Molina Marketplace California Broker Training

Amy DeMarco CA Broker Channel Manager The Molina Story While working as an emergency room physician, Dr. C. David Molina saw a need to change how the health care system cared for people on a budget.

In 1980, he opened a community clinic where caring for people was more important than their ability to pay. Today, his legacy lives on through Molina Healthcare, a company that cares for more than 4 million members in 13 states serving people with Medicare, Medicaid, and Marketplace, Molina Healthcare remains true to Dr. Molina’s convictions: treating each person like a member of the family.

Our Molina Mission To provide quality healthcare services to financially vulnerable families and individuals covered by government programs 2018: We’re fixing the plane while in flight...

Core Ops Care Delivery

Cost of Care

2019: The future is looking bright!

3 We Are Here to Stay!!

#152 on the Fortune 500 List in 2018

4 Member Experience Improvements

Network audit • Reached out to all provider networks to confirm participation Claims overhaul • Improved accuracy and speed of claims approval and payment Member Services leadership • New VP who is spearheading restructuring and training Wellness Assessment • Enhanced ability to identify high risk members and incentivize them to see their PCP and health needs met

5 Molina Marketplace 2019 Rate Changes Next Open Enrollment Period

Covered California “sign up period” dates:  October 15, 2018 – January 15, 2019

• Renewals will start October 1, 2018 • Passive Renewals will start October 31, 2018 • Healthcare.gov states only have until 12/15/18 for OEP • Some members may qualify for a Special Election Period (SEP) year-round

7 Covered CA 2019 Benefits Chart

8 Molina Marketplace in 2019

Molina’s Covered CA average plan change percentage is 1.4%, with most of our Silver plans seeing a decrease

Los Angeles County Region Gold Silver Bronze Imperial 13 -2% -5% 5% N. Los Angeles 15 0% -4% 7% S. Los Angeles 16 2% -2% 9% San Bernardino

Inland EmpireRiverside 17 0% -4% 7%

San Imperial Orange Diego 18 5% 1% 12% San Diego 19 -3% -6% 4%

9 Molina LA Region 16 Rates

2nd lowest cost QHP in Silver, Gold and Platinum

3rd lowest in Bronze

Los Angeles

San Bernardino

Riverside

San Imperial Diego

10 Molina LA Region 15 Rates

4th lowest cost QHP in Silver and Gold

Los Angeles

San Bernardino

Riverside

San Imperial Diego

11 Molina Orange County Rates

2nd lowest cost QHP in Bronze, Silver and Gold

1st lowest cost in Platinum

Los Angeles

San Bernardino

Riverside

San Imperial Diego

12 Molina San Diego Rates

1st lowest cost QHP in Bronze, Silver, and Gold

2nd lowest cost in Platinum

Los Angeles

San Bernardino

Riverside

San Imperial Diego

13 Molina Inland Empire Rates

1st lowest cost QHP in Bronze, Gold and Platinum

2nd lowest in Silver (by $1)

Los Angeles

San Bernardino

Riverside

San Imperial Diego

14 Molina Imperial Rates

1st lowest cost QHP in Bronze, Silver, Gold and Platinum

Los Angeles

San Bernardino

Riverside

San Imperial Diego

15 Molina Marketplace Provider Network IPA’s/Medical Groups – Los Angeles County

• Allied Pacific IPA • Preferred IPA of California • AltaMed Medical Group • Regal Medical Group • Angeles IPA (Heritage) • Asian Community Medical • Regent Medical Group Group • Seoul Medical Group • Bella Vista Medical Group • Serra Community Medical • California Pacific Physicians Group Medical Group • Sierra Medical Group • El Proyecto Del Barrio (Heritage) • Global Care Medical Group • South Atlantic Medical Group • Golden Shore Medical Group • Southern California Children’s • Healthcare LA IPA Healthcare • Healthy New Life Medical Corp • Southland Advantage Medical • High Desert Medical Group Group (Heritage) • Southland San Gabriel Valley • La Salle Medical Associates IPA Medical Group • Lakeside Medical Group • Superior Choice Medical (Heritage) Center • Noble Community Medical • United Physicians International Associates • Vantage Medical Group

