medicare 101 & cigna medicare supplement overview 101.pdfmedicare 101 & cigna medicare...

MEDICARE 101 & CIGNA MEDICARE SUPPLEMENT OVERVIEW

Insured by Insured by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company and Loyal American Life Insurance Company

U.S. INDIVIDUAL SALES TRAINING

FOR AGENT USE ONLY. NOT FOR DISTRIBUTION TO THE PUBLIC.

MEDICARE BASICS

What is Medicare?

Traditional Medicare provides health insurance for most Americans aged 65 and older, certain younger people with disabilities and people with End-Stage Renal Disease*.

Different parts of Medicare cover different services, broken down between four parts:

*For eligibility information contact Medicare, Social Security Administration, or State DOI. https://www.medicare.gov/forms-help-and-resources/your-medicare-card.html

Part A Hospital

Insurance

Part B Medical

Insurance

Part C Medicare

Advantage Plans

(HMOs/PPOs) Includes Part A, Part

B and sometimes Part D coverage

Part D Medicare

Prescription Drug

Coverage

There are potential costs customers could pay under Medicare.* Below are the additional cost details for Part A covered services.

Medicare Cost

Hospital Inpatient

Skilled Nursing

Facility Care

Hospice Care

Home Health Care Services

Amount customer pays per benefit

period in 2017

• $1,316 deductible

• Days 1-60: $0 coinsurance

• Days 61-90: $329 coinsurance per day

• Days 91-150: $658 per each ‘Lifetime Reserve Day’ (up to 60 days per lifetime)

• Customer responsible for all costs after 150 days

• Days 1-20: No coinsurance

• Days 21-100: $164.50 coinsurance

• Customer responsible for all costs after 100 days

• Medicare only pays for skilled level care in a Medicare-approved Skilled Nursing Care Facility

• 5% of the Medicare-approved amount for inpatient respite care (coinsurance).

• A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.

• $0 for home health care services

• 20% of the

Medicare-approved amount for durable medical equipment.**

Medicare Part A Hospital Insurance

Note: Visit www.Medicare.gov for full list of costs and covered services.

* Premiums and deductible amounts are set by Centers for Medicare & Medicaid Services (CMS) and change yearly. ** Limited to walkers, wheelchair, hospital bed prescribed by a doctor for use in home.

Doctor Services Out-Patient Hospital Services Medical Supplies and Services

Home Health Care

• Services that are medically necessary, (includes outpatient and some doctor services received when a hospital inpatient) or covered preventive services

• Emergency Room Charges

• Hospital Out-patient charges for:

‾ Lab tests, X-rays, Radiology, Medical Treatments, splints, casts, and other services

• Heart Pacemakers • Artificial limbs and

braces • Corrective lenses after

cataract operations • Wheelchair

rental/purchase • Surgical dressings,

casts, splints • Ambulance charges

• Part-time or intermittent skilled care, and home health aide services.

• Medicare Covers 100% of approved amount.

Medicare Part B

Medicare Part B covers medically necessary services and preventative services. There is a Part B monthly premium each month. Medicare covers 80% of the APPROVED amount after the $183 deductible.

Medical insurance

Medicare Cost Amount Customer Pays

Coinsurance and copayment for

Part B services

• Generally 20% coinsurance for most covered services, like doctor’s services and some preventive services, if provider accepts Medicare.

• $0 for some preventive services • Generally 20% coinsurance for outpatient mental health

services, and copayments for hospital outpatient services

Visit www.Medicare.gov for full list of covered services.

Medicare Part C and Part D

Part C

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans” are offered by private insurance companies approved by Medicare. If a customer joins a Medicare Advantage Plan, they still have Medicare Parts A & B coverage. Medicare Advantage plans may require customers to go to doctors or hospitals in the plan's network (except in an emergency situation).

Part D

Medicare Part D, also called the Medicare prescription drug benefit, is a United States federal-government program to help subsidize the cost prescription drugs for Medicare beneficiaries. Part D plans are also offered by private insurance companies approved by Medicare.

Part C and Part D are subject to enrollment guidelines and customers can enroll or make changes during the following situations: • During their Initial Enrollment Period –first eligible for Medicare • During certain enrollment periods that happen each year, usually called Open Enrollment • Under certain circumstances that qualify for a Special Enrollment Period

What is a Medicare Supplement?

A Medicare Supplement policy, sold by private insurance companies, can help pay for some of the health care costs that Medicare Parts A or B does not cover, like copayments, coinsurance and deductibles.

It is sometimes called Med Supp for short, Medigap, Secondary Insurance, or Supplemental Insurance.

