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Get in the game with Humana!
Broker Kick Off Event - Thursday, July 30


                          Let’s huddle up to
                          discuss Humana’s
                          integration with
                          Cariten Healthcare!




                    1
Game Plan

  Welcome & Humana Overview - Evans Looney

  Integration Update - Tim Moorhead

  Products, Solutions and Quote Processes

     – Large Group & Specialty - Tim Moorhead

     – Small Business & Specialty - Bryan Wenger

  Q&A


                           2
Welcome & Humana Overview

       Evans Looney




            3
National Snapshot

                    Fortune 100 company with revenues of approximately
                    $30 billion, employing 29,000 associates
                    One of the nation’s largest publicly traded
                    health benefits companies; founded in 1961 as nursing
                    home and later evolved to hospital operator
                    10.4 million medical members nationwide
                    More than 5 million specialty product members
                    110 hospital system clients; largest single industry
                    Integrated national networks with 450,000+ providers
                    First health benefits company awarded ISO 9000
                    Ranked #6 among all U.S. companies in all sectors for
                    technology leadership
                    Offer full spectrum of consumer-choice solutions
                    Industry-leading clinical, network, eHealth, service and
                    technology solutions


                             4
Integration Update

   Tim Moorhead




        5
Integration Journey

Where we have been…

  Acquired Cariten/PHP on October 31, 2008
  Developed an integration plan to leverage strengths of both
  organizations
  Aligned Cariten teams within Humana structure
  Combined Cariten’s regional network with Humana’s national network
  to increase provider access and employer savings
  Added Open Access HMO and NPOS products to Humana-
  Tennessee’s portfolio of Traditional and Consumerism solutions




                                6
Commercial Network Strategy

                                            Humana Provider Networks

                                                       PPO
Cariten Provider Networks                          ChoiceCare
                                                  ChoiceCare +
                                                  Preferred PPO

         PPO                                         HMO
         HMO                                      HMO Premier
         POS                                       HMO Select

                                                       POS
                          Expansion to         Preferred POS - OA
                           national &               NPOS-OA
                            regional               NPOS-OA+
                        network solutions




                                     7
Network Strength


  Highly stable networks and positive provider
  relationships

  Humana ranked #1 in annual PayerView rankings by
  Phyisician’s Practice magazine

  Leading the industry to streamline claims process,
  simplifying back office systems for doctors’ offices

In short – providers prefer us and that means
fewer network disruptions for members


                                8
Our Medical Networks




                                               Tri-Cities
                                            Knoxville




  National PPO & NPOS Networks

  HMO (Most Competitive Cost of Care)

  Humana Preferred Networks (HPN)

                                        9
Commercial Product Strategy




                                                Humana Portfolio
                                                  • PPOs
Cariten Portfolio                                 •   HDHP & HRA Plans
   • PPOs                                         •   Gated HMO
   •   HDHPs                                      •   Open Access HMO
   •   Gated HMO           Planful transition     •   National POS
   •   POS                    to Humana           •   CoverageFirst
   •   Sevier First          solutions as         •   SmartSuite
   •   Vendor RX Support   business renews        •   SmartResults
                                                  •   HumanaRewards
                                                  •   HumanaRX Solutions
                                                  •   HumanaOne
                                                  •   Humana Specialty




                                     10
Commercial Branding

   Transition Branding        Starting TODAY




                         11
Integration Journey

Where are we going…

New Humana Product Portfolio with Enhanced Network
  Quote new business starting 8/1/09 for 9/1/09 and later effectives
  Offer Humana renewals to existing business starting 12/1/09

Create a Superior Experience …
   Broker and employer education sessions
   Provider communications and education sessions
   Member communications




                                   12
New Business Quotes

  Quoting & Effective Dates
   – Medical Products
       – Quoting August for effective dates of September and later
   – Dental, Life, Disability, Voluntary, Stop Loss and Worksite Products
       – Already in place
  Get a Quote!
   – Small Business
       – Contact your sales representative for 2-99 eligible employee groups
       – Go online to Easy Rate at Humana.com for single-location, 2-50 groups
       – Call Easy Rate at 1-800-327-9728 or 1-800-243-6827 for 2-99 groups
       – Fax to 1-800-344-3294 or 1-800-432-4805 for 2-99 groups
       – Email ezrate@humana.com for 2-99 groups
   – Large Group
       – Contact your sales representative for 100-999 eligible employee groups
       – Contact Barry Boster at 615.221.2155 ext. 1030610 for 1000+ groups


                                        13
Integration of Cariten Producer Compensation

  Maintain (i.e., “grandfather”) existing commission schedules on customers initially sold
  Cariten plans, even after migration to Humana products and platform

  All new business sold with a September or later effective date will be compensated
  based on Humana commission schedule and our Volume Growth bonus programs
  (Cariten had no volume-based program. We will credit all Cariten medical production,
  in force prior to 2009 and new in 2009, towards Humana's bonus(es) and Leader's
  Club criteria.)

                            Leaders Club
                               Concierge service to handle your claims,
                               billing, and enrollment, as well as customer service issues
                               HumanaWatch, a daily e-mail with news coverage about
                               Humana, our competitors, and the healthcare industry
                               Preferred quote and new case processing
                               Invitation to special events with Humana leaders
                               Free continuing education courses

                                          14
Large Group Solutions
(100 or more eligible employees)

          Tim Moorhead




               15
Our Approach

A comprehensive approach to help
members manage their health through
behavior change and improve their
experiences in choosing, financing
and using their benefits
•Engages consumers in sustainable
behavior change
•Involves action and participation of all
parties
     •   Employers, members, providers,
         brokers, and Humana
•Results in improved health status
for employees and an improved
bottom line for employers




                                            16
The Humana Guidance Solution


  Product and Network Design
                                           2000                  Clinical Programs and Forecasting
  • Traditional plans                                               • Disease Management
                                                                    • Transplant Management
                                                                    • Utilization Management
                                                                    • Concurrent Review
                               Product and        Clinical          • Case Management
                               Network            Programs and      • HumanaBeginnings
                               Design             Forecasting       • HumanaFirst®


                                        The
                                      Humana
                                      Guidance
                                      Solution
   Consumer Education
                                                                    Financial Analysis and Forecasting
                               Consumer           Financial
                               Education          Analysis and
                                                  Forecasting




                                             17
The Humana Guidance Solution

 Product and Network Design                          2008                         Clinical Programs and Forecasting

 • Traditional plans                                                                 • Disease Management
 • Real-time operating platform                                                      • Transplant Management
 • SmartSuite®                                                                       • Utilization Management
 • CoverageFirst® PPO                                                                • Concurrent Review
 • HumanaAccessSM card                                                               • Case Management
 • RxImpact                                                                          • HumanaBeginnings
 • Wellness programs                     Product and          Clinical Programs      • HumanaFirst®
 • Medical spending accounts             Network              and Forecasting        • Humana Health Assessment
                                         Design                                      • Personal Nurse®
 • HDHP with Health Savings Account
 • Humana Preferred                                    The                           • MyHumana personal web page
 • 90-Days-at-Retail Program                                                         • Maximize Your Benefit
 • RightSourceSM                                     Humana                          • Predictive modeling
 • SmartResultsSM                                    Guidance                        • Health Agent
                                                                                     • Pharmacy MEDS Team
                                                     Solution
  Consumer Education                                                                Financial Analysis and Forecasting
                                         Consumer                 Financial
 • Online Enrollment Center and Wizard   Education                Analysis and
                                                                  Forecasting        • SmartStart
 • MyHumana personal Web page                                                        • Customer Reporting Package
 • Physician Finder Plus                                                             • Benefit Utilization Director for brokers
 • Transparency tools                                                                • Employer portal tools
 • Healing Kitchen                                                                   • RxCalculatorSM
 • Family Health Budget                                                              • Pharmacy Repricing and Formulary
 • Comparative Pricing by Pharmacy                                                   • Verisight Analysis
 • YourHumana Handbook                                                               • MD Consultation
 • SmartSummarySM




                                                         18
Product: A Multi-Year, Phased Approach
 Premise #1: 12 months does not make a trend        Smart Products and Population
 Premise #2: Consumers want choice                  Health Management
 Premise #3: There is no silver bullet              •   3-6 plans (min. of 2 CDHPs)
                                                    •   Defined contribution strategy
                                                    •   Reduce risk/cost variability
                                                    •   Moderate cost trends over time