17 • Los Angeles Community Hospital Hospitals – Los Angeles County • Martin Luther King Jr Community Hospital • Alhambra Hospital Medical Center • Memorial Hospital of Gardena • Aurora Charter Oak Hospital – Behavioral Health • Methodist Hospital of Southern California • Aurora Las Encinas Hospital – Behavioral Health • Miller Children’s Hospital Long Beach • Beverly Hospital • Monterey Park Hospital • Citrus Valley Medical Center – West Covina Campus • Norwalk Community Hospital • Citrus Valley Medical Center – Covina Campus • Olive View UCLA Medical Center • Coast Plaza Hospital • Pacific Alliance Medical Center • College Hospital of Cerritos - Behavioral Health • Pacifica Hospital of the Valley • College Medical Center – Long Beach • Pomona Valley Hospital Medical Center • Community Hospital of Huntington Park • Promise Hospital of East LA • East Los Angeles Doctors Hospital • Rancho Los Amigos Rehabilitation Medical Center • Encino Hospital Medical Center • Silver Lake Medical Center • Foothill Presbyterian Hospital • Southern CA Hospital at Culver City • Garfield Medical Center • Southern CA Hospital at Hollywood • Glendale Adventist Medical Center • Southern CA Hospital at Van Nuys • Good Samaritan Hospital • St. Francis Medical Center • Greater El Monte Medical Center • St. Vincent Medical Center • Harbor UCLA Medical Center • Twin Town Treatment Centers North Hollywood • Hollywood Presbyterian Medical Center • Twin Town Treatment Centers West Hollywood • Keck Hospital of USC • Twin Town Treatment Centers Torrance • LA County – USC Medical Center • Valley Presbyterian Hospital • Lakewood Regional Medical Center • White Memorial Medical Center • Los Alamitos Medical Center • Whittier Hospital Medical Center 18 Urgent Care Centers - LA County • AltaMed (Los Angeles, El Monte) • US Healthworks Medical Group (LA, City of Industry, • Pacific Alliance Medical Center (LA) Compton, Torrance, Chatsworth, El Monte, Ontario, • Silverlake Medical Center (LA) Pomona, Saugus, Valencia, Commerce, Van Nuys) • Proactive Urgent Care (El Segundo, LA) • Dusk to Dawn (Gardena, LA, Lynwood, Paramount) • A.N.D. Inc., Urgent Care (North Hollywood) • AME Medical Group (Long Beach, 2 in Downey) • Reliant Immediate Care Medical Group (LA) • Long Beach Urgent Care (Long Beach) • Serra Community Medical Clinic (Sun Valley) • MedPost Urgent Care (Cerritos, Cypress, Los • Urgent Care Center of South Bay (Torrance) Alamitos, Long Beach, La Habra) • Encino Urgent Care (Encino) • Concentra Urgent Care (La Palma) • AMG Medical Corp. (Alhambra) • Greater Covina Healthcare Urgent Care (Covina) • Valley Urgent Care (Northridge) • AP Urgent Care Center (City of Industry) • ProActive Urgent Care Services (LA) • Chino Total Care Walk-in Clinic (Chino) • Teodoro Diaz MD (Ontario) • Smart Clinic Urgent Care (West Covina, Santa Clarita) • Pasadena Community UCC (Pasadena) • MD After-Hour Care Center (Monterey Park) • Glendora Urgent Care (Glendora) • Imperial Primary Care Medical Group (La Mirada) • Los Angeles Urgent Care (LA) • After Hours Medical Group Inc. (Whittier, La Habra) • Burbank Urgent Care (Burbank) • Central Avenue Urgent Care (Montclair) • Montebello Urgent Care (Montebello) • Orthopedic Medical Center Urgent Care (LA) • Temple Medical Center (LA) • Rapid Care Urgent Care Center (Glendale, Burbank) • Wilmington Urgent Care (Wilmington) • Glenoaks Urgent Care Medical Group (Glendale) • South Atlantic Medical Group (LA) • Reseda Family Medicine Urgent Care (Reseda) • Sierra UCC (Palmdale, Lancaster) • Reliant Immediate Care (2 in LA, Montebello) • Mend Health (2 in Sherman Oaks) 19 IPA’s/MG’s – Orange County

