Transcript Document

2009 RETIREE LUNCHEON
MARCH 23, 2009
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2009 Benefit Plan Update
Medical Plan Changes
– Non-network Option and HDHP Option now
have unlimited Preventive Care Benefit
• physician must file with Medicare first
– Full Time Student Status no longer required for
Dependent Children up to age 25
–must satisfy eligibility plan provisions for
dependent child
– Added Medicare Crossover service
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2009 Benefit Plan Update
(continued)
Dental Plan Changes
– Increased benefit coverage for composite
fillings
– allows a benefit composite fillings regardless of
tooth location
– Salaried Retirees will now have access to
continue Dental coverage as Post-65 Retiree
– same coverage offering as Hourly program
– Retirees pay 100% of the contribution
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2009 Benefit Plan Update (continued)
Vision Program
– No Plan Design Changes
– Full Time Student Status no longer required for
Dependent Children up to age 25
–must satisfy eligibility plan provisions for
dependent child
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UPDATE ON
COORDINATION OF
BENEFITS
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Medicare Crossover
Highlights of Medicare Crossover
• Medicare Cross-Over is the process by which
Medicare automatically forwards medical claims to
UnitedHealthcare for processing
• Based on agreements with the Medicare Part B
and Durable Medical Equipment (DME) claim
processors
• UHC will be able to keep out-of-pocket balance
current
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Medicare Crossover (continued)
• Medicare Cross-Over is available to any
Medicare-primary CITGO enrollee.
• It is available to both enrollees and their
Medicare-eligible dependents, if they do not have
group coverage from another source.
• Medicare pays first, then claims are submitted
electronically to UnitedHealthcare.
• Process eliminates provider submission of claim
to UHC after Medicare processing
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Coordination of Benefits
Medicare Part D Prescription Drug Plan
(continued)
• If you enroll in Medicare Part D you and your
covered dependents will no longer be eligible to
participate in the CITGO Medical Plan
• The CITGO Prescription Drug program meets the
requirement for creditable coverage
• Must be enrolled in Part A and B to be eligible for
Medicare Part D
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Coordination of Benefits
Preventive Care Benefits
• Preventive care benefits are now eligible for a
100% benefit when not covered by Medicare.
• Routine screenings and immunizations are
covered under the CITGO plan
• The 2009 Medicare Preventive Care benefits can
be found on the Medicare website at
http://www.medicare.gov/Publications/Pubs/pdf/10110.pdf
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Coordination of Benefits
Preventive Care Benefits (continued)
• Your physician must still file with Medicare for the
CITGO plan to process the benefits as the
secondary plan
• Filing with Medicare is required in order for the
CITGO plan to process secondary benefits
• Because the CITGO plan is secondary to
Medicare, the filing requirement applies even
when Medicare is not going to pay a benefit
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APPENDIX
2009 Retiree Health
Benefits Overview
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Retiree Medical Benefits
Eligibility Requirement for Retiree Medical
10 Years Continuous Plan Participation while in
active employment AND
Meet one or more of the following:
Age plus service equals 70 points
OR
• Retire under Company retirement plan
OR
• Age 55 or older and eligible to retire from the
Pension Plan
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Retiree Medical Benefits
Eligibility (continued)
• Can waive and re-enroll at a future date
– Enrollment allowed at Annual Election or when
you have a Qualified Change in Status
– No pre-existing condition exclusions
– Enroll at Annual Election or Change in Status
• Other coverage primary
• Continue to receive important and critical benefits
information you should always review.
