2010 Broker Training Ohio

1. 2010 Broker Training Ohio Kelly Howard National Broker Manager Kelly.Howard@MolinaHealthcare.com Phone (562)901-1078 http://www.molinamedicare.com/Pages/index.aspx

2. Agenda • Welcome/Introduction • History of Molina • CMS Marketing and Compliance • Medicare Overview • Election Periods • Molina Medicare Overview • Molina Eligibility Requirements • Benefits • Enrollment Process • Broker Support Unit • Q&A

3. Welcome/Introduction • This product training session is just one step in a 6 step process to sell Molina Medicare products. Contracting Eligibility: • Valid Insurance License • Approved Agent Appointment Application • Errors & Omissions Insurance • Complete the online 2010 AHIP training • Attend a product training class • Complete product test and pass with 85% or higher • Complete the 2010 CMS Medicare Marketing Guidelines Test and pass with 85% or higher • Signed Acknowledgement and review of CMS guidelines

4. National Broker Support Unit • Broker Support Unit Contact Information • Cindy Van Scoten, Supervisor • Jamie Neslen, Unit Lead • Kelly Ward, Broker Support Coordinator • Tammy Bodell, Broker Support Coordinator • Molina Medicare • 7050 Union Park Center, Suite 200 • Midvale, UT 84047 • Toll Free 866-440-9788 (M-F 7am to 6pm MST) • Fax – 562-499-0732 • broker@molinahealthcare.com • Our Broker Support Unit can help with the following: • Verify Medicaid Eligibility • Medicare Infocrossing • Look up Physicians, Medical Group, and Hospitals in your network area • Dedicated help with member issues and concerns

5. Molina Healthcare Mission Statement Our mission is to provide quality health services to financially vulnerable families and individuals covered by government programs. “I want this to be an exemplary organization.” Mary R. Molina Founder

6. History of Molina Healthcare

7. History of Molina Medicare • Molina Healthcare, Inc. entered the Medicare market effective January 1, 2006 • Multi-state Managed Care Organization that arranges for the delivery of health care services • Services are offered to persons eligible to receive health care benefits through government-sponsored programs for low-income families and individuals, such as Medicaid and Medicare Advantage • Molina Healthcare is licensed by the Centers for Medicare & Medicaid Services (CMS) to serve the Medicare beneficiaries in the plan’s service areas of: • California • Florida • Michigan • New Mexico • Ohio • Texas • Utah • Washington Michigan California Ohio

8. Commitment to Quality • Molina’s eligible health plans named among the nation’s Top 50 Medicaid health plans by US News & World Report • Recognized for innovation in multi-cultural healthcare by The Robert Wood Johnson Foundation, NCQA and CHCS • A Fortune 1000 Company • Ranked among Forbes 400 Best Big Companies in America

9. 87% 87% TANF TANF Membership growth Medicaid Markets and members served – Q2 ‘09 in thousands Business Snapshot Washington 323,000 Michigan 207,000 Nevada <1,000 Ohio 203,000 Utah 64,000 Our members SCHIP MEDICARE <1% AGED, BLIND & DISABLED Missouri 78,000 5% 5% 8% 8% California 349,000 Florida 29,000 New Mexico 85,000 Texas 30,000 TANF = Temporary Assistance for Needy Families

10. 86% SNP Membership growth Medicare Markets and members served – Q2 ‘09 Medicare Business Snapshot Washington 995 Michigan 2,502 Ohio Less than 100 Nevada 355 Utah 3,423 Our members MA-PD 14% California 1,829 Florida Jan 1, 2010 effectives New Mexico 420 Texas 462

11. 2009 CMS Marketing and Compliance • Who is CMS? • Centers for Medicare and Medicaid services – Federal Agency responsible for administering Medicare, Medicaid and other federal health programs. • Branch of the U.S. Department of Health and Human Services. • What is our Responsibility to CMS? • To adhere to CMS marketing guidelines and other regulations. This includes, but not limited to all information presented in this training session. • To comply with applicable Federal and State laws and regulations

