Insurance Trust for Delta Retirees (ITDR) Q&A following the October 18, 2017 BCBSGA Medicare Advantage PPO Webinar Is the Medicare Advantage plan an HMO? Answer. No, the Medicare Advantage plan is a PPO (Preferred Provider Organization). Referrals from a Primary Care Physician are not require to see a specialist. What is the premium and subsidy for the Medicare Advantage plan? Answer: You may find premium amounts in the ITDR Benefit Guide on page 36 and the 2018 Subsidies on page 37. Subsidies do apply to either Medical Plan option. The ITDR Benefit Guide is in your annual enrollment packet, or you may also find it online at itdr.com/enrollment. Which day of the month are premiums billed? Answer: If you pay with electronic funds transfer, billing takes place on the 5th business day of the month. Please call the Trust Retiree Service Center with additional questions, at 1-877-325-7265 Option 1. Can monthly premiums be paid online? Answer: Please call the Trust Retiree Service Center with billing and premium payment questions, at 1-877-325-7265, Option 1. My spouse and I are both retirees, is it less expensive if we enroll as retiree + spouse or both as retirees? Answer: Please call the Trust Retiree Service Center with billing and premium payment questions, at 1-877-325-7265, Option 1. Do we have to continue to pay Medicare? Answer: Yes, you must continue to pay your Medicare premiums. Are we able to change medical plans in the future? Answer: Yes, you can change medical plans during the next Enrollment period. However, if you enroll and then leave the ITDR plan, you are not allowed to re-enroll at a later date. If I have coverage elsewhere, can I enroll in the Medicare Advantage plan without evidence of insurability? Answer: Yes, if you have never before enrolled in the ITDR medical plan, you can enroll now with no evidence of insurability. Please contact the Retiree Service Center at 1-877-325-7265 Option 1 with additional enrollment questions. Can the retiree and spouse choose different medical plans? Answer: Yes, married ITDR members may make individual elections for medical or dental, and options may be changed annually.
Are there any limitations for existing conditions? Answer: No, there are no pre-existing condition restrictions. If I choose the Medicare Advantage plan, will my dental, vision or pharmacy plan change? Answer: No, the dental, vision & pharmacy carriers will remain the same for 2018. The dental, vision & pharmacy options are all listed in the ITDR Benefit Guide or you may visit itdr.com. For additional assistance, please call the Trust Retiree Service Center at 1-877-325-7265, Option 1. Do I have to enroll in the pharmacy plan through ITDR? Answer: Enrollment in ITDR's medical Plan and Prescription Drug Plan are a combined election. Medical Only is only available if you are receiving Rx coverage through the VA/Tricare. Please contact the Retiree Service Center at 1-877-325-7265 Option 1 with additional enrollment questions. I will be turning 65 in 2018, what will the process be? Answer: You will receive a Pre Enrollment kit approximately 90 days prior to becoming Medicare eligible. Do I have to live in a certain area or state to enroll in the Medicare Advantage plan? Answer: No, you may reside in any of the 50 states, Washington D.C. or Puerto Rico to be eligible to enroll in the Medicare Advantage plan. What applies to the Medicare Advantage Out of Pocket Maximum? Answer: All medical copays and coinsurance listed in the Medicare Advantage benefit chart are accrued toward the medical plan out-of-pocket maximum with the exception of the foreign travel emergency and urgently needed care deductible or coinsurance amounts. Plan premiums and your Part D prescription costs do not apply to your Out of Pocket maximum. The out of pocket maximum applies to each enrolled member. Why is the Out of Pocket maximum so high? Answer: The BCBSGa option was added to provide ITDR members with a choice that offered lower monthly premiums. The benefits were designed to obtain the low monthly cost. Benefits should be reviewed carefully to determine the member share impact for your individual needs under each plan. Click here to view the BCBSGa plan detail on the ITDR website. Is there a maximum annual or lifetime benefit limit? Answer: Yes, once the out of pocket maximum is met, you will have no cost share for covered services for the remainder of plan year. The exception to this is for the foreign travel benefits, which are limited to a $100,000 maximum benefit per lifetime. What is coinsurance? Answer: It is a percentage that the member is responsible for vs. a set copay. For instance, if there is a 10% coinsurance percentage, you would be responsible for 10% of the allowed amount for that service.
