UHC Group Medicare Advantage PPO Frequently Asked Questions

Transcription

1 UHC Group Medicare Advantage PPO Frequently Asked Questions Question General Information Is the UHC Group Medicare Advantage PPO plan replacing the Secure Horizons plan currently offered to CenturyLink retirees? Yes. The Secure Horizons PFFS product will no longer be offered after December 31, This change is mandated under the Patient Protection and Affordable Care Act (PPACA) as part of national health care reform. More information about the reason for this change can be found in the Quick Start Guide included in your 2011 annual enrollment packet. The UHC Group Medicare Advantage PPO covers the same medical services as the Secure Horizons plan. The copay and coinsurance amounts also remain the same. In addition, the UHC Group Medicare Advantage PPO will continue to offer enrolled members access to the Silver Sneakers and Caregiver programs. Enrollment Do I need to be enrolled in both Medicare Parts A and B in order to elect the United Healthcare (UHC) Medicare Advantage Plan? Yes, you must enroll in both Medicare Parts A and B to be eligible for the UHC Medicare Advantage plan. Contact Medicare directly regarding enrollment in Parts A and B. Page 1 of 10

2 Enrollment (continued) If I disenroll from UHC Medicare Advantage in the future, will I be eligible for my original Medicare (Parts A and B) coverage? Do I have any other CenturyLink medical plan options? Page 2 of 10 Yes, you will continue to be enrolled in Medicare Parts A and B. You do not lose this coverage. However, if you decide to disenroll from the UHC Medicare Advantage plan, you will need to send a letter to the CenturyLink Benefits Administration department in order to remove the Medicare assignment from United Healthcare. You can simply write a letter requesting disenrollment. The letter should include the last four digits of your Social Security Number along with your telephone number. Sign and date the letter and send it to Benefits Administration at: CenturyLink Benefits Administration Mailstop: KSOPKR0301-A 5454 W. 110 th Street Overland Park, KS You may also fax the letter to Benefits Administration at (913) Yes. You may choose from two other medical plans Highmark/UHC Medicare Supplement (your plan will be administered by Highmark or UHC depending on the state you reside) or UHC Post-65 CDHP. Highmark administers the Medicare Supplement Plan in the following states: Indiana, Michigan, Nevada, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee and Virginia. United Healthcare administers the Medicare Supplement Plan in all other states.

3 Enrollment (continued) How does UHC Medicare Advantage coordinate with Medicaid? Tricare? What is the difference between a Medicare Supplement Plan and a Medicare Advantage Plan? UHC Medicare Advantage will be your primary coverage and Medicaid will pay secondary. The same order of payment applies to Tricare UHC Medicare Advantage is primary and Tricare will pay secondary. A Medicare Supplement Plan is a plan that is secondary to Medicare. Medicare pays your claim first and then the supplemental plan pays after Medicare has paid. The level of coverage depends on the plan. A Medicare Advantage Plan is one where Medicare A&B has been assigned to another health plan. UHC Group Medicare Advantage PPO is an example of a Medicare Advantage plan. Your Medicare A&B benefits are assigned to UHC and UHC is then responsible for paying your claims there is no coordination with Medicare. Medicare no longer receives or pays your claims. In exchange for taking on claims responsibility, UHC receives a fixed payment from Medicare. You are still enrolled in Medicare A&B when you enroll in a Medicare Advantage Plan, but you do not present your Medicare card to providers since your Medicare benefits have been assigned to another health plan and that plan is now responsible for paying your claims. Claims will be denied if submitted to Medicare. Page 3 of 10

4 Enrollment (continued) How does UHC Medicare Advantage coordinate with a prior employer s medical plan, assuming it is a Medicare supplement plan? Can I enroll in UHC Medicare Advantage if I m currently enrolled in another Medicare Advantage plan? How does UHC Medicare Advantage coordinate if I m still employed by another company and covered under my current employer s medical plan? You cannot be enrolled in both a Medicare Advantage and Medicare Supplement Plan. Under the Medicare Advantage plan, your Medicare benefits have been assigned to United Healthcare. Therefore, you cannot be enrolled in a Medicare Supplement plan where Medicare pays primary. You will need to choose between the two plans available to you. No. You can only be enrolled in one Medicare Advantage plan. By enrolling in this plan, you will automatically be disenrolled by the Centers for Medicare & Medicaid Services (CMS), from any other Medicare Advantage plan you are enrolled in. If CMS receives notification in the future that you have enrolled in a Medicare Advantage Plan (other than UHC Medicare Advantage), then you will be disenrolled from the UHC Medicare Advantage plan. You will only be enrolled in the most current Medicare Advantage plan. Your current employer s plan will pay primary and UHC Medicare Advantage will pay secondary. However, you are still required to be enrolled in both Medicare Parts A and B in order to have UHC Medicare Advantage pay as secondary. Page 4 of 10

