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New plans and new benefitsfor 2022
2021 STAR RATING
KCA HISTORIC STAR RATING.•5 Star Rated for 5 years in a row (2017, 2018, 2019, 2020, 2021)
•Only one in 20 plans in 2020 rated 5 Stars
•The ONLY plan in Houston in rated 5 Stars for 5 CONSECATIVE
•Voted Best MA Plan in Texas by US News (2017, 2018, 2019, 2020, 2021)
MEDICARE
5 STAR RATING
KELSEYCARE ADVANTAGE SERVICE AREA
• Austin
• Brazoria
• Chambers
• Fort Bend
• Galveston
• Grimes
• Harris
• Liberty
• Montgomery
• San Jacinto
• Waller
• Walker
• Wharton
New clinic locations
Number of Clinics: 22Number of Providers: 540
Number of Clinics: 29Number of Providers: 598
Number of Clinics: 38Number of Providers: 701
Number of Clinics: 43Number of Providers: 847
New Plans = New Names
2021 Plan Names 2022 Plan Name MA Type Plan Type Service Area
- Platinum – NEW! MA-PD HMO 5 Counties
Rx Gold MA-PD HMO 5 Counties
Rx+Choice Gold Freedom MA-PD HMO-POS 5 Counties
Essential Silver MA Only HMO 5 Counties
Essential+Choice Silver Freedom MA Only HMO-POS 5 Counties
Essential Select Silver Community MA Only HMO-POS Surrounding Counties
Rx Select Gold Community MA-PD HMO-POS Surrounding Counties
5 Counties = Harris, Brazoria, Fort Bend, Galveston, MontgomerySurrounding Counties = Austin, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, Wharton
New Plan NameMonthly Premium
Drug Coverage
Provider NetworkComprehensive
Dental
Platinum – NEW! $0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC X
Gold Freedom $0(down from $77)
XIn-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)X
Gold $0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC Only w/ add-on
Silver $0 Kelsey-Seybold Clinic: Referrals needed for outside of KSC X
Silver Freedom $0In-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)X
Silver Community
$0In-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)Only w/ add-on
Gold Community $15 XIn-Network Cost-Share: KSC + Affiliates (no referral)
Out-of-Network Cost-Share: All other providers (no referral)Only w/ add-on
Quick Comparison
New Freedom PlansGold Freedom | Silver Freedom
You can keepyour current doctorIn addition to Kelsey-Seybold physicians, Freedom Plans allow members
to keep their out-of-network doctor with a low copay & $0 monthly premium.
Talk about a game-changer!
Taking Advantage on In-Network Cost-Share Accessing Out-of-Network Cost-Share
Member sees aKelsey-Seybold Clinic PCP
$0Member sees an
out-of-network PCP$10
Member sees aKelsey-Seybold Clinic specialist
$25Member sees an out-of-network
specialist$35
Member sees an affiliate providercontracted with Kelsey
$25 Member sees anMD Anderson provider
40%
No referrals needed! No referrals needed!
