Presented by Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association. Life has a plan.

Transcription

1 Presented by Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association. Life has a plan. It's hard to believe that another year has gone by. We want to thank you for your membership with Excellus BlueCross BlueShield, and help you prepare for the annual enrollment period, October 15 to December 7, This video will provide you with a summary of some of the key benefits changes to your Medicare Blue Classic Plan for For a full list of all the changes to your plan, please refer to your 2016 Annual Notice of Change that you recently received in the mail, or you can view your Annual Notice of Change online by going to MyExcellusMedicare.com/2016PlanInfo. It's very important that you read these documents thoroughly and that you save them for future reference so that you understand all the plan changes for Before we outline the premium and benefit changes for 2016, we'd like to remind you about some of the benefits of "Blue." With Excellus BlueCross BlueShield, you continue to enjoy the security of a trusted, reliable brand wherever you go. A robust network of top quality doctors and hospitals. No-cost preventive services when performed by an in-network provider. Urgent care and emergency care coverage when you travel. A fitness benefit to help you get and stay healthy. We know you have choices when it comes to your health insurance. Rest assured that your decision to remain a member of the Excellus BlueCross BlueShield family will continue to provide you access to the health care you need whenever and wherever you need it. Now for some of the highlights of your prescription drug benefit changes for plan year Many of our members will be pleased to learn that, effective January 1, 2016, Rite Aid will be back in our pharmacy network. We are also pleased to announce that we are partnering with Express Scripts in 2016 for mail order pharmacy service. Effective January 1, Prime Mail will no longer be a participating mail order pharmacy. If you currently receive your medications through Prime Mail, you will need to choose another participating mail order or retail pharmacy. For more information on your prescription drug benefit, contact our Pharmacy Benefit Member Help Desk at TTY/TDD users call , 8:00 AM to 8:00 PM, Monday through Friday, and Saturday, 9:00 AM to 1:00 PM. October 1 to February 14, representatives are available to assist you seven days a week, 8:00 AM to 8:00 PM. With Excellus BlueCross BlueShield Medicare Advantage PPO plans, your provider network coverage is extended to parts of the 35 states shown in blue on the map and Puerto Rico. At Provider.BCBS.com, you can research which doctors and health care facilities participate in our Medicare Advantage plans. All Medicare members will be receiving a new Excellus BlueCross BlueShield identification card for the 2016 plan year. This is a result of changes to some of the copays for 2016 which we will cover shortly. For those of you who were enrolled in the Silver&Fit benefit in 2015, we've made it easier and more convenient for you to pay the annual enrollment fee. In 2016, you'll be able to pay your $25 annual fee directly to most participating Silver&Fit fitness facilities. Now for the premium and benefit changes for your plan. For 2016, the Medicare Blue Classic plan monthly premium will be $24. The 2015 amount was $18. The annual deductible will remain zero It's important to understand that many different factors combine to cause health

