THE EMERITI PROGRAM in your retirement years

Transcription

1 2014 Benefits THE EMERITI PROGRAM in your retirement years Helping you achieve healthcare security in retirement This presentation is copyrighted exclusively by Emeriti 1

2 2 TODAY S AGENDA What s new in Medicare for 2014? What s new in Health Care Reform for 2014? What are your 2014 Emeriti insurance options? What are your next steps towards annual enrollment? What are Emeriti s ongoing participant services?

3 3 Emeriti s Service Providers For Annual Enrollment Savitz Insurance Enrollment Premium Billing Call Emeriti Service Center to speak with Savitz representative to enroll or change coverage Aetna Insurance Underwriter Premium Rates Call Emeriti Service Center to ask Aetna representative specific questions about Emeriti medical, Rx and dental insurance plans Emeriti Service Center EMERITI ( ) Press #1

4 4 Medicare Changes for 2014 Based on current information from the Centers for Medicare and Medicaid Services (CMS) Medicare Component 2013 Rate 2014 Rate Part A deductible $1,184 Waiting for CMS Monthly Part B new entrant premium $104 Waiting for CMS Part B annual deductible $147 Waiting for CMS Part D Coverage Gap threshold $2,970 $2,850 Part D True Out-of-Pocket (TrOOP) $4,750 $4,550 *Higher income beneficiaries will pay an additional amount for the Part B and D premiums, based on their prior year AGI on the federal tax return.

5 5 Health Care Reform Updates for 2014 Implications for Part D Benefit Part D - 50% discount remains on brand-name drugs in Part D Coverage Gap at point-ofpurchase (all Rx Plans). A 50% discount on the negotiated price of preferred and non-preferred brand drugs (excluding the dispensing fee) continues to be available from manufacturers that have agreed to provide the discount. The discount is applied first. Part D - 72% participant cost sharing limit change on generic drugs in Coverage Gap (Rx Low Plan) Since the Rx Mid and Rx High Plans already include generic drug benefits during the Coverage Gap, this cost share does not apply to those plans. Only the Rx Low Plan will continue to be revised to reflect this required change by Medicare (CMS). Part D 97.5% cost sharing limit on brand drugs in the Coverage Gap (Rx Mid Plan and Rx Low Plan) In addition to the 50% discount that pharmaceutical manufacturers are paying in the Coverage Gap, the Plan will continue to pay 2.5% of the total brand cost. Since the Rx Mid-High and Rx High Plans already include brand drug benefits during the Coverage Gap, this cost share does not apply to those plans. Only the Rx Mid Plan and the Rx Low Plan will continue to be revised to reflect this required change by Medicare (CMS).

6 6 Insurance Highlights in 2014 Plan designs will generally remain the same Retirees and their post-65 spouse/domestic partner will be able to enroll in different plans A new Medicare Advantage Low Plan will be available A new fitness program will be available through both the Medicare Advantage High and Low Plans Emeriti s national insurance offerings with Aetna will experience, on average, a 10% increase overall across all plans.

7 7 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. PLEASE NOTE: Emeriti will offer Aetna Group Medicare Supplement Insurance (GMS) Plans to retirees living in Florida.

8 8 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.

9 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 copayments Preventive services and annual physical covered 100% by the Plan Silver & Fit Exercise & Healthy Aging Program available with both 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. 9

10 10 You May Have Heard Health Care Reform is eliminating Medicare Advantage plans. TRUE FALSE Medicare Advantage is just another supplemental plan like the one you already have TRUE FALSE If you enroll in Medicare Advantage, you lose your Medicare coverage. TRUE FALSE You can t get more coverage for less money. It s too good to be true. TRUE FALSE

11 Medicare Advantage Benefits Go Beyond Original Medicare 11 Annual eye and hearing exams at no extra cost Eyewear and hearing aid allowances Coverage for unlimited inpatient hospital days Emergency medical coverage worldwide Low plan premiums, depending on where you live Advocacy for health and wellness. If you have a serious medical condition, a highly skilled Aetna nurse case manager can help you and your family: Understand your doctor s instructions Access services and support you may need Coordinate your care

12 12 Aetna Fitness Discount Program Available with Aetna Medicare Advantage Plans Work out Stay healthy Get discounts on gym memberships, home exercise equipment and exercise DVDs

13 13 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.

14 14 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.

