Texas DSNP Market Overview - The Brokerage · OTC Product Credits Member-facing catalog:...

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Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx usage based on 2016 year to date claims data. Texas Dual Special Needs Plans 2017 Service Area Texas DSNP Market Overview Current Footprint Expansion Highlights 8 expansion counties added Benefit improvements in all markets New plan in the Rio Grande Valley Local agency support available Market Landscape Estimated Dual Eligibles 673,876 Total Dual Enrollees 125,698 Estimated FFS Eligibles 548,178 Eligibles in Expansion Area 79,769

Transcript of Texas DSNP Market Overview - The Brokerage · OTC Product Credits Member-facing catalog:...

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

TexasDual Special Needs Plans 2017 Service Area

Texas DSNP Market Overview

Current Footprint

Expansion

Highlights• 8 expansion counties added

• Benefit improvements in all markets

• New plan in the Rio Grande Valley

• Local agency support available

Market Landscape

Estimated Dual Eligibles 673,876

Total Dual Enrollees 125,698

Estimated FFS Eligibles 548,178

Eligibles in Expansion Area 79,769

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4514-001

Plan Type HMO

Service AreaBastrop, Brazoria, Burnet, Caldwell, Fort Bend, Galveston, Harris, Hays, Henderson, Jefferson, Liberty, Montgomery, Polk,

Smith, Travis, Van Zandt, Waller, Williamson and Wood.

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $200/quarter $800/year; annual expiration

Dental $2,500 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 24 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H2228-041

Plan Type HMO

Service Area El Paso

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $250/quarter $1,000/year; annual expiration

Dental $2,500 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 36 one-way rides for health care visits and prescription needs

Fitness Enrollment in the SilverSneakers fitness program

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4527-003

Plan Type HMO

Service Area Hays, Travis, Williamson

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $110/quarter $440/year; annual expiration

Dental $1,000 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $150 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 60 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4527-004

Plan Type HMO

Service Area Aransas, Kleberg, Nueces, San Patricio

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $55/quarter $220/year; annual expiration

Dental Preventive dental coverage

Vision Annual exam and $300 credit every year for eyewear

Transportation 60 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4527-006

Plan Type HMO

Service Area El Paso

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $80/quarter $320/year; annual expiration

Dental Preventive dental coverage

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $300 credit every two years for hearing devices

Transportation 30 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4527-015

Plan Type HMO

Service Area Cameron, Hidalgo, Willacy

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $100/quarter $440/year; annual expiration

Dental $1,000 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $225 credit every year for eyewear

Hearing Annual exam and $300 credit every two years for hearing devices

Transportation 60 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4590-020

Plan Type HMO

Service Area Collin, Dallas, Denton, Ellis, Johnson, Kaufman, Rockwall, Tarrant

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $175/quarter $700/year; annual expiration

Dental $2,000 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 24 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4590-022

Plan Type HMO

Service Area Atascosa, Bexar, Comal, Guadalupe, Kendall, Wilson

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $95/quarter $380/year; annual expiration

Dental $2,000 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $70 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 24 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H4590-033

Plan Type HMO

Service Area Bee, Jim Wells, Kleberg, Nueces, San Patricio

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $150/quarter $600/year; annual expiration

Dental $2,000 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 24 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H5322-026

Plan Type HMO

Service Area Cameron, Hidalgo, Willacy

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $75/quarter $300/year; annual expiration

Dental $2,000 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 36 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017

Plan designs and service areas described in this document are pending government approval and are subject to change. Benefits reflect pending in-network cost sharing. Other

limitations and exclusions may apply. Star ratings are current as of July 2016 and are subject to change in October. Confidential property of UnitedHealth Group. For Agent use only.

Not intended for use as marketing material for the general public. Do not distribute, reproduce, edit or delete any portion without the express permission of UnitedHealth Group. Rx

usage based on 2016 year to date claims data.

Texas DSNP Benefit Overview

Dual Complete Plans H5322-025

Plan Type HMO

Service Area Hardin, Harrison, McLennan, Orange, Rusk

Premium $0

Additional Benefits

OTC Product Credits Member-facing catalog: $75/quarter $300/year; annual expiration

Dental $1,250 annually; covers exams, x-rays, cleanings, extractions, periodontal services and more

Vision Annual exam and $200 credit every year for eyewear

Hearing Annual exam and $2,000 credit every two years for hearing devices

Transportation 24 one-way rides for health care visits and prescription needs

NurseLine Available 24 hours a day/7 days a week

Improved for 2017 No changes for 2017Degraded for 2017