Freedom in action
MEDICAL+DRUGCOVERAGE
Gold (HMO) 5 core counties
Gold Freedom (POS) 5 core counties
Gold Community (POS) 8 outlier counties
Platinum (HMO) NEW! 5 core counties
11
MAPD w/Drug Coverage / Value-Added Benefits
Platinum Gold Gold Freedom Gold Community (outlier counties)
IP Hospital $350/stay $375/stay $375/stay $375/stay
T2 Drug $0/$15 $0/$15 $0/$15 $0/$15
DentalComprehensive with
$1,500 limitPreventive + option to purchase
supplemental ($32.80)Comprehensive with
$1,500 limit
Preventive + option to purchase supplemental
($32.80)
COVID-19Benefit
Yes Yes Yes Yes
OTC $25 monthly $25 quarterly $25 monthly $25 quarterly
Wellness Benefit
Yes No Yes No
MEDICAL COVERAGE ONLY
Silver (HMO) 5 core counties
Silver Freedom (POS) 5 core counties
Silver Community (POS) 8 outlier counties
1313
MA Only Value-Added Benefits
Silver Silver Freedom Silver Community(outlier counties)
IP Hospital $325/stay $325/stay $325/stay
DentalComprehensive with
$1,500 limitComprehensive with
$1,500 limitPreventive + option to purchase
supplemental ($32.80)
COVID-19Benefit
Yes Yes Yes
OTC $50 quarterly $50 quarterly $25 quarterly
Vision Allowance
$125 $125 $75
Wellness Benefit Yes Yes No
Morechangesfor 2022
Comprehensive dental*With $1,500 allowance
Plus …
• $0 copay for Tier 1 & 2 drugs*
• Increased vision allowance*
• Wellness benefit* –up to $100 a year in gift card rewards
• COVID-19-related care and waiver of IP copay
• Simplified in-hospital stay copays
• Monthly and/or quarterly OTC allowances*
* Available in specific plans
2022 PART D SUMMARY
MAPD w/ DRUG COVERAGE MA ONLYOUTLIER COUNTIES (MA/MAPD-POS)
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO
(001)Silver Freedom
POS (003)Silver Community
POS (007)
Gold Community POS (008)
$15 premium
Part D Deductible $100 (T3, T4, T5) $100 (T3, T4, T5) $100 (T3, T4, T5)
No Drug CoverageNo Drug
Coverage
$100 (T3, T4, T5)
T1 Drug $0/$3 $0/$3 $0/$3 $0/$3
T2 Drug $0/$15 $0/$15 $0/$15 $0/$15
T3 Drug $40/$45 $40/$45 $40/$45 $40/$45
T4 Drug $80/$90 $80/$90 $80/$90 $80/$90
T5 Drug 31% 31% 31% 31%EXCLUDED drugs covered
Generic Viagra with QL 6/30days
Generic Viagra with QL 6/30days
Generic Viagra with QL 6/30days
Generic Viagra with QL 6/30days
17
VALUE ADDED BENEFITS: DENTAL BENEFITS
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO (001)
Silver Freedom POS (003)
Silver Community POS (007)
Gold Community POS (008)
Embedded Preventive Dental (mandatory) + Optional Buy-Up (Supplemental)
Prev Included + Option to
Purchase Supp($32.80
premium)
No No No No
Prev Included + Option to
Purchase Supp ($32.80
premium)
Prev Included + Option to
Purchase Supp($32.80
premium)
Comprehensive included in plan (mandatory)
No$1,500 Comp
Included$1,500 Comp
Included$1,500 Comp
Included$1,500 Comp
IncludedNo No
$25 per visit copay*
Once the member reaches the $1,500 threshold everything else is their responsibility, which is 0%/0% for the preventive and diagnostic services and 50% coinsurance for each of those comprehensive procedures listed
in the Dental EOC. Product doesn’t have a per visit copay it has per procedure coinsurance.
$25 per visit copay*
$25 per visit copay*
*Covers certain preventative services: Oral exam, Comprehensive oral exam, Adult Cleaning – prophylaxis, Intraoral-Complete Series of Radiographic Images, Bitewings (2 or 4) 18
VALUE ADDED BENEFITS CONTINUED
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO (001)
Silver Freedom POS (003)
Silver Community POS (007)
Gold Community POS (008)
Vision Allowance contacts/glasses
$75 $125 $125 $125 $125 $75 $75
OTC Monthly Benefit
-- $25 $25 -- -- -- --
OTC Quarterly Benefit
$25 -- -- $50 $50 $25 $25
Up to $100/yrWellness Benefit (based on health actions)
Not Offered Yes Yes Yes Yes Not Offered Not Offered
19
VALUE ADDED BENEFITS CONTINUED
Gold HMO (002)Platinum HMO
NEW (009)Gold Freedom
POS (004)Silver HMO (001)
Silver Freedom POS (003)
Silver Community POS (007)
Gold Community POS (008)
Hearing Aid Allowance
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
$750 per ear every 3 years
Inpatient Cost Share waived with COVID19 diagnosis, all testing and related visits as well as Meal Delivery post discharge (w/ covid diagnosis) 2 meals per day for 7 days*
Yes Yes Yes Yes Yes Yes Yes
20 one-way trips to medical appointments
Yes Yes Yes Yes Yes Not Covered Not Covered
*EGWPs not covered20
Thank you!