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Blues Agent Portal Training

e-Learning on the BCBSM Agent Portal

Today’s information is also available online via a new effort by the

BCBSM Sales Force Development area. In the future look for

online e-Learning modules to become your first step when

learning about new things from the Blues.

To access:

• 1. Go to bcbsm.com

• 2. Sign on to the agent portal

• 3. Click on the Education tab and click on e-Learning

• 4. Click on Click Here to Access Online Training: 4Q12 Training:

Product Updates4Q12 Training and BCN HMO HSA

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Blues Agent Portal Training

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Workshop Objectives

• What:

o Review the updates to the BCBSM/BCN products.

• Why:

o Explain the advantages and benefits of these product

updates.

• How:

o Gain a practical understanding of how the process has

changed as a result of these updates.

5

4Q Product Menu Changes

• BCN HSA: – Identify individuals

eligible to participate in

HSA.

– Explain

advantages/benefits of

our HealthEquity

partner’s member and

group portals.

• Identify other BCN

menu changes.

6

• Explain the new

Simply Blue tiered

copay options.

• Explain removal of

sponsored plan

requirements.

• Identify changes to

Blue Vision.

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HSA Basics Review

Tax Benefits

– Contributions are tax free

– Dollars grow tax free

– Dollars spent on qualified medical expenses are tax free

HSA dollars can be used to pay for:

– Medical

– Pharmacy

– Dental

– Vision

– COBRA premiums

– Long term care premiums

– Medicare premiums

7

HSA Basics Review

What are the IRS guidelines for eligibility for an HSA?

• May not also be covered under any health plan that isn’t a

qualified HDHP.

• Must not be enrolled in Medicare.

• Must be covered under a qualified HDHP on the first day of

any month for which eligibility is claimed.

• May not be claimed as a dependent on another individual’s

tax return.

8

BCN HMO HSA Product Features

Available October 1, 2012

Objectives: – Retain and grow BCN membership

– Meet market expectations of employer groups and agents

– Remain competitive in the market

National HSA growth increased 14.3% from 2010 to 2011

BCN goal – 35000 members in 2 years

Target market: – Groups 2+

– Houghton & Marquette groups 50+

– Health-conscious buyer

– Cost-conscious buyer

9

BCN HMO HSA Product Features

• No monthly cost or set up fee.

• Low cost HMO option for employers

looking for a health savings account.

• Preventive services covered at 100%.

• Multiple high deductible and

coinsurance plan options.

• Includes integrated pharmacy benefit.

• Integrated, online health savings

account.

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BCN HMO HSA Products

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Individual / Family

Deductible

Coinsurance

After deductible

Prescriptions Drugs after

deductible

Out-of-Pocket Maximum

(include deductible)

$2000/$4000 0%

$10/$40/$80 $4000/$8000*

$2000/$4000 0%

$20/$60/50%

$80 min /$100 max $4000/$8000*

$3000/$6000 0% $10/$40/$80 $5000/$10000*

$3000/$6000 0%

$20/$60/50%

$80 min /$100 max

$5000/$10000*

$2000/$4000 20% $10/$40/$80 $4000/$8000

$2000/$4000 20%

$20/$60/50%

$80 min /$100 max $4000/$8000

$3000/$6000 20% $10/$40/$80 $5000/$10000

$3000/$6000 20%

$20/$60/50%

$80 min /$100 max $5000/$10000

$1250/$2500 20%

$15/$50/50%(

$70/$100 $2250/$4500

$1250/$2500 20% 20% coin after ded $2250/$4500

$2000/$4000 20% 20% coin after ded $4000/$8000

$3000/$6000 20% 20% coin after ded $5000/$10000

*Once deductible is met only drug copayments apply to out-of-pocket maximum

BCN HMO HSA Product Features • 3-8% reduction in premium over comparable BCN plan

– Aggregate deductible vs. Embedded deductible

– Pharmacy applies toward deductible

– Consumerism behavior

• Products not available with HSA:

