100 Monthly
Medically Necessary Transportation
Unlimited Unlimited Unlimited Unlimited
Fitness MembershipUnlimited visits to
Silver & FitUnlimited visits to
Silver & FitUnlimited visits to
Silver & FitUnlimited visits to
Silver & Fit
Dental Benefits $3,000 Max $3,000 Max $3,000 Max $3,000 Max
Vision Benefits $350 Max $350 Max $350 Max $350 Max
Hearing Benefits $0 (2 Aids) $0 (2 Aids) $0 (2 Aids) $0 (2 Aids)
Rx Deductible $415 $415 $415 $415
Deductible Tiers Tiers 3-5 Tiers 3-5 Tiers 3-5 Tiers 3-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $0 Generic: $0 Generic: $0 Generic: $0
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 25% Specialty Tier: 25% Specialty Tier: 25% Specialty Tier: 25%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0 $0 $0
X-Ray Services $0 $0 $0 $0
Parent Organization: Sunshine Health Plan
29Agent Use Only. Proprietary and Confidential.
FLORIDA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO HMO HMO
Counties Duval Miami-Dade Broward Palm Beach
State/Plan/PBP H9276-002 H9276-004 H9276-012 H9276-021
Premium Part B Giveback $75.00 $0 $0 $0
Total Premium (Part C and D) $0 $0 $0 $0
In-Network Plan Deductible No Deductible No Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $6,700 $3,400 $6,700 $6,700
Inpatient Hospital - Acute
Days 1-7: $250 Copay per day Days 8-90: $0 Copay per day
Days 1-7: $90 Copay per day Days 8-90: $0 Copay per day
Days 1-7: $90 Copay per day Days 8-90: $0 Copay per day
Days 1-7: $290 Copay per day Days 8-90: $0 Copay per day
PCP Office Visists $0 $0 $0 $0
Specialist Office Visits $40 $0 $10 $40
Over-the-Counter Items $35 Monthly $100 Monthly $80 Monthly $40 Monthly
Medically Necessary Transportation
30 one way trips 30 one way trips 30 one way trips 30 one way trips
Fitness MembershipUnlimited visits to
Silver & FitUnlimited visits to
Silver & FitUnlimited visits to
Silver & FitUnlimited visits to
Silver & Fit
Dental Benefits $500 Max $1,000 max $1,000 max $500 Max
Vision Benefits $100 Max $350 Max $250 Max $150 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1580 (2 Aids)
Rx Deductible No Deductible No Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $10 Preferred Generic: $10 Preferred Generic: $10 Preferred Generic: $10
Tier 2: Generic Generic: $20 Generic: $20 Generic: $20 Generic: $20
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non Preferred Brand Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs: $10 Select Care Drugs: $10 Select Care Drugs: $10 Select Care Drugs: $10
Laboratory Services $0 to $100 $0 to $50 $0 to $100 $0 to $150
X-Ray Services $0 to $100 $0 to $50 $0 to $100 $0 to $150
Parent Organization: Sunshine Health Plan
30 Agent Use Only. Proprietary and Confidential.
GEORGIA
= DSNP
= DSNP & MAPD= New Counties*
1. Butts 2. Chattahoochee 3. Clayton 4. Cobb 5. Dawson 6. DeKalb 7. Douglas
8. Fayette 9. Forsyth 10. Fulton 11. Greene 12. Gwinnett 13. Harris 14. Heard
15. Henry 16. Lumpkin 17. Marion 18. Morgan 19. Muscogee 20. Oconee 21. Paulding 22. Pickens
23. Rabun 24. Rockdale 25. Spaulding 26. Taliaferro 27. Towns 28. Troup 29. Union 30. White
*
*
*
*
*
22
29 27
3016
5
9
720
11 262438
14
28
1525 1
13
17192
18
21 4
10 612
23
31Agent Use Only. Proprietary and Confidential.
GEORGIA
2020 Product Highlight Overview
Market Highlights: • $30 Part B Give back
available in the Metro Atlanta Area
• Hearing and Vision Benefits available on all products
• Worldwide Emergency coverage available on select products
RX Highlights: • $0 cost share on Tier 1 and 6
• Mail order is available
Providers:• Emory, Grady, Columbus
Regional, WellStar
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
32 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
CountiesButts, Chattahoochee, Clayton, Cobb, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton,
Greene, Gwinnett, Harris, Heard, Henry, Lumpkin, Marion, Morgan, Muscogee, Oconee, Paulding, Pickens, Rabun, Rockdale, Spalding, Taliaferro, Towns, Troup, Union, White
State/Plan/PBP H7173-001
Premium Part B Giveback $0
Total Premium (Part C and D) $24.10
In-Network Plan Deductible No Deductible
Maximum Out of Pocket (MOOP) $6,700
Inpatient Hospital - Acute Days 1-90: $0 Copay per day
PCP Office Visists $0
Specialist Office Visits $15
Over-the-Counter Items $200 Quarterly
Medically Necessary Transportation 24 -One way trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $1,500 Max
Vision Benefits $250 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible $345
Deductible Tiers Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $7
Tier 3: Preferred Brand Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 26%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services 20%
Parent Organization: Peach State Health Plan
33Agent Use Only. Proprietary and Confidential.
GEORGIA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO HMO
Counties
Chattahoochee, Clayton, DeKalb, Douglas, Fayette, Fulton, Greene, Gwinnett,
Harris, Henry, Morgan, Muscogee, Oconee, Paulding,
Rockdale, Spalding, Troup
CobbDeKalb, Fulton, Greene,
Gwinnett, Muscogee
State/Plan/PBP H7173-002-000 H7173-008 H7173-007-000
Premium Part B Giveback $0 $0 $30
Total Premium (Part C and D) $0 $25 $30
In-Network Plan Deductible No Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $5,900 $5,900 $6,500
Inpatient Hospital - AcuteDays 1-6: $295 Copay per day Days 7-90: $0 Copay per day
Days 1-6: $295 Copay per day Days 7-90: $0 Copay per day
Days 1-5: $350 Copay per day Days 6-90: $0 Copay per day
PCP Office Visists $0 $0 $10
Specialist Office Visits $40 $40 $40
Over-the-Counter Items $70 Quarterly $60 Quartely $30 Quartely
Medically Necessary Transportation 10 one way trips Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit
Unlimited visits to Silver & Fit
Unlimited visits to Silver & Fit
Dental Benefits $1,500 Max $1,500 Max $2,000 Max
Vision Benefits $150 Max $250 Max $150 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $280 $280 No Deductible
Deductible Tiers Tiers 4-5 Tiers 4-5 No Deductible
Tier 1: Preferred Generic Preferred Generic: $5 Preferred Generic: $5 Preferred Generic: $10
Tier 2: Generic Generic: $12 Generic: $12 Generic: $20
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $96
Tier 5: Specialty Tier Specialty Tier: 27% Specialty Tier: 27% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 to $30 $0 $0 to $20
X-Ray Services $0 $0 $40
Parent Organization: Peach State Health Plan
34 Agent Use Only. Proprietary and Confidential.
ILLINOIS
1. Cook 2. Kane 3. Will
= MAPD Counties
21
3
35Agent Use Only. Proprietary and Confidential.
ILLINOIS
2020 Product Highlight Overview
Market Highlights: • Strong 4.0 Star Plan offerings
and over 30 years in the market
• Now one plan for all three counties to include low $2,700 MOOP
• $0 Premium plan with comprehensive dental embedded!
RX Highlights: • No deductible and low copays
for Tier 1 and Tier 2, the most commonly used drugs
• Tier 1 & 2 coverage with 90% of generic claims on these tiers
• 8 of the top 10 most used generics are in Tier 1
Providers:Cook and Will Counties• U of Chicago Med Center
• Northshore
• Adventist Lagrange Memorial
• Methodist Hospital of Chicago
• Mount Sinai
• Norwegian American Hospital
• Oak Street Health Clinic
• Paios Community Hospital
• St Anthony Hospital
• Swedish Covenant
• Presence (St E’s campus, St Mary, St Joseph, Resurrection Medical Center, Presence St Joe’s, and St Francis)
Kane County• Presence Mercy Med Ctr
• Provena Health
• St Joseph Hospital
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer $0 deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
36 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO
Counties Cook, Kane, Will
State/Plan/PBP IL- H1475-001
Premium Part B Giveback N/A
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $2,700
Inpatient Hospital - AcuteDays 1-6: $300 Copay per day Days 7-90: $0 Copay per day
PCP Office Visists $0
Specialist Office Visits $35
Over-the-Counter Items $75 Quarterly
Medically Necessary Transportation
Is this non medical Transportation? If so, Not covered
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $1000 Max Benefit
Vision Benefits $350 Max Benefit
Hearing Benefits $0-$1,580
Rx Deductible $0
Deductible Tiers N/A
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $6
Tier 3: Preferred Brand Preferred Brand: $39
Tier 4: Non-Preferred Drug Non-Preferred Drug: $85
Tier 5: Specialty Tier Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0-$25
Parent Organization: Illinicare Health Plan
37Agent Use Only. Proprietary and Confidential.
