2018 Retiree Option Period
Agenda • • • • • • • • • •
Introductions Medical Plans Billing Administrator Medical Premiums Dental Plans Dental Premiums Vision Plans Vision Premiums Voluntary Life How to Enroll
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Aetna informational meeting
Tulsa Community College
Welcome TCC retirees
We are here to support your health journey
Simplicity
Support
Satisfaction
1. How the TCC retiree plan works
What we’ll cover
2. Keeping the doctors you know and trust 3. Extra support you’ll get with your new plan 4. What happens next 5. Questions and answers
How simply and efficiently
your new plan works
How traditional Medicare plan works •
•
•
•
A payment process with many steps Three ID cards for medical and prescription drug coverage Paperwork from: ─
Health care providers
─
Medicare
─
Current medical plan
─
Current drug plan
Multiple bills and Explanation of Benefits
Medicare Part A
Supplement plan
Separate prescription drug plan
Medicare Part B
How the Medicare Advantage plan works •
One step for you
•
One ID card for medical and pharmacy
•
A monthly Explanation of Benefits each for medical and pharmacy
Medicare Advantage plans must cover all Medicare-approved services
Medicare Part D
Medicare Part A
pharmacy
One plan: benefits Simplicity with care advocacy and wellness
More benefits than Medicare Parts A & B
Medicare Part B
Simplicity
Medicare Advantage is an all-in-one plan • Easy to use • One ID card for medical and pharmacy needs • More benefits than Original Medicare Parts A and B • Care advocacy programs
Medicare Advantage
• Wellness benefits • A monthly Explanation of Benefits for each medical and pharmacy
Aetna Medicare Advantage Preferred Provider Organization with an Extended Service Area (PPO ESA) nationwide Access to providers
We’ve got you covered in or out of network
Your doctor does not have to be in our network Same benefits in or out of network No referrals needed Covers you nationally when traveling
Will my doctors accept this plan? They can, if they are: Eligible to receive Medicare payment Willing to accept your Aetna Medicare Advantage plan Your copays or cost-share amounts are the same both in and out of network.
Will my doctors accept this Here’s how to find outplan? if your doctor will accept the
Aetna Medicare Advantage PPO Extended Service Area (ESA) plan
Call us 1-800-307-4830 (TTY: 711) Monday – Friday 8 a.m. to 6 p.m. all time zones
Go online to www.aetnaretireeplans.com Can’t find your doctor online? Call us. Chances are they may accept the plan.
Check directly with your doctor’s billing office
Medical benefits
designed for TCC retirees
Let’s review your medical benefit plan options High Plan (C04) Low Plan (S02) Your premium
$388.85
$295.09
Deductible
$150
$0
Out-of-pocket maximum
$150
$6700
$0
$0
$0
$25
$0
$25
Inpatient hospital
$0
$250
Outpatient surgery
$0
$0
Emergency room
$0
$50
Preventive care Primary care office visit Specialty care office visit
Prescription drug benefits
designed for TCC retirees
Aetna’s Prescription Drug Plan offers you: 65,000+ pharmacies/65,000 pharmacies with 24,000 preferred pharmacies nationwide * Aetna Rx Home DeliveryŽ Easy-to-use online tools *The number of pharmacies listed is approximate and is subject to change, due to CMS' "any willing provider" requirement as well as ongoing contracting efforts. Data is current as of 7/1/16 and is subject to change.
Defining Part D phases for your plan Phases
What you pay for covered prescription drugs in each phase
1
Deductible
Your plan does not have a deductible /You pay a deductible
2
Initial coverage limit
You pay a copayment/coinsurance cost sharing
3
Coverage gap “donut hole�
You pay the same/a different level of copayment/coinsurance
Catastrophic
You pay nothing; your plan pays all costs/ You pay a smaller cost share; your plan pays most of the cost
4
Let’s look at your new prescription drug benefits Aetna Part D plan Deductible Tier 1 - Preferred Generic
None $5
Tier 2 - Generic
$10
Tier 3 – Preferred Brand
$45
Tier 4 – NonPreferred
$75
Tier 5 - Specialty
33%
Coverage gap
Full gap coverage
Catastrophic phase
You pay $0
Mail-order drugs
2.5 times retail cost share for 90 supply
So much more with
Aetna Medicare Advantage
Support
You can get help anywhere on your health journey
Wellness • Healthy home visits • Preventive reminders • 24-hour nurse line • Personal health record
Support
Complex care
• Chronic condition support
• A nurse who follows your care
• Fracture prevention program
• Readmission avoidance
• Resources For Living®
• Aetna Compassionate CareSM
Voluntary visit where a nurse comes to your home
What is a
healthy home visit?