12. 2009 CMS Marketing and Compliance • CMS update/supplement to the Medicare Marketing Guidelines • These new guidelines provide details on new regulations specifically CMS 4131-F, CMS 4138-IFC and the Medicare Improvements for Patients and Providers Act (MIPPA). Effective September 18, 2008, these new provisions modify existing marketing guidelines and help implement the new Federal regulations.  • As a contracted Molina Medicare sales agent or plan representative you are required to follow and adhere to all of the Medicare Marketing Guidelines. The effective date for most of these new provisions is September 18, 2008. • Prohibiting plans (and their representatives) from conducting sales presentations or accepting plan applications or distributing any plan information (flyers, brochures, pamphlets etc) at educational or health events. • Displaying of Molina Medicare marketing materials of at educational or health events will be prohibited • Prohibiting plans (and their representatives) from making unsolicited outbound calls of any kind unless the beneficiary requested the call. • Any and all calls being conducted where Molina Medicare is a plan being offered must cease immediately.

13. 2009 CMS Marketing and Compliance • Prohibiting plans (and their representatives) from offering meals at any event or meeting in which plan benefits are being discussed or plan materials are being distributed • Snacks can be provided • Requiring plans (and their representatives) to attain agreement from the beneficiary regarding the scope of the marketing appointment prior to the marketing appointment. The agreement must be documented. This documentation must be in writing or recorded. This applies to marketing appointments that result from either an inbound or a properly solicited outbound call as well as appointments made at a sales or marketing event or activity. • Appointment made over the phone must be recorded and saved for 10 years per the record retention requirement. • Appointments made at a event or sales activity must be documented in writing • We understand and appreciate that this is a lot of information to digest and that these new regulations will affect the way you do business. We are in the process of getting further clarification from CMS and hope to be able to provide you more details in the coming weeks. Please feel free to contact our Broker Support Unit 866-440-9788 with any questions or comments.

14. What are the Types of Marketing Events? *Educational events have the most sales restrictions

15. EDUCATIONAL EVENTS are solely educational in nature – no selling or discussing plan benefits • Display banner with plan name and/or logo • Distribute educational material (material about Medicare –no benefit information can be distributed) • Distribute promotional items, include items with the plan name, logo, or contact information • Distribute a business card (that is free of plan marketing or benefit information) if the beneficiary request information on how to contact the sales agent for additional information • Provide refreshments and light snacks Allowed • Conduct sales presentations • Discuss plan-specific premiums and/or benefits • Compare benefits to other health or drug plans • Distribute or collect enrollment applications • Collect names/addresses of potential enrollees • Distribute or display business replay cards, scope of appointment forms or sign-up sheets • Set-up personal sales appointments or get permission for an outbound call to the beneficiary • Attach business cards or contact information to educational materials Prohibited

16. HEALTH FAIRS are defined as having a more casual atmosphere than sales events and are typically comprised representatives at booths available to answer questions • Advertisements and Pre-enrollment materials may be distributed (including an enrollment form) • Plan representatives can ONLY respond to a specific question asked by a beneficiary • Health fair advertising may be sent to enrollees and non-enrollees • Health fairs can have the following sponsorships: • Sole sponsor: single sponsor for an event - Value of giveaways or free items should not exceed $15 per attending person, based on the retail purchase price of all items provided by the plan sponsor • Multiple sponsor: more than one sponsor for an event • Both: single and multiple-sponsor events • For multi-sponsor events: door prizes or raffles can exceed the $15 limit if a plan sponsor contributes to a pool • Plan must not be individually identified and must be listed along with other contributors Allowed • Should not include a sales presentation • No enrollment forms should be accepted at the event- Including the collection of completed applications • Value of giveaways or free items should not exceed $15 per attending person, based on the retail purchase price of all items provided by the plan sponsor Prohibited

