Coventry Health Care of Texas Medicare Advantage (MA) Coordinated Care Plans (CCP) 2014

1. Broker/Agent Product Training Coventry Health Care of Texas Medicare Advantage (MA) Coordinated Care Plans (CCP) 2014

2. Before we begin… Reminders: • Silence Your Phone • Handling Questions • Complete all 2014 Requirements PRIOR to Selling

3. Agenda • Service Area • Value Proposition • Ready to Sell • Product • Servicing Your Clients • Compliance • Additional Resources

5. Provider Network Highlights Coventry Health Care of Texas Houston Metro • Memorial Hermann System • Methodist System • Christus St. John Hospital • Cypress Fairbanks Medical Center • Houston Northwest Medical Center • Park Plaza Hospital San Antonio Metro • Baptist Health Systems • Medina Community Hospital Beaumont Metro • Christus Dubois Hospital • Christus St. Elizabeth Hospital • Christus St. Mary Hospital • The Medical Center of SE Texas • El Paso Metro • Providence Memorial • Sierra Medical Center • Sierra Providence East • University Medical Center • Texarkana • Christus St. Michael • Wadley Regional • Corpus Christi • ChristusSpohn Hospitals • Weatherford • Weatherford Regional Hospital

6. Value Proposition Coventry Health Care of Texas • Local presence and understanding • National experience and infrastructure • Products that are relevant and valuable to the beneficiary • High quality network • History of provider collaboration • Patient-centered care model & case management • Local Texas team for both members and agents/brokers

7. What’s New for 2014 • $0 PCP Co-Pay • $0 Co-Pay for Tier 1 Prescriptions • HMO product in 10 counties • Gap coverage Tiers 1 & 2 {HMO Only} • Co-Branding with Baptist Hospital Systems in San Antonio • Expanded networks in many markets

8. How to Be ‘Ready to Sell’ for 2014 • Complete the online AHIP/Coventry training and testing at www.coventry-medicare.com • Complete local health plan product training and testing for all service areas you plan to sell in • Contact your up-line, BSD, or local health plan to ensure you are properly contracted and certified for the service area you intend to represent • New Brokers must complete your online Coventry “Contract Package” • Must have State Appointment – in each state where you are licensed and the state(s) where a prospective member resides. • Receive “Ready to Sell” notification from Coventry and your Agent Writing Number (AWN) ID Card for 2014. (Via Email) • Must have up to date Errors & Omissions coverage on file • Contact the Broker Service Department (BSD) if you have not received your AWN ID Card (E-Mail) before you intend to present Coventry to a prospective member If you sell Coventry Products without completing the steps above you WILL NOT receive commission payments and you will be non-compliant.

9. Local Health Plan Training & Testing • A local health plan test must be successfully completed • 20 multiple choice questions • Must achieve a 90% or better • Can complete the test online, by email, face to face or fax • If by email check your spam folder! • Tests that are not taken online can be turned in to your local Medicare sales team or faxed to the test center via toll-free number • Completed test will be kept for 10 years by Coventry

10. 2014 Product Information

11. Product Strengths • True balanced product portfolio with $0 premium HMO and PPO plans offered • Access to a very broad network of quality hospitals and physicians for 2014. • Get the best value for your health care dollar with premium stability- we have offered $0 PPO plans for several years • Full access to any Health Club facility in the network with no co-payments for club membership • Prescription drug coverage is included on all plans

12. Comparison Grid • Your Coventry Product Sales Tool! • Let’s take a tour of the Comparison Grid

13. Prescription Drug Coverage Note- LIS members will pay the lessor of the plan member cost share or their CMS defined LIS copayments

14. 2014 Pharmacy Benefits ComparisonOutpatient Rx Cost-Sharing Information Preferred Pharmacies Non-preferred Pharmacies Network Tier 1: $0 copay Tier 2: $3 copay Tier 3: $35 copay Tier 4: $70 copay Tier 5: 33% Tier 1: $3 copay Tier 2: $10 copay Tier 3: $45 copay Tier 4: $95 copay Tier 5: 33% 30-Day Supply at Network Pharmacy Note- LIS members will pay the lessor of the plan member cost share or their CMS defined LIS copayments

