Enrollment Guide for Medicare Members

Transcription

1 c/o AmWINS Group Benefits 50 Whitecap Drive North Kingstown, RI Concordia Health Plan Enrollment Guide for Medicare Members Your 2018 Benefits S

2 Welcome The plan options outlined in this guide are meant to supplement Medicare. If you intend to begin this coverage effective please contact Social Security immediately to initiate enrollment into Medicare Part A & B. The Medicare set-up process can take 60 days and needs to be complete in order for this supplemental coverage to take effect. Prescription drug coverage is included in the CHP Group Plan Options, so there is no need to enroll in Medicare Part D. You can reach Social Security by calling or visit them at ssa.gov. Page 2

3 Welcome! Concordia Plan Services is pleased to assist you with your retiree healthcare coverage. We partner with AmWINS who administers three Concordia Health Plan (CHP) Group Options. These options have been designed by the CHP. AmWINS can also introduce you to individual retiree health plans available in your area. We want to make sure you are enrolled in a retiree health plan that meets YOUR needs. Call AmWINS at with questions or visit: ConcordiaPlans.org/Medicare We look forward to serving you and are pleased to offer you these healthcare options. We are confident this partnership between Concordia Plan Services and AmWINS will provide you with the same high-quality service you have come to expect. If you have any questions, please call the CHP Customer Care Center with AmWINS at , Monday through Friday, 8:00 AM to 8:00 PM (EST) Concordia Health Plan Enrollment Guide Call AmWINS at: ConcordiaPlans.org/Medicare Page 3

4 Table of Contents Understanding your Options CHP Group Medical Plan Options CHP Group Prescription Plan Options CHP Group Dental Program CHP Group Vision Program CHP Group Plan Options Monthly Cost Chart Shopping for Individual Plans Enrollment Instructions CHP Enrollment Form Waiver of Coverage CHP Group Plan Provisions Answers to your Questions for CHP Group Plan Options Answers to your Questions for Individual Plans This guide is for CHP Medicare supplemental coverage only. If you or your spouse are currently under the age of 65, or you are over 65 but are not enrolled in both Medicare Part A and Part B, you are not eligible to participate in this program. You will receive a separate communication from Concordia Plan Services with applicable coverage information Concordia Health Plan Enrollment Guide Call AmWINS at: ConcordiaPlans.org/Medicare Page 4

5 Understanding Your Options Concordia Plan Services partners with AmWINS who administers three CHP designed retiree health plans as well as CHP group vision and group dental plans. AmWINS also has access to individual retiree health plans available in the different geographic areas. Concordia Plan Services wants to pair you with the health coverage that best meets YOUR needs. Please note that the member or spouse who is enrolling in any post 65 retiree health plan must be enrolled in Medicare Part A and B. What s the difference in these plan types? The CHP Group Plan Options were developed by Concordia Plan Services. They provide supplemental health coverage to Medicare and include a Part D Prescription Drug benefit, SilverSneakers benefits and access to the HearUSA discount program. Dental and vision programs are optional plans that can also be purchased. This Enrollment Kit includes benefit information about the three CHP Group Plan Options called Premium, Plus or Basic, as well as everything you need to activate your coverage: Enrollment Instructions and Form Benefit Summary Postage-Paid Return Envelope See the sidebar or page 15 for enrollment information and instructions. How to Enroll: CHP Group Options Review the enclosed plan options carefully. Contact an AmWINS Benefit Specialist at if you would like to discuss the plan options available. Complete both sides of the CHP Enrollment Form and return it in the enclosed postage-paid envelope prior to your effective date along with a check for the first month s premium. Individual Medicare Plans Call an AmWINS Benefit Specialist at if you would like to discuss available plan options. A specialist will walk you through the enrollment process. The Individual Medicare Plans are available in the open market from various insurance companies and may be suited to your geographic area and budget. These plans are not CHP Plans, but this is still an option available to you. AmWINS is able to research many individual Medicare plans. The CHP group dental and vision programs are not available with the individual Medicare plans. SilverSneakers benefits varies by individual plan. Page 5

