Coventry

Report
Broker/Agent Product
Training
Coventry Health
Care of Texas
Medicare Advantage (MA)
Coordinated Care Plans (CCP)
2014
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
© 2013Coventry Health Care, Inc.
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2014 MAPD Product Training
Before we begin…
Reminders:
• Silence Your Phone
• Handling Questions
• Complete all 2014 Requirements PRIOR to
Selling
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Agenda
•
•
•
•
•
•
•
Service Area
Value Proposition
Ready to Sell
Product
Servicing Your Clients
Compliance
Additional Resources
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Provider Network Highlights
Coventry Health Care of Texas
Houston Metro
 Memorial Hermann System
 Methodist System
 Christus St. John Hospital
 Cypress Fairbanks Medical Center
 Houston Northwest Medical Center
 Park Plaza Hospital
San Antonio Metro
 Baptist Health Systems
 Medina Community Hospital
Beaumont Metro
 Christus Dubois Hospital
 Christus St. Elizabeth Hospital
 Christus St. Mary Hospital
 The Medical Center of SE Texas
El Paso Metro

Providence Memorial

Sierra Medical Center

Sierra Providence East

University Medical Center
Texarkana

Christus St. Michael

Wadley Regional
Corpus Christi

Christus Spohn Hospitals
Weatherford
 Weatherford Regional Hospital
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Value Proposition
Coventry Health Care of Texas
• Local presence and understanding
• National experience and infrastructure
• Products that are relevant and valuable to the
beneficiary
• High quality network
• History of provider collaboration
• Patient-centered care model & case
management
• Local Texas team for both members and
agents/brokers
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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What’s New for 2014
$0 PCP Co-Pay
$0 Co-Pay for Tier 1 Prescriptions
HMO product in 10 counties
Gap coverage Tiers 1 & 2 {HMO Only}
Co-Branding with Baptist Hospital Systems in
San Antonio
• Expanded networks in many markets
•
•
•
•
•
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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How to Be ‘Ready to Sell’ for 2014
•
Complete the online AHIP/Coventry training and testing at
www.coventry-medicare.com
•
Complete local health plan product training and testing for all service
areas you plan to sell in
– Contact your up-line, BSD, or local health plan to ensure you are
properly contracted and certified for the service area you intend
to represent
•
New Brokers must complete your online Coventry “Contract Package”
•
Must have State Appointment – in each state where you are licensed
and the state(s) where a prospective member resides.
•
Receive “Ready to Sell” notification from Coventry and your Agent
Writing Number (AWN) ID Card for 2014. (Via Email)
•
Must have up to date Errors & Omissions coverage on file
•
Contact the Broker Service Department (BSD) if you have not received
your AWN ID Card (E-Mail) before you intend to present Coventry to a
prospective member
If you sell Coventry Products without completing the steps above you
WILL NOT receive commission payments and you will be non-compliant.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Local Health Plan Training & Testing
• A local health plan test must be successfully
completed
• 20 multiple choice questions
• Must achieve a 90% or better
• Can complete the test online, by email, face to
face or fax
– If by email check your spam folder!
• Tests that are not taken online can be turned in
to your local Medicare sales team or faxed to
the test center via toll-free number
• Completed test will be kept for 10 years by
Coventry
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 Product Information
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2014 MAPD Product Training
Product Strengths
• True balanced product portfolio with $0 premium
HMO and PPO plans offered
• Access to a very broad network of quality
hospitals and physicians for 2014.
• Get the best value for your health care dollar
with premium stability- we have offered $0 PPO
plans for several years
• Full access to any Health Club facility in the
network with no co-payments for club
membership
• Prescription drug coverage is included on all plans
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Comparison Grid
• Your Coventry Product Sales Tool!
• Let’s take a tour of the Comparison Grid
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2014 MAPD Product Training
Prescription Drug Coverage
Stage 1
Yearly Deductible Stage
Stage 2
Initial Coverage Stage
Stage 3
Coverage Gap Stage
Stage 4
Catastrophic Coverage
Stage
Member will pay 100% of
the cost of drugs until
the plan deductible is
met. The deductible for
2014 is $310.00.
During this stage, the
plan pays its share of the
cost of drugs and the
member pays their share
of the cost.
Members pay 47.5% of
negotiated drug cost for
brand and 72% of
negotiated drug cost for
generics.
Members pay $2.55 for
generics and $6.35 for
brand or 5% (whichever
is greater).