5 Enrollment (continued) What can I expect to receive from United Healthcare and/or Secure Horizons over the next couple of months? Current Secure Horizons members will receive a pre-enrollment kit from UHC in mid-october which will include additional details about the UHC Group Medicare Advantage PPO plan, including a plan summary. This kit is being mailed to all current Secure Horizons enrolled members. In order to meet government requirements, Secure Horizons must mail current members a notice in mid-december informing you that the Secure Horizons PFFS plan will be terminated effective January 1, Do not be concerned when you receive this notice it is a government requirement and does not mean you are not enrolled in a CenturyLink medical plan. It does not affect your enrollment in the UHC Group Medicare Advantage PPO plan or any other CenturyLink retiree medical plan. You will receive your new medical ID card(s) at the end of December. And finally, retirees enrolled in the UHC Group Medicare Advantage PPO for 2011, will receive a post-enrollment kit that includes tips to get the most from your coverage, important reminders about finding providers, etc. Page 5 of 10

6 Providers Am I required to see a UHC network provider when enrolled in the UHC Group Medicare Advantage PPO plan? How do I find network providers in my area? What if I choose to see an out-of-network provider? Do I need to present my United Healthcare ID card each time I go to the doctor? What about my Medicare ID card? No, you are not required to use UHC network providers. You can find network providers on the UHC website ( or by calling customer service at (866) You pay the same copayment and/or coinsurance when you see a network or out-of-network provider. You can see any provider you choose that accepts Medicare assignment. Most providers will file claims for you, however, if you use an outof-network provider they may ask you to pay up front and submit your own claim. If you pay for a service out of your own pocket and need to be reimbursed from UHC, you will send a claim to UHC along with proof of payment. UHC will then process the claim and send reimbursement to you. Your provider will usually ask for a copy of your ID card at each visit. If your provider doesn t ask at your first visit in 2011, be sure to let them know you have a new medical plan and present your ID card. If you are seeing a new provider, be sure to confirm the provider accepts Medicare assignment. You should not present your Medicare ID card to the doctor. You can put that card away in a safe place. Page 6 of 10

7 Plan Benefits What services are covered under the UHC Medicare Advantage plan? Is the UHC Medicare Advantage $250 deductible in addition to my Medicare deductible of $135? Do I need to pay the deductible before I receive preventive services? Is there a lifetime maximum under the UHC Medicare Advantage plan? What is the annual out-of-pocket maximum? There is no change to the covered services or level of payment from the Secure Horizons to the UHC Medicare Advantage plan. You can find a summary of covered services on You will also receive a plan summary in the welcome kit you receive from UHC. No. You no longer pay the Medicare deductible of $135, but you are still required to pay the UHC Medicare Advantage deductible of $250. No. Preventive services are covered at 100% with no deductible. A list of preventive services can be found on No, there is no lifetime maximum. The annual out-of-pocket maximum is $1,500 per individual. Once the out-of-pocket maximum has been reached, all claims are paid at 100% of eligible charges for that individual for the remainder of the calendar year. Page 7 of 10

8 Plan Benefits What if I live or travel outside the United States? What happens to my prescription benefits? What is the Silver Sneakers Fitness program? UHC Medicare Advantage is not available to retirees living outside the 50 United States. However, emergency services are available to you if you are traveling outside the United States. You will be required to pay the provider at the time service is received and file a claim with United Healthcare after the bill has been converted to U.S. dollars. If you are enrolled in the UHC Group Medicare Advantage PPO plan, your prescription coverage is administered by Express Scripts. There is no change in your prescription coverage from Silver Sneakers is a benefit available to you as a UHC Medicare Advantage member. Silver Sneakers provides you with a free access to a local health center/gym. Visit to view locations by state. If you need additional information or have questions, call UHC at (866) Page 8 of 10

9 Plan Benefits What is the Caregiver program? What services are available on the website? The Caregiver program is a benefit available to you as a UHC Medicare Advantage member. This program is available to you as a caregiver or to someone who is caring for you. The program provides unlimited telephonic support 24 hours a day, 7 days a week to assist you in researching local resources that fit your caregiving needs. You can also receive coaching on how to deal with family issues and the stress of caregiving. In addition, you are eligible for up to six hours of Professional Care Management each year. This includes a personalized in-home assessment along with a comprehensive plan of care. Help in finding and coordinating local support services, such as helping you or a loved one get to and from the drugstore or doctor s office. If you have questions about the Caregiver program, contact UHC at (866) You will be able to create an account, login and access your specific benefit plan, claims and health related information. You will also have the ability to search for providers and find prescription drug information. Page 9 of 10

10 General Contact Information How do I contact United Healthcare (UHC) if I have questions about my plan? Who should I contact if I have questions about other CenturyLink health care or life insurance benefits? You can reach UHC customer service at You may also log on to the UHC website ( to find plan information, access your claims information, find providers, etc. Contact CenturyLink Benefits Administration tollfree at or by to benefits@centurylink.com. The toll-free number is available Monday Friday between the hours of 7:00 am 7:00 pm CST (during annual enrollment period). After annual enrollment, the hours of operation are 7:00 am 5:00 pm CST. Page 10 of 10