IPA/Medical Groups • Heritage Provider Network • Affiliated Doctors of OC • Regal Medical Group • Lakeside Medical Group • Monarch Health Plan

20 Hospitals – Orange County

• Anaheim Regional Medical Center • Kindred Hospital Santa Ana • Anaheim Lighthouse – Behavioral Health • Kindred Hospital Westminster • Chapman Global Medical Center • La Palma Intercommunity Hospital • CHOC Children’s Hospital • Los Alamitos Medical Center • CHOC Children’s Hospital at Mission • Miller Children’s Hospital • Coastal Communities Hospital • Orange Coast Memorial Medical Center • College Hospital of Costa Mesa • Park Anaheim Healthcare - Rehab • Fountain Valley Regional Hospital and • Placentia-Linda Hospital Medical Center • Saddleback Memorial Medical Center • Garden Grove Hospital and Medical Center • Saddleback Memorial San Clemente Campus • Healthbridge Children’s Rehabilitation • Seal Beach Health and Rehabiliation Hospital • University of California Irvine (UCI) Medical • HealthSouth Tustin Rehabilitation Hospital Center • Huntington Beach Hospital • West Anaheim Medical Center • Western Medical Center – Anaheim • Western Medical Center – Santa Ana

21 Urgent Care Centers - Orange County • Concentra Urgent Care (Anaheim, La Palma, Placentia) • MedPost Urgent Care (Brea, Cerritos, • AME Medical Group (Anaheim, Long Beach) Costa Mesa, Cypress, Huntington • Hoag UCC (Anaheim Hills, Huntington Beach, Tustin, Orange) Beach, Los Alamitos, Anaheim Hills, La • OC UCC (Anaheim, Foothill Ranch, Huntington Beach, Orange) Habra, Long Beach, Yorba Linda) • Gateway Urgent Care (Anaheim Hills) • Sand Canyon Urgent Care (Irvine) • Surfside Urgent Care (Laguna Beach) • US HealthWorks (Santa Ana) • Xpress Urgent Care (Costa Mesa, Tustin) • Nellie Gail Urgent Care (Laguna Hills) • Laguna Dana Urgent Care (Dana Point, Laguna Beach) • Long Beach Urgent Care • Clinica Medica, Dr. Don Garcia (Anaheim, Buena Park) • Newport Urgent Care • MemorialCare (Huntington Beach, Westminster) • Pacific Urgent Care (Fullerton, Orange) • Family Care Centers (Costa Mesa, Fountain Valley, Irvine • Hawaiian Gardens Walk-in • OptumCare (Ladera Ranch, Mission Viejo, SJC, Seal Beach) • Cypress Urgent Care • Saddleback UCC (Lake Forest, Mission Viejo) • Brea Urgent Care • South County UCC (San Clemente) • Anaheim Urgent Care • Hybrid MD (San Clemente) • Marque Urgent Care (Aliso Viejo) • Caduceus Urgent Care (Laguna Beach, Yorba Linda) • South Coast Pediatrics (Santa Ana) • Newport Urgent Care (Newport Beach) • AltaMed (Garden Grove) • Marque UCC (Newport Beach, Rancho Santa Margarita) • Vital UCC (Newport Beach) • Imperial Primary Care Medical (La Mirada • Dyer’s Urgent Care (Laguna Hills) • Sunrise Multispecialist MC (Orange, Tustin) • Mission Medical (Mission Viejo) • South County UCC (San Clemente) • Advance Urgent MC (Santa Ana) • Kids Doc (Mission Viejo) • San Juan Pediatrics (SJC)

22 IPA’s/Medical Groups in Riverside and San Bernardino Counties

• Desert Oasis Medical Group • Golden Shore Medical Group • Heritage Victor Valley Medical Group • Inland Faculty Medical Group • La Salle Medical Associates • Regal Medical Group • Vantage Medical Group