*Some plans have
coverage in the gap. If so,
members pay a
copayment for covered
drugs.
During this stage, the
plan will pay most of the
cost of the member’s
drugs for the rest of the
calendar year (through
December 31,2014)
If the plan does not have Member stay in this
a deductible member will stage until their year-tobegin in Stage 2
date “total drug costs”
(member’s payments
plus any plan’s
payments)
total$2850.00.
Members stay in this
stage until member’s
year-to-date “out-ofpocket costs”(member’s
payments)reach a total of
$4550.00. This amount
and rules for counting
costs toward this amount
have been set by
Medicare.
Note- LIS members will pay the lessor of the plan member cost
share or their CMS defined LIS copayments
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
2014 Pharmacy Benefits Comparison
Outpatient Rx Cost-Sharing Information
Network
30-Day Supply at
Network Pharmacy
Preferred
Pharmacies
Tier 1: $0 copay
Tier 2: $3 copay
Tier 3: $35 copay
Tier 4: $70 copay
Tier 5: 33%
Nonpreferred
Pharmacies
Tier 1: $3 copay
Tier 2: $10 copay
Tier 3: $45 copay
Tier 4: $95 copay
Tier 5: 33%
Note- LIS members will pay the lessor of the plan member
cost share or their CMS defined LIS copayments
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Coventry Preferred Pharmacies!
More ways for your clients to save money with Coventry!
A “Preferred Pharmacy” is one that’s within our overall pharmacy
network where we’ve negotiated lower cost-sharing levels (pricing) for
Coventry members. Prescriptions can still be filled at any network
pharmacy, but your clients can save even more money by using a
preferred pharmacy. Any pharmacy in our network not listed here as
a Preferred Pharmacy is a Non-Preferred Pharmacy (CVS, Safeway,
Costco, etc.)
-Walgreens
-Wal-Mart {Sams}
-Kroger
-Medicine Shoppe
-Target
-LeaderNET Pharmacy Network
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
HMO & PPO Additional Value
Benefits
• Health Club membership – available on all plans
through contracted facilities
• Dental Benefits – available on select plans as a
reimbursement
• Vision Benefits – available on all plans
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Selling Coventry Medicare Advantage
•Coventry is now an Aetna owned Fortune 53 company
•Coventry leads the Industry in Broker Support
•Coventry’s reputation with customer service to their
membership is industry leading
•Coventry’s home grown model of care and care
coordination for your clients differentiates them from other
companies
•Coventry maintains a high member retention rate
•Coventry pays 10 year renewals
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
Servicing Your Clients
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Outbound Education and
Verification Calls
What Happens After an application is submitted?
•
A Coventry Health Care Representative will call your client within 10
days of receiving an Enrollment Form to:
1. Confirm their enrollment in the Coventry plan of their choice.
•
2. Review the plan rules and make sure they understand how their
new plan works.
Coventry Health Care will make three attempts to reach your client
by phone. If we are unable to speak with them after the second
attempt, they will receive a letter outlining the plan rules.
•
Both the telephone calls and letters will cover the same information
that your client has in their enrollment kit.
Please contact Alexis Horton or Kenna Rickett for a copy of the
verification call script.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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Servicing The Member
ID Cards and New Member Kits
•
Member will receive an ID Card
–
•
Members will also receive an Enrollment Confirmation letter than may be presented as proof of
enrollment
New member kits will be mailed within 10 days of receipt of CMS confirmation of
enrollment or by the last day of the month prior to the effective date, whichever is
later. The new member kit contains:
– Welcome letter
– Evidence of Coverage (EOC)- Gives members the details about their Medicare health
care and prescription drug coverage for the plan year. The EOC explains how to get
coverage for Medicare health care services and prescription drugs
– Formulary drug list- Lists the covered drugs selected by the plan in consultation with a
team of health care providers. It indicates drug information such as the therapeutic
class of drugs, drug tier, and special requirements that may apply like Prior
Authorization and Step Therapy. Members can review it to see if the medications they
take are covered by the plan.
– Provider/Pharmacy directory- Provides a list of participating network providers
(physicians, hospitals, skilled nursing facilities, urgent care centers or other duly
licensed institutions or health professionals) and pharmacies.
– Other health-related informational flyers
NOTE: If a member requires assistance regarding their membership/member ID, the
member MUST call Customer Service.
•
Newsletters to help members learn how to use their plan, including education on
