Medicare Advantage Fall Enrollment 2012 FOR RETIREES WITH MEDICARE PART A & PART B1

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1 Office of Group Benefits Medicare Advantage Fall Enrollment 2012 FOR RETIREES WITH MEDICARE PART A & PART B1

2 This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan, read the plan documents carefully and consult other OGB and plan administrators publications. 2

3 WELCOME... This presentation will cover Enrollment information Key facts Overview of plans Life insurance 3

4 Medicare Advantage Enrollment Timeline Enrollment starts Enrollment ends October 1 December 2 December 31 January 1 OGB must receive enrollment form to ensure correct deductions on January retirement check Effective date of coverage

5 Enrollment Restrictions OGB Medicare Advantage Enrollment is the ONLY TIME eligible ibl OGB retirees can enroll in OGB Medicare Advantage plans (also called Part C Medicare plans) OGB retirees can also enroll in OGB standard health plans during Annual Enrollment each fall Eligible retirees who enroll in an OGB Medicare g Advantage plan must keep it through December 31, 2012

6 Key Points Can change health plans once each year during Annual Enrollment and Medicare Advantage Enrollment both are now held in the fall Compare costs, benefits and restrictions when choosing a plan Retirees who choose to keep the same plan do not need to fill out an enrollment form

7 What happens if you drop coverage? If you drop OGB coverage without transferring to an OGB standard plan or OGB Medicare Advantage Plan YOU LOSE O G B YOU LOSE O.G.B. COVERAGE FOREVER!!

8 You lose OGB coverage forever EXCEPT if You joined an individual id (non-ogb) Medicare Advantage plan and it is no longer available or you withdrew, OR You joined TriCare for Life and it was discontinued or had a significant reduction in benefits, OR You lost other creditable continuous coverage and meet all requirements in PPO Plan Document Call OGB Customer Service for more information

9 Enrollment Procedures 1 If you are not transferring from one plan to another, DO NOT send in a health plan enrollment form. 2 If your spouse is covered as a dependent on your OGB plan, both you and your spouse must have Medicare Part A and Part B to be eligible for a Medicare Advantage plan. You must both join the same plan. If choosing an OGB Medicare Advantage plan 3 Complete an OGB Medicare Advantage Plan enrollment form (available at meetings, on OGB s website or at any OGB office). Medicare requires a street address (not a post office box). Sign and date the form and mail it to: OGB Eligibility Division P.O. Box Baton Rouge, LA OGB must receive enrollment form by to ensure accurate January premium deductions; final deadline for OGB to receive form is

10 Enrollment Form

11 Change Notification If the following information changes at any time, report it immediately to OGB Mailing address Address Working status Working status Eligible dependents Eligible dependents Medicare status t Eligibility for Medicare

12 Change Notification To report changes Go to the Human Resources office at the agency from which you retired or Send a letter to OGB or Visit an OGB office

13 OGB Medicare Advantage Plans Key Facts & Decision Questions 13

14 Key Fact # 1 You DO NOT have to join an OGB Medicare Advantage plan. You can keep pyour OGB standard plan (PPO, HMO, Regional HMO or Medical Home HMO).

15 Key Fact # 2 The Medicare program allows each person to enroll in only ONE medical or prescription drug Medicare-type plan.

16 Key Fact # 2 (continued) Once you enroll in an OGB Medicare Advantage plan, DO NOT purchase or enroll in A Medicare supplemental plan; A Medicare Advantage plan not sponsored by OGB that includes Medicare Part D prescription p drug coverage; A group Medicare Advantage plan not sponsored by OGB; or A Medicare Part D plan for drug coverage only.

17 Key Fact # 2 (continued) Signing up for a plan other than those offered by OGB cancels your previous choice and could leave you without OGB health and prescription drug coverage.

18 Key Fact # 3 If If you DO join an an OGB Medicare Advantage plan plan, you will get ALL of your You health will get benefits ALL of your through health that plan, benefits including through your h that prescription t plan, including drug coverage. You will continue to pay You your MUST Medicare continue Part to pay B premium. your your prescription drug coverage; and Medicare Part B premium.

19 Key Fact # 4 If your spouse is covered as a dependent Your covered spouse must also have both Medicare Part A and Part B to join an OGB Medicare Advantage plan. You and your covered spouse must join the same plan.

20 Key Fact # 5 Medicare Advantage plans are NOT Medicare supplement plans. If you enroll in an OGB Medicare Advantage plan, it will replace whatever Medicare and OGB coverage you currently have.

21 Key Fact # 6 Even though OGB Medicare Advantage plans replace traditional Medicare coverage, OGB Medicare Advantage plan members still retain all rights and protections provided by traditional Medicare. However, benefits may vary by plan. ALL Medicare Advantage plan companies are regulated by the federal Centers for Medicare and Medicaid Services (CMS).

