Public Employee s Benefits Program

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1 Public Employee s Benefits Program Public Employees Benefits Program 901 S. Stewart Street, Suite 1001 Carson City, NV mservices@peb.state.nv.us Pre-Medicare Age In Presentation Plan Year 2019 July 1, 2018 June 30,

Today s Topics Preparing for Medicare Enrollment Who Qualifies for Medicare? PEBP s Medicare Requirements Enrollment Options Who is Via Benefits?

2 Today s Topics Preparing for Medicare Enrollment Who Qualifies for Medicare? PEBP s Medicare Requirements Enrollment Options Who is Via Benefits? PEBP Dental Plan Option CDHP HRA vs Via Benefits HRA How the HRA through Via Benefits Works Importance of Maintaining Enrollment through Via Benefits 2

3 Happy Birthday! Approximately 2 months before your 65 th birthday, PEBP will mail you: Happy Birthday letter PEBP and Medicare Guide Retiree Benefit Enrollment and Change Form - RBECF *If not received about 6 weeks prior to your birthday month please call PEBP Member Services to be sure it is on its way* 3

4 It s as easy as (4-5) Contact the Social Security Administration and enroll in Medicare A+B (as eligible) Send PEBP a copy of your Medicare A+B card (fax, , mail, walk-in) Mail PEBP the original Retiree Benefit Enrollment and Change Form-RBECF Call and schedule an appointment with a licensed benefit advisor and complete your enrollment with Via Benefits over the phone Wait for your funding packet to arrive from Via Benefits (this can take between 8-12 weeks from your effective date)

5 Step 1 Who Qualifies for Medicare? PEBP s Medicare Requirements 5

benefits or You are under age 65 and approved for Social Security Disability benefits Please call Social

6 Premium-Free Medicare Part A You or your spouse (or former spouse of 10 years) have at least 40 credits (10 years) of work in any job in which you paid Social Security taxes or You are eligible for Railroad Retirement benefits or You are under age 65 and approved for Social Security Disability benefits Please call Social Security to verify your Medicare Eligibility Note: Everyone age 65 or older can purchase Medicare Part B 6

7 CURRENTLY RETIRED Approaching 65th birthday Enroll in premium-free Part A* Must purchase Medicare Part B CURRENTLY RETIRED Under 65 and approved for Social Security Disability benefits Enroll in premium-free Part A* Must purchase Part B after SSA s 24 month waiting period ACTIVE EMPLOYEE Not required to enroll in Medicare until days prior to retirement PEBP s Medicare Requirements NEWLY RETIRING After age 65 (60-90 days prior to retirement) Enroll in premium-free Part A* Must purchase Medicare Part B TRICARE Copy of Military identification card (front and back) Copy of Medicare A & B card SPOUSE/DP Medicare requirements also apply to covered spouses and domestic partners *Eligibility requirements apply for premium-free Medicare Part A. Contact the Social Security Administration (SSA) to check your Medicare eligibility. 7

8 Steps 2 and 3 Sending In Your Paperwork 8

PEBP s Medicare Enrollment Retiree or newly retiring Medicare A + B No covered Dependents Must enroll at Via Benefits Copy of Medicare A+B card to PEBP Mail RBECF to elect or decline dental Newly

9 PEBP s Medicare Enrollment Retiree or newly retiring Medicare A + B No covered Dependents Must enroll at Via Benefits Copy of Medicare A+B card to PEBP Mail RBECF to elect or decline dental Newly retiring? Enroll in Medicare A+B days prior to retirement Retiree or newly retiring Medicare A + B and Tricare Not required to enroll at Via Benefits Copy of Medicare A+B card and Military ID (front and back) to PEBP Mail RBECF to elect or decline dental Retiree with Medicare A + B Covering non-medicare Dependent Retiree may stay on PEBP PPO, EPO or HMO with dependent(s) OR Retiree may enroll at Via Benefits Dependent(s) may stay on PEBP or terminate coverage Copy of Medicare A+B card to PEBP Mail RBECF to elect or decline dental Active- Not yet Retiring Not required to enroll in Medicare If Medicare is obtained, submit copy of card to PEBP CDHP HSA will become HRA (if applicable) Retiree or newly retiring NOT eligible for free Medicare Part A May remain on PPO, EPO or HMO Must purchase Medicare Part B Obtain Social Security Eligibility Letter- lack of credits Complete RBECF Submit all documents to PEBP Monthly premium reduced by $134 after receipt of Medicare Part B card RBECF = Retiree Benefit Enrollment & Change Form Via Benefits = Medicare Exchange

10 Step 4 Who is Via Benefits? Your Future Coverage Almost Done 10

11 Who is Via Benefits? First and Largest Individual Medicare Market Exchange Licensed advisors provide guidance and ongoing advocacy Personalized options with plans from a nationwide network

