Humana 2013 Annual Report Download - page 18

Since the enactment of the Health Care Reform Law, states are pursuing stand-alone dual eligible CMS
demonstration programs in which Medicare, Medicaid, and Long-Term Care Support Services (LTSS) benefits
are more tightly integrated. Eligibility for participation in these stand-alone dual eligible demonstration programs
may require state-based contractual relationships in existing Medicaid programs. We were successful in our bids
for state-based contracts in Florida and Virginia in 2013 and in Ohio, Illinois, and Kentucky in 2012. Ohio,
Illinois, and Virginia are contracts for stand-alone dual eligible demonstration programs serving individuals
dually eligible for both the federal Medicare program and the state-based Medicaid program. We partner with
organizations, including CareSource Management Group Company, to serve individuals in certain states. We
began serving members in Kentucky and certain LTSS regions in Florida in 2013, and we expect to begin serving
new members in Ohio, Illinois, Virginia, and Florida at various dates between the first quarter and third quarter
of 2014.
LTSS eligible beneficiaries heavily overlap with the dual eligible population. On September 6, 2013, we
acquired American Eldercare Inc., or American Eldercare, the largest provider of nursing home diversion
services in the state of Florida, serving frail and elderly individuals in home and community-based settings.
American Eldercare complements our core capabilities and strength in serving seniors and disabled individuals
with a unique focus on individualized and integrated care, and has contracts to provide Medicaid long-term
support services across the entire state of Florida. The enrollment effective dates for the various regions range
from August 2013 to March 2014.
Individual Commercial Coverage
Our individual health plans are marketed under the HumanaOne®brand. We offer products both on and off
of the public exchange, including exchange offerings in certain metropolitan areas in 14 states. We offer products
on exchanges where we can achieve an affordable cost of care, including HMO offerings and select networks in
most markets. Our off-exchange products offered in 22 states are primarily PPO and POS offerings, including
plans issued prior to 2014 that were previously underwritten. In addition, we offer most of our on exchange
products off exchange as well. Policies issued prior to the enactment of the Health Care Reform Law on
March 23, 2010 are grandfathered policies. Grandfathered policies are exempt from the requirements of the
Health Care Reform Law, including mandated benefits. However, our grandfathered plans include provisions that
guarantee renewal of coverage for as long as the individual chooses. Policies issued between March 23, 2010 and
December 31, 2013 are required to conform to the Health Care Reform Law, including mandated benefits, upon
renewal in 2014 or 2015, depending on the state.
The initial open enrollment period began for plans effective January 1, 2014 offered through federally
facilitated, federal-state partnerships or state-based exchanges for individuals on October 1, 2013. Federal and
state regulatory changes in December 2013 extended the enrollment deadline for January 1, 2014 insurance
coverage from December 15, 2013 to December 24, 2013, required plans to accept payment for policies with a
start date of January 1, 2014 as late as December 31, 2013 (we voluntarily extended our deadline for payment to
January 31, 2014 and voluntarily extended our deadline for payment to February 28, 2014 for policies with a start
date of February 1), and allowed certain individuals to remain in their existing underwritten off-exchange health
plans that are not compliant with the Health Care Reform Law. Individuals have until March 31, 2014 to enroll
for insurance without paying the penalty imposed by the Health Care Reform Law.
Prior to 2014, our HumanaOne®plans primarily were offered as PPO plans in 27 states where we could
generally underwrite risk and utilize our existing networks and distribution channels. As indicated above, this
individual product included provisions mandated by law to guarantee renewal of coverage for as long as the
individual chooses.
Rewards-based wellness programs are included with many individual products. We also offer optional
benefits such as dental, vision, life, and a portfolio of financial protection products.
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