2019 Ohio Product Launch & Agent...

2019 OhioProduct Launch & Agent Training

Kahassai Tafese (KT)Broker Channel Manager – Eastern Region (Ohio, Michigan, Wisconsin)[email protected] Cell

The Molina Mission

Our Vision

Our Mission

We envision a future where everyone receivesquality health care.

To provide quality health care to persons receivinggovernment assistance.

Caring Enthusiastic Respectful Focused

Thrifty Accountable Feedback One Molina

Core Values

What We Do

4

We Are Here to Stay!!

#156 on the Fortune 500 List

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Molina For Marketplace 2019

Molina is selling on-exchange products in 9 states:1. California2. Florida3. Michigan4. New Mexico5. Ohio6. Texas7. Washington8. Wisconsin9. Utah

Serve our members and support our agents

as we prepare for future growth.

2018: We’re fixing the plane while in flight!

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Core Ops

Cost of Care

Care Delivery

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“In order to RISE

from its own ashes,

a Phoenix first must

Burn.”

09/17/2018

Stock Performance

5 years ago Molina’s stock was trading at $36

1 year ago Molina’s stock was trading at $62

6 months ago Molina’s stock was trading at $77

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• 2014 – 2,032

• 2015 – 5,937, 292% growth

• 2016 – 15,244, 257% growth

• 2017 – 26,647, 174% growth

• 2018 – 15,117, -43% growth

• 2019 -

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Effectuated Marketplace Membership

Year Total

2014 (December) 14,675

2015 (December) 207,734

2016 (April) 649,663

2017 (January) 1,025,122

2018 (January) 456,111

2019 (January)

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Source Cumulative Broker Enrollment Stats 2017 Slide Updated 1.27.2017

48%

64%

34%

27%

41%

25%

42%

47%

*UT-57%, WI-39%

Marketplace Product

Strategy 2019

All States

V.15

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Molina Marketplace Product Strategy - 2019

• Product Portfolio –

Renewing – Molina Marketplace Product in all States

Discontinuing –

Molina Options Product (CMS Standard Plans) – TX, OH, MI, FL

Molina Options Members will be mapped to matching Molina Bronze or Silver upon renewal

Molina FFM Bronze plans – OH, MI

Bronze Members will be mapped to Silver 250 per regulation, upon renewal

Plan Design Positioning

Maintain one FFM standard plan portfolio for all FFM states Competitive research by state, indicated no imperative for market specific plans.

Agreement by state Health Plans

SBM States: WA – Continue to use FFM Silver and Gold standard portfolio

CA – Continue to apply Covered CA portfolio by contract

Plan cost share changes 2019 AV calculator is forcing higher cost share; adjusted plan deductibles/maximum out

of pocket/cost shares to meet AV targets

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• Service Area Planning

Renewing in Existing Counties/Rating Areas – CA, FL, MI, NM, TX, WA

Marketplace Service Area Expansion – OH

o New counties: Champaign, Clinton, Fayette, Highland, Huron,

Muskingham, Pickaway, Pike

Marketplace Re-entry – UT, WI

o UT Service Area: Weber, Davis, Utah, Salt Lake (pending network

negotiations: Washington, Cache, Summit, Tooele, Iron)

o WI Service Area: Milwaukee, Racine, Kenosha, Washington,

Ozaukee, Waukesha, Brown

• Pricing

2019 pricing will again account for premiums without CSR funding

2018 Federal regulation supporting stabilization did not pass to fund CSRs

“Silver-loading” in all states; will increase 2nd lowest Silver plan premiums

and premium subsidies

Pricing elasticity – actuarial team calculated rate and corresponding

membership impact to find the target rate for optimal profits.


• Product Portfolio (continued) –

Plan Cost Share Revisions

Completed competitive analysis and recommendations for cost share

changes to steer usage towards the appropriate level of care and improve

plan performance, in three key service categories:

Product Design Changes: Final Recommendations and Rationale

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1 Emergency Services – Move from copay to coinsurance after plan deductible as applicable Rationale – Financial disincentive for ER use, parity against competitors, selection avoidance

Reduce Barriers to Urgent Care – reduced cost share; more than PCP office visit, but less than Specialist office visit and ER Rationale – Incents Urgent Care over ER, avoids Specialty use

Prescription Drugs –

Separate Rx deductible for Silver 200 & 250 plans – Reversion back to 2018 positioning Rationale - Provides limited financial steerage on use, but retains access, allowing high risk

members to obtain drugs supporting Rx data for Risk Adjustment

Revised Rx Tier Definitions – Market parity, flexibility & performance Rationale - Revised Rx Tier definitions address financial performance, allowing formulary

flexibility by placing drugs within tiers by cost

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3

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2019 Marketplace Plan Design SummaryLegend:

• Benefit reduction from 2018 highlighted in Red

• Benefit increase from 2018 highlighted in Green

• Description change - Blue

▲ Plan deductible Applies

2019 MarketplaceAll FFM States

Bronze Silver 100 Silver 150 Silver 200 Silver 250 Gold

AV (2019 calculator) 63.00% 94.82% 87.58% 73.79% 68.35% 78.91%ACCUMULATORS

Medical Deductible, Individual $6,400Combined Med/Rx

N/A $750 $3,300 $5,350 $2,925

Rx Deductible, IndividualIncluded in

Medical deductibleN/A N/A

$400(Ded applies to Tiers 3

& 4)