2 insurance premiums to rise, even for those people who don't use many health care services. We've prepared a video that explains these factors in detail, with easy-tounderstand examples. You can access the video on our website at MyExcellusMedicare.com/2016PlanInfo. Now let's cover the most commonly-used benefits for your plan. All the benefit information that we will present will be for innetwork cost sharing amounts. As a reminder, this plan covers in- and out-of-network services. Out-of-network services are covered at a higher out-of-pocket cost. For doctor visits, the primary care physician copay is decreasing from $15 to $10 per visit. The copay to see a specialist will remain the same, at $50 per visit. The copay for an inpatient hospital stay will increase from $325 per day to $350 per day for days one through five. The cost for skilled nursing care will continue to be zero dollars for days 1 through 20, while the cost for days 21 through 100 will increase from $150 to $160 per day. In 2016, the cost for ambulatory surgery center services, observation room services, and outpatient hospital services will remain the same, at 20% coinsurance. To help clarify, observation room services are charged when you are overnight in a hospital, but are not formally admitted by a physician. Examples of services performed in the outpatient department of a hospital or at a free-standing ambulatory surgery center would include a colonoscopy and cataract surgery. The charges are for the use of the facility. The cost for lab tests will increase from $15 in 2015 to a $20 copay in Diagnostic radiology such as CAT scans or MRIs will remain at 20% coinsurance. X-rays and ultrasounds will remain the same as well, at a $50 copay. It is important to note that all of these benefits are per visit, not per test or image. For example, when having blood drawn and the provider draws multiple vials of blood for multiple tests, you only pay one $20 copay. Ambulance services to a health facility will decrease from a $300 copay to a $250 copay. This applies to ground as well as air transportation. Hospital emergency room visits will increase, from a $65 copay to a $75 copay. Urgent care visits will decrease, from a $50 copay to a $40 copay. Rest assured, you're covered for emergency services wherever and whenever you're traveling worldwide. Urgent care is covered when you are traveling nationwide. In 2016, the cost for diabetes testing supplies and durable medical equipment will remain the same, at 20% co-insurance. Physical therapy will also remain the same, at a $40 copay. As a reminder, Excellus BlueCross BlueShield requires that diabetic supplies be purchased through our preferred provider, Abbott Diabetes Care. In 2016, the Silver&Fit fitness benefit continues to give you the power to improve your health through learning and exercise. The annual fee options will remain the same in We encourage you to take advantage of this benefit designed to keep you healthy. Choose one of three options. Option one, for a low annual fee of $25, you have access to a participating facility of your choice. Option two, for a fee of $10, you get a choice of up to two home exercise kits per year. Option three, you are eligible to receive up to a $150 reimbursement for membership to a nonparticipating facility. Annual vision and hearing exam will remain the same, at a $50 copay. There are minimal changes to the copayments for medications in 2016 for a 30-day supply. Tier One, Preferred Generics, are select generic drugs that are used for maintenance of health for chronic conditions and other clinical and cost savings advantages. Your cost for Tier One

3 drugs will decrease to a $3 copay. Tier Two, Generics, are most other generics on our formulary. Your cost for Tier Two drugs will remain the same, at an $8 copay. Tier Three, Preferred Brand, are drugs that have unique, significant clinical advantages, and offer overall greater value compared to other products in the same drug class. Certain generic drugs may appear in Tier Three due to the high cost of the drug or the potential safety concerns for our Part D members. Your cost for Tier Three drugs will remain the same, at a $45 copay. Tier Four, Non-Preferred Brand, are all other brand name drugs on our formulary. Certain generic drugs may appear in Tier Four due to the high cost of the drug or the potential safety concerns for our Part D members. In 2016, your cost for Tier Four drugs will remain the same, at a $95 copay. Tier Five, Specialty, are high-cost, specialty generic and brand name drugs that exceed $600 per month. For drugs in Tier Five, you will continue to pay 33% of the cost of the drug. Here's an overview of the changes to the Medicare Part D drug coverage phases for plan year During the first phase, Initial Coverage, you pay out-of-pocket for your drugs. During this phase, the following costs are tracked, your copay, coinsurance, and deductible amounts, plus the negotiated ost that Excellus BlueCross BlueShield pays for the drugs. Once the total of what you pay and what Excellus BlueCross BlueShield pays, added together, reaches $3,310, you move to the Coverage Gap phase. In this phase, also known as the "Donut Hole," you pay for a percentage of the drugs you receive. You pay 58% of the cost for generic drugs and 45% of the cost for brand name drugs. Once you reach the annual out-of-pocket limit of $4,850, you move to the final phase, also known as the Catastrophic Coverage phase. While in the Catastrophic Coverage phase, you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year. In 2016, you will pay $2.95 for generic drugs and $7.40 for brand name drugs, or a 5% co-insurance, whichever is greater. In 2016, the maximum out-of-pocket protection will increase from $6 to $6,400 for in-network services, nd a combined total of $10,000 for in-and out-of-network services. With Medicare Advantage plans, the total out-of-pocket costs you pay on medical services go toward your out-of-pocket maximum. This is the most amount of money you will have to spend each year on medical services. If the amount you spend in a given year reaches the out-of-pocket maximum, Excellus BlueCross BlueShield will pay in full for any medical services you receive for the remainder of the year. There's no better way to give yourself peace of mind than by getting the preventive screenings you need. They're completely free to you as an Excellus BlueCross BlueShield Medicare member when performed by an in-network provider. Zero-dollar preventive services include, but are not limited to, mammogram, flu shot, bone density, screening colonoscopy, annual wellness visit, pap smear, and pneumonia vaccination. For details, and a complete list of preventive screening services and limits, please refer to your 2016 Evidence of Coverage. Please keep in mind that, when services other than preventive are performed, the office visit copayment may apply. Also, if the service is considered diagnostic, not preventive, a copayment may apply. This is not uncommon. For example, you pay a zero-dollar copay for a colorectal cancer screening. A copay may apply if the screening detects a lesion or growth resulting in a biopsy or removal of the growth, and your doctor bills

