Welcome to Wellcare� �OHIO MARKET ��2024
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Here’s why…�
Robust Network
Competitive Plans:
Strong Partnership with Oak Street
Strong Partnership with Dedicated
New Spendable Card
Part B Diabetic Testing Supplies
(1 meter per 365 days; 100 test strips per 25 days)
Improved Formulary
Payment of all D-SNP and C-SNP HRAs to effectuation vs. submission effective April 1, 2024.
This applies to all D-SNP and C-SNP HRAs completed in both Ascend and Sunfire
Highlights:
$150 per completed HRA for effectuated members (1 per member, D-SNP and C-SNP only) No payment on non-SNP HRAs
Plans in all Ohio 88 Counties
Corey
Kim
Nicole
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Portfolio Approach
Special Needs Plans
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Products | Product Examples | Target Market |
Zero Cost-Share D-SNP – Fully Eligible Medicare/Medicaid |
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Zero Cost-Share D-SNP – Cost-Share Protected Duals in each state |
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NEW Non-Zero D-SNP – All MSP Levels allowed in each state |
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Non-Zero D-SNP |
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Portfolio Approach
Traditional Medicare Advantage
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Products | Product Examples | Target Market |
Part B Premium Giveback |
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$0 premium |
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Part D Premium (LIS) |
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PY2024 NEW All Dual Plan Offerings
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Dual plans will have a consistent structure of MSP eligibility levels across plans.
STRUCTURE
All Dual/All Dual Assure Plan Design:
Liberty
MSP: QMB+, SLMB+, and FBDE
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Access
MSP: QMB, QMB+, SLMB+, and FBDE
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All Dual or All Dual Assure
MSP: QMB, QMB+, SLMB+, FBDE+, SLMB only, QDWI, and QI
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Plan Offering | States |
Wellcare All Dual Assure (HMO D-SNP) | AL H6975, AR H9630, KY H9730, LA H2491, MI H5475, MS H1416, NC H4073, OK H9900, OH H0908- 006 TX H0174, WI H8189 |
Wellcare All Dual (HMO D-SNP) | FL H1032, GA H1112, NM H2134 |
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All information on this slide is subject to change until approved by CMS.
Low Income Subsidy Plans
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It is important to understand LIS status at the point of enrollment in order to properly articulate premium, deductible, and copays, and get members into the best plan for them.
Medical
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Key Benefit Highlights
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Primary Benefits
2024 Part D Product Design for MAPD
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PART D PROGRAM REDESIGN
PRODUCT IMPROVEMENT AND INNOVATION
2024 Part D Product Design for MAPD
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MAINTAIN COMPETITIVE BENEFITS
OPTIMIZE BENEFIT DESIGN
Deductible
Reduced Cost-Sharing
Gap Coverage
Medication Home Delivery
Preferred Pharmacy Network
Ohio Market Overview
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Ohio | Review
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2024 MAPD Supplemental Benefits
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2024 MAPD Benefit Highlights
Benefit | Availability | Highlight |
Wellcare Spendable Card | Many plans |
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Dental | Most Plans |
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Vision | Most Plans |
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Hearing | Most Plans |
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2024 MAPD Benefit Highlights
Benefit | Availability | Highlight |
Non-Emergency Medical Transportation (NEMT) | Most plans |
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Fitness | Most plans |
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Personal Emergency Response System (PERS) | Some Plans |
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Meals | Most plans |
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In-Home Support | Some plans |
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2024 MAPD Benefit Highlights
Benefit | Availability | Highlight |
Telehealth | All plans |
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Nursing Hotline | All plans |
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CAM | Some plans |
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Routine Acupuncture | Some plans |
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Routine Chiropractic | Some plans |
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Routine Podiatry | Some plans |
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Part B Diabetic Testing Supplies Strategy
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Where Can I Find the First Looks?
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Our Brand and Plan Details
PY2024 Multi-Benefit Card:�Introducing Wellcare Spendables ™
A single card provides an allowance access to multiple benefits:
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Introducing Wellcare Spendables™
All information on this slide is subject to change until bids are submitted and approved by CMS.
