Medical Plan Options - Retirees Age 65 or Over/ Disabled Participants with Medicare Coverage

Transcription

1 l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re Program Name Group Prime Solution Group Prime Solution for Seniors for Seniors Type of Policy re Cost Plan with re Prescription Drug re Cost Plan with re Prescription Drug re Advantage Plan including Prescription Drug re Advantage Plan including Prescription Drug Monthly Premium $ $ $ $ How Plan Works with re and re Assignment re pays primary for Part A inpatient hospital, skilled nursing facility, and home health care expenses. pays re Part B provider expenses. re pays primary for Part A inpatient hospital, skilled nursing facility, and home health care expenses. pays re Part B provider expenses. administers benefits and claims payment of re Parts A and B, as well as additional benefits included in plan, such as Prescription Drug coverage (Part D) and preventive care. Bills for health care services are sent directly to by providers (not to re) and are processed in Claims department. administers benefits and claims payment of re Parts A and B, as well as additional benefits included in plan, such as Prescription Drug coverage (Part D) and preventive care. Bills for health care services are sent directly to by providers (not to re) and are processed in Claims department. re Assignment You are encouraged to use network providers, but you do not assign your re benefits to. You are allowed to use your re benefits outside of the network. You are encouraged to use network providers, but you do not assign your re benefits to. You are allowed to use your re benefits outside of the network. You cannot use your re benefits outside of network unless an emergency occurs. You cannot use your re benefits outside of network unless an emergency occurs. Outpatient Hospital Outpatient Surgery 100% 100% after $50 copay 100% 100% after $100 copay Lab/X-Ray, CT scan, MRI, other outpatient diagnostic tests Lab Services 100%. All other services $15 copay Lab Services 100% All other services $20 copay Primary or Specialty - 100% OP Hospital / Surg. Ctr. $25 copay Primary or Specialty - 100% OP Hospital / Surg. Ctr. $25 copay Emergency Services 100% after $50 copay 100% after $65 copay (20% coinsurance outside the U.S. Expenses do not apply to Out-of-Pocket Maximum) 100% after $50 copay 100% after $75 copay Ambulance 100% 80% coinsurance 100% 100% after $100 copay 11

2 l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re Urgent Care Visit 100% after $15 copay 100% after $30 copay 100% after $20 copay 100% after $35 copay Inpatient Hospital 100% 100% after $200 copay 100% 100% after $200 copay Skilled Nursing 100% after 3-day hospitalization for up to 100 days per benefit period 100% after 3-day hospitalization for up to 100 days per benefit period 100% coverage for up to 100 days per benefit period; no 3-day hospital stay requirement 100% coverage for up to 100 days per benefit period; no 3-day hospital stay requirement Mental Health 100% 100% after $200 copay 100% 100% after $200 copay Chemical Dependency 100% 100% after $200 copay 100% 100% after $200 copay Outpatient l Preventive 100% 100% 100% 100% Physician Office Visit 100% after $15 copay 100% after: Primary Care $20 copay/ Specialist $30 copay 100% after $15 copay 100% after: Primary Care $20 copay/ Specialist $30 copay 13

3 l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re tions Delivered in Physician Office Setting and Paid under re Part B Routine Eye and Hearing Exams Outpatient Mental Health is 80% is 80% 80% covered 80% covered 100% 100% 100% 100% Outpatient Chemical Dependency Chiropractic Care 100% after $15 copay 100% after $20 copay 100% 100% Podiatry Physical & Occupational Therapy Speech & Language Therapy Home Health Care 100% 100% 100% 100% l Equipment DME Prosthetics 100% 80% coinsurance 80% DME/ 100% Prosthetics 80% DME/ 100% Prosthetics Hearing Aids $500 allowance per year No coverage $500 allowance every 36 months $500 allowance every 36 months 15

