Karen McDaniel: Good morning everybody. Thanks for joining us today. I am Karen McDaniel, the director of Compliance here at URL Insurance Group. I know the invitation had listed Christy as the introductory person today, but she unfortunately is not able to make it. So I'm filling in for her. I am going to be passing over the baton to Tom Kennedy and possibly Mike McCook from Capital Blue Cross.

Tom is the manager of the broker field sales and Mike is the Director of Sales for Capital. They're going to be going over the Capital Blue Cross Medicare Advantage Plans for 2023. Before I hand over the mike to Tom. If you have any questions during the presentation to your right hand side, there is the box where you can see a couple different options.

There's a chat, there's a Q&A, there's a poll and there's handouts. I do not believe we have any polls for this presentation. If you have any questions, please type them in the Q&A box and not in the chat box. That will help us get through the questions a lot faster.

And I don't believe we have any handouts except for just a couple of different URL invitations and different things on our website. So with that, I'm going to hand it over to Tom and Tom, you can go ahead and, and start.

Tom Kennedy: Hi, good morning everybody. Tom Kennedy with Capital Blue Cross. Thanks very much for joining me this morning and thank you URL for hosting this.

I'm happy as always, if you know me, talk about Capital Blue Cross and, and our Medicare plans. What we're offering for 2023. In this presentation I'm going to run through this morning is a sort of a modified version of a presentation that we did in the first couple months of the year.

Touching on the presentation was for new members to Capital Blue Cross. So I'm hoping that it's going to give you a nice perspective on what offerings and how we present capital to our new members, your clients. What they can see in some of the digital experience platforms that we offer.

From the member's perspective and real high level here, obviously. Capital Blue Cross is all about offering as much coverage and benefits as possible. It's interesting, this market that we work in is one of the most competitive Medicare advantage markets in the country, as you well know.

It forces us carriers, to be pretty darn aggressive with our benefits, premiums, and our co-payments. We try to keep the maximum out of pocket as low as possible. Certainly, staying away from, if we can help it, the maximum allowed MOP from CMS. All of our plans include of course zero deductibles for medical, zero deductibles for prescriptions zero co-payment on tier one's.

Tom Kennedy: For our prescriptions and some of our plans have zero co-payment for tier one and tier two. I'm gonna talk a little bit more about the Insulin Saver program and and capital's participation in that pilot program offered by CMS. What we're doing for our insulin dependent diabetics.

Of course, on all of our plans, we include dental, vision, and hearing. Those are the benefits that obviously your prospects, and members and clients are looking for when they're looking at a Medicare Advantage plan.

Tom Kennedy: Transportation. I think we do a pretty good job in this market with a transportation benefit. That's a benefit that's getting more and more utilization with us from our members. Our transportation benefit is pretty comprehensive when you compare it to other carriers in the market. Our over-the-counter allowance for drugs and supplies and how we approach that. That I think is a little unique compared to some of the other competition in the area.

And then of course, the virtual care visits, been pretty popular the last three years with the lockdown and covid. The platform that we offer for virtual care I'll talk about. We also like to be as proactive as possible and encourage our members and supply them with tools to be as healthy as possible. Utilize as many of these benefits to stay healthy and be proactive about their health.

So things like a zero copayment for an annual routine physical exam, which is in addition to, of course, the Medicare wellness exam that's covered by Medicare. Zero co-payment for all the Medicare covered preventive services, cancer screenings and things like that.

Mammograms, prostate exams, silver sneakers is included on all of our plans. As well as health education sessions with a certified coach. We have a team of certified coaches. They're tied to our retail team. But members can call and just get a no-cost health education session with a certified coach.

Super proud of our benefits and support for the 30% of the senior population that is diabetic. We have no cost. Diabetes prevention, management, and reversal programs. We'll talk about here in a couple minutes. As well as zero co-payment for self-monitoring and diabetic supplies using our preferred manufacturer life scan.

Tom Kennedy: Before I jump into some of that I always like to make the point when I'm talking to especially our producer partners out in the market. Obviously talking to those of you that are already appointed with Capital Blue Cross and are selling our products.

