MEDICARE SUPPLEMENT PLANS PLUS PRESCRIPTION COVERAGE

Transcription

1 MEDICARE SUPPLEMENT PLANS PLUS PRESCRIPTION COVERAGE FOR EMPLOYER GROUPS 2015 Toll-free ext TTY/TDD 711 HealthAlliance.org mkt-grpmspdpbro-1014

2 Group Medicare Plans-Coverage for real life. Choices Made Easy Your retirees and active employees who are Medicare primary need comprehensive coverage. Start with one of our Medicare Supplement option, which can be sold to employers in Illinois, retirees may reside anywhere in the U.S. Then add a Stand-Alone Prescription Drug Plan (PDP), which helps pay for prescriptions through Medicare s Coverage Gap, and can be sold to employers nationwide, and retirees may reside anywhere in the U.S. answers all your questions. Health Alliance Medicare takes care of the details for you and your retirees. We administer the plan, which means less paperwork for you. No Annual Election Period like for individual plans. Underwriting isn t required.** A dedicated client consultant Medicare Services answers members questions and helps them get to know their plan. We provide all membership materials, including ID cards and annual renewals. Case management offers extra help for members with chronic conditions. If your retirees have Medicare Parts A and B, they will be automatically accepted as Health Alliance Medicare Supplement members. Members can choose any doctor and hospital that accepts Medicare, without a referral. They pay a low monthly premium, which you can assist with at any level, but no copayments with Plans A and F. Health Alliance Medicare Services representatives are right here in Illinois, and they re happy to help members with their questions. Pharmacy programs help members save money and take their prescriptions safely. *Our PDP Option 2 provides prescription coverage through Medicare s Coverage Gap. PDP Option 1 does not. 2

3 Our Medicare Supplement Plan Rates Premiums listed are for Illinois residents who live outside of Cook, DuPage, Kane, Lake, McHenry or Will counties. Your client consultants can provide premium information for retirees in those Chicago-area counties. Age Plan A Plan F Plan N <65 $ $ $ $ $ $ Toll-free ext TTY/TDD 711 HealthAlliance.org 66 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

4 Please review the benefits here to help you choose what s best for your retirees. Medicare (Part A) Hospital Services Services/Benefits Hospitalization Health Alliance Pays Plan N Plan F Plan A Member Pays Health Alliance Pays Member Pays Health Alliance Pays Member Pays First 60 days $1,260 $0 $1,260 $0 $0 $1,260 Days 61 through 90 $315 per day $0 $315 per day $0 $315 per day $0 91 st day and after while using 60 lifetime reserve days Additional 365 days (after lifetime days are used) $630 per day $0 $630 per day $0 $630 per day $0 100% of Medicare-eligible expenses $0 100% of Medicare-eligible expenses $0 100% of Medicare-eligible expenses Beyond 365 days $0 All costs $0 All costs $0 All costs Skilled Nursing Facility First 20 days $0 $0 $0 $0 $0 $0 Days 21 through 100 $ per day $0 $ per day $0 $0 $ per day Day 101 and after $0 All costs $0 All costs $0 All costs Blood First three pints Cost of three pints $0 Cost of three pints $0 Cost of three pints $0 Additional pints $0 $0 $0 $0 $0 $0 Hospice Care Medicare $0 Medicare $0 Medicare $0 copayment/ copayment/ copayment/ coinsurance coinsurance coinsurance $0 4