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Retiree Medical Benefits
Spouse Eligibility
• CITGO Retiree becomes Medicare eligible before
eligible spouse
– Not eligible for network options
– Coverage Non-Network Medical Option
• Eligible Spouse becomes Medicare eligible before
CITGO retiree
– Coverage for retiree remains the same
– Medicare becomes primary payer for the spouse
– Medicare coordination of benefits is applied
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Retiree Medical Benefits
Spouse Eligibility (continued)
• CITGO Retiree dies before eligible spouse
– Coverage continues
– Medical options depend on spouse’s eligibility
for Medicare
• Eligible children
– Eligible for coverage up to age 25
– Full Time Student Status no longer required for
Dependent Children up to age 25
• must satisfy eligibility plan provisions for
dependent child
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Retiree Medical Benefits
Retiree Medical Benefits when Retiree is NOT
Medicare Eligible
• Same medical plan options as active employees
• CITGO is the primary plan
• CITGO secondary for dependents age 65 and
over
• Includes same Prescription Drug Program
available to Active Employees
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Retiree Medical Benefits
Retiree Medical Benefits when Retiree is
Medicare Eligible
• Medicare becomes the primary payor
– Medicare Part A – Hospital
– Medicare Part B – Medical Expenses
• CITGO becomes secondary not a supplement
• CITGO Plan provides a “carve-out” benefit and
does not “supplement”
• CITGO primary for < age 65 dependents
• Includes full Prescription Drug Program
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Prescription Drug Program
Retiree Coverage is Same as Active
Coverage
• CITGO is the primary plan for both Pre-65 and
Post-65 Retirees except when
– You enroll in Medicare Part D
– You are enrolled as an Active Employee under
another employer plan
• Prescription drug program benefits
– not subject to deductible
– not subject to annual or lifetime limits
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Prescription Drug Plan Snapshot
For Short-Term and Immediate
Prescriptions
Retail Pharmacy Program*
You pay 30% with $10 minimum a $200
maximum per prescription for Tier 1 and
Tier 2.
Up to a 31 day supply.
You pay 40% with $10 minimum and a $200
maximum per prescription for Tier 3.
You pay 40% with $10 minimum and a $200
maximum per prescription for Tier 3.
For Long-Term and Maintenance
Medications
Up to a 90 day supply:
Mail-Order Program*
·
$25 for Tier 1
·
$50 for Tier 2
·
$75 for Tier 3
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Retiree Dental Benefits
Pre-65 and Post-65 Retiree Dental
• Applies to Hourly and Salaried Retirees
• Same as active employees
• CIGNA Preferred Provider Program (PPO)
• Retiree is responsible for 100% of the
contribution for Retiree
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Dental Benefits Snapshot
Benefits
Covered Services
Coverage - You Pay
Preventive and Diagnostic
Two oral examinations
per year, routine
cleaning and scaling,
and X-rays.
You pay 0%
Basic
Fillings, extractions, oral
surgery, periodontics
and endodontics
You pay 20% after calendar
year deductible
Major Restorative
Crowns, bridges and
dentures
You Pay 50% after calendar
year deductible
Orthodontic
Braces and other
appliance therapy
You Pay 50%
Deductible
$50 per person per year
Dental Maximum
$1,500 per person per lifetime for orthodontia
Orthodontic Maximum
$1,500 per person per lifetime for orthodontia
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Retiree Vision Benefits
United Healthcare Vision - SPECTERA)
• Same coverage as Active Employees
• Provides coverage for routine eye exam,
corrective lenses, eyeglass frames, contact
lenses
• Discount available on progressive lenses
• In-network benefits available after applicable
copay
• Out of Network benefits available
• Coverage available for your dependents
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Vision Benefits Snapshot
Benefits
Comprehensive Vision Exam
In-Network Covered Services
Once Every 12 months by a network
optometrist or ophthalmologist
Materials
Materials copay applies to the
entire purchase of eyeglasses
(lenses and frames), or contacts
in lieu of eyeglasses
Pair of lenses (for eyeglasses) once
every 12 months for standard single,
lined bifocal, lined trifocal, standard
lenticular:
Frames
Once every 24 months
You Pay
You pay
$10
You pay
$25
Elective Contact Lenses (in lieu Once every 12 months
of eyeglasses)
Deductible
None
Refractive Eye Surgery
Discounts available from Spectera providers
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Long Term Care Insurance
Aetna insures the Long Term Care
• Personal care, health care and social services
– Assistance with normal activities of daily living
– Assistance if you have a serious Cognitive
disorder such as Alzheimer’s Disease
• For more information:
– Call Aetna at 1-800-537-8521 or
– Learn more at the website:
www.aetna.com/group/citgo
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For More Information
• Log on to www.hr.citgo.com to view your
benefit information using your Retiree
PRNR
For personal questions contact the
Benefits HelpLine toll free at 1-888-443- 5707
You can also email: [email protected]
About this Material
This material provides an overview of CITGO’s Retiree benefits. The benefits
described are governed by legal plan documents, contracts, and insurance policies.
If a conflict should occur, the legal plan documents, acts, and insurance policies will
prevail.
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