– HBL/HBLR

– Blue Elect Plus

– Medicare products

– Individual products

• The HSA cannot be wrapped

• Non-Medicare retirees are eligible

• COBRA enrollees are eligible 12

BCN HMO HSA Product Features • Product based on new High Deductible Health Plan (HDHP)

certificate

• HDHP will have an aggregate and integrated deductible

– Aggregate

• Family contract deductible must be met prior to medical and/or pharmacy

coverage. Collective family deductible – benefits are payable once the entire family

deductible is met by one or more family members

– Integrated

• Deductible accumulates all medical and pharmacy costs

• Plan cannot pay capitation for PCP and other captiated services

• Product is based on calendar year

• No 4th quarter carryover

• PDC

– From qualified HSA plan only

– Credit deductible back to January

• No deductible carryover from a BCN deductible product

13

BCN HMO HSA Targets

• Groups currently purchasing a low premium, high deductible

plan looking for an opportunity to allow employees to enjoy

lower out-of-pocket costs by allowing deductible expense to

flow through HSA accounts using pre-tax dollars.

• Groups interested in a healthier work force encouraging

healthy lifestyles through consumerism and the opportunity for

HSA account growth for future medical expense planning.

• High earning professional groups that are looking for the

advantages of tax free savings.

14

BCN HSA Partner – HealthEquity

• BCN will partner with leading CDH vendor: HealthEquity Web link from MiBCN.com member site to HealthEquity

– Single sign-on available in 2013

– Debit card

– Dual logo – BCN and HealthEquity

• HealthEquity provides 24/7 customer service.

• Customized phone number for BCN members:

1-877-219-4506

• Online statements with current account balance.

• Personalized group enrollment.

• HealthEquity member and group portals.

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Member Home Page

16

My Account

17

My Account

18

My Money

19

My Money

20

My Money

21

My Money

22

My Money

23

My Money

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My Toolkit

25

My Profile

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Employer Portal Home Page

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Employer Information

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Insurance Information

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Manage Money

30

Manage Money

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32

Manage Money

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Company Detail

• Employee Account Summary – Summary of data displayed

on home page of employer portal.

• Contributions (Tax Year) – Contribution summary report by

member for the tax year.

• Contributions (Calendar Year) – Contribution summary report

by member for the calendar year.

• Potential Over Contributions – Report of any member that

may be in a potential over contribution status.

34

Available HSA Reports

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Resources

BCN HSA/HealthEquity Facts

• BCN will not need Notice of New CDH Business.

• BCN created a new certificate for the HDHP.

• Forms & Docs page will be available on the HealthEquity portal.

• Member experience with HealthEquity is the same across the

enterprise.

• HealthEquity website will be customized for BCN.

• HealthEquity will not be used for BCN HRA.

BCN HSA/HealthEquity Facts

• BCN has one file for group and member information.

• BCN configuration supports standard HealthEquity

interface requirements.

• BCN will use standard HealthEquity documents.

• Member welcome kit contains:

• Debit card

• Debit card mailer

• Tri-fold welcome letter

BCN HSA/HealthEquity Facts • Lead Time – 45 days

• BCN Coverage Agreement

– Parts A, B and C for New Business

– Part C for Group Wide Change

• Group Set-Up

– Two classes will be established

• HDHP with HSA

• HDHP only

• Enrollment Data

– Enrollment/Change of Status Form

• Indicator to be checked if contract enrolls in HSA

– eMCS

• Provide indicator to be checked if contract enrolls in HSA

– Electronic Enrollment

• Group will provide enrollment by class using Facets set-up 38

• All documents required to enroll a group are located on the

secure agent portal.

• CDH Administration, after receiving the Notice of New Business

Form, assigns an analyst to support implementation activities.

• All communications or questions related to implementation can

be directed to CDH Administration.

39

BCBSM CDH Implementation Guide

BCN $4,000 Deductible Plan with 0% Coinsurance

• On the 2+ portfolio, but is also available to groups 50+.

BCN Drug Plans

• New $10/$40/$80 plan added to the menu.