5 Medicare (Part B) Medical Services Plan N Plan F Plan A Services/Benefits Health Alliance Pays Member Pays Health Alliance Pays Member Pays Health Alliance Pays Member Pays Medical Expenses First $147 of Remainder of Part B Excess Charges (above ) Blood $0 $147 $147 $0 $0 $147 Remaining balance other than up to $20 per office visit and $50 per emergency room visit Up to $20 per office visit and up to $50 per emergency room visit Generally 20% $0 Generally 20% $0 $0 All costs 100% $0 $0 All costs First three pints All costs $0 All costs $0 All costs $0 Next $147 of $0 $147 $147 $0 $0 $147 Remainder of 20% $0 20% $0 20% $0 $0 $0 $0 $0 $0 $0 Clinical Laboratory Services or Tests for Diagnostic Services Medicare (Parts A and B) Services Home Health Care Medically necessary skilled care services and medical supplies Durable medical equipment First $147 of Remainder of $0 $0 $0 $0 $0 $0 $0 $147 $147 $0 $0 $147 20% $0 20% $0 20% $0 Other Benefits Not Covered by Original Medicare Foreign Travel Not Covered by Original Medicare First $250 $0 $250 $0 $250 $0 All costs Remainder of charges 80% to a lifetime 80% to a lifetime $0 All costs maximum of $50,000 maximum of $50,000 20% and amount over the lifetime maximum of $50, % and amount over the lifetime maximum of $50,000

6 2015 Stand-Alone Prescription Drug Plan (PDP) Benefits Health Alliance Medicare offers prescription drug coverage that you can pair with a Medicare Supplement plan. In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply. PDP 1 does NOT include full drug coverage through Medicare s Coverage Gap. Plan Design Prescription Drug Plan 1 Monthly Premium $57 Member Benefits In-Network One-month (30-day) supply from a retail $0 for Tier 1 Preferred Generic at Walmart and Sam s Club pharmacy or through mail order until $20 for Tier 1 Preferred Generic Elsewhere total drug costs (both the member s $40 for Tier 2 Non-Preferred Generic costs and the plan s costs) reach $2,960 $40 for Tier 3 Preferred Brand $50 for Tier 4 Non-Preferred Brand $60 for Tier 5 Specialty Pharmacy Out-of-Network Covered drugs are available in special circumstances, including illness and while traveling outside the plan s service area where there is no network pharmacy. Members may incur an additional cost. Coverage Gap From $2,960 until member s annual drug costs reach $4,700. One-month (30-day) supply of Member pays 65% for generic drugs and 45% for brand-name drugs. prescription drugs from a retail pharmacy or through mail order. Post-Coverage Gap After member s yearly out-of-pocket drug costs reach $4,700, member pays the greater of: One-month (30-day) supply $2.65 copay for Tier 1 and Tier 2 drugs and $6.60 copay for all other drugs, or 5% coinsurance. 6

7 Plan Design Prescription Drug Plan 2 Monthly Premium $107 Member Benefits One-month (30-day) supply from a retail pharmacy or through mail order until total drug costs (both the member s costs and the plan s costs) reach $4,700*. Post-Coverage Gap One-month (30-day) supply PDP 2 includes full drug coverage through Medicare s Coverage Gap. In-Network $0 for Tier 1 Preferred Generic at Walmart and Sam s Club $15 for Tier 1 Preferred Generic Elsewhere $30 for Tier 2 Non-Preferred Generic $30 for Tier 3 Preferred Brand $50 for Tier 4 Non-Preferred Brand $60 for Tier 5 Specialty Pharmacy Out-of-Network Covered drugs are available in special circumstances, including illness and while traveling outside the plan s service area where there is no network pharmacy. Members may incur an additional cost. After member s yearly out-of-pocket drug costs reach $4,700, member pays the greater of: $2.65 copay for Tier 1 and Tier 2 drugs and $6.60 copay for all other drugs, or 5% coinsurance. Closed Formulary The Health Alliance Medicare formulary is a closed formulary. Generally, we only cover drugs listed in the formulary. View the formulary at HealthAlliance.org. Quantity limitations and restrictions may apply. Health Alliance is a Medicare approved Part D sponsor. Health Alliance Medicare members can use more than 2,200 pharmacies. Health Alliance Medicare is a Medicare-approved Part D sponsor. The Stand-Alone Prescription Drug benefit information provided herein is a summary, not a comprehensive description of benefits. Drug benefits, formulary, pharmacy network, premium and copayments/coinsurance may change January 1, Toll-free ext TTY/TDD 711 HealthAlliance.org 7

8 Toll-free ext TTY/TDD HealthAlliance.org GROUP MEDICARE PLANS