15. Coventry Preferred Pharmacies! More ways for your clients to save money with Coventry! A “Preferred Pharmacy” is one that’s within our overall pharmacy network where we’ve negotiated lower cost-sharing levels (pricing) for Coventry members. Prescriptions can still be filled at any network pharmacy, but your clients can save even more money by using a preferred pharmacy. Any pharmacy in our network not listed here as a Preferred Pharmacy is a Non-Preferred Pharmacy (CVS, Safeway, Costco, etc.) -Walgreens -Wal-Mart {Sams} -Target -Kroger -Medicine Shoppe -LeaderNET Pharmacy Network

16. HMO & PPO Additional Value Benefits • Health Club membership – available on all plans through contracted facilities • Dental Benefits – available on select plans as a reimbursement • Vision Benefits – available on all plans

17. Selling Coventry Medicare Advantage • Coventry is now an Aetna owned Fortune 53 company • Coventry leads the Industry in Broker Support • Coventry’s reputation with customer service to their membership is industry leading • Coventry’s home grown model of care and care coordination for your clients differentiates them from other companies • Coventry maintains a high member retention rate • Coventry pays 10 year renewals

18. Servicing Your Clients

19. Outbound Education and Verification Calls What Happens After an application is submitted? • A Coventry Health Care Representative will call your client within 10 days of receiving an Enrollment Form to: • Confirm their enrollment in the Coventry plan of their choice. • Review the plan rules and make sure they understand how their new plan works. • Coventry Health Care will make three attempts to reach your client by phone. If we are unable to speak with them after the second attempt, they will receive a letter outlining the plan rules. • Both the telephone calls and letters will cover the same information that your client has in their enrollment kit. Please contact Alexis Horton or Kenna Rickett for a copy of the verification call script.

20. Servicing The Member ID Cards and New Member Kits • Member will receive an ID Card • Members will also receive an Enrollment Confirmation letter than may be presented as proof of enrollment • New member kits will be mailed within 10 days of receipt of CMS confirmation of enrollment or by the last day of the month prior to the effective date, whichever is later. The new member kit contains: • Welcome letter • Evidence of Coverage (EOC)- Gives members the details about their Medicare health care and prescription drug coverage for the plan year. The EOC explains how to get coverage for Medicare health care services and prescription drugs • Formulary drug list- Lists the covered drugs selected by the plan in consultation with a team of health care providers. It indicates drug information such as the therapeutic class of drugs, drug tier, and special requirements that may apply like Prior Authorization and Step Therapy. Members can review it to see if the medications they take are covered by the plan. • Provider/Pharmacy directory- Provides a list of participating network providers (physicians, hospitals, skilled nursing facilities, urgent care centers or other duly licensed institutions or health professionals) and pharmacies. • Other health-related informational flyers NOTE: If a member requires assistance regarding their membership/member ID, the member MUST call Customer Service. • Newsletters to help members learn how to use their plan, including education on specific health-related topics.

21. Care Coordination Programs Coventry cares about your client’s health and wants to ensure they are receiving the most appropriate and highest quality care possible. • Disease Management Programs • Diabetes • Heart Disease • COPD • Heart Failure • Disease Management • Outreach Calls for Preventive/Wellness Services • Member Health Support Center • Social Services Coordination • Member Health Assessments from Matrix

22. Diabetic Clients - Glucometer Information • One Touch ® LifeScan blood glucose monitoring system (one per member) • Only LifeScan brand test strips are covered at a $0 copay under the Part B pharmacy benefit • All other brands covered at 20% copay • The member must call CSO directly to enroll. CSO will set them up with Health Services to insure they get the correct meter

23. AltegraFormerly known as Social Services Coordinators • Coventry Members will be screened to determine eligibility for extra help • Helps button up the sale to solidify Coventry’s desire to ensure they get what they deserve • May be used to screen for Special Election Period

24. BenefitsCheckUp www.BenefitsCheckUp.org/Coventry One-stop resource for determining eligibility for programs that can help members with all types of expenses, including health care, prescriptions, taxes, utilities and more!