                                                                                                                            High
        Traditional Plans and




                                                                                               Value of Benefits Strategy
                                                    •   Behavior change via actionable
        Disease Management                              information/transparency, clinical
        •   Reduce acute illness costs                  outreach/guidance and wellness/
        •   No consumer engagement                      workplace productivity initiatives

                                                    Transitional Plan Strategy
Single & Dual                                       and Clinical Guidance
                                                    •   Triple option, incl. a CDHP
Option Traditional                                  •   “Bridge” contribution strategy
Plans Only                                          •   Reduce acute illness and chronic
                                                         condition costs
                                                    •   Early-stage impact on cost trend via
                                                         initial consumer engagement




                                                                                                                            No/Low
                      Low          Employer/Employee Engagement                        High


                                               19
SmartResultsSM In Three Easy Steps
                                      • Offer Humana HMO
                                                                      • Include a CDHP                      • Offer SmartSuite
                                        or PPO plan
  1
                          Traditional                        Transitional                       SmartSuite
 Employer chooses
  the plan strategy                    • Trend factor                 • Trend factor                         •Trend factor
                                        as low as 9%                  as low as 7.5%                        as low as 6.0%




  2                   Health risk data for                 Employee participation              Ongoing partnership
                      earlier intervention in              for better choices and              with long-term
Partnered approach    health conditions                    better health                       impact
   for employee
    engagement



                                                                            Review Scorecard progress during
  3                          Track
                      service level                                         consultative sessions
                      performance
Employer, broker &
 Humana monitor                                                                        View progress on participation goals
 progress against
     targets                                                                   Detailed program participation data




                                                            20
Member Guidance: Humana Pharmacy Solutions

  We employ over 1,600 employees and approximately 160 pharmacists

  We process over 250 million prescriptions and over $13 billion in spend, approximately
  $11.5 billion is Humana’s risk

  One of the first PBMs to earn the URAC Pharmacy Benefit Management Accreditation

  Products: Rx3, Rx4, RxImpact and Mail-Order Rx (RightSource)

  Humana Pharmacy manages its book of business using a “net cost management”
  approach versus a “rebate maximization approach”

  In 2007, Reden & Anders compared our Rx claims data against their benchmark
  database (Caremark, ESI, Medco, United, etc.)

                      Reden & Anders Comparison

                        Humana         Benchmark          Difference

  Total PMPM             55.56           59.82             -7.10%

  Cost/Day               2.43             2.52             -3.60%

  Utilization            274.5           284.41            -3.50%
                                         21
Clinical: The Guidance Solution Delivers

                     Better health outcomes
                       –   Health promotion and disease prevention
                       –   Condition management
                       –   Increases productivity
                     Better opportunity for cost savings
                       –   Enhanced identification and engagement
                       –   Focus on major clinical conditions / cost drivers

                     Better health benefits experience – for everyone
                       –   Member support, whether ill or healthy
                       –   High employee satisfaction
                       –   Ease of administration (HumanaFirst)


               The bottom line
               • Commercial members engaged                             14%
               • Total costs engaged with Health Resources              64%
               • Total cost savings                                     4-6%
               • Savings PMPM                                           $11-$15



                                22
Consumer: Tailoring Guidance




                     Consumer
                     Segment
                   Change Stage

                      Condition

                      Channel

                   Cultural Identity


                          23
Consumer: Health & Wealth Guidance
www.staysmartstayhealthy.com




Click Here




                               24   Click Here
Wellness Designed to Fit
                             A Continuum of Wellness Solutions
 Core Wellness Package                 Wellness Plus Package                    Custom Wellness (a la carte)
 • Self-help web content               • Tailored Web Program                   • Wellness Consulting
   (MyHumana)                          • Telephonic Health                      • Onsite Wellness Programs
 • Wellness Monthly                      Coaching                               • Print Collateral
   Calendar                              (Tobacco Cessation, Stress
                                         Management, Back Care, Weight
                                                                                • Physical Activity Incentive
 • Preventive Reminders                  Management, Physical Activity,           and Reward Program
 • Humana Health                         Nutrition)

   Assessment (HHA)




                                           Humana’s CareHub
                            •Complete integration of infrastructure and data (2008)
                                        •A single view of the member
  HumanaFirst                             Personal Nurse                              Case Management
  HumanaBeginnings                        Disease Management                          Transplant Management
  NICU Case Management                       (CAD, HF, Cancer, Asthma, CKD, ESRD,     Utilization Management
  Behavioral Health Management               Diabetes, Rare Diseases)                 Employee Assistance Programs




                                                         25
Virgin HealthMiles

  The first-of-its-kind incentive program for physical activity
  Engagement and communications to promote increased activity and track results
    – Members log exercise, count steps, measure results: BMI, body fat percentage, and blood
      pressure using the LifeZone web site, GoZone pedometer, and HealthZone kiosk




  Flexible Incentive fulfillment platform
    – Accumulate HealthMiles for effort, measurement, and achievement, then redeem miles for
      rewards at over 40 leading U.S. retail partners




                                              26
Our Results: Behavior Change and Improved Health

     Smoking
      Smoking       Weight Mgmt/
                    Weight Mgmt/                               Stress
                                                                Stress
                                             Nutrition
                                             Nutrition                          Back Care
                                                                                Back Care
     Cessation
     Cessation     Physical Activity
                   Physical Activity                         Management
                                                             Management




Over 52%         Over 57% lost         95% have          Over 56%           Over 47%
remained         weight                made a            decreased          improved and
smoke free                             positive          personal           better manage
                 Of those with a
after 180 days                         change in their   symptoms of        back pain
                 BMI of >30:
of beginning                           eating habits     stress after
                   29% lost more
the program                                              enrolling in the
                  than 5% of
                                                         program
                  their body
                  weight
                   10% lost more
                  than 10%


                                             27
Humana Innovations




                     Get Moving!!!



                           28
What is Perfect Service?

What Perfect Service means to Humana
  Delivering unexpected value and quality
  Providing guidance on complex needs
  Going beyond satisfaction
  Creating engagement with those we
  serve.
  Building a proactive culture.
  Making what’s most important to those we
  serve, most important to us
  An aspirational journey
   – that changes as those we serve
      and as we ourselves change.




                                    29
Member Service

How we measure performance:

 National Call Quality
     Enhanced our National Call Quality processes and measurements are
     aligned with Perfect Service in a new Call Quality form. Implemented -
     January 2007




                        ECHO – Voice of the Customer
                             Provides a random outbound-automated survey to our members,
                             helping us ‘hear’ real opinions of their experience with Humana.
                             Implementation – Pilot in progress



 REACH
     New version rewards CCS for using the Perfect Service filter in what they do every day by a
     changed weighting system that better balances quality and time. Implemented - January 2007



                                                30
Member Service: Customer Satisfaction Technology

                                 Customer Rep knows that
                                  Customer Rep knows that
                                 in the past 30 days almost
                                 in the past 30 days almost
                                    94% of her customers
                                    94% of her customers
                                   have been satisfied or
                                    have been satisfied or
                                   very satisfied with the
                                    very satisfied with the
                                    service she provides.
                                    service she provides.




                                                                 Rep can
                                                                  Rep can
                                                                  access
                                                                   access
                                                                  specific
                                                                  specific
                                                              information by
                                                              information by
                                                                clicking on
                                                                clicking on
                                                               any of these.
                                                               any of these.



CCS = Customer Care Specialist                31
How do we measure up?

          Just released for 2009, J.D. Power ranks Humana # 1 in overall
          satisfaction and service delivery among all national health plans!



