Best of Health. Welcome to a special edition of Best of Health. SPECIAL EDITION

Transcription

1 Best of Health FALL 2015 Information about the Michigan Public School Employees Retirement System health plan SPECIAL EDITION Welcome to a special edition of Best of Health. In this issue, you will find the updates to your 2016 Michigan Public School Employees Retirement System health plan, along with additional information to help you make the most of your plan. A message from the Office of Retirement Services It can be a confusing world for retirees. In recent years, the number of employers who offer health care coverage to their retirees has steadily declined. A recent survey conducted by the Kaiser Family Foundation shows the percentage of large employers (200 employees or more) offering retiree health coverage dropped from 40 percent in the mid to late 1990s to 28 percent in As medical costs continue to rise, the Office of Retirement Services is committed to keeping your plan sustainable for the long run and making sure it provides the services you need to live a longer, healthier life. To do that, periodic plan updates are necessary. During the past 20 years, the Retirement System s board has passed 20 initiative packages to ensure the long term survivability of retiree health care plans for you and future Michigan public school retirees. Medicare You too can do your part by taking care of your health and taking advantage of programs offered through your retirement system s health plan. Being healthy means more quality time to enjoy your retirement and less money spent on deductibles and coinsurances.

2 Have you ever wondered how decisions about your retiree health coverage are made? Most retirees think the plan changes come from union negotiations or from insurance vendors, but this isn t the case. Blue Cross Blue Shield of Michigan, OptumRx (formerly Catamaran), Delta Dental and BlueVision SM administer their part of your health care coverage, but they don t make any decisions about the plan benefits, coinsurance, deductibles, copayments or out-of-pocket maximum amounts. Unlike the benefit plan you had as an employee of Michigan public schools, your retiree health care benefits and costs are decided by the Office of Retirement Services with the oversight of a 12 member board of directors. One board member represents state government; the remaining members are appointed by the governor to represent active and retired public school employees. Benefit plan decisions are made by the Michigan Public School Employees Retirement System board of directors with guidance from ORS benefit specialists and external health care benefit and actuarial consultants. Keeping your health plan sustainable in the current health care environment is a serious responsibility that to which the Michigan Public School Employees Retirement System board of directors, ORS and all of our partners are committed. Every dollar spent on retiree health care coverage comes directly from public school budgets. The board s goal is to maintain a quality health care plan that is affordable to both the schools and retirees. That s a challenging task given continuously rising health care costs. And yet, the board s been greatly successful. Over the years, the board s approved the addition of numerous benefits such as routine physicals, disease management programs, medication management programs and the LivingWell program, while keeping overall cost increases less than 3 percent. The ORS and the board of directors will continue to work on your behalf to make sure your health care plan is there for you when you need it most. We ve got you covered. 2 Best of health

3 Michigan Public School Employees Retirement System: Health Plan 101 New retirees are sometimes surprised to learn their retiree health care coverage differs from the coverage they had as active employees. The reason? There s no connection between employer based health care coverage negotiated by the unions and the coverage provided by the Michigan Public School Employees Retirement System. These are two completely different health care plans. Updates to your retirement system medical plan in 2016 The following updates to your medical coverage administered by Blue Cross Blue Shield will go into effect Jan. 1, 2016: Cost share updates Annual deductible $650 $700 Annual coinsurance maximum $800 $850 Emergency room copay $50 $75 If you have questions about your retirement system s Blue Cross medical plan, call Blue Cross Customer Service at TTY users should call 711. Hours of operation are Monday through Friday, 8:30 a.m. to 5 p.m., Eastern.? Want to learn more about your 2016 health coverage? Check out the newest webcasts added to bcbsm.com/mpsers. You can find the webcasts by clicking on the For Members tab, then clicking Webinars Best of health 3