25. Servicing The Member Member Resources Customer Service is open: • 10/1/2013- 2/14/2014 • 7 days a week- 8 am – 8 pm (local region time zone) • 2/15/2014-9/30/2014 • Monday- Friday 8 am- 8 pm (local region time zone) • Telephone number on back of the member’s ID Card • Thanksgiving and Christmas days – voicemail available Customer Service for Pharmacy (Express Scripts) is open: • 24 hours/day, 7 days/week • Telephone number on back of ID Card Website: www.coventry-medicare.com • My Online Services (MOS) • Access to important plan information such as: • Evidence of Coverage, Summary of Benefits, Formulary, Provider/Pharmacy directory

26. Servicing The Member Appeals & Grievances • The member's treating provider can make a coverage request by contacting the number on the back of the member's ID card (called an Initial Coverage Determination). • An “appeal” – is when a member disagrees with decision their plan made to deny a request for coverage of health care services or prescription drugs or payment for services or drugs you already received. • A “grievance” – a type of complaint a member makes about their plan or one of their plan’s network providers or pharmacies, including a complaint concerning the quality of your care. This type of complaint does not involve coverage or payment disputes. • Detailed information on the initial coverage determination, appeal and grievance processes can be found in the member's Evidence of Coverage.

27. 2014 Compliance Review

28. Scope of Appointment (SoA) • Scope of Appointment (SoA) is required for any personal or individual marketing appointment (this excludes attendees at formal and informal marketing/sales events). • CMS-approved Scope of Appointment Forms (CMS model & Coventry non-model) can be found on the Broker Portal. • Agents may not market any health care related product during a marketing appointment beyond the scope that the beneficiary agreed before the meeting with that individual. • SoA’s must be documented before the appointment (48 hours in advance when practical). If this is not feasible, agent may have beneficiary sign SoA at the beginning of the marketing appointment. • Explanation must be documented directly on the SoA in the area provided why SoA was not obtained 48 hours in advance. • Distinct lines of plan business include MA, MAPD, PDP and Cost Plan products. • If the beneficiary requests to discuss other products, agent must document a second scope of appointment for the additional product type to continue the marketing appointment.

29. Scope of Appointment – contd. • Agents cannot record SoA’s. SoA’smust be secured on a CMS-approved SoA form. • A beneficiary may set a SoA at a marketing/sales event for a future appointment. • Agents must attach a copy of the signed SoA to any application received from a personal/individual appointment before submitting the application to Coventry Health Care of Texas. • Agents may not: discuss plans options not agreed by the beneficiary, ask for referrals, market non-health care products (such as annuities or life insurance), solicit/accept enrollment applications for a Jan 1 effective date prior to the start of AEP unless the beneficiary is entitled to another enrollment period, provide meals or have meals subsidized, or market through unsolicited contacts. • All SoA must be maintained for 10 years and available upon CMS or Coventry’s request. This includes initial and second SoA’s obtained at the same appointment

30. How do you stay informed as to what the rules are so that your marketing activities are in compliance with CMS? • Monitor the release of new CMS regulations by signing up for the Federal Register List at http://www.gpoaccess.gov/fr/index.html • CMS marketing guidance can be found at cms.gov and: http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp • Watch for Coventry bulletins (Compliance Connection and/or Broker Flash emails) that includes guidance such as any new updates on Medicare Marketing Guidelines. Check Broker Portal “Recent Field Communications”. • Adhere to Coventry CMS-approved Sales Presentation!

31. Sales Presentation Materials The following materials must be provided to each beneficiary at the time of the presentation: • Formulary- Lists the covered drugs selected by the plan in consultation with a team of health care providers. It indicates drug information such as the therapeutic class of drugs, drug tier, and special requirements that may apply like Prior Authorization and Step Therapy. Members can review it to see if the medications they take are covered by the plan • Summary of Benefits- Lists important plan benefits. Beneficiaries can use the SB to compare benefits. • Multilanguage Insert- provides member in various language instructions for seeking interpreter services • Plan Stars Rating information- CMS rating of the plan’s quality and performance. These ratings help the beneficiary to know how the plan is doing and allows them to compare our plan's performance to other plans.