ILLINOIS
NOTES: ___________________________________________________________________________________________________________
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38 Agent Use Only. Proprietary and Confidential.
INDIANA
1. Allen 2. Boone 3. Delaware 4. Elkhart 5. Hamilton 6. Hancock 7. Hendricks 8. Howard 9. Johnson 10. Lake 11. LaPorte 12. Madison
= DSNP, MAPD & PPO
13. Marion 14. Porter 15. Posey 16. St. Joseph 17. Shelby 18. Tippecanoe 19. Tipton 20. Vanderburgh 21. Warrick 22. Wells 23. Whitley
10
188
123
6137
9 17
20 2115
19
52
22
23 1
14 1116 4
39Agent Use Only. Proprietary and Confidential.
INDIANA
2020 Product Highlight Overview
Market Highlights: • Very attractive $4,500
MOOP. 0/0/0/0 (Premium/PCP/Tier 1 and Tier 6 Rx) Added transportation benefits and added comprehensive dental as an OSB! Top plan on Medicare Plan Finder in 2019!
• Very attractive $5,500 IN/$9,000 OON MOOP. Top 3 on Planfinder in 2019, NEW!-copayments for OON PCP and Specialist
• Very attractive $4,100 MOOP on HMO-002
• Strong benefits, including: OTC benefit, transportation, meals, comprehensive dental
RX Highlights: • Many of our Allwell plans
offer $0 deductible and low copays for Tier 1 and 6 drugs which are the most commonly used drug tiers
Providers:• IU Health, Community
Health Network, Suburban Health Organization
• Elkhart Clinic, Beacon, Lutheran, LaPorte and Porter hospitals
• Deaconess
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
· To enhance the embedded Medicare benefits we offer an Optional Supplemental Benefit rider to our HMO and PPO. The OSB cost for both plans is a mere $12.80.
Over-the-Counter
· All Plans in Indiana offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions. Virtual Visits are not offered on DSNP
Prescription Drugs
· Many of our Allwell plans offer $0 deductible and low copays for Tier 1 and 6 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
40 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
Counties
Allen, Boone, Delaware, Elkhart, Hamilton, Hancock, Hendricks,
Howard, Johnson, Lake, LaPorte, Marion, Madison, Porter, Posey, Shelby, St. Joseph, Tippecanoe, Tipton, Vanderburgh, Warrick,
Wells, Whitley
State/Plan/PBP IN-H3499-005-000
Premium Part B Giveback $0
Total Premium (Part C and D) $31.80*
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $3,400
Inpatient Hospital - Acute $0
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $325 Quarterly
Medically Necessary Transportation 50 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $1,750 Max
Vision Benefits $250 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible $160
Deductible Tiers Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $20
Tier 3: Preferred Brand Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 30%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0
Parent Organization: Coordinated Care Corporation
* The member is not responsible for the $31.80 premium.
41Agent Use Only. Proprietary and Confidential.
INDIANA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties
Existing: Boone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Marion, Madison, Shelby, Tippecanoe,
Tipton, Consolidation: Posey, Vanderburgh, Warrick
Existing: Allen, Elkhart, St. Joseph, Wells, Whitley Consolidation: Lake, LaPorte, Porter
State/Plan/PBP IN-H3499-001-000 IN-H3499-002-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $4,500 $4,100
Inpatient Hospital - AcuteDays 1-6: $295.00 Copay per day Days 7-90 $0.00 Copay per day
Days 1-6: $295.00 Copay per day Days 7-90 $0.00 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $40
Over-the-Counter Items $65 Quarterly $65 Quarterly
Medically Necessary Transportation 30 One-Way Trips 30 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max** $1,000 Max**
Vision Benefits $150 Max $150 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $200 No deductible
Deductible Tiers Tiers 4-5 No deductible
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $5 Generic: $5
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non-Preferred: $90 Non-Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0-$35 $0-$25
**Dental benefits on both HMO’s are OSB. This is an optional add on for a premium and not included in the base HMO.
42 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) PPO PPO
CountiesBoone, Delaware, Hamilton, Hancock, Hendricks, Howard, Johnson, Marion, Madison, Shelby, Tippecanoe, Tipton
Allen, Elkhart, St. Joseph, Wells, Whitley
State/Plan/PBP IN-H6348-001-000 IN-H6348-002-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $19 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $5,500 $5,500
Inpatient Hospital - AcuteDays 1-6: $300.00 Copay per day Days 7-90 $0.00 Copay per day
Days 1-6: $300.00 Copay per day Days 7-90 $0.00 Copay per day
PCP Office Visists $5 $5
Specialist Office Visits $40 $40
Over-the-Counter Items $75 Quarterly $75 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max** $1,000 Max**
Vision Benefits $150 Max $150 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $200 No deductible
Deductible Tiers Tiers 4-5 No deductible
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $5 Generic: $5
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non-Preferred: $90 Non-Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $5-$15 $5
X-Ray Services $0-$35 $0-$35
Parent Organization: Coordinated Care Corporation
**Dental benefits on both HMO’s are OSB. This is an optional add on for a premium and not included in the base PPO.
43Agent Use Only. Proprietary and Confidential.
INDIANA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) PPO PPO
Counties Posey, Vanderburgh, Warrick Lake, LaPorte, Porter
State/Plan/PBP IN-H6348-003-000 IN-H6348-004-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $19 $19
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $5,500 $5,500
Inpatient Hospital - AcuteDays 1-6: $300.00 Copay per day Days 7-90 $0.00 Copay per day
Days 1-6: $300.00 Copay per day Days 7-90 $0.00 Copay per day
PCP Office Visists $5 $5
Specialist Office Visits $40 $40
Over-the-Counter Items $75 Quarterly $75 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max** $1,000 Max**
Vision Benefits $150 Max $150 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible No deductible No deductible
Deductible Tiers No deductible No deductible
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $15 Generic: $5
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non-Preferred: $90 Non-Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $5 $5
X-Ray Services $0-$35 $0-$35
**Dental benefits on both HMO’s are OSB. This is an optional add on for a premium and not included in the base PPO.
44 Agent Use Only. Proprietary and Confidential.
KANSAS
1. Allen 2. Butler 3. Bourbon 4. Cherokee 5. Crawford
= DSNP & MAPD
6. Douglas 7. Harvey 8. Johnson 9. Leavenworth 10. Linn
= New Counties* 11. Miami 12. Sedgwick 13. Sumner 14. Woodson 15. Wyandotte
14 1 3
512
7
13
2
4
11
10
6 8
9
*
* **
*
*
15
45 Agent Use Only. Proprietary and Confidential.
KANSAS
2020 Product Highlight Overview
Market Highlights: • $0 Premium with a $5,000
MOOP; $3,400 for D-SNP
• $0 PCP Visits
• $0 Labs
• $0 Diabetic Supplies
• Preventive Dental
• $0-$1580 Copay for Hearing Aids
• $50-$325 OTC Benefit/Quarter
• A big benefit highlight for Kansas is QMBs will be excepted for our DSNP Plan
• Silver and Fit Gym Benefit
And
• Chiropractic visits per year: 6 visits for HMO MAPD 001 & 12 visits for HMO D-SNP 004; 003 follows Medicare-covered services
• Transportation - 24 one way trips; D-SNP only
• Meals – 2 per day/14 days
• Dental benefits - $1,000 HMO MAPD-$2,000 HMO D-SNP, including dentures
• Vision Benefit - $100 for HMO MAPD-$450 for HMO D-SNP including eyewear
RX Highlights: • $0 Rx Deductible, $0 Tier 1 Rx
copay,$0 Tier 6 Rx copay
Providers:• Large Provider Network,
including University of Kansas Health System
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
46 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
CountiesJohnson, Leavenworth, Miami, Wyandotte
Douglas, LinnAllen, Bourbon, Cherokee, Crawford,
Sedgwick, Sumner, Woodson
State/Plan/PBP KS-H6550-001 H6550-003
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $5,000 $4,850
Inpatient Hospital - AcuteDays 1-5: $325 Copay per day Days 6-90: $0 Copay per day
Days 1-5: $325 Copay per day Days 6-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $40
Over-the-Counter Items $60 Quarterly $75 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max $1,000 Max
Vision Benefits $100 Max $100 Max
Hearing Benefits $0 to $1,580 (2 Aids) $0 to $1,580 (2 Aids)
Rx Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $5 Preferred Generic: $5
Tier 2: Generic Generic: $15 Generic: $15
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 to $10 $0 to $10
X-Ray Services $30 $30
Parent Organization: Sunflower Health Plan
47Agent Use Only. Proprietary and Confidential.