Can you explain Part B Excess Charges on page 15 of the Resources guide? Answer: With in-network providers, the coinsurance percentage is applied to the contracted rate agreed to by BCBSGa and the provider. With out-of-network providers, the coinsurance percentage is applied to the Medicare allowable charge. Out-of-network providers can charge 15% above the Medicare allowable rate this is called the limiting or excess charge. In the rare situation that this occurs, Trust Plan Members would be responsible for 10% of the additional amount. Example: The allowed amount is $400. The doctor would be able to charge 15% higher than the $400, in this case roughly $60 additional to the original $400 already approved by Medicare. The BCBSGa plan will pay 90% or $54 and the member will pay the 10% coinsurance or $6. Does the provider get paid the same by Medicare and Medicare Advantage? Answer: The provider agrees to accept BCBSGa s contractual terms of payment. The payments may vary from Medicare s original payment amount. If our Primary Care Physician is not in the BCBSGa network, how do we pay the copay? Answer: The Plan will process and pay the claim assuming you paid the copay to the provider at the time of service. If you did not pay the copay at the time of service, the provider will likely bill you for the copay when they receive the Explanation of Benefits from BCBSGa. Which fitness centers are included in the Silver Sneakers program? Answer: You may visit silversneakers.com for a list of participating fitness centers in your area. Trust Medical Plan Members should visit silversneakers.com or call 1-888-423-4632 (TTY: 711), Monday through Friday, 8:00am to 8:00pm EST. Is there a charge for Silver Sneakers? Answer: No, once you are enrolled in the Medicare Advantage plan, the fitness center should not be charging you a fee. If that happens, you should contact Member Service for assistance. Trust Medical Plan Members should visit silversneakers.com or call 1-888-423-4632 (TTY: 711), Monday through Friday, 8:00am to 8:00pm EST. What do I have to pay for the online doctor? Answer: There is a $0 copay for video doctor visits. There is a maximum allowance of $49 for each visit with a board-certified doctor and a maximum allowance of $80 for each visit with a therapist and $95 for each visit with a psychologist. After the plan pays the benefits for video doctor visits, you are responsible for the remaining cost. If your online visit is with LiveHealth Online, the maximum allowance equals the charge, so you would owe nothing. If you use another online service you may owe the difference between the maximum allowed amount and the charged amount. Can you explain the "$49 per visit for all others" comment on the presentation under online doctor visits? Answer: The $49 cost is for any person who is NOT a member of the BCBSGa Plan to have a LiveHealth Online medical visit. The example we used on the call was a visiting grandchild. The grandchild is not a member the ITDR/BCBSGa plan, but, can have a visit for $49.
How do I obtain a list of providers? Answer: A BCBSGa First Impressions representative is able to assist you with obtaining this information. Please contact First Impressions at 844-889-6356. Representatives are ready to assist you. Are in-network providers located in just Georgia or in all states? Answer: The service area includes all 50 states, Washington D.C and Puerto Rico. Is Piedmont and their doctors covered? Answer: Piedmont is not contracted, however, members have the same copays and coinsurance percentage whether the provider is in-network or out-of-network. The key is that the provider accepts Medicare. It sounds like BCBSGa prefers we use in network doctors, why? Answer: Choosing an in-network doctor adds efficiency to the process for everyone involved. The process to coordinate your care and plan your discharge follows a set protocol with in-network doctors. We follow these steps with out-of-network providers too, but, the process is already established with a BCBSGa in-network provider. You say you have a rigorous credentialing process and that when there is a chronic or critical care need for someone BCBSGa works closely with these doctors. Do you not do the same for out of network doctors? Answer: BCBSGa works with Out of Network doctors to manage patient s care and needs. Board certification is typically by specialty. Is the board certification you reference for "internal medicine" only, or are other specialties available? Answer: We believe this question was submitted during the LiveHealth Online portion of the presentation. LiveHealth Online offers a variety of board certified physicians, such as internal medicine, emergency, pediatricians, dermatology and many more. You can see each physician s credentials and details about their schooling and experience before selecting which physician you wish to see. The Resource Guide states (pg. 9) provider accepts Medicare AND the plan. Both are required? Answer: BCBSGa has contracts and payment channels in place with contracted providers, this adds efficiency to the process for everyone involved. However, members can see any provider, as long as they accept Medicare. Am I correct that if a provider doesn t accept Anthem then they wouldn t accept BCBSGa? Answer: That may not be true. You should use the BCBSGa.com provider finder for the Medicare Advantage PPO plan. You may also contact First Impressions at 844-889-6356 for assistance to determine if your provider is in or out-of-network.
