Your plan at your fingertips

Transcription

1 WELCOME STATE OF MINNESOTA RETIREES Your plan at your fingertips Manage your plan, cut costs and feel confident when you get care Your medical plan benefits 6 Health and wellness 8 Tools, resources and phone support 10

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3 Dear State of Minnesota Retiree, HealthPartners is pleased to offer you Medicare and prescription drug coverage plan options for Before you look through this booklet, you might be interested in a few of the great features you can expect from HealthPartners Freedom: virtuwell You ll get unlimited visits to virtuwell, the 24/7 online clinic that provides treatment through a nurse practitioner for everyday medical conditions. Silver&Fit Exercise and Healthy Aging Program For just $25 a year, you can get a membership at a participating fitness center. Travel coverage With up to nine months of travel coverage within the U.S., you can take your health plan with you wherever you go. Award-winning service Your Medicare Member Services team is just a phone call away. You can also easily manage your health care through your personal account at healthpartners.com/segipmedicare. Log on to get your medical and prescription drug information 24/7, whenever and wherever it works for you. I'm very proud to tell you that HealthPartners Freedom is a 5-star plan for 2016!* You'll learn more about what this means on the next page. Most of all, please choose HealthPartners in 2016; we would be so happy to be your plan in the year ahead. Your partner in health, Mary Brainerd President and CEO *Medicare evaluates plans based on a 5 star rating system. Star Ratings are calculated each year and may change from one year to the next.

4 Quality you deserve There s no guessing about what you can expect from Freedom. We deliver on our promise to provide top-notch care and timely service, so you can focus on doing more of what you love. 5 stars Now that s something you can trust It s important to choose the right plan for you. Be bold in your next adventure knowing you have a reliable partner in HealthPartners Freedom (Cost) plan. The Centers for Medicare and Medicaid Services awarded us the highest Star Rating* for 2016 making us a top plan in Minnesota. Here are some reasons why: We help people get healthy and stay healthy with preventive care. We re there when you need us for the little things and the big things with advice, treatment and support. Our members get outstanding service from our team of experts. More assurance you re teaming up with a first-class plan In addition to getting 5 stars, we also received a 5 out of 5 rating from The National Committee for Quality Assurance (NCQA).** In fact, Freedom is the highest-rated plan in Minnesota. Our rating is based on how we measure against strict quality standards. Think of it as a way to know which plans are doing a bang-up job. HEALTH INSURANCE PLAN RATINGS MEDICARE PLAN *Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. **NCQA Medicare Health Insurance Plan Ratings The National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. HealthPartners Freedom, a Medicare plan, is also known as Group Health Plan (Cost), Inc. NCQA ranked 376 Medicare health plans on clinical performance, member satisfaction and NCQA accreditation. Statistical data represented by NCQA is not endorsed by CMS nor given by Medicare. To view the plan s official CMS star rating, visit medicare.gov. 4

5 HealthPartners Freedom Group (Cost) It s important to find a plan that supports you and your health goals. We're here for you. As a member, you'll have the online tools and information you need to make good decisions about your health care and coverage. Your Freedom network Choose from more than 45,000 doctors and other care providers in Minnesota and western Wisconsin. See any specialist in the network with no referrals needed. Search the Freedom network by visiting healthpartners.com/segipmedicare.»» Search for doctors by name, clinic name, specialty, language, gender, hours of business, parking and more.»» See cost and quality ratings for doctors. Sick. Click. Cured. virtuwell is convenient online care that treats everyday medical conditions - such as colds, coughs, ear pain or flu. All from the comfort of your home. Get 24/7 access to nurse practitioners who will give you personalized care and a treatment plan. And, if needed, a prescription sent right to your pharmacy. You'll get unlimited access at no cost. Visit virtuwell.com to learn more. 5

6 Your benefits Get the care and coverage you deserve so you can do more of what you love. The HealthPartners Freedom Group plan, offered by the State of Minnesota, is outlined here. BENEFIT STATE OF MINNESOTA PLAN Office visits You pay $10 Inpatient hospital You pay $100 Ambulance You pay $0 Emergency room You pay $50 Urgent care You pay $10 DME You pay 10% of the total cost Mental health You pay $10 for individual sessions and $5 for group sessions Occupational/physical therapy You pay $0 Speech therapy You pay $10 Preventive care You pay $0 Prescription drug coverage You pay $10 for preferred generic and generic, $30 for preferred brand, $50 for non-preferred brand and $50 for specialty drugs Monthly premium $ See plan Summary of Benefits or Evidence of Coverage for more details. For more details on your provider network and travel coverage, go to healthpartners.com/segipmedicare. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. 6