What to Do Next YOU VE ALREADY: Enrolled in Medicare A+B (Original Medicare) through Social Security, as eligible Medicare provides about 80% coverage and will be your primary coverage Provided proof

12 What to Do Next YOU VE ALREADY: Enrolled in Medicare A+B (Original Medicare) through Social Security, as eligible Medicare provides about 80% coverage and will be your primary coverage Provided proof of your Medicare enrollment by sending PEBP a copy of your Medicare A/B card Mail your original RBECF to elect or decline PEBP dental coverage and change your status to Medicare Eligible 1. Prepare for making your medical and pharmacy plan selections by reading all material PEBP will mail to you about 2 months prior to your 65 th birthday 2. Get Medicare card, doctor, hospital and prescription information ready, then: a. Call Via Benefits at to complete your profile and schedule an enrollment appointment with a certified licensed benefit advisor (LBA) or b. Setup an online personal profile through Via Benefits at My.ViaBenefits.com/PEBP and start to shop for plans 3. Complete enrollment by calling and speaking to a licensed benefit advisor 4. Wait for your HRA funding packet to arrive from Via Benefits (8-12 weeks) Via Benefits will now manage your new plan and funding account.

13 The Via Benefits Process 13

Step 2: Enrollment Via Benefits Application Data Processor will assist you with the telephonic enrollment process.

14 Via Benefits Process Step 1: Evaluate plan options A Licensed Benefit Advisor will assist you with selecting: medical, prescription drug, dental and/or vision coverage that fits your medical requirements and budget. Step 2: Enrollment Via Benefits Application Data Processor will assist you with the telephonic enrollment process. Step 3: Manage After Enrollment HRA funding for eligible retirees Advocacy assistance, claims support, network provider assistance, etc.

15 Your Future Coverage How Medicare Coverage Works Primary Coverage Medicare A and B 15

16 Medicare Options Option 1 Medicare Advantage Plan Option 2- Medigap/Supplement Plan 16

17 Option 1 Medicare Advantage with Prescription Drug Coverage (MAPD) HMO PPO 17 Medicare Advantage plans are generally network based plans.

18 Option 2 Medicare Supplement Insurance (Medigap) + Part D Prescription Drug Plan (PDP) MEDIGAP PLAN + PART D PDP Note: You may need to pay your first premium when you initially enroll. 18

19 Medicare Supplement Insurance (Medigap)- Lettered Policies Benefits A B C D F* G K L M N Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%*** Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A hospice care coinsurance or copayment Skilled nursing facility care coinsurance 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100% Part B deductible 100% 100% Part B excess charges No No 100% 100% Foreign travel exchange (up to plan limits) 80% 80% 80% 80% 80% 80% Out-of-pocket limit** 2018 Out of pocket limit $5,240 $2,620 Source: * Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,200 in 2018 before your Medigap plan pays anything. ** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. *** 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 emergency room visits that don't result in inpatient admission. Please discuss all of your options with a Licensed Benefit Advisor.

20 PEBP Dental Option Medical plan through Via Benefits = option to elect the PEBP Dental Plan. Effective for entire plan year (July 1-June 30). A Retiree Benefit Enrollment and Change Form (RBECF) is required to elect or decline dental coverage. No paper claim required for reimbursement. Will occur automatically. Dental premium will be deducted from your PERS pension in most cases. Plan Year 2018 Dental Premium State Retiree Non-State Retiree Retiree Only $40.63 $41.06 Retiree + Spouse/DP* $81.26 $82.13 *Spouse/DP must also have a medical plan through Via Benefits in order to elect PEBP dental.

21 Step 5 Funding and Health Reimbursement Arrangements (HRA) 21

22 Via Benefits HRA vs Consumer Driven Health Plan HRA PEBP offers two types of HRAs: Consumer Driven Health Plan (CDHP/PPO) Funded on an annual basis on July 1 st Funded according to participant tier: $700 retiree and $200 per covered dependent (maximum 3) Once transitioned to Via Benefits, remaining funds are no longer available Via Benefits HRA Funded on a monthly basis Funded according to the retirees years of service (5-20 YOS) and retirement date You will not get to keep the CDHP HRA when you enroll through Via Benefits. Any HRA money left on the HealthSCOPE Visa debit card will revert back to the State. Please note: PEBP HMO and EPO participants do not have a CDHP HRA account.