I can visit any doctor, in any place that accepts Medicare regardless of whether he accepts BCBSGA is that correct? Answer: Yes, that is correct, members have the same copays and coinsurance percentage whether the provider is in-network or out-of-network. The key is that the provider accepts Medicare. What happens if my doctor accepts Medicare but does not want to deal with BCBSGa? Answer: Physicians and practitioners are required to submit claims on behalf of beneficiaries for all items and services they provide for which Medicare payment may be made under Part B. What types of providers are considered Primary Care Physician vs. Specialist? Answer: General Practice, Family Practice & Internal Medicine are considered Primary Care Physicians. All other providers are considered specialists. Is there a deductible on the Medicare Advantage plan? Answer: No, there is no deductible. Why would I want a plan with copay? Answer: The advantage to having a plan with copays is that you know what your cost share will be upfront. How often are claim statements sent out? Answer: You will receive an Explanation of Benefits (EOB) for each medical claim processed, as well as a monthly statement, as long as there is medical claims activity that month. Once enrolled, you may choose to elect electronic only EOBs through the BCBSGA.com website. What if a provider balance bills me? Answer: If you believe a provider has balance billed you, please call Member Services at the phone number on your ID card. Does Travel Assistance include international? Answer: Yes, Travel Assistance allows you to get the help you need when traveling 100 miles or more from home anywhere in the world, 24 hours a day/7 days a week. Travel Assistance does not cover the cost of your medical care while traveling but does aid you whenever you re traveling, by Finding a local doctor or hospital, receiving an emergency or other medical evacuation, replacing medications, and eyeglasses and more. If you are traveling with a dependent child and he or she is left alone because you are in the hospital, Travel Assistance can also help in getting them home. What is the best way to compare the differences between the two medical plans? Answer: We recommend you review the comparison pages in the ITDR Benefit Guide in your enrollment kit and also available on itdr.com/enrollment. It begins on page 12. For detailed questions, please call Hartford, BCBSGa, or a Personal Health Advocate.
What is the benefit of changing from the current plan to BCBSGa? Answer: The BCBSGa option was added to provide ITDR members with choice under the BCBSGa option, the member pays less in monthly premium. Benefits should be reviewed carefully to determine the member share impact for your individual needs under each plan. Click here to view the BCBSGA plan detail on the ITDR website. Why is your plan cheaper? Answer: The BCBSGa plan differs in coverage: copays, and coinsurance applies with a $5000 annual out of pocket maximum. Benefits should be reviewed carefully to determine the member share impact for your individual needs under each plan. Click here to view the BCBSGa plan detail on the ITDR website. Does BCBSGa have other Medicare Advantage plans outside of the ITDR plan and if so, can I find details including costs for those plans? Answer: Inquiries on individual plans offered outside the ITDR offering can be directed to 877-202-3632. Specific Benefit & Prior Approval Questions: Please refer to the benefit chart located in the BCBSGa Pre Enrollment guide located on the ITDR website click here or contact First Impressions at 844-889-6356. Representatives are ready to assist you.
Insurance Trust for Delta Retirees (ITDR) Q&A following the October 18, 2017 The Hartford Group Retiree Health Plan Webinar Is the Hartford Plan considered a Medicare Plan F supplemental plan? Answer: The Hartford plan is a group insurance plan specifically designed for ITDR and is a supplement to your existing Medicare Part A and Part B coverage. Does Hartford also offer a Medicare Advantage plan? Answer: No, The Hartford does not offer a Medicare Advantage Plan. Are there no co-pays? Answers: Correct, there are no co-pays on The Hartford plan. Once the plan deductible is met, the plan reimburses 50% of the remaining 20% of Medicare covered charges Please explain the $300 deductible and the 20% coinsurance that applies towards the out-of-pocket. Answer: The Medicare Part B deductible is applied to The Hartford $300 plan deductible and reduces the out-of-pocket maximum. After the $300 deductible is satisfied, coinsurance of 50% of the remaining 20% is applied until the $1,500 out of pocket maximum is reached. Is the $1500 out-of-pocket maximum combined for husband and wife? Answer: The annual out of pocket maximum is a per person maximum. Does the $300 deductible, all the 10% coinsurance payments and prescription costs apply to the $1,500 out-of-pocket maximum? Answer: The plan deductible and 10% coinsurance payments applies toward your annual out-ofpocket maximum of $1,500. Prescription drugs expenses do not apply to the out of pocket expenses.