Those of you maybe that are considering adding Capital Blue Cross to your portfolio of plans that you present to your members. The unique thing about Capital Blue Cross, one of the reasons I joined the organization a number of years ago is, we're the small blue, right? We're a small regional Medicare advantage plan. We have a footprint of 21 counties in central Pennsylvania, in the Lehigh Valley.

We've been serving this market for over 80 years. With that you get all the benefits of a smaller Medicare Advantage Plan. Meaning you get the benefits as well as your members get the benefits. Things like member services, which is key, right? We don't outsource our member services.

So when your clients call us, if they have a problem or an issue, they need to get addressed. Question about benefits or claims, they're calling somebody local right here in central Pennsylvania. We live and work in the same communities as our members. We don't outsource our member services. You're not not calling Pittsburgh, you're not calling Connecticut, you're not calling out of the country.

Tom Kennedy: When you're talking to our member services, you're talking to somebody local. And so things like that, the benefits that, you know, we're never gonna outspend in terms of marketing the big national carriers. But what we can do is bring a level of service and support not only to our members, but to our broker partners that we think is unmatched.

So in addition to that, however, because we're a smaller regional, Blue. A lot of folks, and we get the question a lot, well, "can I use my benefits outside of the 21 county service area that is Capital Blue Cross?" The answer is as long as you enroll in the PPO plans that we offer, of course, because you have the power of blue.

Our affiliation with the Blue Cross and Blue Shield Association, the fact that we're a blue, allows access in 48 out of the 50 states. As long as your members are traveling to a state and seeing a doctor that accepts the local Blue Cross and Blue Shield PPO it's considered an in-network claim.

Nobody likes surprises and so we're all about predictable out pocket cost and exposure when they have to use their health insurance or go see a medical professional. In addition to that, if you happen to go to Wyoming or Alaska, the two states that don't participate currently in the Blue Cross Blue Shield Association PPO Traveler Program it's considered an out-of-network claim.

With a PPO you still have benefits out of network. It's just potentially a higher co-payment. What's interesting, when you look closely at our plans, many of the co-payments, PCPs, specialist co-payments. Many of the co-payments mirror each other in and out of network.

To the member, they're not necessarily going to get that surprise or that unpredictable out-of-pocket cost. We're very proud of being part of the Blue Cross Blue Shield Association. There's some resources there on your screen for members or you can look up providers.

Tom Kennedy: Nationwide by going to bcbs.com or calling 800-810-blue and checking providers all over the country. If you have members that are snowbirds or traveling, going to visit kids or grandkids in California. They have those resources available to them, to make sure they have access to care wherever they are in the country.

So important point. I like to mention that while I'm talking about sort of the Why Capital Blue Cross. The digital experiences is important to us. 10,000 seniors a day are turning 65 and going on Medicare. Obviously we're trying to earn the business of as many of them as possible, as are you.

This younger medicare population is a little more tech savvy than some of our older seniors. We have a whole sort of platform of digital access to care, starting with our Capital Blue Cross member app. In addition to the member app, of course, is create an account on capital blue cross.com.

The app is a great tool because right from your smartphone you can check claims and balances. Find benefits and coverage even view share. Request ID cards. You can have a digital version of your ID card, right on your member app.

Tom Kennedy: Virtual Care is another digital tool that has been utilized quite a bit the last few years. Our virtual care app is of course zero co-payment. Doesn't cost a member anything. It's available 24 hours a day, seven days a week from anywhere in the country.

What's nice about this tool is, especially when you're traveling, you could be out in California and middle of the night get sick. You feel terrible and you can fire up the virtual care app. Talk to a doctor 24 hours a day, seven days a week, that doctor can call in a prescription to the local 24 hour pharmacy wherever you are.

You can go out and pick up that prescription, that antibiotic or whatever you need. Get some relief and hopefully a good night's sleep. Just the flexibility and another tool that's available to our members we think is a great resource. Especially this younger tech savvy population.

Tom Kennedy: There's another screenshot of the virtual care app. You can access the virtual care from more than just your smartphone, any mobile device, laptop. Even if you don't have access to an iPad, iPhone or smartphone, you can call the telephone number and speak to a provider 24 hours a day, seven days a week as well.