6 What are the benefits to choosing a CHP Group Plan Option? There are three Group Plan options from which to choose - Premium, Plus or Basic. You have flexibility and a choice! All three options include: o Prescription drug coverage so you don t have to worry about enrolling in Medicare Part D. o SilverSneakers free basic fitness membership to more than 13,000 gym/health club locations nationwide, as well as group exercise classes. If you don t have access to a SilverSneakers participating fitness club or class, you can still take advantage of wellness resources online at silversneakers.com/member or request an in-home exercise kit. This wellness benefit is offered at no additional cost to you. o HearUSA hearing care benefits for everyone enrolled in a CHP Medicare supplemental option. These benefits will provide complimentary hearing screening, discounts on hearing aids and supplies, free annual hearing aid cleaning, and discounts on hearing aid accessories. Optional group dental and vision coverage is available for purchase at competitive prices. These low-premium coverages are only available to members enrolled in one of the CHP Group Plan Options. Paying your CHP Group Plan Option premium is easy with pension deduction. You can have it deducted straight from your Concordia Retirement Plan (CRP) pension to save you the hassle of making monthly payments through ACH or by Check. If the CHP Group Plan Options are not the right fit for you, AmWINS Certified Consultants can assist you in selecting an individual medical plan. Page 6

7 2018 CHP Group Medical Plan Options Insured by The Hartford Life Insurance Company and Administered by AmWINS Annual deductible PREMIUM OPTION $183** Part B deductible PLUS OPTION $183** Part B deductible BASIC OPTION $183** Part B deductible Retiree coinsurance amount $0 20% 20% Annual out-of-pocket maximum $183 $500 $2,000 Annual plan maximum Unlimited Unlimited Unlimited Medicare (Part A) - Hospital Services - per benefit period* In general, Medicare Part A covers hospital care, skilled nursing care (even if received in a nursing home), and some health services. First $183 of Medicareapproved amounts** Remainder of Medicareapproved amounts PREMIUM OPTION PREMIUM OPTION $183** Part B deductible $0 PLUS OPTION PLUS OPTION $183** Part B deductible 20% up to $500. Then $0 BASIC OPTION $183** Part B deductible 20% up to $2,000. Then $0 Part B excess charges $0 $0 $0 BASIC OPTION First 60 days $0 $0 $0 61 st 90 th day $0 $0 $0 91 st 150 th day (Reserve days) $0 $0 $0 Additional 365 days $0 $0 $0 Skilled nursing facility care * First 20 days $0 $0 $0 21st through 100th day $0 $0 $0 Blood First three pints $0 $0 $0 Additional amounts $0 $0 $0 Medicare (Part B) - Medical Services - per calendar year In general, Medicare Part B covers services such as lab tests, surgeries, doctor visits, and medical supplies considered medically necessary to diagnose or treat a disease or condition. The above plan options chart represents the amount you pay when the CHP Group Plan Option and Medicare are integrated to provide your coverage. *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. **Once you have been billed $183 of Medicare approved amounts for covered services, your Medicare Part B deductible will be satisfied for the calendar year. The Medicare amounts listed above are for the 2018 plan year, however the amounts may change on January 1 of each year. Page 7