                                                                                                  2009 Overall Plan Rankings
                                                                                                       & Satisfaction Score
                                                                                                 1. Humana        718
                                                                                                 2. Wellpoint     708
                                                                                                 3. CIGNA         706
                                                                                                 4. Aetna         698
                                                                                                 5. United        696




SOURCE: JD Power 2009 Commercial Health Insurance Plan Study
High = top 25th percentile, Medium = middle 50th percentile, Low = bottom 25th percentile
                                                                                            32
Large Group Client Support Team

                                                       Report/
              Implement                                Serve/                                      Serve
                                                       Renew



                                                    Lisa Johnson
                                                       Director,
    Melissa Trelfa                                                                                     Melissa Trelfa
                                                  Account Management
        Director,                                                                                          Director,
    Account Services                                                                                   Account Services
    (Plan build oversight)                                                                           (Escalated service issue
                                Sales Executive                           Account Advisor                   oversight)
                                  (OE meeting                              (Escalated service
                                   oversight)                             issue owner/liaison)

            TBA
 Account Implementation                            Account Executive
 Manager or Coordinator                                (Overall client
 (Plan build project manager)                       relationship owner)




         Corporate Resources                       Market Resources                              Corporate Resources



                                                              33
Specialty Benefits




        34
Enhancing Our Product Portfolio




      30+ years of experience   18 years of experience       50 years of experience
      Dental, life and vision   Dental and vision services   Single source solution for
      services                  4.8M members                 ancillary services and
      2.9M members              Broad dental and vision      voluntary benefits
      Broad dental and vision   networks                     Well-respected TPA
      networks                                               1.1M members


Specialty Benefits
                                          35
Options to Fit Your Clients’ Needs

You can offer employer-sponsored or voluntary funding
options to clients of all sizes.


 Dental                     Vision                      Health & productivity
    PPO                         Vision Care Plan           Employee assistance
    Traditional Preferred       Advantage, Focus,          & work-life
    Advantage Plus              Optimum                    Wellness / healthcare
    DHMO
    Preventive Plus                                        coaching
                            Disability
                                Short-term income       Behavioral health
 Life                           protection
    Basic term
                                Long-term disability
    Voluntary term
    Level term
    AD&D                    Accident
    Whole life              Critical illness
    Lifestyle – Care Life
    and Critical Life       Supplemental health

                                       36
Add Specialty Benefits and Save




                       37
Small Group Solutions
(2 to 99 or more eligible employees)

            Bryan Wenger




                 38
Sales Support and Service

You’ll receive exceptional sales support and
service to sell and keep more business, and to
maximize your earnings:

   Local Humana sales executive helps you sell new
   business

   Retention executives and online resources help    Other benefits include:
   you renew cases
                                                     • Centralized billing
                                                       and enrollment
   Dedicated Small Business Customer Care team to    • Group-dedicated
   serve your clients                                  billing representative

                                                     • State-specific plan change
                                                       and service teams




                                     39
Our Business Is to Help You Grow Yours

Here’s what you can expect:
  Exceptional sales support and service
  Online resources to quote, enroll, and manage your business
  Broad product portfolio
  Direct access to underwriters
  Convenient, fast quotes
  Welcome calls to all new groups
  Wellness and employee assistance programs
  Plan utilization reports
  Comprehensive renewal reports
  Competitive commission and recognition programs



                                          40
Our Broad Product Portfolio

With Humana’s broad product portfolio, you can deliver an even
more competitive benefits package to your customers. We offer
employer-sponsored and voluntary benefits including:


• Medical      • Disability
• Dental       • Critical Illness
• Vision       • Supplemental Health
• Accident
• Life




                                    41
Humana Product Continuum




         Traditional benefits with a wide
         range of out-of-pocket options

         First step toward
         consumer-directed plans
         Innovative, cost-saving solutions
         with banking arrangements




                              42
P0S Product Small Business

POS: Cariten to Humana
   Plan Design             In-Network Out of Pocket (excludes deductible)
   • 100/60 to 100/70      • $750 to $2000
   • 90/70 to 90/60        • $1000 to $1000 (90% plan)
   • 80/60 to 80/50        • $1000 to $2000 (70% and 80% plan)
   • 70/50 to 80/50        • $1500 to $2000
                           • $1750 to $2000
   ER Copay                • $2000 to $2000
   • $100 to $150          • $2250 to $3000
                           • $3000 to $3000
   In-Network Copay
                           • $3500 to $4000
   • $20/$35 to $20/$40
                           • $4000 to $4000
   • $25/$40 to $30/$50
                           • $5000 to $4000
   • $30/$45 to $30/$50
                           • $5500 to $4000
   • $35/$50 to $30/$50
   • $40/$55 to $30/$50

   In-Network Deductible     Additional Deductible Options:
   • $250 to $250            $3000
   • $500 to $500            $4000
   • $750 to $1000           $5000
   • $1000 to $1000          $6000
   • $1500 to $1500          $7000
   • $2000 to $2000          $8000
   • $2500 to $2500


                                         43
PPO Product Small Business

PPO: Cariten to Humana
    Plan Design            In-Network Out of Pocket (excludes deductible)
    • 100/60 to 100/70     • $750 to $2000
    • 90/70 to 90/60       • $1000 to $1000 (90% plan)
    • 80/60 to 80/50       • $1000 to $2000 (70% and 80% plan)
    • 70/50 to 70/50       • $1500 to $2000
                           • $1750 to $2000
    ER Copay               • $2000 to $2000
    • $100 to $150         • $2250 to $3000
                           • $2500 to $3000
   In-Network Copay        • $3000 to $3000
   • $20 to $25            • $3500 to $4000
   • $25 to $25            • $4000 to $4000
   • $30 to $35            • $4500 to $4000
   • $35 to $35            • $5000 to $4000
   • $40 to $35            • $5500 to $4000

   In-Network Deductible     Additional Deductible Options:
   • $250 to $250            $3000
   • $500 to $500            $4000
   • $750 to $1000           $5000
   • $1000 to $1000          $6000
   • $1500 to $1500          $7000
   • $2000 to $2000          $8000
   • $2500 to $2500

                                        44
Standard PCA (HRA)

  A coinsurance PPO plan combined with a personal healthcare
  spending account

  Positively engage consumers — generates long-term savings

  Employer funded

  HumanaAccess card




                                45
Personal Care Account (PCA)
How does it work?

               You use funds to pay for eligible medical and
               pharmacy expenses
               PCA funds can be applied to the deductible
               Once all the funds are spent, you must satisfy the
               deductible and pay the specified coinsurance
               amount
               You always have protection against medical
               expenses for catastrophic illness or injury
               Simple plan design:
                – Preventive covered 100%
                    – Exception endoscopic services for Small
                      Business
                – Everything else coinsurance after deductible




                           46
Humana HDHP 08 With Optional HSA

  An HSA qualified HDHP plan available with or
  without an HSA
  Preventive care at 100 percent
  Medical and pharmacy—integrated deducible
  HSA covers medical plan deductible,
  coinsurance, and other qualified services
  HSA offered through UMB Bank
  Both integrated and embedded family
  deductibles available




                                   47
Humana CoverageFirst 08

The easy first step toward
consumer-choice plans
  No banking arrangements
  All the benefits of a full PPO
  plus an up-front allowance of $500
  Allowance built in to the plan design
  Motivates employees to
  use their benefits wisely
  Guides employees in becoming
  informed consumers of health care


                                   48
CoverageFirst
Product Details

  $500 allowance covers:
   – Doctor’s office visits
   – Routine outpatient labs and x-rays
   – Hospital services, emergency room services and outpatient surgery
   – Other services such as home health care, physical therapy and
      hospice care
  Allowance does not cover:
   – Prescription drugs
   – Mental health treatments (unless mandated) – only until 11/1/09 due to
      Federal Mental Health Parity
   – Copayments
   – Services from non-participating providers
  Unused funds do not carry-over from year to year




                                        49
CoverageFirst
Positioning

  Feels like traditional PPO plans
   –   Par/Nonpar providers
   –   Copayments for some benefits; ded/coins for others

  First dollar coverage
   –   $500 per member
   –   Allowance is used for expenses prior to paying the deductible

  Allowance promotes financial involvement and incentives
   –   Members see allowance as “their” money
   –   Members more apt to take active role in decision-making and budgeting
   –   Encourage utilization from participating providers

  Preventive covered at 100% after copay
  NOT a lower price alternative, but a baby step into consumerism




                                               50
Benefit Design Solutions for Today and Tomorrow

                         Provide guidance with choice and flexibility

                         Traditional benefit designs
                           – Rx4: Tiered by cost, more sophisticated

                         Value-based benefit designs
                           – RxImpact: Unique




                           51
Rx4

  Most plans group drugs by generic, preferred brand, non-preferred brand and specialty
   – This is not sophisticated enough given the variance in the gap between
     generic and brand drug pricing
  Humana’s Rx4 groups drugs by cost
   –   Tier 1 – lowest cost brands and generics
   –   Tier 2 – higher priced brands and generics
   –   Tier 3 – high cost (mostly) brands with less expensive alternatives
   –   Tier 4 – Specialty drugs
  Some drugs have been moved to less expensive tiers due to proven medical efficacy
  (e.g., Procrit and Lovenox)




