Transcript 2014 TCU One Exchange Presentation

Welcome
to the
TCU – One Exchange
Informational Meeting
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What’s changing?
• TCU changed the way it provides medical
benefits to Medicare-primary retirees and their
Medicare-primary dependents.
• Retiree’s medical benefits will be managed
through a Health Reimbursement Arrangement
account (HRA).
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2
What we’ll cover today
• Why this approach?
• How this affects you
• Medicare 101
• Introducing OneExchange
• Going forward
• Questions & answers
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Why This Approach?
•
Provides Medicare-eligible retirees with:

Greater flexibility in how to use health care dollars

A broader range of plan options

The possibility that new coverage will cost less than
current coverage
•
Enables TCU to continue supporting retirees during
a time of uncertainty surrounding the rising cost of
medical insurance and services
•
Enables TCU to predict and budget for health care
costs more accurately
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How This Affects Medicare
Eligible Retirees
What you
pay
How to
enroll
Your
support
• Medical premiums and out-of-pocket costs will vary
depending on the coverage you choose.
• You will work with OneExchange to enroll in a plan
that meets your medical and Rx needs.
• TCU will establish your Health Reimbursement
Account. This account will be administered by
OneExchange
• OneExchange Advisors will help you understand the
costs associated with your coverage – premiums, copayments, deductibles and all other costs.
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Medicare 101
•
Everything you wanted to know about Medicare, but
were afraid to ask!
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Original Medicare:
• A Health insurance program for
– People 65 years of age and older
– Some people with disabilities
– People with End Stage Renal Disease (ESRD)
• Administered by CMS
• Enrollment handled by Social Security Administration or Railroad
Retirement Board
Key Terms
Medicare Part A = Hospital Coverage – administered by CMS
Medicare Part B = Medical Coverage – administered by CMS
Medicare Part C = Medicare Advantage Plans – private plans – group or individual market
Medicare Part D = Prescription Drug Coverage – private plans – group or individual market
Medicare Supplement (Medigap) – private plans – group or individual market
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Original Medicare: Part A (Hospital)
Premiums:
• Most people do not pay a monthly Part A premium because they or a
spouse have 40 or more quarters of Medicare-covered employment.
–
$254.00 for 30-39 quarters of Medicare-covered employment.
–
$461.00 for people who have less than 30 quarters of Medicare employment.
Foreign citizens and Americans who worked abroad
Coverage:
• Medicare Part A covers:
– Hospital Stays
– Skilled Nursing Facility (SNF)
– Home Health Care
– Hospice Care

– Pints of blood received at a hospital or skilled nursing
facility during a covered stay
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Original Medicare: Part B
(Medical)
Coverage:
•
•
•
•
Doctors’ services (physician office and some hospital
settings)
Limited Chiropractic Services
Outpatient Services:
Diagnostic tests- clinical Lab
o
•
(x-ray, MRI, CAT, EKT, nutritional therapy, etc…)
Other medical services
o Durable medical equipment (DME)- prosthetic, wheelchair etc.
o Diabetic Supplies
o Ambulance service
Initial Enrollment Period:
o When turning 65.
o
3 months before, the month of, and three months after 65th B-Day. (7 month window)
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Medicare Part B - Late Enrollment Penalty
A person that is eligible for Medicare but opts out of Part B may be
subject to a 10% per year Part B penalty
•
Penalty is waived if beneficiary has coverage through a group policy based
on active employment
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Medicare Eligibility & Active
Employment
For employers with 20 or more employees, group coverage is primary for
Medicare beneficiaries who are still active, and Medicare is
secondary. Therefore, active beneficiaries don’t have to enroll in Part B and will
not be penalized when they decide to retire. When they decide to retire,
beneficiaries should enroll in Part B three months prior. This will insure that they
can enroll in a Medicare Supplement plan and have it effective as soon as their
group coverage ends.
•
If active and covered under the group health plan, employee does not enroll in Medicare Part B
or select a Medicare supplemental plan(s) until they retire or lose coverage.
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Post-65 Coverage Options
Original MedicareFFS (Fee For Service)
Part A
• Hospital
• Institutional
Part B
• Doctors
• Supplies
• Outpatient
• Professional
Medicare
Advantage
(MA)
PFFS
Added Optional Coverage
Medicare
Supplement
(Medigap Plans)
Fills in Medicare
payment “gaps” in
coverage
MA-PD
OR
+ Part D
Drugs
(Stand
Alone)
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PPO
HMO
+ Part D
Drugs
Part D: What is Medicare Part D?
• Medicare Part D is optional prescription drug coverage for
everyone with Medicare Part A or B
• PDP’s are run by private insurance companies approved by
Medicare (Like MA plans)
• If beneficiaries decline to enroll in a Medicare drug plan
when they are first eligible, they may be penalized. (1% of
national average per month)
• Beneficiaries sign up when they first become eligible for
Medicare, or during the AEP
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OneExchange
Helping You Prepare For Your Upcoming Medicare Enrollment
TOWERS WATSON
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
Who We Are

Transitions Can Be A Good Thing!

