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Medicare Offerings

In this issue:
    

There's a Lot to Be Excited About For This Annual Enrollment Period
 

In only two years since we launched, Braven Health has quickly become one of the largest and fastest-growing individual Medicare Advantage plans in New Jersey. And we're only getting started. In 2023, we can now offer Braven Medicare Choice (PPO) Plan –with a $0 premium--in every county in New Jersey.

Braven Health Individual Medicare Advantage plan benefits are better than ever in 2023 with:

  • Our new Braven Health+ Smart Card. An innovative new way for members to use their extra benefits with no reimbursement forms necessary. It is as easy as swiping your card. Members get up to $1,300 in extra benefits loaded onto your card including:
    • A $70 quarterly Over-the-Counter (OTC)benefit allowance ($90 for Braven Medicare Freedom (PPO) members)
    • A $200/year Fitness Benefit Allowance
    • Up to $350/year in Healthy Rewards
    • And more
  • Expanded Flex Benefits – now $275 a year. Members can now use their Flex Benefit allowance for health-related Uber or Lyft transportation to doctor's appointments and pharmacies.
  • More flexible, no-cost meal delivery after inpatient hospital stay or surgery. There is no limit on the number of times they can use this benefit.
  • More Papa in-home support service hours—now up to 36 hours. Members can also use their Flex Benefit to purchase additional hours with their Braven Health+ Smart Card.
  • More retailers for eligible members to take advantage of their Healthy Foods benefit.*  Our list of participating retailers is more extensive than ever before and includes CVS, Rite Aid, Walgreens, Walmart, Schnucks, Giant Eagle, Dollar General, Target, Albertsons, Safeway, Acme, Kings Food Markets, Balducci's Food Lovers Market, Kroger, Wakefern-Shoprite, Aldi, Costco, Wholefoods, Trader Joes and Key Food.

Plus, members will continue to enjoy a $0 medical deductible, $0 in-network primary care doctor visits, and $0 in-network routine dental, vision, and hearing.
 

2023 Braven Health Plan FAQs

Does Braven Medicare Choice PPO have an out-of-pocket limit for Inpatient Hospital stays?

Yes, there is an out-of-pocket limit for Inpatient Hospital stays. For 2022, the limit is $1,600 per stay ($320 x 5 days = $1600), and for 2023, the limit is $1,675 per stay ($335 x 5 days). Even though the 2023 Braven Medicare Choice Annual Notice of Change (ANOC) does not include this information, members are still protected by this limit per stay.  

What plans are Braven Health offering in the 13 expansion counties?

Braven Health will offer Braven Medicare Choice (PPO) in the 13 expansion counties. Four new Plan Benefit Packages (PBP) will be offered in different regions - all will have a $0 premium, and each will have slightly different benefits.
 
H0885-003
 		 Braven Medicare Choice (PPO)
 		 Mercer, Morris, Somerset
 
H0885-004
 		 Braven Medicare Choice (PPO)
 		 Hunterdon, Sussex, Warren
 
H0885-005
 		 Braven Medicare Choice (PPO)
 		 Burlington, Camden, Cumberland, Gloucester, Salem
 
H0885-006
 		 Braven Medicare Choice (PPO)
 		 Atlantic, Cape May
 

In 2023, what changes were made to the hearing benefit for Braven Health PPO members?*

In 2023, the Braven Health benefit for the annual routine hearing exam, fitting/evaluation for a hearing aid, and hearing aids will be managed by HearUSA for all members, including PPO members.

Beginning 1/1/2023, all providers who service our Braven PPO members must submit claims for annual routine hearing exams, fitting/evaluations for hearing aids, and hearing aids directly to HearUSA, even when they utilize OON providers. Claims will deny if sent to Horizon.

PPO members who do not use a HearUSA provider must pay out of pocket for their hearing aids and coordinate reimbursement through HearUSA up to the $1,250 coverage limit. There is no discount available if members go to out-of-network providers.

Members can contact HearUSA at:
HearUSA Network Claims
PO Box 31927
West Palm Beach, FL 33420
Or email networkclaims@hearusa.com with the information.

Will Braven members be receiving new member ID cards for 2023?
Yes, all Braven Health members will receive a new ID card for the following two reasons:
  • Emergency Room (ER) copay is changing for all plans
  • The customer service number to support the Braven Health+ Smart card was added to the back of the card
    


An Excellent Member Experience Starts at Enrollment


With Medicare's Annual Enrollment Period about to start, here are a few reminders to help you make sure your client is enrolling in the best plan for their needs.
 
  • Review the complete list of plan benefits. Talk to your client about any healthcare services they routinely use.

Get a Refresher on What's Allowed for AEP.

The Centers for Medicare & Medicaid Services (CMS) put out guidelines for Agents and Brokers on appropriate and permitted behavior.

Download Agent and Broker Do's and Don'ts Now .

