OFF TO A FRESH START. ENROLLMENT GUIDE.

Transcription

1 Let RHA help find the right individual health insurance policy for you. Visit or call toll-free , Monday through Friday, 9 a.m. 7 p.m. (ET). OFF TO A FRESH START. ENROLLMENT GUIDE. NEWLY ELIGIBLE Retiree Health Access and RHA are registered trademarks of the Health Care Policy Roundtable, LLC, used under license with Health Care Policy Roundtable. All rights reserved. State mandates may apply. RHAPH2NEDTE (7/14)

2 Welcome! First things first. Retiree Health Access (RHA ) is here to help you choose your individual health insurance policy. A fresh approach To make enrolling easier, we ll help you understand your options every step of the way. You can shop for your health insurance policy by visiting We ve included a few worksheets to help you compare coverage benefits and costs when you go online. Or, you can call toll-free , Monday through Friday, 9 a.m. 7 p.m. (ET), and talk to an RHA Benefit Advisor who is happy to walk you through the process. During the weeks ahead, we ll keep you on track to make sure you know what you need to do and when. It s all about helping you get the most from your health insurance policy. From the start. Contents Prepare...2 Learn...6 Enroll Glossary Mark your calender 90 days prior to your RRA Effective Date Personalized plan information is available. Visit or call toll-free , Monday through Friday, 9 a.m. 7 p.m. (ET) to speak to an RHA Benefit Advisor. 90 days prior to your retirement date until your RRA Effective Date (your RRA Effective Date was previously communicated in a letter from DTE) You can enroll in your health plan. Visit or call toll-free , Monday through Friday, 9 a.m. 7 p.m. (ET) to speak to an RHA Benefit Advisor. 21 days prior to your RRA Effective Date Your welcome kit from PayFlex will be mailed to you days after CMS approves your enrollment Confirmation from your selected insurance carrier, including plan information and your ID Card, will be mailed to you.

3 PREPARE 3 Health Information Worksheet PREPARE Take a few minutes to complete this simple worksheet. The information you provide here will help you when it comes time to enroll or when you call an RHA Benefit Advisor. 1. Are you enrolled in both Medicare Part A and Part B? Yes No To enroll in Medicare Part A and Part B, go to I don t know Call an RHA Benefit Advisor toll-free at so we can help determine if you are enrolled in both Medicare Part A and Part B. 2. Do you currently take any prescription drugs? Yes No, go to question 5 3. What is the name of the pharmacy where you usually fill your prescriptions?

4 PREPARE 4 PREPARE 5 4. What prescriptions do you fill most often? Drug Name Dosage Drug Name Dosage Drug Name No. of Pills Per Month No. of Pills Per Month 6. Rank the four items below based on what s most important to you in selecting your health coverage. Keep in mind that 1 is the most important and 4 is the least important. Be sure to enter a different number (1, 2, 3 or 4) on each line. Low monthly premium Physician choice Low payment when admitted to the hospital Low payment for doctor office visit Dosage Drug Name Dosage No. of Pills Per Month No. of Pills Per Month 7. Who are the doctors I see most often? Name Address Check here if you would like to use a mail-order pharmacy. 5. For what reason do you see your current doctor(s)? (Check all that apply) I see my doctor(s) primarily for preventive care or an occasional health problem. I see my doctor(s) for one chronic condition or multiple health issues. I see my doctor(s) for more than one chronic condition or if I may need a major procedure. Specialty Name Address Specialty Name Address Specialty Name Address Specialty

5 LEARN 7 What type of health insurance policy is right for you? Let s look at the types of health insurance policies and how they differ. You may find that the information you jotted down in the Prepare section can help you choose a policy that s right for you. LEARN IF You are willing to change doctors if necessary You don t go to the doctor often You want a single plan and a single premium You don t travel THEN A Medicare Advantage Plan may be right for you Offered by private companies that contract with Medicare to provide you with both Part A and Part B benefits, most Medicare Advantage Plans also include prescription drug coverage. They may also offer additional discounts and wellness programs. You are required to go to participating doctors, hospitals, pharmacies and other health care providers and usually pay a copayment or coinsurance for covered services. If you go to providers who don t participate, you will pay some or all of the costs. Plans such as Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Private Fee-For-Service (PFFS) are considered Medicare Advantage plans.* *See our glossary for descriptions of the plans noted here.