23 Hospitals in Riverside and San Bernardino Counties

• Arrowhead Regional Medical • Inland Valley Medical Center Center • JFK Memorial Hospital • Casa Colina Hospital • Loma Linda University Medical Center • Colton Clinical Services • Loma Linda University Medical Center – • Corona Regional Medical Center Murrieta • Desert Regional Medical Center • Loma Linda University Children’s Hospital • Desert Treatment Clinic – • Menifee Valley Medical Center Behavioral Health • Pacific Grove Hospital • Hemet Valley Medical Center • Parkview Community Hospital • Pomona Valley Hospital and Medical Center • Rancho Springs Medical Center • Riverside County Regional Medical Center • Riverside Treatment Center • San Antonio Community Hospital • San Gorgonio Memorial Hospital • Temecula Valley Hospital • Temecula Valley Treatment Center • Victor Valley Global Community Hospital

24 Urgent Care Centers - Riverside and San Bernardino • US Healthworks Medical Group (Chino, San Bernardino, • Trinity Medical Clinic (Ontario) Ontario, Pomona, Colton, Moreno Valley, Riverside) • Desert Urgent Care (Palm Desert) • Desert Oasis (Palm Springs, Indio, Yucca Valley) • Manzoor Kazi Medical Assoc (Palm Desert) • Desert Regional Immediate Care (Palm Desert) • Yucaipa Urgent Care (Yucaipa) • Healthcare Express Urgent Care (Palm Desert) • Teodoro Diaz MD (Ontario) • Dr. Mike’s Walk-In Clinic (Apple Valley, Hesperia, • Rapid Care (Rancho Cucamonga) Barstow, Victorville) • Consumer Medical Group (Rancho Cucamonga • Family Practice Associates (Hesperia) • San Jacinto Family and UCC (San Jacinto) • CareFirst Medical Group (Ontario) • Advanced Medical and UCC (Upland) • Hayes Medical and UCC (Ontario) • Apex Urgent Care (Beaumont) • Novak Urgent Care (Indio) • Comprehensive Primary Care (Fontana) • Canyon Lake UCC (Lake Elsinore) • Apple Urgent Care (Hemet, Perris) • Moreno Valley UCC (Moreno Valley) • Meridian Urgent Care (Barstow, Beaumont, • Concentra UCC (Rancho Cucamonga) Apple Valley, Hesperia) • Reddy Care Medical (Pomona) • Heritage Victor Valley UCC (Victorville) • Mission Grove Medical (Riverside) • Pinnacle Medical Group (Rialto, San • A Plus Walk In (Menifee, Murrieta, Sun City) Bernardino, Fontana, Yucaipa) • West Point MC (Fontana, San Bernardino, Rancho Cuc) • Parkview Outpatient (Riverside) • Medicross Clinic (Corona) • Impact Care Access Network Inc (Hesperia) • Premier (Pomona, Chino Hills, Indio, Palm Springs) • Integrated Health & Wellness (Apple Valley) • Alta Loma Medical Group (Rancho Cucamonga) • Inland Urgent Care (Wildomar) • Inland UCC (Temecula, Wildomar, Menifee) • Doctors Express Urgent Care (Riverside) • SJ Medical Clinic UCC (San Jacinto) 25 IPA’s/MG’s and Hospitals – San Diego County IPAs/Medical Groups- San Diego • Vantage Medical Group • Community Care IPA • Integrated Health Partners

Hospitals – San Diego County • Rady’s Children’s Hospital San Diego • Alvarado Parkway Institute • Scripps Memorial Hospital Encinitas • Aurora Behavioral Health of San Diego • Scripps Memorial Hospital La Jolla • Kindred Hospital San Diego • Scripps Mercy Hospital Chula Vista • Palomar Medical Center Escondido • Scripps Mercy Hospital San Diego • Pomerado Hospital • Scripps Green Hospital • Sharp Memorial Hospital • Sharp Chula Vista Medical Center • Sharp Mesa Vista Hospital • Sharp Mary Birch Hospital • Sharp Grossmont Hospital • Sharp Coronado Hospital • Tri-City Medical Center • UCSD Medical Center • UCSD Thornton Hospital • Vibra Hospital of San Diego