$400(Ded applies to Tiers 3

& 4)N/A

OOPM, Individual $7,900 $1,400 $2,600 $6,300 $7,900 $5,000

EMERGENCY/URGENT SERVICES

Emergency Room - Applies to facility charges only— Waived if admitted (Inpatient cost-sharing applies)

40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲

Urgent Care $75 $10 $20 $50 $50 $35

OUTPATIENT PROFESSIONAL/FACILITY SERVICES Office Visit — Primary Care $35 $0 $10 $20 $30 $10

Office Visit — Specialty Care $80 (after ded) ▲ $15 $30 $60 $75 $50

Outpatient Professional & Facility— OP Surgery— OP Non-Surgical Services


Specialized Scanning Services (CT/PET Scan, MRI) 40% (after ded) ▲ 10% 20% (after ded) ▲ 30% (after ded) ▲ 30% (after ded) ▲ 20% (after ded) ▲

INPATIENT HOSPITAL SERVICESMedical / Surgical — Professional & Facility


PRESCRIPTION DRUGS §

Tier 1 - Lower-Cost Generic and Brand Name Drugs $20 $2 $5 $10 $20 $10

Tier 2 – Preferred Generic and Brand Name Drugs 40% (after ded) ▲ $15 $30 $60 $60 $50

Tier 3 – Non-Preferred Brand Name Drugs 50% (after ded) ▲ 20% 30% 40% (after Rx ded) ▲ 40% (after Rx ded) ▲ 30%

Tier 4 – Generic and Brand Name Specialty Drugs 50% (after ded) ▲ 20% 30% 40% (after Rx ded) ▲ 40% (after Rx ded) ▲ 30%

Tier 5 – Preventive Drugs No Charge No Charge No Charge No Charge No Charge No Charge

Cost Share Changes by Metal Plan Note: FFM Portfolio (no Bronze Plan offering) applies to WA, MI, OH, and market reentry in UT & WI

Perspective Check

What is the story with Bronze?

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Silver Bronze

Premium $500 $450

Claims $350 $178

Risk Transfer $50 $200

Admin $90 $81

Net Income $10 -$9

• Premium is low

• Claims are low

• Risk Transfer is the breaking point

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2019 Product ChangesFederal Requirements and Molina EOC Revisions

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Product Changes: Regulatory Requirements

ACA Product Revisions Regulatory Impact

Operational Impact

Open Enrollment• FFM States

• November 1, 2018 through December 15, 2018

• State based Marketplaces-• WA – November 1, 2018 through December 15, 2018• CA -- October 15, 2018 through January 15, 2018

Yes –• CMS

Templates

Yes –• EP&B• Web Site• Network Data• Renewal

Communication• Contact Center• Sales and

Distribution• Configuration

Increased Maximum Out of Pocket Amounts Yes –• CMS

Templates• EOC• Schedule

of Benefits

• SBC

Yes –• QNXT

Configuration• Web Site• Marketing• Configuration

2018 2019 2019 Silver CSR Maximums

Individual $7,350

Individual $7,900

100 – 150% AV Plan

$2,600 / $5,200

2X Family $14,700

2X Family $15,800

150 – 200% AV Plan

$2,600 / $5,200

200 – 250% A V Plan

$6,300 / $12,600

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Product Changes: Molina EOC Revisions

Molina EOC Revisions Regulatory Impacts

Operational Impacts

Prescription Drug Tier Definition Revisions, Are Intended To:• Address better financial performance with drug tiering based upon cost • Allow the flexibility for generic and/or brand drug placement within the appropriate

drug tier • Better align EOC language and ensure that member cost share corresponds to drug

efficacy, cost and administration, regardless of generic/brand/specialty drug types • Bring Molina into parity with other ACA Issuers, mitigating adverse selection risk

Yes -• EOC• SBC• ID cards• Member

materials

Yes –• Member

Portal• IT• Contact

Center

2018 – Pharmacy Tier Naming 2019 – Pharmacy Tier Naming

EOC – Same definitions 2014-18 EOC - Modified Tier Definitions will track to:

EOC and SBCTier-1 Formulary Generic DrugsTier-2 Formulary Preferred Brand Name DrugsTier-3 Formulary Non-Preferred Brand Name DrugsTier-4 Formulary Specialty (oral and injectable) Drugs Tier-5 Formulary Preventive Drugs

EOC and SBC:Tier-1: Lower-Cost Generic and Brand Name DrugsTier-2: Preferred Generic and Brand Name DrugsTier-3: Non-Preferred Brand Name DrugsTier-4: Generic and Brand Name Specialty DrugsTier-5: Preventive Drugs

ID Cards:Prescription Drugs:• Generic Drugs• Preferred Brand Drugs• Non-Preferred Brand Drugs• Specialty Drugs

ID Card: Prescription drugs -• Tier-1 • Tier-2 • Tier-3 • Tier-4

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Operational Impacts

Section: Definitions, and changes as needed throughout Description of Change: Added “Allowed Amount” definition to clarify Molina’s maximum coverage

amount for emergent and non-emergent services, obtained from par or non-par providers. Legal approved language below:

“Allowed Amount“ - Allowed Amount means the maximum amount that Molina will pay for a Covered Service less any required Member Cost Sharing.