4 l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re Prescription Drugs Generic Drugs Retail Preferred Generic - $10 Copay Non-Preferred Generic - $30 Copay Preferred Generic - $10 Copay Non-Preferred Generic - $20 Copay $10 copay $10 copay Formulary Brand Drugs Retail Non-preferred Formulary Retail $30 copay $30 copay $30 copay $30 copay $30 copay $70 copay $50 copay $60 copay Specialty Drugs $30 copay 75% coverage $50 copay 75% coverage Supplemental Drugs Not covered Not covered Mail Order 90-day supply for 2 copays 90-day supply for 2 copays Covered at generic and brand copays shown above 90-day supply for 2 copays through mail order or Preferred Pharmacy network (retail) Not covered 90-day supply for 2 copays through mail order or Preferred Pharmacy network (retail) Benefits in the re Gap (Between $3,750 total prescription costs and $5,000 total out-of-pocket expenses) 100% coverage after $10 or $30 generic copay or $30 brand copay 100% coverage after $10 or $20 copay for generic medications. 65% coverage for brand name medications. 50% reimbursement from brand drug manufacturer at pharmacy counts toward the $5,000 OOP expenses. 100% coverage after $10 generic copay, $30 preferred brand copay, $50 non-preferred drug or specialty drug copay (counts toward the OOP max.) 100% coverage after $10 generic copay. No coverage for brand drugs but 60% manufacturer discount assessed at the pharmacy (counts toward the OOP max.) Catastrophic Level (after $5,000 in total out-of-pocket expenses) 100% coverage after $10 generic copay or $30 brand copay Member cost will be the greater of 5% of drug cost or $3.35 copay for generic drugs and $8.35 copay for brand/ formulary drugs 100% coverage after $10 generic copay, $30 preferred brand copay, $50 nonpreferred drug or specialty drug copay Member cost will be the greater of 5% of drug cost or $3.35 copay for generic drugs and $8.35 copay for brand/ formulary drugs Wellness Benefits Fitness Club Membership Nurseline Other Wellness Benefits Silver Sneakers Fitness Program Personal Health Advocate can help navigate the healthcare system as well as provide access to registered nurses for guidance and support 24 hours a day/7 days a week Hearing Aid Discount program A survey for senior members that is reviewed by nurses in s Care Management area to assess additional needs tion Therapy Management (MTM) program provides information and resources to improve medication use and patient care Silver Sneakers Fitness Program Health Club Savings Program Health Connections 24-Hour Nurse Line, Community Education Class reimbursement, My Health Decisions Online Tool Hearing Aid Discount program $150 Annual Eyewear allowance Quit Smoking, plus Disease and Case Management Programs Weight Loss Mammogram Incentive Programs 17

5 l Plan Options - Retirees Age 65 or Over/ Disabled Participants with re Plan features Travel and Out-of-Area Benefits Travel benefits Extended Absence Option allows members to use medical and prescription drug coverage when traveling away from the service area for up to 9 consecutive months Extended Absence Option allows members to use medical and prescription drug coverage when traveling away from the service area for up to 9 consecutive months Members may be out of service area for up to 6 consecutive months. Members do not need to notify when they leave or return. Emergency benefits are worldwide: $50 copay for ER visits; waived if admitted to the hospital. 80% coverage for nonemergency services anywhere in the US. $100,000 plan benefit maximum; $10,000 OOP maximum Members may be out of service area for up to 6 consecutive months. Members do not need to notify when they leave or return. Emergency benefits are worldwide: $75 copay for ER visits; waived if admitted to the hospital. 80% coverage for non-emergency services anywhere in the US. $100,000 plan benefit maximum; $10,000 OOP maximum Option to live outside of service area No No No No Maximums Annual Out-of-Pocket $1,000 on l (Pharmacy copays $3,000 on l (Pharmacy copays $3,400 l Out-of- Pocket Maximum (Pharmacy copays $3,400 l Out-of-Pocket Maximum (Pharmacy copays Lifetime Unlimited Unlimited Unlimited Unlimited 2018 Monthly Premium (includes premium for re Part D) l Plan Blue Cross Blue Shield U of M Retiree Plan Group Platinum Blue SM Plan C Cost per person* Plan 1: $ Plan 2: $ HealthPartners Freedom Plan and HealthPartners Retiree National Choice Plan 1: $ Plan 2: $ Group Prime Solution for Seniors Plan 1: $ Plan 2: $ Plan 1: $ Plan 2: $ * Retiree, spouse, surviving spouse, and participant on disability status with re Part A and Part B 19