specific health-related topics.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Care Coordination Programs
Coventry cares about your client’s health and wants to ensure
they are receiving the most appropriate and highest quality care
possible.
• Disease Management Programs
 Diabetes
 Heart Disease
 COPD
 Heart Failure
 Disease Management
• Outreach Calls for Preventive/Wellness
Services
• Member Health Support Center
• Social Services Coordination
• Member Health Assessments from
Matrix
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
Diabetic Clients - Glucometer
Information
• One Touch ® LifeScan blood glucose monitoring
system (one per member)
• Only LifeScan brand test strips are covered at a $0
copay under the Part B pharmacy benefit
• All other brands covered at 20% copay
• The member must call CSO directly to enroll. CSO
will set them up with Health Services to insure they
get the correct meter
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Altegra
Formerly known as Social Services Coordinators
• Coventry Members will be screened to determine
eligibility for extra help
• Helps button up the sale to solidify Coventry’s desire
to ensure they get what they deserve
• May be used to screen for Special Election Period
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
BenefitsCheckUp
www.BenefitsCheckUp.org/Coventry
One-stop resource for determining eligibility for programs that
can help members with all types of expenses, including health
care, prescriptions, taxes, utilities and more!
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Servicing The Member
Member Resources
Customer Service is open:
•
10/1/2013- 2/14/2014
–
•
7 days a week- 8 am – 8 pm (local region time zone)
2/15/2014-9/30/2014
–
Monday- Friday 8 am- 8 pm (local region time zone)
•
Telephone number on back of the member’s ID Card
•
Thanksgiving and Christmas days – voicemail available
Customer Service for Pharmacy (Express Scripts) is open:
•
24 hours/day, 7 days/week
•
Telephone number on back of ID Card
Website: www.coventry-medicare.com
•
My Online Services (MOS)
•
Access to important plan information such as:
•
Evidence of Coverage, Summary of Benefits, Formulary, Provider/Pharmacy directory
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Servicing The Member
Appeals & Grievances
•
The member's treating provider can make a coverage request by
contacting the number on the back of the member's ID card (called an
Initial Coverage Determination).
•
An “appeal” – is when a member disagrees with decision their plan made
to deny a request for coverage of health care services or prescription
drugs or payment for services or drugs you already received.
•
A “grievance” – a type of complaint a member makes about their plan or
one of their plan’s network providers or pharmacies, including a complaint
concerning the quality of your care. This type of complaint does not
involve coverage or payment disputes.
•
Detailed information on the initial coverage determination, appeal and
grievance processes can be found in the member's Evidence of
Coverage.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 Compliance Review
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2014 MAPD Product Training
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Scope of Appointment (SoA)
•
•
•
•
•
•
Scope of Appointment (SoA) is required for any personal or individual
marketing appointment (this excludes attendees at formal and informal
marketing/sales events).
CMS-approved Scope of Appointment Forms (CMS model & Coventry
non-model) can be found on the Broker Portal.
Agents may not market any health care related product during a
marketing appointment beyond the scope that the beneficiary agreed
before the meeting with that individual.
SoA’s must be documented before the appointment (48 hours in
advance when practical). If this is not feasible, agent may have
beneficiary sign SoA at the beginning of the marketing appointment.
• Explanation must be documented directly on the SoA in the area
provided why SoA was not obtained 48 hours in advance.
Distinct lines of plan business include MA, MAPD, PDP and Cost Plan
products.
If the beneficiary requests to discuss other products, agent must
document a second scope of appointment for the additional product
type to continue the marketing appointment.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Scope of Appointment – contd.
•
•
•
Agents cannot record SoA’s. SoA’s must be secured on a CMSapproved SoA form.
A beneficiary may set a SoA at a marketing/sales event for a future
appointment.
Agents must attach a copy of the signed SoA to any application
received from a personal/individual appointment before submitting the
application to Coventry Health Care of Texas.
•
Agents may not: discuss plans options not agreed by the beneficiary, ask
for referrals, market non-health care products (such as annuities or life
insurance), solicit/accept enrollment applications for a Jan 1 effective
date prior to the start of AEP unless the beneficiary is entitled to another