7 Travel benefits Get care anywhere Travel with peace of mind. You have in-network coverage nine months out of the year when you travel in the U.S. Plus, you get worldwide emergency and urgently needed care. To use your Extended Absence Benefit, just let Member Services know before you leave. How does it work? You can get Medicare-covered health care from any provider in the U.S. that participates in and accepts Medicare. You have the option to use a non- Medicare provider but you may be required to pay for some or all services up front. If that happens, HealthPartners will reimburse you once your claim has been submitted and processed. Tools to help you plan your trip Get travel ready with the help of these tools: HealthPartners Mail Order Pharmacy: Get up to a 90-day supply of your prescription and over-the-counter medications so you ll have plenty with you. Travel medicine specialists: Get help with tripspecific health questions or concerns, especially if you re traveling internationally. Health Information Library : Go to healthpartners.com/healthlibrary for tips on immunizations, health concerns and injury prevention before or during your travels. To learn more about this benefit, visit healthpartners.com/segipmedicare. 7

8 Get healthy savings Save money while doing something great for your health. Signing up for Silver&Fit is easy. When you join the Silver&Fit Exercise & Healthy Aging Program, you can get a membership at a participating fitness club for just $25 a year. Visit silverandfit.com to find a club. Or, if you prefer to work out at home, choose the Home Fitness Program. Pay $10 a year and get up to two Home Fitness kits. You ll also get: Pay the annual fee directly to the participating fitness facility of your choice. Some exceptions may apply. Visit silverandfit.com or call Silver&Fit customer service at (TTY ) for more information. To enroll in the Home Fitness program, visit silverandfit.com or call Silver&Fit Customer Service to pay your annual fee. The Silver Slate, a quarterly newsletter. Healthy Aging materials (online or DVD). Silver&Fit Connected! *, to track your exercise at a facility, or through a wearable fitness device or app and earn rewards. (These rewards may change, and the purchase of the device or app is not included.) A toll-free customer service hotline to answer questions about the program. Once you re a HealthPartners member, you ll learn more about other great discounts available to our members. *Your use of Silver&Fit Connected! serves as your consent for American Specialty Health Fitness, Inc. (ASH) Fitness to receive information about your tracked activity and to use that data to process and administer available rewards to you under the program. The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit, Silver&Fit Connected!, the Silver&Fit logo, and The Silver Slate are federally registered trademarks of ASH and used with permission herein. 8

9 Coverage for your medicines Is my prescription covered? You can see if your prescriptions are covered by searching the 2016 Medicare Formulary. This is the list of medicines that are covered by your plan. Searching the list is easy. Just go to healthpartners.com/medicarerx and search by: The name of your medicine (ex. simvastatin) The type of medicine (drug category) you are taking (ex. cholesterol) The first letter of the medicine you are taking (ex. S ) What if my medicine isn't on the list? If your medicine isn't on the list, it's not covered by your plan. In that case, we may suggest alternative drugs that are on the formulary. If you want to switch to a covered medicine, we can help you see what your options are. Go to healthpartners.com/medicarerx and scroll to the Drug Category tab. Then, search for the type of medicine you're taking. A list of covered medicines will come up. Print it out and bring it to your doctor to see if one of those will work for you. How much do I have to pay for my medicines? You pay $10 for preferred generic and generic, $30 for preferred brand, $50 for non-preferred brand and $50 for specialty drugs. You can find more benefit details by looking at your Summary of Benefits. For help understanding your medicines and saving money on your presctiptions, use "Ask a pharmacist" at healthpartners.com/pharmacy. Save time and money Get your medicines your way with HealthPartners mymailrx. Your prescriptions are delivered right to your door. There's no additional cost and shipping is free. Typically, you can expect to get your medicines within five to eight business days of when the mail order pharmacy receives your order. Log on to healthpartners.com/mymailrx to sign up. Or, call or

10 We're here to help Contact us when you have questions about your coverage or health we re here for you. IF YOU HAVE QUESTIONS ABOUT CONTACT Medicare Sales Finding a doctor, drug or benefit details before enrolling in this plan How to enroll Your coverage, claims or account balances Finding a doctor, dentist or specialist Health plan services Whether you should see a doctor Home treatment options A medicine you're taking Monday - Friday, 8 a.m. - 8 p.m , or (TTY) Interpreters are available if you need one. healthpartners.com/segipmedicare Member Services Monday - Friday, 8 a.m. - 8 p.m. Call the number on the back of your member ID card or , or (TTY). Interpreters are available if you need one. healthpartners.com/medicare CareLine SM Service nurse line 24/7, 365 days a year , or (TTY) healthpartners.com/medicare Understanding your health care and benefits How to choose a treatment option HealthPartners Nurse Navigators program Monday - Friday, 7:30 a.m. - 5 p.m. Call the Member Services number on the back of your member ID card. healthpartners.com/medicare Finding a mental or chemical health care professional in your network Your behavioral health benefits Behavioral Health Navigators Monday - Friday, 7:30 a.m. - 5 p.m or healthpartners.com/medicare 10

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12 Questions? Call us at or TTY users should call or Or go to healthpartners.com/segipmedicare for everything you need to know about enrolling! HealthPartners is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal rd Ave S Bloomington MN, StMN R (10/15) 2015 HealthPartners H2462_92524 IR Approved 10/9/2015