Your Retiree Health Plan Options for Medicare Primary Outreach Event

Transcription

1 Your Retiree Health Plan Options for 2016 Medicare Primary Outreach Event

2 Presentation Overview Medicare Advantage Refresher Plan Year 2016 Options Changes Preparing Humana UnitedHealthcare Blue Cross and Blue Shield of NC Income Related Monthly Adjustment Amount (IRMAA) Question and Answer Session 2

3 Medicare Advantage Refresher 3

4 What is Medicare Advantage? Medicare Advantage Overview A Medicare health plan choice. It may be an individual or group product. You are still considered to be in the Medicare program but you do not have Original/Traditional Medicare. Keep same rights and protections as Original Medicare. Must cover all services Original Medicare covers. Group Medicare Advantage Plans are different than Individual Medicare Advantage Plans. Must be an eligible member of the specific group to enroll. Customized for the State Health Plan. Private companies contract with Medicare to provide your Medicare Part A and Medicare Part B benefits. Most include Medicare Prescription Drug Coverage, Part D. Members must have and continue to pay Medicare Part A and Medicare Part B premiums. 4

5 Medicare Advantage (PPO) Plans National Preferred Provider Organization (PPO) plans. Access to providers nationwide The plans offered were customized by the State Health Plan to provide additional benefits at a lower cost and include an open network. With these Group MAPDP plans your copays or coinsurance remain the same, regardless of who you see in- or out-of-network. Out-of-network providers must participate with Medicare and agree to accept and file claims on member s behalf. May offer extra services not covered under Original Medicare. Wellness programs/silversneakers Disease and Case Management 5

6 Medicare Advantage & Other Insurance Medicare Advantage provides one ID card for medical services and prescription drugs. Remember: no longer under Original/Traditional Medicare Must use your Humana or UnitedHealthcare ID card not your red, white and blue Medicare card No need for additional coverage. Additional Medicare product coverage can cause you to be disenrolled from your State Health Plan Humana or UnitedHealthcare MAPDP. If enrolled in an MAPDP, agents cannot sell you a Medicare Supplement or Medigap plan without you terminating your MAPDP. If already enrolled in another Medicare Advantage or Part D prescription drug plan, your coverage with those plans will terminate unless you elect not to enroll in one of these Group Medicare Advantage plans. 6

7 TRICARE & Other Insurance TRICARE for Life (TFL) (TRICARE + Medicare) TFL beneficiaries can enroll in Medicare Advantage plans and TFL will reimburse your copayments for services covered by TFL. TFL pays secondary to the Medicare Advantage plan. In most pharmacies if you present both Medicare Advantage and TFL ID cards, online coordination of benefits will occur for prescriptions. Cannot utilize TFL mail-order prescription coverage if enrolled in Medicare Advantage plan. You cannot use Medicare or Medicare Advantage in a Military Treatment Facility, like a VA Hospital. Other Insurance If covered by a Federal Employee Health Benefit Plan or another former employer s retiree group health plan, it is important to check with them to ensure enrollment into one of these Medicare Advantage plans will not disrupt coverage with them. 7

8 Automatic Enrollment Reminder The State Health Plan conducts auto-enrollments into a Group Medicare Advantage Base Plan as younger retired members age in to Medicare (typically when turning 65). Auto-enrollment letters are sent approximately days before a younger retiree becomes Medicare eligible. Auto-enrollment occurs even for those retirees living outside of North Carolina. Members who have been auto enrolled have the opportunity to change plans prior to their effective date. State Health Plan members retiring when they are already 65 years or older are automatically enrolled into either a Group Medicare Advantage Base Plan or the Traditional 70/30 PPO. 8

9 2016 Benefit Plan Year 9

10 2016 Plan Options for Medicare Retirees Your Plan options for 2016 will remain the same but the plans have changed. You will learn more about those changes today. Humana Group Medicare Advantage (PPO) Base Plan Humana Group Medicare Advantage (PPO) Enhanced Plan UnitedHealthcare Group Medicare Advantage (PPO) Base Plan UnitedHealthcare Group Medicare Advantage (PPO) Enhanced Plan Traditional 70/30 Plan Traditional 70/30 Plan premium free for Medicare Primary members; Base Plan premium free for primary member Enhanced Plan monthly premium for primary member ($66) Each plan includes monthly premiums for spousal and dependent coverage. To be eligible for dependent coverage under the Medicare Advantage plans, dependents must be Medicare eligible. 10

