To qualify as a group that Humana can underwrite, the following must be true:
-The group must be a legal entity
-The group must have a business reason to exist other than the purchase of insurance
-Group Medicare Advantage products can be offered to members who reside in one of our Medicare service areas; Employer HMO and PPO products are limited to the counties within our approved service areas
-The minimum case size for most of our plans is 11 members per product.
Humana's Pharmacy and Therapeutics (P&T) Committee reviews and updates the Drug List. Humana corporate pharmacy management implements Drug List changes to promote safety and help control costs. We also update the Drug List because:
Medications available may change
New medications are introduced to the market
New generics become available as brand-name medications lose their patents
Medications may gain new indications
Medications may have changes in dosing guidelines or prescribing recommendations
The price of medications may change
Humana notifies members of Drug List changes if:
Their current medication has moved to a higher level
A clinical or safety edit has been amended or put into place
Financial Accounting Standards Board (FASB) statement 106 requires private-sector companies to accrue the cost of Other Post Employment Benefits (OPEB) like retiree medical coverage and to record a liability for unfunded retiree medical costs explicitly on their financial statements. Public-sector entities are subject to similar guidelines set forth by the Governmental Accounting Standards Board (GASB).
To respond to these standards, some companies and organizations have eliminated retiree benefits altogether. But this drastic change may not be necessary. Organizations can address FASB and GASB by switching to a Group Medicare Advantage plan, which may be less expensive. Also, they can modify benefits by adding age and service requirements, or migrating to a defined contribution health benefit.
Also, one or more of these financial strategies may help your clients address FASB and GASB requirements:
One-time charge — Taking a one-time charge against earnings on their financial statements
Amortizing — Amortizing the cost of the transition to the new accounting statement over time
Prefunding — Prefunding the liability with tax-advantaged accounts such as IRC Sec. 501(c)(9) — also known as Voluntary Employees' Beneficiary Associations (VEBA) trusts and Section 115 trusts
Please note that this is not legal or financial advice.
We do. Humana has a dedicated spending account division. This allows for single-source management of the FSA, PCA, and debit card, as well as the client's medical plan. Our goal is to integrate administration as much as possible to give your clients and their employees a more streamlined health benefits experience.
Humana has one National Pharmacy Provider Network with approximately 61,000 pharmacies. The network includes all national chains, all major regional chains, and more than 25,000 independent pharmacies.
The implementation process can take approximately four to eight weeks from the date the Employer Group Application is completed. The implementation timeframe varies for each customer. A Sales Account Coordinator works with both new and current customers to determine an implementation timeline for adding the HSA to their benefits package. For larger employers, the Account Service Manager or Account Service Coordinator appropriately manages all aspects of implementation.
Humana's portfolio of workplace voluntary benefits includes disability, life, accident, critical illness, cancer, and supplemental health. These benefits can be 100 percent employee paid so your clients can expand their benefit options without increasing their costs. And employees can choose the benefits best suited for their own needs and fund them through payroll deduction.
Portfolio Product Simplification makes it easier for you and your clients to do business with Humana. It reduces the complexity and number of plan designs and combinations. We've also improved the speed of our underwriting and the speed and accuracy of our group installation.
Portfolio Product Simplification helps you because you'll get:
More satisfied customers
Quicker alternative quoting
Faster installation time
Improved accuracy and reduced frustration
Improved business processes
For your clients, Portfolio Product Simplification provides:
Private insurance companies like Humana sell both Medicare Advantage plans and Medicare Supplement plans — which are also referred to as Medigap plans. However, they're not the same. Humana's Medicare Advantage plans combine the benefits of Original Medicare with additional coverage in a single plan that Humana administers.
Medicare Supplement plans work with Medicare Parts A and B, covering costs such as copayments and deductibles.
Unlike Medicare Advantage plans,Humana does not offer Medicare Supplement plans at the group level. However, secondary coverage is available to groups.
For more details about secondary coverage, including Retiree Wrap plans, see our Group Medicare information for Small Business or Large Group.
The Employer Registration Report in the secure agent section of Humana.com lists each business linked to a specific broker group. You can see which clients are registered for the employer section and their most recent visit to the site.
