Medicare-Eligible Welcome Kit

Transcription

1 Medicare-Eligible Welcome Kit This booklet contains important information on how healthcare plan changes will affect you. *Services provided by Mercer Health & enefits Administration LLC. Mercer Marketplace 365SM* P.O. ox 14401, Des Moines, IA (toll-free) / 9:00 a.m. - 5:00 p.m. ET, M-F (TTY) (fax) Quest.Exchange@mercer.com

2 INCLUDED IN THIS KIT WHO S WHO...3 There are many people supporting you through this change. This list will help you understand the roles and responsibilities of each group. WHAT YOU NEED TO KNOW...4 Knowing what to do and what to expect will help you prepare for a smooth transition. APPOINTMENT PREPARATION...5 Following these steps will help you get the most out of your appointment with a enefits Counselor. QUESTIONS TO THINK AOUT...6 Considering these issues will help you make an informed decision. HEALTHCARE PROVIDER TRACKER...7 List your important healthcare providers to help determine what kind of plan will best meet your needs. PRESCRIPTION DRU TRACKER...8 ather your 2016 prescriptions in one place to give you a head start toward making a sound selection. MEDICARE OPTIONS...9 This tutorial will help you decide which plan options best fit your needs and budget. PREMIUM REIMURSEMENT ACCOUNT (PRA)...10 Important facts about the PRA. NOTES...11 Use this page to keep track of any items you wish to discuss when you talk to your enefits Counselor. Welcome to Mercer Marketplace 365. Having the right healthcare coverage to meet your needs and budget during retirement is important. That s why Quest Diagnostics is partnering with Mercer Marketplace 365 to provide resources that will help you choose a plan from a variety of healthcare coverage options. You will shop for and enroll in your new coverage through Mercer Marketplace 365. You now have several options to choose from to meet your medical, prescription drug, dental and vision needs. Mercer Marketplace 365 and its dedicated enefits Counselors are ready to support you before, during, and long after your healthcare plan changes. They will help you understand the different individual plans offered to you, determine the best plan for you, and help you enroll. When you sign up for your new Mercer Marketplace 365 coverage, Quest Diagnostics will provide you with a credit to offset the cost of your medical insurance. The credit will be placed in a Premium Reimbursement Account ( PRA ) set up in your name. This is a special, taxfree account that you may use to reimburse yourself for medical insurance premiums. Page 10 provides more information about your Premium Reimbursement Account. To be eligible for the PRA credit, you must enroll for medical coverage through Mercer Marketplace 365. You will have a dedicated enefits Counselor from Mercer Marketplace 365. Your counselor will help you compare your medical, prescription drug, dental, and vision coverage options. You can also visit our website to compare your options and learn more about Medicare. Refer to page 5 for more information about connecting with your enefits Counselor. In the meantime, review this Welcome Kit. It contains tools and exercises to help you start learning about your new health plan options. Completing the information in this kit will make it easy for you and your enefits Counselor to evaluate your options and get you enrolled. Our team is excited to serve you in this new program. enefits Counselors are available to support you during your enrollment period. You may reach Mercer Marketplace 365 Monday through Friday, from 8:00 am to 5:30 pm ET at toll-free (TTY ) to set up a consultation. Or, visit us online at at your convenience, 24 hours a day, seven days a week. For additional information about Mercer Marketplace 365, including our compensation and privacy practices, please see the enclosed documents. We look forward to working with you. Mercer Marketplace 365 PAE 2

