THE EMERITI PROGRAM for those planning for retirement

Transcription

1 2014 Benefits THE EMERITI PROGRAM for those planning for retirement Medicare and Emeriti s Health Insurance and Reimbursement Benefit This presentation is copyrighted exclusively by Emeriti 1

2 Your Institution s Commitment Your Institution is: Giving you a tax-free way to pay for your health care expenses in retirement Providing access to group health insurance when you retire Keeping you informed about retiree health care issues along the way 2

3 Emeriti s Core Benefit Features Emeriti Health Accounts Tax-advantaged savings and investment vehicle for payment of future medical expenses in retirement Emeriti Health Insurance Portable group retiree health insurance options building on the foundation of Medicare Emeriti Reimbursement Benefits Tax-free reimbursement of qualified medical expenses not covered by Medicare or Emeriti insurance options Participant Education & Decision Support Services Online In print On the phone In person 3

4 4 Emeriti s Service Providers Emeriti TIAA- CREF Savitz Aetna HealthPartners Accumulation Recordkeeping Trust Services Investment Management Disbursement Recordkeeping Retiree Health Plans Retiree Health Plans Proprietary Mutual Funds Non Proprietary Mutual Funds Insurance Premiums Qualifying Medical Expenses Debit Card Manual Claims

5 It s Not Too Late To Save 5

6 Health Expenses in Retirement Can Add Up Medicare Supplemental Insurance Other Medical Expenses Parts A, B & D deductibles Parts B & D* premiums Part D Coverage Gap cost share Part D (True Outof-Pocket) TrOOP Premiums for all insurance Out-of-pocket medical costs Co-pays and co-insurance Out-of-Pocket Expenses Vision Hearing Medical equipment Long-term care Nursing Home *Part D premium is indexed to income. 6

7 Medicare is Not Enough Other 14%* Medicare 59% Out-of- Pocket 13% Private Insurance 14% Source: EBRI estimates from the 2009 Medical Expenditure Panel Survey. *VA, Tricare, other private, Medicaid, other. 11 7

8 Keep This In Mind Building up tax-free assets for retiree healthcare protects your pension retirement income. Medicare cost shares are increasingly indexed to income. Investment and tax diversity are key. 8

9 How Medicare Works Part A (Hospital) and Part B (Medical) Original Medicare Medicare provides these coverages You have your choice of doctors & providers Part C Medicare Advantage, PPO Plan Private insurers approved by Medicare provide Parts A & B coverage You may get extra benefits Part D Prescription Drug Private insurers approved by Medicare provide coverage Different plans cover different drugs at different levels You can choose from a range of plan designs 9

10 Emeriti Retiree Health Insurance Platform Guaranteed issue group health insurance for lifetime of the participant Portable, nationwide access* Choice of insurance options (medical, Part D Rx, dental) Annual choice among plans Catastrophic protection Foreign urgent or emergency care* Ongoing information and decision support services *Available in some plans. 10

11 When You Can Access Emeriti Health Insurance After age 65 When you retire After enrollment in Medicare Parts A & B Must meet all three requirements in addition to satisfying your Plan s retirement eligibility rules (age and service criteria). 11

12 Who Can Use Emeriti Health Insurance Available for Eligible Participant & Dependents Participant s dependents include: Spouse (pre- or post-65) Domestic partner (pre- or post-65) depending on your plan* Dependent children (before majority, to age 26) Permanently disabled children** Post-65 dependents can enroll in separate coverage from participant. *Domestic partners coverage is available only if elected by the institution. Nondependent domestic partners pay for insurance outside of the Health Account. **Determination of permanent disability also confers access to post-65 insurance for these individuals. Disability must occur before majority. 12

13 Emeriti Insurance Choices for 2014 Five Group Medical Plans* One Medicare coordination plan Two Medicare supplemental plans (availability based on state approval) Two Medicare Advantage PPO (Extended Service Area (ESA) available for geographical areas outside Aetna s network) Three Rx Plans** Rx High Plan continuing coverage in coverage gap Rx Mid Plan generic coverage only in coverage gap Rx Low Plan no coverage in coverage gap One Dental Plan* One dental plan * Availability based on state approval. ** The Rx Mid-High Plan is a grandfathered plan and is closed to new entrants. 13

14 Create Your Own Plan STEP 1 STEP 2 STEP 3 select a medical plan select an Rx plan Consider the optional dental plan 14

15 Or Preserve Your Options Select Rx Low Plan Choose Rx Low Plan as stand-alone option Consider Dental Add dental to the Rx Low Plan if you wish Selecting an RX Low Plan allows you to remain in the Emeriti Program and permits you to change coverage in future years. 15

16 Emeriti s Other Program Components Emeriti Reimbursement Benefits A tax-free method for you to pay for other qualified out-of-pocket medical expenses not covered by Medicare or Emeriti insurance. Emeriti Health Accounts A tax-advantaged way to save and invest for future medical expenses. 16