8 2018 CHP Group Medical Plan Options Insured by The Hartford Life Insurance Company and Administered by AmWINS Blood PREMIUM OPTION PLUS OPTION BASIC OPTION First three pints $0 $0 $0 Additional amounts $0 $0 $0 Clinical laboratory services Blood tests for diagnostic services $0 $0 $0 Medicare (Part A & B Home health care Medically necessary skilled care services and medical supplies Durable medical equipment Remainder of Medicare-approved amounts PREMIUM OPTION PLUS OPTION BASIC OPTION $0 $0 $0 $0 20% up to $500. Then $0 20% up to $2,000. Then $0 Preventive Services PREMIUM OPTION PLUS OPTION Annual wellness exam $0 $0 $0 Other preventive services (per Medicare schedule) including cardiovascular screenings, cancer screenings, flu shots, etc. Other benefits not covered by Medicare BASIC OPTION $0 $0 $0 Foreign travel emergency*** Foreign emergency outside of U.S. PREMIUM OPTION $250 deductible. Then 20% up to $50,000 PLUS OPTION $250 deductible. Then 20% up to $50,000 BASIC OPTION $250 deductible. Then 20% up to $50,000 Included Medicare Part D prescription plan (summaries on next pages) Other benefits not covered by Medicare PREMIUM OPTION PLUS OPTION BASIC OPTION Medicare Part D prescription coverage Premium Rx Option Plus and Basic Rx Option The above plan options chart represents the amount you pay when the CHP Group Plan Option and Medicare are integrated to provide your coverage. ***Foreign travel coverage deductible is a separate deductible and does not apply to the Part A or B deductible amounts. The summary of benefits described herein is for illustrative purposes only. In case of differences or errors, the Group Policy governs. Page 8

9 2018 CHP Group Prescription Plan Options Administered by Express Scripts Premium Prescription Plan Option Included with Premium Medical Plan Option Only Annual Deductible: $0 Copay tier Retail (31 Days) Retail (90 Days) Mail Order (90 Days) Generic tier* $15 $45 $25 Preferred brand tier* $30 $90 $60 Non-preferred brand tier* $60 $180 $120 Coverage gap**: This option has NO coverage gap (also known as Donut Hole ). *May include specialty drugs. **After your total yearly drug costs reach $3,750, you will pay 50% of the copay schedule for the Preferred and Non-preferred brand tier noted above. The copays shown do not include the manufacturer discounts on brand name drugs by the Medicare Coverage Gap Discount Program. The Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D enrollees who have reached the coverage gap and are not already receiving Extra Help through a low income subsidy provided from Medicare. The amount discounted by the manufacturer counts toward your out-of-pocket costs as if you had paid this amount and moves you through the coverage gap. Catastrophic coverage begins once your total yearly out-of-pocket drug costs reach $5,000. In this stage, copays will be $3.35 for generic prescriptions and $8.35 for brand name prescriptions. Specialty drug copays for the Premium Plan Option may be less if purchased from the specialty drug mail order pharmacy specified by Express Scripts. Prescription drug coverage is administered by Express Scripts, a Prescription Drug Plan (PDP) with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact AmWINS. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary and/or pharmacy network may change at any time. Page 9

10 2018 CHP Group Prescription Plan Options Administered by Express Scripts Plus & Basic Prescription Plan Option Included with Plus & Basic Medical Plan Options Annual Deductible: $0 Copay tier Retail (31 Days) Retail (90 Days) Mail Order (90 Days) Generic tier $15 $45 $45 Preferred brand tier $40 $120 $120 Non-preferred brand tier $80 $240 $240 Specialty tier $100 $300 $300 Coverage gap*: This option has NO coverage gap (also known as Donut Hole ). *After your total yearly drug costs reach $3,750, you will pay the same copay schedule noted above. The copays shown already include the manufacturer discounts on brand name drugs by the Medicare Coverage Gap Discount Program. The Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D enrollees who have reached the coverage gap and are not already receiving Extra Help through a low income subsidy provided from Medicare. The amount discounted by the manufacturer counts toward your out-of-pocket costs as if you had paid this amount and moves you through the coverage gap. Catastrophic coverage begins once your total yearly out-of-pocket drug costs reach $5,000. In this stage, copays will be $3.35 for generic prescriptions and $8.35 for brand name prescriptions or 5% of the cost of the drug, whichever is greater. Prescription drug coverage is administered by Express Scripts, a Prescription Drug Plan (PDP) with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact AmWINS. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. Page 10