Services obtained from a Participating Provider: This means the contracted rate for such Covered Services.

Emergency Services and emergency transportation services from a Non-Participating Provider: Unless otherwise required by law or as agreed to between the Non-Participating Provider and Molina, the Allowed Amount shall be the greatest of 1) Molina’s median contracted rate for such service(s), 2) 100% of the published Medicare rate for such service(s), or 3) Molina’s usual and customary method for determining payment for such service(s).

All other Covered Services received from a Non-Participating Provider in accordance with this Agreement: This means the lesser of Molina’s median contracted rate for such service(s), 100% of the published Medicare rate for such service(s), Molina’s usual and customary rate for such service(s), or a negotiated amount agreed to by the Non-Participating Provider and Molina.

Yes -• EOC• Legal

Yes –• No

New EOC language highlighted in Red

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Operational Impacts

Section: Outpatient Hospital/Facility Services, Laboratory Tests Description of Change: Revise description of laboratory tests to clarify that non-par lab

services are not coveredWe cover the following services when Medically Necessary. These services are subject to Cost Sharing. You must receive these services from Participating Providers. Otherwise, the services are not covered, You will be 100% responsible for payment, and the payments will not apply to Your Deductible or Your Annual Out-of-Pocket Maximum.

Yes -• EOC

No

Section: Outpatient Hospital/Facility Services, Specialized Scanning Services Description of Change: Revise description of specialized scanning services to allow health

plans the flexibility to steer towards lower cost outpatient facilitiesWe cover specialized scanning services to include CT Scan, PET Scan and MRI by Participating Providers. Separate Cost Sharing may apply for Professional services and Facility services. Prior Authorization is required. Hospital locations are covered for Emergency Services, observation stay, or during an inpatient hospital admission. Molina will help you select an appropriate facility.

Yes -• EOC

Yes –• UM

Section: Exclusions Description of Change: Add/Update language for the following services

• Add -- Gene Therapy: Molina does not cover gene therapy.• Revise to align with state coverage requirements -- Dietician: A service of a

dietician is not a covered benefit. This exclusion does not apply to services under “Hospice Care” or for Covered Services described in the section titled, “Phenylketonuria (PKU) and Other Inborn Errors of Metabolism”.

Yes -• EOC

No


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Operational Impacts

Section: Schedule of Benefits Description of Change: Revise to clarify member cost share for covered services received

in the home settingSeparate cost share may apply for other covered benefits delivered in the home setting (e.g., injectable drugs, durable medical equipment, etc.)

Yes -• EOC

No

Section: Schedule of Benefits and Prescription Drug Sections Description of Change: Clarified language to include all types of cost-sharing reduction

programs.Please note, Cost Sharing reduction for any prescription drugs obtained by You through the use of a discount card or coupon provided by a prescription drug manufacturer, or any other form of prescription drug third party cost-sharing assistance, will not apply toward any Deductible, or the Annual Out-of-Pocket Maximum under Your Plan

Yes• EOC

No

Section: Summary of Benefits, Inpatient and Outpatient Services Sections Description of Change: Updated language to apply coinsurance to all medically covered

drugs, regardless of place of service (not outpatient drugs obtained through a network pharmacy)

Chemotherapy and Other Provider-Administered DrugsWe cover chemotherapy and other provider-administered drugs when furnished by Participating Providers and Medically Necessary. Chemotherapy and other provider-administered drugs, whether administered in a physician’s office, an outpatient or an inpatient setting, are subject to either outpatient facility or inpatient facility cost sharing.

Yes• EOC

Yes• CIM


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Operational Impacts

Section: What is a Prior Authorization (PA)? Description of Change: Updated PA section to align with PA guidelines effective

1/1/2019; guidelines vary by statePlease note: more PA stringent requirements cannot be implemented for Marketplace if policies are changed after EOCs are filed and approved; easing of PA rules can be implemented mid-year

Yes• EOC

No

Section: Outpatient Professional Services, Preventive Care and Services Description of Change: Updated preventive services list reflect most recent USPTF

guidelines; states may also require coverage for additional services

Yes• EOC

Yes• CIM

Section: Health Education Description of Change: Updated to reflect the current programs/services available

through MHI and State Health Plans

Yes• EOC

Yes• Member

Portal• Marketing

Materials

Section: Definitions and changes as needed throughout Description of Change: Replace “Benefits and Coverage” definition with a revised

definition of “Covered Services;” ensure consistency throughout the document“Covered Services” refers to all the healthcare services, including supplies, and prescription drugs covered by the [Policy] and that You are entitled to receive from Molina under this [Policy].