32. Applications Do’s and Don’t DO: • Submit applications to the RIGHT fax number (i.e. fax MAPD applications to the MAPD fax number and Part D applications to the Part D fax number). • Use the Coventry Enrollment /First Health Part D Fax Coversheet when faxing enrollment application. • If using paper applications, be sure to use the application provided in the pre-sales kit. • Use Ascend, the Coventry iPad application, for paperless sales presentations and electronic application submission. • Complete the Scope of Appointment section of the application. • Submit Scope of Appointments with all paper applications. • Use, and submit, the Coventry Enrollment Checklist for ALL non-AEP applications. • Write the FULL NAME of provider and appropriate Physician I.D. for ALL plans requiring the selection of a PCP. • Select a premium payment method (even for plans with $0 monthly premium). • Date the application when you receive it. • Complete the requested effective date (note effective date may be modified in accordance with CMS requirements)

33. Applications Do’s and Don’t DON’T: • Submit applications to the Broker Services Department this will delay application processing. • Use the Consumer Enrollment Website, found by clicking “Enroll Now” on the health plan websites, to submit applications. (May assist the beneficiary in their completion of the on-line enrollment but cannot do it yourself.) • Download and use the application in PDF available on the health plan websites. • Copy the paper applications for use with different beneficiary. • Enter any information or notes in the “Internal Use Only” section. • Submit an application without the actual Medicare coverage dates. “Applied for” will not allow the application to process. • Forget to complete the Medicare Part A and B effective dates on the application.

34. IMPORTANT! Completed Enrollment Applications must be received by Coventry Within 2 Calendar Days!! You can submit enrollment applications • Fax (a preferred method) orovernight to the designated Health Plan contact as listed in the Health Plan Application Contacts section, under Agent Resources headingtowards the end of this module. • Paper applications MUST be received by Coventry Health Care/First Health Part D within 2 calendar days of agent’s receipt of signed enrollment applicationor agent’s completion of an electronic application effectuated through a Coventry approved electronic application. • IPAD App(a preferred method) – faster, real time submission of the enrollment application

35. Expanding Our Service to YOU! THE Ascend iPAD APPLICATION! • Capture client information. • Conduct PAPERLESS Sales Presentations. • Easily utilize the Coventry Sales Presentation Video • Take and submit enrollment applications in REAL TIME (eliminate turn around time issues). • Decrease application pending issues

36. Broker Services Department Our dedicated Medicare Broker Services Department (BSD) will assist you with questions pertaining to: • Commissions / contracting questions • Broker portal, website support • Please do not call Broker Services for product or benefits questions. For those questions you may call Customer Service at (866) 731-9570 BSD Contact Information: • Phone- (866) 714-9301 • 8am– 6pm Eastern Time, Monday-Friday • Email - Brokersupport@cvty.com • Broker Portal: https://broker.cvty.com

37. Producer Manual • Producer Manual can be found on the Broker Portal at: http://coventrymedicare.coventryhealthcare.com/web/groups/public/@cvty_medicare_coventrymedicare/documents/webcontent/c062429.pdf • Will answer most of your questions! • Renewals upon your death? • Commission Charge Backs? • Agent of Record? • Ctrl F = Find what you are looking for

38. Coventry Local Resources

39. The WHO, WHY, and HOW to Contact List

40. Continued

41. Continued

42. LOCAL PLAN OFFICES • Coventry Health Care of Texas 3900 Rogers Road San Antonio, TX 78251 • Coventry Health Care {Customer Service} 14955 Heathrow Forest Houston, TX 77032 Local Presence

43. Broker Next Steps • Score 90%+ on the Product Exam • Supplies • Sales Presentation • ANOC/Retention • Referrals • Marketing Now go get some sales!!

44. Thank you for attending the 2014 Kick-Off Training Class! Don’t Forget to make sure allTesting and Contracting has beencompleted! Coventry Health Care of Texas Medicare Advantage (MA) Coordinated Care Plans (CCP) 2014