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MEDICARE SUPPLEMENT PLANS 2004

MEDICARE SUPPLEMENT PLANS 2004. Presented By BLUE CROSS OF CALIFORNIA. Start. Back to Portfolio for Success . MARKET POTENTIAL. 2 Million people turn 65 each year in the U.S. = 166,667 each month, 5,574 each day 3.6 MILLION CALIFORNIA SENIORS

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MEDICARE SUPPLEMENT PLANS 2004

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  1. MEDICARE SUPPLEMENT PLANS 2004 Presented By BLUE CROSS OF CALIFORNIA Start Back to Portfolio for Success

  2. MARKET POTENTIAL • 2 Million people turn 65 each year in the U.S. = 166,667 each month, 5,574 each day • 3.6 MILLION CALIFORNIA SENIORS • Approximately 200,000 Californians become Medicare eligible each yr. = 16,000 each month * Based on 2000 U.S. census data.

  3. MEDICARE DEFINITIONS/ EXPLANATIONS • Benefit Period - Each new benefit period requires a new Part A (Hospital) deductible, but also restores the Hospital day 1 - 90 benefits, as well as the SNF day 1 -100 benefits. A new benefit period begins when the beneficiary has been out of the hospital or SNF for 60 days. • Lifetime Reserve Days - Hospital days 91 - 150 that do not renew each benefit period. Once exhausted, beneficiary responsible for all charges.

  4. MEDICARE DEFINITIONS/ EXPLANATIONS • Accept Assignment - term referring to doctors who accept the Medicare Approved Charges as full payment for services. • Excess Charges - Amount doctors are allowed to charge in excess of Medicare Approved Charges. Cannot exceed 15% of the Medicare Approved Charges. • Foreign Travel Benefit - $250 deductible, 80/20 coverage for medically necessary emergency care.

  5. MEDICARE DEFINITIONS/ EXPLANATIONS • At Home Recovery Benefit - Pays up to $1,600 per year for short-term, at home assistance with activities of daily living (ie. dressing and bathing) for those recovering from illness, injury or surgery • Preventive Care Benefit - Pays up to $120 per year for things like a physical exam, cholesterol screening, hearing test, etc.

  6. Hospitalization - First 60 days Days 61 - 90 Days 91 - 150* Days 151+ Skilled Nursing Facility - Days 0 - 20 Days 21 -100 Days 100+ *Lifetime Reserve Days Gaps $876 per Benefit Period $219 per Day $438 per Day No Coverage No Copayment (if Approved) $109.50 (if Approved) No Coverage TRADITIONAL MEDICAREGAPS IN COVERAGE - YR. 2004

  7. Physician Services Annual Deductible Medicare Approved Charges Excess Charges Blood First 3 pints Prescription Drugs Care Outside of US Gaps $100 20% Up to 15% of approved charges No Coverage No Coverage No Coverage* *Very Limited Coverage in Mexico and Canada TRADITIONAL MEDICARE GAPS IN COVERAGE

  8. Doctor Bill Medicare Approved Charges 15% Excess Charges Maximum Medicare Pays 80% of Approved Charges Member Pays 20% of Approved Charges Member Pays 100% of Excess Charges Doctor writes off amount above 115% of approved charges $2,000 $1,500 $1,725 (+15% of approved charges) $1,200 $300 $225 $275 UNDERSTANDING MEDICARE PAYMENTS

  9. BLUE CROSS OPTIONS • Medicare Supplement Plans • Standard Plan A • Select • Select Plus • Classic C • Classic F • Classic I • Classic J • SmartChoice • SmartChoice Plus • AdvantageCare NEW!

  10. BLUE CROSSClassic Plans

  11. BLUE CROSSClassic Plans

  12. BLUE CROSSClassic Plans

  13. BLUE CROSSClassic Plan Rates - area 1, 2, 3

  14. BLUE CROSSClassic Plan Rates - area 4, 5, 6

  15. BLUE CROSSStandard Plan A, Select Plans

  16. BLUE CROSSStandard Plan A, Select Plans

  17. BLUE CROSSStandard Plan A, Select Plans

  18. BLUE CROSSStandard Plan A, Select Plan Rates - Area 1, 2, 3

  19. BLUE CROSSStandard Plan A, Select Plan Rates - Area 4, 5, 6

  20. BLUE CROSSPre-65 Plan Rates

  21. Blue Cross Medicare Supplements • SELECT Plans • Medicare SELECT is a type of Medigap insurance policy which requires the member to utilize a contracted network of physicians or hospitals in order to receive full plan benefits. • ALL Blue Cross of California Medigap plans are SELECT plans with the exception of Standard Plan A