11 Preparing for 2016 All members who are enrolled in Group Medicare Advantage ENHANCED plans for 2015 are being automatically moved to their carrier s (Humana or UnitedHealthcare) BASE plan for During this Annual Enrollment Period, members may elect to return to their ENHANCED plan or elect any plan option that is available to them. It will be important for all members to carefully review their Annual Enrollment materials concerning plan choices for Review your medical needs in conjunction with benefit structures. Review pharmacy needs formularies (list of drugs covered) may vary between companies. Look at requirements such as prior authorizations, step therapy and quantity limits. 11

12 2016 Medicare Advantage PPO Benefits Both the Base and Enhanced PPO plans include: No deductibles. Maximum medical out-of-pocket limits $4,000 Base Plans $3,300 Enhanced Plans Predictable copayments. Medicare Part D prescription drug coverage No donut hole $2,500 maximum drug out-of-pocket limit Preventive care. Additional benefits like a nurse help line and SilverSneakers Vision, podiatry and hearing benefits. 12

13 Changes for 2016 Plan Year Group Medicare Advantage BASE plans have no changes to copays, coinsurance or maximum out-of-pocket limits but there are changes in the formularies (list of covered drugs). Prior Authorizations Step Therapy Group Medicare Advantage ENHANCED plans will have changes to some copays, increased medical maximum out-ofpocket limit and changes in formularies. Prior Authorizations Step Therapy Traditional 70/30 PPO plan will have changes across the board which include copays, deductible, and maximum out-of-pocket limits will be increasing for both medical and pharmacy benefits. 13

14 Traditional 70/30 Plan Members will still have the option to choose the Traditional 70/30 plan, which is administered by Blue Cross and Blue Shield of NC (BCBSNC). Original Medicare is primary, State Health Plan coverage is secondary. You would use your red, white and blue Medicare card along with your BCBSNC 70/30 ID card. Includes the Traditional prescription drug coverage. Not necessary to have a Medicare Part D plan as this is creditable drug coverage. Significant changes for 2016 Increased deductible, copays, maximum out-of-pocket limits Changes align with the State Health Plan s strategic plan that was adopted by the Plan s Board of Trustees in

15 2016 Plan Comparison (Medical) 2016 Traditional 70/30 BCBSNC 2016 Humana Enhanced Plan 2016 UHC Enhanced Plan Physician Services Primary Care Physician $39 copay * $15 copay $15 copay Preventive Care $39 copay * $0 copay $0 copay Specialist $92 copay * $35 copay $35 copay Urgent Care $98 copay * $35 copay $40 copay Deductible/Coinsuranc Outpatient Lab/X-ray e $25 copay $20/$25 copay Emergency Room $329 Copay/Ded/Coins $65 copay $65 copay Physical, Speech, Occupational Therapy $72 copay* $20 copay $20 copay Chiropractic Visits $72 copay* $20 copay $20 copay $0 copay (after PCP or Specialist copay) $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) Labs/X-ray (conducted within Office Visit) Deductible/Coinsuranc Durable Medical Equipment e 20% coinsurance 20% coinsurance Annual Deductible $1,054/$3,162* $0 $0 Deductible/Coinsuranc Outpatient Hospital Services e $100 copay $100 copay Deductible/Coinsuranc Diagnostic (CT, MRI, PET scans) e $100 copay $100 copay Deductible/Coinsuranc Outpatient Surgery e $175 copay $250 copay $160/day (Days 1-10) Zero after that $150/day (Days 1-10) Zero after that $329 Copay/Ded/Coins Inpatient Hospital Confinement $4,282 Individual Max $3,300 OOP $3,300 OOP Coinsurance Max/OOP $12,846 Family Max (No Family Max) (No Family Max) 15 Fitness Not Covered SilverSneakers SilverSneakers