Yes -• EOC

No


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2019 Product ChangesState-specific EOC Changes

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Product Changes: State EOC Revisions – MI


Operational Impacts

Section: External Review Process Description of Change: Update to DIFS’ External appeal information

Yes -• EOC

Yes –• Configuration• Member

Services• Appeals

Filing External Review Request

2018 2019

Timeframe Change 120 Days 127 Days

Updated URL www.Michigan.gov/difs https://difs.state.mi.us/Complaints/ExternalReview.aspx

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Product Changes: State EOC Revisions – OH


Operational Impacts

Section: Prescription Drugs Description of Change: Update to the Opioid benefit to comply with state law.

Add opioid analgesics for chronic pain in the PA list.

Added Provision on Opioids to define the benefit offering in compliance with Ohio. Rev. Code § 3923.851

Yes -• EOC

Yes –• Configuration• Member

Services• Appeals

Opioid Analgesics Prescribed for Chronic Pain If You are prescribed Opioid Analgesics for Chronic Pain You must obtain a Prior Authorization prior to receiving Opioid Analgesics for Chronic Pain, except under the following circumstances:• Opioid Analgesics prescribed to a Covered Person who is a

Hospice Patient in a Hospice Care Program;• Opioid Analgesics prescribed to a Covered Person who has

been diagnosed with aTerminal Condition, but is not a Hospice Patient in a Hospice Care Program; or

• Opioid Analgesics prescribed to a Covered Person who has cancer or another condition

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APPENDIX

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Molina Marketplace Product Portfolio – 2019 Overview


Product Design Changes: Final Recommendations and Rationale

State Benefit Marketplaces

State Catastrophic Bronze Silver 100 Silver 150 Silver 200 Silver 250 +Gold Platinum

Covered California CC Standard CC Standard CC Standard CC Standard CC Std

Washington HBE Not Available Not Available Molina Marketplace ChoiceMolina Marketplace

ChoiceNot Available

New Mexico Not Available Molina Marketplace Molina Marketplace Molina Marketplace Not Available

Federally Facilitated Markets

State Catastrophic Bronze Silver 100 Silver 150 Silver 200 Silver 250 +Gold Platinum

Michigan Not AvailableNot AvailableDiscontinue -

• Molina Options • Molina

MarketplaceMolina Marketplace

Discontinue - Molina Options

Molina Marketplace(Except for Holmes

County)Not Available

Ohio Not Available

Florida Not AvailableMolina Marketplace

Discontinue -• Molina Options

Texas Not Available

Molina Marketplace Consumer Choice

Molina MarketplaceConsumer Choice

Discontinue - Molina Options

Molina Marketplace Consumer Choice

Not Available

Not Avalable Molina State Mandated PlanMolina State Mandated

Plan

Wisconsin Not Available Not Available Molina Marketplace Molina Marketplace Not Available

Utah Not Available Not Available Molina Marketplace Molina Marketplace Not Available

Note: "Molina Options" is the Molina product name for the CMS Standard Bronze & Silver Plans. These plans will be discontinued effective 1/1/2019.

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State Offering Type Service Area Action Plans

CA On-Exchange No changes Renewing all 5 metal level plans: Minimum Coverage, Bronze, Silver, Gold and Platinum

FL On-Exchange No changes Renewing FFM Portfolio• Bronze, Silver & Gold plansDiscontinuing:• Molina Options Bronze & Silver plans

MI On-Exchange No changes Renewing FFM Portfolio• Silver and Gold plansDiscontinuing:• Molina Options Bronze & Silver plans• FFM Bronze plan

NM On-Exchange No Changes Renewing FFM Portfolio:• Bronze, Silver, and Gold plans

OH On-Exchange County Expansion:Champaign, Clinton, Fayette, Highland, Huron, Muskingham, Pickaway, Pike

Renewing FFM Portfolio:• Silver and Gold plans (no Gold plan in Holmes County)Discontinuing:• Molina Options: Bronze & Silver plans• FFM Bronze plan

WA On-Exchange No Changes Renewing FFM Portfolio:• Silver & Gold plans only

WI On-Exchange Market Re-entry Pending: Brown, Kenosha, Milwaukee, Ozaukee, Racine, Washington, Waukesha

FFM Portfolio:• Silver and Gold plans only • No Bronze Plans

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State Offering Type Service Area Action Plans

TX On-Exchange No changes Renewing:- TX Department of Insurance prerequisite Consumer Choice

offerings: Silver and Gold plansRenewing FFM Portfolio: - Molina Consumer Choice Bronze, Silver, & Gold plansDiscontinuing:• Molina Options – Silver plans

UT On-Exchange Market Re-entry Pending:• Weber, Davis, Utah, Salt

Lake, Washington, Cache, Summit, Tooele, Iron

FFM Portfolio:• Silver and Gold plans only• No Bronze Plans

2019 Ohio Health Plan

Benefits and Rates

Molina Healthcare of Ohio’s Offices

Greater Cleveland6161 Oak Tree Blvd, Independence

Ohio Headquarters3000 Corporate Exchange Drive, Columbus

Greater Cincinnati 25 Merchant Street, Springdale

Molina Marketplace

35

• Molina Marketplace serves 33

counties

• New counties in 2019: Champaign,

Clinton, Fayette, Highland, Huron,

Muskingham, Pickaway, Pike

1. Ashtabula

2. Athens

3. Butler

4. Champaign

5. Clark

6. Clermont

7. Clinton

8. Coshocton

9. Cuyahoga

10. Fairfield

11. Fayette

12. Franklin

13. Greene

14. Hamilton

15. Hancock

16. Highland

17. Holmes

18. Huron

19. Lake

20. Licking

22. Lorain 23. Lucas23.Madison24. Mahoning25. Montgomery26. Muskingum27. Pickaway28. Pike 29.Ross30. Scioto31. Stark32. Trumbull33. Wood,