•
Talks about safety
•
Reviews your medications
•
Offers care advocacy resources and support programs
Home safety assessment
Activity and independence assessment
Medication review
Holistic health screening
We share results with your doctor with your approval
Our diabetes program—proven results Voluntary four- to six-month coaching program One of our nurses calls you regularly Makes sure your medicines are correct Coaches you on keeping a healthy lifestyle
Dietitian helps with your nutrition needs
We can help you try to reach your health goals – whatever they are
97% overall satisfaction
with Aetna Medicare Advantage plan coverage and benefits*
*2015 Aetna Medicare Advantage group plan member satisfaction survey
Aetna
1-800-307-4830 Important information !
www.aetnaretireeplans.com If you want to change your plan for 2018 or want to drop coverage in the Aetna plan, Please mail your enrollment form to: TCC, 6111 East Skelly Drive, Tulsa, OK 74135 Attention: Danika Howeth By November 3
Coming up Aetna PO Box 14088
Lexington, KY 40512 JOHN DOE 11102015
11102017 JOHN DOE 1234 ANY ST ANY TOWN, MD 21010
DCN#
Member ID: MEB01012 Dear John Doe: Thank you for enrolling in Aetna Medicare Plan (PPO). Medicare has approved your enrollment in Aetna Medicare Plan (PPO) beginning 0101201 8. Beginning 01012018, you must get your health care as provided in your ‘Evidence of Coverage’. You will need to pay your plan copayments and coinsurance at the time you get health care ser vices, as provided in your member materials. This letter is proof of insur ance that you should show during your doctor appointments until you get your member card from us. What if I have a Medigap (Medicare Supplement Insurance) polic y? Now that we have confirmed your enrollment, you may cancel any Medigap or supplemental insurance that you have. Please note that if this is the first time that y ou are a member of a Medicare Advantage or Medicare Cost plan, y ou may have a trial period during which you have certain rights to leave (disenroll from) Aetna Medicare Plan (PPO) and buy a Medigap policy. Please contact 1800MEDICARE (18006334227) an ytime, 24 hours a day, 7 days a week for further information. TTY users should call 18774862048. If you have any questions, please call Aetna Medicare Plan (PPO) at 18002825366. TTY users should call 711. We are open Monday through Sunday 8:00 a.m. to 8:00 p.m. local time. Please be sure to keep a copy of this letter for your records. Thank you. Sincerely,
AetnaMember Services Aetna Member Ser vices Medicare Client Ser vices
GRP_11_201 09/2011
Confirmation letter
OCT
Enjoy your new benefits
Page 1 of 2
Welcome kit
NOV
DEC
DEC
JAN
JAN
FEB
FEB
Welcome call
Medical and Pharmacy ID card
Why you’ll love the Aetna Medicare Advantage plan Simplicity
Support
Satisfaction
One plan One ID card Predictable costs
Care advocacy Wellness benefits Joining you
97%
*2015 Aetna Medicare Advantage group plan member satisfaction survey
Overall satisfaction with Aetna Medicare Advantage plan coverage and benefits*
Thank you and enjoy your plan
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. [For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within <x> days. You can call <phone number/TTY/hours of op> if you do not receive your mail-order drugs within this timeframe. <Members may have the option to sign-up for automated mail-order delivery.>] The <formulary, pharmacy network, and> provider network may change at any time. You will receive notice when necessary. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a preservice organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website.
GRP_6013_1193 10/2017 Š2017 Aetna Inc. 58.25.304.1 (10/17)
Plan Premiums
Retiree Premiums Plan Premiums PlanSource will continue as our Retiree Payment Collection Administrator. Once your enrollment or changes during the Option Period have been processed, PlanSource will send you a letter confirming your new premium deductions. For retirees who have elected to have premiums automatically deducted through the Automated Clearing House (ACH), you will not need to take action to continue your deductions. Your premium will continue to be deducted as scheduled. PlanSource will be mailing you a new coupon booklet prior to February 2018. If you do not receive a coupon booklet promptly, please mail your check as scheduled to PlanSource in order to ensure your benefit to remain active. If you participate in the ACH deduction please disregard the coupon booklet.
