Brand Building

2013 Lovelace Medicare PlanPlan and benefit changes for 2013LMP_398

Lovelace Medicare Plan Retention TeamOver 67 Years of Experience!

Aaron Duran, Customer Advisor LaNette Torrez, Customer AdvisorSharon Lopez, Customer AdvisorSuzanne Janser, Customer Advisor

DeYonna Garcia, SupervisorMaureen Manring, Manager

Goals and Objectives Define Annual Election PeriodIdentify Plan Changes for 2013Identify Plan Options for 2013Review available Savings ProgramsReview Value Added Benefits

Annual Election PeriodAnnual Election Period (AEP) begins October 15, 2012 and ends on December 7, 2012

Effective date of coverage is January 1, 2013

Annual Election Period (AEP)If you are interested in changing plans for 2013:

You must complete a Short Enrollment Form. The Short Enrollment Form must be received in our office no later than December 7, 2012.The Short Enrollment Form will be included in your Annual Notice Of Change (ANOC) Packet.

If you want to remain on your current plan with 2013 benefits, there is NO NEED to do anything.

Short Enrollment Form

During this presentation any benefit NOT mentioned for the Standard and Enhanced Planswill remain the same for 2013!

Additional Service Areas in New Mexico

10 NEW COUNTIES!

LeaLincolnCibolaLos AlamosOtero

Chaves Rio ArribaSan MiguelTaosEddy

The Medical Only Plan is NO LONGER going to be offered as an option with the Lovelace Medicare Plan in 2013.

Lovelace Medicare PlanStandard and Enhanced Plan Changes20122013Preventive Dental ServicesDiscount offered throughDental SourceBenefit is now being offered with a $0 copay through Liberty Dental PlanVision$30 Supplement Routine Eye Exam $30 to diagnosis/treat disease of the eye$0 Supplement Routine Eye Exam $0-$25 to diagnosis/treat disease of the eyeHearing$30 Hearing Exam$25 Hearing ExamAnnual 4 ONE WAYnon-emergency transports to contracted provider or facilityBenefit was not offeredBenefit is now being offered with a $0 copay through Superior Medical Transport

$0 Glaucoma screenings for those with diabetes are covered at $0 copay. CAs you will need to explain on this screen the consistent services that have changed under both Enhanced and Standard.10Lovelace Medicare PlanStandard Plan Changes

Lovelace Medicare PlanStandard Plan ChangesStandard HMO 2012Standard HMO2013 Urgent Care$20-$50$20-$65Emergency Care$50$65Outpatient/ServicesSurgery$150$275Inpatient Hospital/Mental Health Care$200 per day 1-3 ($600 calendar year max)$250 per day 1-3 ($750 calendar year max)Podiatry$30$25

12Lovelace Medicare PlanStandard Plan ChangesStandard HMO 2012Standard HMO2013Prescription DrugsTier 1 Preferred Generic $5Tier 2 Preferred Brand $36Tier 3 Non-Preferred Brand $70Tier 4 Specialty 33%/350max

$2,930 ICL, Tier 1 IN THE GAP

Tier 1 Preferred Generic $0Tier 2 Non-Preferred Generic $4 Tier 3 Preferred Brand $30 Tier 4 Non-Preferred Brand $70 Tier 5 Specialty 33%/350max

$2,970 ICL, Tier 1 and 2 IN THE GAP

Lovelace Medicare PlanEnhanced Plan Changes

Lovelace Medicare PlanEnhanced Plan ChangesEnhanced HMO-POS 2012Enhanced HMO-POS 2013Premium$55.30$55.90Inpatient Hospital/Mental Health Care Stay$150 per day 1-3 ($450 calendar year max)$250 per day 1-3 ($750 calendar year max)PrescriptionsTier 1 Preferred Generic $7Tier 2 Preferred Brand $36Tier 3 Non-Preferred Brand $70Tier 4 Specialty 33%/350max

$4,000 ICL, Tier 1 IN THE GAPTier 1 Preferred Generic $0Tier 2 Non-Preferred Generic $7Tier 3 Preferred Brand $36Tier 4 Non-Preferred Brand $70 Tier 5 Specialty 33%/350max

$4,000 ICL, Tier 1 & 2 IN THE GAP

ASK CAS IF THERE WERE ANY ADDITIONAL CHANGES!!!!! Ask CAs about the pres drugs for 2012 are the TIER LEVELS CORRECT????