3 Our enefits Counselors will help you through the change in health insurance and get the most out of your Premium Reimbursement Account (PRA). Who s Who? You are not alone in this change. Quest Diagnostics carefully evaluated the health insurance market and selected a team of companies and individuals to support you throughout the enrollment period and in the future. Quest Diagnostics values their relationships and continues to work to provide access to comprehensive programs that support the needs of participants and their families. Quest Diagnostics research determined that the robust individual health insurance market offers more choice and greater flexibility in coverage options to maximize the value of your PRA dollars. To best support participants with the service and support necessary for this transition, Quest Diagnostics evaluated several potential partners and has assembled the following team: Mercer Marketplace 365 Our enefits Counselors are licensed insurance professionals who are available to assist you with this transition. They will help you learn how to evaluate and compare plans to select a strategy that best fits your needs. When you have selected your plan(s), your enefits Counselor will help you through the enrollment process to ensure that all information is submitted accurately and timely to the insurance carrier(s). Once you have enrolled, your enefits Counselor continues to support you throughout the year with your reimbursement requests, PRA inquiries, and insurance advocacy. INSURANCE COMPANIES You will be able to enroll in individual health plan policies offered by leading health insurance companies. You may choose from any of several Medicare Supplement, Medicare Advantage, Part D, Dental and Vision plans. Once you enroll in your selected plan, a new health insurance card will be issued to you by your new insurance carrier. PAE 3

4 WHAT YOU NEED TO KNOW efore your call with Mercer Marketplace 365 KEEP TRACK OF YOUR HEALTH AND PRESCRIPTION DRU COSTS AND LIST YOUR PROVIDERS Start by keeping track of your individual healthcare needs. This step will prepare you for your call with your enefits Counselor. Use the Healthcare Provider Tracker to list your important providers. Use the Prescription Drug Tracker to record your monthly prescriptions. Providing correct information in the trackers will help your enefits Counselor at Mercer Marketplace 365 analyze your healthcare insurance needs. As soon as possible SCHEDULE A TELEPHONE CONSULTATION WITH YOUR ENEFITS COUNSELOR Call Mercer Marketplace 365 to schedule a one-on-one consultation with your enefits Counselor. During this call, you should notify your enefits Counselor if you will be opting-out of coverage. If you are uncertain about what to do, take this opportunity to discuss your options with your enefits Counselor. efore you apply for plans TALK WITH A ENEFITS COUNSELOR enefits Counselor consultations and enrollments are available for eligible members and dependents. Plan summaries and applications are available on ENROLL IN YOUR HEALTH PLAN After your one-on-one consultation with a enefits Counselor, he or she can provide the assistance to enroll you and submit the necessary documentation to the carrier to initiate your plan. PAE 4

5 ACT QUICKLY for your new healthcare plan to be effective NEXT STEPS Appointment Preparation Follow these steps to ensure that you are prepared for your phone consultation with your Mercer Marketplace 365 enefits Counselor. as soon as possible. 1 Call Mercer Marketplace 365 Monday through Friday between 8:00 am and 5:30 pm at to schedule your one-on-one consultation with a enefits Counselor. QUESTIONS FOR MY ENEFITS COUNSELOR Appointment Date Time enefits Counselor Phone 2 Prepare for your appointment. To help guide your decision, please see the Questions To Think About on page 6. 3 Complete the Healthcare Provider Tracker and Prescription Drug Tracker forms included in this kit. Please mail, fax, or this information at least days before your appointment. Quest.Exchange@mercer.com Secure fax: Address: Mercer Marketplace 365 P.O. ox Des Moines, IA Please see page 9 for information on the differences among Medicare, Medicare Supplement, and Medicare Advantage Plans. 4 5 Write down your questions or concerns in the space on the left side of this page. Your enefits Counselor will take the time to explain your healthcare insurance options and answer any questions you have. Our goal is to help you select the health plan that best fits your needs. Have your Medicare (red, white, and blue) ID card available. You will need to provide both your Part A and Part effective dates. Please do not or fax this card or Medicare number. PAE 5