OneExchange – For Your Benefit

A Deeper Dive – Benefit Advisors,
Private Exchange, Optimize Savings,
Health Reimbursement for You

Next Steps

Questions & Answers
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15
Your Transition
Transitioning the way access is provided to
retiree health benefits for Medicare-eligible retirees
and their Medicare-eligible dependents
• OneExchange has been chosen after an extensive evaluation
of choices
• OneExchange will help you with total care in transitioning
over to more-effective individual Medicare health insurance
• The private exchange offers greater choice and flexibility;
many affordable choices exist and in many cases provide
more value at a lower cost than an employer group plan
• Ongoing support – at no cost to you
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About OneExchange
Towers Watson
over
100
Hundreds of
thousands
of retirees served across
300+ employers
Licensed advisor
provides
guidance and lifetime
advocacy
years experience
Personalized options with plans
from
a nationwide network of
carriers
Founded in 2004
First and Largest
No added
fees for our
services
towerswatson.com
In the middle of our
9th annual
private Medicare Exchange
enrollment season
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Why OneExchange?
White-Glove Service
Consultative
Process
Consultative
Process:

Your Benefit
Advisor will
determine coverage
needs and
thoroughly research
your options
Simplified
Selection
Selection Process:

Your Benefit Advisor
will provide the
guidance you need
to easily understand
your Medicare
options
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Effortless
Enrollment
Enrollment
Process:
100% paperless,
telephonic
enrollment
 Secure and
efficient

Lifetime
Advocacy
Advocacy:

Specialized and
focused; trained
in insurance,
Medicare and
issue resolution
towerswatson.com
Our Service Centers
Salt Lake City, UT
100% Domestic Workforce
- NO Outsourcing!
Dallas, TX
Operating hours:
Monday-Friday 7am-8pm CT
towerswatson.com
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19
Plans and Partners
All Medicare Plan Types
Medicare Supplement
(Medigap)
Medicare Advantage
Prescription Drug
(Part D)
A few examples of the carriers on our Medicare exchange:
Multiple plans available to you from national/regional carriers
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Your Experience
Announcement
& Education
towerswatson.com
Evaluation &
Enrollment
Ongoing
Communications
& Advocacy
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21
Education
Enrollment Guide
Prepare for your enrollment
consultation
• Review Medicare basics
TOLL FREE
1-888-429-8490
medicare.oneExchange.com/TCU
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22
Decision Support Tools
• Help Me
Choose
• Prescription
Profiler
medicare.oneExchange.com/TCU
24/7 access to your information
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23
Benefit Advisors
Hours of
Operation

Licensed / Certified / Appointed

OneExchange University™

Average age 43

Objective & unbiased

100% domestic workforce
Monday – Friday
7 am – 8 pm CT
towerswatson.com
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Enrollment Process