Molina Healthcare of Ohio

Network Operations

Online Provider Search

https://providersearch.molinahealthcare.com/

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https://providersearch.molinahealthcare.com/

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Pharmacy Services and Prescriptions

You can find a list of our contracted pharmacies in your area here:

https://www.caremark.com/wps/myportal/PHARMACY_LOCATOR_FAST

Molina contracts our pharmacies through CVS/Caremark

http://www2.caremark.com/micro/asset/mp_ca_pharmloc.htm

https://www.caremark.com/wps/myportal/PHARMACY_LOCATOR_FAST

Specialist Referrals

Molina does NOT require referrals for specialist visits

• Specialist DOES need to be contracted with Molina Marketplace• PCP should forward pertinent member information and findings to

the specialist when referring. • Some specialists may require referrals (however Molina does not)

*** Note – Authorizations are different than referrals

• Some procedures may need Prior Authorization • Helps make sure participating providers are utilized, and appropriate

level of care is provided to meet the member’s needs.

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40

Marketplace Provider Network – Hamilton County

• Mercy Health Formerly Catholic Health Partners*

• Anderson Hospital

• The Jewish Hospital

• West Hospital (merged with Mt. Airy Hospital)

• Clinics, Medical Centers and Urgent Care

• University of Cincinnati Medical Center

• Federally Qualified Health Centers (FQHC’s)

*Ohio’s largest health system

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Marketplace Provider Network – Franklin County

• OSU Wexner Medical Center

• The James Cancer Hospital

• Select Specialty Hospital Columbus, Inc.

• University Hospital East

• Regency Hospital OF Columbus

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Marketplace Provider Network – Licking County

• Licking Memorial Hospital

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Marketplace Provider Network – Hancock County

• Blanchard Valley Health System (HOSP)

44

Marketplace Provider Network – Butler County

• Mercy Health

• Mercy Fairfield

• Kettering Health Network

• Fort Hamilton Hospital

• TriHealth

• McCullough-Hyde Memorial Hospital

• UC Health

• West Chester Hospital

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Marketplace Provider Network – Clermont County

• Mercy Health

• Clermont Hospital

46

Marketplace Provider Network – Montgomery County

• Kettering Health

• Kettering Medical Center

• Soin Medical Center

• Grandview Medical Center

• Southview Medical Center

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Marketplace Provider Network – Greene County

• Kettering Health

• Greene Memorial Hospital (Xenia)

48

Marketplace Provider Network – Ross/Scioto Counties

• ADENA Regional Medical Center

• Kings Daughter Medical Center

• Southern Ohio Medical Center

• Portsmouth City Health Department (FQHC)

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Marketplace Provider Network – Mahoning/Trumbull Counties

• Mercy Health

Humility of Mary Health Partners:

• St. Elizabeth Boardman Hospital (Mahoning)

• St. Elizabeth Youngstown Hospital (Mahoning)

• St. Joseph Warren Hospital (Trumbull)

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Marketplace Provider Network – Cuyahoga County

• MetroHealth System

• Lake Health

Formerly Lake Hospital System

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Marketplace Provider Network – Lorain County

• Mercy Allen Hospital

• Mercy Regional Medical Center

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Marketplace Provider Network – Lucas County

• Mercy Health

• Mercy St. Ann’s

• Mercy St. Charles

• Mercy St. Vincent

• University of Toledo Medical Center

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Marketplace Provider Network – Madison County

• Madison Health

• Madison Health Hospital• Madison Family Health Corp (prof group of

specialists owned by the hospital)

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Marketplace Provider Network – Fairfield County

• Fairfield Medical Center

• Fairfield Healthcare Professionals, Inc.

(employed/owned physicians)

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Marketplace Provider Network – Stark County

• Sisters of Charity Health System

• Mercy Medical Center Canton

• Mercy Professional Care Corp

(employed/owned physicians)

Renewal/Member Communication

© 2018 Molina Healthcare, Inc.

2019 Open Enrollment

California

10/1/18 – Window Shopping

10/15/18 – Open Enrollment Begins

10/31/18 – 11/21/18 - Passive Renewal

12/15/18 – Deadline to Enroll for Jan 1 Coverage

1/15/18 – Open Enrollment Ends for Feb 1 Coverage

FFM

10/16/18 – 10/27/18 - Passive Renewal

11/1/18 - Open Enrollment begins

11/3/18 – 12/15/18 – Switch files from Exchange

12/15/18 – Deadline to Enroll for Jan 1 Coverage

12/15/18 – Open Enrollment Ends

Washington

11/1/18 - Open Enrollment begins

12/15/18 – Deadline to Enroll for January 1 Coverage

12/15/18 – Open Enrollment Ends

57


2019 Discontinuation and Renewal Notices

58

Mailing Schedule

Samples of Renewal, Discontinuation/Renewal (Plan Change), Discontinuation/Renewal (Product Change) Notices