Benefits Covered |
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DVH Cost-Share Assistance (Dental, Vision & Hearing) | Network = Approved MCC Codes | N/A |
OTC (Over-the-Counter) | Retailer Network | Yes, Limited |
| *Online shipping and delivery fees will use allowance funds. | **Mail order will require minimum amount for free shipping. |
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Wellcare Spendables™ Debit Cards�
Category level: Items are managed at a category level. Categories allow members to purchase brand name/generic items, and we have the ability to limit approved categories to ensure members purchase approved items.
OTC Items:
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Solutran Network Coverage
Merchant Group Coverage Across 37 Markets | ||
Ahold | Giant Eagle | Publix |
Albertsons Companies | Hmart | RiteAid |
Butera | HyVee | Southeastern Grocers Inc |
Coborn's | Independent Retailers | Walgreens |
Cub Corporate | Kroger | Walmart Store |
CVS | Miners Super One | Western Beef |
Delhaize - Food Lion - Hannaford | Niemann Foods | Woodman's |
Dollar General | Piggly Wiggly Midwest |
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Network as of July 2023. Network build ongoing.
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Ohio | Review
Wellcare
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Ohio | Service Area
Wellcare Continued Coverage Counties:
Wellcare
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Ohio | At a Glance
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Push Plans | Plan Type | Benefit Highlights |
Wellcare by Allwell Dual Access (H0908-001) | HMO D-SNP |
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Wellcare All Dual Assure (H0980-006) | HMO D-SNP |
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Wellcare by Allwell No Premium (H0908-003) | HMO |
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Wellcare by Allwell Giveback (H0908-005) | HMO |
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Wellcare by Allwell Dual Access Open (H7169-003) | PPO D-SNP |
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Wellcare No Premium Open (H7169-001) | PPO |
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*Additional eligibility is required to qualify for SSBCI benefits
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Ohio | Key Selling Features
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Plan Name | Benefit Highlights |
Wellcare Dividend Giveback (HMO) H5475032000 | Giveback, Dental, Hearing, OTC Allowance, Vision |
Wellcare No Premium Open (PPO) H7169001000 | Multi-wallet benefit including dental, vision, hearing, and OTC, Dental, Hearing, Meal, Vision |
Wellcare Dual Access Open (PPO D-SNP) H7169003000 | VBID RX, Dental with dentures and crowns, Multi-wallet benefit including dental, vision, hearing, OTC, groceries, utilities, and rent assistance, Vision, Transportation, Non-emergency |
Wellcare Classic (PDP) S4802085000 | Designed for Duals (LIS), $0 Tier 1 (after deductible if applicable) at preferred pharmacies, New $0 drug tier added with medications commonly used to treat diabetes |
Wellcare Value Script (PDP) S4802149000 | Low Premium, No deductible on Tier 1 and 2 medications (preferred generic and generic), $0 copay for Tier 1 drugs at preferred pharmacies |
Wellcare Medicare Rx Value Plus (PDP) S4802217000 | No deductible for all tiers, $0 copay for Tier 1 drugs at preferred pharmacies, low cost drug tier designed for medications commonly used to treat diabetes |
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2024 MAPD Product Overview
HMO, HMO-POS & PPO Plan Options
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2023 MA & DSNP Provider Network
*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries.
2023 DSNP Only Provider Network
*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries.
Wellcare No Premium HMO�H0908-0003-000 | In-Network
$0 Premium & $0 Medical Deductible
$4,700 Maximum-Out-Of-Pocket (MOOP)
$3,000 Comprehensive Dental Allowance + Dentures
$66Wellcare Spendables Card for OTC and/or Additional DVH services every month
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Wellcare Assist (HMO) �H0908-0004-000 | In-Network
$0 Premium & $0 Medical Deductible
$4,700 Maximum-Out-Of-Pocket (MOOP)
$3,000 Comprehensive Dental Allowance + Dentures
$67 Wellcare Spendables Card for OTC and/or Additional DVH services every month. 2nd Allowance of $50 per month available for Utility Assistance for qualified members.