                                         52
RxImpact

  Drugs grouped based on:
   – Medical efficacy
   – ROI
   – Timeframe for “medical payoff”
  Each drug in a class is in the same level
     Group A      Evidence-based short-term effectiveness (acute)
                  (asthma, infections, juvenile diabetes, antidepressants)



     Group B      Evidence-based long-term effectiveness (chronic)
                  (cancer, heart disease, MS)


     Group C      Drugs that provide symptom relief
                  (antihistamines, anti-inflammatory, antacids)


     Group D      Drugs that may impact lifestyle
                  (sexual dysfunction, cosmetic, obesity, smoking cessation)



  Turns the member into the ultimate consumer
                                                   53
RxImpact Example

  Each tier has an allowance assigned to it
   – Members pay the difference between the allowance and the
     discounted cost of the drug
   – Members had $0 expenses 65% of the time

                                                 Retail                Plan
          Drug name            Quantity                    Allowance            Member Pay
                                                 Cost                  Pays


       Fluoxetine 20mg              30           $14.99     $30.00     14.99       $0.00



       Lexapro 20mg                 30           $89.99     $30.00     $30.00     $59.99



       Cymbalta 30mg                30          $130.32     $30.00     $30.00     $100.32


       Drug price source: www.drugstore.com, 10/01/2008




                                                      54
Pharmacy Choices


 Rx Impact                                    Rx4
   Employers save 2 to 5 percent               Eliminate unexpected charges
   on premium                                  at the pharmacy
   About 60 percent of prescriptions           Drugs are grouped into four levels, each
   have no out-of-pocket cost to               with corresponding copayment amounts
   employees
                                               85 percent of prescriptions filled are those
   If there is a cost to the employee,
   the average is $16                          with the lowest copayments—those in the
                                               first two levels
   Out of pocket protection
     – $100 cap per prescription
     – $2,500 annual maximum
         (groups A, B, C)




                                         55
Fast, Convenient Quotes

Receive medical, dental, and life quotes in easy-to-use
Excel and PDF formats. You can:

• Quickly compare health plan choices
• See market popular plans
• Filter data to view specific plans and
  benefit options
• Model premium costs for your clients
  and their employees




                                    56
Talk Directly to Your Underwriter

Humana’s underwriters provide you with the support you need to sell more
cases, both new and existing business:
  Direct access to underwriters

  Local expertise to ensure your clients receive the
  best fit in products and rates

  Meet face-to-face with your underwriting team
  during Underwriting Days
   – Next session: September 16t and 17

  Express underwriting/phone, fax and e-mail, or
  produce a quote request online and receive a firm
  risk rate, in most cases, within 48 hours




                                          57
See How Your Clients Used Their Benefits

Using Humana’s exclusive
Benefit Utilization Director (BUD)*,
you can view how often employees:

       • Visit their doctors
       • Purchase prescription drugs
       • Meet deductibles and
         out-of-pocket maximums
                                                     Knowing how health benefits are
Plus, create a customized packet                     used will help you build more effective
to share with your clients.                          strategies for your clients.




 * Available for groups with 5 - 99 employees




                                                58
Easily Explain Your Clients’ Renewals

The Renewal Center provides transparency of the renewal
process and helps you clearly explain your clients’ renewals.
The Renewal Center contains:

• Client renewal letters
• Renewal rates and rate details
• Census information and health status
• Alternate quote summaries
• Enrollment and plan change forms
                                                 You can view the data the way
                                                 you prefer: e-mail, paper, or Web.




                                   59
Communicate With Employers

Humana works closely with you to help your clients manage
their plans and control healthcare costs. We provide:

   Welcome calls to all new groups

   Employer welcome kit sent to every new group

   HealthMatters, which offers ideas on how to control
   healthcare costs and tips for managing their plan

   Humana Health Plan Guide, which shows employers
   how their employees use their benefits




                                      60
Help Members Choose, Use and Finance Their Benefits

We help employees manage their plan, take control of their
health, and better understand their healthcare costs by offering:

    Member enrollment kit

    Member welcome kit

    Educational materials on Humana’s wellness
    resources

    SmartSummarySM, a quarterly statement to
    help employees keep track of their healthcare
    spending

    MyHumana, a password-protected personal
    page on Humana.com




                                         61
Humana’s Health Resources

Your 2 - 99 clients automatically receive
a comprehensive health and wellness
program that includes:

    • Humana Health Assessment

    • Personal health coaching

    • Discounts on health products
      and gym memberships

    • Employee assistance program              Healthier employees use
                                               fewer healthcare dollars,
    • Disease management / clinical programs
                                               and have fewer claims,
                                               miss less work, and are
                                               more productive.




                                     62
Quote, Enroll and Manage Your Business Online

The agent section on Humana.com has resources to help you do
business with us, and service your clients. You can:
   • Order marketing materials                       If you haven’t registered yet,
                                                     go to Humana.com and
   • Submit a quote
                                                     click on “Agents” and
   • View utilization reports                        “Register Today.”

   • Access comprehensive renewal information,
     including rate detail and census information

   • Perform administrative functions on behalf of
     your clients

   • Get details about our compensation, bonus,
     and Leaders Club recognition programs



                                        63
Producer Partnership Plan


                  Strong first-year and renewal
                  commissions for all lines of coverage
                   – 2-3 lives per case       5%
                   – 4-25 lives per case      7%
                   – 26-50 lives per case 5%
                       – Paid on base premium

                  Quarterly bonuses for growing block of
                  business with Humana




                         64
Leaders Club

Become a member of Leaders Club and enjoy the
beauty of San Francisco, along with other rewards
such as:                                            20th Anniversary of
                                                 Humana’s Leaders Club
  Concierge service to handle your claims,           The Ritz-Carlton Half
  billing, and enrollment, as well as customer       Moon Bay, California
  service issues                                            May 2-7, 2010
  HumanaWatch, a daily e-mail that links news
  coverage about Humana, our competitors,
  and the healthcare industry
  Preferred quote and new case processing

  Invitation to special events with
  Humana leaders

  Free continuing education courses




                                           65
Summary

          100 percent of our small business
          products are distributed through you,
          our valued broker partners

          We help you educate your clients on
          solutions to control their healthcare
          costs

          We give you information so you can
          recommend the most appropriate,
          cost-effective healthcare plan

          We listen to you and act on your
          feedback




           66
Q&A
TN Management Team




        67
Kick-Off Contest

   First three producers who place Humana medical product sale
   (8/1 and later quote date) will receive Garmin GPS devices

   Producer who places first multi-line sale (8/1 and later quote date)
   will receive:
         8 tickets and use of skybox
         UT vs. Auburn Game
         October 3, 2009

Medical + Dental / Life / Voluntary / Worksite




                                        68
Get in the game with Humana!




                  Thanks for
                  attending!


             69

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Kick-Off Presentation - July 30, 2009