Removal of Two BCN’s HRA Options

• Removal of HRA options for the $5000 and $7500 deductibles options,

with 20% coinsurance and 30% coinsurance.

40

BCN Product Updates

3-Jul-12 41

New Group 2+ (Page 1)

3-Jul-12 42


3-Jul-12 43


44


3-Jul-12 45


46

ECOS (Page 1)

3-Jul-12 47

ECOS (Page 3)

Removal of Sponsored Plan

Requirements- BCBSM and BCN

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• Effective 10/1/12, groups will no longer be required to be sponsored

through a chamber or association in order to have access to all of

our small group products.

• Groups may still be sponsored, but are not required to be.

• Applies to all medical, dental and vision plans.

Simply Blue tiered copay riders are a new option for Simply Blue

that offers different levels of copayments for primary care office

visits, specialist visits, urgent care visits, and emergency room

visits. Tiered copays encourage appropriate use of each of these

services to avoid unnecessary expenses.

49

Simply Blue Tiered Copay Options

Target Market

• Businesses that are cost-conscious buyers, needing affordable,

yet comprehensive coverage.

• Simply Blue groups who want to further lower their premiums.

• Groups that have been dropping employer-sponsored health care

coverage opting for individual coverage.

• Groups in Community BlueSM and Flexible BlueSM plans seeking

to lower costs.

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Scenario

• The customer is a Benefits Manager for a BCBSM group of 62

employees. The group just received a BCBSM 10/1/12 renewal-

13% increase over last year’s rate.

• Last year the group saved money by moving from Community

Blue 4 to Simply Blue 500. They made that change because they

did not want to raise employee deductibles or change their

prescription benefits. They felt that those two plan components

were the most visible to employees and would have been met

with the most resistance.

• Although employees have since become accustomed to the

difference in medical benefits between Community Blue and

Simply Blue, the group is hesitant to make a big benefit change

again this year.

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• Delivers ambulatory care.

• Is offered outside of hospital emergency rooms.

• Is offered on a walk-in basis without a scheduled appointment.

• Offers evaluation and treatment for a sudden illness or injury that needs immediate medical attention, but is not an emergency.

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What Is Urgent Care?

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Cost Savings

Current

Standard Tiered Copay Optional Rider 1 Tiered Copay Optional Rider 2

OV ER OV Spec UC ER OV Spec UC ER

SB 250 20 150 20 40 60 150 40 60 60 250

SB 500 20 150 20 40 60 150 40 60 60 250

SB 1000 30 150 30 50 60 150 40 60 60 250

SB1500 30 150 30 50 60 150 40 60 60 250

SB 2500 30 150 30 50 60 150 40 60 60 250

SB 4000 30 150 30 50 60 150 40 60 60 250

SB HRA 1000 30 150 30 50 60 150 40 60 60 250

SB HRA 1500 30 150 30 50 60 150 40 60 60 250

SB HRA 2500 30 150 30 50 60 150 40 60 60 250

SB HRA 4000 30 150 30 50 60 150 40 60 60 250

Cost difference vs

standard

SB 250 -1.1% -4.5%

SB 500 -1.2% -4.9%

SB 1000 -1.4% -4.2%

SB1500 -1.5% -4.6%

SB 2500 -1.8% -5.4%

SB 4000 -2.2% -6.8%

SB HRA 1000 -1.2% -3.8%

SB HRA 1500 -1.3% -4.0%

SB HRA 2500 -1.5% -4.7%

SB HRA 4000 -1.8% -5.6%

Average -1.5% -4.9%

Revised Simply Blue Fact Sheets

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55


Dental Claim Comparison

PPO dentist Blue Par Select

dentist

Non-participating

dentist

Dentist’s fee $1,200 $1,200 $1,200

We approve $650 $650 $650

We pay $325 $325 $325

Member copay $325 $325 $325

Member total out-

of-pocket cost $325 $575 $875

Comments Dentist accepts our PPO fee

as full payment for covered

services. Member has 50%

copayment, so member

owes $325.