KANSAS
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
CountiesAllen, Bourbon, Butler, Cherokee, Crawford, Douglas, Harvey, Johnson,
Leavenworth, Linn, Miami, Sedgwick, Sumner, Woodson Wyandotte
State/Plan/PBP H-6550-004
Premium Part B Giveback $0
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $3,400
Inpatient Hospital - Acute $0
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $325 Quarterly
Medically Necessary Transportation 24 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $2,000 Max
Vision Benefits $550 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible $205
Deductible Tiers Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $20
Tier 3: Preferred Brand Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 28%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0
Parent Organization: Sunflower Health Plan
48 Agent Use Only. Proprietary and Confidential.
LOUISIANA
1. Acadia 2. Ascension 3. East Baton Rouge 4. Iberville 5. Je�erson 6. Lafayette
= DSNP
= MAPD
= DSNP & MAPD= New Counties
7. Livingston 8. Orleans 9. Pointe Coupee 10. St. James 11. St. Landry12. St. Martin
*
13. St. Tammany 14. Tangipahoa 15. Washington 16. West Baton Rouge
11 9 14
15
13
12
73
16
1 6 4 2
1048 8
5
* *
49Agent Use Only. Proprietary and Confidential.
LOUISIANA
2020 Product Highlight Overview
Market Highlights: • $0 premium in St. Tammany
• Top plan in Tangipahoa
• Very competitive plan design
• Plan for Full Duals- QMB, QMB+ only
• Plan for Partial duals
RX Highlights: • No deductible, zero copay
Tiers 1 and 6
• Over 3,000 maintenance drugs covered on Tier 6 at $0 copay
• Wide network of pharmacies
• LIS Level will dictate copays
Providers:• Baton Rouge Clinic in
network
• Strong relationships with FQHC’s
• LHCC well known in market
• Solid network
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers.
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
50 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP DSNP
CountiesAscension, E. Baton Rouge, W. Baton Rouge,
Livingston, Pointe Coupee, Tangipahoa, Washington, St. Tammany, Jefferson, Orleans
Ascension, E. Baton Rouge, W. Baton Rouge, Livingston, Pointe Coupee, Tangipahoa,
Washington, St. Tammany, Jefferson, Orleans
State/Plan/PBP LA- H5117-004 LA-H5117-005
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 Medicare Defined Part B
Maximum Out of Pocket (MOOP) $6,700 $6,700
Inpatient Hospital - Acute $0 Days 1-8: $75 Copay per day Days 9-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $0 $10
Over-the-Counter Items $325 Quarterly $200 Quarterly
Medically Necessary Transportation 50 One-Way Trips 40 One-Way Trips
Fitness Membership Unlimited Visits to Silver & Fit Unlimited Visits to Silver & Fit
Dental Benefits $2,000 Max $1,000 Max
Vision Benefits $350 Max $250 Max
Hearing Benefits $0 (2 Aids) $0 (2 Aids)
Rx Deductible $200 $340
Deductible Tiers Tiers 2-5 Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $19 Generic: $7
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred Drug: $100 Non-Preferred Drug: $100
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 26%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Louisiana HealthCare Connections
51Agent Use Only. Proprietary and Confidential.
LOUISIANA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO
CountiesAcadia, Lafayette, St. Landry, St. Martin, Ascension, East Baton Rouge, Iberville), Livingston,
Pointe Coupee, St. James, Tangipahoa, Washington, West Baton Rouge, St. Tammany
State/Plan/PBP LA- H5117-003-000
Premium Part B Giveback N/A
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $6,700
Inpatient Hospital - AcuteDays 1-10: $90 Copay per day Days 11-90: $0 Copay per day
PCP Office Visists $0
Specialist Office Visits $40 copay
Over-the-Counter Items $80 Quarterly
Medically Necessary Transportation 40 One-Way Trips
Fitness Membership Unlimited Visits to Silver & Fit
Dental Benefits $1,000 Max
Vision Benefits $ 200 max
Hearing Benefits $0-$1,580 (2 Aids)
Rx Deductible $0
Deductible Tiers No Deductible
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $10
Tier 3: Preferred Brand Preferred Brand: $37
Tier 4: Non-Preferred Drug Non-Preferred Drug: $90
Tier 5: Specialty Tier Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $40
Parent Organization: Louisiana HealthCare Connections
52 Agent Use Only. Proprietary and Confidential.
MISSISSIPPI
1. DeSoto 2. George 3. Hancock 4. Harrison 5. Hinds 6. Jackson 7. Lafayette
= MAPD
= DSNP & MAPD
= New Counties
8. Madison 9. Panola 10. Rankin 11. Stone 12. Tate
*
1
9 7
8
105
34 6
11 2
12
*
53Agent Use Only. Proprietary and Confidential.
MISSISSIPPI
2020 Product Highlight Overview
Market Highlights: • H9811-AA7: Partial dual plan.
Transportation, hearing, dental, OTC all included.
• H9811-006: Full dual plan. QMB, QMB+ only. Strong benefit design
• H9811-001, 005: Dental added at $0 premium
RX Highlights: • H9811-AA7, 006: LIS Level
will dictate copays
• H9811-001, 005: $0 copay for Tiers 1 & 6. Most common maintenance medications in these tiers
Providers:• H9811-AA7, 001 and 00:
Solid network, addition of Memorial on the coast
• H9811-005: Baptist System in network including Memphis
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers.
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
54 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP DSNP
CountiesGeorge , Harrison, Hinds, Jackson, Madison , Rankin, Stone, Hancock
George, Harrison, Hinds, Jackson, Madison, Rankin, Stone, Hancock
State/Plan/PBP MS-H9811-006-000 MS-H9811-007-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $26.90 $25
In-Network Plan Deductible $0 Standard Medicare Part B
Maximum Out of Pocket (MOOP) $6,700 $6,700
Inpatient Hospital - Acute $0 Days 1-6: $295 Copay per day Days 7-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $0 $10
Over-the-Counter Items $250 Quarterly $125 Quarterly
Medically Necessary Transportation 24 One-Way Trips 24 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $2,000 Max $1,500 Max
Vision Benefits $350 Max $250 Max
Hearing Benefits $0-$1,580 (2 Aids) $0- $1,350
Rx Deductible $210 $375
Deductible Tiers Tiers 2-5 Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $20 Generic: $7
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 26%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services 20% $10
Parent Organization: Magnolia Health Plan
55Agent Use Only. Proprietary and Confidential.
MISSISSIPPI
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
CountiesGeorge, Harrison, Hinds, Jackson, Madison, Rankin, Stone, Hancock
DeSoto, Lafayette, Panola, Tate
State/Plan/PBP MS-H9811-001-000 MS-H9811-005-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $6,700 $6,700
Inpatient Hospital - AcuteDays 1-7: $260 Copay per day Days 8-90: $0 Copay per day
Days 1-6: $300 Copay per day Days 7-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $45
Over-the-Counter Items $50 Quarterly $50 Quarterly
Medically Necessary Transportation Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max $1,000 Max
Vision Benefits $200 Max $200 Max
Hearing Benefits Not Covered Not Covered
Rx Deductible $300 $300
Deductible Tiers Tiers 3-5 Tiers 3-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $15 Generic: $15
Tier 3: Preferred Brand Preferred Brand: $42 Preferred Brand: $42
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 27% Specialty Tier: 27%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $20 $20
Parent Organization: Magnolia Health Plan
56 Agent Use Only. Proprietary and Confidential.
MISSOURI
1. Barry 2. Cass 3. Christian 4. Clay 5. Crawford 6. Dallas 7. Franklin
= DSNP & MAPD= New Counties
8. Greene 9. Jackson 10. Jasper 11. Je�erson 12. Laclede 13. Lawrence 14. Lincoln
*
15. McDonald 16. Newton 17. Platte 18. Polk 19. St. Charles 20. St. Louis 21. St. Louis City
22. Stone 23. Taney 24. Warren 25. Washington 26. Webster 27. Wright
17 4
9
2
10
16
15
13
1
18
8
2
23
26 27
126
11
255
7
14
24 1920
22
21* *
*
*
**
57Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Market Highlights: • We’re expanding into 6 new counties
including St. Louis City and County with lower MOOPs and cost sharing. We added gap coverage for T1 & T6 and comprehensive dental coverage to all plans. We eliminated deductibles on Part D in all markets
• When we get the opportunity, we’re selling in Jasper, Newton, McDonald counties due to having strong networks in these areas
• DSNP opportunities love that the Comprehensive Dental benefit includes dentures! Excited about PERS system as well
• We’ve had constant positive feedback about our Member Services team providing excellent service to our members!