Great tool and great resource. The MyCare Finder tool that's our provider lookup tool, that's available online as well as from a mobile device. From your computer, from your laptop, as well as a mobile device where you can search for doctors.

Tom Kennedy: You can see real patient ratings and reviews. You can compare costs. It's a great resource and a great tool that my Care Finder is available online for our members as well.

One other thing I wanna mention here is your Rewards program. This is our way of trying to encourage our members again to be healthy and be proactive about their health. So more than a dozen different health and wellness activities can earn your rewards. Once they complete one of the rewards that qualifies for a gift card. The gift cards range from $10 to $25. You can choose, our members can choose, your clients can choose from retailers including target, Walmart, CVS, cracker Barrel, things like that.

It's pretty simple to access. This screen is showing just some of the things available, including an annual physical exam, a colonoscopy, and what the reward amount is. It's a great benefit again to try to encourage members to stay as healthy as possible and proactive about your health. The next thing I wanna talk about again sort of on the theme of the additional benefits and ancillary items. In addition to our very competitive PO and HMO plans and low co-payments and low premiums.

I'm super proud that Capital Blue Cross is an organization that is really committed to and dedicated to helping our diabetic population in Medicare and we offer two diabetes management virtual platforms.

Tom Kennedy: These are both online platforms. The first one, Omada Health is designed for prevention as well as management prevention. Meaning, somebody that's pre-diabetic as well as management and support for those members who have type one or type two diabetes. The Verta Health program is designed for folks that are currently type two diabetic. It's a diabetes reversal program. It's a physician-led platform. And again, it's a remote medical care focused on, you know sustainable carbohydrate restriction. The idea is to get somebody eating better and managing their type two. With the hope and the goal of getting to the point where they're not dependent on their medication anymore for type two diabetes.

We get testimonials and hear from current members every day of their success on both of these platforms. We were at one of our member meetings last month and a woman had lost 70 pounds. She's on Verta Health, she's type two diabetic. Lost 70 pounds and is on the path of hopefully getting off of insulin and and metformin, another diabetic medication.

Our prescription drug coverage. All of our plans or MAPD plans include prescription drug coverage. For those of you who are familiar with Capital Blue Cross and have contracted with us. In previous years, we used to have a six tier formulary. We've changed that for 2023.

Tom Kennedy: It was creating a little too much confusion in the market and we wanted to align with what else was available out there for folks. And so that tier six that we had, that was primarily a zero co-payment for maintenance medications. We have now shifted those drugs into primarily a tier one and tier two category.

We're better aligned, we think for 2023 with our five tier structure in our formulary. We still have the same list of preferred pharmacies and so you can go to just about any pharmacy using our drug coverage. But if you want the best bang for your buck and the lowest co-payment possible our recommendation is that you go to of our preferred pharmacies for the low co-payment, zero co-payment on tier one. Some of our plans, zero co-payment for tier two at our preferred pharmacies, including CVS, Rite Aid, Giant, Walmart, and Sam's Club. Because Sam's is owned by Walmart and Weiss Markets our mail order pharmacy is obviously a preferred pharmacy with us where you're gonna get the lowest copayment.

Tom Kennedy: Dental care included on all of our plans. Of course, the routine dental visits which include the bite wing x-rays, oral exam, fluoride cleaning. Two of those a year. Depending on what plan you're on, it's gonna be either a low co-payment or a zero co-payment for routine dental work.

Then the comprehensive dental is the benefit for restorative services. Including root canals, crowns, simple extractions, dentures, things like that. It's a 50% benefit where we share from dollar one with our members. So if they have a $1,000 worth of restorative care, they're gonna pay $500, we'll pay the other five.

Tom Kennedy: Quick tip on finding a provider for dental care. If you go to the MyCare Finder tool online or on your smartphone, and select doctors by specialty. Add general dentist and you'll be able to search for local dental providers that are part of the network.

Vision care is included in all of our plans. Of course the Medicare covered exams to diagnose and treat diseases and conditions of the eyes is gonna be covered on the medical portion. But your routine annual eye exam, including standard eyeglass lenses and allowance towards eyeglass frames or contact lenses, is built into all of our plans.