4 the procedure as diagnostic. Here are few cost-saving suggestions to reduce your outof-pocket spending on health care. With Blue365, you have exclusive, member-only access to leading national companies that provide special online savings on a wide variety of health-related products and services, including vision, hearing, fitness, and nutrition products. Visit ExcellusBCBS.com/Blue365Med to get started. You can save money by ordering a 90-day supply of your medications at the retail pharmacy or through the Mail Order program. When ordering 90-day supplies, you will pay 2 and 1/2 copays instead of 3 copays. You can order and receive a 90-day supply of your long term medications through the mail from Express Scripts, Walgreens, and Wegmans mail order pharmacy. All of these mail order pharmacies allow you to have our medications delivered right to your door. Did you know that urgent care services cost you less than similar emergency care services? For non-life-threatening conditions such as burns, minor cuts, sprains, and nausea, you can choose to go to an urgent care facility. You will pay a lower copayment than you would if you had gone to the emergency room. Here are two government programs that can help qualified members save money on Medicare Part D prescription drugs. If you have limited income and resources, you may qualify for help to pay for some health care and prescription drug costs. To see if you qualify, contact your Social Security office at TTY/TDD users, call Or visit their website at SocialSecurity.gov/i1020. You may also qualify for the Elderly Pharmaceutical Insurance Coverage program, also known as EPIC. This is a New York statesponsored prescription plan for senior citizens that helps supplement your out-ofpocket Medicare Part D drug plan cost. EPIC has increased the income thresholds to $75,000 for single and $100,000 for married. To see if you qualify for EPIC, call TTY/TDD users call By now, you should have received your 2016 Annual Notice of Change, with your Evidence of Coverage and Formulary. These documents provide detailed information regarding changes to your 2016 plan costs and benefits. It is very important that you read the Annual Notice of Change and Evidence of Coverage carefully so that you can fully understand all plan changes for By October 15, you will receive a packet of information from us. Included in the packet will be a product brochure that outlines all of the plans we will be offering for 2016 and a new Plan Advisor Tool to assist you with choosing the right plan for you. The annual enrollment period runs from October 15 to December 7. This is the time of year that you can make a change to your Medicare Advantage plan. If you are happy with your current health plan, you do not have to do anything during the annual enrollment period. Your current plan will remain in effect for Your new 2016 Excellus BlueCross BlueShield identification card will be sent to you on or around December 15. If you're interested in learning about our other plan options, you can do so by viewing the Member Product brochure on our website, MyExcellusMedicare.com/2016PlanInfo. There, you'll find information about all of our plan options for 2016, including our new Zero Premium plan. On the website, you'll also find other helpful information and tools. You can view your Annual Notice of Change and Evidence of Coverage, register for a live webinar, where one of our specialists will highlight the plan changes for 2016, use our Plan Advisor Tool to help

5 you choose a plan that fits both your individual health and financial needs, watch a video to help you understand the reasons for rising health insurance costs, and view a list of helpful Medicare terms. For more information, or to request an enrollment form, call our Customer Care department at TTY/TDD users call , 8:00 AM to 8:00 PM, Monday through Friday. October 1 to February 14, representatives are available to assist you seven days a week, 8:00 AM to 8:00 PM. You can also visit us at the locations listed on our website, MyExcellusMedicare.com/2016PlanInfo. Thank you for your membership, and for choosing Excellus BlueCross BlueShield. We look forward to serving you in the year ahead.