15Four NEW Plans at a Glance$0 Plan Plus HMO(with Part B Buy Down)HMO plan which will give back $35 per month in a members Social Security check; additional Rx gap coverage.

$0 Plan Deluxe HMO (with Part B buy down)HMO plan which will give back $97 per month in a members Social Security check; there is a 20% cost-sharing on most Medicare services.$70.80 Classic PPOFlexibility to receive all Medicare-covered services out-of-network from Medicare providers at slightly higher cost-sharing.$153.60 Premier PPO$0 copay for in-network Medicare-covered services with flexibility to receive all Medicare-covered services out-of-network for slightly higher cost sharing.

Lovelace Medicare Plan AdditionsPlan Plus HMO/Plan Deluxe HMO with Part B buy down

Plan Plus HMO Plan Deluxe HMOPremium$0$0Out of Pocket Max$3,400$6,700Buy-Down$35.00$97.00Primary Care Provider$10.0020% coinsuranceSpecialist$3020% coinsuranceEmergency/Urgent Care$65.00$65.00Inpatient Stay$300 days 1-3 (with a $900 calendar year max)$1000 per stayOutpatient $30020% coinsuranceAnnual 4 ONE WAYnon-emergency transports to contracted provider or facility$0 copay through Superior Medical Transport$0 copay through Superior Medical Transport

ASK CAs if there is a DEDUCTIBLE????17Lovelace Medicare Plan AdditionsPlan Plus HMO/Plan Deluxe HMO with Part B buy down

Plan Plus HMO Plan Deluxe HMOPreventative Dental Services $0 copay through Liberty Dental Plan

$0 copay through Liberty Dental Plan

Vision Services$0 Annual Routine Eye Exam$0 Annual Routine Eye ExamAmbulance$15020%CT/MRI/MRA$10020%Prescriptions

Tier 1 Preferred Generic $0Tier 2 Non-Preferred Generic $4Tier 3 Preferred Brand $36Tier 4 Non-Preferred Brand $75 Tier 5 Specialty 33%

$2970 ICL Tier 1& 2 Coverage in THE GAP$325 Pharmacy Deductible

Tier 1 Preferred Generic $0Tier 2 Non-Preferred Generic $6.50Tier 3 Preferred Brand $45Tier 4 Non-Preferred Brand $95 Tier 5 Specialty 25%

$2,970 ICL NO COVERAGE IN THE GAP

18Lovelace Medicare Plan AdditionsClassic PPO and Premier PPO PlansClassic PPOPremier PPOPremium$70.80$153.60Deductible$750 combined$750 combinedOut of Pocket Max$3,350 In-Network$3,400 Out-of-Network$3,350 In-Network$3,400 Out-of-NetworkPrimary Care Provider$10 In-Network$20 Out-of-Network$0 In-Network$20 Out-of-NetworkSpecialist$30 In-network$40 Out-of-Network$0 In-Network20% Out-of-NetworkEmergency/Urgent Care$50 In-Network$50 Out-of-Network$50 In-Network$50 Out-of-NetworkInpatient Stay$250 days 1-3($750 calendar year max) In-Network20% Out-of-Network$0 In-Network20% Out-of-NetworkOutpatient Surgery$150 In-network$250 Out-of-Network$0 In-Network20% Out-of-Network