Dentist accepts our Blue Par

Select fee as full payment

for covered services.

Because plan payment is

based on the PPO fee,

member owes difference

between PPO fee and Blue

Par Select fee—$250—

along with a 50% copayment

of $325.

Dentist doesn’t accept our

fee as payment in full.

Member is responsible for

difference between plan

payment and dentist’s fee—

$550—along with a 50%

copayment of $325.

58

Scenario

61

Blue Vision Expanded VSP Network

Go where you want. When you want.

Summary

What:

• Review the updates to the BCBSM/BCN products.

Why:

• Explain the advantages and benefits of these product updates.

How:

• Gain a practical understanding of how the process has changed

as a result of these updates.

62 62

Fourth Quarter 2012

Rate Exhibits

63 63

Small Group Rate Changes

Area 1 2 3 4 5 6 7 8 9 All

LOB Southeast Lansing KalamazooGrand

RapidsSaginaw Flint

Traverse

City

Upper

PeninsulaSouthwest Statewide

Medical 8.9% 7.5% 6.5% 9.6% 6.9% 8.9% 13.0% 17.2% 4.5% 9.0%

Drug 13.7% 16.2% 16.9% 11.6% 14.4% 9.6% 8.9% -8.0% 12.9% 12.2%

Dental 2.8% 1.8% 2.8% 1.6% 3.3% 3.8% 1.5% 2.4% 2.2% 2.5%

Vision 7.6% 8.3% 8.2% 8.4% 7.6% 9.9% 9.0% 8.2% 5.4% 8.0%

Total 9.6% 8.8% 8.2% 9.8% 8.1% 8.8% 11.9% 12.2% 5.7% 9.4%

Area 1 2 3 4 5 6 7 8 9 All


RapidsSaginaw Flint

Traverse

City

Upper


Medical 5.8% 1.1% 0.4% 5.3% 3.8% 5.9% 14.5% 12.7% 5.6% 5.7%

Drug 21.1% 20.0% 23.6% 18.6% 15.9% 15.0% 19.4% 2.6% 20.2% 18.9%

Dental 5.0% 4.6% 4.8% 2.8% 3.0% 4.5% 3.4% 3.8% -1.7% 4.1%

Vision 8.3% 7.1% 7.7% 10.2% 8.1% 12.3% 10.6% 7.8% 4.5% 8.7%

Total 8.0% 4.0% 3.3% 7.0% 5.5% 7.1% 14.7% 11.1% 7.0% 7.5%

Area 1 2 3 4 5 6 7 8 9 All


RapidsSaginaw Flint

Traverse

City

Upper


Medical 8.3% 6.7% 5.9% 8.8% 6.5% 8.4% 13.1% 16.5% 4.6% 8.4%

Drug 14.7% 16.6% 17.5% 12.5% 14.5% 10.2% 9.9% -6.8% 13.6% 13.0%

Dental 3.1% 2.0% 3.0% 1.9% 3.2% 4.0% 1.8% 2.4% 2.0% 2.7%

Vision 7.7% 8.0% 8.1% 8.8% 7.7% 10.5% 9.2% 8.1% 5.3% 8.1%

Total 9.3% 8.2% 7.7% 9.3% 7.8% 8.6% 12.2% 12.0% 5.8% 9.1%

Reform

Non Reform

Total Small Group

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Historical Rate Changes by Area Reform and Non-Reform

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Rate Change History Reform Groups

0%

2%

4%

6%

8%

10%

12%

14%

2006 2007 2008 2009 2010 2011 2012

Rate

In

cre

ase

Year

Rate Change HistoryReform Groups

First Quarter Second Quarter Third Quarter Fourth Quarter

66

Rate Change History Non-Reform Groups

0%

5%

10%

15%

20%

25%

2006 2007 2008 2009 2010 2011 2012

Rate

In

cre

ase

Year

Rate Change HistoryNon Reform Groups

First Quarter Second Quarter Third Quarter Fourth Quarter

67

BCN Rate Changes

68

BCN Historical Rate Changes

69

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