Household

CountState Scenario Template ID

FTP to Merrill Date / Time of

Day

Mailing

Date

Quantity to

Mail

Per Day

Delivery

Date

Regulatory

Requirement -

Received by

Date

5,871 OH Renewal T538 10/10/2018 - Evening 10/11/2018 5,871 10/15/2018 11/1/2018 September 2018

4,779 OH Renewal (Plan Change) T817 10/10/2018 - Evening 10/11/2018 4,779 10/15/2018 11/1/2018 Su M Tu W Th F Sa

3,259 OH Renewal (Product Change) T820 10/10/2018 - Evening 10/11/2018 3,259 10/15/2018 11/1/2018 1

16,401 NM Renewal T540 10/10/2018 - Evening 10/11/2018 16,401 10/16/2018 11/1/2018 2 3 4 5 6 7 8

128,240

TX Renewal T542 10/11/2018 - Evening 10/12/2018 30,000 10/17/2018 11/1/2018 9 10 11 12 13 14 15



TX Renewal T542 10/11/2018 - Evening 10/17/2018 30,000 10/22/2018 11/1/2018 30

TX Renewal T542 10/11/2018 - Evening 10/18/2018 8,240 10/23/2018 11/1/2018

6,273 TX Renewal (Product Change) T821 10/11/2018 - Evening 10/18/2018 6,273 10/23/2018 11/1/2018 October 2018

4,048 MI Renewal T539 10/18/2018 - Evening 10/18/2018 4,048 10/22/2018 11/1/2018 Su M Tu W Th F Sa

3,371 MI Renewal (Plan Change) T816 10/18/2018 - Evening 10/18/2018 3,371 10/22/2018 11/1/2018 1 2 3 4 5 6

4,193 MI Renewal (Product Change) T819 10/18/2018 - Evening 10/18/2018 4,193 10/22/2018 11/1/2018 7 8 9 10 11 12 13

8,194

FL Renewal (Product Change) T818 10/17/2018 - Evening 10/18/2018 3,000 10/23/2018 11/1/2018 14 15 16 17 18 19 20

FL Renewal (Product Change) T818 10/17/2018 - Evening 10/19/2018 5,194 10/24/2018 11/1/2018 21 22 23 24 25 26 27

23,641 FL Renewal T537 10/17/2018 - Evening 10/19/2018 23,641 10/24/2018 11/1/2018 28 29 30 31

38,594 CA Renewal T175 10/18/2018 - Evening 10/22/2018 30,000 10/27/2018 11/1/2018

http://www.calendarpedia.com/

http://www.calendarpedia.com/


New Member - Application Accuracy

Double check application and contact information from applicants for accuracy

Will help to avoid:

Incorrect premiums due to inaccurate DOB

APTC adjustments due to inaccurate income information

Undeliverable mail resulting in lapsed payments and termination for non-payment

Inability to contact the member concerning important medical or administrative issues

Molina cannot correct application inaccuracies. To correct inaccuracies in their application or *contact information, members must call the Exchange or access their online account with the Exchange.

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*Robocall and email outreach performed monthly for members with bad addresses instructing them to contact the Exchange to correct.


New Member Application - Data Inconsistencies

Upon submitting an application, members must provide all documents required by the Exchange to support their application for coverage.

Types of documents the Exchange may request to prove identity, eligibility status, or income:

Citizenship

Immigration

Yearly Household Income

Self-Employment

Unearned Income

Veteran Status

Incarceration

American Indian / Alaska Native

Employer-Sponsored Coverage

No Minimal Essential Coverage

Residency

Social Security Number

Failure to submit documents within 90 days will ultimately result in either a loss of APTC and/or eligibility for coverage. Members will not be able to apply again until the following Open Enrollment period.

CMS and Covered CA send notices to members advising what information is needed and by when to avoid termination of eligibility or loss of APTC. As of July 2017, Molina no longer sends a subsequent notice for FFM members.

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Communications Process for New Members

61

Application

Payment PCP Selection

Start

Welcome letter Binder Invoice

ID Card andWelcome Kit

Members can register for Autopay during enrollment application

• Members who do not pay the full binder upon application will not have the ability to select a PCP.

• A PCP will be selected for them.

If payment made upon application, first invoice will show $0 balance

During OE, binder reminder robocall and email outreach is

performed

Correspondence triggered daily when 834 file transaction is received from the ExchangePCP is auto-assigned upon receipt of the

enrollment file from the Exchange

© 2018 Molina Healthcare, Inc. 62

Binder invoice mailed upon receipt of enrollment file

from the Exchange and monthly thereafter

(No paperless option at this time)

Binder Due Date

CA, FFM, WA Binder Due Date is 1st of coverage effective

month

Premium Due Date thereafter is:

25th of the month prior to the coverage effective month for FFM and WA

26th of the month prior for CA, or 4 business days prior to the beginning

of the coverage effective month, whichever is earlier

AutoPay

• Autopay withdraws on the 23rd of the month, or next business day

• December Autopay withdraw date will be pushed to 12/28/18 to

allow time for enrollments to process and the correct amount to be

withdrawn for January coverage

Payment Channels offered by Molina

(always include the Subscriber ID or Account Number with

payments to avoid processing delays)

1. AutoPay – for convenience and peace of mind.

Register at MyMolina.com

2. Online (Mobile Device or Desktop) - can use savings

or checking account, credit or debit card at

MolinaPayment.com. Or log in to MyMolina.com.