22 Key Fact # 7 If you enroll in an OGB Medicare Advantage plan, you must stay in that plan until December 31, You can only change plans during OGB Annual Enrollment or Medicare Advantage Enrollment each fall.

23 Decision Questions 1. Is the plan available in your area or parish? 2. Are your hospitals and doctors in the plan s provider network? 3. Does the plan have out-of-state coverage if you need it? 4. What is the plan s monthly premium cost? 5. How much will you pay in total yearly out-of- pocket costs? 6. How does the plan compare to the costs and benefits of your current plan?

24 Overview of Plans 24

25 OGB Medicare Advantage Plans offer premium savings 3 HMO Plans 2 PPO Plans Humana HMO Peoples Health HMO-POS Humana PPO UnitedHealthcare PPO Vantage HMO-POS

26 OGB Medicare Advantage Plans HMO Plans PPO Plans Usually have lower premiums Offered in designated areas Must utilize network providers HMO-POS plans offer out-of- network benefits Encourage preventive care Expanded networks outside of Louisiana Can use any provider that accepts Medicare assignment No referrals required

27 OGB Medicare Advantage Plans Coverage Areas Humana Peoples Health Vantage Humana UnitedHealthcare HMO HMO-POS HMO-POS PPO PPO Alexandria Baton Rouge Hammond Houma Lafayette Lake Charles New Orleans North Shore Shreveport Thibodaux Baton Rouge Hammond New Orleans North Shore Statewide 23 states Nationwide

28 HMO Plan Overview Plan Member Out-of-Pocket Expenses (Jan. 1 Dec. 31, 2012) Humana Peoples Health Vantage HMO HMO-POS HMO-POS Lifetime Maximum Unlimited Unlimited Unlimited Deductible (Calendar Year) $0 $0 $0 Out-of-Pocket $3250 $2500 $2500 Maximum in-network Inpatient $10 co-pay $100 co-pay Hospital Care $0 co-pay Per Day 1, 2 per day (days 1-10) per day (days 1-5) Outpatient Hospital Care $100 maximum co-pay $0 co-pay $100 co-pay (facility) 2 Surgery/Anesthesia/ X-ray $0 co-pay $0 co-pay $0 co-pay (physician) 2 Ambulatory Surgical Facility Doctor Visit Primary/Specialist $50 co-pay $0 co-pay $100 co-pay 2 $5/$15 co-pay $5/$10 co-pay $5/$30 co-pay 1 Semi-private room, ancillary services and doctor visits 2 Some services may require pre-certification

29 HMO Prescription Drug Coverage Plan Member Out-of-Pocket Expenses (Jan. 1 Dec. 31, 2012) Humana Peoples Health Vantage HMO HMO-POS HMO-POS Formulary Open Open Closed with exceptions Retail (30-day supply) 1 Level 1 - Generic Drugs $0 co-pay $0 co-pay $0 co-pay Level 2 - Preferred Brands $20 co-pay $20 co-pay $20 co-pay Level 3 - Non-Preferred Brands $40 co-pay $40 co-pay $40 co-pay Level 4 - Specialty Drugs $60 co-pay 20% co-insurance 25% co-insurance Mail Order (90-day supply) Level 1 - Generic Drugs $0 co-pay $0 co-pay $0 co-pay Level 2 - Preferred Brands $40 co-pay $40 co-pay $60 co-pay Level 3 - Non-Preferred Brands $80 co-pay $80 co-pay $120 co-pay Level 4 - Specialty Drugs 1 Vantage covers 31-day supply at retail $60 co-pay 30-day limit 20% co-insurance 25% co-insurance

30 PPO Plan Overview Plan Member Out-of-Pocket Expenses (Jan. 1 Dec. 31, 2012) Humana United Healthcare PPO PPO Lifetime Maximum Unlimited Unlimited Deductible (Calendar Year) $0 $0 Out-of-Pocket Maximum $3,400 $1,800 Inpatient Hospital Care $180 co-pay $180 co-pay Per Day 1, 2 per day (days 1-5) per day (days 1-5) Outpatient Hospital Care Surgery/Anesthesia/X-ray Ambulatory Surgical Facility Doctor Visits Primary Care/Specialist 20% co-insurance 20% co-insurance 20% co-insurance $0 co-pay to 20% co-insurance 20% co-insurance 20% co-insurance $15/$30 co-pay $15/$30 co-pay 1 Semi-private room, ancillary services & doctor visits 2 Some services may require pre-certification

31 PPO Prescription Drug Coverage Plan Member Out-of-Pocket Expenses (Jan. 1 Dec. 31, 2012) Formulary Retail (30-day supply) Humana PPO Open UnitedHealthcare PPO 100% of all Medicare-approved drugs and bonus drug list Level 1 - Generic Drugs $5 co-pay $5 co-pay Level 2 - Preferred Brands $35 co-pay $25 co-pay Level 3 - Non-Preferred Brands $60 co-pay $50 co-pay Level 4 - Specialty Drugs $80 co-pay $50 co-pay Mail Order (90-day supply) Level 1 - Generic Drugs $0 co-pay $10 co-pay Level 2 - Preferred Brands $70 co-pay $50 co-pay Level 3 - Non-Preferred Brands $120 co-pay $100 co-pay Level 4 - Specialty Drugs $80 co-pay 30-day limit $100 co-pay