23 What is a Heath Reimbursement Arrangement (HRA)? 23

24 How is my HRA Funded? PY 2019 HRA Contribution Years of Service $ Contribution Effective July 1, 2018 PY 2019 HRA Contribution Years of Service $ Contribution PY 2019 HRA Contribution Years of Service $ Contribution PEBP will automatically establish your Exchange-HRA once you have enrolled in a qualified medical plan through Via Benefits. Once established, you will receive the Via Benefits-HRA funding kit with information on how to use the Exchange-HRA. The kit will include claim forms and a direct deposit form and will normally arrive within 8-12 weeks from your effective date. If you retired before January 1, 1994, HRA based on 15 years of service If you retired after January 1, 1994, HRA contribution is $12 per month, per year of service

25 Qualifying for your Via Benefits HRA Must be enrolled in Medicare Parts A and B in order to enroll in a plan through Via Benefits. Participants must enroll in a medical plan through Via Benefits before their enrollment period ends in order to have access to their HRA (normally within 60 days from the Medicare effective date). Participants must remain enrolled through Via Benefits each year to continue to have access to their HRA or risk permanently forfeiting the rights to their HRA, basic life insurance, PEBP dental benefits, and any voluntary products (if applicable). Your Via Benefits reimbursement will be based on your retirement date and earned years of service credit. It will take 8-12 weeks from your effective date to be established.

Understand your Explanation of Payment Statement You must submit all claims to Via Benefits within one

26 Managing your Reimbursement Funds Pay for your expenses Important Documents Submit for Reimbursement Website and your Online Account Automate your Premium Payment PEBP Dental is Automatically Reimbursed Understand your Explanation of Payment Statement You must submit all claims to Via Benefits within one year from date of service Initial Funding Packet may take between 8-12 weeks from your effective date to be received

27 Reimbursement Options Auto-Reimbursement Enroll in a participating plan Ask to select option Pay premiums as required Available for plan premiums only Recurring Premium Reimbursement Form is required to be filled out You pay your requested expense first Attach required documentation one time Available for premiums / Medicare Part B premium One-Time (Manual) Reimbursement Request Fill out paper form to request reimbursement for all eligible expense types Attach required documentation Submit via fax, mail, or online 27

28 Option 1 Auto-Reimbursement Enrollment in a participating plan is required Available for plan premiums only You pay your premium to carrier directly first Ask Via Benefits to turn on auto-reimbursement Call Via Benefit at to activate or ask for it to be turned on during your initial enrollment Available on most plans Works for premium reimbursement only No paper forms required, just set it and forget it! Can take 2 to 3 months to initiate and receive your first reimbursement May also be some delay January March each year and when you enroll in a new plan

29 How Option #1 Works Automatic Reimbursement Participant pays plan premium directly to insurance company Step 1 Step 2 Step 2 Insurance company forwards receipt of payment to Via Benefits Via Benefits reimburses participant via check or direct deposit up to allowed monthly amount Step 4 Step 3 Via Benefits verifies receipt of payment and eligibility 29

Option 2 Recurring Premium Reimbursement You pay your requested expense first Fill out required Via Benefits Recurring Claim Form Attach required documentation once Available for premiums and

30 Option 2 Recurring Premium Reimbursement You pay your requested expense first Fill out required Via Benefits Recurring Claim Form Attach required documentation once Available for premiums and Medicare Part B premium Monthly plan premiums (i.e. vision) or Monthly Medicare Part B premium Submit once for the entire year or if premium changes for any reason Must submit with appropriate supporting documentation and proof of payment Expires 12/31 each year All forms MUST include signature and date.

Option 2 Continued: Medicare Part B Part B Premium Deducted From Social Security Pension BENEFICIARY S NAME Your New Benefit Amount Marge Simpson Your Social Security benefits will increase by 1.

31 Option 2 Continued: Medicare Part B Part B Premium Deducted From Social Security Pension BENEFICIARY S NAME Your New Benefit Amount Marge Simpson Your Social Security benefits will increase by 1.5 percent in 2014 because of a rise in the cost of living. You can use this letter when you need proof of your benefit amount to receive food, rent, or energy assistance; bank loans; or for other business. Keep this letter with your other important financial documents. How Much Will I Get And When? Your monthly amount (before deductions) is $1, The amount we deduct for Medicare medical insurance is (If you did not have Medicare as of Nov. 14, 2013 or if someone else pays your premium, we show $0.00.) The amount we deduct for your Medicare prescription drug plan is The amount we deduct for voluntary federal tax withholding is (If you did not elect voluntary tax withholding as of November 14, 2013, we show $0.00) After we take any other deductions, you will receive on January 15, $ $ $0.00 $0.00 $1, If you disagree with any of these amounts, you must write to us within 60 days from the date you receive this letter. We would be happy to review the amounts. You may receive your benefits through direct deposit, a Direct Express* card, or an Electronic Transfer Account. If you still receive a paper check and would like to switch to an electronic payment, please visit or call What If I Have Questions? Please visit our website at for more information and a variety of online services. You also can call and speak to a representative from 7 a.m. until 7 p.m., Monday through Friday. Recorded information and services are available 24 hours a day. Our lines are busiest early in the week, early in the month, as well as during the week between Christmas and New Year s Day; it is best to call at other times. If you are deaf or hard of hearing, call our TTY NUMBER, If you are outside of the United States, you can contact any U.S. embassy or consulate office. Please have your Social Security claim number available when you call or visit and include it on any letter you sent to Social Security. If you are inside the United States and need assistance of any kind, you also can visit your local office.