11 2018 CHP Group Dental Program Insured by Ameritas Life Insurance Corp. Class A Preventative services Annual deductible per insured: $0 Initial & periodic exam 100% Two cleanings/year 100% Annual bitewing series 100% All other x-rays 100% Waiting period None Class B Basic services Annual deductible per insured: $50/year Fillings 80% Simple extractions* 80% Oral surgery 80% Waiting period None Class C Major services ** NOT COVERED Maximum benefit per insured: $1,000 You must be enrolled in a CHP Group Plan Option to be eligible for the dental program. *When a tooth is visible above the gum line and your dentist can easily remove it with forceps, the procedure is called a simple extraction. **Major services are porcelain crowns, bridges, inlays, and dentures. Other crowns, such as prefabricated steel crowns are Class B Basic services. Ameritas Customer Service: Page 11

12 2018 CHP Group Vision Program Insured by Vision Service Plan (VSP) Your Coverage with a VSP Doctor $15 Copay Every 12 months Well Vision exam focuses on your eye health and overall wellness Every 12 months Prescription glasses Lenses Every 12 months Single vision, lined bifocal, and lined trifocal lenses Frame Every 24 months $150 allowance for wide selection of frames $170 allowance for featured frame brands 20% off the amount over your allowance OR Contacts (instead of glasses) Every 12 months Up to $60 copay for your contact lens exam (fitting and evaluation) $150 allowance for contacts Extra Discounts and Savings Glasses and Sunglasses Average 20-25% savings on all non-covered lens options 20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last Well Vision exam Contacts 15% off cost of contact lens exam (fitting and evaluation) Laser vision correction Average 15% off the regular price of 5% off the promotional price. Discounts only available from contracted facilities. Your Coverage with Other Providers Visit vsp.com for details if you plan to see a provider other than a VSP doctor. Exam up to $45 Single vision lenses up to $30 Lined bifocal lenses up to $50 Lined trifocal lenses up to $65 Frame up to $70 Contacts up to $105 DOCTOR NETWORK: VSP CHOICE VSP Customer Service: Please Note: You must be enrolled in a CHP Group Plan Option to be eligible for the vision program. Your coverage with a retail chain affiliate provider may be different than the coverage with a VSP doctor. Once your benefit is effective, visit vsp.com for details. VSP guarantees service from VSP providers only. In the event of a conflict between this information and Concordia Plan Services contract with VSP, the terms of the contract will prevail. Page 12

13 2018 CHP Group Plan Options Monthly Cost Chart 2018 PLAN OPTIONS RETIREE ONLY RETIREE AND SPOUSE PREMIUM $394 $788 PLUS $336 $672 BASIC $280 $560 OPTIONAL DENTAL PROGRAM $43 $84 OPTIONAL VISION PROGRAM $9 $13 The above rates are effective from 1/1/2018 to 12/31/2018 and are subject to change each year on January 1. Payment Information Monthly contributions for these plans can be deducted from your CRP monthly benefit or through an automatic deduction from your bank account via ACH. If you choose to have your contributions deducted from your CRP benefit, mark the appropriate box on the enrollment form. If you choose to have the premium deducted from your bank account, please complete the ACH Authorization section which is located on the back of the enrollment form. You will have a choice of dates for payment deduction, which can coincide with your pension direct deposit date or Social Security payment date. Page 13

14 Shopping for Individual Plans This guide contains everything you need to enroll in a CHP Group Plan. However, if these plans are not adequate for your needs, we can help you find and enroll in an Individual Plan. Prior to investigating Individual Plans, we recommend that you review the plan types below to familiarize yourself with the differences between Medicare Supplement and Medicare Advantage Plans. You will be required to purchase a Medicare Part D Prescription Plan as well. MEDICARE SUPPLEMENT PLANS These plans provide secondary coverage to traditional Medicare to fill in the "gaps." There are no restrictive provider networks and you can see any provider that accepts traditional Medicare. The CHP Group Plan Options offered in this guide are Supplemental Plans. MEDICARE ADVANTAGE PLANS These plans replace traditional Medicare with a Medicare Advantage insurance company providing "first dollar" coverage. You will no longer use your Medicare card for these plans. Most Medicare Advantage plans require the use of restrictive provider networks, but can offer increased benefits for a lower monthly premium. Some Medicare Advantage plans offer additional benefits such as coverage for hearing aids, dental services, and gym memberships. MEDICARE PART D PRESCRIPTION DRUG PLANS Individual Part D plans typically have fewer benefits than the CHP Group Options contained in this guide. These plans usually have a coverage gap or "Donut-Hole". However, they can also have very low premiums. All Part D plans have a Formulary List or "covered" list of drugs. You will want to be sure that the plan you are considering has coverage for your current medications or you may be required to use an alternative medicine. ADDITIONAL NOTES ON INDIVIDUAL PLANS While enrolled in an Individual Plan, you will have a direct relationship with the insurance company. You will pay your Individual Plan premiums directly to the insurance company. WHAT TO CONSIDER BEFORE YOU CALL When calling us to research an Individual Plan, we ask that you think about the following questions. These will assist in your decision-making process: What prescriptions do I take? Do I see multiple doctors? Do I see specialists? How important is "choice of providers" for me? Do I reside outside the state for a portion of the year? Do I travel frequently? Page 14

