Group Medicare Medical and Pharmacy Plans

Transcription

1 Group Medicare Medical and Pharmacy Plans

2 Medigap Benefits Plan A Plan F Plan N Part A Coinsurance and Hospital Costs Medicare Part B Coinsurance or Copayment Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for an emergency room visit that does not result in an inpatient admission Blood (First 3 Pints) Part A Hospice Care Coinsurance or Copayment Skilled Nursing Facility Care Coinsurance Medicare Part A Deductible Medicare Part B Deductible Medicare Part B Excess Charges (15%) Foreign Travel Emergency (To Limits) 2

3 Rx Benefit Initial Coverage Period AARP Medicare RX Saver Plus AARP Medicare RX Preferred Comprehensive Premier Deductible $360 $0 $0 $0 Generic $1-$7 $2-$20 $10 $7 Brand Preferred/ Non-preferred $23-30/ 30%-40% $36-$47/ 40%-50% $45/$75 $30/$60 Specialty 25% 33% 33% $75 Gap Generic Preferred 58% 58% $10 $2 to $7 Brand Preferred/ Non-preferred 45% 45% 45% $30/$60 Specialty 45% 45% 45% $75 Catastrophic Generic $2.95 or 5% $2.95 or 5% $2.95 or 5% $2.95 or 5% Brand $7.40 or 5% $7.40 or 5% $7.40 or 5% $7.40 or 5% Monthly Premium $27.50 $63.80 $ $

4 Benefit Rewards Plan Group Plus A Group HMO POS Medical HMO HMO INN OON Annual Deductible $0 $0 $0 $0 Annual OOP $6,650 $2,000 $3,000 $6,000 Hospital Admit $275/Day to 7 Days $250 $150/Day to 5 Days Office Visits $10/$40 $10/$20 $15/$25 20% Emergency Care $75 $50 $50 $50 Outpatient Surgery $350 $125 $150 20% Rx Generic $0 to $10 $0 to $10 $0 to $10 N/A Brand $45/$95 $25/$45 $45/$90 N/A Specialty 33% $90 33% N/A Coverage Gap Applies No Gap Applies Applies Monthly Premium $0.00 $ $ % 4

5 Benefit Zero Premium National PPO Comprehensive National PPO Premier National PPO Medical PPO OON National PPO OON Same National PPO OON Same Annual Deductible $0 $250 $0 Annual OOP $5,900 $10,000 $6,700 $2,500 combined Hospital Admit $275/Day to 40% $230/Day to 7 Days $175 6 Days Office Visits $20/$50 $35/$60 $20/$30 $5/$15 Emergency Care $75 $65 $65 $65 Outpatient Surgery 20% 40% 20% $15 Rx Generic $10 N/A $7 $5 N/A Brand $45/$100 N/A $40/$90 $30/$60 N/A Specialty $100 N/A $90 $80 N/A Coverage Gap Applies N/A No Gap No Gap N/A Monthly Premium $0.00 $ $ Plan design and/or rate varies by County of residence 5

6 Group Dental Insurance Plans PPO Plans additional plan choice for 2016 DHMO Plans reduced rates for 2016 Group Vision Insurance Plan additional plan choice for 2016 Identity Theft Protection Plan IT Tech Support Program VPI Pet Insurance New for 2016 Non-Medical Plan Options Will be Expanded to Meet the Unique Needs of Retirees in the Future 6

7 Benefits Low PPO Plan Medium PPO Plan High PPO Plan In Network Out of Network* In Network Out of Network* In Network Out of Network* Annual Max $800 per person per year $1,250 per person per year $1,500 per person per year Annual Deductible Diagnostic & Preventive $50/ person to max $150 for Basic or Major Services $100/ person to max $300 for Basic or Major Services $25 per person to max $75 for Basic or Major Services $50 per person to max $150 for Basic or Major Services $50 per person to max $150 for Basic or Major Services 100% 100% 100% 80% 100% 100% Basic 70% 70% 80% 60% 80% 80% Major 50% 50% 50% 40% 50% 50% Plan Inclusions Out of Network Allowance* Monthly Rates 2 Preventive Cleanings and 2 Perio. Basic Cleanings/Year 2 Preventive Services Cleanings per Year *Coverage based on negotiated contracted fees for the Preferred Provider Network. 2 Preventive Cleanings and 2 Perio. Basic Cleanings/Year 2 Preventive Cleanings and 2 Perio. Basic Cleanings/Year *Coverage based on negotiated contracted fees for the Preferred Provider Network. 2 Preventive Cleanings and 2 Perio. Basic Cleanings/Year 2 Preventive Cleanings and 2 Perio. Basic Cleanings/Year *Coverage based on usual, customary, and reasonable fees. Retiree only $28.25 $33.28 $38.69 Retiree + 1 $56.24 $57.15 $77.04 Retiree + Family $73.29 $81.73 $

