Group medicare advantage hmo recording 2 (solo)
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GROUP MEDICARE ADVANTAGE HMO
Arizona State RETIREMENT SYSTEM
Welcome to the Arizona State Retirement Systems webcast about our contracted Medical provider UnitedHealthcares Group Medicare Advantage HMO Plan. 1Tier 1 Rx Copay Reduction
Whats New for 2013Hearing DiscountsRx Manager New NameWellCard Enhancements
Whats NEW for 2013? The Tier I Prescription copay is going DOWN!Prescription Solutions has changed their name to OptumRx All the medical plans will include hearing exam and hearing aid discounts. ANDWellCard has expanded their discounts! Please see the 2013 Retiree Group Insurance Guide for details.2WEBCAST TOPICS
The topics we will be covering are the Eligibility Requirements, the In-Network Benefits, what the copays are and the variety of additional benefits.3ELIGIBILITY REQUIREMENTS
Lets start with the Eligibility Requirements for this Plan so you can see who can enroll.4
The below are eligible for the Group Medicare Advantage HMO Plan:
RetireeLTD RecipientQualified SurvivorDomestic PartnerEligible DependentsELIGIBILITY REQUIREMENTSGroup Medicare Advantage
University Optional Retirement Plans
You may enroll if you are a retiree of the Arizona State Retirement System, Public Safety Personnel Retirement System, Corrections Officer Retirement Plan, Elected Officials Retirement Plan or one of the three State Universitys Optional Retirement Plans
- You may enroll if you are on the ASRS Long Term Disability AND Not enrolled in your former employers insurance.
For survivor qualifications, your survivor should contact the ASRS as soon as possible.
Not only can you enroll for yourself, you may cover a domestic partner and eligible dependents5To enroll in the Group Medicare Advantage HMO Plan, you must have:
Medicare Parts A & BELIGIBILITY REQUIREMENTSMedicare Plan
You must have Medicare Parts A & B6
The Group Medicare Advantage HMO Plan is available:
ArizonaAll CountiesELIGIBILITY REQUIREMENTSGroup Medicare Advantage
Arizona residency is required7
Question & Answer 1ELIGIBILITY REQUIREMENTSRoland is an ASRS retiree with Medicare Parts A&B. He lives full time in Carefree, Arizona. Can he enroll in this plan?
Roland is an ASRS retiree with Medicare Parts A&B. He lives full time in Carefree, Arizona. Can he enroll in this plan? Yes or No what do you think? . There is coverage for all counties in Arizona, so, YES he may enroll.8
Question & Answer 2ELIGIBILITY REQUIREMENTSNora is an actively contributing member of the ASRS. She has Medicare parts A and B. Can she enroll in the Medicare Advantage HMO? ?
Nora is an actively contributing member of the ASRS. She has Medicare parts A and B. Can she enroll in this plan? Yes or No? This plan is for eligible retirees and their dependents so the answer is B: No. Once she does retire, she could enroll!9IN-NETWORK BENEFITSDoctorsHealth Care ProfessionalsHospitals
This is an in-network only plan.10
IN-NETWORK BENEFITSMedicare Part D:Is included, and is equal to or better than the standard Medicare Part D Coverage.Group Medicare Advantage
You do not need to enroll in a separate Part D Plan. The Medicare prescription drug plan included offers more than what is available under Medicare Part D.11
PrescriptionIN-NETWORK BENEFITSUnitedHealthcare Formulary:
Approved outpatient prescription drugsDoctor must useParticipating pharmacy
Your medication costs are kept down by use of a Formulary. That is a list of Medicare Part D approved prescription drugs. Your doctor must prescribe medication for you from this formulary and the prescription must be filled at a participating pharmacy.12
Additional InformationIN-NETWORK BENEFITSNo annual benefit limit in coverage
No annual deductibles
No prescription coverage gap
There is no annual benefit limit, annual deductibles and no prescription coverage gap.13
SelectionIN-NETWORK BENEFITSYou must select a Primary Care Physician in the network.
Your doctor will make referrals to specialists within the network
The Group Medicare Advantage HMO is an IN-NETWORK plan. By enrolling, you have made a decision to receive all your routine health care from contracted providers. You will need to select a Primary Care Physician and network. Your doctor will make referrals to specialists within the network14
Pre-Existing ConditionIN-NETWORK BENEFITSCurrently the ASRS does not deny health insurance for any reason in relation to a pre-existing condition
A pre-existing condition is generally considered to be an illness a person has prior to applying for health insurance. Currently the ASRS does not deny health insurance for any reason in relation to a pre-existing condition 15Health Insurance CardIN-NETWORK BENEFITSYou will be issued one card that covers your MedicalVisionPrescriptions
You will be issued 1 card that covers your medical, vision and prescription drug plan.16
Question & Answer 1IN-NETWORK BENEFITSDoes the Medicare Part D prescription coverage gap apply to the Group Medicare Advantage HMO plan?
Heres a question for you. Does the Medicare Part D prescription coverage gap apply to the Group Medicare Advantage HMO plan? Yes or No? No. There is no coverage gap or annual limit.17
Question & Answer 2IN-NETWORK BENEFITSPaula is an ASRS retiree and is enrolled in the Medicare Advantage HMO plan. Does she need to select a primary physician?