  • 1. Get in the game with Humana! Broker Kick Off Event - Thursday, July 30 Let’s huddle up to discuss Humana’s integration with Cariten Healthcare! 1
  • 2. Game Plan Welcome & Humana Overview - Evans Looney Integration Update - Tim Moorhead Products, Solutions and Quote Processes – Large Group & Specialty - Tim Moorhead – Small Business & Specialty - Bryan Wenger Q&A 2
  • 3. Welcome & Humana Overview Evans Looney 3
  • 4. National Snapshot Fortune 100 company with revenues of approximately $30 billion, employing 29,000 associates One of the nation’s largest publicly traded health benefits companies; founded in 1961 as nursing home and later evolved to hospital operator 10.4 million medical members nationwide More than 5 million specialty product members 110 hospital system clients; largest single industry Integrated national networks with 450,000+ providers First health benefits company awarded ISO 9000 Ranked #6 among all U.S. companies in all sectors for technology leadership Offer full spectrum of consumer-choice solutions Industry-leading clinical, network, eHealth, service and technology solutions 4
  • 5. Integration Update Tim Moorhead 5
  • 6. Integration Journey Where we have been… Acquired Cariten/PHP on October 31, 2008 Developed an integration plan to leverage strengths of both organizations Aligned Cariten teams within Humana structure Combined Cariten’s regional network with Humana’s national network to increase provider access and employer savings Added Open Access HMO and NPOS products to Humana- Tennessee’s portfolio of Traditional and Consumerism solutions 6
  • 7. Commercial Network Strategy Humana Provider Networks PPO Cariten Provider Networks ChoiceCare ChoiceCare + Preferred PPO PPO HMO HMO HMO Premier POS HMO Select POS Expansion to Preferred POS - OA national & NPOS-OA regional NPOS-OA+ network solutions 7
  • 8. Network Strength Highly stable networks and positive provider relationships Humana ranked #1 in annual PayerView rankings by Phyisician’s Practice magazine Leading the industry to streamline claims process, simplifying back office systems for doctors’ offices In short – providers prefer us and that means fewer network disruptions for members 8
  • 9. Our Medical Networks Tri-Cities Knoxville National PPO & NPOS Networks HMO (Most Competitive Cost of Care) Humana Preferred Networks (HPN) 9
  • 10. Commercial Product Strategy Humana Portfolio • PPOs Cariten Portfolio • HDHP & HRA Plans • PPOs • Gated HMO • HDHPs • Open Access HMO • Gated HMO Planful transition • National POS • POS to Humana • CoverageFirst • Sevier First solutions as • SmartSuite • Vendor RX Support business renews • SmartResults • HumanaRewards • HumanaRX Solutions • HumanaOne • Humana Specialty 10
  • 11. Commercial Branding Transition Branding Starting TODAY 11
  • 12. Integration Journey Where are we going… New Humana Product Portfolio with Enhanced Network Quote new business starting 8/1/09 for 9/1/09 and later effectives Offer Humana renewals to existing business starting 12/1/09 Create a Superior Experience … Broker and employer education sessions Provider communications and education sessions Member communications 12
  • 13. New Business Quotes Quoting & Effective Dates – Medical Products – Quoting August for effective dates of September and later – Dental, Life, Disability, Voluntary, Stop Loss and Worksite Products – Already in place Get a Quote! – Small Business – Contact your sales representative for 2-99 eligible employee groups – Go online to Easy Rate at Humana.com for single-location, 2-50 groups – Call Easy Rate at 1-800-327-9728 or 1-800-243-6827 for 2-99 groups – Fax to 1-800-344-3294 or 1-800-432-4805 for 2-99 groups – Email ezrate@humana.com for 2-99 groups – Large Group – Contact your sales representative for 100-999 eligible employee groups – Contact Barry Boster at 615.221.2155 ext. 1030610 for 1000+ groups 13
  • 14. Integration of Cariten Producer Compensation Maintain (i.e., “grandfather”) existing commission schedules on customers initially sold Cariten plans, even after migration to Humana products and platform All new business sold with a September or later effective date will be compensated based on Humana commission schedule and our Volume Growth bonus programs (Cariten had no volume-based program. We will credit all Cariten medical production, in force prior to 2009 and new in 2009, towards Humana's bonus(es) and Leader's Club criteria.) Leaders Club Concierge service to handle your claims, billing, and enrollment, as well as customer service issues HumanaWatch, a daily e-mail with news coverage about Humana, our competitors, and the healthcare industry Preferred quote and new case processing Invitation to special events with Humana leaders Free continuing education courses 14
  • 15. Large Group Solutions (100 or more eligible employees) Tim Moorhead 15
  • 16. Our Approach A comprehensive approach to help members manage their health through behavior change and improve their experiences in choosing, financing and using their benefits •Engages consumers in sustainable behavior change •Involves action and participation of all parties • Employers, members, providers, brokers, and Humana •Results in improved health status for employees and an improved bottom line for employers 16
  • 17. The Humana Guidance Solution Product and Network Design 2000 Clinical Programs and Forecasting • Traditional plans • Disease Management • Transplant Management • Utilization Management • Concurrent Review Product and Clinical • Case Management Network Programs and • HumanaBeginnings Design Forecasting • HumanaFirst® The Humana Guidance Solution Consumer Education Financial Analysis and Forecasting Consumer Financial Education Analysis and Forecasting 17
  • 18. The Humana Guidance Solution Product and Network Design 2008 Clinical Programs and Forecasting • Traditional plans • Disease Management • Real-time operating platform • Transplant Management • SmartSuite® • Utilization Management • CoverageFirst® PPO • Concurrent Review • HumanaAccessSM card • Case Management • RxImpact • HumanaBeginnings • Wellness programs Product and Clinical Programs • HumanaFirst® • Medical spending accounts Network and Forecasting • Humana Health Assessment Design • Personal Nurse® • HDHP with Health Savings Account • Humana Preferred The • MyHumana personal web page • 90-Days-at-Retail Program • Maximize Your Benefit • RightSourceSM Humana • Predictive modeling • SmartResultsSM Guidance • Health Agent • Pharmacy MEDS Team Solution Consumer Education Financial Analysis and Forecasting Consumer Financial • Online Enrollment Center and Wizard Education Analysis and Forecasting • SmartStart • MyHumana personal Web page • Customer Reporting Package • Physician Finder Plus • Benefit Utilization Director for brokers • Transparency tools • Employer portal tools • Healing Kitchen • RxCalculatorSM • Family Health Budget • Pharmacy Repricing and Formulary • Comparative Pricing by Pharmacy • Verisight Analysis • YourHumana Handbook • MD Consultation • SmartSummarySM 18
  • 19. Product: A Multi-Year, Phased Approach Premise #1: 12 months does not make a trend Smart Products and Population Premise #2: Consumers want choice Health Management Premise #3: There is no silver bullet • 3-6 plans (min. of 2 CDHPs) • Defined contribution strategy • Reduce risk/cost variability • Moderate cost trends over time High Traditional Plans and Value of Benefits Strategy • Behavior change via actionable Disease Management information/transparency, clinical • Reduce acute illness costs outreach/guidance and wellness/ • No consumer engagement workplace productivity initiatives Transitional Plan Strategy Single & Dual and Clinical Guidance • Triple option, incl. a CDHP Option Traditional • “Bridge” contribution strategy Plans Only • Reduce acute illness and chronic condition costs • Early-stage impact on cost trend via initial consumer engagement No/Low Low Employer/Employee Engagement High 19
  • 20. SmartResultsSM In Three Easy Steps • Offer Humana HMO • Include a CDHP • Offer SmartSuite or PPO plan 1 Traditional Transitional SmartSuite Employer chooses the plan strategy • Trend factor • Trend factor •Trend factor as low as 9% as low as 7.5% as low as 6.0% 2 Health risk data for Employee participation Ongoing partnership earlier intervention in for better choices and with long-term Partnered approach health conditions better health impact for employee engagement Review Scorecard progress during 3 Track service level consultative sessions performance Employer, broker & Humana monitor View progress on participation goals progress against targets Detailed program participation data 20
  • 21. Member Guidance: Humana Pharmacy Solutions We employ over 1,600 employees and approximately 160 pharmacists We process over 250 million prescriptions and over $13 billion in spend, approximately $11.5 billion is Humana’s risk One of the first PBMs to earn the URAC Pharmacy Benefit Management Accreditation Products: Rx3, Rx4, RxImpact and Mail-Order Rx (RightSource) Humana Pharmacy manages its book of business using a “net cost management” approach versus a “rebate maximization approach” In 2007, Reden & Anders compared our Rx claims data against their benchmark database (Caremark, ESI, Medco, United, etc.) Reden & Anders Comparison Humana Benchmark Difference Total PMPM 55.56 59.82 -7.10% Cost/Day 2.43 2.52 -3.60% Utilization 274.5 284.41 -3.50% 21