16 Humana Medical Benefits Comparison - State Health Plan Medicare Primary Retirees 2015 Humana Base Plan 2016 Humana Base Plan 2015 Humana Enhanced Plan 2016 Humana Enhanced Plan Physician Services Primary Care $20 copay $20 copay $10 copay $15 copay Physician Specialist $40 copay $40 copay $30 copay $35 copay Urgent Care $50 copay $50 copay $40 copay $35 copay Outpatient Lab/X-ray $40 copay $40 copay $25 copay $25 copay Emergency Room $65 copay $65 copay $50 copay $65 copay Physical, Speech, Occupational Therapy $20 copay $20 copay $20 copay $20 copay Chiropractic Visits $20 copay $20 copay $20 copay $20 copay Labs/X-ray (conducted within Office Visit) $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) 16 $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) Durable Medical Equipment 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance Outpatient Hospital Services $125 copay $125 copay $75 copay $100 copay Diagnostic (CT, MRI, PET scans) $100 copay $100 copay $100 copay $100 copay Outpatient Surgery $250 copay $250 copay $150 copay $175 copay Inpatient Hospital Confinement Coinsurance Max/OOP $160/day (Days 1-10) Zero after that $160/day (Days 1-10) Zero after that $150/day (Days 1-10) Zero after that $160/day (Days 1-10) Zero after that $4,000 OOP $4,000 OOP $2,600 OOP $3,300 OOP (No Family Max) (No Family Max) (No Family Max) (No Family Max) Fitness SilverSneakers SilverSneakers SilverSneakers SilverSneakers

17 Humana Prescription Drug Benefits Comparison - State Health Plan Medicare Primary Retirees 2015 Humana Base Plan 2016 Humana Base Plan 2015 Humana Enhanced Plan 2016 Humana Enhanced Plan Prescriptions Drug Coverage Part D Gap Coverage Full Coverage Full Coverage Full Coverage Full Coverage Formulary Name Custom Custom Custom Custom Part D Retail (up to a 31 day supply) Tier 1 $10 co-pay $10 co-pay $7 co-pay $7 co-pay Tier 2 $40 co-pay $40 co-pay $35 co-pay $33 co-pay Tier 3 $64 co-pay $64 co-pay $50 co-pay $50 co-pay Tier 4 25% co-insurance ($100 Max) 25% co-insurance ($100 Max) 25% co-insurance ($95 Max) 25% co-insurance ($100 Max) Tier 5 N/A N/A N/A N/A Maintenance Drugs (up to a 90 day supply) Tier 1 $24 co-pay $24 co-pay $14 co-pay $14 co-pay Tier 2 $80 co-pay $80 co-pay $70 co-pay $66 co-pay Tier 3 $128 co-pay $128 co-pay $100 co-pay $100 co-pay Tier 4 25% coinsurance ($300 Max) 25% coinsurance ($300 Max) 25% coinsurance ($190 Max) 25% coinsurance ($200 Max) Tier 5 N/A N/A N/A N/A Diabetic Supplies Preferred Brand Testing Supplies Test strips/lancets Needles 20% coinsurance ($50 max) 20% coinsurance ($50 max) 20% coinsurance ($50 max) 20% coinsurance ($50 max) Non-Preferred Brand Testing Sup Test strips Needles Prescription Drug Annual OOP Max $2,500 $2,500 $2,500 $2,500 17

18 UnitedHealthcare Medical Benefits Comparison - State Health Plan Medicare Primary Retirees Physician Services 2015 UHC Base Plan UHC Base Plan 2015 UHC Enhanced Plan 2016 UHC Enhanced Plan Primary Care Physician $20 copay $20 copay $10 copay $15 copay Preventive Care $0 copay $0 copay $0 copay $0 copay Specialist $40 copay $40 copay $35 copay $35 copay Urgent Care $50 copay $50 copay $35 copay $40 copay Outpatient Lab/X-ray $40 copay $40 copay $25 copay $20/$25 copay Emergency Room $65 copay $65 copay $50 copay $65 copay Physical, Speech, Occupational Therapy $20 copay $20 copay $10 copay $20 copay Chiropractic Visits $20 copay $20 copay $10 copay $20 copay Labs/X-ray (conducted within Office Visit) $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) Durable Medical Equipment 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance Outpatient Hospital Services $125 copay $125 copay $50 copay $100 copay Diagnostic (CT, MRI, PET scans) $100 copay $100 copay $50 copay $100 copay Outpatient Surgery $250 copay $250 copay $100 copay $250 copay Inpatient Hospital Confinement Coinsurance Max/OOP $160/day (Days 1-10) Zero after that $160/day (Days 1-10) Zero after that $150/day (Days 1-8) Zero after that $150/day (Days 1-10) Zero after that $4,000 OOP $4,000 OOP $2,600 OOP $3,300 OOP (No Family Max) (No Family Max) (No Family Max) (No Family Max) Fitness SilverSneakers SilverSneakers SilverSneakers SilverSneakers

