Insurance Options Summary

Transcription

1 Insurance Options Summary For Public School Retirees Department of Technology, Management & Budget Your Health Plans The Office of Retirement Services strives to be good stewards of your pension and healthcare dollars; we work with the Public School Employees Retirement System Board yearly to maintain a quality plan and remain fiscally responsible for the future of our Enrolling in or Changing Your Insurances After Retirement Enrolling after retirement. If you initiate a new enrollment for yourself, your spouse, or another dependent in the retirement system's insurance after your retirement effective date, they will be subject to a 6-month wait to enroll, starting from the date ORS receives your new insurance enrollment request and all required proofs. For example, if we receive your request and/or HMO enrollment form with the necessary proofs of eligibility on February 10, your coverage would begin August 1. The waiting period does not apply if you or a dependent has a qualifying event and ORS gets the request and proofs within 30 days of the qualifying event. For retirees who do not have Medicare, coverage can begin the first of the month after the month we receive your completed application and proofs. For retirees with Medicare, if we get your request and proofs by the 15th of the month, we will enroll you the following month. If we get the request and proofs later, but within 30 days of the qualifying For More Information This is a summary document to help you compare plans. For detailed plan information, answers to benefit questions, and HMO enrollment forms, use the numbers below. Review the Insurance Information (R0058C) sheet for details about how to enroll, who can be Insurance Plans Available The following list is current at the date of printing. If you are interested in enrolling in an retirement system. We offer several competitive insurance options to choose from. Below are the current options. Plan offerings are updated regularly, so check the ORS website for the most current information. event, you may not be enrolled until a month later. Personal Healthcare Fund. If you have the personal healthcare fund, you cannot enroll in insurances after you have retired. You can only change plans. If you re not sure if you have the Personal Healthcare Fund, check miaccount Changing plans. If you are currently enrolled in an HMO, you must remain in the HMO for at least six months, unless the coverage is no longer available because of a move. To change from an HMO to BCBSM with or without drug, complete the Insurance Enrollment/Change Request and return it to ORS along with all required proofs. To switch from one HMO to another HMO or change from BCBSM with or without drug to an HMO, request an application from the HMO and return it to ORS with the Insurance Enrollment/Change Request and all necessary. enrolled, insurance cards, effective dates of coverage, required proofs, the effects of Medicare and other group insurance coverage. This form can be found on the ORS website, in retirement application packets, or by contacting ORS. HMO, you should contact the HMO directly to receive the most current coverage area listing.

2 NON-MEDICARE CARRIERS COUNTIES Catamaran Rx (866) Blue Network (800) No county restrictions. Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Dickinson, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Houghton, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Lenawee, Leelanau, Livingston, Mackinac, Macomb, Manistee, Marquette, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenaw, Wayne, and Wexford. NON-MEDICARE CARRIERS COUNTIES Priority Health (800) Health Alliance Plan (800) Henry Ford Preferred Network HealthPlus MEDICARE CARRIERS Medicare Plus Blue Catamaran Rx (855) BCN Advantage (866) HAP Senior Plus (800) PriorityMedicare (888) HealthPlus MedicarePlus Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Clare, Clinton, Crawford, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Leelanau, Lenawee, Livingston, Mackinac, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenaw, Wayne, and Wexford. Non-Medicare Participants Only: Macomb, Oakland, Wayne. Arenac, Bay, Genesee, Huron, Iosco, Lapeer, Livingston, Macomb, Oakland, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw and Wayne COUNTIES No county restrictions. Medicare Participants Only Expanded Network: Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Bay, Benzie, Branch, Calhoun, Charlevoix, Cheboygan, Clare, Clinton, Crawford, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Leelanau, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph (only the following zip codes: 49011, 49030, 49052, 49072, 49093, 49097), Tuscola, Van Buren, Washtenaw, Wayne and Wexford. Medicare Participants Only: Genesee, Lapeer, Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne. Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Clare, Clinton, Crawford, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Leelanau, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenaw, Wayne, and Wexford. Arenac, Bay, Clare, Clinton, Genesee, Gladwin, Gratiot, Huron, Ingham, Iosco, Isabella, Lapeer, Livingston, Macomb, Midland,, Oakland, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw and Wayne.