26 Community Clinics – San Diego County San Diego Community Clinics (FQHC) • Borrego Community Health Foundation - El Cajon, Escondido, La Mesa, Borrego Springs • Community Health Systems, Inc. - Fallbrook Family Health Center • Family Health Centers of San Diego - El Cajon (Chase, Main), Lemon Grove, Spring Valley, Chula Vista, San Diego (Federal, Market, 30th, Polk, El Cajon, 4th, Island, Broadway, Commercial, Elm, Mission, National, 6th) • Imperial Beach Community Clinic -Imperial Beach, San Diego • La Maestra Family Clinic - El Cajon (Broadway, 1st), San Diego, National City • Logan Heights Family Counseling Center – San Diego • Mountain Health & Community Services - Santee, Alpine, Escondido, San Diego (Date, Elm, Valley Parkway, 25th, El Cajon) • Neighborhood Healthcare - Lakeside, El Cajon, Escondido (Elm, Valley Pkwy), Pauma Valley • North County Health Services – Encinitas, Carlsbad, Ramona, San Marcos, Oceanside (Mesa, Mission, Crouch) • Operation Samahan - San Diego (Camino Ruiz, Carmel Mountain), National City • San Diego American Indian Health Center – San Diego, • San Diego Family Care – San Diego (Polk, University, Linda Vista) • San Ysidro Health Center – Chula Vista, El Cajon, San Diego, National City (D, 8th), San Ysidro (3rd, Beyer), Otay • Southern Indian Health Council, Inc.- Campo, Alpine • St. Vincent De Paul Village – Sa Diego • Vista Community Clinic – Oceanside, Vista (Pier View, Durian, Vale Terrace), Chula Vista

27 Urgent Care Centers - San Diego County

• AFC Urgent Care (Bonita/Chula Vista, San Diego, Santee) • Centro Medico (Escondido, El Cajon) • Coronado Bay Urgent Care (Imperial Beach) • Emergency Care Dynamics (San Diego) • MD Today Urgent Care (2 locations in San Diego) • Partners Urgent Care (Eastlake/Chula Vista, Grossmont/La Mesa, San Diego) • A Plus Walk-in Urgent Care (Fallbrook) • Rady’s Children’s Urgent Care (La Mesa, San Diego, Escondido, Oceanside) • South Coast Medical Clinic and San Diego Physical Therapy (National City)

28 IPA’s/MG’s/Hospitals – Imperial County

IPA/Medical Groups • Community Care IPA • EasyAccess Care IPA

Hospitals • Pioneers Memorial Hospital • El Centro Regional Medical Center

29 Online Provider Search

https://providersearch.molinahealthcare.com/

30 Advanced Online Provider Search Search by Specialty, Name, Language, Hospital and IPA affiliations

31 Pharmacy Services and Prescriptions Molina contracts our pharmacies through CVS/Caremark

You can find a list of our contracted pharmacies in your area here: http://www2.caremark.com/micro/asset/mp_ca_pharmloc.htm

32 Molina Marketplace Broker Resources Covered CA Pay Now and PCP Selection

Brokers can help their member:  Pay first month’s premium  Setup auto-pay  Select their PCP All at the time of application

Members who pay at time of signing will receive a printable recap of their plan, payment and PCP, AND they’ll get their member ID card within 10 business days

Member effectuation rates are also much higher if payment is taken when they apply

34 Molina Broker Portal

Easy Access to Broker Support Tools Broker Portal Functionality Book of Business, Member Payment info and Grace Period Status BSU (Broker Support Unit)

Phone: 1.855.885.3179

Broker Services - # 1 [email protected] • General inquiries, account access issues, member EOC and SBC questions Broker Care Team- # 2 [email protected] • Member access to care issues, billing discrepancies, terminations in error Commission Team- # 3 [email protected] • Broker Book of Business reconciliation for unpaid policies Contracting Inquiries - # 4 [email protected] • Appointment requests, E&O/license/contact information updates 37 Monday through Friday – 8:00 AM to 5:00 PM (CST) CARE Team – Member issue resolution support

