2016 Healthy Living Programs & Discounts

Transcription

1 2016 Healthy Living Programs & Discounts The products and services described in this booklet are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the IU Health Plans grievance process. Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS IUHealth 3/16 IUH#20915 H7220_IUHMA16150A CMS File & Use

2 Get more value from your Medicare Advantage membership with these programs offered by IU Health Plans and our partners ProCare Network Personalized assistance and discounts Corestream...3 Hand-selected shopping discounts EyeMed Summary of benefits and additional vision discounts Cigna Dental Oral Health Integration Program summary of benefits and discounts TruHearing Hearing care and product discounts Preventive Care Record Keep track of your preventive services

3 Finding Solutions A Personalized Assistance Service dedicated to finding solutions and saving you money Indiana University Health Plans is pleased to announce that its members now have access to ProCare Network! Priority Access to Services Discounted Pricing Free Concierge Assistance ProCare is here to simplify your life with solutions Savings on services from over 60 different leading area professionals Easy access, online at or call , we take care of the rest Helpful staff to personally assist you with a wide variety of needs Access online 24 hours a day or by phone from 8 a.m. to 7 p.m. Mon. - Fri. The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Indiana University Health Plans grievance process. 1

4 Professional Services Automotive Auto Purchasing/Selling Auto Maintenance Financial Services Planning/Investments Tax Preparation Mortgages Home Program Realtors & Builders Mortgages Home Maintenance* Plumbing Electrical Heating & Air Conditioning Cabinets, Carpeting & Flooring Irrigation Legal Services Wills & Estate Planning Real Estate Injury Litigation Bankruptcy Special Access quickly get assistance through the ProCare Call Center or Website. You receive prompt and courteous assistance from a network of quality resources. If the task requires support from our network of partner firms, ProCare s staff will make the arrangements. Photography Children & Family Wedding Special Events ProCare Hotels 3,000+ Hotels (U.S. & Canada) Services to your home* Computers & Smart Phones Auto Maintenance Mary Kay Cosmetics Travel & Entertainment Tours: US and overseas Cruises & Packages Information Center City & Family Information Senior Care Information Behavioral Health Shopping Online Community Resources Government Non Profit Organizations Finding Solutions Call Center In the Indianapolis area call or outside the Indianapolis area call toll free Monday - Friday 8:00 a.m. to 7:00 p.m. Website * Applies to residents of Marion and surrounding counties. 2

5 Spectacular Savings for IU Health Plans Members! 3

6 As a member of IU Health Plans, you now have access to all of the benefits and advantages EyeMed Vision Care has to offer. Whether you choose a provider based on your schedule, style or value with the Insight network, we have you covered: n 73,963 providers nationwide n Convenient weekend and evening times available at most locations n 2,606 providers in the state of Indiana n Online, in-network providers through contactsdirect.com and glasses.com n Right mix of independent and desired retail providers n Same day/1-hour service available at some locations n Benefits and discounts applied consistently We also have popular designer brands to choose from so that your eyewear meets your needs and suits your style. We make finding an in-network provider and using your benefit easy: Locate a provider Check out ways to find one 1. eyemedvisioncare.com/ iuhealth 2. Customer Care Center Receive care and eyewear Simply tell providers your name and date of birth it s easy. Providers are open days, nights and weekends. Your claim is processed In-network providers file claims on your behalf so you won t have to worry about anything. For out-ofnetwork providers, members submit claims and OON checks are paid out daily. 4 Looking for more savings? n 40% off unlimited additional pairs n Up to 60% discount on popular lens options not covered by the plan n 35 50% off contact lens fit & follow-up n 20% off any item not covered by the plan n 20% off any frame balance Ready to learn more? Check out eyemedvisioncare.com/iuhealth.

