Helping You Prepare For Your Upcoming Medicare Enrollment

Transcription

1 Welcome PEBP 1

2 Helping You Prepare For Your Upcoming Medicare Enrollment October, Willis Towers Watson. All rights reserved.

3 OneExchange Who We Are Your Future Coverage OneExchange For Your Benefit A Deeper Dive Benefit Advisors, Private Exchange, Optimize Savings Health Reimbursement for You Next Steps Questions and Answer 3

4 OneExchange Medicare Insurance Marketplace Towers Watson over 100 years experience Over 1.5-million retirees served across 540+ employers Licensed benefit advisor provides guidance & ongoing advocacy Personalized options with plans from a nationwide network of carriers More Choice, More Flexibility Better Value Founded in 2004 No fees for our service Our 11th annual enrollment season First & Largest private Medicare Exchange 4

5 OneExchange Service Centers Operating hours: Monday Friday, 5:00 a.m. until 6:00 p.m. Pacific Time Salt Lake City, UT Phoenix, AZ Dallas, TX 100% Domestic Workforce No Outsourcing! 5

6 Plans and Insurers Medicare Advantage Medicare Supplement (Medigap) Prescription Drug (Part D) Wide selection of plans from leading national / regional insurers Dental and Vision Plans Available 6

7 Your Future Coverage 2016 Willis Towers Watson. All rights reserved.

8 Your Future Coverage How Medicare coverage works Primary Coverage Medicare A and B Additional Coverage (your choice) *Medicare Advantage with Prescription Drug (MAPD) or *Medigap + Prescription Drug Optional Coverage (your choice) Dental Plans Vision Plans 8

9 Your Medicare Options Option 1: MAPD: Medicare Advantage + Part D Prescription Drug plan HMO MAPD PPO * Note that Medicare Advantage plans are generally network based plans. Medicare Advantage plans are unavailable in some rural areas. 9

10 Your Medicare Options Option 2: Medicare Supplement Insurance (Medigap) and Part D Prescription Drug plan MEDIGAP PLAN PART Part D D PLAN Prescription Drug Plan Note: You may need to pay your first premium when you enroll in coverage. 10

11 Medicare Supplement Insurance (MediGap) Lettered Policies Medicare Supplement Insurance (Medigap) Policies Benefits A B C D F G K L M N Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) Medicare Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 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 100% 100% Foreign travel emergency (up to plan limits) Source: CMS 80% 80% 80% 80% 80% 80% Out-of-Pocket limit in 2016 $4,960 $2,480 11

12 Part D Plans 5 Tiers of Co-Pays A prescription drug plan will typically break the formulary into tiers. The tiers correspond to the copayment or coinsurance the beneficiary will pay. Cost-sharing increases with the tier number. Tier 1 is the least expensive, tier 4 or 5 is the most expensive. Tier descriptions: Tier 1 preferred generic Tier 2 non-preferred generic Tier 3 preferred brand Tier 4 non-preferred brand Tier 5 specialty drugs or injectable medicine 12

13 Medicare Prescription Drug Coverage 2017 You Pay Full Retail Until Deductible is Met $0 to $400 You pay 40% of Brand Name and 51% of Generics until your out of pocket costs reach $4950; Pharmaceutical contributions will count towards the $4950 TrOOP Deductible Initial Coverage Coverage Gap Catastrophic Coverage You pay copays for your plan coverage for the first $3700 in actual costs of Medications Only 25% reach Donut Hole Only 4% reach Catastrophic You Pay $3.30 for Generics and $8.25 for Brand Name or 5% - whichever is greater 13

14 A Deeper Dive Into Our Process 2016 Willis Towers Watson. All rights reserved.

15 The OneExchange process Consultative Process Simplified Selection Effortless Enrollment Ongoing Advocacy 15

16 Education Enrollment Guide: Prepare for your enrollment Pre-existing conditions will not limit your plan selection * *Except end stage- renal disease Make an appointment to enroll Call Toll Free Medicare.OneExchange.com/PEBP Review Medicare basics What to expect on your enrollment call FAQ s 16

17 Benefit Advisors Licensed / Certified / Appointed OneExchange University Average age 43 Objective & unbiased 100% domestic workforce Benefit advisors are available: Monday Friday, 5:00 AM. until 6:00 PM Pacific Time 17