• Plans are standardized by the Federal Government* • Freedom to utilize services from any provider that accepts Medicare • Customers must have Medicare A and B to be eligible • Some services are not covered and customers may have additional

out-of-pocket costs

Things to Consider: • Depending on the policy, customer will have coverage for at

least some deductible and coinsurance costs • There may be coverage for extra benefits not otherwise

covered by Medicare • You will have to pay a premium for your supplemental policy • Medicare Supplement plans do not cover LTC, Vision,

Dental, Hearing Aids, Eye Glasses, Private-Duty Nursing, Rx Plans

*Plans are standardized with the exception of Minnesota, Massachusetts, and Wisconsin.

Medicare Supplement 101 FOR AGENT USE ONLY. NOT FOR DISTRIBUTION TO THE PUBLIC.

Medicare Supplement policy Outline of coverage – Plan F

Note: Plan F outline of coverage displayed for example only. Please see the Outline of Coverage document to review all available plan offerings in selected area.

Medicare Supplement policy Outline of coverage – Plan F

Medicare Supplement policy

Outline of coverage – Plan F

Why Buy Medicare Supplement Insurance? FOR AGENT USE ONLY. NOT FOR DISTRIBUTION TO THE PUBLIC.

Medicare has deductibles and copayments and one could easily spend thousands of dollars each

year for out-of-pocket medical expenses. Medicare Supplement

insurance, provides coverage for out-of-pocket expenses that Medicare does not cover and can help save

money.

…a Medicare Supplement Policy can help a person cover the

deductible and costs not covered by Medicare…

CIGNA MEDICARE SUPPLEMENT POLICIES

Insured by American Retirement Life Insurance Company, Loyal American Life Insurance Company & Cigna Health & Life Insurance Company

U.S. INDIVIDUAL SALES TRAINING 14

Focus on health care, not sick care

If seniors stay healthier, they can

get more out of life

Seniors deserve to live better lives

The Cigna difference Why we do what we do

Cigna Mission Statement:

To help the people we serve improve their health, well being, and sense of security

Cigna’s Medicare Supplement portfolio

Cigna Health and Life Insurance

Company (CHLIC)

Charter Launched in 2016

Loyal American Life Insurance

Company (LOYAL)

American Retirement Life

Insurance Company (ARLIC)

Cigna is fulfilling its mission statement to the customer.

– Offering a variety of Medicare Supplement standardized plan options to choose from: A, B, C, F, High Deductible F, G and N.1

– Medicare Supplement policies allow customers the freedom to choose ANY doctor, hospital or provider that accepts Medicare.

– Policies are guaranteed renewable2 for life. Help ensures the plan will be there when customers need it most.

– No membership or association fees – Value-added customer programs.3

– Cigna HealthCare 24-Hour Health Information LineSM Our toll-free, 24-hour Health Information Line, allows customers to talk to a trained nurse, and get live support 24/7.

– MyPolicyHQ.com allows customers to easily review claims, change premium payment options, print temporary ID cards, and more!

– Most claims are received electronically and auto-adjudicated, resulting in quick turnaround times for customers.

The Cigna value to a customer

1. Not all plans are available in all states. Premium and benefits vary by plan selected. Check the state’s outline of coverage for availability. 2. All Medicare Supplement policies are guaranteed renewable for life, subject to the company’s right to adjust premium on a class basis. The policy cannot be terminated for any reason other

than non-payment or material misrepresentation in the application for insurance 3. Customer programs are provided through third party vendors who are solely responsible for their products and services. Promotional discussion is allowed pre-sale in state where

marketing material has been filed. Pre-sale discussions are not allowed in Kansas. Please see state specific brochures and marketing materials for further information.

Product Availability Chart

Updated Regularly!

Located in AgentView: home > products > resource center

Check for availability in your selling states!

CUSTOMER PROGRAMS

Enhanced customer programs add value

Eyeglasses Reduced rates at over 15,000 participating retailers and providers. Discounts on eyeglasses prescription sunglasses and vision exams.

Cigna Healthy Rewards® discounts

Not all programs available in all states.

Just Walk 10,000 Steps-A-Day walking program and fitness devices 8-week online program allows you to log your daily steps, track your progress and receive coaching tips and fun facts. Members receive pedometer and related materials ($29.95 + S&H) Option to extend online program by purchasing the 52-week step-up maintenance program.

Health and wellness products ChooseHealthy Store offers discounts on vitamins and supplements, herbal products, dental products, homeopathic remedies, natural products, diet and sports nutrition, yoga and fitness activities, personal body care, books, audio, video and DVDs. Gaiam also offers yoga related products. Complementary and alternative medicine

Reduced rates from over 32,500 participating providers including acupuncturists, chiropractors, massage therapists, physical and occupational therapists, podiatrists and registered dieticians.

Laser Vision Correction (LASIK) Reduced rates at over 600 participating facilities

Weight management discount programs On-line, at home, telephone-based and traditional meeting options

Hearing exams, aids and protection devices Through Amplifon, save 40% on hearing exams and 20% on aids. Enjoy a 60 day trial with a money back guarantee. Screening is free and there is no charge for follow-up visits for the first year.

