Benefit Solutions for Public Employers

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Transcript Benefit Solutions for Public Employers

Welcome to Public Safety
Retirement System
Open Enrollment
2008
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Agenda
Updates for 2008
Plan Options
Benefits
Medicare
Non-Medicare
Enrollment and Contact
Information
Questions
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Updates for 2008
 No rate increase on all plans
 Senior Supplement Medicare Part D Changes
 TDE $2,510
 TrOOP $4,050
 PPO RX copays
 $20/$40
 New ID cards for all Medicare and PPO
members
 SecureHorizons Brand
(no change for PSPRS)
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Plan Options
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Medicare Eligible Medical Plans
 MedicareComplete HMO (Secure Horizons)
Medicare eligible retirees/dependents
living in Cochise, Coconino, Graham,
Greenlee, La Paz, Maricopa, Pima,
Pinal, Santa Cruz, Yavapai and Yuma
Counties
 Senior Supplement
Medicare eligible retirees/dependents
living nationwide
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare Medical Plans
 Health Maintenance Organization (HMO)
Non-Medicare eligible retirees/dependents
using providers in Maricopa, Pima and Pinal
Networks
 Preferred Provider Organization (PPO)
Non-Medicare eligible retirees/dependents
living in the state of Arizona
 Indemnity
Non-Medicare eligible retirees/dependents
living outside the state of Arizona
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Additional Programs
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
SilverSneakers
 Offered to all medical plans
Membership at participating fitness centers
at no additional cost
Group exercise classes designed to
increase strength, flexibility and energy
Senior Advisor at each fitness center
Social events
Steps Program for the Rural Areas
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Caregivers
 Offered to all medical plans
Unlimited telephonic access to geriatric
experts
Personalized research into and
screening of community programs
Assistance in making and coordinating
care arrangements
Six hours of geriatric care management
services annually
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Benefit
Overview
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MedicareComplete HMO
(SecureHorizons)
 Must have Medicare Parts A & B
 Automatically enrolled with Medicare
Part D
 Sign Statement of Understanding
 Select a Primary Care Physician (PCP)
 Select a Hospital Network
 PCP Referral to Specialists
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO
(SecureHorizons)
 Outpatient Services
Primary Care Physician
Specialist
Lab
Standard X-Rays
Specialized Scans
$15 copayment
$30 copayment
You pay nothing
You pay nothing
$50 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO
(SecureHorizons)
 Outpatient Services
Urgent Care
Emergency Room
$15 copayment
$50 copayment
(waived if admitted)
Ambulance
$25 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO
(SecureHorizons)
 Hospitalization
Inpatient
$100 copay per admit
Mental Health
$100 copay per admit;
190 days lifetime maximum
Skilled Nursing
Facility
No copay; limit of
100 days per benefit period
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO
(SecureHorizons)
Prescription Drug Benefit
 Formulary Applies
 Unlimited Annual Maximum
 Retail
30 day supply
Tier 1
Tiers 2, 3 & 4
 Mail Order
Tier 1
Tiers 2, 3 & 4
$20 copayment
$40 copayment
90 day supply
$40 copayment
$80 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO
(SecureHorizons)
 Optical Benefits
 Routine Care - Spectera Providers
Eye Exam
$20 copayment
Frames
$130 allowance/yr
Lens
Covered 100%
Or
Contact Lenses
$105 allowance/yr
 Medically Necessary – Contracted Medical
Providers
Eye Exam
$15 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO
(SecureHorizons)
 Hearing Benefits
Medically Necessary
Hearing Exam
$30 copayment
Routine hearing exams
Not covered
Hearing Aids
Not Covered
 See page 13 of ASRS/PSPRS brochure for
discounts on routine hearing exam and hearing
aids – Please note this is not an insurance
benefit
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Must have Medicare Parts A & B
 Automatically enrolled in Medicare Part D
 ID cards Medical (including vision)
Prescription Drugs – UnitedHealth Rx
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Freedom to use any provider who
accepts Medicare
 Medicare is primary insurance
 Senior Supplement helps pay for
deductibles and coinsurance not covered
by Medicare (based on schedule of
benefits up to policy limit)
 Calendar Year Deductible - $100
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Medical Services Physician services, inpatient and outpatient
medical and surgical services and supplies,
physical and speech therapy, diagnostic tests
and durable medical equipment
After Satisfying the Calendar Year Deductible,
Plan pays the Part B deductible
Plan pays 20% of Medicare approved
amounts
Plan pays 50% of outpatient Mental Health
services
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Hospitalization
After Satisfying the Calendar Year
Deductible, Plan pays the Part A
Deductible and the daily coinsurance rates
after the 61st day
After you have exhausted the Medicare
covered days, Plan pays 100% of Medicare
eligible expenses for 365 additional
lifetime days
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Limitations
Inpatient Mental Health – 190 days lifetime
maximum
Skilled Nursing Facility – 100 days per
benefit period
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
UnitedHealth RX for Group PDP
Prescription Drug Benefit
 Open Formulary
 Retail
Tier 1
Tiers 2, 3 & 4
 Mail Order
Tier 1
Tiers 2, 3 & 4
30 day supply
$10 copayment
$35 copayment
90 day supply
$20 copayment
$70 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
UnitedHealth RX for Group PDP
 Prescription Drug Benefit continued
Copays applies to the first $2,510 of
prescription drug cost per person.