19 UnitedHealthcare Prescription Drug Benefits Comparison - State Health Plan Medicare Primary Retirees 2015 UHC Base Plan 2016 UHC Base Plan 2015 UHC Enhanced Plan 2016 UHC Enhanced Plan Prescription Drug Annual OOP Max Formulary Name Custom Custom Custom Custom Part D Retail (up to a 31 day supply) Tier 1 $10 co-pay $10 co-pay $5 co-pay $10 co-pay Tier 2 $40 co-pay $40 co-pay $30 co-pay $35 co-pay Tier 3 $64 co-pay $64 co-pay $40 co-pay $50 co-pay Tier 4 25% co-insurance ($100 Max) 25% co-insurance ($100 Max) 25% co-insurance ($95 Max) 25% co-insurance ($100 Max) Tier 5 N/A N/A N/A N/A Maintenance Drugs (up to a 90 day supply) Tier 1 $24 co-pay $24 co-pay $10 co-pay $20 co-pay Tier 2 $80 co-pay $80 co-pay $60 co-pay $70 co-pay Tier 3 $128 co-pay $128 co-pay $80 co-pay $100 co-pay Tier 4 25% co-insurance ($300 Max) 25% co-insurance ($300 Max) 25% co-insurance ($200 Max) 25% co-insurance ($200 Max) Tier 5 N/A N/A N/A N/A Diabetic Supplies Preferred Brand Testing Supplies Test strips/lancets Needles Non-Preferred Brand Testing Sup Test strips Needles 20% coinsurance 0% cost for Preferred Brands/One Touch and Accu-Chek monitors & strips $0 cost for lancets & lancet devices 20% coinsurance 0% cost for Preferred Brands/One Touch and Accu-Chek monitors & strips $0 cost for lancets & lancet devices Prescription Drug Annual OOP Max $2, $2,500 $2,500 $2,500

20 BCBSNC Comparison Medical Benefits - State Health Plan Medicare Primary Retirees 2015 Traditional 70/30 PPO - BCBS of NC 2016 Traditional 70/30 PPO - BCBS of NC Physician Services Primary Care Physician $35 copay* $39 copay * Preventive Care $35 copay* $39 copay * Specialist $81 copay* $92 copay * Urgent Care $87 copay* $98 copay * Outpatient Lab/X-ray Deductible/Coinsurance Deductible/Coinsurance Emergency Room $291 Copay/Ded/Coins $329 Copay/Ded/Coins Physical, Speech, Occupational Therapy $64 copay* $72 copay* Chiropractic Visits $64 copay* $72 copay* $0 copay (after PCP or Specialist copay) $0 copay (after PCP or Specialist copay) Labs/X-ray (conducted within Office Visit) Durable Medical Equipment Deductible/Coinsurance Deductible/Coinsurance Annual Deductible $933/$2,799* $1,054/$3,162* Outpatient Hospital Services Deductible/Coinsurance Deductible/Coinsurance Diagnostic (CT, MRI, PET scans) Deductible/Coinsurance Deductible/Coinsurance Outpatient Surgery Deductible/Coinsurance Deductible/Coinsurance $291 Copay/Ded/Coins $329 Copay/Ded/Coins Inpatient Hospital Confinement $3,793 Individual Max $4,282 Individual Max Coinsurance Max/OOP $11,379 Family Max $12,846 Family Max Fitness Not Covered Not Covered 20

21 BCBSNC Prescription Drug Comparison State Health Plan Medicare Primary Full Coverage Full Coverage Formulary Name Custom Custom Part D Retail (up to a 31 day supply) Tier 1 $12 co-pay $15 co-pay Tier 2 $40 co-pay $46 co-pay Tier 3 $64 co-pay $72 co-pay Tier 4 Tier 5 25% coinsurance ($100 Max) 25% coinsurance ($100 Max) 25% coinsurance ($125 Max) 25% coinsurance ($132 Max) Maintenance Drugs (up to a 90 day supply) Tier 1 $36 (61-90 days) $45 (61-90 days) Tier 2 $120 (61-90 days) $138 (61-90 days) Tier 3 $192 (61-90 days) $216 (61-90 days) Diabetic Supplies Tier 4 Tier 5 Preferred Brand Testing Supplies Test strips/lancets Needles Non-Preferred Brand Testing Sup Test strips Needles 25% coinsurance ($300 Max) (61-90 days) 25% coinsurance ($300 Max) (61-90 days) 25% coinsurance ($375 Max) (61-90 days) 25% coinsurance ($396 Max) (61-90 days) For brand name drugs w/generic equivalent, if For brand name drugs w/generic equivalent, if brand brand name chosen, members must pay the Tier 1 name chosen, members must pay the Tier 1 copayment copayment plus the difference between the Plan's plus the difference between the Plan's cost of the brand cost of the brand name drug and the Plan's cost of name drug and the Plan's cost of the generic drug not the generic drug not to exceed $100 per 30 day to exceed $100 per 30 day supply of brand medication. supply of brand medication. $10 (0-30 day supply) $10 (0-30 day supply) $25 (0-30 day supply) $25 (0-30 day supply) Prescription Drug Annual OOP Max $2,500 $3,294 21

