2019 RETIREE MEDICAL PLAN Information Session

Transcription

1 2019 RETIREE MEDICAL PLAN Information Session

2 Freedom, Journey & Retiree National Choice Freedom, Journey & Retiree National Choice Program Name U of M Retiree Plan with Group reblue SM Rx re Supplement Group Plan F (High Deductible) with Group reblue SM Rx Freedom Plan, Journey Plan & Retiree National Choice Freedom Plan, Journey Plan & Retiree National Choice Type of Policy Coordinates with re and includes re Prescription Drug Plan re Supplement Plan with re Prescription Drug Plan - re Cost Plan with re Prescription Drug Coverage - Prescription Drug Plan with a re contract - re Advantage Plan Monthly Premium $ $ $ $ How Plan Works with re and re Assignment U of M Retiree Plan pays after applying U of M Retiree Plan inpatient deductible and coinsurance. You pay re Part B annual deductibles. re pays first. You pay Part A and B deductibles and/ or coinsurance until you meet your Plan F (High Deductible) - $2,240 (2018); then plan pays 100%. Deductible may change in Freedom - In general, re pays primary for Part A services. pays Part B provider expenses. Retiree National Choice - re pays primary for A and B. pays secondary. Journey - is responsible for all re expenses. re Assignment You are encouraged to use BCBS network providers, but you do not assign your re benefits to Blue Cross. You are allowed to use your re benefits outside of the BCBS network. You can use any recontracted provider nationwide. Freedom members are encouraged to use network providers, but are able to use re benefits outside of the Freedom network. Retiree National Choice members may see any provider who accepts re. Journey members must see providers in our re Advantage network. Out-of-network benefits are available. Outpatient Hospital Outpatient Surgery 100% 100% after $75 copay Lab/X-Ray, CT scan, MRI, other outpatient diagnostic tests 100% of remaining balance after re Part B deductible is met Lab services at 100% and all other services at $15 Lab services at 100% and all other services at $30 copay Emergency Services 100% after $50 copay 100% after $100 copay Ambulance 100% 80% 2 Open Enrollment

3 Program Name Group Group Group re Group re Type of Policy re Cost Plan with re Prescription Drug Coverage or re Advantage PPO plan with re Prescription Drug Coverage re Cost Plan with re Prescription Drug Coverage or re Advantage PPO plan with re Prescription Drug Coverage re Advantage Plan including Prescription Drug Coverage re Advantage Plan including Prescription Drug Coverage Monthly Premium $ $ $ $ How Plan Works with re and re Assignment Cost: re pays primary for Part A inpatient hospital, skilled nursing facility, and home health care expenses. pays re Part B provider expenses. re Advantage: pays primary for Part A hospitalization and Part B provider expenses. Cost: re pays primary for Part A inpatient hospital, skilled nursing facility, and home health care expenses. pays re Part B provider expenses. re Advantage: pays primary for Part A hospitalization and 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 Cost Plan: 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. re Advantage Plan: You can see any provider that accepts re assignment. Cost Plan: 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. re Advantage Plan: You can see any provider that accepts re assignment. Travel anywhere within the U.S. and pay only your in-network copay on routine care, including clinic and specialist visits, physical therapy and counseling services through s Point-of-Service benefit. You may see any provider that accepts re. will also cover 80% of many other services throughout the U.S. 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 Open Enrollment 3

4 Urgent Care Visit Part B annual deductible $183 for 2018/subject to change for % after $15 copay 100% after $30 copay Inpatient Hospital Plan pays 80% of first $2,900 of total allowed amount following $100 annual inpatient deductible; then 100% through end of calendar year. Out-of-pocket expense limited to $680 per year including $100 deductible. No limit on number of days covered by plan 100% 100% after $200 copay per visit Skilled Nursing Plan pays 80% of first $2,900 of total allowed amount following $100 annual inpatient deductible; then 100% through end of calendar year. Out-of-pocket expense limited to $680 per year including $100 deductible. No 3-day hospital stay requirement 100% after 3-day hospitalization for up to 100 days per benefit period after deductible 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 Mental Health Plan pays 80% of first $2,900 of total allowed amount following $100 annual inpatient deductible; then 100% through end of calendar year. Out-of-pocket expense limited to $680 per year including $100 deductible is satisfied up to 190 days of inpatient psychiatric hospital care in a lifetime. This limitation does not apply to inpatient psychiatric services furnished in a general hospital 100% 100% after $200 copay per visit Chemical Dependency Plan pays 80% of first $2,900 of total allowed amount following $100 annual inpatient deductible; then 100% through end of calendar year. Out-of-pocket expense limited to $680 per year including $100 deductible 100% 100% after $200 copay per visit Outpatient l Preventive 100% 100% 100% Physician Office Visit Part B annual deductible $183 for 2018/subject to change for % after $15 copay 100% after: Primary Care $20 copay/ Specialist $30 copay 4 Open Enrollment

