Can't Discuss Value Added Services During AEP

[rousemark]

This is how Humana wants us to handle it....

"IF ASKED SPECIFICALLY ABOUT VAIS, an appropriate response for
an agent to provide would be:
“Mr./Mrs._________, yes we do have some additional discounts and
services and they vary by geographic area. However, those additional
discounts and services are not considered actual benefits of the plan
and are not really part of what we think you should be basing your
enrollment decision on whether this is the right plan for your possible
medical needs. In fact, CMS asks us not to discuss them until you
actually become a member so that the focus isn’t taken off of what is
most important.
When you become a plan member, you’ll be sent all the information
about those additional discounts and services, and we can discuss them
at length when we talk again during your New Member Orientation. At
that time, I’ll be reviewing those value added services, some additional
information on how to get the most out of your plan and a few other
things. Would that be alright with you?”"

And, the crusty old senior says, "No, that won't be alright.. I want all the information available upon which to base my opinion and I don't like being patronized by a young kid half my age."

Someone gives me that CMS speech, they may end up wondering why they are standing in the driveway instead of sitting at the table.

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Answer: Any and all value added services will be mentioned in the Welcome Kit you receive. Once you receive your Welcome Kit, call me, and we will discuss them in greater detail.[/I]

Better, but I think that I would preface it with, "In their infinite wisdom of knowing what is best for you, the federal government has forbidden me to discuss that with you right now."

 

[sman]

And, the crusty old senior says, "No, that won't be alright.. I want all the information available upon which to base my opinion and I don't like being patronized by a young kid half my age."

Someone gives me that CMS speech, they may end up wondering why they are standing in the driveway instead of sitting at the table.

----------



Better, but I think that I would preface it with, "In their infinite wisdom of knowing what is best for you, the federal government has forbidden me to discuss that with you right now."

The good news is Humana was wrong and we ARE allowed to discuss all of the benefits with you. Humana may have a rule where they don't allow it, but CMS doesn't have that rule. And if Humana has it in their Summary of Benefits, how in the world do they expect an agent not to cover that since we are required to go through the Summary of Benefits with a prospective client? Sometimes people just have no common sense.

 

[rousemark]

The good news is Humana was wrong and we ARE allowed to discuss all of the benefits with you. Humana may have a rule where they don't allow it, but CMS doesn't have that rule. And if Humana has it in their Summary of Benefits, how in the world do they expect an agent not to cover that since we are required to go through the Summary of Benefits with a prospective client? Sometimes people just have no common sense.

Fortunately, that doesn't apply to any agents working in the field.... Just gubermint and HO types...

 

[jbage007]

Did you see this for AEP ?.....

"NEW: Value Added Services can no longer be discussed during the
Medicare Advantage Appointment. The prospect must be a member
before the Value added services for a plan can be discussed.
Agents are not permitted to discuss or mention VAIS during the initial
sales presentation."

Vision discounts, Silver Sneakers, etc.

Why are you guys so concerned about not being able to discuss Silver Sneakers?
Silver Sneakers is NOT a "value added" service.


Where available, Silver Sneakers is a benefit, period.

 

[sman]

Why are you guys so concerned about not being able to discuss Silver Sneakers? Silver Sneakers is NOT a "value added" service. Where available, Silver Sneakers is a benefit, period.

Number one, the carriers consider SS a value added benefit, period. As a matter of fact, I went to a carrier meeting this week and they had SS, dental and vision all listed under VAB's. Second, it's not that we are "so concerned" about not being able to discuss VAB's. It's the fact that a carrier says we can't when they will likely be in the Summary of Benefits. It makes no sense.

 

[vic120]

Number one, the carriers consider SS a value added benefit, period. As a matter of fact, I went to a carrier meeting this week and they had SS, dental and vision all listed under VAB's. Second, it's not that we are "so concerned" about not being able to discuss VAB's. It's the fact that a carrier says we can't when they will likely be in the Summary of Benefits. It makes no sense.

I've seen with several companies

Including Humana

VAS is not referring to Silver Sneakers or the dental that is listed in the benefits section of the summery of benefits

But it is referring to the dental discounts and other discounts the jenny Craig
Life lock

All those odd discounts you see after the benefits section is complete

 

[sman]

I've seen with several companies

Including Humana

VAS is not referring to Silver Sneakers or the dental that is listed in the benefits section of the summery of benefits

But it is referring to the dental discounts and other discounts the jenny Craig
Life lock

All those odd discounts you see after the benefits section is complete

The issue here is Humana, if my memory serves me correctly, specifically listed SS in the training saying it can't be discussed as a VAB (I tried to go back and pull up the training material, but it won't allow me to do it). And in my Aetna/Coventry meeting, they listed Fitness, Dental, Hearing and Vision under the heading "Value Added Benefits". I don't disagree that the discounts to the other things are value added benefits. But this entire discussion began because Humana said things like Silver Sneakers couldn't be discussed.

 

[vic120]

The issue here is Humana, if my memory serves me correctly, specifically listed SS in the training saying it can't be discussed as a VAB (I tried to go back and pull up the training material, but it won't allow me to do it). And in my Aetna/Coventry meeting, they listed Fitness, Dental, Hearing and Vision under the heading "Value Added Benefits". I don't disagree that the discounts to the other things are value added benefits. But this entire discussion began because Humana said things like Silver Sneakers couldn't be discussed.

I've done webinar with Humana in the past

and they made it clear VAS are not benefits and do not appear as a benefit
in summery but they appear after as discounts for carious services

Dental can be VAS if it not in the main summery but show as a discount later

but if there is a copay or a $0 copay and shows in the main summery it is not a VAS but a benefit of the plan

I do believe I have seen other opinions from some other carriers
Every carrier has there on way of interpreting things
sometimes Different people from the same company has deferent ways
of interpreting things

 

[sman]

Every carrier has there on way of interpreting things

There was never a more true statement. Take for example the ability to mail an enrollment kit and still get paid for the enrollment, Humana says you can't while several other carriers have no issue with it.

I'm so glad that Aetna/Coventry has gotten Piedmont in their network for this coming year. In my county and one county over, there is a Piedmont Hospital in both counties (the only hospitals within 20 miles) and until this year, Humana was the only carrier who had them in network (Kaiser did as well, but they aren't a viable option in this area for most people - and CIP treated them in-network, but their plan leaves a lot to be desired). Piedmont WellStar Health plan came to town this past year and likely put a dent in Humana's business in this area. And now Aetna/Coventry will have these two hospitals.

I'm just glad to have someone other than Humana to offer in this area. The plan in this area for Humana is a zero premium HMO (which requires referrals) or a $50 premium PPO. Not sure what it will be for 2015, but Aetna/Coventry will have a zero premium PPO. Most people prefer a PPO over an HMO in this area (can't speak for other parts of the country). So given the choice, they will likely choose the PPO given most other things being fairly equal.

 

[vic120]

Def interested to see how Aetna/Coventry is this year

I did not recert yet with them

but last year Coventry gave me a hard time about reserts for over the phone
in some states

while Aetna is easy to work with

hopefully this merger will help