15 Emeriti Rx Coverage in 2014 Underwritten by Aetna 15 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.

16 16 Aetna Online Formulary Aetna will provide an Emeriti-specific formulary guide, representing the three tiers of coverage specific to Emeriti s Rx plans: 1. Generic 2. Preferred brand 3. Non-preferred brand MyEmeritiBenefits.org EmeritiHealth.org

17 17 CMS 28% Mandate in the Coverage Gap For generic drugs in the Gap (one month supply obtained at in-network retail pharmacy): Sample Generic - $30 Rx Low Plan Rx Mid Plan Rx-High Plan Your Cost Share 72% 15% 15% You Pay $21.60 $4.50 $4.50 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. All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low income cost sharing subsidies.

18 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. 18

19 19 Aetna Insurance ID Cards Participants may have up to 3 cards: Medical Rx Dental New enrollees: If you need your insurance card information before cards arrive, you may call the Emeriti Service Center to obtain the insurance numbers. You may also log-on to Aetna Navigator to download temporary cards.

20 20 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).

21 21 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, up to age 26) Permanently disabled children** Post-65 dependents can enroll in different plans from participant. NOTE: The employer s plan establishes specific rules for vesting in the Emeriti account balance and retirement eligibility for the Emeriti insurance. *Domestic partners coverage is available only if elected by the institution. Independent 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.

22 22 Weighing Your Options Medical and Rx Expenses Lower Deductibles Higher Premium Lower Coinsurance Lower Out-of-pocket Limit Lower Premium Higher Deductibles Higher Coinsurance Higher Out-of-pocket Limits Immediate Financial Expense Potential Financial Exposure Immediate Financial Expense Potential Financial Exposure

23 23 Create Your Own Plan STEP 1 STEP 2 STEP 3 select a medical plan select an Rx plan Consider the optional dental plan

24 24 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 Health Insurance Options and permits you to change coverage in future years.

25 25 How are Insurance Premiums Paid? Seamless transfer from your Health Account Seamless transfer from your personal bank account* *If no Health Account funds, payment is made from Automatic Clearing House (ACH) withdrawals after institutional premium subsidy, if applicable

26 Don t Forget ACH Banking Information Form 26 WHY? To facilitate your timely payment of premiums from your personal bank account when insufficient funds remain in your Emeriti Health Account. WHAT YOU WILL NEED: Provide bank name, branch name and address, and routing number Or attach a voided check Please call Emeriti Service Center to request a ACH Banking Information Form, complete, and return to Savitz if you have not already done so.

27 27 Decision Time Already Enrolled? Do nothing, if satisfied with current coverage.* Call Emeriti Service Center to make changes to your coverage. Enrolling for the first time? Call Emeriti Service Center to enroll Have your Medicare Parts A and B numbers Have your Social Security number Have dates of birth of any eligible dependents Have social security numbers for eligible dependents Return ACH Banking Form to Savitz *Participants will default into the same plans as current coverage.

28 28 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.

29 29 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

30 30 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, up to age 26) Permanently disabled children Dependent relatives depending on your plan

31 31 Reimbursement Benefits at Work 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.

32 32 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.

33 33 Participant Education and Decision Support Tools Online In Print On the Phone In Person Coming Soon

34 34 View Your Health Account, Health Insurance, and Reimbursement Benefit Information Register It s easy!

35 35 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)

36 36 Emeriti Retiree Teleconferences Want another review of Emeriti s Insurance Plans 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:

37 37 Access 2014 Annual Enrollment Materials Click on ALREADY A PARTICIPANT tab EmeritiHealth.org

38 38 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.

39 39 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.

40 Addendum 40

41 41 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.

42 CMS 2.5% Mandate in the Coverage Gap For eligible brand drugs in the Gap (one month supply obtained at in-network retail pharmacy): Sample Brand - $100 (Preferred Brand) Rx Low Plan Rx Mid Plan Rx High Plan Pharma Cost Share 50% Manufacturer Discount on total cost of drug 50% Manufacturer Discount on total cost of drug 50% Manufacturer Discount on total cost of drug Plan Cost Share 2.5% of $100 total drug cost 2.5% of $100 total drug cost Plan pays balance, after your 25% cost share Your Cost Share 47.5% 47.5% 25% of total drug cost You Pay $47.50 $47.50 $25 All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low-income cost sharing subsidies. There is also a dispensing fee. 42

43 43 How are Insurance Premiums Paid? Paid through Emeriti Health Account if participant has sufficient funds, in this order: 1. Grantor Trust 2. Employer VEBA 3. Employee VEBA 4. ACH* *If no Health Account funds, payment is made from ACH withdrawals after institutional premium subsidy, if applicable