7 Explanation of your vision care benefits Vision Care Services Member Cost In-Network* Out-of-Network Reimbursement* Exam with Dilation as Necessary 0 Copay Up to 30 Exam Options Standard Contact Lens Fit and Follow Up Premium Contact Lens Fit and Follow Up Frames Any available frame at provider location Standard Plastic Lenses Single Vision Bifocal Trifocal Lenticular Standard Progressive Lens Premium Progressive Lens Δ Lens Options UV Treatment Tint (Solid and Gradient) Standard Plastic Scratch Coating Standard Polycarbonate Adults Standard Polycarbonate Kids under 19 Standard Anti-Reflective Coating Polarized Photocromatic/Transitions Plastic Premium Anti-Reflective Other Add Ons Up to 55 10% off Retail Price 20 Copay; 120 Allowance, 20% off balance over Copay 20 Copay 20 Copay 20 Copay 85 Copay Tier Tier Tier Tier 4 85 copay; 80% of charge less 120 allowance % off Retail Price 75 Tier 1 57 Tier % off Retail Price Up to 60 Up to 25 Up to 40 Up to 55 Up to 55 Up to 40 Up to 40 Up to 40 Up to 40 Up to 40 EyeMed is an independent vision care program and network of providers utilized by IU Health Plans Medicare Advantage HMO and HMO-POS. Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/ physicians/providers are available in our network. Product types include HMO and HMO-POS IUHealth 9/15 IUH#20052 H7220_IUHMA16033 CMS Approved

8 6 Explanation of your vision care benefits (continued) Vision Care Services Member Cost In-Network* Out-of-Network Reimbursement* Contact Lenses^ (Contact lens allowance includes materials only) Conventional 0 Copay; 120 allowance, 15% off balance over 120 Up to 96 Disposable 0 Copay; 120 allowance, plus balance over 120 Up to 96 Medically Necessary 0 Copay, Paid-in-Full Up to 200 Laser Vision Correction Lasik or PRK from U.S. Laser Network 15% off Retail Price or 5% off promotional price Additional Pairs Benefit Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the funded benefit has been used. Frequency Examination Lenses or Contact Lenses Frame Once every 12 months Once every 24 months Once every 24 months For a complete list of providers near you, use our Provider Locator on eyemed.com or call For Lasik providers, call 877.5LASER6. Benefits are not provided from services or materials arising from: Orthopic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses, medical and/or surgical treatment of the eye, eyes or supporting structures; Any Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety eyewear; Services provided as a result of any workers compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; Plano (non-prescription) lenses and/or contact lenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or materials provided by any other group benefit plan providing vision care; Services rendered after the date an insured person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the insured Person are within 31 days from the date of such order. Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/ Premium Progressive lens not covered fund as a Bifocal lens. Standard Progressive lens covered fund Premium Progressive as a Standard. Benefit allowance provides no remaining balance for future use with the same benefits year. This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer. *For the period EyeMed provides members the option of visiting an out-of-network provider and being reimbursed at in-network benefit levels for copay, frame and contact lens allowances only. Standard contact lens exam is funded for members 18 years and younger. Premium fit is covered at 0% off retail less 0 allowance. ^A 12-month supply is defined as the supply required to last 12 months with the patient following the manufacturer s approved wear schedule. ΔPremium progressives and premium anti-reflective designations are subject to annual review by EyeMed s Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Not available in all states. Some provisions, benefits, exclusions or limitations listed herein may vary.

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10 8 Research shows an association between oral health and overall health. By getting the right oral health care, along with regular medical treatments, high-risk individuals may be able to improve their overall health.