22 It s a New Day at Humana! GHHJELLEN_16

23 Changes for 2016 Humana Base Plan (Medical) Benefit Routine Vision Exam (1 exam every 12 months) Routine Hearing Exam (1 exam every 12 months) Not covered $40 copayment Not covered Covered 100% There are NO changes to the Pharmacy copayments on the Base Plan 23

24 Changes for 2016 Humana Enhanced Plan (Medical) Benefit Routine Vision Exam (1 exam every 12 months) Not covered $25 copayment Routine Hearing Exam (1 exam every 12 months) Not covered Covered 100% Urgent Care $40 copayment $35 copayment Other Benefit Changes Annual Maximum Out of Pocket (MOOP) - $3,300 Primary Care Physician - $15 copay Specialist - $35 copay Inpatient Hospital - $160 copay (days 1-10) Outpatient Hospital Services - $100 copay Outpatient Surgery - $175 copay Emergency Room Care - $65 copay 24

25 Changes for 2016 Humana Enhanced Plan (Pharmacy) 31-day supply (retail) Tier 2 - $33 copay (reduced from $35) Tier 4 25% coinsurance ($100 maximum per prescription) 90-day supply (retail or mail order) Tier 2 - $66 (reduced from $70) Tier 4 25% coinsurance ($200 maximum per prescription) Be sure to check the drug formulary to see if the drugs you are taking have changed Tiers or are subject to prior authorization. 25

26 Humana Benefit Highlights! NO annual deductible Referrals are NOT required Choose ANY doctor or hospital who participates with Medicare Preventive services/health screenings are covered at 100% Maximum Out-of-Pocket (MOOP) limit on the plan 90-day supply available for most prescriptions at mail or retail, cost is same for both No coverage gap or donut hole Coverage travels with you anywhere in the United States One ID card for your medical and pharmacy Worldwide coverage for emergencies AND the very popular SilverSneakers fitness program! 26

27 Are you a Member of a 4.5 Star Health Plan? Humana has received a 4.5 out of 5.0 Star rating from CMS in 2015 All Medicare Health Plans are rated from one to five stars, with five being the highest for quality and service. What do the plan ratings measure? Staying healthy Managing long-term conditions Member satisfaction Member complaints and appeals Telephone customer service Drug patient safety Why is this important to YOU? This overall summary score makes it easier to compare plans based on quality and performance, to choose the right plan for you! 27

28 Plans that are EASY to Use and Meet YOUR NEEDS Humana has been named a Top Payer by PayerView - 4th year in a row - for its ease of doing business with health care providers! Use any provider who participates with Medicare and agrees to bill Humana. You are NOT limited to providers that are listed in our network directories or on the website! More than 18,000 contracted providers throughout North Carolina More than 400,000 contracted providers across the United States More than 65,000 pharmacies nationwide including major chains and local pharmacies. 28

29 It s a New Day at Humana! High quality, highly-rated Medicare plan (4.5 Star Rating) New vision and hearing benefits Network growth more than 5,000 new providers in North Carolina Wellness rewards We bring Humana to You! * More than 90% of NCSHP Humana members were satisfied Overall with Humana and would recommend Humana to family or friends *Based on Humana Customer Service Satisfaction Survey that was conducted in December

30 Where Can You Get More Information? Dedicated North Carolina State Health Plan Customer Care Toll-free (800) (TTY: 711) Monday through Friday from 8 a.m. 9 p.m.

31 Humana is a Medicare Advantage PPO plan with a Medicare contract. Enrollment in this Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, formulary, premium and/or member cost-share may change each year. You must continue to pay your Medicare Part B premium. The pharmacy network and provider network may change at any time. You will receive notice when necessary. Other pharmacies are available in our network. You should get your new prescription by mail in 7-10 days after Humana Pharmacy has all the necessary information. It may take longer if Humana Pharmacy calls you or your healthcare provider with questions about the order. If you do not receive your order in 7-10 days, please call (TTY: 711), Monday Friday, 8 a.m. 11 p.m., and Saturday, 8 a.m. 6:30 p.m., Eastern time. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. This information is available for free in other languages. Please call our customer care number at (TTY: 711). You can call Monday - Friday, from 8 a.m. - 9 p.m., Eastern time. Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de Atención al Cliente al (TTY: 711). Los representantes están disponibles de lunes a viernes de 8 a.m. a 9 p.m., hora del Este.