  22. Blue Cross Medicare SupplementsCommon Guarantee Issue Rules:

  23. Blue Cross Medicare Supplements • Enrollment Tips • The applicant MUST have BOTH Parts A & B of medicare - check their medicare card! • You must provide an Outline of Coverage and the Guide to Medicare at the point of sale • Applicant must complete the medical health questions, signature, and date THEMSELVES • All questions - including the question regarding Prescription drug usage - must be completed regardless of plan applied for or whether the member is in a guarantee issue period

  24. Blue Cross Medicare Supplements • Enrollment Tips • If the member is coming from a Senior HMO plan, they MUST disenroll prior to becoming effective on the supplement plan. If they fail to do so, any and all resulting claims will be the members responsibility! • Applications may be submitted up to 90 days prior to the requested effective date. • Applications must be RECEIVED in Senior Services by the last BUSINESS day of the month to receive a 1st of the following month effective date.

  25. Blue Cross Medicare Supplements • Enrollment Tips • Applications received after the 1st of the month and prior to the 15th of the month will receive a 15th of the month effective date - unless a specific effective date that falls AFTER the receipt date is specified. • Any effective date other than the 1st or 15th must be the result of loss of coverage and the applicant must provide proof in the form of a letter or phone number.

  26. Blue Cross Medicare Supplements • Changing Supplement Plans within Blue Cross • Blue Cross will not process any changes (including disenrollments) until the “paid-to-date”. • Be certain that the member receives the appropriate outline of coverage for the plan they are changing to. • Both downgrades and upgrades in coverage require a new application • Change from Frozen (inactive) to Active Plans ALWAYS requires underwriting.

  27. Blue Cross Medicare SupplementsUnderwriting Rules for Coverage Changes

  28. Blue Cross Medicare Supplements • Two party rates will only be accepted in the following situations: • Both individuals must be enrolled on the same plan. • The applicant is within their 6 month Medicare guaranteed enrollment period -- obtaining Part B coverage. • The applicant is terminating a group policy. • Both applicants pass medical underwriting.

  29. Blue Cross Medicare Supplements • Two party rates will only be accepted in the following situations: • If adding to an existing plan, the paid-to-date must coincide. If existing member paid-to-date is the following month, the enrolling member should pay one month as a single enrollee. The next month they may pay the 2 party rate. • Note: if the existing member has paid annually, it is possible to back out the premium to accommodate a 2 party rate - however, be aware that the premium will be reapplied at the current premium rate.

  30. Blue Cross Medicare Supplements • FREE Senior Passport Savings Program • Pharmacy Discount Program • Vision Care Discount Program • Medical Records Service • Hearing Care Discount Services • Travel & Car Rental Discounts • Lodging Discounts • Retirement Planning • Moving Services • Mail-Order Discounts

  31. Blue Cross Medicare Supplements • Free Senior Passport Savings Program • LifeResource Solutions • One-Stop resource for issues relating to Elder Care Services, Legal & Financial matters, and everyday life • Unified Health Care • Discount on medical equipment • HealthyExtensions Program • Programs and services designed to help you stay healthy New New New

  32. Blue Cross Medicare Supplements • Broker of Record • If an individual converts from a BCC individual plan to a Senior Plan directly through BCC, the Agent of Record on the individual plan will be loaded onto the system and receive 8% flat commission • Per agent agreement, Agents will not be reflected as the Broker of Record when replacing an existing BCC supplement or an existing policy. A 3 month lapse in coverage is required in order to be considered a ‘new policy’.

  33. Blue Cross Medicare Supplements • Agent Services Toll Free Line: • 1-888-209-7839 • Customer Service Toll Free Line: • 1-800-333-3883

  34. Blue CrossCross Selling Opportunities • Blue Cross Long Term Care Plans • Competitive Plans • Separate Agent Agreement required • LifeBenefits Whole Life Insurance • 85% first year, 5% renewal commissions • $3K - $25K Face Value • Simplified Underwriting • Dental SelectHMO • Available in select areas

  35. Retention Tools The impact of automatic bank draft: Members on Bank draft have a higher retention rate that non-bank draft members. Since the average Senior member stays with Blue Cross for 10 years, each additional year a members stays with Blue Cross would generate an additional $294.84 in annual commissions*. 3 additional years = $ 884.52 5 additional years = $1,474.20 7 additional years = $2,063.88 *This example is based on the sale of one F Plan to a 65 year old in Southern CA.

  36. Thank You Back to Portfolio for Success

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