Health Options Program

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1 Pennsylvania Public School Employees Retirement System (PSERS) Health Options Program NEWS For Retirees Eligible for Premium Assistance Winter 2015 The DANGER of Food Allergies A food allergy is a serious medical condition that affects about 15 million Americans. Your immune system keeps you healthy by fighting infections and other dangers to your health. However, if you have a food allergy, it means your immune system mistakenly targets the food as a danger and triggers a protective response, which includes producing large amounts of an antibody called immunoglobulin E (IgE for short). In response to the danger, IgE antibodies release histamine and other chemicals, which trigger the symptoms of an allergy. Allergic reactions range from mild to severe, including the potentially life-threatening condition called anaphylaxis. Anaphylaxis can occur within seconds or minutes of exposure to the allergen. In the U.S., food allergy symptoms send someone to the emergency room every three minutes. Since food allergies cannot be cured, the best way to manage one is to avoid the food that causes you problems. In the U.S., eight foods account for 90 percent of all food allergies: Peanuts Tree nuts (e.g., pecans, walnuts, almonds, and cashews) Milk Egg Wheat Soy Fish (e.g., bass, flounder, cod) Shellfish (e.g., crab, lobster, shrimp) The federal government requires manufacturers to identify the presence of any of these foods. If you or a family member has a food allergy, it is important that you read all food labels each time you shop. Keep in mind that ingredients change from time to time. A food that was safe in the past may no longer be so. Surprising Sources Some foods contain allergens that are not easily recognized. For example, eggs have been found in egg substitutes, macaroni and marshmallows; peanuts, in hot sauces and pesto, egg rolls, glazes and marinades. If you have a milk allergy, beware of deli meat slicers that are also used for cheese. Some canned tuna and even medications contain milk protein. One of the strangest offenders is the pink peppercorn, an ingredient used in a variety of spices. Despite the name, it is not a peppercorn at all, but a dried roasted berry related to the cashew and extremely dangerous to anyone with a tree nut allergy.

2 WHY JOIN THE HEALTH OPTIONS PROGRAM Age 65 Discount. If you enroll in the HOP Medical Plan within 180 days of your 65th birthday, you will pay a discounted premium. Substantial Premium Subsidy. If you are eligible for Premium Assistance and enroll in the Health Options Program, you can receive up to $100 per month in Premium Assistance from PSERS to help pay for health care coverage. Designed with You in Mind. The Health Options Program is sponsored by the Pennsylvania Public School Employees Retirement System (PSERS) for the exclusive benefit of our retirees and their families. It provides comprehensive medical and prescription drug coverage at competitive rates. We work hard to provide you with health care coverage that meets your needs. Choice. The Program offers a choice of medical and prescription drug coverage options for both Medicareeligible and non-medicare-eligible participants. Convenience. We make paying monthly premiums easy by deducting them automatically from your retirement benefit (as long as your benefit exceeds the premium cost). Flexibility. You can change your option each year starting in early October during the Option Selection Period. You can also enroll, add dependents, or change your option at any time if you or one of your dependents experience a Qualifying Event (see below). SilverSneakers. If you enroll in the HOP Medical Plan or the HOP Pre-65 Medical Plan, you can join the SilverSneakers Fitness Program at no additional cost. SilverSneakers offers treadmills, weights, heated pools, and fitness classes all included with your basic fitness membership. To find a location near you, go online to Access to Resources. You have access to health care information to help you make informed health care decisions and lead a healthier lifestyle. You will receive newsletters and booklets to help you make the most of your participation. Customer service representatives are specially trained and dedicated to helping participants. You can reach one by calling weekdays from 8 a.m. to 5 p.m EST. A website ( is accessible 24 hours a day, 7 days a week. Examples of Qualifying Events You retire or lose health care coverage under your school employer s health plan. Coverage under your school employer s health plan includes any COBRA continuation coverage you may elect under that school employer s plan. You involuntarily lose health care coverage under a non-school employer s health plan (which includes any COBRA continuation coverage you may elect under that non-school employer s health plan). You or your spouse reach age 65 or become eligible for Medicare. There is a change in your family status (including divorce, your death or death of a spouse, addition of a dependent through birth, adoption, or marriage, or a dependent loses eligibility). You become eligible for Premium Assistance due to a change in legislation. A plan approved for Premium Assistance terminates or you move out of a plan s service area. Depending on individual circumstances, Qualifying Events may apply independently to you, your spouse, and/or your dependents. For example, if your spouse turns age 65 and becomes eligible for Medicare, he or she can choose to enroll in the Health Options Program, whether or not you also enroll. 2