Lovelace Medicare Plan AdditionsClassic PPO and Premier PPO PlansClassic Plan PPOPremier Plan PPOAmbulance$75 In-Network and Out-of-Network$0 In-Network20% Out-of-NetworkCT/MRI/MRA$50$0Vision Services$0 Annual Routine Eye Exam In-Network20% Out-of-Network$0 Annual Routine Eye Exam20% Out-of-NetworkAnnual 4 ONE WAYnon-emergency transports to contracted provider or facility$0 copay through Superior Medical Transport$0 copay through Superior Medical Transport

Lovelace Medicare Plan AdditionsClassic PPO and Premier PPO PlansClassic Plan PPOPremier Plan PPOPrescription

Tier 1 Preferred Generic $4Tier 2 Non-Preferred Generic $4Tier 3 Preferred Brand $36Tier 4 Non-Preferred Brand $75 Tier 5 Specialty 33%

$2,970 ICL NOT COVERAGE IN THE GAP

Tier 1 Preferred Generic $0Tier 2 Non-Preferred Generic $0Tier 3 Preferred Brand $36Tier 4 Non-Preferred Brand $75 Tier 5 Specialty 25%

$2,970 ICL NOT COVERAGE IN THE GAP

Non-Emergency Transport BenefitFor plans with the non-emergency transport benefit, Superior Medical Transport (SMT) will be the provider.

A member should call 48 hours in advance of scheduled appointment; will need member ID# and the address to which they are going.

In limited situations, same day appointments may be covered.

Summary of Benefits and Evidence of Coverage will provide details on how to contact them and guidelines on timing and distance.

Preventative Dental ServicesFor plans with preventive dental services, Liberty Dental Plan will be the provider. The benefit offers:

$0 co-pay for two exams per yearOne full mouth or panoramic X-ray every 24 monthsTwo cleanings per calendar year

Philips Lifeline Medical Alert SystemsIn partnership with Lovelace Medicare Plan, Lifeline will offer a monthly rate of $34 for its basic medical alert service to all Lovelace members. You will also receive free activation.

All plans will continue to offer

Silver Sneakers and Assist America

Annual Notice of Change PacketSummary of BenefitsEvidence of CoverageFormularyPost Card to Order Provider DirectoryShort Enrollment Form

Savings Programs!Get help with your Medicare out-of-pocket prescription expenses, Medicare premiums, and more.Limited Income Subsidy (LIS) Part D Extra HelpMedicare provides extra help to pay prescription drug costs for people who meet specific income and resource limits.Medicare Savings ProgramsNew Mexico offers programs that could pay your Medicare Part B

SOCIAL SERVICES COORDINATORS now referred to as ALTEGRA HEALTH1-866-706-6874SSC is now Altegra Health

Customer Care Center1-855-730-LOVE (5683)TTY/TTD 711Hours of Operation are seven days a week from 8:00 am to 8:00 pm

Be sure to visit our website. You can view all plan documents, the current formulary and search the most current provider plan finder

www.lovelacemedicareplan.com

CAs will need to really manage up and encourage to call their Customer Advisor or 28SUMMARYDefined Annual Election PeriodExplained how to make a plan switch within Lovelace Medicare PlanIdentified Plan Changes for 2013Identified Plan Options for 2013Reviewed available Savings ProgramsReviewed Value Added BenefitsExplained additional points of contact for future reference

Disclaimers:

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

As a member with the Lovelace Medicare Plan you will need to continue to have both Part A and Part B.

You must also continue to pay your Part B premium each month to maintain membership.

You may only enroll in the plan during specific times of the year. Contact Lovelace Medicare Plan for more information.

People with limited incomes may qualify for Extra Help to pay for their prescription drug premiums, annual deductibles and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and dont even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week, TTY users should call 1-877-486-2048.

This information is available in a different format, including Spanish and large print. Please call Customer Care at the number listed above if you need plan information in another format or language.

Esta informacin esta a su disposicin en diferentes formatos, incluso en espaol y en letras mas grandes. Srvase llamar al Centro de Atencin a los Clientes al 505-727-5683 o al 1-855-730-5683 (LOVE); para la lnea telefnica TTY/TDD llame al 711, si usted necesita recibir la informacin sobre el plan en algn otro formato.