17. CMS-sponsored Health Fairs • CMS is required to conduct an outreach and education campaign to inform potential enrollees on health and drug plans • Plans may do the following: • Assist in planning local health fairs • Distribute health plan brochures and application forms • Have a booth at the health fair • Value of giveaways or free items should not exceed $15

18. PROVIDER EVENTS : Agents CANNOT conduct sales activities in healthcare settings, EXCEPT in common areas****common areas include – hospital/ nursing home cafeterias, community or recreational rooms, and conference rooms**** • Provide names of plans they are contracted with • Provide information and assistance in applying for LIS • Provide objective information on ALL plan sponsors benefits and formularies • Make available and/or distribute information on all plans the provider participates with • Refer patients to other sources of information (Medicaid office, marketing representatives, etc) • Print and share information from CMS’s website Allowed • Offer sales/appt forms • Accept MAPD applications • Mail marketing materials on behalf of plan • Steer beneficiaries to a plan based on financial or ant other interest • Offer anything of value to urge plan enrollees to select them as their provider • Health screening when distributing information to patients • Accepting compensation directly or indirectly from plan for beneficiary enrollment activities Prohibited

19. Sales/Marketing Events CMS has defined 2 types of sales /marketing events in 2010 --- KEY DIFFERENCES Formal Sales Events • These follow a structured presentation (ex. seminar). • Presenters MUST announce all products they will cover at beginning of Presentation Informal Sales Events • Non-structured (ex. Table or kiosk manned by a sales person) • Can only discuss plan merits when approached by a Medicare Beneficiary

20. Sales Events • Distribute marketing material • Distribute and collect sales applications • Present benefit information from presentation, scripted talk, electronic slides, handouts, etc. • If a beneficiary request 1:1meeting –must completed scope of appt for a subsequent meeting • Provide nominal gifts with no obligations Allowed • Conduct health screenings or like activities that could be considered “cherry picking” • Compare one plan sponsor to another by name • Provide meals to attendees Prohibited

21. Cancelling/Changes Events • Changes to events: • If you have already set up an event, but made a change in the meeting ID, date, time and/or location this change must be reported to CMS. • Cancellations: • Sales Agents must attend the cancelled event and stay for the full advertised time to redirect any potential prospects.

22. Please refer to CMS chapter 3 Marketing Guidelines link http://www.cms.hhs.gov/manuals/downloads/mc86c03.pdfif you have additional questions or • Contact: Molina Medicare Broker Support Unit (BSU) • Toll Free 866-440-9788 (M-F 7am to 6pm MST) • Fax – 562-499-0732 • broker@molinahealthcare.com

23. Medicare Overview • Medicare is the nation’s largest health insurance program, covering approximately 42 million Americans Administered by Centers for Medicare and Medicaid Services (CMS) • The Medicare Program has four parts: • Part A Hospital Insurance • Medicare Part A helps cover inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also helps covers hospice care, some home health care, and blood. • Part B is Voluntary Medical Insurance • Monthly premium estimate of $96.40 deducted from Social Security check or paid for by state if recipient is enrolled in full Medicaid benefits. • Medicare Part B helps cover doctor’s services, outpatient hospital care, testing, labs certain preventative screenings and DME. • Part C Medicare Advantage plans • Part D is Voluntary Prescription Drug Coverage • First comprehensive prescription drug benefit ever offered • Nearly 4 in 10 Medicare Part D plan enrollees are receiving low-income subsidies. • Medicare prescription drug coverage helps the Medicare beneficiary pay for the prescriptions they currently need or may need in the future. • There is also additional help for those who are low income. • Medicare prescription drug coverage pays for brand name as well as generic drugs.

24. Medicare Overview •  Will my Medicare Part B premium increase in 2010? • Answer • Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium will not have an increase in their Part B premium for 2010.  • For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  In 2010: • New Part B beneficiaries will pay $110.50 (because they did not have the premium withheld from their Social Security benefit in the previous year). • Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit will pay $110.50. • Higher-income beneficiaries pay $110.50 plus an additional amount,  based on the income-related monthly adjustment amount (IRMAA).