enrollment period, provide meals or have meals subsidized, or market
through unsolicited contacts.
•
All SoA must be maintained for 10 years and available upon CMS or
Coventry’s request. This includes initial and second SoA’s obtained at
the same appointment
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
How do you stay informed as to what the rules
are so that your marketing activities are in
compliance with CMS?
•
Monitor the release of new CMS regulations by signing up for the
Federal Register List at http://www.gpoaccess.gov/fr/index.html
•
CMS marketing guidance can be found at cms.gov and:
http://www.cms.hhs.gov/ManagedCareMarketing/03_FinalPartCMarketi
ngGuidelines.asp
•
Watch for Coventry bulletins (Compliance Connection and/or Broker
Flash emails) that includes guidance such as any new updates on
Medicare Marketing Guidelines. Check Broker Portal “Recent Field
Communications”.
•
Adhere to Coventry CMS-approved Sales Presentation!
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Sales Presentation Materials
The following materials must be provided to each beneficiary at the
time of the presentation:
• Formulary- Lists the covered drugs selected by the plan in
consultation with a team of health care providers. It indicates drug
information such as the therapeutic class of drugs, drug tier, and
special requirements that may apply like Prior Authorization and Step
Therapy. Members can review it to see if the medications they take
are covered by the plan
• Summary of Benefits- Lists important plan benefits. Beneficiaries can
use the SB to compare benefits.
• Multilanguage Insert- provides member in various language
instructions for seeking interpreter services
• Plan Stars Rating information- CMS rating of the plan’s quality and
performance. These ratings help the beneficiary to know how the
plan is doing and allows them to compare our plan's performance to
other plans.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Applications Do’s and Don’t
DO:
•
•
•
•
•
•
•
•
•
•
•
Submit applications to the RIGHT fax number (i.e. fax MAPD applications to
the MAPD fax number and Part D applications to the Part D fax number).
Use the Coventry Enrollment /First Health Part D Fax Coversheet when faxing
enrollment application.
If using paper applications, be sure to use the application provided in the presales kit.
Use Ascend, the Coventry iPad application, for paperless sales presentations
and electronic application submission.
Complete the Scope of Appointment section of the application.
Submit Scope of Appointments with all paper applications.
Use, and submit, the Coventry Enrollment Checklist for ALL non-AEP
applications.
Write the FULL NAME of provider and appropriate Physician I.D. for ALL plans
requiring the selection of a PCP.
Select a premium payment method (even for plans with $0 monthly premium).
Date the application when you receive it.
Complete the requested effective date (note effective date may be
modified in accordance with CMS requirements)
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Applications Do’s and Don’t
DON’T:
•
•
•
•
•
•
•
Submit applications to the Broker Services Department this will delay
application processing.
Use the Consumer Enrollment Website, found by clicking “Enroll Now”
on the health plan websites, to submit applications. (May assist the
beneficiary in their completion of the on-line enrollment but cannot
do it yourself.)
Download and use the application in PDF available on the health
plan websites.
Copy the paper applications for use with different beneficiary.
Enter any information or notes in the “Internal Use Only” section.
Submit an application without the actual Medicare coverage dates.
“Applied for” will not allow the application to process.
Forget to complete the Medicare Part A and B effective dates on the
application.
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
IMPORTANT!
Completed Enrollment Applications must be received by
Coventry Within 2 Calendar Days!!
You can submit enrollment applications
• Fax (a preferred method) or overnight to the designated Health Plan
contact as listed in the Health Plan Application Contacts section,
under Agent Resources heading towards the end of this module.
Paper applications MUST be received by Coventry Health Care/First
Health Part D within 2 calendar days of agent’s receipt of signed
enrollment application or agent’s completion of an electronic
application effectuated through a Coventry approved electronic
application.
• IPAD App(a preferred method) – faster, real time submission of the
enrollment application
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Expanding Our Service to YOU!
THE Ascend iPAD APPLICATION!
• Capture client
information.
• Conduct PAPERLESS
Sales Presentations.
• Easily utilize the Coventry
Sales Presentation Video
• Take and submit
enrollment applications in
REAL TIME (eliminate
turn around time issues).
• Decrease application
pending issues
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Broker Services Department
Our dedicated Medicare Broker Services Department (BSD)