4 You have the power to stop the flu The flu is a serious illness that can lead to pneumonia, hospitalization and sometimes death, even in healthy people. People over the age of 65 are among those at the highest risk for experiencing complications from the flu. People with chronic conditions, such as asthma, diabetes and heart disease, and young children are at increased risk as well. Symptoms of the flu often come on quickly and can include fever, chills, sore throat, runny or stuffy nose, cough, body aches and headaches. Flu season in the United States can begin as early as October and last as late as May. Getting a flu vaccine may protect yourself and those around you from the flu. Get your vaccine as early as you can for the best protection against the virus. Where can I get a flu shot? You can get a flu shot at your doctor s office, local health department or a retail pharmacy. Your flu shot is covered at 100 percent, but not all locations can bill Blue Cross directly. This means you may have to pay for the shot out-of-pocket and get reimbursed. The easiest way to avoid any out-of-pocket costs is to know before you go. Just make a quick call and make sure your doctor, health department or pharmacy can bill Blue Cross directly for your flu vaccine. If you need to get reimbursed for a flu vaccination, please follow the steps below: 1. Go to bcbsm.com/medicare 2. Click Forms and Documents under Help. 3. Click Claim Forms under Forms. 4. Click Medicare Plus Blue PPO plans under What you ll need 5. Click Medicare Advantage Member Application for Payment Consideration (PDF) to access the form. 6. Complete the form and mail it to Blue Cross along with your receipt. Or, you can call Blue Cross Customer Service at TTY users call 711. After the greeting and entering your information, say reimbursement form to get to the correct prompt where you can request a reimbursement form be sent to you. Frequently asked questions about the flu shot Can you get the flu from the flu shot? No. Flu shots are made using flu viruses that are inactive or without using any viruses at all. The most common side effects of the flu shot are redness and tenderness where the shot was given. Is it better to get the flu instead of the flu shot? No. The flu can be serious, especially among young children, older adults and people with chronic health conditions. Do you need to get the flu shot every year? Yes. Our immune protection from the flu weakens over time, so it s important to get a flu shot every year for the best protection against the virus. 4 Best of health

5 Five quick tips to help you lower your health care costs Take advantage of preventive services. Visiting the doctor for your annual wellness visit and the preventive screenings covered by your plan could help catch health issues early or prevent them from starting. This will help you save on out of pocket costs over time. 1 Choose the right kind of care. When you have a health issue, knowing where to go for care can make a big impact on your wallet. If you have a medical issue that needs immediate attention, but isn t life threatening, consider visiting an urgent care center instead of the emergency room. Not only will you pay less out of pocket, but you ll also spend less time waiting to see a doctor. 2 3 Ask about generic drugs. If your doctor prescribes a medication, ask if there s a generic alternative. Generic drugs work the same way their brand name equivalents do and cost less. Live a healthy lifestyle. Small steps toward a healthier lifestyle can add up to big savings on health care costs. Eating a well balanced diet, getting enough sleep and exercising regularly are a few things you can do to avoid serious medical conditions and expensive medical bills. 4 5 Use your member discounts. You have access to discounts, including gym memberships and groceries, plus daily coupons, through HealthyBlueXtras SM and Blue365. Visit healthybluextras.com to view current offers and coupons. Continue LivingWell in 2016 Keep making healthy lifestyle choices in 2016 by following the steps below: 1. Complete the Medicare Advantage Health Assessment. In 2016, the Medicare Advantage Health Assessment will only be mailed to new Medicare Advantage members. Taking the Medicare Advantage Health Assessment is a great way to get a snapshot of your current health status and keep track of your progress. You will receive the health assessment in the beginning of 2016, so keep an eye out! 2. Select a primary care physician. A primary care doctor will help you manage your health by keeping track of your conditions and progress. If you don t have a regular doctor, use the Find a Doctor tool on bcbsm.com to find a doctor near you. 3. Visit your doctor for an annual wellness visit. An annual wellness visit is a preventive visit to your doctor that is covered at 100 percent, once a year. During this visit, your doctor will check for potential health issues and suggest ways you can improve your health. Keep in mind that additional services provided by your doctor may not be covered at 100 percent. Be sure to ask your doctor whether services will be covered before you receive them. Best of health 5