  • 22. Clinical: The Guidance Solution Delivers Better health outcomes – Health promotion and disease prevention – Condition management – Increases productivity Better opportunity for cost savings – Enhanced identification and engagement – Focus on major clinical conditions / cost drivers Better health benefits experience – for everyone – Member support, whether ill or healthy – High employee satisfaction – Ease of administration (HumanaFirst) The bottom line • Commercial members engaged 14% • Total costs engaged with Health Resources 64% • Total cost savings 4-6% • Savings PMPM $11-$15 22
  • 23. Consumer: Tailoring Guidance Consumer Segment Change Stage Condition Channel Cultural Identity 23
  • 24. Consumer: Health & Wealth Guidance www.staysmartstayhealthy.com Click Here 24 Click Here
  • 25. Wellness Designed to Fit A Continuum of Wellness Solutions Core Wellness Package Wellness Plus Package Custom Wellness (a la carte) • Self-help web content • Tailored Web Program • Wellness Consulting (MyHumana) • Telephonic Health • Onsite Wellness Programs • Wellness Monthly Coaching • Print Collateral Calendar (Tobacco Cessation, Stress Management, Back Care, Weight • Physical Activity Incentive • Preventive Reminders Management, Physical Activity, and Reward Program • Humana Health Nutrition) Assessment (HHA) Humana’s CareHub •Complete integration of infrastructure and data (2008) •A single view of the member HumanaFirst Personal Nurse Case Management HumanaBeginnings Disease Management Transplant Management NICU Case Management (CAD, HF, Cancer, Asthma, CKD, ESRD, Utilization Management Behavioral Health Management Diabetes, Rare Diseases) Employee Assistance Programs 25
  • 26. Virgin HealthMiles The first-of-its-kind incentive program for physical activity Engagement and communications to promote increased activity and track results – Members log exercise, count steps, measure results: BMI, body fat percentage, and blood pressure using the LifeZone web site, GoZone pedometer, and HealthZone kiosk Flexible Incentive fulfillment platform – Accumulate HealthMiles for effort, measurement, and achievement, then redeem miles for rewards at over 40 leading U.S. retail partners 26
  • 27. Our Results: Behavior Change and Improved Health Smoking Smoking Weight Mgmt/ Weight Mgmt/ Stress Stress Nutrition Nutrition Back Care Back Care Cessation Cessation Physical Activity Physical Activity Management Management Over 52% Over 57% lost 95% have Over 56% Over 47% remained weight made a decreased improved and smoke free positive personal better manage Of those with a after 180 days change in their symptoms of back pain BMI of >30: of beginning eating habits stress after 29% lost more the program enrolling in the than 5% of program their body weight 10% lost more than 10% 27
  • 28. Humana Innovations Get Moving!!! 28
  • 29. What is Perfect Service? What Perfect Service means to Humana Delivering unexpected value and quality Providing guidance on complex needs Going beyond satisfaction Creating engagement with those we serve. Building a proactive culture. Making what’s most important to those we serve, most important to us An aspirational journey – that changes as those we serve and as we ourselves change. 29
  • 30. Member Service How we measure performance: National Call Quality Enhanced our National Call Quality processes and measurements are aligned with Perfect Service in a new Call Quality form. Implemented - January 2007 ECHO – Voice of the Customer Provides a random outbound-automated survey to our members, helping us ‘hear’ real opinions of their experience with Humana. Implementation – Pilot in progress REACH New version rewards CCS for using the Perfect Service filter in what they do every day by a changed weighting system that better balances quality and time. Implemented - January 2007 30
  • 31. Member Service: Customer Satisfaction Technology Customer Rep knows that Customer Rep knows that in the past 30 days almost in the past 30 days almost 94% of her customers 94% of her customers have been satisfied or have been satisfied or very satisfied with the very satisfied with the service she provides. service she provides. Rep can Rep can access access specific specific information by information by clicking on clicking on any of these. any of these. CCS = Customer Care Specialist 31
  • 32. How do we measure up? Just released for 2009, J.D. Power ranks Humana # 1 in overall satisfaction and service delivery among all national health plans! 2009 Overall Plan Rankings & Satisfaction Score 1. Humana 718 2. Wellpoint 708 3. CIGNA 706 4. Aetna 698 5. United 696 SOURCE: JD Power 2009 Commercial Health Insurance Plan Study High = top 25th percentile, Medium = middle 50th percentile, Low = bottom 25th percentile 32
  • 33. Large Group Client Support Team Report/ Implement Serve/ Serve Renew Lisa Johnson Director, Melissa Trelfa Melissa Trelfa Account Management Director, Director, Account Services Account Services (Plan build oversight) (Escalated service issue Sales Executive Account Advisor oversight) (OE meeting (Escalated service oversight) issue owner/liaison) TBA Account Implementation Account Executive Manager or Coordinator (Overall client (Plan build project manager) relationship owner) Corporate Resources Market Resources Corporate Resources 33
  • 35. Enhancing Our Product Portfolio 30+ years of experience 18 years of experience 50 years of experience Dental, life and vision Dental and vision services Single source solution for services 4.8M members ancillary services and 2.9M members Broad dental and vision voluntary benefits Broad dental and vision networks Well-respected TPA networks 1.1M members Specialty Benefits 35
  • 36. Options to Fit Your Clients’ Needs You can offer employer-sponsored or voluntary funding options to clients of all sizes. Dental Vision Health & productivity PPO Vision Care Plan Employee assistance Traditional Preferred Advantage, Focus, & work-life Advantage Plus Optimum Wellness / healthcare DHMO Preventive Plus coaching Disability Short-term income Behavioral health Life protection Basic term Long-term disability Voluntary term Level term AD&D Accident Whole life Critical illness Lifestyle – Care Life and Critical Life Supplemental health 36
  • 37. Add Specialty Benefits and Save 37
  • 38. Small Group Solutions (2 to 99 or more eligible employees) Bryan Wenger 38
  • 39. Sales Support and Service You’ll receive exceptional sales support and service to sell and keep more business, and to maximize your earnings: Local Humana sales executive helps you sell new business Retention executives and online resources help Other benefits include: you renew cases • Centralized billing and enrollment Dedicated Small Business Customer Care team to • Group-dedicated serve your clients billing representative • State-specific plan change and service teams 39
  • 40. Our Business Is to Help You Grow Yours Here’s what you can expect: Exceptional sales support and service Online resources to quote, enroll, and manage your business Broad product portfolio Direct access to underwriters Convenient, fast quotes Welcome calls to all new groups Wellness and employee assistance programs Plan utilization reports Comprehensive renewal reports Competitive commission and recognition programs 40
  • 41. Our Broad Product Portfolio With Humana’s broad product portfolio, you can deliver an even more competitive benefits package to your customers. We offer employer-sponsored and voluntary benefits including: • Medical • Disability • Dental • Critical Illness • Vision • Supplemental Health • Accident • Life 41
  • 42. Humana Product Continuum Traditional benefits with a wide range of out-of-pocket options First step toward consumer-directed plans Innovative, cost-saving solutions with banking arrangements 42
  • 43. P0S Product Small Business POS: Cariten to Humana Plan Design In-Network Out of Pocket (excludes deductible) • 100/60 to 100/70 • $750 to $2000 • 90/70 to 90/60 • $1000 to $1000 (90% plan) • 80/60 to 80/50 • $1000 to $2000 (70% and 80% plan) • 70/50 to 80/50 • $1500 to $2000 • $1750 to $2000 ER Copay • $2000 to $2000 • $100 to $150 • $2250 to $3000 • $3000 to $3000 In-Network Copay • $3500 to $4000 • $20/$35 to $20/$40 • $4000 to $4000 • $25/$40 to $30/$50 • $5000 to $4000 • $30/$45 to $30/$50 • $5500 to $4000 • $35/$50 to $30/$50 • $40/$55 to $30/$50 In-Network Deductible Additional Deductible Options: • $250 to $250 $3000 • $500 to $500 $4000 • $750 to $1000 $5000 • $1000 to $1000 $6000 • $1500 to $1500 $7000 • $2000 to $2000 $8000 • $2500 to $2500 43
  • 44. PPO Product Small Business PPO: Cariten to Humana Plan Design In-Network Out of Pocket (excludes deductible) • 100/60 to 100/70 • $750 to $2000 • 90/70 to 90/60 • $1000 to $1000 (90% plan) • 80/60 to 80/50 • $1000 to $2000 (70% and 80% plan) • 70/50 to 70/50 • $1500 to $2000 • $1750 to $2000 ER Copay • $2000 to $2000 • $100 to $150 • $2250 to $3000 • $2500 to $3000 In-Network Copay • $3000 to $3000 • $20 to $25 • $3500 to $4000 • $25 to $25 • $4000 to $4000 • $30 to $35 • $4500 to $4000 • $35 to $35 • $5000 to $4000 • $40 to $35 • $5500 to $4000 In-Network Deductible Additional Deductible Options: • $250 to $250 $3000 • $500 to $500 $4000 • $750 to $1000 $5000 • $1000 to $1000 $6000 • $1500 to $1500 $7000 • $2000 to $2000 $8000 • $2500 to $2500 44
  • 45. Standard PCA (HRA) A coinsurance PPO plan combined with a personal healthcare spending account Positively engage consumers — generates long-term savings Employer funded HumanaAccess card 45