5 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 Open Enrollment 5

6 tions Delivered in Physician Office Setting and Paid under re Part B 100% after $15 copay (If Part B drugs are billed separately, coverage is 80%) 100% after Primary Care $20 copay/specialist $30 copay (If Part B drugs are billed separately, coverage is 80%) Routine Eye and Hearing Exams 100% No coverage 100% 100% Outpatient Mental Health 100% after $15 individual/ $7.50 group 100% after $30 individual/ $15 group Outpatient Chemical Dependency 100% after $15 copay 100% after $30 copay Chiropractic Care 100% 100% after $30 copay Podiatry 100% after $15 copay 100% after $30 copay Physical & Occupational Therapy 100% after $15 copay 100% after $30 copay Speech & Language Therapy 100% after $15 copay 100% after $30 copay Home Health Care 100% 100% l Equipment DME Prosthetics 90% 80% Hearing Aids No coverage. Discounts available. 80% coverage for 1 selected hearing aid for each ear every 3 years. No implantable devices No coverage. Discounts available 6 Open Enrollment

7 tions Delivered in Physician Office Setting and Paid under re Part B Routine Eye and Hearing Exams Outpatient Mental Health Coverage is 80% Coverage is 80% 80% covered 80% covered 100% 100% 100% 100% 100% after $15 copay 100% after $30 copay 100% after $15 copay 100% after $30 copay Outpatient Chemical Dependency 100% after $15 copay 100% after $30 copay 100% after $15 copay 100% after $30 copay Chiropractic Care 100% after $15 copay 100% after $20 copay 100% 100% Podiatry 100% after $15 copay 100% after $30 copay 100% after $15 copay 100% after $30 copay Physical & Occupational Therapy 100% after $15 copay 100% after $30 copay 100% after $15 copay 100% after $30 copay Speech & Language Therapy 100% after $15 copay 100% after $30 copay 100% after $15 copay 100% after $30 copay 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 Open Enrollment 7

8 Prescription Drugs Generic Drugs Retail $10 copay $10 copay $10 copay Preferred Generic - $10 copay Non-preferred Generic - $20 copay Formulary Brand Drugs Retail Non-preferred Formulary Brand Retail $30 copay $25 copay $30 copay $35 copay $50 copay $60 copay $30 copay $70 copay Specialty Drugs $50 copay Participants will pay 25% coinsurance $50 copay 75% coverage Supplemental Drugs Participants will pay 25% coinsurance Participants will pay 25% coinsurance Covered at generic and brand copays shown above Covered at generic and brand copays shown above Mail Order 3-month supply for 2 copays through mail order or if using Preferred Extended Network (PXT) within Group reblue Rx pharmacy network 3-month supply for 2 copays through mail order or if using Preferred Extended Network (PXT) within Group re- Blue Rx pharmacy network 3-month supply for 2 copays 3-month supply for 2 copays Benefits in the re Coverage Gap (Between $3,820 total prescription costs and $5,100 total outof-pocket expenses) 100% coverage after $10 generic copay, $30 brand copay or $50 non-preferred brand and specialty copays. 25% coinsurance for supplemental drugs 100% coverage after $10 generic copay, $25 brand copay or $60 non-preferred brand copay. 25% coinsurance for specialty and supplemental drugs 100% coverage after $10 generic, $30 brand, or $50 specialty copay 100% coverage after $10 or $20 generic copay. Participants will pay 35% coinsurance for their brand or specialty medications Catastrophic Level (after $5,100 in total out-of-pocket expenses) Member cost will be the greater of $3.40 for covered generic or multisource preferred brand drugs and $8.50 for all other covered drugs, or 5% of the cost of the drug Member cost will be the greater of $3.40 for covered generic or multi-source preferred brand drugs and $8.50 for all other covered drugs, or 5% of the cost of covered drugs The lesser of 5% or the above copays Member cost will be the greater of 5% of drug cost or $3.40 copay for generic drugs, and $8.50 copay for brand/ formulary drugs Wellness Benefits Fitness Club Membership Fitness discount that credits your fitness center account $20 a month for membership fees when you work out 12 times a month Silver & Fit Exercise and Healthy Aging Program provides a fitness club membership at participating facilities or home exercise kits Fitness club membership provided at no cost for participating facilities. You may also request a home exercise kit. Nurseline 24-hour Nurse Line 24-hour Nurse Line Free access to registered nurses 24/7 through the CareLine SM nurse line Other Wellness Benefits Stop Smoking Program Wellness Discount Marketplace blue365deals.com/bcbsmn Stop Smoking support Wellness Discount Marketplace blue365deals.com/bcbsmn Free, unlimited number of virtuwell visits for Freedom and Journey Plan members. Available for a fee to Retiree National Choice members. Healthy discounts on hearing aids, eating services, delivery services, fitness equipment and much more Up to 35% discount off eyewear 8 Open Enrollment

