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Welcometo the
TCU – One Exchange Informational Meeting
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What’s changing?
• TCU changed the way it provides medical benefits
to Medicare-primary retirees and their
Medicare-primary dependents.
• Retiree’s medical benefits will be managed
through a Health Reimbursement Arrangement
account (HRA).
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What we’ll cover today
• Why this approach?
• How this affects you
• Medicare 101
• Introducing OneExchange
• Going forward
• Questions & answers
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Why This Approach?• Provides Medicare-eligible retirees with:
Greater flexibility in how to use health care dollars A broader range of plan options The possibility that new coverage will cost less than
current coverage
• Enables TCU to continue supporting retirees during a time of uncertainty surrounding the rising cost of medical insurance and services
• Enables TCU to predict and budget for health care costs more accurately
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How This Affects Medicare Eligible Retirees
• Medical premiums and out-of-pocket costs will vary depending on the coverage you choose.
• You will work with OneExchange to enroll in a plan that meets your medical and Rx needs.
• TCU will establish your Health Reimbursement Account. This account will be administered by OneExchange
• OneExchange Advisors will help you understand the costs associated with your coverage – premiums, co-payments, deductibles and all other costs.
What you pay
How to enroll
Your support
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Medicare 101
• Everything you wanted to know about Medicare, but were afraid to ask!
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Original Medicare:• A Health insurance program for
– People 65 years of age and older
– Some people with disabilities
– People with End Stage Renal Disease (ESRD)
• Administered by CMS
• Enrollment handled by Social Security Administration or Railroad Retirement Board
Key TermsMedicare Part A = Hospital Coverage – administered by CMSMedicare Part B = Medical Coverage – administered by CMSMedicare Part C = Medicare Advantage Plans – private plans – group or individual marketMedicare Part D = Prescription Drug Coverage – private plans – group or individual marketMedicare Supplement (Medigap) – private plans – group or individual market
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Original Medicare: Part A (Hospital)
Premiums:
• Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Medicare-covered employment.– $254.00 for 30-39 quarters of Medicare-covered employment.
– $461.00 for people who have less than 30 quarters of Medicare employment.
Foreign citizens and Americans who worked abroad
Coverage:
• Medicare Part A covers:
– Hospital Stays
– Skilled Nursing Facility (SNF)
– Home Health Care
– Hospice Care
– Pints of blood received at a hospital or skilled nursing facility during a covered stay
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Original Medicare: Part B (Medical)
Initial Enrollment Period:
o When turning 65. o 3 months before, the month of, and three months after 65 th B-Day. (7 month window)
Coverage:• Doctors’ services (physician office and some hospital
settings)• Limited Chiropractic Services• Outpatient Services:• Diagnostic tests- clinical Lab
o (x-ray, MRI, CAT, EKT, nutritional therapy, etc…)
• Other medical serviceso Durable medical equipment (DME)- prosthetic, wheelchair etc. o Diabetic Supplieso Ambulance service
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A person that is eligible for Medicare but opts out of Part B may be subject to a 10% per year Part B penalty
• Penalty is waived if beneficiary has coverage through a group policy based on active employment
Medicare Part B - Late Enrollment Penalty
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For employers with 20 or more employees, group coverage is primary for Medicare beneficiaries who are still active, and Medicare is secondary. Therefore, active beneficiaries don’t have to enroll in Part B and will not be penalized when they decide to retire. When they decide to retire, beneficiaries should enroll in Part B three months prior. This will insure that they can enroll in a Medicare Supplement plan and have it effective as soon as their group coverage ends.
Medicare Eligibility & Active Employment
• If active and covered under the group health plan, employee does not enroll in Medicare Part B or select a Medicare supplemental plan(s) until they retire or lose coverage.
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Post-65 Coverage Options
Added Optional Coverage
Part A• Hospital• Institutional
Part B• Doctors• Supplies• Outpatient• Professional
Medicare Supplement (Medigap Plans)Fills in Medicare payment “gaps” in coverage
Medicare Advantage
(MA)
Part D Drugs
HMO
Part D Drugs
(StandAlone)
PFFS
OROriginal Medicare-
FFS (Fee For Service)
+
+
MA-PD
PPO
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Part D: What is Medicare Part D?