32 Your 2016 UnitedHealthcare Group Medicare Advantage (PPO) plans H2001_150825_105743

33 Your UnitedHealthcare Plans Two (2) plans from which to choose: Base plan Enhanced plan Both plans include prescription drug coverage All members who currently have UnitedHealthcare coverage will be automatically enrolled in the UnitedHealthcare Base plan. If you want the Enhanced plan, you will need to contact Eligibility and Enrollment Support Center Call: , TTY 711, 8 a.m. 5 p.m. ET, each state business day (extended to 8 p.m. during Annual Enrollment) Visit: Annual Enrollment: October 15 November 18, 2015

34 2016 Enhanced Plan Changes at a Glance Medical Benefit Coverage Doctor s Office Visit Enhanced Plan Changes for Primary Care Physician: $10 Specialist: $35 Primary Care Physician: $15 Specialist: $35 Inpatient Hospital Care $150 co-pay per day: days 1-8; $0 co-pay after that $150 co-pay per day: days 1-10; $0 co-pay after that Outpatient Surgery $100 $250 Diagnostic Radiology Services Ambulance Emergency Care $50 $100 $40 $75 $50 $65 Urgent Care $35 $40 Please refer to your Annual Notice of Change and 2016 Summary of Benefits for more detail.

35 2016 Enhanced Plan Changes at a Glance Rx Benefit Coverage 2015 Enhanced Plan 2016 Enhanced Plan Maximum Rx Out-of-Pocket $2500 $2500 Retail (31-day supply) Tier 1 - Generic $5 co-pay $10 co-pay Tier 2 Preferred Brand $30 co-pay $35 co-pay Tier 3 Non-Preferred Brand $40 co-pay $50 co-pay Tier 4 Specialty Tier Tier 1 - Generic Tier 2 Preferred Brand Tier 3 Non-Preferred Brand 25% co-insurance or a $95 maximum Retail and Mail Order (90-day supply) 25% co-insurance or a $100 maximum $10 co-pay $20 co-pay $60 co-pay $70 co-pay $80 co-pay $100 co-pay Tier 4 Specialty Tier 25% co-insurance or a $200 maximum 25% co-insurance or a $200 maximum

36 Diabetic Supplies Changes for 2016 Beginning January 1, 2016, your plan will only provide coverage for the following brands of blood glucose testing strips and meters: OneTouch Ultra 2 OneTouch Verio OneTouch UltraMini ACCU_CHEK Aviva ACCU_CHEK SmartView Good news! This change allows us to reduce your member cost-share for diabetic testing supplies to $0. These supplies include the above brands of test strips and meters, and any brand of lancets, lancing device, glucose control solution (to test the accuracy of your meter), and replacement batteries for your meter. You may be required to see your doctor to get a new prescription for these preferred testing and monitoring supplies. If you are using a different brand than identified above, a temporary supply of your current brand can be requested.

37 Health & Wellness Programs Available at no additional cost for both the Base and Enhanced plans. HouseCalls program Caregiver Support program SilverSneakers Fitness program Identity Theft & Fraud Protection QuitPower Smoking Cessation Online Will Preparation Plus with the Enhanced Plan: UnitedHealthcare Global Travel Assistance

38 HouseCalls A health and wellness program that comes to you. HouseCalls is designed to support and complement your regular doctor s care. For qualified members, you can meet with one of our licensed clinicians in the convenience of your own home at no additional cost to you. The appointment may include: Important health screenings Extra time to talk about any health-related concerns you may have Review of your current medications Discussion of your diet Educational materials that may help you maintain your health You may even be eligible for a reward when you complete a HouseCalls visit.