25. Medicare Overview • Eligibility: • People age 65 or over who are entitled or whose spouse is entitled to monthly Social Security benefits • People under age 65 who have been entitled to Social Security disability benefits for at least 24 months • People who are entitled to Social Security benefits and need maintenance kidney dialysis (ESRD – End Stage Renal Disease). • People under age 65 with ALS, the first month they are entitled to Social Security benefits. • Amyotrophic lateral sclerosis (ALS), often referred to as "Lou Gehrig's Disease," is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease may become totally paralyzed.

26. Medicare Overview Beneficiaries who choose a Medicare Advantage plan do NOT give up their Medicare benefits. The Medicare beneficiary retains their Medicare Card, also known as the red, white and blue card and shows their Medicare Advantage and/or Prescription Drug Plan Identification Card when obtaining plan benefits. For more information on Medicare Program, call 1-800-MEDICARE or log on to www.medicare.gov or call Social Security at 1-800-772-1213

27. Election Periods • CMS Indicates Annual Enrollment Period Remains Unchanged for 2011; Modifications for Open Enrollment Period • The Centers for Medicare & Medicaid Services (CMS) is in the process of finalizing the Marketing and Enrollment Guidelines to address the modifications to the enrollment periods for Medicare beneficiaries starting in 2011 required by the Patient Protection & Affordable Care Act (PPACA) that became law on March 23, 2010. • NOTE: It is important to remember that CMS has not issued final guidance and this information is only based on non-binding statements from CMS. • 2011 Annual Enrollment Period (AEP) • There are no changes expected for the 2011 AEP that runs November 15 - December 31, 2010. All elections made during that time period will be effective on January 1, 2011.  • Open Enrollment Period (OEP) replaced with Annual Disenrollment Period (ADP) • Starting in 2011, the OEP will no longer exist. In its place, CMS will implement an election period called the Medicare Advantage 45-Day Annual Disenrollment Period (ADP). The ADP will run from January 1 through February 14th. During the ADP, beneficiaries who are enrolled in a Medicare Advantage (MA) plan (either MA-only or MAPD) have one election available and may disenroll from that plan back to Original Medicare. Beneficiaries may also use the ADP to pick up a stand-alone Part D plan, regardless of whether or not they have had Part D coverage previously.  • 2012 AEP • CMS will modify the 2012 AEP dates to October 15, 2011 through December 7, 2011. All elections made during that time period will be effective January 1st 2012.

28. Election Periods • Initial Enrollment Period (IEP) Individuals who are becoming eligible for Medicare will have an IEP that is the 7 month period surrounding Medicare Eligibility (same as IEP for part B). The IEP for Part B is 7-month period that begins 3 months before the month an individual meets eligibility requirements for Part B and ends 3 months after the month of eligibility. • Special Election Periods (SEP) • There are a large number of SEP’s. Below you will find a few examples of what qualifies as a SEP. • Beneficiaries listed below can change plans at any time during the year, or until their status changes: • Dual Beneficiaries – those with Medicaid and Medicare coverage • Beneficiaries in a Medicare Savings Program • Qualified Medicare Beneficiary (QMB) • Special Low Income Medicare Beneficiary (SLMB) • Qualified Individual (QI’s) • Institutionalized beneficiaries • The following SEP election periods are time-limited • Chronic illness (e.g. diabetes, heart failure) • Loss of credible coverage

29. Molina Medicare Eligibility Requirements • The following are the eligibility requirements to join the Molina Option and Option Plus plans. • Must be entitled and enrolled in Medicare Part A and Medicare Part B • Must live in the plan’s service area. • Must not have End Stage Renal Disease (ESRD). • ESRD is permanent kidney failure and requires regular kidney dialysis or a transplant to stay alive. • Must complete the enrollment form during an applicable enrollment period. • Must use providers, pharmacy and services within the Molina network. • Must choose a Primary Care Physician (PCP) and coordinate all care with specialists through the PCP. • Must use the formulary for prescriptions. • Must have the required services pre-certified. Molina Option Plus Must have full Medicaid/Cal. Partial Medicaid/Cal is not allowed on plan