3. IVR – savings or checking account, Visa, MasterCard

or Discover card.

4. Mail – submit payments with coupon from invoice.

Allow 15 days for receipt and processing.

5. Cash – go to MoneyGram.com to find a location, or

call (800) 666-3947.

Member Services phone number and hours are located on the

invoice and welcome letter

Invoicing and Payment Options


Welcome Letter

Sent upon receipt of enrollment transaction from the Exchange

Messaging:

Subscriber ID

My Molina registration

How to Make Premium Payments

PCP Selection Options / Auto-Assignment

Wellness Check Appointment Information

ID Card – process and timing to receive

Drug Formulary location

Member Services – contact information

Accessibility to information – language and disability options

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Member ID Cards

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Important Information about ID Cards Mailed only once the full binder payment is received and posted In paper form (not laminated) Comes in a large envelope, appears first in the package, must be torn along the perforated line Includes one ID card per covered family member ID cards can be printed from MyMolina.com Available on mobile devices and can be printed or emailed Can be used by providers and facilities as a valid ID card where accepted ID card templates may vary slightly based on state regulations – sample below

Front Back

Timing• New Members - Sent once full binder payment is received and processed• Active Renewals – Sent as members actively renew during Open Enrollment• Passive Renewals – Sent in early January


Welcome Kit and Renewal Kit Contents

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Contents ID Card for each covered member of the family Effective Date of Coverage Cover Letter including important information and tips – varies slightly by state

For Texas members who select the Consumer Choice or Options product, the kit includes a form that must be completed, signed and returned to Molina per Texas state law.

For CA members, the cover letter provides information on Timely Access to Care and how to file a grievance.

Privacy, Security, and HIPAA Information Financial Information Privacy Notice (except CA) 1557 Non-Discrimination Notice and Limited English / ADA statement plus taglines in

top 15 languages per state

Welcome Kit Contents Renewing Kit Contents


My Molina – Self Service Member Tool

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MyMolina.com

View invoice and real-time balance Change PCP

Sign up for AutoPay, or make a payment

View Claim History

View Plan and Benefits Print ID Card

View/Print SBC or EOC Get Reminders for Health Services

View Drug Formulary …and much more!


Other Notices - Premium Billing

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1. Notice of Enrollment Separation (Binder Cancellation Notice)

Cancellation occurs one month after the coverage effective date Notice is triggered once cancellation is processed

2. AutoPay Notices

AutoPay Confirmation – upon registration AutoPay Cancellation Letter

Upon member request to disable Autopay via MyMolina.com Can be disabled up until the morning of the 23rd of the month to be effective the next

coverage month Also triggered by Enrollment termination or upon notification by Chase that the member’s

bank account is no longer active AutoPay Non-Sufficient Funds – as result of Autopay run on the 23rd of the month AutoPay Disabled – triggered the day before the Autopay run (22nd of the month)

Initiated by Molina Notice sent when AutoPay has been disabled when there is complete loss of APTC and an

increase in the member responsibility amount of $100 or greater

3. Grace Period Notices Past Due – sent with the monthly invoice when the member has an outstanding balance Termination for Non-Payment

Sent after grace period has expired Three months grace period for APTC Members One month grace period for Non-APTC Members, except 10 days in Florida, Ohio and

Wisconsin, and 15 days in UT

4. Refund Notices (Full, Partial, Denied)


Accessibility of Information

Translation, interpretation and accessibility

Molina automatically sends enrollment and billing materials to members in either English or Spanish.

Molina provides translation and interpretation services in at least 150 languages upon request at no additional charge as required by federal law.

Molina provides information in other formats such as Braille, audio, or large font for members with disabilities at no additional charge.

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Regulatory Update

Broker Fraud!

• All 200 policies written by one insurance agency under one NPN number.

• At least 5 addresses were used dozens of times which were found to be homeless shelters, mental health care centers, PO Boxes and the like…

• Dozens of members only phone number was the number of the insurance agency, or the homeless shelters

• Dozens of members had fake email addresses or emails of the insurance agency

• ALL 200 policies had $0 net premium owed by the member since someone who earned exactly $12,000 and chose a bronze plan in Florida received 100% APTC

• All 200 policies had no claims

• All 200 policies had no calls from members. Except one.

Regulatory Update

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Brokers: Do not list your email address on consumer

accounts

• Never enter your own agent or broker professional or company email or

mailing address on a consumer’s application.

• You also should not create or use dummy addresses in place of the

consumer’s email or mailing address.

• Consumer accounts should only have the consumer’s (or his or her

legally authorized representative’s) email and mailing addresses.

• Only consumer email and mailing addresses should be entered on

Marketplace applications.