RX Highlights: • Many of our Allwell plans offer $0
deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay.
• $0 on Tier 1 and Tier 6 at preferred pharmacies (this includes our gap coverage) and $0 Tier 2 copays at Mail-order
Providers:• Mercy Health Systems, Freeman Health
Systems, Ozark Community Hospital, Select Specialty Hospital, Citizen’s Memorial Hospital, Cass Regional Medical Center, Belton Regional Medical Center, Truman Hospital, Lee’s Summit Medical Center, SSM Health System, Saint Luke’s Des Peres Episcopal Presbyterian and more…
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· All Missouri plans offer additional comprehensive dental benefits
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care (MAPD Only)
· Supplemental smoking and tobacco use cessations (counseling to stop smoking or tobacco use)
• Additional DSNP benefits: PERS, non-emergency
transportation
MISSOURI
58 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
Counties
Barry, Cass, Christian, Clay, Crawford, Dallas, Franklin, Greene, Jackson, Jasper, Jefferson,
Laclede, Lawrence, Lincoln, McDonald, Newton, Platte, Polk, St. Charles, Warren,
Washington, Webster, St. Louis, St. Louis City, Stone, Taney, Wright
State/Plan/PBP H1664-005-000
Premium Part B Giveback $0
Total Premium (Part C and D)$0 or $32
Based on member’s level of eligibility.
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $6,700
Inpatient Hospital - Acute $0
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $325 Quarterly
Medically Necessary Transportation
48 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $2,000 Max
Vision Benefits $350 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible $0, $89 or $250 Based on member’s level of eligibility
Deductible Tiers Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $15
Tier 3: Preferred Brand Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 28%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0
Parent Organization: Home State Health Plan
59 Agent Use Only. Proprietary and Confidential.
MISSOURI
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO HMO
Counties
Barry, Christian, Dallas, Greene, Jasper, Laclede,
Lawrence, McDonald, Newton, Polk, Webster, Stone, Taney,
Wright
Cass, Clay, Jackson, Platte
Crawford, Franklin, Jefferson, Lincoln, St. Charles, Warren,
Washington, St. Louis City, St. Louis
State/Plan/PBP H1664-001-000 H1664-002-000 H1664-004-000
Premium Part B Giveback $0 $0 $0
Total Premium (Part C and D) $0 $0 $0
In-Network Plan Deductible $0 $0 $0
Maximum Out of Pocket (MOOP) $3,400 $3,500 $3,000
Inpatient Hospital - AcuteDays 1-5: $300 copay per day Days 6-90: $0 copay per day
Days 1-6: $300 copay per day Days 7-90: $0 copay per day
Days 1-7: $275 copay per day Days 8-90: $0 copay per day
PCP Office Visists $0 $0 $0
Specialist Office Visits $35 $50 $30
Over-the-Counter Items $75 Quarterly $60 Quarterly $100 Quarterly
Medically Necessary Transportation
Not Covered Not Covered Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max $1,000 Max $1,000 Max
Vision Benefits $250 Max $200 Max $350 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible No Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $5 Generic: $5 Generic: $5
Tier 3: Preferred Brand Preferred Brand: $37 Preferred Brand: $37 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non-Preferred: $90 Non-Preferred: $90 Non-Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 to $35 $0 $0 to $30
X-Ray Services $0 to $35 $50 $0 to $30
Parent Organization: Home State Health Plan
60 Agent Use Only. Proprietary and Confidential.
NEVADA
1. Clark 2. Nye
= MAPD= New Counties*
*
*
2
1
61Agent Use Only. Proprietary and Confidential.
NEVADA
2020 Product Highlight Overview
Market Highlights: • New Market Opportunity with
Allwell; Strong Network, Rich Benefits, an MAPD HMO plan under two strong networks
RX Highlights: • No deductible and low copays
for Tier 1 and Tier 2, the most commonly used drugs
• Tier 1 & 2 coverage with 90% of generic claims on these tiers
• 8 of the top 10 most used generics are in Tier 1
Providers:• Strong Network of Drs —
associated with P3 and USHS
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Comprehensive Dental, Vision, Meals, Fitness, Hearing and more included
Over-the-Counter
· Plan offers a competitive quarterly OTC benefit.
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers.
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
62 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO
Counties Clark, Nye
State/Plan/PBP H6446-001
Premium Part B Giveback $0
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $2,150
Inpatient Hospital - Acute Days 1-6: $0 Copay per dayDays 7-90: $0 Copay per day
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $75 Quarterly
Medically Necessary Transportation 30 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max
Vision Benefits $150 Max
Hearing Benefits $0-$1,580 (2 Aids)
Rx Deductible No Deductible
Deductible Tiers No Deductible
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $10
Tier 3: Preferred Brand Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0
Parent Organization: Silver Summit
63Agent Use Only. Proprietary and Confidential.
NEVADA
NOTES: ___________________________________________________________________________________________________________
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64 Agent Use Only. Proprietary and Confidential.
NEW MEXICO
1. Bernalillo 2. Cibola 3. Dona Ana 4. Luna 5. McKinley
= DSNP= New Counties*
*
6. San Juan 7. Sandoval 8. Santa Fe 9. Torrance 10. Valencia
6
75
10
12
8
9
34
*
**
* *
*
65Agent Use Only. Proprietary and Confidential.
NEW MEXICO
2020 Product Highlight Overview
Market Highlights: • Considered new Market Plan
(2nd year), Very Rich benefits, Western Sky Community Care and Allwell DSNP awarded Medicaid & DSNP Contracts by the State of New Mexico
RX Highlights: • No deductible and low copays
for Tier 1 and Tier 2, the most commonly used drugs
• Tier 1 & 2 coverage with 90% of generic claims on these tiers
• 8 of the top 10 most used generics are in Tier 1
Providers:• Strong provider network
Allwell Healthcare Experience:Dental Coverage
· Very Competitive Preventive & Comprehensive Dental Benefits
Over-the-Counter
· Competitive Quarterly OTC benefit
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to stop smoking or tobacco use)
• Transportation benefits
66 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO
CountiesBernalillo, Cibola, Dona Ana, Luna, McKinley, San Juan, Sandoval,
Santa Fe, Torrance, Valencia
State/Plan/PBP NM-H2134-001
Premium Part B Giveback $0
Total Premium (Part C and D) $0
In-Network Plan Deductible No deductible
Maximum Out of Pocket (MOOP) $6,700
Inpatient Hospital - Acute Days 1-6: $0 Copay per dayDays 7-90: $0 Copay per day
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $325 Quarterly
Medically Necessary Transportation 50 One-Way Trips
Fitness Membership Unlimited visits to Silver and Fit
Dental Benefits $3,000 Max
Vision Benefits $250 Max
Hearing Benefits 2 Hearing Aids Per Year
Rx Deductible No deductible after cost share
Deductible Tiers No Deductible
Tier 1: Preferred Generic Preferred Generic: $0-$3.80
Tier 2: Generic Generic: $0-$3.80
Tier 3: Preferred Brand Preferred Brand: $0-$8.50
Tier 4: Non-Preferred Drug Non-Preferred: $0-8.50
Tier 5: Specialty Tier Specialty Tier: $0-$8.50
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0
Parent Organization: Western Sky Community Care
67Agent Use Only. Proprietary and Confidential.
NEW MEXICO
NOTES: ___________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
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68 Agent Use Only. Proprietary and Confidential.
OHIO
1. Adams 2. Allen 3. Ashland 4. Ashtabula 5. Auglaize 6. Brown 7. Butler 8. Carroll 9. Champaign 10. Clark 11. Clermont 12. Clinton 13. Columbiana 14. Coschocton 15. Crawford
16. Cuyahoga 17. Darke 18. De�ance 19. Delaware 20. Erie 21. Fair�eld 22. Fayette 23. Franklin 24. Fulton 25. Geauga 26. Greene 27. Guernsey 28. Hamilton 29. Hancock 30. Hardin
= DSNP
= DSNP and MAPD
= MAPD
= New Counties*
31. Harrison 32. Henry 33. Highland 34. Hocking 35. Holmes 36. Huron 37. Jackson 38. Je�erson 39. Lake 40. Logan 41. Lorain 42. Lucas 43. Madison 44. Mahoning 45. Medina 46. Meigs
47. Mercer 48. Miami 49. Monroe 50. Montgomery 51. Morgan 52. Morrow 53. Noble 54. Ottawa 55. Paulding 56. Perry 57. Pickaway 58. Pike 59. Portage 60. Preble 61. Putnam 62. Sandusky
63. Seneca 64. Shelby 65. Stark 66. Summit 67. Trumbull 68. Tuscarawas 69. Van Wert 70. Vinton 71. Warren 72. Wayne 73. Williams 74. Wood 75. Wyandot
DSNP only: MonroeJacksonJe�ersonDarkeAshland
73 24 4254
20 4116
39 4
25
6759664536
62
63
75 15 3 72
35
65
44
13
8
743218
55
692
47
1748
50
919
23
2157
10
1228
1122
43
34
4637
70
58
26
1
33
6
7 71
60
5
64 40
30
52
1468
27
4951
5356
3138
61 29
*
*
*
*
*
69Agent Use Only. Proprietary and Confidential.