Retirement System Contribution to Your Monthly Insurance Premium Your retirement system may contribute toward your health insurance premiums. The premiums listed in this guide do not reflect any retirement system contribution.
Retiree Premiums Over 65 Retiree
Aetna Medicare Advantage (C04) High Plan
$388.85
Aetna Medicare Advantage (S02) Low Plan
$295.09
Under 65 Retiree Aetna ACO Plan Aetna ACO Plus Plan Retiree Only Retiree + Spouse Retiree + Child Retiree + Children Retiree + Spouse + Child Retiree + Spouse + Children
$535.11 $1,236.69 $798.33 $941.22 $1,476.03 $1,615.32
$542.47 $1,254.17 $808.91 $954.16 $1,496.34 $1,637.54
Aetna Plan
Aetna Plus Plan
$600.56 $1,388.51 $895.99 $1,056.36 $1,656.60 $1,812.92
$589.93 $1,363.93 $880.14 $1,037.66 $1,627.29 $1,780.84
Dental
Member Resources INTERACTIVE WEB TOOLS Dentist Finder Dental Cost Advisor Ask a Dentist Dental Dictionary Treatment & Procedure Animations Relevant news articles
Dental Plan Comparison Chart DENTAL COVERAGE Calendar Year Deductible Maximum Calendar Year Benefit Diagnostic & Preventive – routine exams, cleanings, fluoride, x-rays Miscellaneous – Sealants, space maintainers, labs/tests, palliative care Restorative – fillings, simple extractions General – anesthesia, stainless steel crowns Endodontics – root canal therapy, direct pulp cap and more Periodontics – periodontal disease treatment, gingivectomy and more Oral Surgery – surgical tooth extractions, alveoloplasty, vestibuloplasty Crowns, Inlays/Onlays – crown repair recementation of crowns, inlays/ onlays and more Prosthodontics – bridges, dentures,
BCBS Base Plan In-Network Out-of-Network
BCBS Buy-Up Plan In-Network Out-of-Network
$50 Ind./$150 Fam. $1,000
$50 Ind./$150 Fam. $1,000
$50 Ind./$150 Fam. $3,000
$50 Ind./$150 Fam. $3,000
Plan pays 100%, no deductible
Plan pays 100%, no deductible
Plan pays 100%, no deductible
Plan pays 100%, no deductible
After deductible, plan pays 100%
After deductible, plan pays 100%
After deductible, plan pays 100%
After deductible, plan pays 100%
After deductible, you pay 30%
After deductible, you pay 30%
After deductible, you pay 20%
After deductible, you pay 20%
After deductible, you pay 30%
After deductible, you pay 30%
After deductible, you pay 20%
After deductible, you pay 20%
After deductible, you pay 60%
After deductible, you pay 60%
After deductible, you pay 50%
After deductible, you pay 50%
After deductible, you pay 60%
After deductible, you pay 60%
After deductible, you pay 50%
After deductible, you pay 50%
After deductible, you pay 60%
After deductible, you pay 60%
After deductible, you pay 50%
After deductible, you pay 50%
After deductible, you pay 60%
After deductible, you pay 60%
After deductible, you pay 50%
After deductible, you pay 50%
Blue Max Advantage - Rollover BlueMax Advantage Offering BCBSOK offers flexible benefit options and can customize the amount of increase in annual maximum and the number of years between increments based on your group’s situation.