6 LEARN 8 LEARN 9 What type of health insurance policy is right for you? IF You want to keep seeing the same doctors You visit the doctor often You travel frequently or live elsewhere during the year THEN A Supplemental medical plan may be right for you This type of plan can help pay some of the costs for hospital and doctor s services that basic Medicare doesn t cover, like copayments, coinsurance and deductibles. Supplemental medical plans offer flexibility by being accepted by doctors and hospitals around the country. In return, supplemental plans often charge higher premiums than other types of plans. Some supplemental policies also offer coverage for services that basic Medicare doesn t cover, like medical care when you travel outside the United States. What type of health insurance policy is right for you? IF You have significant drug costs You want to avoid a possible late enrollment penalty You are enrolled in a Supplemental medical plan which does not provide prescription drug benefits THEN A Part D Prescription Plan may be right for you A Medicare Part D plan, also known as Medicare Prescription Drug Coverage, is an option administered by private insurance carriers. It is approved by and under contract with Medicare. This type of coverage may help lower your prescription drug costs and help protect against higher costs in the future. Exact coverage and costs are different for each Part D plan. Generally, these plans have a yearly deductible. After the deductible, you and your drug plan share in the cost of covered prescriptions through copayments or coinsurance.

7 LEARN 10 LEARN 11 Medicare Basics Medicare is a federal health insurance program for individuals age 65 and older. Certain disabled individuals who are under age 65 can also have Medicare insurance. Medicare consists of four different parts. Each part covers specific services and has different costs for the services covered. Medicare Services Part A Coverage Helps cover inpatient care in hospital, skilled nursing facility, hospice and home health care. Cost Most people don t need to pay a premium for Medicare Part A because they have contributed the required amount of payroll taxes during their working years. Part A requires a deductible for most benefits. The deductible is based upon benefit periods. PART B Coverage Medicare Part B helps cover doctor and other health care providers services, outpatient care, durable medical equipment and some preventive services. Cost You pay a monthly premium for Medicare Part B, which is usually deducted from your Social Security check. Part B helps to pay benefits once you have met an annual deductible. Some people may pay a different amount because of their yearly income. PART C Coverage If you have Medicare Parts A and B, you can choose Medicare Part C (Medicare Advantage Plan). Medicare Advantage plans offer other benefits and discounts, as well as health care information and tools, not offered by Basic Medicare. Cost You may pay a monthly premium to a private insurance company depending on the policy you choose. You will continue to pay your Medicare Part B premium. PART D Coverage If you have Medicare Parts A and/or B, you can choose a Medicare Part D (Medicare Prescription Drug) plan. Part D helps cover the cost of prescription drugs. Available through your Medicare Advantage plan or through a separate or standalone Medicare Prescription Drug Plan. Cost Your Part D premium depends on where you live, which plan you choose and other eligibility factors. Some people may pay a different amount because of their yearly income.

8 LEARN 12 LEARN 13 Online support One-on-one support The RHA website makes it easy for you to understand your options. Now that you ve considered your needs and what the different types of plans offer, you can go online to see the health insurance policies for which you are eligible, and you can compare coverage options side-by-side to make an informed decision. Visit Experience personalized support through our RHA Benefit Advisors. If you re not quite sure what to do or want to ask some questions, our team welcomes your phone calls. Keep in mind that RHA Benefit Advisors are not paid a commission for helping you enroll in a new health insurance policy. Call an RHA Benefit Advisor Toll-free Monday through Friday 9 a.m. 7 p.m. (ET) If you are assisting a Medicare participant with enrollment If you are an adult child or authorized representative of a Medicare beneficiary, you are welcome to call an RHA Benefit Advisor or visit the RHA website to learn about available plan choices in order to help elect coverage. If you are authorized to act on the Medicare beneficiary s behalf, you may be required to provide legal documentation, such as a Power of Attorney, at some point during the enrollment process.