If a provider is not a participating Medicare fee provider and performs a procedure and the reimbursement from Medicare to the provider for that procedure is less than what the provider charges, can the provider bill the patient? And if they can, does the Hartford plan cover half of that remaining charge? Answer: Part B Excess Charges are outlined on page 15 of the Benefit Guide. The plan covers the difference between the Medicare Part B approved amount and Medicare's 115%. The provider may NOT balance bill the patient. I thought anyone that accepts Medicare is required to accept the negotiated rates. How can they say they accept Medicare and then bill back to me for coverage? Answer: Providers may be accepting Medicare patients, however, they may not be a participating Medicare fee provider and have the option to bill more than the Medicare allowed amounts. The Hartford plan will cover the difference between the Medicare Part B approved amount and Medicare's 115% limiting fee. The provider may not balance bill the patient. Do you need prior approval for a procedure? Answer: No, The Hartford does not have a prior approval requirement, however, you should check with Medicare because a few procedures do requirement Medicare s prior approval. If Medicare does not require prior approval for the services and the services are approved by Medicare then they would be covered under the Hartford plan. If we enroll in the Medicare Advantage Plan for 2018 we can change back to the supplemental Plan with Hartford during Open Enrollment next year (for 2019) if we choose? Answer: Each year retirees and spouses receive an annual enrollment packet that will outline the plan options available to them. During the annual enrollment you are able to make changes in your plan. You will be able to switch between the medical plans during the annual enrollment with coverage being effective every January 1 of the following year. Can one change plans during the enrollment period at the end of the year if one is in the hospital? Answer: Members are able to make changes during the enrollment period even if they are in the hospital. The new benefits are effective the 1st of the following year.
Can you be enrolled in one plan and your spouse in another plan i.e. Husband in The Hartford plan and spouse in BCBSGa? Answer: Yes spouses can be enrolled in different medical plan options. Can a member opt in and out of the plans but still remain within the ITDR Trust each year? Answer: Yes as long as you remain in a medical plan you may switch back and forth between the BCBSGa plan and The Hartford plan, however, medical plan changes is only available during the open enrollment period. What I'm understanding here is that The Hartford is ONLY a Medicare supplemental insurance plan. I'm not enrolled in Medicare, other than part A, so I believe supplemental insurance is not available to me. Is this correct? Answer: The Hartford plan does supplement Medicare A & B. If you are not enrolled in Part B you would still be eligible for The Hartford plan; however, you would not receive Medicare s full benefits under the plan. The Hartford plan would pay as if Medicare Part B was in place and pay our normal liability on the services. Is there an increase in premiums? Answer: Premiums are listed for 2018 in your Benefit Guide on page 36. Your Benefit Guide is in your enrollment packet and may also be found on itdr.com/enrollment. Where do I find the monthly premiums? Answer: Premiums and enrollment information may be found the Benefit Guide, page 36, which was included in the Annual Enrollment packet. Packets were mailed to your home October 12. You can also find Premium/Rate information on the ITDR website, www.itdr.com. Does the subsidy apply equally to both The Hartford and the BCBSGa premiums? Answer: Yes, the subsidy amount applies in full to either ITDR Medical Plan option, regardless of which option you choose.
I was sent a quote for 2018 Hartford plan for me and spouse $91.02/ month. The guide says it should be $245.10; is this correct? Answer: You may be eligible for a subsidy from Delta - both spouse and retirees who meet specific criteria are eligible for a subsidy. You can locate the Delta Subsidy Eligiblity Guidelines on page 37 of the Benefit Guide or you can go to WWW.ITDR.com. Why are the premiums for the Hartford plan different than the BCBSGa plan? Answer: The plans offer different levels of coverage and need to be evaluated individually to fully understand the cost difference. Why should I remain with Hartford when BCBSGa monthly payment is lower? What is Hartford providing to make up the cost difference? Answer: It will be important for you to evaluate both plans and what is covered based on your specific health care needs. Each of the plans offer different levels of coverage and your specific needs should be considered to understand the cost differences. If you need assistance in making the evaluation, you may contact a Personal Health Advocate a 1-877-325-7265 option 2. Why would an individual choose a $5,000 out-of-pocket maximum plan versus a $1,500 out-of-pocket? Answer: The plans offer different levels of coverage and need to be evaluated individually to fully to understand the cost difference and how the plan would pay based on services being provided. A Personal Health Advocate can assist you with this evaluation. To contact a Personal Health Advocate call 877-325-7265 option 2. BCBSGa charges a 10% co-insurance; how would the Hartford be a better choice? Answer: The plans offer different levels of coverage and need to be evaluated individually to fully to understand the cost difference and how the plan would pay based on services being provided. A Personal Health Advocate can assist you with determining which plan options are best for you. Call 877-325-7265 option 2 to connect with a Personal Health Advocate.