Benefit Advisors can discuss coverage options with anyone

Telephonic enrollment – 2 part process

100% of calls are recorded
towerswatson.com
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25
Tag-Team Enrollment Expertise
• Allows BAs to Have More Time for Consultations
• Ensures Accuracy of Application Submissions
Licensed
Benefit
Advisors
(BAs)
Licensed / Certified / Appointed by
Departments of Insurance; the experts in
probing health plan needs and helping to
recommend the right plan
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Application
Data
Processors
(ADPs)
Trained in carrier enrollment applications;
the experts in accurately filling out the
paperless applications to optimize firsttime acceptance by the carriers
26
Enrollment Confirmation Notice
Features: Sent once a participant
has enrolled into a plan
Confirms all plan selections and
enrollments
• Carrier Name
• Plan Name
• Confirmation Number
• Premium
• Coverage Effective Date
• Whether or not they have
selected Automatic
Reimbursement
What Happens Next
• Expectations on Carrier
correspondence, including ID
Cards
• Subsidy Packet
• Automatic Reimbursement
• Direct Deposit
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OPTION 1: Medicare Advantage Plan with
Prescription Drug Coverage (MAPD)*
MEDICARE
ADVANTAGE
+ PD
* Note that Medicare Advantage plans are generally network based plans
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28
OPTION 2: Medigap Plan + Part D Plan
MEDIGAP
PLAN
PART D
PLAN
Note: You may need to pay your first premium when you enroll in coverage
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29
Medicare Prescription Drug Coverage
You pay 45% of Brand
2015
Name and 65% of
Generics until your out of
pocket costs reach
$4700; Pharmaceutical
contributions will count
towards the $4700 True
Out Of Pocket costs
You Pay Full
Retail Until
Deductible is Met
2015 - $320
Deductible
Initial
Coverage
Coverage
Gap
Only 25% reach
Donut Hole
You pay copays
for your plan
coverage for the
first $2960 in
actual costs of
Medications
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Catastrophic
Coverage
Only 4% reach
Catastrophic
You Pay $2.65 for
Generics and
$6.60 for Brand
Name or 5% whichever is
greater
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30
How This Affects You
What you pay
• Depends on the plan you choose
• Choose the right level of coverage for you
and your spouse individually
How you enroll
• You enroll directly through OneExchange
• You and your Medicare-eligible spouse enroll
in separate plans
Your support
• OneExchange will be your partner as you
make this decision and enroll in plans
• OneExchange will provide ongoing support
- at no cost to you
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31
Local Plan Slides
Note: 2014 rate examples; 2015 rates will be
available in the October 2014 time frame
towerswatson.com
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32
Plans Available in Dallas and Tarrant Counties
Number of
Plans Offered
Plan Type
2014
Monthly Premium
Carriers
Medicare Advantage
19
$0 - $89
Coventry, Humana,
AARP, Aetna, Scott
& White, CIGNA
Health Spring
Medigap /
Medicare Supplement
16
$66 - $306
AARP, Humana, BC
BS TX
$13 - $127
AARP, Aetna,
CIGNA, Express
Scripts, Humana,
Silver Script,
WellCare
Prescription Drug
(Part D)
17
Note: 2014 rate examples; 2015 rates will be
available in the October 2014 time frame
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33
Also Available in Dallas & Tarrant Counties
Plan Type
Vision
Number of
Plans Offered
2014
Monthly Premium
1
$14 per person per month
Annual eye exam: $5
Company
Vision Service Plan
(VSP)
Coverage for eye glasses,
lenses and frames
Dental
4
$16 - $46
$50 - $75 deductible
$750 - $1500 annual
maximum
Delta Dental,
Humana,
MetLife Dental
Vision plans and Dental plans are not Medicare plans
Note: 2014 rate examples; 2015 rates will be
available in the October 2014 time frame
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34
Medicare Advantage Plan
Benefit
Cost
Premium
Network
$34
PPO
Deductible
Doctor Copay
Specialist Copay
$0
$10
$40
Hospital
Emergency Room
Deductible
Rx
$300 copay per days: 1-7
$65 unless admitted to the hospital
$0
$0/ $2/ $39/ $85/ 33%
30-day supply
Mail Order
$13/ $18/ $110/ $238
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2014
90-day supply
35
Medigap Plan F + PDP (75 year old male)
Benefit
Cost
Premium
Network
$220 ($202 Medical + $18 PDP)
Any doctor who accepts Medicare
Deductible
Doctor Copay
Specialist Copay
$0
$0
$0
Hospital
Emergency Room
Deductible
Rx
$0
$0
$0
$0/ $15/ $40/ $90/ 33%
30 day supply
Mail Order
$0/ $30/ $80/ $180
90 day supply
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2014
36
Health Reimbursement Arrangement
(HRA)
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What Is An HRA?
•
Tax-free account used to reimburse you for eligible health
care expenses – you pay first and then get reimbursed
•
If you are eligible, your former employer will make an
annual contribution to a Health Reimbursement Account
(HRA)
•
You may use HRA funds to reimburse yourself for eligible
medical expenses which include premiums that you pay
coverage for (including Medicare Part B) and certain
out-of-pocket expenses
•
Your HRA funds will be available on the first of the month
of your retirement, prorated for the year. On Jan 1st of the
next year, you receive the full annual amount.
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38
Health Reimbursement Arrangement
If you are eligible,
reimbursements are
made up to the
amount available
in your HRA
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39
Health Reimbursement Arrangement
Reimbursement Options
1.
Automatic
2.
Manual
Reimbursement
Reimbursement
[including recurring claims]
If you are eligible,
reimbursements are
made up to the
amount available
in your HRA
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40
Auto-Reimbursement (AR)
•
Service offered by OneExchange
•
Available on most plans
•
Works for premium reimbursement only
•
No claim form is required
•
Can take 2-3 billing cycles to initiate
•
If you need your reimbursement sooner,
simply file a paper claim. The form and
instructions will be provided in your
Funding and Reimbursement Guide
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Next Steps
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What You Need To Do: Action Required!
• You MUST enroll in Medicare Part B if not
already enrolled
– contact the SSA
• Contact OneExchange at your toll free #
• Make a first contact call now and
schedule an enrollment appointment
• Enroll in your new coverage
• Call us during your scheduled appointment time
• You are guaranteed coverage
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43
Your First Contact Call – We’re Ready!
Review Enrollment Guide
Gather Medicare card,
Prescriptions and
Doctors/Hospital information
Call OneExchange
1-888-429-8490
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44
Personal Guidance: For a Lifetime
A lifetime advocate:
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
Navigation

Enrollment

Claim issues

Denied policies

Affordability concerns

Prescription

Late enrollment

HRA

Annual plan review
Why OneExchange Retiree
Experience
First and largest Medicare Exchange; private
Satisfaction
99% client retention rate
Average retiree satisfaction 9.2/10.0
Relationship
As life happens, we are here for you
Technology
Most automated connections, across 90 carrier partners
Size and
Strength
300 employers and 500,000 retirees being served
People
Objective and personal touch through stringent
training processes and CMS compliance criteria
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We Are Ready For Your Call
1-888-429-8490
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50