will assist you with questions pertaining to:
– Commissions / contracting questions
– Broker portal, website support
– Please do not call Broker Services for product or benefits
questions. For those questions you may call Customer
Service at (866) 731-9570
BSD Contact Information:
– Phone- (866) 714-9301
• 8am– 6pm Eastern Time, Monday-Friday
– Email - [email protected]
– Broker Portal: https://broker.cvty.com
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Producer Manual
• Producer Manual can be found on the Broker Portal at:
http://coventrymedicare.coventryhealthcare.com/web
[email protected]_medicare_coventrymedicare/do
cuments/webcontent/c062429.pdf
• Will answer most of your questions!
•
Renewals upon your death?
• Commission Charge Backs?
• Agent of Record?
• Ctrl F = Find what you are looking for
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Coventry Local Resources
Manager Of Sales
Don Hansford
3900 Rogers Rd
San Antonio, TX 78251
210-366-6294
[email protected]
Broker Manager
Alexis Horton
3900 Rogers Rd
San Antonio, TX 78251
210-346-2146
[email protected]
Broker Manager
Kenna Rickett
3900 Rogers Rd
San Antonio, TX 78251
210-346-2175
[email protected]
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
The WHO, WHY, and HOW to Contact List
WHO
WHY
How
Customer Service
General questions regarding medical benefits,
claims, prior authorization
status/requirements, Part B Issues, explanation
of benefits, verification of premium receipt,
coupon book issues, ID cards, and new member
kit request
866-731-9570
Express Scripts
Medicare Advantage Part D questions including
prior authorization & Step Therapy. NOT PART
B ISSUES. (Diabetic supplies are Part B)
866-295-4119
MHNet
All Questions regarding mental health
services. Including any questions regarding
prior authorizations and participating doctors.
800-336-2030
Health Services
Providers ONLY should call this number to
obtain Prior Authorizations for medical
services. (all Part D questions including
authorizations should go through Express
Scripts- See number above)
888-651-1802
First Health Part D
First Health Part D Questions ONLY. Prior
Authorizations, step therapy, premium
payments, ID cards, Etc.
888-736-0486
Life Scan
Questions regarding diabetic monitors.
800-227-8862
Ordering a LifeScan monitor
800-227-8862
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Continued
WHO
WHY
How
Broker Services Department
(BSD)
Contracting issues and questions, License
updates, E&O updates, changes to agent
contact information, commission questions,
broker portal or ACOM questions including
password resets.
(866) 714-9301
BSD Fax
Sending E&O license updates, or other
requested information or updates to broker
services. EXCEPTION: All contracting must go
through NO MORE FORMS via the Broker
Portal. (Broker Portal can be accessed via the
below website
(724) 741-7285
Website
Broker Portal access, online provider searches,
my online services, (for member use only),
claim forms, online formulary search, EFT
forms, and much more.
www.coventry-medicare.com
IPAD Enrollment
the only acceptable way for a broker or
captive to submit an electronic application is
through the iPad Application tool. To Receive
Permission to access the application for IPAD
enrollments please call the BSD
866-714-9301
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Continued
WHO
WHY
How
Premium Payment
EFT Request
(must send EFT form: which is available on our
website)
Accounts Receivable Department
Coventry Health Care
PO Box 6411
Carol Stream, IL 60197
Pharmacy Claims
(claim forms are available online)
Express Scripts
PO Box 14711
Lexington, KY 40512
Medical Claims
(no Claim Form Needed)
CHC of Texas
PO Box 7154
London, KY 40742
This includes standard and expedited appeals
Advantra
Attn: Medicare Medical Appeals and
Grievance Department
PO Box 7776
London, KY 40742
This includes standard and expedited appeals
Advantra
Attn: Medicare Part D Appeals and Grievance
Department
PO Box 7773
London, KY 40742
Important Addresses
Part C Appeal & Grievances
(A&G)
Pharmacy Appeals & Grievance
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
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2014 MAPD Product Training
Local Presence
LOCAL PLAN OFFICES
 Coventry Health Care of Texas
3900 Rogers Road
San Antonio, TX 78251
 Coventry Health Care {Customer Service}
14955 Heathrow Forest
Houston, TX 77032
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
2014 MAPD Product Training
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Broker Next Steps
•
•
•
•
•
•
Score 90%+ on the Product Exam
Supplies
Sales Presentation
ANOC/Retention
Referrals
Marketing
Now go get some sales!!
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
Thank you for
attending the 2014
Kick-Off Training
Class!
Don’t Forget to make sure all Testing
and Contracting has been completed!
Coventry Health
Care of Texas
Medicare Advantage (MA)
Coordinated Care Plans (CCP)
2014
Data Classification: INTERNAL USE – BROKER/AGENT ONLY
© 2013Coventry Health Care, Inc.

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