TX HealthSpring Medicare Program Training January 1, 2014—Go Live

1. TX HealthSpring MedicareProgram TrainingJanuary 1, 2014—Go Live

2. Agenda • Overview of Plans • Medicare Plans & Benefits • Member ID Cards • Complaints and Appeals • Questions

3. Overview of Plans – High Level • Cigna-HealthSpring offers 13 Medicare Advantage dental plans that have been filed as part of their Texas market with CMS. HealthSpring categorizes the plans by Contract ID. • All Medicare plans are effective 1/1/2014 • All Medicare plans operate on a calendar year • January 2014 – December 2014 • Some of the Medicare plans have out-of-network benefits • Some of the Medicare plans have co-insurance • None of the Medicare plans require authorization or UM review

4. Overview of PlansWhat types of dental plans are offered? • HealthSpring’s Medicare Advantage dental plans are similar to commercial insurance plans. There are 4 different benefit sets that members can choose to buy based on where they live: • Preventive Plan • Preventive + Out-of-Network Plan • Preventive & Comprehensive Plan • Preventive & Comprehensive Optional Supplemental Plan

5. Overview of Plans • The plans with the same benefits are rolled up into the same exhibits in the ORM. The subgroup names are listed below by plan category: • Preventive Plans • TX HS Preferred Advantage Medicare • TX HS Preferred AR Medicare • Preventive + Out-of-Network Plan • TX HS Preferred Advantage Medicare (50% Co-Ins) • Preventive & Comprehensive Plan • TX HS Preferred TotalCare Medicare • Preventive & Comprehensive Optional Supplemental Plans • TX HS Preferred TX/AR Medicare (Opt Supp) • HS Preferred AR Medicare (Opt Supp)

6. Preventive PlanDentaQuest Subgroups: TX HS Preferred Advantage Medicare, TX HS Preferred AR Medicare Covered Plans and Counties: • H4528-001 Cigna-HealthSpring Preferred (HMO) Service Area: Bexar, Collin, Dallas, Denton, Ellis, El Paso, Hood, Johnson, Parker, Rockwall, Tarrrant, Wise, TX • H2165-018 Cigna-HealthSpring Preferred (HMO) Service Area: Cherokee, Grayson, Gregg, Hale, Henderson, Hockley, Lubbock, Rains, Rusk, Smith, Upshur, Van Zandt, Wood, TX • H4513-009 Cigna-HealthSpring Advantage (HMO) Service Area: Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston*, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller, Willacy, Webb, TX • H4528-016 Cigna-HealthSpring Advantage (HMO) Service Area: Bexar, Collin, Dallas, Denton, Ellis, El Paso, Hood, Johnson, Parker, Rockwall, Tarrrant, Wise, TX • H6972-001 Cigna-HealthSpring Preferred (HMO) Service Area: Yell, Sebastian, Scott, Pope, Logan, Johnson, Franklin, Crawford, Conway, AR

7. Preventive Benefits

8. Preventive + OON Benefits PlanDentaQuest Subgroup: TX HS Preferred Advantage Medicare (50% Co-Ins) Covered Plans and Counties: • H7787-001 Cigna-HealthSpring Preferred (PPO) Service Area: Cherokee, Collin, Dallas, Denton, Grayson, Gregg, Hale, Henderson, Hockley, Johnson, Kaufman, Lubbock, Rockwall, Smith, Tarrant, Rains, Rusk, Upshur, Van Zandt, Wood • H7787-002 Cigna-HealthSpring Advantage (PPO) Service Area: Cherokee, Collin, Dallas, Denton, Grayson, Gregg, Hale, Henderson, Hockley, Johnson, Kaufman, Lubbock, Rockwall, Smith, Tarrant, Rains, Rusk, Upshur, Van Zandt, Wood

9. Preventive + OON Benefits • Members have the option of going Out-of-Network to receive the preventive services on this plan. If members receive services from a non-participating (Out-of-Network) dentist they will be responsible for 50% of the dentist’s charges for services (50% co-insurance).