15 Enrollment Instructions How to Enroll in a CHP Group Plan Option 1 Review the enclosed plan options carefully and make your selection(s). 2 Call an AmWINS Benefit Specialist at if you would like to discuss available plan options. 3 Complete the Enrollment Form. 4 Return your signed Enrollment Form in the enclosed postage-paid envelope prior to your effective date along with a check for the first monthly payment regardless of payment method selected. How to Enroll in an Individual Plan 1 Call an AmWINS Benefit Specialist at to discuss individual plan options. 2 The AmWINS Benefit Specialist will assist you in enrolling in the selected individual plan option. Page 15

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17 CHP Enrollment Form Effective Date: Member Information (Please Print Clearly in ink or type) First Name: Middle Initial: Last Name: Address: City, State, Zip: Social Security Number: Sex: M F Phone Number: Medicare ID Number (on Medicare Card): Birth Date: Address: Spouse Information (Please print clearly in ink or type only if enrolling spouse in coverage) First Name: Middle Initial: Last Name: Sex: M F Birth Date: Medicare ID Number (on Medicare Card): Social Security Number: Address: Plan Selection - Member and Spouse must elect the same plan. CHECK DESIRED COVERAGE: PREMIUM OPTION PLUS OPTION BASIC OPTION MEMBER SPOUSE Dental/Vision Plan Selection (You must enroll in a CHP Group Plan Option to be eligible for dental or vision coverage.) CHECK DESIRED COVERAGE DENTAL PROGRAM VISION PROGRAM I/WE DECLINE THIS COVERAGE MEMBER SPOUSE Please Complete the Following Information: Do you currently have any Medicare Supplement policies or Medicare Advantage Policies in force (other than the current CHP coverage)? Member (if enrolling): Yes No Spouse (if enrolling): Yes No If YES, with which company? Page 17

18 CHP Enrollment Form Please be sure to sign, date and return this completed Enrollment Form along with a check for the first monthly payment* to: AmWINS/Concordia Health Plan, 50 Whitecap Drive, North Kingstown, RI using the enclosed postage-paid envelope. Member Signature: Spouse Signature: Date: Date: PAYMENT METHOD Monthly Pension Deduction (only available if your pension covers the full cost of your elections) Monthly ACH (please complete below) ACH AUTHORIZATION Name (Last, First, Middle Initial): Street Address: City: State: Zip: Type of Account: Savings Checking Select Monthly Withdrawal Date: 1st 8th 15th Please ensure the following: To deduct monthly from your checking account; A VOIDED check must accompany this signed authorization (starter checks are not accepted). To deduct monthly from your savings account; A signed letter from your banking institution must accompany this signed authorization. Monthly payments are withdrawn on the first business day on or after the date you selected above. You will receive a confirmation from AmWINS Group Benefits that we have set up your account information to withdraw from your designated bank account. Note: Your monthly deduction will show as AmWINS on your bank statement. I authorize AmWINS to withdraw payment from my checking or savings account according to my agreed payment schedule. This authorization is to remain in force until AmWINS has received written notification from me of its termination in such time and manner as to afford AmWINS a reasonable opportunity to act on the request. If my account is erroneously charged, my financial institution will immediately credit the same amount to the account up to 15 days following issuance of the statement or 45 days after the erroneous posting, whichever occurs first. Signature: Date: * Regardless of payment method elected, please return this completed form with a check for your first monthly payment. Page 18