8 Services Low DHMO Plan High DHMO Plan Network Network Only Network Only Annual Maximum NA NA Deductible $0 $0 Office Visit Copay $0 $0 Panoramic X-ray & Bitewings $0 $0 Prophylaxis $0 $0 Amalgam One Surface Permanent $5 $0 Resin Based Composite One surface, Anterior $30 $0 Endodontic Therapy, Molar $250 $210 Periodontal Scaling & Root Planning- 4 or $55 $50 More Teeth Complete Denture Maxillary $375* $325* Crown Porcelain Fused to Nobel Metal $270* $245* Extraction, Erupted Tooth or Exposed Root $0 $5 Monthly Rates new lower rates for 2016 Retiree Only $9.75 (previously $9.95) $15.83 (previously $16.15) Retiree + 1 $19.70 (previously $19.70) $31.34 (previously $31.98) Retiree + Family $35.02 (previously $34.32) $55.71 (previously $56.85) 8

9 Plan Options Option 1 Designer In Network Benefits Option II Designer In Network Benefits Frequency (Exam /Lenses/ Frames) 12/12/24 12/12/12 Exam/Spectacle Lenses $10/$15 $5/$15 Eyeglass Benefit Frame Non-Collection Frame Allowance (Retail): Up to $130 OR Up to $180 at Vision Works Up to $130 OR Up to $180 at Vision Works Davis Vision Frame Collection (in lieu of Allowance): Fashion Level and Designer Level Included Included Premier Level $25 $25 Eyeglass Benefit Spectacle Lenses Member Charges Member Charges Clear Plastic Lenses & Scratch- Resistant Coating Included Included Polycarbonate Lenses Adults $30 $30 Progressive Lenses (Standard / Premium / Ultra) $50/$90/$140 $50/$90/$140 Contact Lens Benefit (in lieu of Eyeglasses) Up to $130 Up to $130 Monthly Rates: Retiree $6.17 $7.01 Retiree + 1 $11.11 $12.62 Retiree + Family $17.28 $

10 Plan Features Premium Ultimate Restoration services Yes Yes Lost wallet assistance Yes Yes Identity safety resource center Yes Yes Internet surveillance monitoring and alerts Yes Yes Social security monitoring and alerts Yes Yes Change of address monitoring and alerts Not Available Yes Court/criminal monitoring and alerts Not Available Yes Sex offender monitoring and alerts Not Available Yes Anti-Virus, anti-spyware protection Not Available Yes Anti-phishing, anti spam protection Not Available Yes Junk mail-list removal Not Available Yes Monthly Rates Retiree $7.00 $10.50 Retiree + Family $15.00 $

11 Remote Support via Internet, Live Chat, Telephone 24/ 7/ 365 Assistance With Various Devices Including: Computers (PC and MAC) Smartphones Cameras Printers and Scanners Modems Gaming Consoles Computer Protection Software Self Help Database for Assistance With Technology Issues Secure Data Back Up Data Protection Onsite Support Available at $80 per Hour Unlimited Support Unlimited Support with Data Backup $10.00 per Household $14.00 per Household 11

12 Veterinary Pet Insurance is the leading pet insurance provider of pet health insurance. Nation s largest & oldest provider VPI is wholly owned by Nationwide Mutual Insurance Co. Plans are completely portable Discounts (5% core policies / 10% for 2-3 pets) Available plans Major Medical Plan Comprehensive covers accidents, illnesses & hereditary conditions Pet Wellness Basics Economical Covers Accidents & Illnesses Major Medical Plan with Pet Wellness Easy Enrollment FSRBC specific web page for enrollment at or Retirees can call 877-PETS-VPI and mention FSRBC to receive their 5% discount. 12