30. Dual Eligible Populations • Qualified Medicare Beneficiary (QMB) – Up to 100% of the FPL • Full Benefits – Part B Premiums, co-insurance and deductibles paid by Medicaid • No retro coverage; eligibility begins the month after approval • Eligible for Special Needs Plan – Molina’s “Options Plus” if eligible for Medicare Part A and enrolled on Part B and receiving full Medicaid benefits • Specified Low Income Medicare Beneficiary (SLIMB) – Up to 135% of the FPL • Part B Premiums Paid; automatically enrolled in Medicare Part D • Retro coverage up to three months; eligibility begins the month of approval • Pro-rated low income subsidy • Not eligible for Molina Options One • Qualified Individual (QI) – UP to 150% of the FPL • Part B Premiums Paid; automatically enrolled in Medicare Part D • Retro coverage up to three months; eligibility begins the month of approval • Pro-rated low income subsidy • Not eligible for Molina Options One

31. Morrow Delaware Union Franklin Madison Montgomery Preble Greene Pickaway Molina Medicare Plans - Ohio • Molina Medicare Ohio service areas include the counties of: • Delaware • Franklin • Greene • Madison • Montgomery • Morrow • Pickaway • Preble • Union

32. Molina Medicare OH Network updates

34. Molina Medicare Plans - Ohio • Molina Options Plus -Medicare Advantage Special Needs Plan with Part D (SNP) • Molina Options -Medicare Advantage Prescription Drug (MAPD)

35. Why Molina Options Plus OH • Generic Prescription Drugs - $0 co-pay • Podiatry Routine - $0 co-pay - 12 visits per year • Dental Preventive - $0 2 per year • Oral exams • Prophylaxis • Fluoride Treatment • X-Rays • Dental Comprehensive $500 • ER Services, Diagnosis Svcs, • Restorative Svcs, • Endodontics/Periodontics/Extractions, • Prosthodontics, other oral/maxillofacial surgery - $500 per year • Routine Hearing test - $0 co-pay - 1 per year • Hear Aids - $400 limit - every 3 years • Hear Aid Fitting Eval - $0 co-pay - 1 every 3years • Vision Exam - $0 co-pay – 1 per year • Glasses/Contacts/Lenses/Frames/Upgrades - $200 - every 2 years • Transportation 60 One Way Trips - $0 co-pay • Over The Counter (OTC) Benefit - $20.00 a month

36. Molina Medicare Plans - Ohio

37. Molina Medicare Plans - Ohio

38. Molina Medicare Plans - Ohio

39. Molina Medicare Plans - Ohio

40. Molina Medicare Plans - Ohio

41. Molina Medicare Plans - Ohio

42. Prescription Drug Coverage - Ohio

43. What is MTM’s criteria for transportation?  • Medical Transportation Management, Inc (MTM) toll-free at 1-866-867-3208, Monday through Friday from 8 a.m. to 5 p.m. • Members are expected to: • Call MTM to arrange transportation at least 72 hours (3 business days) in advance.  Saturday, Sunday, and holidays do not count towards the 3 business days. You will need to know your Molina Medicare ID number, full name, current address and telephone number, and have the complete address and telephone number of the office where your appointment is scheduled. You will also be asked the medical reason for your transportation request and the type of appointment (doctor, dentist, pharmacy, etc.) • MTM will assign a mode of transportation based on your specific needs and abilities. • What is MTM’s criteria for Mileage Reimbursement? • MTM would provide reimbursement to anyone the member identifies as the transportation provider, this would include the group home or caregiver. • The member would call MTM to schedule the trip and request reimbursement at that time.  • MTM will verify that the trip took place by calling the doctor or service provider to make sure the member kept the appointment.  • MTM will then send a check to the appointed person ($.35/per mile).  If a group home or caregiver is involved and they call to schedule a trip on the member’s behalf, the same process would apply. Call us right away if you need to cancel your ride or if you have any other concerns. (Reimbusements usually take between 3-6 weeks to receive once submitted)

