Hum1ana's New Member Welcome Guide

Humana'sNew Member Guide

2021

What to do when a new member calls

Confirm mbr had received their ID card and plan information (EOC, Drug List, Pharmacy directory)

www.Humana.com/plandocuments -CRM --> OMS

Ask mbr if they recieved their welcome kit which includes:-ID card-PDP Outlier flier-Envelope If mbr has not recieved it yet, offer to send one.(transfer the case to)

First remember to welcome our member

Welcome to Humana! I'm glad you called today So I can Help you review how your new plan works. I noticed you just join Humana! welcome! I'll be happy to review anyquestions you have about your new plan

Offer our member to help them discover benefits of their new plan, such as:

• Prices of their medications thru Rx calculator -www.humana.com/Rxcalculator
• Coverage on different pharmacies and help them find their closest preferred and standard pharmacies. -Pharmacy Finder (CRM) Mentor document

Always remember to be kind and make our new members feel Humana cares for them

Payment Methods

Member can choose from the 2nd to the 7th day of the month to make their payment.

Show our member the different types of payment method Humana offers to them.

mentor document

Credit/Debit card payments (can be recurring or one-time payment) ACH/Bank account payment (can be recurring or one-time payment) Social Security Administration SSA(recurring payment only) RailRoad Retiree Board RRB (recurring payment Coupon Book (they send the check montlhy) Also accesing to www.humana.com

STAGES

Deductible:Your deductible is the amount you pay out of pocket before Humana begins to help pay for your higher tier prescriptionsYoupay 100% of your medication costs of tiers without a copay until you reach your deductible $445(2021)Some policies exclude tier 1 and 2 medications from the deductible stage, make sure to open teir benefit grid to get all the information needed. If you have a copay for a drug in the deductible stage, that copay does not count towards the deductible because you aren’t responsible for the entire cost.

Explain to the member the different stages their plan has and the benefits of each one.

Coverage Gap (donut hole)

Initial coverage (Stage 2)

Once the amount the member and Humana have paid exceeds initial coverage for your medications, you enter on what is called the “Coverage Gap”.You will stay at this level of coverage until your total out of pocket cost (TrOOP) for the year has gone above $6550During this time you will pay a maximum of 25% of the cost of brand name drugs and the cost of generic drugs. Everything you have paid out of pocket in the previous stages counts toward the $6550 (2021)Any amount Humana has paid in this stage while sharing the cost of your medications DOES NOT COUNT to the $6550.

After your deductible is met, Humana will share the cost of your medications with you until the shared total equals your initial coverage limit $4130 (2021)You’re only responsible for a portion of your medication costs in this stage. You will pay a flat rate for each medication or a percentage of the total cost depending on the tier of the drug.The flat rate for a medication is called a “copay” or “copayment” and the percentage of the medication’s cost is called “coinsurance”

Catastrophic Stage Last stage

If your total out of pocket costs for medications would be more than $6350 (2021) for the year, you will be eligible for what is called Catastrophic Coverage.During this stage you will pay a flat rate of $3.70 for generic/preferred, or $9.20 for all other drugs, OR you will pay 5% coinsurance of the medications total cost. (Whichever is greater)

ALL THE PRICES MENTIONED on the prevous pages are nationally set Medicare values. Members changing plans to another company will not reset their accumulations.These accumulations (including the deductible) will reset and potentially change every year. That means Every January they restart.

Important mentor documents