3 QUICK NOTES New, Must-See Video from the Health Options Program Want to see a lively, easy-to-follow introduction to Medicare and the Health Options Program? Go online to HOPbenefits.com and click on the video link that appears on the home page. A brief (under six minutes), animated video will walk you through your options when you become eligible for Medicare. You ll learn about the basic differences between a Medicare Supplement plan and a Medicare Advantage plan both of which are available to you under the Health Options Program. After you watch the video, please be sure to answer the short online survey that follows it. We re interested in your feedback! Open Enrollments Periodically, the Health Options Program conducts an Open Enrollment in the fall instead of an Option Selection Period. During an Open Enrollment, current members can change plans (just like during an Option Selection Period) plus eligible nonmembers can join the Health Options Program without a Qualifying Event. The Health Options Program notifies all PSERS retirees well in advance of an Open Enrollment. It s Flu Season If you haven t had a flu shot, now s the time to get one. According to the Centers for Disease Control (CDC), it s not too late. The flu generally peaks in January or February and can still be around in March, April, and May. High Scores for the Rx Options Each year, Medicare evaluates prescription drug plans based on customer service, the frequency of member complaints, overall member satisfaction, and patient safety--and awards a star rating to each plan based on performance. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. For 2015, the Basic and Enhanced Medicare Rx Options offered under the Health Options Program were awarded 4.5 out of a possible 5 stars. Nationwide, only 29 of the nearly 500 plans included in Medicare s review ranked higher. LA Fitness Joins SilverSneakers LA Fitness, with about 600 locations in 29 states, is joining the SilverSneakers network of fitness facilities. This fast-growing chain of sports clubs is known for its state-of-the art facilities and offers a wide range of amenities and a highly trained staff. To find an LA Fitness or other participating SilverSneakers facility near you, go online to or call the HOP Administration Unit. 3

4 2015 Medicare Highlights Each year, if needed, the Centers for Medicare and Medicaid Services (CMS) adjusts Medicare s premiums, deductibles, and copayments. As a reminder, Medicare Part A covers hospital expenses and Medicare Part B covers other types of medical expenses, including physician services, certain home health services, and durable medical equipment. Part B Premium and Deductible Are Not Changing Most people do not pay a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes while working. However, to be covered under Medicare Part B, you must pay a monthly premium (in most cases deducted from your Social Security benefit). As required by law, the standard monthly premium is set each year at 25% of the cost for senior beneficiaries. The government pays the remaining 75%. Most Medicare beneficiaries will continue to pay the same Part B premium in 2015 as in If your annual income was less than $85,000 (or $170,000 for joint filers) in 2013, your Part B premium remains at $ a month in New Medicare beneficiaries with annual income above $85,000 (or $170,000 for joint filers) may pay a higher Part B premium. The Part B deductible ($147) is also remaining the same in This is the amount you must pay for health care before Medicare begins to pay for covered services and products. The chart below compares some of your costs in 2015 to Note that the HOP Medical Plan pays your Part A deductible and coinsurance for stays in hospitals and skilled nursing facilities, as well as the Part B deductible. AMOUNT YOU PAY (WITHOUT SUPPLEMENTAL INSURANCE) Part A First-day hospital deductible $1,216 $1,260 Coinsurance for days 1-60 of a hospital stay $0 $0 Coinsurance for days of a hospital stay $304/day $315/day Coinsurance for days 1-20 of a stay in a skilled nursing facility $0 $0 Coinsurance for days of a stay in a skilled nursing facility $152/day $157.50/day Part B Standard monthly premium $ $ Deductible $147 $147 Coinsurance 20% 20% 4

5 Usual and Not-So-Usual Ways to Fight the Common Cold In many parts of the world, it s the height of cold and flu season. While your symptoms may be the same whether you re in Pittsburgh, Paris or Pyongyang, your attempts at relief may depend on where you live. For many Americans, remedies include rest, hot liquids, steamy showers, and gargling. Plenty of over-the-counter medications are also available to bring symptom relief and speed recovery. However, cold sufferers in other parts of the world may not be quite so sure that chicken noodle soup is the answer. Here are some local practices for fighting the sniffles. One rather simple folk cure involves greasing your throat with chicken fat or lard and wrapping it with a dirty sock. Although the history (and therapeutic value) are unclear, the practice may have originated in England where socks around the throat were used in the olden days to label people with potentially fatal throat ailments as a warning to keep your distance. According to a Russian legend, when a Jewish cantor named Gogol caught a cold and lost his voice many years ago, only a concoction of raw eggs, wine and sugar restored his singing ability. A common recipe today for this cure now known as Gogol- Mogol calls for whisking together an egg yolk with a teaspoon of honey or sugar and then pouring the mix into a half-cup of milk that has been heated with a tablespoon of unsalted butter. + + = Grandmothers in Hong Kong are likely to favor lizard soup over chicken in fighting the common cold. Besides dried lizards, the recipe typically calls for yam and Chinese dates simmered in water. Thai and Indonesian versions of the cure-all soup use an oxtail as its base. The Thais add chili peppers; the Indonesians fry or barbecue the tails first. A plate of cooked, mashed turnips is often served to a cold sufferer in Iran. Indians with the sniffles drink haldi ka doodh: milk laced with a hefty dose of antioxidantrich turmeric (a flavorful herb), as well as some ginger, honey, and black peppercorns. Many Europeans and Israelis believe in the power of the onion. An old folk medicine-practice is to down sugar- or honeycoated slices or chunks of onion. If you have a cold or the flu, be sure to talk to your doctor about remedies that are best for you. 5

6 HOP Administration Unit P.O. Box 1764 Lancaster, PA Understanding Food Allergies Have a Question? If You Have a Question About Please Call Or Go Online Enrollment in the Health Options Program Health Options Program in general HOP Administration Unit PSERS25 ( ) 8 a.m. to 5 p.m. eastern time, weekdays Health Options Program Website Premium Assistance Premium Assistance Office a.m. to 4:30 p.m. eastern time, weekdays Retirement PSERS PSERS4U ( ) 7:30 a.m. to 5 p.m. eastern time, weekdays PSERS Website Medicare Medicare MEDICARE ( ) Medicare Website