39 Renew by UnitedHealthcare Challenge yourself to become healthier and happier and earn real rewards for your efforts. Health is your greatest asset. Helping you take control of your health is UnitedHealthcare s top priority. That s why we ve created Renew by UnitedHealthcare. Our Renew magazine and Renew Rewards are exciting new ways for us to give you the tools and know-how to take control of your own health care. Renew Rewards by UnitedHealthcare, can teach you how to be your own best health advocate, and encourage you to make healthy choices and reward you for doing so. Every step of the way you'll be one step closer to being the best you YOU can be. A Healthier. Happier. You. Magazine

40 This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Additional Required Benefits Disclaimers: [Materials for MA and MAPD: <Benefits, premium and/or co-payments/co-insurance> may change on January 1 of each year.] [Materials for off-cycle Employer Group Only: <Benefits, premium and/or co-payments/co-insurance> may change each plan/benefit year.] Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan s contract renewal with Medicare. Consult a health care professional before beginning any exercise program. Availability of the SilverSneakers program varies by plan/market. Refer to your Evidence of Coverage for more details. Healthways and SilverSneakers are registered trademarks of Healthways, Inc. and/or its subsidiaries. <2015> Healthways, Inc. All rights reserved. Solutions for Caregivers assists in coordinating community and in-home resources. The final decision about your care arrangements must be made by you. In addition, the quality of a particular provider must be solely determined and monitored by you. Information provided to you about a particular provider does not imply and is in no way an endorsement of that particular provider by Solutions for Caregivers. The information on and the selection of a particular provider has been supplied by the provider and is subject to change without written consent of Solutions for Caregivers. Questions? Give us a call! Your dedicated resources are here to help! , TTY a.m. 8 p.m., local time, 7 days a week Or go online:

41 70/30 Traditional PPO Plan Benefit Option State Health Plan Retirees 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

42 42 Traditional 70/30 PPO Plan Option PPO Blue Options Network The Traditional 70/30 PPO Plan is supported by the BCBSNC Blue Options network of providers SHP 70/30 members never have to go far to find a doctor either our Blue Options network includes more than 95% of all doctors practicing in North Carolina With the Traditional 70/30 Plan, you can seek care from providers in the BCBSNC Blue Options network or go out-of-network. When you use innetwork providers, you ll have wide access to high quality providers, and you ll save money Information contained in this presentation is considered accurate but not guaranteed. State Health Plan validation with its own legal and tax professionals is required. 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

43 Traditional 70/30 PPO Plan Option 43 Annual Deductible Coinsurance Maximum Preventive Care 2016 Plan Design Changes 70/30 Current $933 Individual $2,799 Family $3,793 Individual $11,379 Family $35 PCP $81 Specialist 70/ $1,054 Individual $3,162 Family $4,282 Individual $12,846 Family $39 PCP $92 Specialist PCP Visit $35 $39 Specialist Visit $81 $92 Urgent Care $87 $98 Chiro/PT/OT $64 $72 Emergency Care $291, then 30% after deductible $329, then 30% after deductible Inpatient Hospital $291, then 30% after deductible $329, then 30% after deductible Information contained in this presentation is considered accurate but not guaranteed. State Health Plan validation with its own legal and tax professionals is required. 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

44 44 Traditional 70/30 PPO Plan Option 2016 Plan Design Changes 70/30 Current 70/ Pharmacy Tier 1 $12 $15 Tier 2 $40 $46 Tier 3 $64 $72 Tier 4 25% up to $100 25% up to $100 Tier 5 25% up to $125 25% up to $132 OOP $2,500 Rx Only $3,294 Rx Only The current Pharmacy Benefit Manager (PBM) for the State Health Plan is Express Scripts For questions regarding your Traditional Pharmacy Benefit Plan, please call Express Scripts Customer Service at Information contained in this presentation is considered accurate but not guaranteed. State Health Plan validation with its own legal and tax professionals is required. 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

45 45 Traditional 70/30 PPO Plan Option Wellness Resources Your online destination for healthy deals Fitness gear Healthy eating Personal care Gym memberships Vision and hearing Family activities Information contained in this presentation is considered accurate but not guaranteed. State Health Plan validation with its own legal and tax professionals is required. 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

46 46 Traditional 70/30 PPO Plan Option Coordination of Benefits Medicare If you elect the Traditional 70/30 PPO plan option, Medicare will be your primary insurance With the 70/30 plan, charges left unpaid by Medicare are paid by the SHP after the yearly deductible, coinsurance and copays are applied If you don t have Medicare Part B, you will be responsible for what Medicare Part B would have paid Medigap (Medicare Supplement) plan A Medigap plan is generally not needed when you have secondary coverage to Medicare Medigap plans ONLY work with Original Medicare. They will not work with Medicare Advantage plans Information contained in this presentation is considered accurate but not guaranteed. State Health Plan validation with its own legal and tax professionals is required. 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