Fitness club memberships American Specialty Health Networks and ChooseHealthy provide access to over 12,300 fitness clubs, including Yoga and Pilates studios

HOUSEHOLD DISCOUNTS

Capture more business per household

Household discounts

• Cigna offers a 7% household discount1 for our Medicare Supplement Insurance policies, insured by American Retirement Life Insurance Company (ARLIC) or Loyal American Life Insurance Company (LOYAL) and now Cigna Health and Life Insurance Company (CHLIC)

• Household Discount:

• When more than one member of the household enrolls or is enrolled2 in a Medicare Supplement policy provided by or through an affiliate company3 of American Retirement Life Insurance Company, Loyal American Life Insurance Company, or Cigna Health and Life Insurance Company (where approved by state).

• Automated quoting in Express App, Text Quote and Mobile Quote – discuss the potential savings for your customer during the quoting process

• Household4 is defined as a condominium unit, a single family home, or an apartment unit within an apartment complex

1. Availability and teams and conditions may vary by state. Please consult plan documents. Household discount is called Spousal Discount in WA 2. Cigna will automatically adjust current qualified customers to the 7% discount upon state approval. 3. Affiliate company is defined as an insurance company that is under common ownership or control with American Retirement Life Insurance

Company, Loyal American Life Insurance Company, or Cigna Health and Life Insurance Co. and that is a member of the same insurance holding company system.

Encourages additional household members to purchase

SUBMISSIONS

Sales and application

• Marketing Materials needed when completing a sale: (use “send forms” in ExpressApp for ease!) • Outline of Coverage (required) • Brochure (optional) • Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

(required) • Replacement Form, if replacing (contained in app packet, required) • Any other state-specific forms included in app packet (required)

Materials for your customer

• Open Enrollment1 (OE) • Starts on first day of the month in which the applicant is both age 65

and enrolled in Part B • Applicant has a guaranteed right to purchase a plan • Effective date not over 180 days from app sign date

• WI applications may be taken up to 90 days prior to the insured’s eligibility

• Underwritten2 (UW) • Health questions must be answered by applicant • Phone Verification (PV) & Rx history check required • Can be submitted 60 days prior to effective date • Effective date not over 60 days from sign date

Types of application submissions

1. The Medicare Supplement Open Enrollment (OE) period lasts six months. OE generally starts on the first day of the month in which the applicant is both, age 65 or older and enrolled in Medicare Part B. Check with your state for any additional Open Enrollment periods. Submit a completed application. Medical questions should not be answered during guaranteed issue periods. All plans for sale in the state of residence will be available. During OE and guaranteed issue, plans should be quoted at the Preferred rate for the applicant’s age, regardless of tobacco use. In Florida and Minnesota, regardless of Open Enrollment or guaranteed issue, plans should be quoted based on the applicant’s age and tobacco usage, using the Tobacco and Nontobacco rates.

2. Applications submitted outside open enrollment (excluding guaranteed issue).

• Guaranteed Issue Rights (GI)1

• Customer loses health coverage under certain circumstances and has guaranteed right to purchase Medicare Supplement Plans A, B, C or F offered by the company in the applicant’s state2

• Medical questions should not be answered • Refer to Section 3, “Your Right to Buy a Medigap Policy” of Choosing a Medigap Policy:

A Guide to Health Insurance for People with Medicare for additional information about Guarantee Issue rights

• Submit a copy of disenrollment / termination letter • Additional documentation may be required for certain GI rights • Applications can be submitted 60 days prior to effective date • Must apply within 63 calendar days following notification of loss of coverage or actual date

that coverage terminates • Disabled applicants under the age of 65

• Some states require Medicare Supplement insurance companies to offer a Medicare Supplement insurance policy to individuals that are under the age of 65 and are eligible for Medicare due to a disability

• Refer to Medicare & You, the official government handbook, for details and updated state guidelines (also available online at medicare.gov)

• Completed applications must be mailed with wet signature and a check for premium

1. Please consult State Brochure, State DOI for any applicable state variances. (Refer to guaranteed issue guidelines in the current CMS Guide, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.) Check your state’s Outline of Coverage for available plans

2. Check your state's Outline of Coverage for available plans.

Types of application submissions

Right #1 Your client is in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area.

Right #2 Your client is in Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. NOTE: in this situation you may have additional rights under state law.

Right # 3 The plan is leaving the Medicare Program, stops giving care in the client's area or the client has moved out of the Medicare SELECT policy's service area. Call the Medicare SELECT insurer for more information about your options.

Trial Right #4 Your client joined a Medicare Advantage Plan or PACE plan when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.