Regulatory Update

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Prohibition on Creating ConsumerHealthCare.gov Accounts:

• Only a consumer or his or her legally authorized representative may

create a username and password for a HealthCare.gov account and should

not share this information with third parties, including agents and

brokers.

• You can assist the consumer in creating his or her account, but the

consumer or a legally authorized representative must enter his or her own

information into the application.

• You may not log in to HealthCare.gov on a consumer's behalf (i.e., using

the consumer's HealthCare.gov account).

Regulatory Update

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Homeless Shelters

• If a consumer is homeless or in transitional housing:

– They can submit a reference letter from a person in their state who can

confirm they live in the area permanently. This could be a friend, family

member, or caseworker. This person must also confirm their own residency

by providing proof of residency documents.

• A statement that the address is a homeless shelter or drop-in center is insufficient

for a rescission request to be approved because these are both allowable for

homeless people who enroll through the FFE.

– Document discussions you had with shelter staff if they said the enrollee is

unknown to them.

Regulatory Update

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Broker Specifics

Molina’s Guiding Principles for Broker

1. We provide quality services to our members throughout the processing of

their enrollment, billing, customer servicing, and claims-related transactions

2. We advocate for the brokers and take ownership for their entire Marketplace

experience

3. We provide an efficient and positive experience in all broker interactions,

including providing the knowledge and self-service tools necessary for

brokers to be effective

4. We pay competitive compensation and incentives accurately and in a timely

manner

5. We seek to contract with agencies / brokers who share Molina’s values and

operate in compliance with Molina policies and with all federal and state

regulations

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Broker

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Have you logged into your Broker Portal?

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Molina Broker Portal – VUE

Passwords reset every 365 days

Look at your Book of Business (BOB) for policy status and paid through date.

Enhancements and updates coming!

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Automated onboarding system enhancements: Termed agents may now re-onboard with us using the automated system.

No more manual process

Agents will pay a $60 non-refundable background fee

Within 30 days of a downline agent completing the onboarding process, MGA’S must review and provide their approval or downline agent will be denied

Courtesy Notifications for expiring E&O’s and Licenses will be sent at 60 and 30 days

No more suspensions – agent terminations will automatically be processed

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Book of Business enhancement:

Agents will now see what the member’s monthly premium is.

Passwords: Passwords will expire in a year

Commission Statements: Adjustments tab will show subscriber ID #

Renewal leads will be vetted by MP BSU and IT QA: CA renewal leads will be loaded into broker portal by Oct 1

FFM States and WA State renewal leads will be loaded into broker portal by Nov 1

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Enhanced Direct Enrollment (EDE):

Issuers have their Healthcare.gov – all consumer functionality available directly on HealthSherpa, with full API access to Federal Data

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MP Broker Communication And Resolution Experts Team! (MP BROKER CARE TEAM)

What type of escalated issues will the MP Broker CARE Team work to resolve?

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What types of escalated issues will team work to resolve?

Access to Care If your Molina client is seeking immediate medical services and/or medications, you may contact the

MP CARE Team. (Please note: Member should always reach out to Member Services)

Billing Issues Claims Enrollments Member Services Prior Authorization

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How do I contact the MP Broker Care Team?

Phone #855-885-3179 and choose OPTION 2Note: This line is for our Broker partners only! This number is not for members to call.

Email Must use Molina Client Escalated Issue Form.The more information you provide will helps us to provide resolution.

Send completed form to us at: [email protected]

mailto:[email protected]

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This template needs to be completed.

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BSU (Broker Support Unit) Ways we can help: Marketing Material Distribution Broker Communications, i.e., eBlasts Process your Molina appointment and contracting to sell our MP products CARE Team-Member Look Up/Issues/Resolution Commission Questions/Issues

Broker Support Unit Team:Jamie Neslen, DirectorRhonda Clark-Manager over CARE Team, Contracting & OnboardingSummer Brown- Manager over Commission & Recon, Broker Services

Contact Info: Molina Marketplace

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BSU (Broker Support Unit)

Phone #: 1.855.885.3179 Broker Services - # 1 [email protected]

Broker Care Team- # 2 [email protected]

Commission Team- # 3 [email protected]

Contracting Inquiries - # 4 [email protected]

Monday through Friday – 8:00 AM to 5:00 PM (CST)




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Northern & Central Florida:BCM: Jocelyn CastilloEmail: [email protected]: (813) 453-7525

Ohio and Michigan:BCM: Kahassai TafeseEmail: [email protected]: (614) 623-8267

Broker Channel Manager: Contact InformationWashington:BCM: James (Jim) MaguireEmail: [email protected]: (253) 441-9182

California:BCM: Amy DeMarcoEmail: [email protected]: (916) 761-8766

Utah, New Mexico & Texas:BCM: Adam GrimaldoEmail: [email protected]: (818) 428-9205






Hours of Operation

Non-Open Enrollment Period Open Enrollment Period

December 16 thru Oct 31

Monday thru Friday

7:00am to 6:00pm MST

Nov 1 to December 15

Monday thru Friday

6:00am to 7:00pm MST

Saturdays

7:00am to 4:00 pm MST

Questions

2019 Ohio Product Launch & Agent...

Documents

Transcript of 2019 Ohio Product Launch & Agent...