6 PREPARIN FOR YOUR CONSULTATION Questions to Think About 1.Do you have end stage renal disease (ESRD)? 2.Do you currently reside in a Nursing Home or Assisted Living Facility? With so many healthcare plans to consider, it helps to narrow down options based on certain criteria that are important to you. Your answers to these questions will help your enefits Counselor discuss healthcare insurance plans that best fit your needs. 3.Do you anticipate spending considerable time away from your primary residence during which you would seek nonemergency medical care? 4.Do you use the same group of healthcare providers? Are they relatively consistent and close to home? 5.Are you comfortable with an HMO/PPO network which may include some, but not all, of your providers and may not provide care outside your area without additional higher fees? 6.Would you be willing to switch providers if the most economical health plan did not include your current providers? 7.Do you use healthcare providers that do not accept Medicare? (You can call your providers and ask the billing department.) 8.Are you entitled to TRICARE For Life, other prescription drug/ health benefits through the VA, or any other health or prescription drug benefits not listed here? 9.Has Medicare or the Social Security Administration notified you that you are eligible for assistance with paying for Medicare prescription drug plan costs? 10.Are you currently receiving Medicaid benefits? PAE 6

7 NAME PHONE (PLEASE PRINT) Healthcare Provider Tracker List your current healthcare providers on this sheet. Most healthcare plans like HMOs and PPOs use networks. athering your healthcare provider information here will help you and Mercer Marketplace 365 compare access to your current providers. You also can contact your providers and ask them which Medicare plans they accept. 1. PRIMARY CARE PHYSICIAN NAME PHONE ADDRESS athering your healthcare providers information will help determine if your providers accept the new health insurance you are considering. TIP Some providers do not participate in certain HMO and PPO plans. 2. SPECIALIST NAME PHONE ADDRESS 3. SPECIALIST NAME PHONE ADDRESS 4. OTHER NAME PHONE ADDRESS 5. OTHER NAME PHONE ADDRESS Please submit this worksheet prior to your scheduled appointment. Mail, fax, or to: Mercer Marketplace 365 P.O. ox 14401, Des Moines, IA Fax: PAE 7

8 All Medicare Part D prescription drug plans cover generic drugs at considerable savings over brandname prescriptions. You may want to have a discussion with your provider regarding the possibility of switching current brand prescriptions to generics before you enroll in a new Prescription Drug plan. NAME PHONE (PLEASE PRINT) Prescription Drug Tracker (Please Print Clearly) In order to construct an accurate cost analysis, we will need your complete and accurate prescription drug information. For example, it is important to indicate the name of the prescription drug that you are taking, and whether you are taking a RAND or ENERIC version. Please note, over-the-counter medications, vitamins, and supplements are not covered by prescription drug plans (e.g., Medicare Part D) and therefore are not required on this form. IF THE IF THE SUPPLY SUPPLY OF A OF PRESCRIPTION A MEDICATION DRU LASTS LASTS LONER LONER THAN THAN ONE ONE MONTH MONTH OR IS OR IS ONLY ONLY USED USED AS NEEDED AS NEEDED, (PRN), PLEASE PLEASE TELL TELL US HOW US HOW OFTEN OFTEN IT IS IT ORDERED. IS NAME OF MEDICINE (Excluding vitamins and over the counter) RAND OR ENERIC FORM AND DOSAE PACKAE SIZE / QUANTITY MONTHLY (Quantities, number of packages) COST EXAMPLES: Simvastatin 20 mg tablet Timolol Maleate Opthalmic Sol 0.5% OP Sol 10 ml bottle 1 bottle per month Nasocort AQ AER 55 mcg/ac 16.5 gm inhaler 1 inhaler per month Ciclopirox el 0.77% gel 30 gm tube 1 tube per month Lantus Solostar INJ PAE ml 3 ml pen (pack of 5) 10 pens (2 packs of 5 pens per month) Please complete one Prescription Drug Tracker per covered member. Please mail, fax, or this worksheet days before your scheduled appointment to: Mercer Marketplace 365 P.O. ox 14401, Des Moines, IA Fax: Quest.Exchange@mercer.com

