MEDICARE SUPPLEMENT PLANS 2004

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MEDICARE SUPPLEMENT PLANS 2004

• Presented By
• BLUE CROSS OF CALIFORNIA

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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.

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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.

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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.

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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.

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TRADITIONAL MEDICAREGAPS IN COVERAGE - YR. 2004

• 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

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TRADITIONAL MEDICARE GAPS IN COVERAGE

• 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

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UNDERSTANDING MEDICARE PAYMENTS

• 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

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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!
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BLUE CROSSClassic Plans
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BLUE CROSSClassic Plans
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BLUE CROSSClassic Plans
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BLUE CROSSClassic Plan Rates - area 1, 2, 3
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BLUE CROSSClassic Plan Rates - area 4, 5, 6
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BLUE CROSSStandard Plan A, Select Plans
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BLUE CROSSStandard Plan A, Select Plans
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BLUE CROSSStandard Plan A, Select Plans
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BLUE CROSSStandard Plan A, Select Plan Rates -
Area 1, 2, 3
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BLUE CROSSStandard Plan A, Select Plan Rates -
Area 4, 5, 6
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BLUE CROSSPre-65 Plan Rates
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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

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Blue Cross Medicare SupplementsCommon Guarantee
Issue Rules
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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

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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.

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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.

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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.

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Blue Cross Medicare SupplementsUnderwriting
Rules for Coverage Changes
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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.

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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.

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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

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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
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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.

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Blue Cross Medicare Supplements

• Agent Services Toll Free Line
• 1-888-209-7839
• Customer Service Toll Free Line
• 1-800-333-3883

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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

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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.

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Thank You
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