9 LEARN 14 LEARN 15 Compare Benefits and Costs Worksheet When you go to you can use this worksheet to help you compare the important details for each of the health insurance policies you are considering. WRITE IN CARRIER NAME PLAN NAME/TYPE DEDUCTIBLE COINSURANCE OUT-OF-POCKET PRIMARY DOCTOR OFFICE VISIT SPECIALIST EMERGENCY ROOM OTHER/NOTES

10 Get ready to shop and enroll Look below to see which shopping scenario applies to you. Family Composition Type of Products Shop by Phone Shop Online Medicare Eligible Retiree and/or Spouse ENROLL 17 Medical Products Note: Each member shops online through their own account ENROLL Ancillary Products (For example, Dental, Vision) Not available Families with Medicare Eligible Retiree and/or Spouse and Child All Products An RHA Benefits Advisor will assist you and your family to complete the enrollment process over the phone. Call Not available * Log in separately to shop for and enroll in your benefits. Both you and your spouse s username and temporary password have already been created. Please follow the instructions provided to log in.

11 ENROLL 18 ENROLL 19 Before you log in for the first time Please read these instructions: Your user name is your first name + last initial + last 4 digits of your social security number. For example: Name: Eric Smith, SSN: XXX-XX-9999 Username: erics9999 If the user ID you enter does not work, it may already be taken. You may need to add letters to your last name: For example: EricS9999, EricSm9999, EricSmi9999, etc. If you continue to have trouble logging in, call and an RHA Benefits Advisor can assist you. If your first name is longer than 10 characters, you will need to reduce your first name to 10 letters. Example: Christopher becomes Christophe If your first name contains an apostrophe, it is included in your user name If your first name contains a hyphen, it is not included in your user name Your user name is not case sensitive Your temporary password is your last name + last 4 digits of your social security number. For example: Name: Eric Smith, SSN: XXX-XX-9999 Password: Smith9999 Your temporary password is case sensitive After you log in for the first time, you will be prompted to change your password. Once you are logged in to the RHA website, you will have access to helpful information as you prepare to shop for your health insurance. You can also access electronic copies of all the materials you have received in the mail from RHA.

12 ENROLL 20 ENROLL 21 Next steps to shop and enroll online Click on Enroll Now From the RHA home page, you will need to click on the Enroll Now button. You will then be taken to the profile section of the RHA website. Click on Get Started After you click Get started, you will be asked some questions and given the chance to update the profile for you and your dependents. In order to complete your profile, you need to be enrolled in Medicare Parts A and B. You will be asked to provide your health insurance claim number (HICN ) as well as Medicare Parts A and B effective dates. You will also need to provide this information for any of your dependents who are eligible for Medicare. Once your profile is updated and saved, you can review your retiree reimbursement account (RRA). You can do this by clicking the Get started button. On the next screen, you will need to click the Plan details button. A pop-up will appear with the details of your RRA. When you are done reviewing the details of your RRA, you will need to click on the Close button to close out the pop-up window. Now you are ready to shop and enroll in a plan. Click on the Get started button. You will then be taken to the ehealth website, where you can shop for and enroll in your health plan. Shop for plans Then you will be taken to the shopping section on the ehealth website where you can view and enroll in a health insurance policy. As you shop, you will see the ehealth logo as well as the RHA logo at the top of the screen, so you know you are in the right place. Once you have completed your health plan application, you will be able to see your plan selection and application status on the RHA website. Or enroll by phone If at any time you have questions or you would like to enroll over the phone, RHA Benefits Advisors are available to assist. RHA Benefits Advisors can be reached at RHA Benefits Advisors can be reached at