In Case You Missed It

We recently sent out an email about regulatory changes issued by CMS in the CY 2023 MA/Part D Technical Rule (87 FR 27704) regarding Third Party Marketing Organizations (TPMO), which became effective June 28, 2022. These TPMO requirements apply to your sales and marketing services for Horizon and Braven Health products. 

Click here to read the email.
 
    

Sales Training: Formulary Exceptions
 

It is no secret that prescription drug coverage is very important to Medicare beneficiaries. Suppose an enrollee's prescription drug is not covered. In that case, an exception may be granted if the plan determines if the requested drug is medically necessary for an enrollee . 

However, DO NOT mention a formulary exception unless the applicant brings it up or asks about it.   We should not be selling prospects plans that do not meet their needs.

  • Explain to the prospective member, "If your medication is not on our formulary, it is because we have other formulary alternatives available. Our formularies have been evaluated to ensure we include safe and effective drug options."
     
  • Using the formulary look-up tool, assist prospective members with identifying what alternatives are covered on the formulary and encourage them to discuss these alternatives with their physicians.
  • If the prospective member would like more information or further assistance with identifying a formulary alternative, encourage them to contact our MTM line at 1-888-706-2820 (TTY 711).
  • If the prospective member brings up the formulary exception option, explain: "While a formulary exception is your right to pursue, there is no guarantee it will be approved as they are handled on a case-by-case basis. Before seeking a formulary exception, you would need to try covered formulary alternatives." Then guide them through the previous steps.
    

Application Submission Procedures

IMPORTANT
  • Always complete enrollment forms in their entirety. If enrollment forms are incomplete, an enrollment rejection may result.
  • Complete a separate enrollment form for each Medicare beneficiary.
  • Make sure all enrollment form fields are complete.
  • If the field does not apply, such as a request for an email address, write "N/A."
  • Sales agents must see the potential member's Medicare card to verify the spelling of the beneficiary's name and:
    • The name on the enrollment form needs to match what is on the member's Medicare card, even if the spelling is incorrect.
    • Ensure the Medicare identification number written on the enrollment form is exactly as it appears on the member's Medicare card.

Final review before submission
Review the enrollment form with the member to ensure accuracy before submission.
 
    
Are You Using Our Broker Portal?


Your success is such a big part of our success that we want you to have all the tools you need – in one centralized hub.

You'll have easy access to:
 
  • Information and resources for both Braven Health and Horizon Blue Cross Blue Shield of New Jersey
  • Online enrollment and tracking
  • Book of business reporting
  • Check the Application Status of your newly submitted enrollments
  • And much more!

Don't have access?
Please email salesPortal_Technicalcommandcenter@horizonblue.com to get connected.
    
Important Reminders
  • Make sure you are using the 2023 Permission to Contact Form. Download the form now.
  • Before submitting your online or paper application, please check you have indicated your NPN to prevent any delays with reporting and commissions.
  • If you have any questions about commissions, contact your GA directly.
  • Please keep your information up to date so we can continue sharing updates with you. Log in to your account at Miramar-agent.com and review your profile information to ensure accuracy.

Important Phone Numbers
Please have your GA/NPN# available when you call.

  • Star Broker Unit – Call 1-888-400-8533 , Monday – Friday, 8 a.m. to 6 p.m. Get answers to your product and benefits questions.
  • Horizon NJ TotalCare (HMO D-SNP) Eligibility – Call 1-888-863-3675 to verify your client can enroll.
    

Contact Us

Individual Medicare Plans

Laud Anderson
Horizon BCBSNJ
Medicare Broker Sales Account Manager, Government Programs
Email: Laud_Anderson@HorizonBlue.com
Mobile: 1-973-901-4683

Nemesio J. Kinsora
Horizon BCBSNJ
Medicare Broker Sales Account Manager, Government Programs
Email: Nemesio_Kinsora@HorizonBlue.com
Mobile: 1-973-558-1866

Medicare Advantage Group Plans

Heide Rivera
Horizon BCBSNJ
Medicare Advantage Group Sales/Account Manager
Email: Heide_Rivera@HorizonBlue.com
Mobile: 1-908-801-3237

Dana Gatto
Horizon BCBSNJ
Medicare Advantage Group Sales/Account Manager
Email: Dana_Gatto@HorizonBlue.com
Mobile: 1-973-498-4347
* Braven PPO members can choose to receive care from providers outside the HearUSA network. However, providers that do not contract with Braven Health or HearUSA are under no obligation to treat the member, except in emergency situations. It is best for the member to ask an out-of-network provider to bill HearUSA first. However, if a member has already paid for the covered services, HearUSA will reimburse the member for their share of the cost for covered services.

Products are provided by HIC, Horizon NJ Health, and/or Braven Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. All are independent licensees of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield ® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. The Braven Health SM name and symbols are service marks of Braven Health. © 2022 Horizon Blue Cross Blue Shield of New Jersey and Braven Health. Three Penn Plaza East, Newark, New Jersey 07105.

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