Trial Right #5 Your client dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare Select policy) for the first time, you have been in the plan less than a year, and you want to switch back.

Right #6 Your client’s Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

Right #7 Your client leaves a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it mislead you.

This chart describes situations, under federal law, that gives your customer a right to buy a Medicare Supplement policy. Some states may provide additional Medigap guaranteed issue rights.1

1. Refer to guaranteed issue guidelines in the current CMS Guide, Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

Sales and application Guarantee issue rights for your customers

• Issue state and residence state based on the applicant primary residence • Agent must be licensed (resident or non-resident) in that state

• Premium calculations • Rate based on applicants age on sign date • Payment modal factors apply

• Premium payments accepted from policy holder or immediate family member • No third-party payers

• Monthly Bank Draft (EFT) • Applicants get to choose their draft date for initial and subsequent payments • First payment drafted on chosen date following the effective date • No monthly Direct Bill option • Checking and Savings accounts are both accepted

• Phone Verification required for UW applications

• At this time, we do not accept applications for customers who are currently covered by a Medicare Supplement policy insured or administered through a CSB company. This includes conversions and exchanges.

• All applications must be signed (or e-sign) by the policy-owner. • A Power of Attorney (POA) is not acceptable except OE or GI cases, or other circumstances as determined

during medical underwriting • Proof of POA required

Application guidelines

PHONE VERIFICATION

Phone Verification (PV)

Completing the Phone Verification (PV) at the point of sale: • Application processed faster • Get paid quicker

Where do I call? PV Line: 866.825.4822 Live PV Associates are available for you and your customer Monday – Friday from 8 a.m. to 6 p.m. central time.

What is a PV? A PV is a phone verification interview that applicants must complete in order for CSB to process applications. The PV acts as an electronic signature and also verifies medical questions with the applicant.

What is a Case number? During the PV, the applicant will receive a PV case number that should be included on the app before submitting.

Phone Verification

Phone Verification Process

Product EXPRESS

APP (no wet

signature)

Phone/Fax (no wet

signature)

Paper/Fax (with wet signature)

Medicare Supplement (CHLIC, ARLIC,

LOYAL)

OE/GI Not needed* Live PV Not needed*

Underwritten States offering Preferred, Standard,

STD II & III classes.1

Live PV Live PV Live PV

*Applicant verification in lieu of a PV Live PV: 8am to 6pm, M-F, call 866-825-4822 For Pre-Qualification questions, you may speak to an Underwriter by calling the New Business Underwriting at 877.454.0923

1. Availability of Standard II & III underwriting classes vary by states and are not available on CHLIC.

Post Sale

Post sale information

• If customer is switching policies, once the new application is accepted, they should call the current insurance company, and ask for the coverage to end.

• The customer can sign up for Part D Rx Coverage

during Annual Enrollment Period (AEP) or other applicable enrollment period.

Post Sale

• If an agent submits an application and there is an issue with processing, the agent may receive an email from New Business. – This is called a Request For Information, or RFI. – The requested information can also be found in

the My Clients section in AgentView.

• New Business may also contact the customer directly to correct any errors.

• If required, agent should correct the issue directly on the application, per New Business direction, and send back to New Business for processing.

• The RFI email may be used as agent fax cover sheet • Fax corrections to New Business at 888.695.2591 • Contact New Business at 877.454.0923 for any questions

Post Sale

Request for information (RFI) Post sale information

Telephone and Email Agent Resource Line: 877.454.0923 Phone Verification (PV): 866.825.4822 Claims: 866.459.1755

To reach any of the following departments, call: 877.454.0923: New Business – email to CSBNewBusiness@Cigna.com Underwriting – email to CSBNewBusiness@Cigna.com Commissions – email to CSBCommissions@Cigna.com Licensing & Website Registration – email to CSBLicensing@Cigna.com Website Log-in Assistance – email to CSBAccountService@Cigna.com Product Availability – email to CSBAgentMarketing@Cigna.com Customer Services – email to CSBSupport@Cigna.com Supplies – email to uconnect.cigna@1touchpoint.com

Fax Numbers New Business: 888.695.2591 Paper App Submission: 877.704.8186 Customer Services: 888.670.0146 Supplies: 888.417.8267 Commissions: 512.531.1469 Licensing: 888.832.4154

Contact sheet – Cigna Supplemental Benefits (CSB)

Addresses Overnight and Express Mail (Physical Address): 11200 Lakeline Blvd, Suite 100 Austin, TX 78717 New Business Address: P.O. Box 559015 Austin, TX 78755-9015 Customer Services Address: P.O. Box 26580 Austin, TX 78755-0580

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including American Retirement Life Insurance Company and Loyal American Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 887258 02/17 © 2017 Cigna. Some content provided under license.

medicare 101 & cigna medicare supplement overview 101.pdfmedicare 101 & cigna medicare...

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