6 Michigan Public School Employees Retirement System Evidence of Coverage Your Medicare Health Benefits and Services as a Member of Medicare Plus Blue Group PPO This booklet gives you the details about your Medicare health care coverage from January 1 December 31, It explains how to get coverage for the health care services you need. This is an important legal document. Please keep it in a safe place. This plan, Medicare Plus Blue Group PPO is offered by Blue Cross Blue Shield of Michigan. (When this Evidence of Coverage says we, us, or our, it means Blue Cross Blue Shield of Michigan. When it says plan or our plan, it means Medicare Plus Blue Group PPO.) Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal. Customer Service has free language interpreter services available for non-english speakers (phone numbers are printed on the back cover of this booklet). This information is available in different format, including large print. Please contact our Member Services number at for additional information. (TTY users should call 711). Hours are 8:30 a.m. to 5 p.m. Eastern time, Monday through Friday. Benefits, provider network, deductible, and/or copayments/ coinsurance may change on January 1, DB OCT 15 CMS material ID Medicare Advantage materials mailing soon Soon, you will receive additional information about your 2016 Retirement System Medicare Advantage plan through Blue Cross Blue Shield of Michigan. Keep your eyes open for your Annual Notice of Changes and 2016 Evidence of Coverage. These documents include a comprehensive list of any updates to your 2016 plan, as well as detailed information about covered services. Catamaran is now OptumRx: Here s what you need to know OptumRx and Catamaran joined forces to deliver enhanced pharmacy coverage and a better experience for members. Your prescription claims will continue to be processed quickly and accurately, and your pharmacy benefits will not change. Read the frequently asked questions below for more details about the combined company, known as OptumRx, and what it means for you. Will I receive a new pharmacy ID card? No. You ll continue to use your current pharmacy ID card. The information pharmacies use to process and fill your prescriptions will not change. If you receive an updated pharmacy ID card in the future, protect your privacy by destroying the old card. Can I continue to go to the same pharmacy? You can continue to visit the same network pharmacy you already use. If there are any changes to the network in the future, OptumRx will notify you. Will my pharmacy benefits change? No. Your plan design will remain the same in Any changes to your prescription drug coverage are determined by your retirement system and are unrelated to the combination of OptumRx and Catamaran. Can I still order my current prescriptions from home delivery? Yes. Your current home delivery prescriptions will continue to be filled through the same convenient mail order pharmacy you use today. You ll continue to place new home delivery orders and refill existing home delivery orders in the same way you do today. Can I still view my prescription information online? You ll continue to use catamaranrx.com to view and manage your prescription information. If you ve already registered for the member site, your login information will not change. You can use the information on your current pharmacy ID card to register if you re a new user. 6 Best of health

7 Delta Dental members: Your plan will cover dental implants in 2016 If you have Delta Dental coverage through the retirement system, your plan will cover dental implants beginning Jan. 1, If you ve been told you might be a good candidate for an implant, here are some things to know about implants and the updates to your coverage: What s covered? Your Delta Dental plan will cover endosteal implants at 50 percent the same level as other prosthodontic services. These services are subject to the annual maximum payment of $1,100. Implant maintenance procedures will be covered twice per calendar year. What s a dental implant? An endosteal implant is an artificial tooth root that is surgically placed into the jaw to fuse to the jawbone for three to six months. Once the implant has fused, a crown is attached to a post that extends from the implant above the gum line. The finished implant looks and feels like a natural tooth. Can I visit my dentist for a dental implant? Any licensed dentist can perform the entire implant procedure. However, a general dentist may refer implant patients to a specialist for the implant surgery. Keep in mind that not everyone is an ideal candidate for dental implants. The best candidates should be in good general and oral health. Best of health 7

