Highmark Senior Markets 2021 Highmark Agent Field Guide HC413722_2021_AgentFieldGuide_BRO_FF.indd 1 7/30/20 11:15 AM HC413722_2021_AgentFieldGuide_BRO_FF.indd 2 7/30/20 11:15 AM Dear Highmark Agent: Welcome to Highmark Senior Markets! You are a valued member of our sales team. And you are the face of Highmark. Change is happening throughout the health care industry, and Highmark is playing a leading role in driving that transformation. We are proud to make a difference in the lives of the nearly 5 million members who we serve. As a Highmark field agent, you’re often our first point of contact with consumers who are shopping for quality health coverage that is both accessible and affordable. That’s why we’re here to support you. And it’s why we’re providing you with this Highmark Agent Field Guide. This helpful resource puts a wealth of information at your fingertips — including details about our Medicare products, important policies, and everything you need to know about doing business with Highmark. On the following pages, you’ll also find guidance on using the Highmark producer web portal, information on the Medicare Star ratings, and other insights to help ensure you’re “Ready to Sell” Highmark products as the ideal solution to your customers’ needs. So please keep this guide handy. It can help you prepare to have more productive meetings with your clients as they search for a health plan offering both comprehensive coverage and real value. Thank you for representing Highmark! And please know that we’re always here to help you — to make your job easier and to help you remain successful. Sincerely, The Highmark Senior Markets Team 3 Confidential & Proprietary — For Agent Use Only HC413722_2021_AgentFieldGuide_BRO_FF.indd 3 7/30/20 11:15 AM HC413722_2021_AgentFieldGuide_BRO_FF.indd 4 7/30/20 11:15 AM Table of Contents Section I: Highmark Snapshot — Who Are We? �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7 Section II: Producer Portal and ShopPRO Resources � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9 Section III: Ethics and Integrity� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19 Section IV: Commissions, Compliance, and Agent Oversight �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23 Section V: Enrollment Process and Eligibility� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 31 Section VI: Highmark’s Medicare Products Star Ratings �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 33 Section VII: Highmark Senior Markets Medicare Products � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 37 Section VIII: Regions — Products and Pricing by County � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �43 Section IX: Additional Enrollment Resources� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 71 Appendix A: Agent Sales Checklist �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 77 Appendix B: Medical Underwriting Guidelines �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 78 Appendix C: Scope of Sales Appointment Confirmation Form� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 81 Appendix D: Highmark Senior Markets �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 83 Appendix E: Glossary � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �85 5 Confidential & Proprietary — For Agent Use Only HC413722_2021_AgentFieldGuide_BRO_FF.indd 5 7/30/20 11:15 AM HC413722_2021_AgentFieldGuide_BRO_FF.indd 6 7/30/20 11:15 AM SECTION I: Highmark Snapshot — Who Are We? 7 Confidential & Proprietary — For Agent Use Only HC413722_2021_AgentFieldGuide_BRO_FF.indd 7 7/30/20 11:15 AM SecTION I: HighmarK Snapshot — Who ARE WE? Highmark Snapshot — Who Are We? Welcome to Highmark Health, a national health and wellness organization with more than 43,000 employees. United Concordia Dental is a leading national dental solutions A national blended health organization, Highmark Health company focused on delivering better, overall health. The and our leading businesses support millions of customers company has nearly 8.5 million members, one of the nation’s with products, services, and solutions closely aligned to largest dentist networks, an AM Best A- (Excellent) rating, and is licensed in all 50 states, District of Columbia, and Puerto Rico. our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we’re regionally focused in Pennsylvania, Delaware, and West Virginia, with HM Insurance Group works to protect businesses from the customers in 50 states and the District of Columbia. potential financial risk associated with catastrophic health care We passionately serve individual consumers and fellow costs. Through its insurance companies, HM Insurance Group businesses alike. And our companies cover a diversified holds insurance licenses in 50 states and the District of Columbia and maintains sales offices across the country. spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. HM Health Solutions, through 4,200 employees who specialize in leading technology and industry expertise, delivers business Highmark Health’s portfolio of Leading solutions to 13 health plans serving 10.3 million members, Health Care Companies enabling plans to run their operations more efficiently in a competitive and ever-changing marketplace. Highmark Inc. | Pittsburgh, PA Allegheny Health Network provides health care delivery, research, medical education, and wellness services through a Highmark Inc. and its collective health insurance leading integrated delivery network of eight hospitals, more than subsidiaries and affiliates are one of America’s largest health 2,400 staff physicians, and key clinical and research partnerships. insurance organizations. Highmark Inc. and its affiliates operate health insurance plans in Pennsylvania, Delaware, and West Virginia that serve more than 5.6 million members and hundreds of thousands of additional individuals through the BlueCard® HM Home & Community Services provides health care program. organizations that are accountable for managing populations within home and community settings with customized solutions Together with its Blue-branded affiliates, Highmark Inc. is for the entire episode following hospitalization, achieving higher collectively the fourth largest overall Blue Cross and Blue levels of performance including lower costs, improved health Shield-affiliated organization in the country based on capital. outcomes, and a better patient experience. Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association. Confidential & Proprietary — For Agent Use Only 8 HC413722_2021_AgentFieldGuide_BRO_FF.indd 8 7/30/20 11:15 AM SECTION II: Producer Portal and ShopPRO Resources 9 Confidential & Proprietary — For Agent Use Only HC413722_2021_AgentFieldGuide_BRO_FF.indd 9 7/30/20 11:15 AM SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES Doing Business with Highmark Senior Markets The Producer Portal Working with Highmark is easy when you use the tools we’ve provided. One of these helpful resources is our online Producer Portal — producer.highmark.com. This user-friendly website gives you many informational tools to help you have productive conversations with your clients. And it will help you build a greater knowledge base about Highmark as well. The Producer Portal enables you to: • Enroll Medicare clients online • Check the status of applications • Order customized enrollment kits through ShopPRO • Request CMS approved marketing materials • View and download important documents • Access the most recent version of this Field Guide Confi dential & Proprietary — For Agent Use Only 10 HC413722_2021_AgentFieldGuide_BRO_FF.indd 10 7/30/20 11:15 AM SECTION II: PRODUCER PORTAL AND SHOPPRO RESOURCES Enroll your clients with ease To enroll your clients faster and easier, utilize the online enrollment tool. The online enrollment tool also provides instant confi rmation that an application has been received by Highmark. To use the online enrollment tool: 1� Log in to the Producer Portal� 5� You will have the option to upload your Scope 2� Select the New Business tab and then the of Appointment and accept the Statement of Medicare option, followed by the Enroll link� Understanding� 3� Enter the ZIP code, select the county the benefi ciary 6� When you have completed entering all of the required Review resides in, enter their date of birth, and choose the plan information, you will come to the screen� in which they are enrolling� At this screen, you will be able to print out a summary of the application� 4� After starting the application, you will be required to enter your producer information, including NPN� 7� After you submit the application, you will be directed to a confi rmation screen� Here you can email yourself a confi rmation for your records� 11 Confi dential & Proprietary — For Agent Use Only HC413722_2021_AgentFieldGuide_BRO_FF.indd 11 7/30/20 11:15