47 47 Traditional 70/30 PPO Plan Option For questions regarding the Traditional 70/30 plan call BCBSNC at or Express Scripts at Thank You Information contained in this presentation is considered accurate but not guaranteed. State Health Plan validation with its own legal and tax professionals is required. 2014, BCBSNC. Proprietary and Confidential Not for Distribution without written permission. BLUE CROSS BLUE SHIELD, the cross and shield symbols and all related derivative marks are registered service marks of the Blue Cross and Blue Shield Association. Other marks and trade names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

48 2016 Annual Enrollment 48

49 Eligibility and When to Select During the Annual Enrollment Period, which will be held Oct. 15-Nov. 18 you can: Stay in the Base or Traditional 70/30 plan in which you are enrolled Switch to a different Base or elect an Enhanced Group Medicare Advantage Plan offered Switch to the Traditional 70/30 plan Drop or add dependents Disenroll from the Plan Medicare Primary dependents will stay together. If spouse/dependents are not Medicare eligible: They have same options available to active employees/non-medicare members. Enhanced 80/20 Traditional 70/30 Consumer-Directed Health Plan w/hra 49

50 Annual Enrollment Period Your opportunity to make changes: Change plans Opt in/out of the State Health Plan Add dependents Remove dependents If you opt out of the State Health Plan during an Annual Enrollment period, you may opt back into the State Health Plan during any following Annual Enrollment period or as a result of a Qualifying Life Event. Annual Enrollment will be from October 15 - November 18, REMEMBER: If you are in one of the Medicare Advantage ENHANCED plans for 2015, you will be enrolled into that carrier s Medicare Advantage Base plan for 2016 UNLESS you make a different selection during the Annual Enrollment Period. 50

51 How to Make a Change for 2016 You will be able to make changes either online or by phone: the ORBIT Online Retirement Benefits through Integrated Technology enrollment system Call , Monday-Friday from 8am-5pm Remember to make note of date, time and whom you spoke with in your records. Any plan changes during Annual Enrollment Period become effective January 1, Retired Medicare Primary members not wishing to enroll into one of the Group Medicare Advantage plans may elect to enroll into the Traditional 70/30 plan. If 70/30 elected for 2016, remember Medicare will be primary and 70/30 will be secondary coverage. 51

52 Effective July 1, 2015 A legislative change became effective July 1, 2015, which now allows retirees and surviving spouses to disenroll from the State Health Plan without a Qualifying Life Event. This mean they can drop entirely from the State Health Plan cannot make changes to coverage type. The legislative change also allows retirees and surviving spouses to disenroll their dependents from the State Health Plan during the Plan year without a Qualifying Life Event. Coverage under the Plan will end on the earliest of the following dates: Last day of the month in which the State Health Plan approves cancellation of coverage or as soon as administratively possible; or Last day of the month for which a premium is paid in full. All other changes must be made during an Annual Enrollment Period or with a Qualifying Life Event. 52

53 Income-Related Monthly Adjustment Amount (IRMAA) Members with higher income levels are required to pay an adjusted Medicare Part B premium plus an additional amount when enrolled in Medicare Part D prescription drug coverage. The additional amount is called Income-Related Monthly Adjustment Amount or IRMAA. Income level based on modified adjusted gross income, which is the total of your adjusted gross income and tax-exempt interest income. IRMAA is mandated by Federal law and each amount is deducted from your monthly Social Security payments. IRMAA will apply if individual income is over $85,000 or if married (filing joint tax return) income is over $170,000. If enrolled in the Group Medicare Advantage plans with Humana or UnitedHealthcare, higher income members may be subject to IRMAA. 53

54 Humana and UnitedHealthcare Medicare Advantage Base Plans Coverage Type Retiree Premium Dependent Premium Total Monthly Premium Retiree Only $0.00 N/A $0.00 Retiree + Child(ren) Retiree + Spouse Retiree + Family $0.00 $ $ $0.00 $ $ $0.00 $ $

55 Humana and UnitedHealthcare Medicare Advantage Enhanced Plans Coverage Type Retiree Premium Dependent Premium Total Monthly Premium Retiree Only $66.00 N/A $66.00 Retiree + Child(ren) Retiree + Spouse $66.00 $ $ $66.00 $ $ Retiree + Family $66.00 $ $

56 Traditional 70/30 PPO Plan Coverage Type Retiree Premium Dependent Premium Total Monthly Premium Retiree Only $0.00 N/A $0.00 Retiree + Child(ren) Retiree + Spouse $0.00 $ $ $0.00 $ $ Retiree + Family $0.00 $ $

57 Thank You! Questions? Photo credits: Thinkstock Images