3 Catamaran Rx (866) NON-Medicare Summary Comparison Sheet* Effective January 1, 2015 Blue Network (800) Office Calls 10% co-ins plus deductible $40 copay Primary/$50 copay after deductible Specialist Routine Physical Exams Routine Pap Smears Routine Mammograms Allergy Testing and Treatment Covered in full once annually Covered in full Dr. office & Quest Labs; 10% co-ins after deductible outpatient Health Alliance Plan (800) Henry Ford Preferred Network $25 copay Primary/$35 copay Specialist Priority Health (800) $15 copay Primary/ $30 copay Specialist HealthPlus $15 copay Primary/ $30 copay Specialist $40 copay Primary/$50 copay after $25 copay $15 copay Primary Covered in full deductible for Specialist Covered in full Covered in full Covered in full Covered in full 10% co-ins plus deductible Covered in full Covered in full Covered in full Covered in full 10% co-ins plus deductible 50%; $5 copay for allergy injections Chiropractic Visits 10% co-ins plus deductible, up to 26 visits annually Hospital Inpatient 10% co-ins plus deductible, up to 365 days Hospital Outpatient (inc. diagnostic services) Medl/Surg (inc. surgery, anesthesia, tech. surg. assist.) Emergency Medical Urgent Medical Outside Outside the Network in 10% co-ins plus deductible Covered in full after deductible; $150 copay after deductible for high tech imaging services 10% co-ins after deductible Included in office visit Covered in full $50 copay after deductible Not Covered $30 copay, max benefit 30 $30 Copay visits/yr with PT & OT Covered in full after deductible 10% co-ins after deductible 10% co-ins 20% co-ins 10% co-ins after deductible 10% co-ins 20% co-ins 10% co-ins plus deductible Covered in full after deductible 10% co-ins after deductible 10% co-ins 20% co-ins 10% co-ins plus deductible, $50 copay/visit after OOP Max met. Waived if admitted within 3 days. $150 copay after deductible, waived if admitted $175 copay, waived if admitted. $100 copay, waived if admitted. Worldwide coverage $150 Copay, waived if admitted. Worldwide coverage 10% co-ins plus deductible $55 copay $50 copay $45 copay, Worldwide coverage $30 Copay, Worldwide coverage Same in US through BlueCard; outside US, hospital coverage through BlueCard. Additional 20% out of network fee. Waived if member has referral from Blue Preferred PPO physician Routine, urgent & follow-up care through BlueCard Emergency & urgent care covered; other care not covered unless member has prior auth on file Emergency or urgent med. care only (Copays will apply) Emergency or urgent med. care only (Copays apply) Emergency & Urgent same as in-network. Most other covered services, travel deductible and coinsurance Emergency & Urgent same as in-network Emergency & Urgent same as services, deductible and coinsurance Emergency & Urgent same as services, deductible and coinsurance