OHIO
2020 Product Highlight Overview
Market Highlights: • Strong product, robust
network, backed by Centene, dedicated agent force, experienced management team. DSNP takes Full and Partial Duals, $0 premium plan, $1,000 built in comprehensive dental
• For 2019 there are four HMO’s and for 2020 three of the four are being cross walked into one and we are adding a great Veterans play with a MA only which will cover the same territory as the HMO (22 counties)
RX Highlights: • $50 deductible and $0 copays
for tiers 1 and 6
• $125 deducible and $0 copays for tiers 1 and 6
Providers:• Comprehensive hospital
network
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need either via mail or in-store
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to
stop smoking or tobacco use)
70 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP HMO
Counties
Adams, Allen Ashland, Ashtabula, Auglaize, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana,
Coschocton, Crawford, Cuyahoga,Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Fulton, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson,
Lake, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan,
Morrow, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Sandusky, Seneca, Shelby,
Stark, Summit,Trumbull, Tuscarawas, Van Wert, Vinton, Warren, Wayne, Williams, Wood, Wyandot
Butler, Columbiana, Cuyahoga, Delaware, Franklin, Farirfield, Fulton,
Greene, Hamilton, Lake, Lorain, Lucas, Mahoning, Montgomery,
Ottawa, Stark, Summit, Trumbull, Wood
State/Plan/PBP H0908-001-000 H-0724-001
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 - $31.60* $0
In-Network Plan Deductible No Deductible $0
Maximum Out of Pocket (MOOP) $6,700 $4,900
Inpatient Hospital - Acute $0 Days 1-5: $360 Copay per day Days 6-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $0 $45
Over-the-Counter Items $60 Monthly $60 Quarterly
Medically Necessary Transportation 50 One-Way Trips Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,500 Max $1,000 Max
Vision Benefits $200 Max $150 Max
Hearing Benefits $0 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible $110 $125
Deductible Tiers Tiers 2-5 Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $20 Generic: $9
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $37
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $90
Tier 5: Specialty Tier Specialty Tier: 31% Specialty Tier: 30%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $45
Parent Organization: Buckeye Health Plan
* Depending on what MSP level and what LIS Tier depends what you will pay. Most Medicaid recipients will pay $0
71Agent Use Only. Proprietary and Confidential.
OHIO
Parent Organization: Buckeye Health Plan
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO
Counties
Butler, Columbiana, Cuyahoga, Delaware, Fairfield, Franklin, Fulton, Greene,
Hamilton, Lake, Lorain, Lucas, Mahoning, Montgomery, Ottawa, Stark, Summit,
Trumbull, Wood
State/Plan/PBP H0724-005
Premium Part B Giveback $0
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $3,400
Inpatient Hospital - AcuteDays 1-5: $200 Copay per day Days 6-90: $0 Copay per day
PCP Office Visists $0 copay
Specialist Office Visits $35 copay
Over-the-Counter Items $65 Quarterly
Medically Necessary Transportation Not Covered
Fitness Membership Unlimited visits to Silver and Fit
Dental Benefits $1,000 Max
Vision Benefits $100 max
Hearing Benefits Not Covered
Rx Deductible Not Covered
Deductible Tiers Not Covered
Tier 1: Preferred Generic Not Covered
Tier 2: Generic Not Covered
Tier 3: Preferred Brand Not Covered
Tier 4: Non-Preferred Drug Not Covered
Tier 5: Specialty Tier Not Covered
Tier 6: Select Care Drugs Not Covered
Laboratory Services $0 copay
X-Ray Services $0-$25
72 Agent Use Only. Proprietary and Confidential.
PENNSYLVANIA
1. Adams 2. Allegheny 3. Armstrong 4. Beaver 5. Bedford 6. Berks 7. Blair 8. Bradford 9. Bucks 10. Butler 11. Cambria 12. Cameron
= DSNP
= DSNP & MAPD
= New Counties
13. Carbon 14. Centre 15. Chester 16. Clarion 17. Clear�eld 18. Clinton 19. Crawford 20. Cumberland 21. Dauphin 22. Delaware 23. Elk 24. Erie
25. Fayette 26. Forest 27. Franklin 28. Fulton 29. Greene 30. Huntingdon 31. Indiana 32. Je�erson 33. Juanita 34. Lackawanna 35. Lancaster 36. Lawrence 37. Lebanon
*
*
38. Lehigh39. Luzerne 40. Lycoming 41. McKean 42. Mercer 43. Mi�in 44. Monroe 45. Montgomery 46. Northampton 47. Perry 48. Philadelphia 49. Pike 50. Potter 51. Schuykill
52. Snyder 53. Somerset 54. Sullivan 55. Susquehanna 56. Tioga 57. Union 58. Venango 59. Warren 60. Washington 61. Wayne 62. Westmoreland 63. Wyoming 64. York
*
*
*
*
***
*
***
*
*
*
*
*
**
*
*
*
1959 41 5650 8 55
61
3463
3944
544018
122326
5842
36 10
16
3
3217
14 57 13
51 4638
9
45
6
221535
3721
52
47
3343
641
20
27
30
71131
28553
62
2
4
60
2529
49
24
48*
*
*
*
*
*
*
*
*
*
*
73Agent Use Only. Proprietary and Confidential.
PENNSYLVANIA
2020 Product Highlight Overview
Market Highlights: • Expansion into 30
Counties
• $0 Premium / $0 PCP copay/ $0 generics HMO
• Great Value-Add Benefits
• $50 quarterly OTC benefit – HMO
• $325 quarterly OTC benefit – DSNP*
• Transportation on HMO and DSNP*
• Acupuncture Coverage in some areas
• Comprehensive Dental with $500 max – HMO
• $1,500-$2,500 max dental benefit dentures included – DSNP only
• $0 Copay for 2 Hearing Aids per ear per year- DSNP only
*Benefit varies by county
RX Highlights: • $0 Deductible
• $0 Copay Tier 1
• $0 Copay Tier 6 Select Care Drugs
Providers:• SW/NW PA Counites:
• Butler Health System
• Monongahela Valley Hospital
• Uniontown Hospital
• UPMC- Multiple Locations
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling to stop smoking or
tobacco use)
• Washington Hospital
• Excela Health Network
• Heritage Valley
• SE PA Counties:
• Temple Hospital & Provider Network
• University of Pennsylvania Hospital & Provider Network
• Crozer Hospital System
• Delaware County Memorial
• Suburban Community Hospital
• Doylestown Hospital
• Central PA Counties:
• UPMC Pinnacle Health Hospitals*
• Penn State Milton Hershey Hospitals
• Lancaster General
• Lehigh Valley Hospital*
• Wellspan Hospital*
• St. Joe’s
• Susquehanna Hospital
• Guthrie Hospital
• Good Samaritan
• Wayne Memorial
*DSNP Only Network
74 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP DSNP
Counties
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette Forest, Greene,
Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren,
Washington, Westmoreland
Bucks, Chester, Delaware, Montgomery, Philadelphia
State/Plan/PBP PA-H2915-001-000 PA-H2915-002-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $37 $37
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $3,400 $3,400
Inpatient Hospital - Acute $0 $0
PCP Office Visists $0 $0
Specialist Office Visits $0 $0
Over-the-Counter Items $250 Quarterly $325 Quarterly
Medically Necessary Transportation 30 One-Way Trips 30 One-Way Trips
Fitness Membership Unlimited Visits to Silver and Fit Unlimited Visits to Silver and Fit
Dental Benefits $2,500 Max $1,500 Max
Vision Benefits $250 Max $250 max
Hearing Benefits $0 (2 Aids) $0 (2 Aids)
Rx Deductible $435 $435
Deductible Tiers NA NA
Tier 1: Preferred Generic Preferred Generic: 25% Preferred Generic: 25%
Tier 2: Generic Generic: 25% Generic: 25%
Tier 3: Preferred Brand Preferred Brand: 25% Preferred Brand: 25%
Tier 4: Non-Preferred Drug Non Preferred: 25% Non Preferred: 25%
Tier 5: Specialty Tier Specialty Tier: 25% Specialty Tier: 25%
Tier 6: Select Care Drugs Select Care Drugs: 25% Select Care Drugs: 25%
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Pennsylvania Health and Wellness
75Agent Use Only. Proprietary and Confidential.