9 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 Coverage Gap (Between $3,820 total prescription costs and $5,100 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. Participant will pay 25% for brand and specialty drugs. (counts toward the OOP max.) Catastrophic Level (after $5,100 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 $3.40 copay for generic drugs and $8.50 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 $3.40 copay for generic drugs and $8.50 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 $15 Community Education Class reimbursement three classes per year, My Health Decisions Online Tool Hearing Aid Discount program $150 Annual Eyewear allowance Quit Smoking, plus Disease and Case Management Programs Falls Prevention Program Mammogram Incentive Programs Open Enrollment 9

10 Travel and Out-of-Area Benefits Travel benefits No limitations No Limitation Broad-based travel benefits available for up to 9 consecutive months. Broad-based travel benefits available for up to 9 consecutive months. Option to live outside of service area Yes Yes Yes, through Retiree National Choice Yes, through Retiree National Choice Maximums Annual Out-of-Pocket $863 that includes $680 plus $183 (for 2018) Part B deductible (Pharmacy copays do not apply). Part B deductible subject to change in 2019 Annual deductible amount ($2,240 in 2018). Deductible amount subject to change in Pharmacy copays do not apply. $3,000 (Pharmacy copays do not apply) $3,000 (Pharmacy copays do not apply) Lifetime Unlimited Unlimited Unlimited Unlimited 10 Open Enrollment

11 Plan features Travel and Out-of-Area Benefits Travel benefits You can see any provider that accepts re assignment while out of the service area. You can see any provider that accepts re assignment while out of the service area. Members may be out of service area for up to 6 consecutive months. Emergency benefits apply. 80% coverage for non-emergency services anywhere in the U.S. $100,000 plan benefit maximum; $10,000 OOP maximum. Out-of-Network physician office visits will be covered with in-network office visit copayments. Members may be out of service area for up to 6 consecutive months. Emergency benefits apply. 80% coverage for non-emergency services anywhere in the U.S. $100,000 plan benefit maximum; $10,000 OOP maximum. Out-of-Network physician office visits will be covered with in-network office visit copayments. Option to live outside of service area No No No No Maximums Annual Out-of-Pocket $1,000 on l (Pharmacy copays do not apply) $3,000 on l (Pharmacy copays do not apply) $3,400 l Out-of- Pocket Maximum (Pharmacy copays do not apply) $3,400 l Out-of-Pocket Maximum (Pharmacy copays do not apply) Lifetime Unlimited Unlimited Unlimited Unlimited 2019 Monthly Premium (includes premium for re Part D) l Plan U of M Retiree Plan re Supplement Group Plan F High Deductible Journey, Freedom Plan and Retiree National Choice Group Plan Cost per person* Plan 1: $ Plan 2: $ Plan 1: $ Plan 2: $ Plan 1: $ Plan 2: $ Group re Plan 1: $ Plan 2: $ * Retiree, spouse, surviving spouse, and participant on disability status with re Part A and Part B Open Enrollment 11

12 U of M Retiree Plan Toll Free: TTY: Call the National Relay Center at 711 and ask for re Supplement Group Plan F (High Deductible) with Group reblue Rx Toll Free: Current Members Prospective Members TTY: Call the National Relay Center at 711 and ask for Prescription Pharmacy for BCBS: Group reblue Rx Telephone: TTY: Group Plan U of M Plans 1 & 2 Telephone: Toll Free: TTY: Please call the National Relay Center at and ask for Group re U of M Plans 1 & 2 Telephone: Toll Free: TTY: TTY: Groupsales@ucare.org Contact Center Telephone: Toll Free: humanresources.umn.edu/benefits Journey, Freedom and Retiree National Choice U of M Plans 1 & 2 Telephone: Toll Free: TYY: Call the National Relay Center at 711, Then ask for Open Enrollment