4 Catamaran Rx (866) Blue Network (800) Health Alliance Plan (800) Henry Ford Preferred Network Home Health Deductible $50 copay after deductible 10% co-ins after deductible up to 60 visits/benefit period Skilled Nursing Facility 10% co-ins plus deductible up to 100 days Covered in full after deductible; up to 120 days/calendar year Hospice Deductible Covered in full after deductible; inpatient hospice care requires prior authorization Outpatient Mental Health Services Prescription Drugs Durable Medical Equipment Supplier Hearing Benefits Deductible** 10% co-ins plus deductible 50% co-ins, up to 20 visits/calendar year 20% Copay Formulary $10 min/$40 max retail (30 day); $25 min/$100 max mail- (90 day) 40% Copay Non-formulary Additional 10% on maint. drug on and after 4th refill In Network -10% co-ins plus deductible; Out of Network - 30% co-ins plus deductible and diff in cost between provider s charge and the BCBSM approved amount; Hearing Exam: 10% co-ins plus deductible. One exam every 36 months Hearing Aids: 10% co-ins plus deductible/ Two hearing aids (if purchased same day) $850 Indiv (Deductible reductions available to Living Well Members) $20 Copay Generic $60 Copay Brand $80 Copay Non-Preferred Brand 20% Specialty 50% coinsurance sexual dysfunction drugs (30 day supply) Up to 90 day supply for 2 times the 30 day copay Mail Order 50% co-ins of the Approved Amount when authorized and obtained from a participating provider One exam every 36 months Hearing Aids: Covered in full. One hearing aid every 36 months. 10% co-ins after deductible up to 100 days/benefit period 10% co-ins after deductible up to 210 days lifetime Priority Health (800) HealthPlus 10% co-ins Covered in full 10% co-ins, 100 days (can be Covered in full renewed) 10% co-ins Covered in full $25 copay. $15 copay $15 Copay $20 Copay Generic $50 Copay Preferred Brand $100 Copay Non-Preferred Brand and Specialty drug- Up to 90 day supply for 2 times the 30 day copay Mail Order and Select Retail 10% co-ins after deductible. Coverage provided for approved equipment based on HAP s guidelines. Some services require prior authorization. Hearing Exam: $35 copay. Hearing Aids: 10% co-ins after deductible auth & conventional hearing aids $10 Copay Generic; $40 Copay Preferred Brand at retail pharmacy (30 day supply); $70 Copay Non-pref brand: 20% coinsurance Specialty (max $100 per Rx) Up to 90 day supply for 2 times the 30 day copay- Mail Order $10 Copay Generic $40 Copay Preferred Brand $70 Copay Non-Preferred Brand 25% coinsurance Specialty 50% Copay Fertility Up to 90 day supply for 2 times the 30 day copay at Retail and Mail Order 20% co-ins 20% co-ins One hearing exam, one audiometric exam every 3 yrs aid per ear every 3 yrs, max of $500 / hearing aid. One hearing exam, one audiometric exam every 36 months. aid per ear every 36 months, max of $1000 / hearing aid. $400 Indiv/$800 Family $300 Indiv/$600 Family $500 Indiv/$1,000 Family None Pharmacy Max** $1000 Indiv None None None None Medical out-ofpocket Co-ins max: $800 Indiv Total med None Co-ins max: $500 Indiv/$1,000 Co-ins max: $800 Indiv/$1,600 Co-ins max: $750 Indiv/$1,500 Max** OOP max: $1650 Indiv Family Family Family *This document is only a summary. For complete plan details, contact the individual providers. Benefit levels are subject to change. **Members enrolled in the LivingWell program have the opportunity to reduce their deductibles and out-of-pocket maximums.

5 Medicare Plus Blue Catamaran Rx (855) R0379C (Rev. 12/2014) Medicare Summary Comparison Sheet* Effective January 1, 2015 BCN Advantage (866) Office Calls 10% co-ins plus deductible $25 copay Primary $35 copay Specialist after deductible Routine Physical Exams Routine Pap Smears Routine Mammograms Allergy Testing and Treatment Medicare Wellness Exam covered in full once annually HAP Senior Plus (800) $30 copay Primary/$50 copay Specialist. Preventative services covered PriorityMedicare (888) $15 copay Primary $30 copay Specialist HealthPlus Medicare Plus $10 copay Primary $30 copay Specialist Covered in Full $30 copay Primary Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full 10% co-ins plus deductible Covered in full 10% co-ins after deductible Covered in full Office visit copay may apply Covered in full Chiropractic Visits 10% co-ins plus deductible $20 copay after deductible when $20 copay $20 copay $20 Copay referred Hospital Inpatient 10% co-ins plus deductible Covered in full after deductible 10% co-ins after deductible 10% co-ins 20% co-ins Hospital Outpatient (inc. diagnostic services) Med/Surg (surg, anesthesia, tech. surg assistance) Emergency Medical Urgent Medical Outside of Outside the Network in 10% co-ins plus deductible Covered in full after deductible; office visit copay may $150 copay after deductible for hi-tech imaging services 10% co-ins after deductible 10% co-ins 20% co-ins 10% co-ins plus deductible Covered in full after deductible 10% co-ins after deductible 10% co-ins 20% co-ins $50 max copay waived if admitted within 3 days $65 copay; waived if admitted $65 copay waived if admitted, applies to deductible $65 copay waived if admitted. Worldwide coverage $65 Copay, waived if admitted. Worldwide Coverage 10% co-ins plus deductible $35 copay $45 copay, applies to deductible $45 copay, Worldwide coverage $45 Copay, Worldwide coverage Same in US; outside US, member pays for services up front & BCBSM will reimburse member. Same as in network Routine, urgent & follow-up care through BlueCard Emergency & Urgent care covered. Other care not covered unless member has prior auth on file Emergency or Urgent Med. only (Copays will apply) Emergency or Urgent Med. only (Copays will apply) Emergency & Urgent same as in-network. Most other covered services, travel deductible and coinsurance Emergency & Urgent same as in-network. Most other covered services, travel deductible and coinsurance Emergency & Urgent same as services, deductible and coinsurance Emergency & Urgent same as services, ded & coinsurance