Option 3 One-Time (Manual) Reimbursement Request Used for: Physician copays or coinsurance, prescription medication copays, prescription eyeglasses, etc.

32 Option 3 One-Time (Manual) Reimbursement Request Used for: Physician copays or coinsurance, prescription medication copays, prescription eyeglasses, etc. Attach legible receipts Complete all key data such as the date of service, amount of reimbursement request, type of service May be submitted: Online Fax Paper form that you fill out to request reimbursement for all eligible expense types Attach required documentation Submit via fax, mail, or online Call Via Benefits for a copy of the new form Sign and Date 32

33 Direct Deposit Direct Deposit Set Up Phone Fax Online Mail Direct Deposit Authorization Forms available at

Enrollment is Required Medical Plan Enrollment is Required to Receive Via

Is your coverage being discontinued? Have questions about your HRA? Moving?

! 1-888-598-7545 IMPORTANT: In order to maintain your PEBP benefits, HRA,

34 Enrollment is Required Medical Plan Enrollment is Required to Receive Via Benefits HRA Funding Received mail that seems confusing? Is your coverage being discontinued? Have questions about your HRA? Moving? Be sure to call Via Benefits!! IMPORTANT: In order to maintain your PEBP benefits, HRA, Basic Life insurance, PEBP dental, and any voluntary products (if applicable), you MUST STAY enrolled in a medical plan with Via Benefits.

35 Medicare Open Enrollment October 15 to December 7 Medicare Open Enrollment* provides an opportunity to change health plans and/or prescription drug coverage. Information for Open Enrollment is normally made available in October. Changes made during the Medicare Open Enrollment period will become effective January 1. If you want to make ANY changes to your coverage, MUST make your changes through Via Benefits Benefits advisors are available you Monday through Friday, 5:00 AM until 6:00 PM Pacific Time Making changes outside of Via Benefits will cause you to forfeit your monthly HRA contribution, Basic Life Insurance, PEBP dental and any voluntary products (if applicable). *Medicare Open Enrollment is different than PEBP s Open Enrollment

36 Lifetime Retiree Advocacy Questions and Concerns? Trained in insurance, Medicare, and issue resolution Supports retirees with everything from basic questions, reviewing plan benefits and addressing more complex issues dealing with insurance carriers or Medicare Provider Questions Billing Issues why did I get this bill? Need help finding a network provider Carrier Questions Late cards, incorrect effective date, late enrollment penalty Clarification of letters Claim Denial/Appeals HRA Funding Providing claim forms and assistance Explaining qualifying expenses Moving or Dual Residences 36

Onsite HRA Assistance A Via Benefits HRA Specialist will be available one week per month to assist participants with: What supporting documents are required to request reimbursement Recurring claims,

37 Onsite HRA Assistance A Via Benefits HRA Specialist will be available one week per month to assist participants with: What supporting documents are required to request reimbursement Recurring claims, including Medicare Part B Premiums How to read the Explanation of Payment (EOP) How to navigate the Via Benefits website One-time reimbursement requests Auto-reimbursement process Available balance inquiries Check the calendar of events on the PEBP website for specific dates and locations. Call to set up an individual appointment regarding your HRA. Telephone assistance is always available through the Via Benefits Customer Service Center by calling Monday through Friday, 5:00 AM until 6:00 PM Pacific Time 37

38 Want more information? Contact Via Benefits at

39 Summary Overview Contact the Social Security Administration. Enroll in Medicare Parts A and B. Send PEBP a copy of your (and if applicable, your spouses) Medicare A+B card and the original Retiree Benefit Enrollment and Change Form (RBECF) included in your Medicare Packet from PEBP. Call Via Benefits and select a qualified Medical plan before your enrollment period ends. Wait for your funding packet to arrive from Via Benefits before you submit for any reimbursement. This will normally take between 8-12 weeks from your effective date.

nv.us mservices@peb.state.nv.us Via Benefits (toll free) 1-888-598-7545 https://my.

40 Contact Information Public Employees Benefits Program 901 S. Stewart St. Suite 1001 Carson City, NV or Via Benefits (toll free) Social Security Administration

41 Thank you!

Plan Year 2019 PEBP and Medicare Guide

Plan Year 2019 PEBP and Medicare Guide Learn About: Enrollment & Eligibility Who is Via Benefits How to Prepare for Your Upcoming Medicare Enrollment Basic Medical Plan Options Dental Plan Options Exchange