  • 46. Personal Care Account (PCA) How does it work? You use funds to pay for eligible medical and pharmacy expenses PCA funds can be applied to the deductible Once all the funds are spent, you must satisfy the deductible and pay the specified coinsurance amount You always have protection against medical expenses for catastrophic illness or injury Simple plan design: – Preventive covered 100% – Exception endoscopic services for Small Business – Everything else coinsurance after deductible 46
  • 47. Humana HDHP 08 With Optional HSA An HSA qualified HDHP plan available with or without an HSA Preventive care at 100 percent Medical and pharmacy—integrated deducible HSA covers medical plan deductible, coinsurance, and other qualified services HSA offered through UMB Bank Both integrated and embedded family deductibles available 47
  • 48. Humana CoverageFirst 08 The easy first step toward consumer-choice plans No banking arrangements All the benefits of a full PPO plus an up-front allowance of $500 Allowance built in to the plan design Motivates employees to use their benefits wisely Guides employees in becoming informed consumers of health care 48
  • 49. CoverageFirst Product Details $500 allowance covers: – Doctor’s office visits – Routine outpatient labs and x-rays – Hospital services, emergency room services and outpatient surgery – Other services such as home health care, physical therapy and hospice care Allowance does not cover: – Prescription drugs – Mental health treatments (unless mandated) – only until 11/1/09 due to Federal Mental Health Parity – Copayments – Services from non-participating providers Unused funds do not carry-over from year to year 49
  • 50. CoverageFirst Positioning Feels like traditional PPO plans – Par/Nonpar providers – Copayments for some benefits; ded/coins for others First dollar coverage – $500 per member – Allowance is used for expenses prior to paying the deductible Allowance promotes financial involvement and incentives – Members see allowance as “their” money – Members more apt to take active role in decision-making and budgeting – Encourage utilization from participating providers Preventive covered at 100% after copay NOT a lower price alternative, but a baby step into consumerism 50
  • 51. Benefit Design Solutions for Today and Tomorrow Provide guidance with choice and flexibility Traditional benefit designs – Rx4: Tiered by cost, more sophisticated Value-based benefit designs – RxImpact: Unique 51
  • 52. Rx4 Most plans group drugs by generic, preferred brand, non-preferred brand and specialty – This is not sophisticated enough given the variance in the gap between generic and brand drug pricing Humana’s Rx4 groups drugs by cost – Tier 1 – lowest cost brands and generics – Tier 2 – higher priced brands and generics – Tier 3 – high cost (mostly) brands with less expensive alternatives – Tier 4 – Specialty drugs Some drugs have been moved to less expensive tiers due to proven medical efficacy (e.g., Procrit and Lovenox) 52
  • 53. RxImpact Drugs grouped based on: – Medical efficacy – ROI – Timeframe for “medical payoff” Each drug in a class is in the same level Group A Evidence-based short-term effectiveness (acute) (asthma, infections, juvenile diabetes, antidepressants) Group B Evidence-based long-term effectiveness (chronic) (cancer, heart disease, MS) Group C Drugs that provide symptom relief (antihistamines, anti-inflammatory, antacids) Group D Drugs that may impact lifestyle (sexual dysfunction, cosmetic, obesity, smoking cessation) Turns the member into the ultimate consumer 53
  • 54. RxImpact Example Each tier has an allowance assigned to it – Members pay the difference between the allowance and the discounted cost of the drug – Members had $0 expenses 65% of the time Retail Plan Drug name Quantity Allowance Member Pay Cost Pays Fluoxetine 20mg 30 $14.99 $30.00 14.99 $0.00 Lexapro 20mg 30 $89.99 $30.00 $30.00 $59.99 Cymbalta 30mg 30 $130.32 $30.00 $30.00 $100.32 Drug price source: www.drugstore.com, 10/01/2008 54
  • 55. Pharmacy Choices Rx Impact Rx4 Employers save 2 to 5 percent Eliminate unexpected charges on premium at the pharmacy About 60 percent of prescriptions Drugs are grouped into four levels, each have no out-of-pocket cost to with corresponding copayment amounts employees 85 percent of prescriptions filled are those If there is a cost to the employee, the average is $16 with the lowest copayments—those in the first two levels Out of pocket protection – $100 cap per prescription – $2,500 annual maximum (groups A, B, C) 55
  • 56. Fast, Convenient Quotes Receive medical, dental, and life quotes in easy-to-use Excel and PDF formats. You can: • Quickly compare health plan choices • See market popular plans • Filter data to view specific plans and benefit options • Model premium costs for your clients and their employees 56
  • 57. Talk Directly to Your Underwriter Humana’s underwriters provide you with the support you need to sell more cases, both new and existing business: Direct access to underwriters Local expertise to ensure your clients receive the best fit in products and rates Meet face-to-face with your underwriting team during Underwriting Days – Next session: September 16t and 17 Express underwriting/phone, fax and e-mail, or produce a quote request online and receive a firm risk rate, in most cases, within 48 hours 57
  • 58. See How Your Clients Used Their Benefits Using Humana’s exclusive Benefit Utilization Director (BUD)*, you can view how often employees: • Visit their doctors • Purchase prescription drugs • Meet deductibles and out-of-pocket maximums Knowing how health benefits are Plus, create a customized packet used will help you build more effective to share with your clients. strategies for your clients. * Available for groups with 5 - 99 employees 58
  • 59. Easily Explain Your Clients’ Renewals The Renewal Center provides transparency of the renewal process and helps you clearly explain your clients’ renewals. The Renewal Center contains: • Client renewal letters • Renewal rates and rate details • Census information and health status • Alternate quote summaries • Enrollment and plan change forms You can view the data the way you prefer: e-mail, paper, or Web. 59
  • 60. Communicate With Employers Humana works closely with you to help your clients manage their plans and control healthcare costs. We provide: Welcome calls to all new groups Employer welcome kit sent to every new group HealthMatters, which offers ideas on how to control healthcare costs and tips for managing their plan Humana Health Plan Guide, which shows employers how their employees use their benefits 60
  • 61. Help Members Choose, Use and Finance Their Benefits We help employees manage their plan, take control of their health, and better understand their healthcare costs by offering: Member enrollment kit Member welcome kit Educational materials on Humana’s wellness resources SmartSummarySM, a quarterly statement to help employees keep track of their healthcare spending MyHumana, a password-protected personal page on Humana.com 61
  • 62. Humana’s Health Resources Your 2 - 99 clients automatically receive a comprehensive health and wellness program that includes: • Humana Health Assessment • Personal health coaching • Discounts on health products and gym memberships • Employee assistance program Healthier employees use fewer healthcare dollars, • Disease management / clinical programs and have fewer claims, miss less work, and are more productive. 62
  • 63. Quote, Enroll and Manage Your Business Online The agent section on Humana.com has resources to help you do business with us, and service your clients. You can: • Order marketing materials If you haven’t registered yet, go to Humana.com and • Submit a quote click on “Agents” and • View utilization reports “Register Today.” • Access comprehensive renewal information, including rate detail and census information • Perform administrative functions on behalf of your clients • Get details about our compensation, bonus, and Leaders Club recognition programs 63
  • 64. Producer Partnership Plan Strong first-year and renewal commissions for all lines of coverage – 2-3 lives per case 5% – 4-25 lives per case 7% – 26-50 lives per case 5% – Paid on base premium Quarterly bonuses for growing block of business with Humana 64
  • 65. Leaders Club Become a member of Leaders Club and enjoy the beauty of San Francisco, along with other rewards such as: 20th Anniversary of Humana’s Leaders Club Concierge service to handle your claims, The Ritz-Carlton Half billing, and enrollment, as well as customer Moon Bay, California service issues May 2-7, 2010 HumanaWatch, a daily e-mail that links news coverage about Humana, our competitors, and the healthcare industry Preferred quote and new case processing Invitation to special events with Humana leaders Free continuing education courses 65
  • 66. Summary 100 percent of our small business products are distributed through you, our valued broker partners We help you educate your clients on solutions to control their healthcare costs We give you information so you can recommend the most appropriate, cost-effective healthcare plan We listen to you and act on your feedback 66
  • 68. Kick-Off Contest First three producers who place Humana medical product sale (8/1 and later quote date) will receive Garmin GPS devices Producer who places first multi-line sale (8/1 and later quote date) will receive: 8 tickets and use of skybox UT vs. Auburn Game October 3, 2009 Medical + Dental / Life / Voluntary / Worksite 68
  • 69. Get in the game with Humana! Thanks for attending! 69