The allowances for the frames or contact lenses. The eyeglass lens is going to be at no cost, and that's gonna be your standard eyeglass lens including bifocal and trifocal lenses. Now if you get some of the fancy stuff like the no glare add-ons, progressive lenses and things like that you're going to pay extra. The benefit includes the standard lenses for bifocals, trifocals, at no cost to the member. Another MyCare finder tip is you can search for a vision provider utilizing tool. You just simply select find an eye doctor, enter your address and search all. It'll pull up all the in-network places close by to you.

Tom Kennedy: Transportation benefit. Another underutilized great resource and benefit for members. We changed this benefit a little bit for 2023 last year. In previous years, our transportation benefit was a roundtrip benefit. We got feedback from members that they didn't always need the round trip.Sometimes they had a way to the doctor's office, but just needed a ride back. So you weren't burning both of them when you only needed a ride to or from.

And the transportation benefit is designed to help you get to or from a medical appointment which includes the pharmacy. I think most of the other plans out there gives you perhaps transportation from the hospital after an inpatient hospital stay.

Our transportation benefit will take you to the eye doctors. It will take you to outpatient procedure. To or from if you need a way to get there. The coverage includes one way trips up to 60 miles, one way. Based on exactly where you are in our footprint and certainly with the cost of gas these days. Some people, if they have a specialist they're meeting with and they're 30 miles away, don't wanna burn their own gas. They can instead utilize that transportation benefit in order to schedule the transportation.

Tom Kennedy: It's as simple as calling member services at least two days, 48 hours prior to your scheduled visit. Obviously you need to have your appointment time, date pick up time and destination address of where you're going. Details about your physical condition, because based on the physical condition, it requires some sort of medical transport. Wheelchair bound, that can all be arranged. You just need to call member services two days prior. The more lead time, the better, but we'll get that scheduled.

The OTC, over-the-counter benefit with our My Benefit card. We rolled this out last year and quite frankly we got a lot of feedback from our broker partners as well as our existing members. They kept telling us, "Look, we want flexibility in purchasing or accessing over-the-counter items. Medicare covered over-the-counter items and we don't want to just be restricted to ordering out of a catalog." So we listened, and we rolled out the My Benefit card, which is a capital Blue Cross branded MasterCard debit card.

With this rollout came some challenges with getting the funds added properly or in some circumstances not working quite right at the point of purchase in a retail environment. It is a debit card because the money is loaded on there and you have access to a certain dollar amount every quarter based on the plan that you're on. It is a debit card, but at the point of purchase it may ask you, is this a debit or a credit transaction?

You'll want to confirm that it is a credit transaction because a debit transaction requires a pin and we don't give you a pin number. There's no pin number associated with our MasterCard debit card for OTC or my benefit card. That's created a little bit of confusion, but you wouldn't treat it as a credit transaction. That'll help things go a little smoother for your members.

Tom Kennedy: Obviously the card needs to be activated when it arrives with the member. There's a sticker on the card, just like receiving your credit card in the mail, you call the number. There's also a QR code that that can be scanned if you have a a tech savvy senior that can scan that QR code and activate the card that way.

I encourage folks also to download the Nation's Benefits or My Benefits portal app from the App Store or Google Play. That way they can check and see in real time what their balance is. The allowance is a quarterly allowance. It's use it or lose it. We don't penalize you if you are gonna utilize the mail order catalog to order your benefits. You can order a mail order shipment every week during the quarter if you wanted to. We're not going to charge you shipping for it ever. There's some carriers out there that starting on the second shipment in a quarter, they start to hit you with shipping charges. But never with us.

If you had download the My Benefits app for your smartphone. Again, you can see in real time what your balance is. That's helpful if you do go to Walmart and pick some things out and pay for them and come home and realize "oh, I forgot to get bandaids". You can go online or call nations directly and order whatever you forgot at the retail store. We're not gonna hit you with shipping charges. Shipping is free. You'll be able to see on that app exactly how much balance you have left. Shopping in a retail environment, this is not an all-inclusive list. More retailers are being added, but currently we're telling folks local retailers, CVS, Rite Aid, Walmart, and Walgreens.