44. Over the Counter Benefit (OTC) • The OTC benefit can be access two different ways; • via the web at CVS.com • via phone order • You may purchase the OTC products at any pharmacy and then submit the invoice for reimbursement under your monthly OTC benefit. Beneficiary must spend their maximum benefit amount; what they don’t use expires at the end of each month (no carryover). • Member Id number is on the ExtraCare Health Card • Beneficiary must have the ID number to access their account • For more information or to order, call the Molina Medicare OTC benefit administrator: 1-888-607-4287 or online anytime at www.CVS.com/OTC • Allow 7-10 days for shipping. Product specifications are subject to change. • *Shipping is free when they order once a month. A flat rate of $5.49 is charged for shipping any order beyond the benefit amount. Checks, money orders, American Express, Master Card and Visa are accepted. Benefit amount varies by plan. Check your 2010 Evidence of Coverage for your plan’s benefit amount.

45. Molina Medicare Enrollment Process • Make sure to check the box of the appropriate plan and state you are enrolling the member in. Options is the MA-PD and Options Plus is the MA-SNP (Dual eligible) • Information on the enrollment form must exactly match the information on Medicare card. • If enrolling into the Options Plus, please enter the member’s Medicaid/Cal number (#4 page 3). • Answer all questions on the application. • Enter the member’s Primary Care Physician and Medical Group/IPA name and ID Number. • Do not sign the Authorized Representative Signature line. This is for member and/or member’s who have a POA. • “OFFICE USE ONLY” You complete the following; • Your name / Broker # • Phone # / Email • Date • Enrollment period as it applies

46. Molina Medicare Enrollment Process • Unauthorized Language Interpretations • If the Agent does not fluently speak the beneficiary’s language, then s/he should suggest that the beneficiary provide a translator. • If the beneficiary does not have someone who can translate for them, the agent should arrange for an agent or translator who speaks the beneficiary’s language to present the plan. • When the beneficiary provides his/her own translator, a Translator/Witness Statement form must be attached to the enrollment form when it is submitted.

47. Molina Medicare Enrollment Process

48. Molina Medicare Enrollment Process • A faxed copy of the enrollment form must be sent to Molina Medicare @ (562) 499-0732 within 48 hours of signature from the prospective member, or mail the original within 48 hours to the following address: Molina Medicare Attention: Cindy Van Scoten 7050 Union Park Center, Suite 200 Midvale, Utah 84047 Fax: 562-499-0732 • All enrollments signed at the end of the month must be faxed to Molina by Noon MST on the first business day of the following month; otherwise, the enrollment will receive an effective date for the month following.

49. Molina Medicare Enrollment Process • A welcome call is made within one week of confirmed enrollment • Verify if member received welcome letter and ID card • Give ID number and explain pharmacy letter • Ask if they have any additional questions regarding the plan • Post sales surveys will be added to a minimum of 25% of the welcome calls. We will measure your response rate on these surveys on a monthly basis, and look for scores to remain above 85% • Did the advisor explain that you still have Medicare and Medicaid / Cal and Molina will provide your Medicare provided hospital, physician and prescription drug coverage? • Did the advisor review your prescription drugs and provide you with the approved list of prescription drugs? • Did the advisor review your hospitals and doctors and provide you with a book of contracted providers? • Did the advisor explain how you will work with your nursing teams and the authorization process? • How did you hear about Molina Medicare? • Where did your enrollment appointment take place? • Overall, were you satisfied with the advisor you met with to enroll?

50. Molina Medicare Enrollment Process • A post-enrollment package is mailed to the member after the enrollment form is processed and confirmation is received from CMS. • The Molina Medicare post-enrollment packet includes: • The Member’s Plan Identification Card • The Member’s Acknowledgment Letter • Evidence of Coverage (includes written explanation of the plan’s exceptions and grievance and appeals processes) • The Mail-Order Pharmacy Forms