What about Paula? She is an ASRS retiree and enrolled in the plan. Does she need to select a primary physician? Yes or No? Yes. She will need to select a Primary Care Physician and network. To find the current online directory, please see the inside back page of the GUIDE 18COPAYMENTS$
This Plan has standardized Copayments. Lets look at some of the most common - but be sure to check the GUIDE for more information19Copayments (examples)Hearing Exam$0Routine Physical$0Ambulance$25
The most common copays
For example, there is no copay for your routine physical or hearing exam. For ambulance service - whether its ground or air there is a $25 copay20Copayments (examples)
The most common copays
Doctor Visit$15Lab Tests$0Specialist$30Emergency$50Waived if admitted
Your Doctors visit is $15. There is no charge for Outpatient Lab Tests, and to see a Specialist, the copay is $30. The $50 Emergency room copay is waived if you are admitted to the hospital. 21Copayments (examples)
Prescription monthly copays
UnitedHealthcare classifies its prescription drugs as Tier 1 and 2. Tier 1 are preferred generics with a $10 copay for a 1-month prescription. THIS HAS GONE DOWN FROM LAST YEARS COPAY OF $20!!! Tier 2 are preferred brand names with a monthly copay of $40.22
COPAYMENTSMail Order Prescriptions90-day supplies:
Tier I $20Tier II $80
You may also take advantage of the convenience in having your prescriptions mailed directly to you. The copays cover a 90-day supply and are $20 for Tier 1, and $80 FOR Tier 2.23
COPAYMENTSAnnual AmountsYour out-of-pocket coinsurance yearly maximum: $6,700 Per Individual
No lifetime maximum benefit
The out of pocket Coinsurance maximums are $6,700 per person and there is NO lifetime maximum benefit24
Question & Answer COPAYMENTSMary isnt sure what her yearly out-of-pocket coinsurance maximum would be. Is it.
Mary isnt sure what her yearly out-of-pocket coinsurance limit would be. Is it.A: $7,600 or B: $6,700? Her individual annual out of pocket maximum would be $6,70025ADDITIONAL BENEFITS
There are included benefits for you at no additional cost through the Plan26
Passport ProgramADDITIONAL BENEFITSAllows you to move your HMO coverage:
9 consecutive months during the yearSame copays
The Passport Program allows you to move your HMO coverage to participating areas for up to 9 consecutive months of the year - and pay your same copays. Please see the GUIDE for more information.27
Wellness ServicesADDITIONAL BENEFITSAdditional benefits include:
Silver SneakersSolutions for CaregiversNurseline
Wellness Services include: the Silver Sneakers Fitness Program which provides complementary membership with access to participating locations throughout the country to you and your covered dependents. If you find yourself in a caregiver situation for a relative or friend in need, Solutions for Caregivers is a comprehensive eldercare management program who can counsel you on your loved ones individual, medical, financial, safety, emotional and social needs. The Nurseline is a direct hotline provided after enrollment. 28
Disease ManagementADDITIONAL BENEFITSDisease and Specialty Case Management
Personal Health Management
Advanced Illness Care Management
The Disease and Specialty Management Services include: The Disease and Specialty Case Management program that targets chronic conditions, provides interventions to help manage those conditions and bridges the gap between you and your care teams. The Personal Health Management program serves retirees with moderate and high risk factors including transitioning from hospital care to home. The Advanced Illness Care Management program provides services for retirees with advanced illness and who are facing end of life issues. Please see the Guide for more information about all these programs29
Question & Answer 1ADDITIONAL BENEFITSGina has a chronic condition. She is enrolled in the Group Medicare Advantage HMO with several very large claims in the last 2 years. Will she reach a maximum lifetime benefit?
Meet Gina. She has a chronic condition and is enrolled in the Plan with several very large claims in the last 2 years. Will she reach a maximum lifetime benefit? Yes or No? No there is no maximum lifetime benefit with the Group Medicare Advantage HMO!30
Question & Answer 2Jennys mother needs more care than she can give her. Which program can provide assistance?
Silver SneakersSolutions for CaregiversNurseline
Which program do you think would help Jenny? Her mother needs more care than she can give her. Would it be A) Silver Sneakers, B) Solutions for Caregivers or C) Nurseline. b) Solutions for caregivers can counsel you on your loved ones individual, medical, financial, safety, emotional and social needs.31Group Medicare - Full Monthly PremiumsRetiree + Dependent$380/$520Retiree$190/$260Retiree & Dependent(s) Medicare & Non Medicare EligibleCombination Plans
The monthly premiums are determined by where you live either in Maricopa, Pima and Pinal County or all other Counties. Single coverage is $190, and $260 for all other counties. If you cover one dependent the monthly premium is $380 or $520 in all other counties. There are combination rates for those of you whom one is Medicare Eligible and one is not.32
For more detailed information please refer to the Guide!ARIZONA STATE RETIREMENT SYSTEMThank you for watching.
Have a great day!
For detailed information please refer to the GUIDE available on our website under the Retiree Tab.
We hope you now have a better understanding of the Group Medicare Advantage HMO. Thank you for taking the time to view this webcast.
Be sure to check our other on-demand webcasts.