17 Reimbursement Benefit Options Manually submit claims to Savitz: Mail Fax Upload through Participant Benefits Dashboard (MyEmeritiBenefits.org) Debit card option in development for 2014 Reimbursement Benefits will be paid from participant s balance in the Money Market Fund. Participants may transfer lump-sum amounts or set-up monthly systematic transfers in amounts of $100 or more. 17

18 How You Can Use Your Reimbursement Benefit Partial List of Uses Medicare premiums and cost shares Supplemental insurance deductibles, co-insurance, co-pays Vision, dental, hearing care Over-the-counter and non-formulary drugs (with Rx prescription from doctor) Medical equipment Long-term care insurance Medical expenses associated with nursing or in-home health care services Other post-65 and pre-65 insurance premiums (if Emeriti coverage is not elected) NOTE: A wide range of health care expenses are eligible for tax-free reimbursement as long as they satisfy the requirements of Section 213 (d) of the IRS Code. Emeriti Reimbursement Form available on MyEmeritiBenefits.org 18

19 Who Can Use Your Reimbursement Benefits Available for You & Your Dependents Participant s dependents include: Spouse (pre- or post-65) Domestic partner (pre- or post-65) depending on your plan Dependent children (before majority, to age 26) Permanently disabled children Dependent relatives depending on your plan 19

20 Investment Options in 2014 CORE FUNDS TIAA-CREF Lifecycle Funds (Retirement Class) TIAA-CREF Money Market Fund (Retirement Class) Lifecycle funds Asset diversification among asset classes Automatic rebalancing A money market mutual fund Seeks to assure the value of your investment at $1 per share CORE PLUS FUNDS Additional Mutual Funds based on institution s election Some TIAA-CREF proprietary funds Some non-proprietary funds from other mutual fund families Core Plus Funds subject to Plan Sponsor election. 20

21 Emeriti Program Fees Your employer may cover all or some portion of the service fees. Check with your institution s benefit administrator if you are uncertain. Monthly Participant Fees Fees Active Service Terminated/Retiree Emeriti $5.00 $5.00 TIAA-CREF $.67 $.67 Savitz $1.00 $6.00 Investment management fees are variable by selected mutual funds (see prospectuses) 21

22 22 Participant Education and Decision Support Tools Online In Print On the Phone In Person Coming Soon

23 Emeriti Retiree Teleconferences Want more information about Emeriti s Insurance Plan Options for 2014? Attend a teleconference Wednesday, November 20 at 3pm (ET) Wednesday, December 4, at 3pm (ET). For both calls, please call , and enter Conference ID:

24 Access 2014 Annual Enrollment Materials Click on ALREADY A PARTICIPANT tab EmeritiHealth.org 24

25 Emeriti Retirement Health Solutions provided this information and is responsible for its content. Emeriti, TIAA-CREF, Savitz, Aetna Life Insurance Company, and HealthPartners are independent corporations and are not legally affiliated. The retirement healthcare program is offered by the employer. Teachers Insurance and Annuity Association (TIAA) will provide services to the plan and make available investment options. TIAA-CREF Trust Company, FSB provides investment management and trust services. Emeriti Retirement Health Solutions is not an insurance company, insurance broker or insurance provider. Summary Plan Description (SPD) This presentation is intended to provide you with a brief summary of some of the details of your Employer s Emeriti Plan and the Emeriti Program. For a full summary of the terms of your Employer s Emeriti Plan you must consult the SPD, which will be provided to you upon enrollment or upon request. 25

26 Investment Adviser Status Emeriti Retirement Health Solutions is a registered investment adviser for purposes of selecting the range of investment options available under the Emeriti Program. Emeriti may provide non-personalized educational materials to plan participants relating to their and their employer s contribution to their Emeriti Plan and the allocation of their Emeriti Health Account balances among available investment options. Emeriti does not provide personalized investment advice to participants. The participation interests in the voluntary employee contribution VEBA trusts associated with the Emeriti plans (the Interests ) may be treated as securities under federal or various state securities laws. The offering of these Interests is subject to compliance with any applicable federal or state law. For residents of Georgia, the Interests are being offered in reliance on paragraph 13 of Code Section of the Georgia Securities Act of 1973, as amended (the Georgia Act ). The Interests may not be sold or transferred except in a transaction which is exempt under the Georgia Act or pursuant to an effective registration under the Georgia Act. 26

27 Addendum 27

28 Understanding Emeriti s National Group Medical Plan Options Aetna Traditional Choice Coordinates with original Medicare Has a plan deductible Parts A & B deductibles covered by plan deductible Most claims for Medicare allowable charges will be paid in full after plan deductible Preventive services and annual physical covered 100% by Medicare Aetna Supplemental Retiree Medical Plans K and L Supplements original Medicare Have no plan deductible Have coinsurance on some services You pay a portion of Part A deductible You pay all of the Part B deductible Preventive services and annual physical covered 100% by Medicare NOTE: Participants always pay the Medicare Part B premium. 28