19 Waiver of Coverage If you DO NOT wish to enroll in a CHP Medicare Supplemental option, please complete, sign and return this Waiver of Coverage form. Retiree Spouse (or Surviving Spouse) Name: Name: Address: Address: City: City: State: Zip Code: State: Zip Code: PLEASE DO NOT ENROLL the above-named member(s) in the CHP Medicare Plan. I understand by choosing this option, I am declining medical and prescription drug coverage, and will not be eligible to enroll in the Premium Option at a later date. However, I may be able to enroll in an option with a higher deductible (i.e., Plus or Basic Options) at a later date. I also understand by declining this coverage I will not be allowed to enroll my pre-65 dependents in a Concordia Health Plan option. Retiree or Surviving Spouse: Date: Reason for Declining Coverage (please check all that apply): I am joining my spouse's coverage. I am returning to work in a position that provides health coverage. The cost. I am enrolling in a Medicare Advantage plan. I am enrolling in a Retiree Health Plan with another carrier. (Please list the carrier): Other: Please return this form using the enclosed envelope or to: AmWINS/Concordia Health Plan, 50 Whitecap Drive, North Kingstown, RI Page 19

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21 CHP Group Plan Option Provisions Please review the below provisions for the CHP Group Plan Options: The Medical and Prescription Drug programs are only offered as a package. If you are enrolling your Medicare eligible spouse in a CHP Group Plan, you must both select the same plan option. Note: If you are both LCMS retirees, and you enroll together in a joint plan, you can t select separate elections later. Conversely, if you enroll separately, you cannot be in a joint plan later. You will NOT be able to elect the Premium plan option in the future, if you do not select it now. You can reduce your coverage on January 1 of any year. If you decline or terminate coverage and choose to return to the plan in the future, you will only be offered the higher-deductible plan option(s) available at that time. You must enroll in a CHP Group plan option to also elect the optional dental and/or vision program. If you enroll in the dental and/or vision program and drop it, you will NOT be allowed to enroll in the future. If a member cancels coverage, the spouse s coverage will be cancelled too. If a member passes away, the surviving spouse can remain on the plan. If a member or spouse is not yet enrolled in Medicare, he/she will be able to join the same plan option as the Medicare-eligible participant when he/she becomes Medicare eligible in the future. If you are currently receiving a contribution from your former employer, you can work with them to continue any arrangement you have in place today. How to get more details about your prescription drug plan options: More detailed information about Medicare plans that offer prescription drug coverage is available in the Medicare & You handbook, which you receive in the mail every year from Medicare. For more information about Medicare prescription drug coverage: Visit medicare.gov Call your State Health Insurance Assistance Program for personalized help (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) Call 800.MEDICARE ( ), 24 hours per day, 7 days per week. TTY users should call Also, please note that you may have to pay a late enrollment penalty if within 63 continuous days after your current coverage with CHP ends: You do not enroll in another Medicare prescription drug plan (or a Medicare Advantage Plan with prescription drug coverage), or You do not have other coverage that is at least as good as Medicare prescription drug coverage (also referred to as creditable coverage ). Page 21