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12 Indiana University Health Plans Cigna Dental PPO Benefit Summary Effective 01/01/2016 This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network. Total Network Cigna Dental PPO Benefits In-Network Out-of-Network (Class I, II, and III Expenses) 0, Class I Applies 0, Class I Applies Calendar Year Deductible Per Individual Per Family No Limit No Limit Class I Expenses - Preventive & Diagnostic Care Oral Exams 100%, After 10 deductible 50%, After 10 deductible Cleanings Routine X-Rays Sealants Space Maintainers (limited to non-orthodontic treatment) Class II Expenses - Basic Restorative Care Non-Routine X-Rays Not Covered Not Covered Emergency Care to Relieve Pain Fillings Oral Surgery - Simple Extractions Class III Expenses - Major Restorative Care Oral Surgery - All Except Simple Extraction Not Covered Not Covered Surgical Extraction of Impacted Teeth Anesthetics Major Periodontics Minor Periodontics Root Canal Therapy / Endodontics Relines, Rebases, and Adjustments Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Crowns / Inlays / Onlays Dentures Bridges Brush Biopsy Stainless Steel/Resin Crowns Class IV Expenses - Orthodontia Not Covered Not Covered Cigna Dental PPO / and Limitations: Procedure Exams Prophylaxis (Cleanings) X-rays (routine) X-rays (non-routine) Exclusions & Limitations 1 per 6-month consecutive period. 1 routine prophy or perio maintenance procedure per 6-month consecutive period. Bitewings: 2 per calendar year Full mouth: 1 every 3 calendar years. Panorex: 1 every 3 calendar years Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS IUHealth 9/15 H7220_IUHMA16063 CMS Approved 9/9/

13 Explanation of your hearing aid benefit Hearing aids improve the quality of life and overall health of people with hearing loss. Unfortunately, hearing aids typically cost 2,000 3,000 each and aren't covered by traditional Medicare. IU Health Plans Medicare Advantage plans provide coverage on high-quality hearing aids and local professional care. Coverage details Your IU Health Plans Medicare Advantage plan hearing aid benefit is offered through TruHearing and covers up to two hearing aids per year. Hearing aids are offered in an array of colors and styles. Your copay includes: * 3 follow-up visits with an in-network provider for fitting and adjustments 45-day money-back guarantee 3-year manufacturer s warranty for repairs and one-time loss and damage replacement 48 batteries per hearing aid Features include: Advanced feedback suppression Speech enhancement Advanced noise reduction HD sound quality 2.4 GHz wireless connectivity 9 channels 2 programs 10 styles Standard features 15 channels 4 programs 10 styles Premium features Routine hearing exam Hearing exam performed by in-network provider Medicare Select HMO 699 copay (per aid) 999 copay (per aid) 75 exam copay Medicare Select Plus HMO 699 copay (per aid) 999 copay (per aid) 75 exam copay Medicare Choice HMO/POS 599 copay (per aid) 899 copay (per aid) 75 exam copay Call TruHearing to schedule a hearing exam (TTY users call ) from 8 am 8 pm, Monday Friday. Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS IUHealth 9/15 IUH#20015 H7220_IUHMA16032 CMS Approved

14 How to use your benefit 1. Call TruHearing at A TruHearing representative will verify your coverage and help you set up a hearing exam with an in-network provider in your area. 3. If hearing loss is discovered, your provider will help you choose the right hearing aid solution and order your hearing aids. 4. When the hearing aids arrive at the provider s office, you ll return for a fitting and programming of the hearing aids. Call TruHearing to verify your benefit and schedule a hearing exam (TTY users call ) from 8 am 8 pm, Monday Friday. *Three follow-up visits must be used within one year after the date of initial purchase. Forty-five day money-back guarantee and hearing aid returns, repairs and replacements subject to provider and manufacturer fees. For questions regarding fees, contact TruHearing customer service. All content 2015 TruHearing, Inc. All Rights Reserved. TruHearing is a registered trademark of TruHearing, Inc. All other trademarks, product names and company names are the property of their respective owners. TruHearing is an independent hearing aid program and network of providers utilized by IU Health Plans Medicare Advantage HMO and HMO-POS. 12

15 TruHearing am to 8 pm Mon. Fri. 13

16 950 N. Meridian St., Suite 200 Indianapolis, IN iuhealthplansmedicare.org If you have questions, we re here to help. Please call our Customer Solutions Center toll free at TTY users call Relay Indiana at Customer Solutions Center Hours of Operation From Oct. 1 Feb. 14; 8 am 8 pm, seven days a week From Feb. 15 Sept. 30; 8 am 8 pm, Monday - Friday. You may receive assistance through alternate technology after 8 pm, on weekends and holidays.