PENNSYLVANIA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
Counties
Adams, Berks, Bradford, Carbon, Centre, Clinton, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juanita, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union,
Wayne, Wyoming, York
State/Plan/PBP PA-H2915-007-000
Premium Part B Giveback $0
Total Premium (Part C and D) $37
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $3,400
Inpatient Hospital - Acute $0
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $325 Quarterly
Medically Necessary Transportation 30 One-Way Trips
Fitness Membership Unlimited Visits to Silver and Fit
Dental Benefits $2,000 Max
Vision Benefits $350 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible $435
Deductible Tiers NA
Tier 1: Preferred Generic Preferred Generic: 25%
Tier 2: Generic Generic: 25%
Tier 3: Preferred Brand Preferred Brand: 25%
Tier 4: Non-Preferred Drug Non-Preferred: 25%
Tier 5: Specialty Tier Specialty Tier: 25%
Tier 6: Select Care Drugs Select Care Drugs: 25%
Laboratory Services $0
X-Ray Services $0
Parent Organization: Pennsylvania Health and Wellness
76 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Parent Organization: Pennsylvania Health and Wellness
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette,
Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter,
Somerset, Venango, Warren, Washington, Westmoreland,
Bradford, Bucks, Centre, Chester, Cumberland, Dauphin, Delaware, Fulton,
Huntingdon, Juniata, Lackwanna, Lancaster, Lebanon, Lycoming, Mifflin, Montgomery, Perry, Philadelphia Berks, Snyder, Sullivan, Susquehanna, Tioga,
Union, Wayne, Wyoming
State/Plan/PBP PA-H2915-003-000 PA-H2915-006-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $6,700 $6,700
Inpatient Hospital - AcuteDays 1-6: $295 Copay per day Days 7-90: $0 Copay per day
Days 1-6: $295 Copay per day Days 7-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $40
Over-the-Counter Items $60 Quarterly $50 Quarterly
Medically Necessary Transportation 20 One-Way Trips 20 One-Way Trips
Fitness Membership Unlimited Visits to Silver and Fit Unlimited Visits to Silver and Fit
Dental Benefits $500 Max $500 Max
Vision Benefits $200 Max $250 Max
Hearing Benefits $0-$1,580 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $10 Generic: $10
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs $0 $0
Laboratory Services $0 $0-$20
X-Ray Services $0 $0-$40
77Agent Use Only. Proprietary and Confidential.
PENNSYLVANIA
NOTES: ___________________________________________________________________________________________________________
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78 Agent Use Only. Proprietary and Confidential.
SOUTH CAROLINA
1. Abbeville 2. Allendale 3. Anderson 4. Bamberg 5. Barnwell 6. Beaufort 7. Berkeley 8. Calhoun 9. Charleston 10. Cherokee
= DSNP AND MAPD
11. Chester 12. Chester�eld 13. Clarendon 14. Colleton 15. Dillon 16. Edge�eld 17. Fair�eld 18. Florence 19. Georgetown 20. Greenville
21. Greenwood 22. Hampton 23. Jasper 24. Kershaw 25. Laurens 26. Lee 27. Lexington 28. Marion 29. Marlboro 30. McCormick
31. Newberry 32. Oconee 33. Orangeburg 34. Pickens 35. Richland 36. Saluda 37. Spartanburg 38. Union 39. Williamsburg
372034
32
3 25
1
10
1138
31
21
3036
16
17 24
12 29
15
2635 18
28
27
8
33
5 4
2
2214
236
9
7
1339
19
*
*
*
*
79Agent Use Only. Proprietary and Confidential.
SOUTH CAROLINA
Market Highlights: • 4 New county expansions
• 4 New major hospitals acquired in-network
• Improved and expanded MAPD and D-SNP benefit offerings
RX Highlights: • $0 Co-pay for Tier 1 and Tier
6 Meds
• No Rx Deductible
Providers:• New Major Hospitals in
Market:
o Lexington Medical Center
o Spartanburg Regional Healthcare System
o McLeod Regional Medical Center
o Providence Health
2020 Product Highlight Overview
Allwell Healthcare Experience:Dental Coverage
· Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for fitness program
· 24 hour nurse advice line
· Chiropractic care (DSNP Only)
80 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
Counties
Abbeville, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Chester, Chesterfield, Cherokee, Clarendon, Colleton, Dillon, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Jasper, Kershaw, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda,
Spartanburg, Union, Williamsburg
State/Plan/PBP H1436-005-000
Premium Part B Giveback $0
Total Premium (Part C and D) $0
In-Network Plan Deductible No Deductible
Maximum Out of Pocket (MOOP) $6,700
Inpatient Hospital - Acute $0
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $325 Quarterly
Medically Necessary Transportation Not Covered
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $2,500
Vision Benefits $450 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible Medicaid RX Cost Sharing
Deductible Tiers Medicaid RX Cost Sharing
Tier 1: Preferred Generic Medicaid RX Cost Sharing
Tier 2: Generic Medicaid RX Cost Sharing
Tier 3: Preferred Brand Medicaid RX Cost Sharing
Tier 4: Non-Preferred Drug Medicaid RX Cost Sharing
Tier 5: Specialty Tier Medicaid RX Cost Sharing
Tier 6: Select Care Drugs Medicaid RX Cost Sharing
Laboratory Services $0
X-Ray Services $0
Parent Organization: Absolute Total Care
81Agent Use Only. Proprietary and Confidential.
SOUTH CAROLINA
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties
Abbeville, Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton,
Dillon, Edgefield, Florence, Georgetown, Greenwood, Hampton, Jasper, Laurens, Lee,
Marion, Marlboro, McCormick, Newberry, Orangeburg, Union, Williamsburg
Anderson, Greenville, Pickens, Spartanburg, Lexington, Oconee, Calhoun, Fairfield,
Kershaw, Richland, Saluda
State/Plan/PBP H1436-002-000 H1436-004-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $5,900 $4,900
Inpatient Hospital - AcuteDays 1-5: $360 Copay per day Days 6-90: $0 Copay per day
Days 1-5: $360 Copay per day Days 6-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $40 $40
Over-the-Counter Items $100 Quarterly $100 Quarterly
Medically Necessary Transportation (Ambulance covered) Not Covered
Fitness Membership Unlimited visits to Silver and Fit Unlimited visits to Silver and Fit
Dental Benefits $1,500 $1,500
Vision Benefits $200 $200
Hearing Benefits $0 - $1,580 (2 Aids) $0 - $1,580 (2 Aids)
Rx Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $12 Generic: $12
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand:$47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Absolute Total Care
82 Agent Use Only. Proprietary and Confidential.
TEXAS
1. Aransas 2. Bexar 3. Cameron 4. Collin 5. Comal 6. Dallas
= DSNP
= DSNP & MAPD
= New Counties
7. Denton 8. El Paso 9. Fort Bend 10. Guadalupe 11. Hidalgo 12. Jim Wells
*
*
13. Lubbock 14. Montgomery 15. Nueces 16. Rockwall 17. Starr
13
8
2510
19
18 6
47
16
1711
3
151
9
14
12
18. Tarrant 19. Wilson
*
*
*
*
83Agent Use Only. Proprietary and Confidential.