Marketplace Broker Communication And Resolution Experts • Access to Care

• BillingSan Bernardino Issue Los • Angeles Claims Riverside

San Imperial • EnrollmentDiego • Member Services • Prior Authorization Status Review

38 Free Promo Items for Brokers • hand sanitizer keychain • hand sanitizer • lip balm • first aid kit • click pen • ID card holder • gel ball stress reliever • physician figurine stress reliever San Bernardino Los • baseball stressAngeles reliever Riverside

• football stress relieverSan Imperial Diego

..\Promo item orders\MOLINA Promo Item Order Form.docx

39 My Molina Member Portal My Molina – Self Service Member MyMolina.comTool . View invoice and real-time balance . Change PCP . Sign up for AutoPay, or make a payment . View Claim History . View Plan and Benefits . Print ID Card . View/Print SBC or EOC . Get Reminders for Health Services

. View Drug Formulary …and much more!

41 42

• View your Member ID Card • Find a new doctor, change your • Pay your bill doctor, or view your doctor's contact • View your health records information • View your benefits and eligibility • Access to many more services!

45 Invoicing and Payment Options

Binder invoice mailed upon receipt of enrollment 1. AutoPay – for convenience and peace of file from the Exchange and monthly thereafter mind. Register at MyMolina.com Binder Due Date 2. Online (Mobile Device or Desktop) - can use savings or checking account, credit or  st CA Binder Due Date is 1 of coverage debit card at MolinaPayment.com. Or log effective month in to MyMolina.com. Premium Due Date thereafter is: 3. IVR – savings or checking account, Visa, MasterCard or Discover card. th  26 of the month prior for CA, or 4 business 4. Mail – submit payments with coupon days prior to the beginning of the coverage from invoice. Allow 15 days for receipt effective month, whichever is earlier and processing. AutoPay 5. Cash – go to MoneyGram.com to find a location, or call (800) 666-3947. Autopay debits on the 23rd of the month, or next business day Always include the Subscriber ID or Account Number with payments to avoid processing delays

46 Molina New Member Communications Communications Process for New Members Member can select PCP and make binder premium Correspondence triggered daily when 834 file transaction is received payment through Pay Now from the Exchange If payment made upon application, invoice will Application Welcome letter Binder Invoice show $0 balance Start

• Members who do not pay the full Members can register binder upon application will not have for Autopay during the ability to select a PCP. enrollment application • A PCP will be selected for them.

Payment PCP Selection ID Card and Welcome Kit

During OE, binder reminder robocall and email outreach is performed 48 Welcome Letter

Sent upon receipt of enrollment transaction from the Exchange

Messaging:  Subscriber ID  My Molina registration  How to Make Premium Payments  PCP Selection Options / Auto-Assignment  Wellness Check Appointment Information  ID Card – process and timing to receive  Drug Formulary location  Member Services – contact information  Accessibility to information – language and disability options

49 Member ID Cards • New Members - Sent once full binder payment is received and processed • Active Renewals – Sent as members actively renew during Open Enrollment • Passive Renewals – Sent in early to mid-December

Important Information about ID Cards  Mailed only once the full binder payment is received and posted  In paper form (not laminated)  Comes in a large envelope, first sheet in the package, tear along perforated line  Includes one ID card per covered family member  ID cards can be printed from MyMolina.com  Available on mobile devices and can be printed or emailed

Front Back

50 Welcome Kit and Renewal Kit Contents

 ID Card for each covered member of the family  Effective Date of Coverage  Cover Letter including important information and tips  Privacy, Security, and HIPAA Information  Financial Information Privacy Notice (except CA)  1557 Non-Discrimination Notice and Limited English / ADA statement plus taglines in top 15 languages per state

Welcome Kit Renewing Kit Contents Contents

51 Molina Member Services

Customer Support Center (888) 858-2150 8:00 a.m. - 6:00 p.m. Monday to Friday PST

Nurse Advice Line (888) 275-8750 (English) (866) 648-3537 (Spanish) 24-Hours a day, Monday to Sunday

Molina Healthcare of California Headquarters 200 Oceangate, Suite 100

Long Beach, CA 90802 52 Questions? ¿Preguntas?

Amy DeMarco 657-243-7461 [email protected]