Sample Annual Max Increment = $100 Sample Applied Increment Cap = 3 years
Year
Annual Benefit Max
Applied Increment
0
1 (2017)
$3,000
0
$1,100
1
2 (2018)
$3,100
1
3 (2019)
$1,200
2
3 (2019)
$3,200
2
4 (2020)
$1,300
3
4 (2020)
$3,300
3
Year
Annual Benefit Max
Applied Increment
1 (2017)
$1,000
2 (2018)
2018 Dental Plan Premiums
Retiree Only
Retiree + Spouse
Retiree + Child(ren)
Retiree + Spouse + Child(ren)
BCBS Base Plan
$20.35
$40.72
$53.97
$82.08
BCBS Buy-Up Plan
$38.01
$76.00
$99.20
$151.29
Vision
• Choose the doctor who’s right for you • 34,000 conveniently located VSP network providers • WellVision Exams can detect signs of eye and health conditions, like: - Diabetes - High blood pressure - Hypertension • Eye care and eyewear in one location
Vision Plan Comparison Chart Base Plan
VISION BENEFITS Eye Exam – Every calendar year Frames – Every calendar year
Buy-Up Plan
Out-of-Network
In-Network
In-Network
Applicable to Both Plan Options
$10 copay
$10 copay
Reimbursed up to $45
Up to $150 allowance* + 20% off additional cost
Up to $170 allowance* + 20% off additional cost
Reimbursed up to $70
$25 copay
Reimbursed up to $30 Reimbursed up to $50 Reimbursed up to $65
$55 allowance $95-$105 allowance $150-$175 allowance 20-25% off 20-25% off 20-25% off
Covered in full + 20-25% off additional lens enhancements
Reimbursed up to $50 Reimbursed up to $50 Reimbursed up to $50 N/A N/A N/A
Covered up to a $130 allowance Up to $60 copay for exam and fitting
Covered up to a $130 allowance Up to $60 copay for exam and fitting
Lenses – Every calendar year Single Vision Lined Bifocal Lined Trifocal Lens Enhancements Progressive – Standard Progressive – Premium Progressive – Custom AntiReflective Coating Scratch-Resistant Coating Tints/Photochromic
Contact Lenses – In lieu of glasses Exam and fitting – Every calendar year Laser Vision Correction By contracted providers only
$25 copay
Average 15% discount off regular Average 15% discount off regular price or 5% discount off price or 5% discount off promotional price promotional price
Reimbursed up to $105
N/A
Featured Frame Benefit Anne Klein bebeÂŽ Calvin Klein ÂŽ Flexon Lacoste Nautica Nike Nine West And more! Visit vsp.com/special offers to view all featured frame brands, and enjoy shopping online at eyeconic.com.
Best Value for Your Dollar – Buy-Up Plan Base Annual Savings
$345.12 Exam/Eyewear
Without VSP
Eye Exam
$163
Frame
$150
With Base VSP With Buy-Up VSP $10 Copay
$10 Copay
$25 Copay
$25 Copay
Single Vision Lenses
$88
Anti-reflective Coating
$111
$69
$0
Photochromic Adaptive Lenses
$106
$70
$0
Employee-only Annual Contribution
N/A
$98.88
$167.28
Total
$618
$272.88
$202.28 Buy-Up Annual Savings
$435.72
Voluntary Life Insurance
Voluntary Life Insurance Retiree Voluntary Life Insurance – You can keep, reduce or drop life coverage you have in place at the time you leave active employment. The election must be made within 30 days of leaving active employment. You cannot add or increase life insurance at retirement. Life Insurance continued at retirement does not include Accidental Death and Dismemberment benefits.
Life Insurance Beneficiaries – If you continue life insurance coverage when you leave active employment, it is very important to keep your beneficiary information current. To ensure we have your current beneficiary designation on file, you are required to complete the information on the enrollment form inside your packet. Age Band
Retiree Rates Per $1,000
Below 20 – 64
$0.850
65-69
$0.936
70-74
$1.456
75-79
$2.486
80-84
$4.556
85-89
$9.233
90 and above
$14.665
Voluntary Life Insurance Dependent Voluntary Life Insurance – You can keep, reduce or drop dependent life coverage you have in place. You cannot add or increase dependent life insurance after retirement or at option period. To qualify for this benefit your retirement must be on or before December 31, 2016. Dependent Voluntary Life Insurance Cost: • $.94 per $500, separate premium for spouse and child.
Beneficiary Resource Services: A Wellness Plan for Life Program provides wellness services for the member and their loved ones (beneficiaries) Members Will preparation, tips and guidance Online pre-planning for funeral and services Website: www.beneficiaryresource.com Username: Dearborn National
Beneficiaries Unlimited telephonic grief counseling for beneficiary and family members 24/7 (Call 800769-9187) Up to 5 sessions for legal, financial or grief counseling Grief and legal counseling offered face-to-face using expansive network of professional resources
Travel Resource Services
Provides medical and travel assistance for employees and families traveling for business or pleasure 100 or more miles from home (Includes travel within U.S.)
Call 877-715-2593 24/7 to access services included but not limited to: Evacuation Medical referrals Repatriation (return home) Monitoring of medical condition Return of mortal remains Coordination/assistance with medical payment Advance of medical expenses
Travel Resource Services is provided by Europe Assistance USA, Inc. Dearborn National does not provide or insure any part of Travel Resource Services.
How to Enroll Over 65
How to Enroll Over 65
How to Enroll Under 65
How to Enroll Under 65
Discussion