29 Understanding Emeriti s National Group Medical Plan Options Aetna Medicare Advantage High and Low PPO (or PPO ESA) Replaces original Medicare Have no plan deductible You pay no Parts A & B deductibles High plan has coinsurance, low plan has coinsurance and copayments Preventive services and annual physical covered 100% by the Plan Silver & Fit Exercise & Healthy Aging Program available with high and low plans Access to over 10,000 fitness clubs and exercise centers Engage online and through educational materials NOTE: Participants always pay the Medicare Part B premium. 29

30 30 Emeriti Group Medical Plan Options in 2014 Underwritten by Aetna Aetna Traditional Choice* Aetna SRM Plan L** Aetna SRM Plan K** Aetna Medicare Advantage High PPO/ESA-PPO Aetna Medicare Advantage Low PPO/ESA-PPO $200 deductible $0 plan deductible $0 plan deductible $0 plan deductible in- and out-of-network 20% coinsurance 25% coinsurance 50% coinsurance 15% coinsurance in-network 25% coinsurance out-of-network $1,250 out-of-pocket limit 100% preventive care covered by Medicare $2,400 out-of-pocket limit (2013 calculation) 100% preventive care covered by Medicare $4,800 out-of-pocket limit (2013 calculation) 100% preventive care covered by Medicare $2,750 out-of-pocket limit in-network $5,500 out-of-pocket limit out-of-network 100% preventive care covered by the plan $0 plan deductible in- and out-of-network Primary care visit at $15 in- and out-of-network Specialist visit at $40 in- and out-of-network $6,700 out-of-pocket limit in-network $10,000 out-of-pocket limit out-of-network 100% preventive care covered by the plan After plan deductible is satisfied, plan payment in full on Medicare eligible costs. Payment based on the balance after Medicare s payment. Payment based on the balance after Medicare s payment. Payment based on total Aetna allowable cost. Payment based on total Aetna allowable cost. NOTES: The ESA-PPO Plan has the same benefits as the In-Network PPO Plan. Aetna s GMS Plans A and L will be offered in Florida in place of SRM Plans K and L. *For 2014 the Traditional Choice plan is not available in MD. **For 2014, the SRM Plans are not available in VT, MD, MN, and U.S. Territories.

31 Retiree Cost Share for Typical Doctor s Visit Bill of $100 Traditional Choice SRMP L SRMP K High MA PPO/ESA Low MA PPO/ESA Charge $100 $100 $100 $100 $100 Medicare Pays $80 $80 $80 $0 $0 Aetna Pays $20 $15 $10 $85 $85 You Pay $0 $5 $10 $15 $15 NOTE: Illustration assumes any annual plan deductibles have already been satisfied for the plan year. 31

32 Four Components of Standard Part D Benefit in 2014 Deductible You pay first $310 as deductible Initial Coverage Period You pay 25% of drug costs Coverage Gap You pay 97.5% of brand drugs You pay 72% of generic drugs Catastrophic Coverage You pay 5% Greater of $2.55 or 5% for covered generic. Greater of $6.35 or 5% for all other drugs. You reach the Coverage Gap at $2,850 in total Part D covered drug expenditures (includes plan deductible, your costs and plan costs in the Initial Coverage Period). You reach Catastrophic Coverage at $4,550 in true out-of-pocket costs. 32

33 Emeriti Rx Coverage in 2014 Underwritten by Aetna Rx Low Plan Rx Mid Plan Rx High Plan Standard Formulary $310 deductible Initial Cov Limit Retail: 15% - 25% Coverage Gap: no coverage* Catastrophic Cov: 95% coverage Step therapy required for some drugs Open Formulary $100 deductible Initial Cov Limit Retail 15% - 25% - 50% Coverage Gap: generic coverage only* Catastrophic Cov: 95% coverage Step therapy required for some drugs Open Formulary $100 deductible Initial Cov Limit and Coverage Gap Retail 15% - 25% - 40% Coverage Gap: full coverage Catastrophic Cov: 100% coverage No Step therapy required Members who use Aetna s Rx Home delivery Mail Order Drug (MOD) program will pay 5% less than the negotiated cost of the drug as compared to retail. 33

34 Aetna Dental Coverage in 2014 Dental Design Preventive Service Coverage 100% Annual Deductible (basic and major services) $100 Basic Services Coverage (e.g. fillings, standard crowns, extractions) Major Services Coverage (e.g. root canal therapy, surgical removals, dentures) 50% 50% Annual Benefit Maximum $1,500 NOTES: 1.Twelve month waiting period applies, but may be waived with evidence of continuing coverage. 2.One-time only opt-in opportunity. 3.Dental is only available when you enroll in a combination Medical/Rx coverage, or elect the stand-alone Rx Low Plan 4. Please note: in the states of CA, OR, WA*, the stand-alone Dental plan may be elected if the participant is enrolled in a Kaiser Permanente MAPD Plan, and with evidence of existing coverage. 5. Dental not available in MD. 34