TEXAS
Market Highlights: • H5294-002: Strong benefit
design. Well known in the market. Very strong Medicaid presence. Unlimited transportation (Lyft)
• H5294-BB9: New to market. Superior has the Medicaid plan to support this
• H0062-001: Dental, vision, transportation, OTC all included at a $0 premium. Spec. copay $35
• H0062-002, 003: Dental, vision, OTC all included at a $0 premium. Spec. copay $30
• H0062-009: Preventive dental, vision, transportation, OTC all included at a $0 premium. Spec. copay $35
RX Highlights: • H0062-001, 002, 003, 009: No
deductible. $0 copay for Tier 6 drugs
• H5294 002, 003, 004, 007, BB9: LIS levels will determine copays
Providers:• H5294-002, H0062-003: Strong
provider network, all hospitals in network
• H5294-003, H0062-002: University, Methodist systems in network
• H5294-004,H0062-001: San Antonio network is strong, all hospitals are PAR. El Paso is growing, all hospitals PAR. Aransas, Comal & Jim Wells new counties for 2020
• H5294-BB9: New for 2020. University system is the network. Only the DSNP for 2020
2020 Product Highlight Overview
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
· Many plans offer additional comprehensive dental benefits for a low monthly premium
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Virtual Visits
· Teladoc offers 24 hours a day/ 7 days a week/ 365 days a year virtual visit access to board certified doctors to help address a wide variety of health concerns and questions
Prescription Drugs
· Many of our Allwell plans offer 0$ deductible and low copays for tier 1 and 2 drugs which are the most commonly used drug tiers
· Tier 6 Select Care Drugs at a $0 copay
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
· Chiropractic care
· Supplemental smoking and tobacco use cessations (counseling
to stop smoking or tobacco use)
84 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP DSNP DSNP
Counties Cameron, Hidalgo, StarrDallas, Tarrant, Denton, Collin,
Rockwall
Bexar, Guadalupe, Nueces, Wilson, Aransas, Comal, Jim
Wells, El Paso
State/Plan/PBP TX-H5294-002-002 TX-H5294-002-003 TX-H5294-002-004
Premium Part B Giveback $0 $0 $0
Total Premium (Part C and D) $0 $0 $0
In-Network Plan Deductible $0 $0 $0
Maximum Out of Pocket (MOOP) $6,700 $6,700 $6,700
Inpatient Hospital - Acute $0 $0 $0
PCP Office Visists $0 $0 $0
Specialist Office Visits $0 $0 $0
Over-the-Counter Items $325 Quarterly $250 Quarterly $325 Quarterly
Medically Necessary Transportation
Unlimited One-Way Trips 30 One-Way Trips Unlimited One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $3,000 Max $1,500 Max $,3000 Max
Vision Benefits $350 Max $100 Max $350 Max
Hearing Benefits $0 (2 Aids) $0 (2 Aids) $0 (2 Aids)
Rx Deductible $155 $155 $155
Deductible Tiers Tiers 2-5 Tiers 2-5 Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $19 Generic: $19 Generic: $19
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 30% Specialty Tier: 30% Specialty Tier: 30%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0 $0
X-Ray Services $0 $0 $0
Parent Organization: Superior Health Plan
85Agent Use Only. Proprietary and Confidential.
TEXAS
Medicare Product Highlights
Product Type (HMO, PPO, Etc) DSNP DSNP
Counties Fort Bend, Montgomery Lubbock
State/Plan/PBP TX-H5294-007-000 TX-H5294-BB9-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible $0 $0
Maximum Out of Pocket (MOOP) $6,700 $6,700
Inpatient Hospital - Acute $0 $0
PCP Office Visists $0 $0
Specialist Office Visits $0 $0
Over-the-Counter Items $250 Quarterly $100 Quarterly
Medically Necessary Transportation 30 One-Way Trips 20 One-Way Trips
Fitness Membership Unlimited visits to Silver &Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max $1,500 Max
Vision Benefits $150 Max $250 Max
Hearing Benefits $0 (2 Aids) $0 (2 Aids)
Rx Deductible $205 $215
Deductible Tiers Tiers 2-5 Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0 Preferred Generic: $0
Tier 2: Generic Generic: $19 Generic: $19
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 29% Specialty Tier: 29%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Superior Health Plan
86 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
CountiesBexar, Guadalupe, Wilson,Nueces, El Paso,
Aransas, Comal, Jim WellsCollin, Dallas, Denton, Rockwall, Tarrant
State/Plan/PBP TX-H0062-001 TX-H0062-002-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $3,900 $3,700
Inpatient Hospital - AcuteDays 1-7: $175 Copay per day Days 8-90: $0 Copay per day
Days 1-7: $250 Copay per day Days 8-90: $0 Copay per day
PCP Office Visists $0 $0
Specialist Office Visits $35 $30
Over-the-Counter Items $60 Quarterly $100 Quarterly
Medically Necessary Transportation 10 One-Way Trips Not Covered
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max $1,000 Max
Vision Benefits $150 Max $150 Max
Hearing Benefits $0-$1,350 (2 Aids) $0-$1,580 (2 Aids)
Rx Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $3 Preferred Generic: $0
Tier 2: Generic Generic: $12 Generic: $14
Tier 3: Preferred Brand Preferred Brand: $47 Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $95 Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Superior Health Plan
87Agent Use Only. Proprietary and Confidential.
TEXAS
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO HMO
Counties Cameron, Hidalgo, Starr Fort Bend, Montgomery
State/Plan/PBP TX-H0062-003-000 TX-H0062-009-000
Premium Part B Giveback $0 $0
Total Premium (Part C and D) $0 $0
In-Network Plan Deductible No Deductible No Deductible
Maximum Out of Pocket (MOOP) $3,600 $3,900
Inpatient Hospital - AcuteDays 1-8: $100 Copay per day Days 9-90: $0 Copay per day
Days 1-8: $150 Copay per day Days 9-90: $0 Copay per day
PCP Office Visists $0 $5
Specialist Office Visits $30 $35
Over-the-Counter Items $80 Quarterly $65 Quarterly
Medically Necessary Transportation 30 One-Way Trips 10 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit Unlimited visits to Silver & Fit
Dental Benefits $1,000 Max Preventive Only
Vision Benefits $100 Max $100 Max
Hearing Benefits $0-$1,350 (2 Aids) $0-$1,350 (2 Aids)
Rx Deductible No Deductible No Deductible
Deductible Tiers No Deductible No Deductible
Tier 1: Preferred Generic Preferred Generic: $2 Preferred Generic: $1
Tier 2: Generic Generic: $12 Generic: $8
Tier 3: Preferred Brand Preferred Brand: $40 Preferred Brand: $42
Tier 4: Non-Preferred Drug Non-Preferred: $95 Non-Preferred: $85
Tier 5: Specialty Tier Specialty Tier: 33% Specialty Tier: 33%
Tier 6: Select Care Drugs Select Care Drugs: $0 Select Care Drugs: $0
Laboratory Services $0 $0
X-Ray Services $0 $0
Parent Organization: Superior Health Plan
88 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
89Agent Use Only. Proprietary and Confidential.
TEXAS
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90 Agent Use Only. Proprietary and Confidential.
WISCONSIN
1. Adams 2. Brown 3. Calumet 4. Clark 5. Columbia 6. Dodge 7. Fond du Lac
= DSNP and HMO MA
8. Green Lake 9. Je�erson 10. Kenosha 11. Kewaunee 12. Langlade 13. Lincoln 14. Manitowoc
15. Marathon 16. Marinette 17. Marquette 18. Menominee 19. Milwaukee 20. Oconto 21. Outagamie
22. Ozaukee 23. Portage 24. Racine 25. Shawano 26. Sheboygan 27. Taylor 28. Walworth
29. Washington 30. Waukesha 31. Waupaca 32. Waushara 33. Winnebago 34. Wood
16
2713 12
201815
25
11221312334
4
1 32 32 3 14
267817
9
282410
5 6 29
3019
22
91Agent Use Only. Proprietary and Confidential.
WISCONSIN
Market Highlights: • Vision-Routine Covered
Services
• PERS- Personal Emergancy Response System
• Gym Membership-Silver and Fit
• OTC Benefits Available
• MA is a totallly new policy for Wisconsin
RX Highlights: • $0 Cost Share for Tier 1 and
Tier 6 Meds
Providers:Northern Counties (North of Milwaukee - Fond du Lac, Outagamie and Winnebago)• ThedaCare
• Agnesian Health Care
• Affinity Health System (Ascension)
North to Northeast (Brown, Manitowoc, Marinette and Oconto)• Aurora
• Bellin Health Care System
• Northshore Health Network
• Holy Family Medical Center
North Central (Marathon, Lincoln, Portage and Wood)• Aspirus
• Ministry Healthcare (Ascension)
Kenosha County• United Hospital Systems
(Froedtert South)
2020 Product Highlight Overview
Allwell Healthcare Experience:Dental Coverage
· Preventative Dental Services including oral exams, cleaning, and x-rays are offered at a $0 copay
Over-the-Counter
· Most plans offer quarterly or monthly allowances so that our members can get the additional medications and supplies they need via mail
Wellness Programs
· $0 copay for Fitness program
· 24 hour nurse advice line
• Kenosha Community Health Center
Milwaukee County • Aurora
• Froedtert
• Medical College of WI
• ProCare
• Isaac Coggs
• Sixteenth St. Clinic
• Ascenscion (Columbia St. Mary’s and Wheaton Franciscan)
Waukesha County • Aurora
• ProHealth Care
92 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) DSNP
Counties
Adams, Brown, Calumet, Clark, Columbia, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette,
Menominee, Milwaukee, Oconto, Oytagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waupaca, Waukesha, Waushara,
Winnebago, Wood
State/Plan/PBP WI-H8189-001
Premium Part B Giveback $0
Total Premium (Part C and D) $40.80
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $3,400
Inpatient Hospital - Acute $0
PCP Office Visists $0
Specialist Office Visits $0
Over-the-Counter Items $120 Monthly
Medically Necessary Transportation 48 One-Way Trips
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $2,400 Max
Vision Benefits $350 Max
Hearing Benefits $0 (2 Aids)
Rx Deductible $175
Deductible Tiers Tiers 2-5
Tier 1: Preferred Generic Preferred Generic: $0
Tier 2: Generic Generic: $20
Tier 3: Preferred Brand Preferred Brand: $47
Tier 4: Non-Preferred Drug Non-Preferred: $100
Tier 5: Specialty Tier Specialty Tier: 29%
Tier 6: Select Care Drugs Select Care Drugs: $0
Laboratory Services $0
X-Ray Services $0
Parent Organization: MHS Health Wisconsin
93Agent Use Only. Proprietary and Confidential.