Hinweis der Redaktion

  1. - PPO and NPOS in every state. NPOS uses the best available contract with the doctor and hospital. For example, if we have the doctor contracted on an HMO and a PPO, the NPOS network will use the HMO negotiated fee in place of the PPO for claims. HPN available where noted HMO available where noted
  2. Industries have educated consumers to move along a “ sophistication” spectrum of products and services When the movement happens it’s barely noticed because it happens over time and then is ingrained-- ATM’s, cell phones, lap tops Because movement takes place in so many areas, one area influences others-- lattes and sushi (new higher-end foods) What does migration mean to the consumer? Better products, greater value, new ways to get things done, and options/choice/control
  3. Integration is key.
  4. SCRIPT: There are three simple steps, or phases to implement SmartResults. Let’s look at those three steps in a little more detail: Chose the strategy you and your employees are comfortable with Over the three years, you can stay in one category, or move toward better trend mitigation by embracing consumerism. In setting your claims cost guarantee, we will apply a trend factor to set your next year's claims cost target. Based on the plan chosen and how well you rate on your Scorecard employee/employer participation levels, your trend factor is capped at a particular percentage. For instance, if you are a SmartSuite group and you meet your Scorecard participation levels, your trend factor is capped at 6%. And if your actual claims projection considering the behavior change credit is lower than the claims projection using 6% trend, then the actual claims projection prevails. Be rest assured you will always benefit from the lowest claim projection. Partner with us for engagement and improved health outcomes which involves three key elements: Health Risk Data Obtaining health risk data for earlier intervention includes collecting the information that helps identify those with chronic health conditions. Data collection includes: For new employers -- providing an electronic file of pharmacy claims data for new 1000+ accounts, Clinical programs participant list from previous carrier Completion of disclosure forms for large claims and high-cost conditions, Encouraging employees and spouses to complete Humana Health Assessment Employee Participation Getting employees actively involved leads to better health benefit choices and health improvement. Participation includes: Providing valid phone numbers for employees, using Humana’s communications package, and allowing Humana to contact employees directly, Supporting Humana’s clinical programs and encouraging employees to switch to lower-cost Rx when applicable for employees, Consider buying-up to Humana core wellness offerings for employees Ongoing Partnership Humana is seeking a partnered approach with you and your broker to deliver healthier outcomes and keep costs in line for everyone. This means agreeing to a three-year program commitment, purchasing Humana’s full spectrum of products – no carve-outs for mental health, pharmacy, etc., and having face-to-face meetings with your broker and Humana. 3. Review results with Humana and your broker, using the Scorecard As we work together we will track and review your progress through a scorecard. Based on the scorecard results, we’ll work together to make any needed changes to the action plan. The scorecard is delivered periodically, avoiding surprises late in the year.
  5. Ultimately, what does all this mean for Humana’s customers? We reach over 14% of members with our focused / nursing interventions. This 14% represent about 64% of medical spending. This does not mean that those members that represent the remaining 36% of spend are not supported. For these lower utilization members, Humana offers a wealth of tools and information through the personalized website, MyHumana. Additionally, the new Smart Summary connects with members on the individual level, allowing for tailored clinical messaging. Through the use of the focused programs and services, Humana is able to reduce the total costs of medical services by around 5%. This is money taken off the table, as members have better outcomes and use the health care system more efficiently. Bottom line – Humana saves $11-$15 per member per month. This is not a per participant number… but per Member . These calculations were based across the fully insured commercial book of business. Particular savings and participation levels may differ depending on product selection (HMOs often see more financial savings than PPOs), demographic of population, proper contact information, etc.
  6. Lisa had been diagnosed with asthma, a chronic disease, about 10 years ago. She recently worked with a Personal Nurse to get her asthma under control. Before being insured by Humana, Lisa had a partial knee replacement of her left knee. Her doctor recently told her she needed a replacement of the right knee. Lisa shared this information with her Personal Nurse. When Lisa expressed interest in a second opinion, the PN showed Lisa how to access My Humana to find a physician in her network, and then helped Lisa compile a list of questions for the doctor. The PN started pre-service guidance, then referred Lisa to a Case Manager for assistance getting post-op rehab. After the surgery, Lisa resumed working with her PN on her return to full mobility and a healthy life.
  7. NATIONAL CALL QUALITY: As we continue on our journey towards Perfect Service, we see our roles and our tasks with a new and enhanced perspective. We now see them through the view provided by the Perfect Service Filter. When we apply the Perfect Service characteristics to the things we do every day, we see opportunities to improve the way we work and to improve our valued customers’ experience with Humana. To adapt to this new Perfect Service perspective, we enhanced our National Call Quality measurements and realigned them with Perfect Service as shown in the new Call Quality form. ECHO: To help us ‘ hear ’ the voice of our customer, Humana will be implementing a great tool called Echo. Echo is a program that will provide a random outbound-automated survey to our members. Echo provides an opportunity to listen to the voice of our customer and to gauge their experience with Humana. Our customers are asked a series of questions about their experience on their call with Humana and they can record comments about their experience. REACH: We received feedback from associates that the REACH (Rewarding Excellence for Associate Contributions to Humana) incentive program and our Perfect Service and Guidance strategies were not in alignment. For example, it became clear that the average handle time (AHT) metric prevented associates from guiding the customer to call resolution, and that it put too much emphasis on the number of calls taken and not enough on the number of calls resolved. In 2007, we will roll out a modified version of REACH that rewards associates for applying Perfect Service to what they do. The program recognizes that providing guidance and perfect service to all our consumers requires a balance of quality and time. The new REACH plan will help us realign and ensures that we’re rewarding Perfect Service experiences.
  8. 2007 Humana finished 2nd to last in the Midwest and South Regions Humana Satisfaction Results: 512,000 additional satisfied/very satisfied members 2008 vs 2007
  9. Use voluntary benefits to complement existing employer paid plans Insure coverage gap and enhance family coverage Benefit decisions in the hands of the employee Mitigate employee dissatisfaction with reduction of employer sponsored benefits Maximize value added services that typically accompany voluntary benefits enrollments
  10. For 1,000+ and renewals, discounts applied at underwriter’s discretion. For voluntary benefits products, discounts are subject to minimum participation requirements. Discounts are not applicable to DHMO or Advantage Plus products.
  11. At this point in the Sales Onboarding presentation, stop and do the interactive activity. Divide the room into three groups and assign each group one of the following benefit designs: Rx3, Rx4, RxImpact. Ask each group to discuss the following 3 questions about the benefit design that was assigned to them: What are the advantages of the benefit design? How does it work? Why would employer offer it? Ask one person in the group to be the speaker. Give them about 15 minutes to discuss and ask each group to present. After each group answers the questions, go through the related slides and highlight what, if anything, they missed. Don’t forget to give Sales Bucks to the presenters! At the end of the activity, review HDHP and “Do they work”.
  12. While most plans group drugs by generic, preferred brand, non-preferred brand and specialty, this is not sophisticated enough given the variance in the gap between generic and brand drug pricing. Rx4, Humana Pharmacy’s first consumer driven product, groups drugs by cost. Drugs are assigned to four levels, with member cost increasing as the level increases: Level 1: Lowest-cost generic and brand-name drugs. Some examples include Lanoxin and Atenolol. Level 2: Higher-priced generic and brand-name drugs. One example is Minocycline. Level 3: High-cost brand drugs with less expensive alternatives. Examples include Accupril, Lasix, and Lovenox, as well as all cold and cough (both brand and generic). Level 4: Specialty drugs. Examples are Arava, Infergen, Nutropin, and Sandostatin.
  13. RxImpact is a revolutionary benefit design that groups drugs according to: Their ability to lower overall medical cost The timeframe in which they impact medical care All drugs within a class (e.g., antidepressants, proton-pump inhibitors, etc.), both brand and generic, are categorized in the same group. This is different from a traditional benefit design that would separate drugs by generic/preferred/non-preferred. RxImpact is designed as an allowance benefit structure – for each group of drugs, the plan pays a specific allowance amount and members pay the drug-cost balance, if any, instead of the traditional copayment structure. The allotted allowance amounts decrease from Group A to Group D and there is a maximum out-of-pocket protection per prescription and a yearly maximum out-of-pocket protection for Groups A-C. RxImpact is designed to generate year-over-year savings and eliminate the need to introduce new prescription drug benefits annually.
  14. In conjunction with Corphealth, a wholly owned subsidiary, a leader in the behavioral health field.