8 Consider a patient centered medical home doctor. Patient centered medical home doctors believe in a team approach to health care. This means when you choose a patient centered medical home doctor as your primary doctor, your doctor will lead a team of health professionals dedicated to providing you with the care you need. Other advantages you ll experience include: 24-hour access to your PCMH care team Coordinated care with your other doctors Personalized strategies for managing your health To find a patient centered medical home doctor: 1. Visit bcbsm.com and click Find a Doctor 2. Click Get Started 3. Select I want to find a Primary Care Physician 4. Enter your search information, then click Go. 5. Check the Patient-Centered Medical Home box on the left. Understanding durable medical equipment Durable medical equipment is prescribed by your doctor to help you manage your health conditions. Examples of durable medical equipment: Oxygen Wheelchairs Canes Walkers Crutches Hospital beds Your doctor will determine if your health condition requires durable medical equipment and what equipment you need. Your durable medical equipment coverage Durable medical equipment and supplies, prosthetics and orthotics In network Out of network 10% coinsurance plus deductible 30% coinsurance plus deductible 8 Best of health

9 A re routine eye exams really necessary? Most of us get our car serviced regularly to make sure they run smoothly. We also visit a dentist regularly to get our teeth cleaned. But how many of us get our eyes checked as recommended by our eye care provider? Many people wait until they notice a change in their vision to see a doctor. But eye problems often have no symptoms, which can be dangerous to the person who is waiting to see a change. A recent study found that one in four adults hadn t had an eye exam in the past two years, and the same proportion was unaware that an eye exam could prevent them from losing their sight. Even if you ve had laser vision surgery or naturally have good vision, you still need routine eye exams. Find out what a routine eye exam says about your overall health by scheduling your regular eye exam. Maybe you ve heard of or received a vision screening. It s not the same as a complete exam. Screenings are partial, limited eye evaluations that take place outside an eye doctor s office. There s no doubt that they can be helpful at times in detecting some problems with vision, but I encourage patients to have a thorough eye exam in an optometrist s or ophthalmologist s office. The doctor can take an entire care history and patients can take advantage of the doctor s diagnostic and treatment tools, says Dr. Kurt DeVito, O.D., of Norfolk, Virginia. During your exam, your eye doctor will look for eye muscle imbalance, vision disorders and eye diseases that could potentially cause future problems. Whether or not you ve elected your retirement system s vision plan, don t wait until a street sign looks blurry, or you have trouble seeing objects close up, before you get an eye exam--even if you have to pay for it out-of-pocket. In addition to detecting vision changes, regular eye exams can also detect life threatening conditions. Find out what a routine eye exam says about your overall health by scheduling your regular eye exam. Do you have retirement system vision coverage? Your BlueVision SM plan covers eye exams once every two years. You can find information about your vision coverage by visiting bcbsm.com/mpsers under the Vision Plan tab. Visit vsp.com/advantage to find a provider. If you have questions about your vision coverage, call VSP at Best of health 9

10 Save money and live healthier with Blue Cross member discounts Blue Cross Blue Shield of Michigan members can save on a variety of healthy products and services from businesses in Michigan and nationwide through Healthy Blue Xtras SM and Blue365. Healthy Blue Xtras offers Michigan-based and online deals, including: Food and nutrition: Local grocery stores for nutritious meals and online grocery delivery Health and fitness: Gym memberships, fitness classes and consultations Recreation: Family activities and outings like golf, skiing or kayaking. Daily Coupons offer over $90 in savings on your favorite grocery brands. Coupons are updated daily and clipping is easy: Go to bcbsm.com/xtras and click Daily Coupons. Click the coupons you want, print them out* and redeem them at your local retailer. Blue365 offers national health and wellness discounts, including: Weekly deals on products and services like hearing aids, fitness gear and nutrition services Access to more than 9,000 fitness centers, including LA Fitness, Snap Fitness and many more, for only $25 a month through Healthways TM Fitness Your Way** Discounts on LASIK and eye care services Visit bcbsm.com/xtras to access your member discounts. Don t forget to check back often for the latest deals. *You ll need to download the Coupon Printer software the first time you print coupons. **A $25 enrollment fee and a three month commitment is required. Rx updates The patents on the following brand name drugs have expired or are set to expire, which means you will be able to save by using the generic equivalents. Any drug that was available on the drug list in its brand name form will continue on the drug list in its generic form. Your pharmacist will automatically dispense the generic on new or refilled prescriptions for these drugs. Brand name Generic name Indication/use Generic availability* Axert Almotriptan Migraine prophylaxis Now available Daytrana Methylphenidate ADHD Now available Lotronex Alosetron Irritable bowel syndrome Now available Mirapex ER Pramipexole ER Parkinson s disease; Restless leg syndrome Now available Namenda Memantine Alzheimer s disease Now available *Generic availability is subject to change based on FDA approval, manufacturer decision and any litigation. 10 Best of health