WISCONSIN
Medicare Product Highlights 2020
Product Type (HMO, PPO, Etc) HMO
Counties
Adams, Brown, Calumet, Clark, Columbia, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, ManiItowoc, Marathon, Marinette, Marquette,
Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Taylor, Walworth, Washington, Waupaca, Waukesha, Waushara,
Winnebago, Wood
State/Plan/PBP WI-H8189-003
Premium Part B Giveback $0
Total Premium (Part C and D) $0
In-Network Plan Deductible $0
Maximum Out of Pocket (MOOP) $4,900
Inpatient Hospital - AcuteDays 1-5: $320 Copay per day Days 6-90: $0 Copay per day
PCP Office Visists $10
Specialist Office Visits $35
Over-the-Counter Items $30 Quarterly
Medically Necessary Transportation Not Covered
Fitness Membership Unlimited visits to Silver & Fit
Dental Benefits $2,400 Max
Vision Benefits $100 Max
Hearing Benefits Not Covered
Rx Deductible Not Covered
Deductible Tiers Not Covered
Tier 1: Preferred Generic Preferred Generic: Not Covered
Tier 2: Generic Generic: Not Covered
Tier 3: Preferred Brand Preferred Brand: Not Covered
Tier 4: Non-Preferred Drug Non-Preferred: Not Covered
Tier 5: Specialty Tier Specialty Tier: Not Covered
Tier 6: Select Care Drugs Select Care Drugs: Not Covered
Laboratory Services $0
X-Ray Services $0
Parent Organization: MHS Health Wisconsin
94 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
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95Agent Use Only. Proprietary and Confidential.
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WISCONSIN
96 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
VENDOR INFORMATION
101100 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS
Vendor Information
4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers
instead of vendor4 PBPs with coverage covered by DBP for Dental
5 Health plan covered by International Fitness for Fitness
6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit
card option through Walmart
State Health Plan CAM Dental Fitness Hearing MealsAdvice
LineOTC PERS Telehealth Vision Dental Dental
Contract Vendor gAcu. Chiro. Naturo.
AR H9630 4 4 4 4 47 4 4 4
AZ
H03514 4 4 41 41 4 41 4 4
H559042 41 41 4 4 42 4 42
H92874 4 4 4 4 4 4
FL
H5190 4 4 4 4 4 4
H9276 4 4 4 4 4 4
GA H7173 4 4 4 4 4 4
IL H1475 4 4 4 4 4 4 4
4
GA Foods
GA Foods
GA Foods
97Agent Use Only. Proprietary and Confidential. 101100 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS
Vendor Information
4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers
instead of vendor4 PBPs with coverage covered by DBP for Dental
5 Health plan covered by International Fitness for Fitness
6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit
card option through Walmart
State Health Plan CAM Dental Fitness Hearing MealsAdvice
LineOTC PERS Telehealth Vision Dental Dental
Contract Vendor gAcu. Chiro. Naturo.
AR H9630 4 4 4 4 47 4 4 4
AZ
H03514 4 4 41 41 4 41 4 4
H559042 41 41 4 4 42 4 42
H92874 4 4 4 4 4 4
FL
H5190 4 4 4 4 4 4
H9276 4 4 4 4 4 4
GA H7173 4 4 4 4 4 4
IL H1475 4 4 4 4 4 4 4
4
GA Foods
GA Foods
GA Foods
98 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
VENDOR INFORMATION
103102 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS
Vendor Information
4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers
instead of vendor4 PBPs with coverage covered by DBP for Dental
5 Health plan covered by International Fitness for Fitness
6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit
card option through Walmart
State Health Plan CAM Dental Fitness Hearing MealsAdvice
LineOTC PERS Telehealth Vision Dental Dental
Contract Vendor gAcu. Chiro. Naturo.
IN
H3499 4 4 4 42 4 4 4 41 4
H6348 4 4 4 4 4 4 4
KS H6550 4 4 4 4 4 4 42 4
LA H5117 4 4 4 4 4 4 4
MS H9811 4 4 42 4 4 42 4 4
MO H1664 4 4 4 4 4 4 42 4 4
NM H2134 42
OH
H0724 4 4 4 4 4 4
H0908 4 4 4 4 4 4 4 4
41
99Agent Use Only. Proprietary and Confidential. 103102 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS
Vendor Information
4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers
instead of vendor4 PBPs with coverage covered by DBP for Dental
5 Health plan covered by International Fitness for Fitness
6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit
card option through Walmart
State Health Plan CAM Dental Fitness Hearing MealsAdvice
LineOTC PERS Telehealth Vision Dental Dental
Contract Vendor gAcu. Chiro. Naturo.
IN
H3499 4 4 4 42 4 4 4 41 4
H6348 4 4 4 4 4 4 4
KS H6550 4 4 4 4 4 4 42 4
LA H5117 4 4 4 4 4 4 4
MS H9811 4 4 42 4 4 42 4 4
MO H1664 4 4 4 4 4 4 42 4 4
NM H2134 42
OH
H0724 4 4 4 4 4 4
H0908 4 4 4 4 4 4 4 4
41
100 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
VENDOR INFORMATION
105104 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS
Vendor Information
4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers
instead of vendor4 PBPs with coverage covered by DBP for Dental
5 Health plan covered by International Fitness for Fitness
6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit
card option through Walmart
State Health Plan CAM Dental Fitness Hearing MealsAdvice
LineOTC PERS Telehealth Vision Dental Dental
Contract Vendor gAcu. Chiro. Naturo.
PA H2915 4 4 4 42 4 4 4
SC H1436 4 4 4 4 4 42 4 4
TX
H0062 4 4 4 4 4 41 4 4
H5294 4 4 4 4 4 4 4
WI H8189 4 4 4 4 4 4 4
101Agent Use Only. Proprietary and Confidential. 105104 Agent Use Only. Proprietary and Confidential.Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview VENDOR INFORMATION2020 HIGHLIGHTS
Vendor Information
4 Benefit covered by featured vendor1 Some PBPs not covered2 Coverage provided only for select DSNPs3 Benefit provided by health plan network providers
instead of vendor4 PBPs with coverage covered by DBP for Dental
5 Health plan covered by International Fitness for Fitness
6 DSNP covered by GA Foods for meals7 Select PBPs in pilot with Speak Retail for OTC debit
card option through Walmart
State Health Plan CAM Dental Fitness Hearing MealsAdvice
LineOTC PERS Telehealth Vision Dental Dental
Contract Vendor gAcu. Chiro. Naturo.
PA H2915 4 4 4 42 4 4 4
SC H1436 4 4 4 4 4 42 4 4
TX
H0062 4 4 4 4 4 41 4 4
H5294 4 4 4 4 4 4 4
WI H8189 4 4 4 4 4 4 4
102 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
2020 AGENT/BROKER RESOURCES AGENT/BROKER SUPPORT Broker Services Member Services
Contact Information Phone:844-202-6811
Email:[email protected]
Phone:Refer to the health plan website
TTY users should dial 711
Hours of Operation October 15 – December 7:• 9:00 a.m. to 7:00 p.m.
Monday – Friday (excluding holidays)• 9:00 a.m. to 1:00 p.m.
Saturday
December 8 – October 14:• 9:00 a.m. to 5:00 p.m.
Monday – Friday (excluding holidays)
October 1 – March 31:• 8:00 a.m. to 8:00 p.m.
7 days a week (excluding certain holidays)
April 1 – September 30:• 8:00 a.m. to 8:00 p.m.
Monday – Friday• Automated phone system on
weekends and on federal holidays
Support Receive help with:
• Contracting & Commission Inquiries
• Member Eligibility Verification
• Verifying PCP/PPG Affiliation
• Ordering Sales Material
Receive help with:
• Claims questions
• Changing a provider
• Referrals
• Formulary questions
• Appeals and Grievances
103Agent Use Only. Proprietary and Confidential.
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104 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
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105Agent Use Only. Proprietary and Confidential.
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106 Agent Use Only. Proprietary and Confidential.
2020 Product Highlight Overview
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