I would think your plan decision would depend on how healthy or not you are and what your costs have been in the past, do you agree? Answer: It will be important for you to evaluate both plans and what is covered based on your specific health care needs. Each of the plans offer different levels of coverage and your specific needs should be considered to understand the cost differences. A Personal Health Advocate can assist you with this evaluation. You can contact them at 877-325-7265 option 2. The guide I received in the mail has different premiums for each of the plans, is this correct? Answer: Correct, the Medicare Advantage Plan and The Hartford Plan designed to supplement Medicare have different premiums and benefits. Where is the plan comparison chart in the booklet? Answer: Page 12 of the Benefit Guide. I'm covered through the VA. Is there any benefit of medical coverage The Hartford provides? Answer: It will be important for you to review your coverage under the VA and compare your VA coverage to what The Hartford plan covers. Health Advocate is able to assist you with this type of comparison to determine your best option at 877-325-7265 option 2. What is the rule when we enroll with regards to pre-existing conditions? Answer: Pre-existing limitations do not apply to either ITDR Medical Plan, Hartford or BCBSGa. Will Mercer continue to be the claims administrator? Answer: Yes, Mercer will continue to be the claims administrator for the Hartford plan. Are rehabilitation services after hospitalization, covered by the plan? Answer: Skilled nursing services approved by Medicare; will have the first 20 days covered by Medicare and The Hartford plan would cover additional days beginning on the 21st day through 100 days.
How would MRI's, PET Scans and Genetic Studies be covered? Answer: Hartford's plan supplements Medicare. Medicare approved Part B services would be considered eligible expenses under Hartford's Outpatient Medical expense benefit; subject to the $300 plan deductible and $1,500 out-of-pocket plan maximum. Medicare would have to approve and cover these services in order for them to be considered for payment under The Hartford Plan. Are 3-D mammograms & sonograms included in the annual breast exam? Answer: Hartford's plan supplements Medicare. If Medicare approves and pays the service then the Hartford s plan would also pay after the calendar year deductible is met. If services are considered preventive by Medicare, The Hartford s Plan would consider the services payable under the Preventive Medical Care benefit. If Medicare pays for a colonoscopy every 10 years for someone with no issues does The Hartford pay if I have it done sooner than 10 years? Answer: Hartford's plan supplements Medicare. If Medicare approves and pays the service then the Hartford s plan would also pay after the calendar year deductible is met. If services are considered preventive by Medicare, The Hartford s Plan would consider the services payable under the Preventive Medical Care benefit. Are chiropractic services included? Answer: Medicare only covers manual manipulation of the spine, if necessary, to correct a subluxation. Hartford's plan supplements Medicare. Medicare approved Chiropractic manipulations would be covered under Hartford s Part B Outpatient Medical benefit; subject to the $300 plan deductible and $1,500 out-of-pocket plan maximum. Do you cover acupuncture? Answer: Medicare does not cover acupuncture,therefore, services are not covered under the plans. Do you cover stem cell injections in knees for pain management? Answer: Hartford's plan supplements Medicare. Medicare approved Part B services would be considered eligible expenses under Hartford's Outpatient Medical expense benefit; subject to the $300 plan deductible and $1,500 out-of-pocket plan maximum.
Do you cover prescription massage therapy? Answer: Medicare does not cover massage therapy,therefore, services are not covered under the plans. Are dermatologist services covered for skin cancer? Answer:. Hartford's plan supplements Medicare. Medicare approved Part B services would be considered eligible expenses under Hartford's Outpatient Medical expense benefit; subject to the $300 plan deductible and $1,500 out-of-pocket plan maximum. Are ambulance trips covered? Answer:. Hartford's plan supplements Medicare. Medicare approved Part B services would be considered eligible expenses under Hartford's Outpatient Medical expense benefit; subject to the $300 plan deductible and $1,500 out-of-pocket plan maximum. Emergency Transportation Services: living in a rural area, patients are often transported by air transport. Does Medicare pay for these services and what would the plan pay if transport was required for an emergency? Answer: If medically necessary, Medicare will cover air ambulance transportation. Hartford's plan supplements Medicare. Medicare approved Part B services would be considered eligible expenses under Hartford's Outpatient Medical expense benefit; subject to the $300 plan deductible and $1,500 out-of-pocket plan maximum. So in essence Hartford does not cover any treatment or services that Medicare doesn't cover, regardless of whether our doctor has recommended or not. Is this true? Answer: Correct - other than some preventive benefits and Foreign Travel Emergency, the Hartford plan is designed to supplement what Medicare has approved and paid. Do you still have hearing services and is it the same providers? Answer: Yes, the EPIC hearing healthcare and the hihealth hearing programs will continue to be offered in 2018. Do you still have Superior Vision? Answer: Yes, the vision program will continue to be offered in 2018.