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Wellcare Giveback HMO�H0809-0005-000 | In-Network
$ 106.00 Premium Part B Giveback
$7500 Maximum-Out-Of-Pocket (MOOP)
$40 OTC per quarter (non rolling) for covered items
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Wellcare Dual Access (HMO D-SNP)�H0908-0001-000 | In-Network
MSP levels FBDE, SLMB+, QMB+, QMB
$8,850 Maximum-Out-Of-Pocket (MOOP)
$5,000 Comprehensive Dental Allowance + Dentures
Single allowance for Gas Pay-at-the-Pump, healthy food, Utilities Assistance. Rent Assistance, OTC and additional DVH Services of $173 every month
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Wellcare All Dual Assure (HMO D-SNP)�H0-0006-000 | In-Network
MSP FBDE, QDWI, QI, QMB+, QMB, SLMB+, SLMB
$6,500 Maximum-Out-Of-Pocket (MOOP)
$1,000 Comprehensive Dental Allowance, includes exams, fillings, and minor restorative
Single allowance for Gas-at-the-Pump. Healthy Food, Utilities Assistance, Rent Assistance, OTC and additional DVH Services of $215 every month
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Wellcare Dual Access Open (PPO D-SNP)�H7169-002-000
MSP levels FBDE, SLMB+, QMB+, QMB
$8,850 Maximum-Out-Of-Pocket (MOOP) IN Network . $13,300 combined
$3,000 Comprehensive Dental services incl. exams, filings, major restorative services and dentures. Out-of-network 50% cost share
Single allowance for Gas Pay-at-the-Pump, healthy food, Utilities Assistance. Rent Assistance, OTC and additional DVH Services of $145 every month
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Wellcare No Premium Open (PPO)�H7169-001-000
Zero Premium PPO
$ 5,900 Maximum-Out-Of-Pocket (MOOP)in-network. Maximum-Out-of-Pocket $8,950 Combined
$1, 000 Comprehensive Dental Allowance + , inc exams, fillings, minor restorative services and dentures
Single allowance for OTC and/or DVH services of $32 every month
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Broker Experience Enhancements
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Commission Statement
SELF-SERVICED
Dashboard Reporting
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Wellcare Enrollment Options
Electronic Application Portal
PURL
(Personalized URL)
Beneficiaries can self-enroll (No SOA is required)
Paper
Applications
Fax to Wellcare or upload in Centene Workbench
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Resources for YOU!
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Broker Communications
Communication Type | Communication Topics |
Broker Bulletins |
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The Ascend Advantage |
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Weekly News |
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Product Pointers |
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Be on the lookout for important email communications throughout the 2024 AEP season.
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Broker Support Resources�
Support | Purpose | Contact Information |
Broker Support | Assistance with contracting, certification, commissions, onboarding, etc | 866-822-1339 Mon – Fri: 8AM – 9PM EST |
Paper Application Submission | Submit paper enrollment applications via FAX | 866-473-9124 (MAPD) 866-388-1521 (PDP) |
Request for Information (RFI) | Resolve applications in Pending status | 866-822-1339 Mon – Fri: 8AM – 8PM EST |
Special Populations (SPOP) Medicaid Eligibility | Eligibility support for Medicare and Medicaid | 866-211-0544 Mon – Fri: 8AM – 8PM EST Sat – Sun: 8AM – 5PM EST |
Telephonic Scope of Appointment (SOA) | Document SOA via Appointment Verification Line (AVL Line) | 877-780-3920 (MAPD) 877-297-3625 (PDP) |
Member Service | Assistance for current members | See Back of Member ID Card |
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Ohio Ancillary Vendors
Benefit | Vendor | Vendor Contact Info |
Transportation | Access2Care | Transportation number on back of ID 844-515-6875 www.access2care.net |
Over the Counter | Solutran | 855-744-8550 |
In-Home support Services | healthAlign | 866-635-7045 |
Meals | Mom’s Meals | 877-508-6667 momsmeals.com |
Fitness | ASH Silver & Fit | 877-427-4788 Silverandfit.com |
Personal Emergency Response System | VRI | 800-750-8694 Wellcarepers.com |
Dental | DentaQuest | dentaquest.com Member Services: 833-206-6300 |
Vision | Premier | 800-738-1889 premiereyecare.net |
Hearing | Hearing Care Solutions | 866-344-7756 hearingcaresolutions.com |
Telehealth | Teladoc Teleadoc.com/wellcare If a provider uses our vendor Teleadoc, then a member’s PCP/Specialist copay can be reduced to $0 | 800-835-2362 (TTY: 711) 24 hours a day, 7 days a week |