Tom Kennedy: You shouldn't have any trouble purchasing your OTC items at those retailers. Now some retailers are a little bit better than others in terms of identifying what OTC items are available and eligible under Medicare from their store. Some retailers will actually brand the packaging with the OTC symbol on the side of the box which will be helpful.

CVS, Rite Aid, Walmart, and Walgreens we recommend and you shouldn't have any issue. I was doing some testing the other week and didn't have any trouble at all making purchases at any of those for retailers.

Tom Kennedy: So the other benefit that's sort of tied to this debit card that we issue to all of our members is the Healthy Food Allowance. This is a popular benefit for folks because if you qualify for it as a member, you have to have one of the four qualifying conditions, diabetes, chronic lung disease, cardiovascular disease, or congestive heart failure. If you qualify, you'll get an extra $60 loaded onto that debit card that you can go to a local grocer and retailer.

Purchase up to $60 per healthy foods. It's a claims-based qualification. In order to be eligible for this healthy food allowance, this additional $60 added to your card, typically when you go to the doctors and then they send us a claim. All the claims should be including from the providers, the diagnosis codes. If the diagnosis code for one of those four conditions is on those claims, it will trigger a letter from us to the member. Prompting them to call the telephone number on the letter to opt into the Healthy Food Benefit program. Medicare requires this be an opt-in program, so they need to call and opt-in once that claim triggers the letter sent to them. So things like dairy food, vegetables, meats, and whole grains are eligible to be purchased utilizing that $60 benefit.

Tom Kennedy: It's just like the OTC allowance. It's a use it or lose it. Again I talked about it being an opt-in benefit. It's loaded into a separate wallet on that same OTC card. Giant, Weiss and Walmart are the three retailers we're currently listing. This benefit has been utilized at other locations besides those three. But those are the three that we're confident. Nations Benefits has an an agreement and a contract with Giant, Weis and Walmart.

The last thing I wanna leave you with before we open it up to a little Q&A is the Capital Blue Cross Connect Stores. This sort of ties back to the benefits of being a small regional Medicare carrier. We're committed to the communities in which we serve in central Pennsylvania. Lehigh Valley including, opening five different capital, blue Cross Connect retail locations accessible to all of our members to utilize the benefits. The Enola store is our flagship store. It's got the Healthy Foods Cafe in there. You can go to the yoga classes. But more importantly, I think for you and for your clients, it's another resource, another layer of service that's available to them.

If they have an issue or a problem and they can't call member services, they'd rather talk to somebody live and in person directly with Capital Blue Cross. They can walk into one of our retail stores and request some assistance with a question they might have specifically about their benefits.

On the screen there, the locations of the five different Capital Blue Cross Connect stores. On the left hand side, of course, some services that are available including the member services, health coaches, screenings, exercise classes, different community events, and at some of the locations, healthy Food and drinks available at the Capital Blue Cross Connect.

If you have any more specific details about the different PPO and HMO plans that we offer. We have a whole portfolio of zero premium and buyback plans, PPO and HMO plans. If you want more information, certainly through URL or reach out to me directly and I'd be happy to get whatever information to you.

If anybody has any questions, I haven't been paying attention to the Q&A much. Hopefully you have been.

Karen McDaniel: So no Q&A. There was one question, but it was, it went away.

So I don't know if the person who wrote it deleted it, but maybe you answered the question and didn't need answered anymore. So, like Tom said, if you have any other questions, please, feel free to reach out to any one of our, agent support staff members here at the office or to Tom directly. Or your broker manager at Capital.

Thank you so much Tom, for joining us. We really appreciate it. It was a lot of great information. I've been to the, the capital store over in Enola. My grocery store is right next door to it. So I've actually gone in and went to the cafe and had something to eat there. It's delicious. So if you're ever the area, I highly suggest going over there.

Thank God It's relatively healthy because it can be dangerous. It's pretty delicious.

So thanks again. We really appreciate it. This is recorded and it will be sent out to everybody who was attended. So you'll be able to listen to the presentation again if you missed anything and maybe gain some additional insight if you did miss something.

Karen McDaniel: So again, thanks again for joining us. Thanks to Tom and Capital for presenting this morning.

Tom Kennedy: Thanks for the opportunity, Karen. I really appreciate it. And thanks for everybody on the call listening. Have a great day.