32 OGB Medicare Advantage Plans Prescription Drug Coverage All OGB Medicare Advantage plans provide coverage in the gap or donut hole Plan member pays applicable co-pays for prescription drugs (at all levels) After $4,700 of eligible out-of-pocket prescription costs in a calendar year, co-pays are $2.60 for generic drugs and $6.50 for brand name drugs or 5% co-insurance, whichever is greater Plans vary, with open and closed formularies for prescription drugs

33 Humana HMO Key Features Wide choice of doctors, specialists and hospitals in network No referral needed to see a network specialist Emergency coverage anywhere in the world Silver Sneakers program Full fitness club benefits at participating locations Special exercise classes at no cost Smart Summary Personalized monthly summary Personalized monthly summary Detailed claims and cost information Includes medical services and prescription drugs

34 Humana HMO Low monthly premium Advantages Weigh costs and benefits Humana s stability 48-year company history Current financial position as Fortune 100 company

35 Peoples Health HMO-POS Key Features 100% hospitalization coverage 0% co-pay! $0 co-pay for X-rays, MRIs, CT scans & labs Vision benefit free glasses or contacts each year Dental coverage including dentures up to $1250 per year Free health club membership

36 Peoples Health HMO-POS Advantages Largest Louisiana-based Medicare Advantage company Coverage for services from any provider you choose Personalized service from representatives based in southeast Louisiana Stability and experience we have continuously served Louisiana Medicare beneficiaries since Medicare Advantage was introduced d Peoples Health was awarded the 2011 Senior Choice Gold ldaward for Excellence in Medicare Benefits Value in Baton Rouge and New Orleans markets

37 Vantage HMO-POS Key Features #1 OGB Medicare Advantage plan for Louisiana state retirees by enrollment Great customer service from a Louisiana-based member service call center Plan offered statewide Access to out-of-network providers through point-of-service of (POS) option

38 Vantage HMO-POS Advantages Low monthly premium m with no deductible $0 generic drug co-pays $5 primary care physician co-pays Smoking cessation and wellness programs available No separate bills from pathologists, t radiologists i and anesthesiologists Speak with a live person every time you call Vantage Member Services

39 Humana PPO Key Features Provider network spans 23 states Preventative office visits covered Prescription mail order program offers generic drugs at $0 co-pay Smart Summary Personalized monthly summary Detailed claims and cost information Includes medical and prescription drug services

40 Humana PPO Advantages Available in 23 states Low monthly premium Weigh costs and benefits Humana s stability 48-year company history Current financial position as Fortune 100 company

41 UnitedHealthcare PPO Key Features A A company you know and trust Nation s largest Medicare insurer serving 1 out of every 5 people eligible for Medicare You don t have to change providers national network withnodifferenceincosttoyou in cost to in or out of network Dedicated Customer Service team No referrals or prior authorizations required More affordable health care $1,800 annual limit on out-of-pocket expenses, then covered at 100% Lab, X-ray and preventive care covered at 100% 100% Medicare-covered medications, with bonus medications covered Access to 60,000 pharmacies including CVS, Target, Walmart, Walgreens and other national chains with optional mail order service Silver Sneakers fitness benefit included at no additional cost

42 UnitedHealthcare PPO Low monthly premiums No deductible! Advantages In-network network and out-of-network of costs are the same No difference in cost to you for in-network or out-ofnetwork benefits Broadest provider network in and out of Louisiana continue to see any provider who accepts Medicare Silver Sneakers fitness program at no additional cost One ID card Exceptional customer service

43 For More Information OGB Medicare Advantage HMO Plans Humana HMO Peoples Health HMO-POS Vantage HMO-POS OGB Medicare Advantage PPO Plans Humana PPO UnitedHealthcare PPO OGB Standard Plans OGB Customer Service TDD (hearing impaired) OGB Website (OGB s home page includes quick links to all OGB health plans)

44 Life Insurance 44

45 Life Insurance Prudential Insurance Co. of America Group term life insurance State pays half of monthly premium for retiree life insurance coverage Retiree pays monthly premium for dependent life insurance coverage 25% reduction in coverage with appropriate reduction in premiums on July 1 after reaching age 65 and age 70

46 Life Insurance Accidental death and dismemberment (AD&D) benefits available to all active and retired employees covered by Basic or Basic Plus plan Retirees over age 70 not eligible ibl for AD&D ALL life insurance changes and inquiries ALL life insurance changes and inquiries must be made through your former agency s Human Resources office

47 Questions?