22 Answers to Your Questions for CHP Group Plan Options Q: How do the medical plans supplement Medicare? A: Medicare has coverage gaps which are the costs that you must pay, like coinsurance, co-payments, and deductibles. These plans help cover those gaps. You may go to any doctor, specialist, or hospital that accepts Medicare. Medicare pays its share and then your plan pays based on the plan option you choose. Q: Will my doctors accept these plans? A: Yes, simply present your new ID card along with your Medicare ID card to any doctor, specialist, hospital, or healthcare provider that accepts Medicare and they will accept your supplemental Medicare health plan option. Q: What services are covered by these medical plan options? A: Any service covered by Medicare is also covered by these plans. Services not covered by Medicare are not covered by these options. Please contact us or visit medicare.gov for the Medicare exclusion list. Q: How do I get my prescriptions filled? A: Simply present your Express Scripts ID card and prescription to a participating pharmacy in the Plan network. You will also receive information about mail order prescriptions when you enroll. You can find more information about your prescription coverage by calling AmWINS Group Benefits at Q: Can I continue to use my pharmacy with this plan? A: Express Scripts has a national retail pharmacy network with more than 64,000 participating pharmacies. All major pharmacy chains participate; please call AmWINS to verify that your current pharmacy is part of the network. Q: Where can I get information about using Mail Order Services? A: Once you enroll, you will receive a fulfillment kit in the mail which will include mail order information from Express Scripts. Please expect your package and materials to arrive shortly before your plan effective date. Q: When will I receive my ID Cards? A: ID cards will be sent prior to your effective date. They will arrive in separate mailings. Q: Do my prescription drug copayments count toward my medical plan deductible or out-ofpocket costs? A: No. Any copayments you make for prescription drugs do not count toward the deductible or out-ofpocket maximum amounts of your medical plan. Q: Who is the Hartford Insurance Company? A: The Hartford Insurance Company was founded in They are rated A Excellent, by A.M. Best (a financial services rating agency). They are insuring all CHP group supplemental options. Q: How can I find out if my drugs are covered? A: You will receive a copy of the formulary (list of covered drugs) in your fulfillment packet once you enroll. Some covered drugs may have additional requirements or limits on coverage. You can find out if your drug has any additional requirements or limits by reviewing the formulary. If your drug is not included on the formulary, you should contact AmWINS Customer Care toll-free at Q: How can I lower my drug expenses? A: Generic medications often cost less than brandname counterparts. Talk to your doctor to determine if a generic medication is available Concordia Health Plan Enrollment Guide Call AmWINS at: ConcordiaPlans.org/Medicare Page 22

23 Answers to Your Questions for Individual Plans Q: What are "Individual" Insurance Plans? A: Individual plans are not established by the CHP (like the custom group options in this kit), but instead they are plans offered directly for sale from insurance companies to individuals who are enrolled in Medicare during Medicare's annual open enrollment period. These are the plans you typically see advertised on TV from companies like Humana and AARP (United Healthcare). Q: How do I shop for an Individual Plan that meets my needs? A: You may contact the AmWINS Customer Care Center and an agent will search for plans in your area and send you pertinent information on plans which may make sense for you. Q: What information should I have ready when I call the AmWINS Customer Service Center to help me search for Individual Plans? A: We recommend you have a list of all of your doctors, hospitals, and other providers you currently use. Also, you should have the name of your pharmacy and a list of your medications handy so that we can help you search for a plan that meets your needs. We will also ask you about any travel you do or "out-of-area" needs you may have. Q: How will I know what is covered by an Individual Plan? A: You will receive an insurance policy directly from the selected insurance company once you are enrolled. This policy will govern your plan's benefits. Q: Will my doctors, pharmacies, and other providers be covered by the Individual Plan I select? A: This will depend on the Plan you choose. Many Individual Plans have provider networks which you must use to receive coverage. AmWINS will help advise you on these networks during the search process. Q: Once enrolled in an Individual Plan, who provides service and help? A: Due to privacy laws, AmWINS will be limited in the service we can provide once you enroll in an Individual Plan. You will have a direct relationship with the insurance company you enroll with in the future. The insurance company will provide your policy documents, ID cards, billing, and answer your claims questions. If you contact AmWINS with questions about your Individual Plan, we will be happy to redirect your call to customer service with your new insurance company. Q: How will I pay my monthly premium for an Individual Plan? A: You will pay your premium directly to the insurance company (usually on a monthly basis). Q: How are the annual renewals handled with an Individual Plan? A: You will receive an annual communication directly from your selected insurance company which will detail any policy or rate changes each year Concordia Health Plan Enrollment Guide Call AmWINS at: ConcordiaPlans.org/Medicare Page 23

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