The website helps your clients become more self-sufficient in administering and using their plans and encouraging their employees to live healthier.
Humana is committed to providing guidance to members in a way that best meets their individual needs. To better serve our Spanish-speaking members, we've introduced Nuestra Salud Humana, a comprehensive suite of Spanish-language offerings:
Humana.com en espanol — All website updates are immediately translated into Spanish using real-time technology. A variety of health and wellness materials are available, including the Healthwise health library and provider search tools.
Dedicated Customer Service — Bilingual representatives are available to help members with questions. In addition, we have automated telephone technology that allows Spanish-speaking members to interact with a computer through pre-recorded voice responses. The system lets members perform tasks — like requesting a new ID card — without waiting for a Customer Care representative.
Health Resources — Including the Humana*Beginnings*® pregnancy program, Personal Nurse®, HumanaFirst® Nurse Advice Line, and Humana Health Assessment.
Custom translation service for employer groups — Humana's on-site translation staff produces Spanish-language marketing materials on a group-by-group basis. For more information, contact your Humana sales consultant.
Enrollment communications — We produce guides, benefits summaries, pharmacy information, and other enrollment communications in Spanish to help employees choose their benefits with confidence.
State continuation know what it means for your clients and their members
State Continuation is an employer/employee relationship for employers with fewer than 20 employees.
Most states have State Continuation laws that require employers to offer former employees and their dependents continuation of health coverage when they no longer are active under the employer's health plan.
How do employees apply?
The employee submits the State Continuation application to his or her employer. This notifies the employer that the employee elected State Continuation. It enables the group to review eligibility and allows for premium arrangements if required by the state.
How should employers submit applications to Humana?
The employer can send the application to Humana by fax to 502-508-9978, by email to firstname.lastname@example.org (please note this is an unsecured email address), or by mail to:
101 East Main St.
Louisville, KY 40202
Attention: State Continuation Department, 6th Floor
How do applicants know if they qualify?
After Humana processes the State Continuation application, we send a confirmation letter to the employee and employer. Or we let them know that the employee does not meet state eligibility guidelines.
What if I have questions?
Contact Humana Customer Care at 1-800-558-4444 or email@example.com (please note this is an unsecured email address).
To be eligible for Humana Group Medicare Advantage coverage, a retiree or dependent must meet these requirements:
The retiree or dependent must be enrolled in both Medicare Part A and Part B through age or disability (for Medicare Advantage plans, individuals must have both Part A and Part B), and they must continue to pay their Medicare premiums.
The retiree or dependent must live in the Humana Medicare service area for the Humana Group Medicare plan. -An individual who is living abroad or incarcerated isn't eligible because he or she isn't considered to "reside" in the plan's service area.
The retiree must not actively be working or be eligible for the Commercial coverage through the employer.
All employer/union group health plan sponsors will not be allowed to enroll their Medicare eligibles in an "800 series" Group Medicare MA Only HMO, LPPO, or RPPO with a standalone Individual Medicare PDP.
All employer/union group health plan sponsors will be allowed to enroll their Medicare eligibles in both an "800 series" Group Medicare MA-Only plan as well as an "800 series" standalone Group Medicare PDP.
Your clients can set their own eligibility guidelines for retirees and dependents. However, the guidelines must comply with Centers for Medicare & Medicaid Services rules.
Retirees and dependents approaching age 65 can enroll in a Group Medicare Advantage health plan:
Humana has a dedicated spending account division. This allows for single-source management of the FSA, PCA, and debit card, as well as the client's medical plan. Our goal is to integrate administration as much as possible to give your clients and their employees a more streamlined health benefits experience.
UMB Bank is the custodian for employees' HSAs. Employees who have the HSA Enhanced and choose to invest HSA funds go through UMB Financial Services.
UMB Financial Corporation (NASDAQ symbol UMBF) is a multi-bank holding company headquartered in Kansas City, Mo. UMB was one of the first banks in the country to offer Medical Savings Accounts — the predecessor of Health Savings Accounts. Your clients and their employees benefit from having Humana as a first point of contact for administration of both the health plan and the HSA.