Humana Updates to the Arizona Market

Humana has updates that may impact you as an Arizona Agent.

• Humana sent an email notifying brokers of the change from the Enhanced household discount, commonly known as the roommate discount, on the Achieve Medicare Supplement to a regular household discount, where both parties in the household must be on a Humana Medicare Supplement plan to receive the 12% discount. The Outline of Coverage, the paper application, and the HEP platform have been updated to reflect this change and now require the “roommates'” names and MBI # s for validation before the discount is approved.
• Centerwell Primary Care will be the focus on Tuesday, April 28^th at 8:30AM during our coffee hour chat.  Click here to register if you are not already apart of the Coffee Hour chat.
• SEP code usage.  Humana is monitoring the use of select SEPs for compliance purposes.  Agent Monitoring and Support Agents who demonstrate excessive SEP use in the below categories will be assigned “Special Election Period (SEP) Refresher Training.” This training is designed to reinforce SEP guidelines and best practices, equipping agents to navigate SEP scenarios and ensure compliant enrollments. Training will be administered in HMU and must be completed within 10 business days. Agencies will be notified of training assignments and are responsible for cascading the requirement to the relevant agent and ensuring timely completion.Agency Monitoring and Corrective Action Agencies that demonstrate three consecutive months of excessive SEP use over the thresholds for the same SEP will be issued a corrective action. This corrective action serves as notice of an identified compliance trend and will include an assessment. The assessment will consist of a random selection of SEP enrollments for review.Based on the results of the assessment, corrective action will either close or escalate if concerning deficiencies are identified. Escalation may include, but is not limited to: training, SEP use requirements, suspensions, and/or terminations.

  These measures are important for Humana to undertake, given the compliance trends with SEP use. Please note that more information will be provided should your agency be identified within scope for any action.

  Current SEP Thresholds:

  DST: 15%

  MOV: 10%

  LCC: 4.7%

  ACC: 3%

  PAP: 5.16%

More information on new household discount requirements.

More information on Medicare Plan Enrollment.

More information on the Outline of Coverage. 

Humana enrollment application.