13 ENROLL 22 ENROLL 23 What is a Retiree Reimbursement Account? A Retiree Reimbursement Account (RRA) is a type of Health Reimbursement Arrangement (HRA). It is an account that is funded only by your former employer that you can use to pay for eligible health care expenses on a tax-free basis. The amount provided is determined by your former employer. You can use the RRA to pay for eligible health care expenses for you, your spouse and your eligible tax dependents. Examples of eligible expenses include: Copays Deductibles Prescription drugs Dental care Vision care, eyeglasses, contacts Chiropractic care Over-the-counter items (OTC drugs and medicines will require a doctor s prescription if you wish to use your RRA funds) Health care premiums For a complete list of eligible expenses refer to Why an RRA? Money for eligible expenses. You get to use money from your former employer to pay for eligible health care expenses on a tax-free basis. It s yours. Any amount left in your RRA at the end of the plan year will carry over to your next plan year under the terms of the plan documents designed by your former employer. Online support. You have 24/7 access to your account information at You can see your account balance, employer contributions, submit claims for reimbursement and enroll in direct deposit. How do I use the funds in my RRA? Once funds are available in your RRA, you have two ways you can use your funds: 1. Pay for an eligible expense with cash, check or a personal credit card. Then, submit a claim for reimbursement. You can submit a claim online, or by using the PayFlex Mobile app, or by filling out a claim form and faxing or mailing it to PayFlex along with your documentation. 2. For quickest reimbursement, sign up for direct deposit. Then, when you submit a claim for reimbursement, you can have the money deposited directly into your checking or savings account. If you do not want to sign up for direct deposit, we can mail a check to your home. 3. Use our online payment tool to pay your provider directly from your RRA.

14 GLOSSARY 25 Questions? Visit or call toll-free , Monday through Friday, 9 a.m. 7 p.m. (ET). Glossary of Health Insurance Terms Basic Medicare Includes Medicare Parts A and B. Benefit The services and expenses covered by the health plans offered. Coinsurance Your share of costs for a covered expense. With some plans, you do not pay coinsurance until you have first paid the required deductible. Copayment (Copay) The set amount you pay for select plan benefits, such as a doctor s visit, usually when you receive the service. Deductible A set amount you may be required to pay before the plan begins to pay benefits. Dependent Your spouse, domestic partner and/or eligible dependent child who meets the eligibility criteria and requirements set by your former employer. Health Maintenance Organization (HMO) A type of Medicare Advantage Plan available in some areas of the country. Plans must cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists or hospitals on the plan s list except in an emergency. Your costs may be lower than in Original Medicare. Medicare Prescription Drug Plan (PDP) This plan provides coverage that helps you pay the cost of covered Part D prescription drugs. Network The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Preferred Provider A provider that has a contract with your health insurer to provide services to you at a discount. Preferred Provider Organization (PPO) A type of Medicare Advantage Plan in which you pay less if the provider you see belongs to the network. You can use providers outside of the network but you may have to pay more. Premium The amount a beneficiary must pay to participate in a medical or prescription drug plan. You and/or former employer usually pay a premium monthly, quarterly or yearly. Private Fee-for-Service (PFFS) Plan A type of Medicare Advantage Plan that lets you visit any Medicareapproved doctor or hospital that accepts the plan s payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare covered benefits. You may have extra benefits Original Medicare doesn t cover. Provider A physician, health care professional or health care facility licensed, certified or accredited as required by state law. Supplemental Retiree Medical Plan (SRMP) This is a health insurance plan that provides coverage for some of the costs not covered under Original Medicare (Medicare Parts A and B), such as deductibles, copays and coinsurance for Medicare-covered services. Rx A commonly used abbreviation for a prescription or pharmacy benefit.