10. Preventive & Comprehensive PlanDentaQuest Subgroup: TX HS Preferred TotalCare Medicare Covered Plan and Counties: • H4513-001 Cigna-HealthSpring Preferred (HMO) Service Area: Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston*, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller, Willacy, Webb • H4513-010 Cigna-HealthSpring TotalCare (HMO SNP) Service Area: Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston*, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller, Willacy, Webb • H4528-002 Cigna-HealthSpring TotalCare (HMO SNP) Service Area: Bexar, Collin, Dallas, Denton, Ellis, El Paso, Hood, Johnson, Parker, Rockwall, Tarrrant, Wise • H2165-019 Cigna-HealthSpring TotalCare (HMO SNP) Service Area: Cherokee, Grayson, Gregg, Hale, Henderson, Hockley, Lubbock, Rains, Rusk, Smith, Upshur, Van Zandt, Wood

11. Preventive & Comprehensive Plan Benefits • Members are entitled to the covered preventive benefits above, plus a Calendar Year Maximum of $1,000 towards comprehensive services including: • Restorative care • Periodontics • Prosthodontics • Oral surgery • Diagnostic and preventive services above do not count towards annual coverage limit. • Full list of covered codes can be found in the ORM.

12. Optional Supplemental Benefits Plan: Preventive & ComprehensiveDentaQuest Subgroups: TX HS Preferred TX/AR Medicare (Opt Supp), TX HS Preferred AR Medicare (Opt Supp) Covered Plan and Counties: • H2676-001 Cigna-HealthSpring Preferred (PPO) Service Area: Bowie, Cass, Titus, TX and Miller, AR • H4871-001 Cigna-HealthSpring Preferred (PPO) Service Area: Howard, AR

13. Optional Supplemental Benefits • Members can decide to opt up to an enhanced dental benefit package at any time during the year. • Members are entitled to the covered preventive benefits above, plus a Calendar Year Maximum of $800 towards comprehensive services including: • Restorative care • Periodontics • Prosthodontics • Oral surgery

14. Optional Supplemental Benefits Continued… • Diagnostic and preventive services above do not count towards annual coverage limit. • Full list of covered codes can be found in the ORM. • Members have the option of going Out-of-Network to receive services on these plans. If members receive services from a non-participating (Out-of-Network) dentist they will be responsible for 50% of the dentist’s charges for services (50% co-insurance). • Both in and out-of-network services apply to the annual maximum of $800.

15. ID Cards & Welcome Letters • The DentaQuest ID card will be printed at the bottom of the Member Welcome Letter. • The ID card will include the HealthSpring product name & the DentaQuest subgroup name. The purpose of this is to ensure that all parties know the name of the plans (member, provider, DQ staff, HS staff). • Example: • HealthSpring product name: H2165019 - Cigna-HealthSpring TotalCare (HMO SNP) • DentaQuest subgroup name: TX HealthSpring Preferred TotalCare Medicare • If a member has been active < 89 days they are considered “reinstated”. Reinstated members will only receive a new ID card/welcome letter. • If lapse in coverage is > 90 days, they are treated as new members. New members receive an ID card/welcome letter, member handbook & EOC document.

16. Sample ID Cards

17. DentaQuest is Primary for Member Services DentaQuest HealthSpring Medicare Member Services 855-343-7341 For reference: HealthSpring Medicare Member Services 866-288-1573 DentaQuest is Primary for Provider Services 888-308-9345 (Dedicated TX MCO Line) Member/Provider Services

18. DentaQuest will not handle HealthSpring Medicare member complaints. HealthSpring members should contact HealthSpring member services to file a complaint. DentaQuest will not handle HealthSpring Medicare member appeals. HealthSpring members should contact HealthSpring member services to file an appeal. Member Complaints & Appeals

19. Provider Complaints & Appeals • DentaQuest will handle HealthSpring Medicare provider complaints and appeals. • Providers should follow the standard TX process to file complaints or appeals with DentaQuest.

20. Questions?