2018 B ROKER R ECERTIFICATION T RAINING S OUTH F LORIDA Simply Healthcare Plans, Inc. is a Medicare-contracted coordinated care plan that has a Medicaid contract with the State of Florida Agency for Health Care Administration to provide benefits or arrange for benefits to be provided to enrollees. Enrollment in Simply Healthcare Plans, Inc. depends on contract renewal.
This presentation contains proprietary information. It is intended for recertification purposes only, use by our contracted brokers. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available to plan members. For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 2
Welcome Thank you for joining us today! We appreciate your support and partnership during 2017. Together, we were able to help thousands of Medicare beneficiaries in the communities we serve. Our promise to you for 2018: a) Robust value propositions b) Competitive compensation c) Ongoing training year round d) Local agent support 3 For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes.
For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 4
Agenda • Simply – Today • 2018 Service Area • Compliance • Sales Process • Customer Service – Important Phone Numbers • 2018 Benefits Review • Compensation Process For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 5
Simply Healthcare • A Florida health plan for Floridians. • We serve more than 621,000 Medicare and Medicaid recipients throughout Florida. • Our more than 1,200 local employees are your neighbors who know the community, physicians and hospitals. • As a Simply Healthcare Partner, your phone calls will always be answered locally by friendly, knowledgeable Simply representatives who treat you with the respect you deserve and provide you with the level of service you expect. • Simply Healthcare is a wholly owned subsidiary of Anthem, Inc. For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 6
Simply Healthcare Plans Star Rating Simply Healthcare Plans, Inc. - H5471 - 2017 Medicare Star Ratings* The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star Ratings help you know how good a job our plan is doing. You can use these Star Ratings to compare our plan's performance to other plans. For 2017, Simply Healthcare Plans, Inc. received the following Overall Star Rating from Medicare. 4.5 out of 5 Stars Learn more about our plan and how we are different from other plans at www.medicare.gov. You may also contact us Monday through Friday, 8:00 a.m. - 8:00 p.m. Eastern at 1-888-577-0212 (toll-free) or 711 (TTY). Current members please call 1-877-577-0115 (toll-free) or 711 (TTY). Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 7
For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 8
Product Portfolio Medicare Simply Medicaid Amerigroup Simply Better Health Long Term Care Florida Healthy Kids Clear Health Alliance For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 9
Counties we’re in… Santa Santa Holmes Holmes Jackson Jackson Rosa Rosa Nassau Nassau Walton Walton Gadsden Gadsden Leon Leon Madison Madison Bay Bay Duval Duval Baker Baker Liberty Liberty Wakulla Wakulla Taylor Taylor Clay Clay Gulf Gulf Union Union Franklin Franklin Bradford Bradford St. St. John’s John’s Alachua Alachua Putnam Putnam Dixie Dixie Flagler Flagler Levy Levy Marion Marion Volusia Volusia Lake Lake Hernando Citrus Citrus Seminole Seminole Seminole Pasco Hernando Hernando Orange Orange Orange Hillsborough Pasco Pasco Osceola Pinellas Polk Polk Indian Indian Polk River River Manatee Hardee Manatee Hardee St. St. Lucie Lucie Highlands Highlands DeSoto DeSoto Martin Martin 2017 Current Service Area Glades Glades Charlotte Charlotte Palm Palm Palm Beach Hendry Hendry Lee Lee Beach Beach 2018 Service Area Expansion Broward Broward Broward Collier Collier Miami-Dade For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 10
Compliance Oversight @ Simply • Complaint Tracking Module (CTM) • Rapid disenrollment & cancellations • Field Evaluations • Review Marketing Code of Ethics • CMS - Marketing Guidelines For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 11
For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 12
Violation Process – Review Agent Allegations can be received from two sources; Internal Complaints, which are received directly by the organization (SHP) o r CTM’s which are complaints received by CMS and then forwarded to the organization. • Agents will receive an email from the Compliance or Sales department letting them know an allegation of misconduct has been filed. • A detailed response is required from the agent generally within 5 days. Sometimes in elevated cases or immediate need cases the response may be required in as little at 24 hours. The agent responses need to be thorough and address all pertinent issues. • A detailed response consists of more than “I used the presentation book.” • The compliance team is your advocate – they pull verification calls, review SOA information, and your notes (when available). • To provide the detailed feedback compliance recommends an agent take notes at every appointment ; record them in your iPads or Prospect Manager. • Once a beneficiary has placed a complaint against an agent, that agent is not allowed to make contact with the beneficiary until the investigation is completed in its entirety and the case has been closed. If the contact is incoming (from beneficiary to the agent) the agent should attend and inform management immediately At some point almost every agent will have an allegation filed against them. That does not mean that the allegation of misconduct is true or false. The compliance team will investigate the allegation. The best case scenario is they will find it to be “unfounded.” They will need your help to do that. For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 13
Allegations of Misconduct - Possible Outcomes Unfounded – No wrongdoing verified, agent followed Marketing Guidelines. Inconclusive – Not enough evidence obtained to come to a determination. Depending on the situation, compliance and the sales department may determine that re-training or a corrective action should be implemented. This is done to ensure that any possibility of wrongdoing is corrected and or the proper procedures are re-enforced. Founded (lesser) – Agent is found to be responsible for a negligent violation. Usually the consequences of the agent’s misconduct are minor and little or no harm was caused to the beneficiary. A lesser founded CTM will usually result in some form(s) of corrective action to the agent or more stringent consequences like suspension or even termination. Founded (major) – Is a serious offense in where the agent is found to be responsible for willful violation of the Code of Ethics. In a Major Founded case the harm or potential harm to the beneficiary is elevated. In these situations the agent will most likely have his contract or employment terminated by the plan and the incident will be reported to the appropriate channels. * Deficiencies may be observed in all four of the possible outcomes. Although a case may be determined Unfounded there may be room for improvement in certain aspects of the agents performance. For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 14
Top CTM Allegations Marketing Enrolled in the wrong Plan Incorrect effective date Unaware of enrollment/ Not aware of HMO Requested not to submit app/Cancellation request Benefits/ Access Part D and Medical co-pays RX not covered/RX QL/ Prior Authorizations Dental Benefits Provider Network PCP and specialist non-par PCP accepts Medicaid LOB only Enrollment Ineligible for Plan (CSNP) Incorrect election For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 15
Use approved marketing materials – Double check the sales kit. It is the right thing to do, avoid CTMs! For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 16
Use approved marketing materials – Double check the sales kit. It is the right thing to do, avoid CTMs! For agent/broker use only. Not for distribution to the general public; nor for solicitation purposes. 17
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