18 Decision Support Tools Prescription Profiler Medicare.OneExchange.com/PEBP 24/7 access to your information Load in your prescriptions Shorten your time on the phone with us! 18

19 Decision Support Tools Help Me Choose comparison tool 19

20 Enrollment Process Benefit Advisors Benefit Advisors can discuss coverage options with anyone Application Data Processors Telephonic enrollment 100% of calls are recorded We ve got your BAC: Benefit Advisors Application Data Processors Customer Service Reps 20

21 Enrollment Process Selection Confirmation Letter Review the plan(s) that you selected the selection confirmation letter will be sent shortly after you enroll. This letter confirms that your applications have been submitted. 21

22 Personal Guidance An Ongoing Advocate Navigation Enrollment Prescription changes Affordability concerns Reimbursement issues Late enrollment HRA Annual plan review The plans you select continue on year to year. No need to re-enroll in the fall unless you want to make a plan change. 22

23 Health Reimbursement Arrangement (HRA) 23

24 How Your HRA Works Allocates benefit dollars to each retiree s HRA account HRA Administered by OneExchange Retiree s work with OneExchange to enroll in individual medical coverage Retiree are reimbursed for eligible health plan expenses or premiums using HRA benefit dollars 24

25 Health Reimbursement Arrangement Tax-free account used to reimburse you for eligible health care expenses you pay first and then get reimbursed If you are eligible, PEBP will make a monthly contribution to a Health Reimbursement Account (HRA) You may use HRA funding to reimburse yourself for eligible medical, prescription drug, dental, vision, and Part B premiums, as well as eligible out-of-pocket healthcare expenses Your HRA funding will be available upon Enrollment and monthly thereafter. Unused funds DO roll over.* *Subject to 365-day rolling reimbursement request submission deadline 25

26 Qualify for your Health Reimbursement Arrangement Enroll in a medical plan through OneExchange before your enrollment period ends to have access to your HRA. Must remain enrolled through OneExchange each year to continue to have access to your HRA or permanently forfeit the rights to your HRA. We recommend you schedule a call to enroll. You can also go online to investigate your options. 26

27 Health Reimbursement Arrangement You may be reimbursed up to the amount available in your HRA! 27

28 Reimbursement Options 1 Automatic Reimbursement Enroll in a participating plan Ask to select option Pay premiums as required Available for plan premiums only 2 Recurring Reimbursement Recurring Reimbursement Request Fill out form Attach required documentation once Available for premiums / Medicare Part B premium 3 Reimbursement Manual Reimbursement Request Fill out form Attach required documentation Submit via Mail, Fax or Web Available for all expense types Subject to 365-day rolling reimbursement request submission deadline 28

29 How Auto-Reimbursement Works Participant pays plan premium to insurance company Step 1 Insurance company forwards receipt of payment to OneExchange Step 2 OneExchange reimburses participant Step 4 Step 3 OneExchange verifies receipt of payment and eligibility

30 How to file a Manual Reimbursement Request Participant pays plan premium or co-pays Step 1 Step 2 Participant fills out Reimbursement Request, attaches required information OneExchange reimburses participant Step 4 Step 3 OneExchange verifies receipt of payment and eligibility

31 Recurring Premium Reimbursement Apply once for the entire year - Expires 12/31 each year- * Must re-submit annually Monthly Plan Premiums Part B Premiums Remember: Sign and Date 31

32 Reimbursement Request Easy One Page Form & any supporting documentation Don t Forget to Sign and Date 32

33 Direct Deposit Authorization The Fastest, Most Secure Way to Receive your Reimbursement Direct Deposit Set Up Phone Fax Online 33

34 Forms and Publications Nevada PEBP Website: 34

35 Reimbursement Guide Manage your Reimbursement Funds Pay for your expenses Automate your Premium Payment Website and your Online Account Submit for Reimbursement PEBP Dental is Automatically Reimbursed Important Documents Understand your Explanation of Payment Statement 35

36 Next Steps 37

37 What You Need To Do: Action Required! Schedule your enrollment call Find your Medicare Card! Contact OneExchange Call now to complete your profile and schedule an enrollment appointment You will need your Medicare card, prescription list, and doctor and hospital information 38

38 Questions and Answers?! 39

39 Thank you! Call Now, We Are Ready! Medicare.oneexchange.com/PEBP 40