• Medicare Part D is optional prescription drug coverage for everyone with Medicare Part A or B
• PDP’s are run by private insurance companies approved by Medicare (Like MA plans)
• If beneficiaries decline to enroll in a Medicare drug plan when they are first eligible, they may be penalized. (1% of national average per month)
• Beneficiaries sign up when they first become eligible for Medicare, or during the AEP
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Helping You Prepare For Your Upcoming Medicare Enrollment
OneExchange
TOWERS WATSON
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Who We Are Transitions Can Be A Good Thing! OneExchange – For Your Benefit A Deeper Dive – Benefit Advisors,
Private Exchange, Optimize Savings, Health Reimbursement for You
Next Steps Questions & Answers
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Your Transition
• OneExchange has been chosen after an extensive evaluation of choices
• OneExchange will help you with total care in transitioning over to more-effective individual Medicare health insurance
• The private exchange offers greater choice and flexibility; many affordable choices exist and in many cases provide more value at a lower cost than an employer group plan
• Ongoing support – at no cost to you
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Transitioning the way access is provided to retiree health benefits for Medicare-eligible retirees
and their Medicare-eligible dependents
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About OneExchangeTowers Watson
over100 years experience
First and Largest private Medicare Exchange
Personalized options with plans from a nationwide
network of carriers
Licensed advisor provides guidance and
lifetime advocacy
Hundreds of thousands
of retirees served across 300+ employers
In the middle of our
9th annualenrollment season
Founded in 2004
No added fees for our services
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Why OneExchange?White-Glove Service
Consultative Process
Simplified Selection
LifetimeAdvocacy
EffortlessEnrollment
Selection Process:Your Benefit Advisor
will provide the guidance you need to easily understand your Medicare options
Enrollment Process:100% paperless,
telephonic enrollment
Secure and efficient
Consultative Process:Your Benefit
Advisor will determine coverage needs and thoroughly research your options
Advocacy:Specialized and
focused; trained in insurance, Medicare and issue resolution
towerswatson.com18
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Our Service Centers
Salt Lake City, UT
Dallas, TX
Operating hours: Monday-Friday 7am-8pm CT
100% Domestic Workforce
- NO Outsourcing!
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All Medicare Plan Types
Plans and Partners
Multiple plans available to you from national/regional carriers
Prescription Drug(Part D)
Medicare Advantage Medicare Supplement(Medigap)
A few examples of the carriers on our Medicare exchange:
towerswatson.com20
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Your Experience
Announcement & Education
Evaluation & Enrollment
Ongoing Communications
& Advocacy
© 2013 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.
EducationEnrollment Guide
Prepare for your enrollment consultation
• Review Medicare basics
TOLL FREE
1-888-429-8490
medicare.oneExchange.com/TCU
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Decision Support Tools
• Help Me Choose
• Prescription Profiler
medicare.oneExchange.com/TCU
24/7 access to your information
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Benefit Advisors
Licensed / Certified / Appointed
OneExchange University™
Average age 43
Objective & unbiased
100% domestic workforceHours of
Operation
Monday – Friday 7 am – 8 pm CT
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Enrollment Process
Benefit Advisors can discuss coverage options with anyone
Telephonic enrollment – 2 part process
100% of calls are recorded
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ApplicationData
Processors(ADPs)
ApplicationData
Processors(ADPs)
LicensedBenefit
Advisors(BAs)
Tag-Team Enrollment Expertise • Allows BAs to Have More Time for Consultations• Ensures Accuracy of Application Submissions
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Trained in carrier enrollment applications; the experts in accurately filling out the paperless applications to optimize first-time acceptance by the carriers
Licensed / Certified / Appointed by Departments of Insurance; the experts in probing health plan needs and helping to recommend the right plan
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Enrollment Confirmation NoticeFeatures: Sent once a participant has enrolled into a plan
Confirms all plan selections and enrollments
• Carrier Name• Plan Name• Confirmation Number• Premium• Coverage Effective Date• Whether or not they have
selected Automatic Reimbursement
What Happens Next• Expectations on Carrier
correspondence, including ID Cards
• Subsidy Packet• Automatic Reimbursement• Direct Deposit
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MEDICAREADVANTAGEMEDICARE
ADVANTAGE
OPTION 1: Medicare Advantage Plan with Prescription Drug Coverage (MAPD)*
* Note that Medicare Advantage plans are generally network based plans
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+ PD
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Note: You may need to pay your first premium when you enroll in coverage
PART DPLAN
PART DPLAN
MEDIGAPPLAN
OPTION 2: Medigap Plan + Part D Plan
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Medicare Prescription Drug Coverage 2015
Catastrophic Coverage
Coverage Gap
Initial Coverage
Deductible
You Pay Full Retail Until Deductible is Met 2015 - $320
You pay copays for your plan coverage for the first $2960 in actual costs of Medications