9 Original Medicare with Medicare Supplement (Medigap) vs. Medicare Advantage Use this chart to help you decide which plan is right for you. TIP oth Part D and Medicare Advantage plans are subject to the coverage gap (i.e., donut hole ) ORIINAL MEDICARE WITH MEDICARE SUPPLEMENT PART A (HOSPITAL INSURANCE) PART (MEDICAL INSURANCE) Medicare provides this coverage. You have your choice of doctors, hospitals, and other providers that accept Medicare. Most people pay a monthly premium for Part. In addition, you will pay deductibles for services covered under Parts A and and pay coinsurance for all Medicare-covered services. IN ADDITION, YOU MAY ADD A MEDICARE SUPPLEMENT POLICY TO YOUR PART A AND MEDICARE COVERAE. These plans are offered by private insurance companies that pay all or part of the deductibles and coinsurance with predictable out-of-pocket expenses. If you have a Medicare Supplement policy you cannot join a Medicare Advantage Plan. No network restrictions, as long as the provider accepts Medicare. STEP 1: DECIDE IF YOU WANT MEDICARE ADVANTAE PLAN LIKE AN HMO OR PPO NETWORK PART C: INCLUDES OTH PART A (HOSPITAL INSURANCE) & PART (MEDICAL INSURANCE) Private insurance companies approved by Medicare provide this coverage. In most plans, you need to use approved network doctors, hospitals, and other providers or you will pay more. You pay a monthly premium (depending upon the plan), your Part premium, and co-payments for covered services. Costs, rules, and coverage beyond what s covered in Medicare Parts A and will vary by plan. Note: If you join a Medicare Advantage Plan, you do not need to have a Medicare Supplement policy. Normally you will see lower monthly premium costs, but higher out-ofpocket expenses when services are rendered. STEP 2: DECIDE IF YOU WANT PRESCRIPTION DRU COVERAE (PART D) If you want this coverage, you must choose a Medicare Prescription Drug Plan. These plans are run by private insurance companies approved by Medicare. You must pay the monthly plan premium and drug co-payments. Most Medicare Advantage Plans include prescription drug coverage (Part D). enerally, the drug premium is included in your monthly Medicare Advantage premium. You will be responsible for co-payments and any other plan costs. PAE 9

10 PRA (Premium Reimbursement Account) A PRA is a notional account established in your name by Quest Diagnostics. Notional means a bookkeeping entry will be established on your behalf; no specific funds are set aside for you and your PRA does not earn interest. Instead, to help offset your healthcare costs, Quest Diagnostics will reimburse your eligible medical plan premiums up to the amount credited to your notional account. Quest Diagnostics may decide to increase, decrease, or terminate the PRA credit at any time. ONLINE ACCESS OF YOUR PRA You will be able to access your PRA information 24/7 by taking the following steps: 1) Visit In the far right box, outlined in red below, click LOIN. > Who s covered? Medicare-eligible participants, if they elect individualmedical insurance coverage through Mercer Marketplace 365. > How can I use the HRA? You can be reimbursed for your monthly medical plan premiums, and other eligible out-of-pocket expenses, including co-payments, coinsurance, deductibles, Medicare Part and D premiums). REIMURSEMENT CLAIMS AND PRA ALANCE Under the PRA, Quest Diagnostics will reimburse you for medical,prescription drug, and dental plan premiums you paid each month up to the amount in your account. Any balance left in your PRA at the end of the year would remain available until March 31st of the following calendar year. You must submit a claim for reimbursement of medical, prescription drug, and dental plan premiums paid during the calendar year by this March 31st deadline. AUTOMATIC REIMURSEMENTS FROM YOUR PRA Your enefits Counselor will let you know if the plan you select is eligible for the Automatic Reimbursement feature. If you are eligible and you select Automatic Reimbursement when submitting a claim, payments will be processed each month based on the scheduled dates for your employer s plan; please refer to the Plan Information section, accessible from your dashboard. Direct deposits are made same-day and hard checks are mailed on Friday. Hard checks will take approximately 3-5 business days to be delivered. If you have problems accessing the website, please call Mercer Marketplace 365 at PAE PAE ) Next, in the red box outlined below, enter your Social Security Number (omit any dashes) as your User Name, and your Date of irth (MMDDYYYY) as your password. You will be prompted to change your password after you complete this initial log in. (This is a secure site.) 3) From your dashboard, shown below, you can: View your account balance Submit claims and check their status Set up or edit direct deposit Access many other convenient features

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