6 Medicare Plus Blue Catamaran Rx (855) BCN Advantage (866) Home Health Covered in full Covered in full after deductible; copay may apply for physician s visit Skilled Nursing Facility 10% co-ins plus deductible, up to 100 days 100% after deductible for 100 days renewable after 60 days HAP Senior Plus (800) PriorityMedicare (888) HealthPlus MedicarePlus 10% co-ins after deductible Covered in full Covered in full 10% co-ins after deductible, 100 days/benefit period 10% co-ins 100 days (can be renewed after 60 days) $0 Copay Days 1-20;$25 copay per day, days Hospice Covered by Original Medicare Covered by Original Medicare Covered by Original Medicare Covered by Original Medicare Covered by Original Medicare Outpatient Mental 10% co-ins plus deductible Covered in full $30 copay $15 copay $10 Copay Health Services Prescription Drugs 20% Copay Formulary $10 min/$40 max retail (30 day); $25 min/$100 max mail- (90 day) 40% Copay Non-formulary Additional 10% on maint. drug on and after 4th refill $15 Copay Generic $50 Copay Preferred Brand $70 Copay Non-Preferred Brand and Specialty drug Up to 90 day supply for 2 Copays Mail Order and Select Retail Durable Medical Equipment Supplier Hearing Benefits In network 10% co-ins plus deductible Out of network 30% co-ins plus deductible Hearing Exam: 10% co-ins plus deductible. One exam every 36 months Hearing Aids: 10% co-ins plus deductible/ Two hearing aids (if purchased same day) $15 Copay Generic $50 Copay Brand $80 Copay Non-Preferred Brand 20% Specialty 50% coinsurance sexual dysfunction drugs (34 day supply) 35 day to 90 day supply for 2 copays Mail Order $10 Copay Generic; $40 Copay Preferred Brand at retail pharmacy (30 day supply); $70 Copay Non-pref brand: 20% coinsurance Specialty (max $100 per Rx) Up to 90 day supply for 2 copays- Mail Order $5 Copay Generic $40 Copay Preferred Brand $70 Copay Non-Preferred Brand 25% coinsurance Specialty 50% Copay Fertility 90 day Supply for 2 copays at Retail and Mail Order Covered in full 20% co-ins after deductible 20% co-ins 20% co-ins One exam every 36 months Hearing Aids: Covered in full. One hearing aid every 36 months. Hearing Exam $50 copay/visit Hearing Aids: 10% co-ins after deductible covered for auth. Conventional hearing aids One hearing exam, one audiometric exam every 3 yrs aid per ear every 3 yrs, max of $1000 / hearing aid. One audiometric exam every 36 months. aid per ear every 36 months, max of $1000 / hearing aid. Deductible** $850 Indiv (Deductible reductions $350 Indiv $500 Indiv $100 Indiv None available to Living Well Members) Pharmacy Max** $1000 Indiv None None None $4,700 Indiv Medical out-ofpocket Max** Co-ins max: $800 Indiv Total med OOP max: $1650 Indiv Total med OOP max:$1000 Indiv Co-ins max: $1,200 Indiv Total med OOP max: $1700 Indiv Total med OOP max: $1,700 Indiv *This document is only a summary. For complete plan details, contact the individual providers. Benefit levels are subject to change. **Members enrolled in the LivingWell program have the opportunity to reduce their deductibles and out-of-pocket maximums. Co-ins max: $1,000 Indiv