You pay 45% of Brand Name and 65% of Generics until your out of pocket costs reach $4700; Pharmaceutical contributions will count towards the $4700 True Out Of Pocket costs
You Pay $2.65 for Generics and $6.60 for Brand Name or 5% - whichever is greater
Only 25% reach Donut Hole
Only 4% reach Catastrophic
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How This Affects You
• Depends on the plan you choose
• Choose the right level of coverage for you and your spouse individually
What you pay
How you enroll
Your support
• You enroll directly through OneExchange
• You and your Medicare-eligible spouse enroll in separate plans
• OneExchange will be your partner as you make this decision and enroll in plans
• OneExchange will provide ongoing support - at no cost to you
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Local Plan Slides
Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame
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Plans Available in Dallas and Tarrant Counties
Plan Type Number of Plans Offered
2014Monthly Premium Carriers
Medicare Advantage 19 $0 - $89
Coventry, Humana, AARP, Aetna, Scott
& White, CIGNA Health Spring
Medigap / Medicare Supplement 16 $66 - $306 AARP, Humana, BC
BS TX
Prescription Drug(Part D)
17 $13 - $127
AARP, Aetna, CIGNA, Express Scripts, Humana,
Silver Script, WellCare
Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame
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Also Available in Dallas & Tarrant Counties
Plan Type Number of Plans Offered
2014Monthly Premium Company
Vision 1 $14 per person per monthAnnual eye exam: $5
Coverage for eye glasses, lenses and frames
Vision Service Plan (VSP)
Dental 4 $16 - $46$50 - $75 deductible$750 - $1500 annual
maximum
Delta Dental, Humana,
MetLife Dental
Vision plans and Dental plans are not Medicare plans
Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame
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Medicare Advantage Plan
Benefit CostPremium $34
Network PPO
Deductible $0
Doctor Copay $10
Specialist Copay $40
Hospital $300 copay per days: 1-7
Emergency Room $65 unless admitted to the hospital
Deductible $0
Rx $0/ $2/ $39/ $85/ 33% 30-day supply
Mail Order $13/ $18/ $110/ $238 90-day supply
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2014
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Medigap Plan F + PDP (75 year old male)
Benefit CostPremium $220 ($202 Medical + $18 PDP)
Network Any doctor who accepts Medicare
Deductible $0
Doctor Copay $0
Specialist Copay $0
Hospital $0
Emergency Room $0
Deductible $0
Rx $0/ $15/ $40/ $90/ 33% 30 day supply
Mail Order $0/ $30/ $80/ $180 90 day supply
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2014
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Health Reimbursement Arrangement
(HRA)
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What Is An HRA?• Tax-free account used to reimburse you for eligible health
care expenses – you pay first and then get reimbursed
• If you are eligible, your former employer will make an annual contribution to a Health Reimbursement Account (HRA)
• You may use HRA funds to reimburse yourself for eligible medical expenses which include premiums that you pay coverage for (including Medicare Part B) and certain out-of-pocket expenses
• Your HRA funds will be available on the first of the month of your retirement, prorated for the year. On Jan 1st of the next year, you receive the full annual amount.
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Health Reimbursement Arrangement
If you are eligible, reimbursements are
made up to the amount available
in your HRA
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Health Reimbursement Arrangement Reimbursement Options
1.
Automatic
Reimbursement[including recurring claims]
2.
Manual Reimbursement
If you are eligible, reimbursements are
made up to the amount available
in your HRA
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• Service offered by OneExchange
• Available on most plans
• Works for premium reimbursement only
• No claim form is required
• Can take 2-3 billing cycles to initiate
• If you need your reimbursement sooner, simply file a paper claim. The form and instructions will be provided in your Funding and Reimbursement Guide
Auto-Reimbursement (AR)
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Next Steps
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What You Need To Do: Action Required!• You MUST enroll in Medicare Part B if not
already enrolled – contact the SSA
• Contact OneExchange at your toll free #
• Make a first contact call now and schedule an enrollment appointment
• Enroll in your new coverage• Call us during your scheduled appointment time
• You are guaranteed coverage 43
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Your First Contact Call – We’re Ready!
Review Enrollment Guide
Gather Medicare card, Prescriptions and Doctors/Hospital information
Call OneExchange1-888-429-8490
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Personal Guidance: For a Lifetime
A lifetime advocate:
Navigation Enrollment Claim issues Denied policies Affordability concerns Prescription Late enrollment HRA Annual plan review
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Why OneExchange Retiree
People Objective and personal touch through stringent training processes and CMS compliance criteria
Size and Strength
300 employers and 500,000 retirees being served
Technology Most automated connections, across 90 carrier partners
Satisfaction99% client retention rateAverage retiree satisfaction 9.2/10.0
Experience First and largest Medicare Exchange; private
Relationship As life happens, we are here for you
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We Are Ready For Your Call
1-888-429-8490