New York Highlights: Northeast Downstate

Transcription

1 Downstate Benefit Highlights $0 Premium Plan Part B Giveback Plan Full Product Continuum DSNP in NYC ED Rx Covered on High Option Plan Plans with premium covered by LIS and SPAP (EPIC) Plans include Dental / Vision / Hearing / OTC (up to $100 CARD on DSNP), Acupuncture and Transportation Network Highlights Northwell Advantage Care Mt. Sinai One Medical Lutheran NYU Flushing Hospital Jamaica Hospital Brooklyn Hospital Wyckoff Hospital brook Jewish Hospital Lenox Hill Staten Island North Hospital Staten Island South Hospital Competitive Advantages Strong National Brand Recognition In Market Local Market office and Support Team Year Round Selling opportunities: Dual Eligible Plans and EPIC Opportunity creating a SEP 1

2 Downstate HMO HMO HMO HMO H Premium: $27.40 MOOP: $6,500 PCP /SPEC: $0 / $15 Inpatient: $ Contract/PBP: H H Premium: $ 69 MOOP: $3,400 PCP /SPEC: $0 / $15 Inpatient: $ Contract/PBP: H Nassau Suffolk (Partial) H with $50 Part B Giveback PCP / SPEC: $10 / $50 Inpatient: $1,000 Plan Ded excluding office visits Contract/PBP: H Nassau Suffolk (Partial) H Premium: $28.80 PCP / SPEC: $0 / $35 Inpatient: $ Contract/PBP: H Nassau Suffolk (Partial) 2

3 Downstate HMO Dual SNP NYC MOOP: $0 PCP /SPEC: $0 / $0 Inpatient: $0 Contract/PBP: H OTC: $100 CARD 3

4 Upstate Benefit Highlights $0 Premium Plan in total footprint Part B Giveback Plan Full Product Continuum DSNP full year sales opportunity Plans with premium covered by LIS and SPAP (EPIC) Plans include Dental / Vision / Hearing / OTC (up to $100 CARD on DSNP), and Transportation Network Highlights Lourdes UHS St James Mercy Arnot Saratoga Hospital Endwell Family Group Competitive Advantages Guthrie Robert Packer JAMA WCA UMPC St. Peter s Hospital Ellis Hospital Community Care Strong National and local Brand Recognition In Market Local Market offices and Support Team Year Round Selling opportunities: Dual Eligible Plans and EPIC Opportunity creating a SEP 4

5 Upstate HMO HMO HMO HMO H PCP /SPEC: $5 / $45 Inpatient: $ Contract/PBP: H Broome Chemung Steuben Tioga H Dual SNP Central NY Expanding to Southern Tier MOOP: $0 PCP /SPEC: $0 Inpatient: $0 Contract/PBP: H OTC: $100 CARD Albany, Oneida, Onondaga, Oswego, Rensselaer, Saratoga, Schenectady, Warren, Broome, Chemung, Steuben, Tioga, Washington H PCP /SPEC: $5 / $40 Inpatient: $ Contract/PBP: H Albany, Rensselaer, Saratoga, Schenectady, Warren, Washington H Premium: $26.40 MOOP: $5,900 PCP /SPEC: $0 / $25 Inpatient: $ Contract/PBP: H Albany, Oneida, Onondaga, Oswego, Rensselaer, Saratoga, Schenectady, Warren, Washington 5

6 Upstate H MA Only (VA Plan) with $40 Part B Giveback MOOP: $4,500 / $10,000 PCP /SPEC: $0 / $40 30% OON Inpatient: $ / 30% OON Rx Included or No Rx: NOT Included Contract/PBP: H Allegany, Broome, Cattaraugus, Chautauqua, Chemung, Chenango, Cortland Schuyler, Steuben, Tioga, Yates, Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, Albany, Greene, Montgomery, Rensselaer Saratoga, Schenectady H Premium: $39 / $10,000 PCP /SPEC: $5/$30 $40/$60 Inpatient: $ / $ Contract/PBP: H Allegany, Cattaraugus, Chautauqua, Chenango, Cortland, Schuyler, Yates, Broome, Chemung, Steuben, Tioga H (757) / $10,000 PCP / SPEC: $10/$50 $40 / $70 Inpatient: $ / $ Contract/PBP: H (757) Allegany Cattaraugus, Chautauqua Chenango, Cortland, Schuyler, Yates, Broome, Chemung Steuben, Tioga H (763) with $40 Part B Giveback $10,000 PCP / SPEC: $15 / $50 50% / 50% Inpatient: $1000 IN and OON $650 /stay IN, 50% OON Contract/PBP: H (763) Allegany, Broome, Cattaraugus, Chautauqua, Chemung, Chenango, Cortland Schuyler, Steuben, Tioga, Yates, Cayuga, Herkimer, Jefferson Lewis, Madison, Oneida, Onondaga, Oswego, Albany Greene, Montgomery, Rensselaer, Saratoga, Schenectady 6