After $2,510 in Total Drug Expenditures
(TDE), you are responsible for 100% of
drug cost until $4,050 in True Out of
Pocket (TrOOP) is met;
Then you pay $2.25 generic, $5.60 brand
name or 5% of the cost; whichever is
greater
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
UnitedHealth RX for Group PDP
How Medicare Part D Prescriptions works:
Cost of RX
$100
$ 50
Applied to
TDE
→
$100
→
$150
↓
$2,510
Your
Copay
$35
→
$10
→
100%
when TrOOP adds up to
generic
$2.25 or 5%
brand
$5.60 or 5%
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Applied to
TrOOP
$35
$45
↓
↓
↓
$4,050
Senior Supplement
 Optical Benefits - Routine & Medical
Eye Exam
$20 deductible
In-Network –
Spectera Vision
Providers
100% after
deductible
Out-of-Network
$80 allowance
after deductible
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Optical Benefits
Frames & Lenses OR Contact Lenses
In-Network
Frames
$130 allowance/yr
Lenses
Covered 100%
Or
Contact Lenses
$105 Allowance/yr
Out-of-Network
Frames & Lenses
Or Contacts
$100 Allowance/yr
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
 Hearing Benefits
Hearing Exam
Hearing Aids
Medically Necessary
Not Covered
 See page 13 of ASRS/PSPRS brochure for
discounts on routine hearing exam and
hearing aids – Please note this is not an
insurance benefit
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Enrollment and
Contact Information
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Forms to Submit
PSPRS enrollment form
Statement of Understanding – if
enrolling in the MedicareComplete
HMO (SecureHorizons) plan
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
How to Reach PacifiCare
Customer Service
Phone Numbers Listed on Back of ID cards
and on the inside cover of the
ASRS/PSPRS Open Enrollment Guide
www.pacificare.com
www.securehorizons.com
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
 Select a Primary Care Physician (PCP)
 Select a Network
 PCP Referral to Specialists
 Self Referral for Mental Health, GYN,
Optical and Hearing
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
 Outpatient Services
Primary Care Physician
Specialist
Lab
Standard X-Rays
Specialized Scans
$20 copayment
$40 copayment
You pay nothing
$20 copayment
$150 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
 Outpatient Services
Urgent Care
$40 copayment
Emergency Room
$75 copayment
(waived if admitted)
Ambulance
You pay nothing
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
 Hospitalization
Inpatient
Outpatient Surgery
Mental Health
You pay 30%
You pay 30%
You pay 30%
 Out of Pocket Maximum
(Inpatient or Outpatient Hospital coinsurance applies)
$3,000 Individual
$9,000 Family
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
 Prescription Drug Benefit
 Formulary Applies
 Unlimited Annual Maximum
 Retail
Generic
Brand Name
 Mail Order
Generic
Brand Name
30 day supply
$20 copayment
$40 copayment
90 day supply
$40 copayment
$80 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
Optical Benefits
Eye Exam
Frames
Lens
Or
Contact Lens
$40 copayment
$50 allowance
$50 allowance
$100 allowance
Hearing Benefits
Hearing Exam
Hearing Aids
$40 copayment
$200 allowance
per calendar year
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
 In Area PPO rates are for retirees and
dependents living in Maricopa, Pima
and Pinal counties
 Out of Area PPO rates are for retirees
and dependents living in all other
counties in Arizona
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
 Freedom to use any licensed provider
 In-Network Providers paid at
contracted rate
 Out-of-Network Providers paid at
Usual, Customary and Reasonable
(UCR)
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
 Calendar Year Deductible
$500 per person
$1,000 per family
 $75 Emergency Room Deductible
 $250 Out-of-Network Hospital
deductible per admission
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
 In-Network Out of Pocket
$2,000 per person
$4,000 per family
 Out-of-Network Out of Pocket
$6,000 per person
$12,000 per family
 Lifetime maximum benefit
$2,000,000
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
In Network
Out of
$15 copay*
60%
 Coinsurance
80%
60%
 Emergency Room
80%
60%
 Ambulance
70%
70%
Network
 Office Visit
including preventative
*lab and x-ray subject to deductible and coinsurance
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
 Prescription Drug Benefit
 Formulary Applies
 Unlimited Annual Maximum
 Retail
Generic
Brand Name
 Mail Order
Generic
Brand Name
30 day supply
$20 copayment
$40 copayment
90 day supply
$40 copayment
$80 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Questions?
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.