11 How to reach us When contacting us, help us help you by providing your contract and Medicare identification numbers. Blue Cross Blue Shield of Michigan For questions about health care claims, ID cards, durable medical equipment and supplies, or participating providers in Michigan: Call: TTY: 711 Weekdays, 8:30 a.m. to 5 p.m. EST Write: Blue Cross Blue Shield of Michigan Attention: MPSERS 600 E. Lafayette Blvd., Dept. X521 Detroit, MI Website: bcbsm.com/mpsers BlueCard PPO providers outside Michigan Call: BLUE ( ) Medicare Call: MEDICARE ( ) TTY: Website: medicare.gov OptumRx (formerly Catamaran) For questions about pharmacy claims, ID cards, or participating providers, contact OptumRx Prescription Drug Plan (PDP) at: Call: Customer service representatives are available 24 hours a day, 7 days a week Website: catamaranrx.com BriovaRx For questions about specialty medications, contact Specialty Pharmacy BriovaRx at: Call: BRIOVA ( ) Weekdays, 8:30 a.m. to 10 p.m., EST Website: briovarx.com BlueVision For questions about vision benefits, contact VSP. Call: Monday through Friday, 8 a.m. to 11 p.m. EST Saturday, 10 a.m. to 11 p.m. EST Sunday, 10 a.m. to 10 p.m. EST For vision ID cards, call Blue Cross Blue Shield of Michigan at TTY: 711 Weekdays, 8:30 a.m. to 5 p.m. EST Website: For benefit information vsp.com To find a provider vsp.com/advantage Delta Dental Plan of Michigan Call: Customer service representatives available weekdays, 8:30 a.m. to 8 p.m. EST. Automated service seven days a week, 24 hours a day. Website: deltadentalmi.com Michigan Public School Employees Retirement System For information about your pension account and health insurance enrollment and eligibility, contact Office of Retirement Services: Call: Weekdays, 8:30 a.m. to 5 p.m., EST Website: michigan.gov/orsschools For address and membership changes: Write: Office of Retirement Services P.O. Box Lansing, MI Website: Upcoming Pension Payment Dates November 25, 2015 December 18, 2015 January 25, 2016 Best of health 11

12 Michigan Public School Employees Retirement System Blue Cross Blue Shield of Michigan 600 E. Lafayette Blvd., MC 517J Detroit, MI PRESORT STANDARD US POSTAGE PAID Blue Cross Blue Shield Of Michigan Best of health Best of health is published four times a year for retirees of the Michigan Public School Employees Retirement System by Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd. MC 517J, Detroit, Michigan Editor: Christine Paul Copyright 2015 Blue Cross Blue Shield of Michigan. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. NOTICE: The information contained here is a summary of coverage and is not a contract. If statements in the description differ from the applicable group contracts, then the terms and conditions of those group contracts will prevail. The Michigan Public School Employees Retirement Board and the Department of Technology, Management & Budget reserve the right to change the plan. For more detailed information about benefit provisions, contact the applicable plan administrator. Medicare R045243