2016 Summary of benefits Includes comparison chart

Transcription

1 FEDERAL EMPLOYEE GROUP RETIREES 2016 Summary of benefits Includes comparison chart Group Health FEHB Medicare Advantage (HMO) Group Health FEHB Medicare Choice Original Medicare Coordination of Benefits

2 2016 Summary of benefits This summary of benefits is meant to give you a snapshot of your plan choices and show you how the benefits for different plans compare. Before you start reviewing these plans, please see the service area descriptions on page 9 to make sure you are eligible to enroll. Medicare Advantage HMO for Federal Retirees High Deductible Health Plan, with HSA or HRA If you live in the Group Health Medicare Advantage service area and are enrolled in Medicare Parts A and B, Group Health Federal Employees Health Benefits (FEHB) MA plans may be a good choice for your health coverage. These plans make it easy to predict and track overall medical expenses. Plans feature: A broad selection of doctors who accept Medicare patients through the Group Health contracted provider network. SilverSneakers and other fitness programs. Optical and hearing hardware allowance. Travel benefit for certain covered services: $25 copay and reimbursement for reasonable charges up to a maximum of $2,000 per person per year.* Medicare Choice Original Medicare Coordination of Benefits (COB) for Federal Retirees High Deductible Health Plan, with HSA or HRA If you do not qualify for a Group Health Medicare Advantage plan, we can coordinate your Group Health plan benefits with Medicare. This option is good for people who do not live in our Medicare Advantage service area or who frequently travel outside of our service area. Coordination of benefits is available to anyone with Medicare Part A, but to take advantage of the lower costs available through Medicare Choice, you must have Medicare Parts A and B. Plans feature: 1 2 Access to any doctor who is accepting new Medicare patients. Travel benefit for certain covered services: $25 copay and reimbursement for reasonable charges up to a maximum of $2,000 per person per year.* The High Deductible Health Plan can be paired with a tax-free Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) through HealthEquity, which allows you to set aside tax-free dollars to use for medical expenses. Group Health will also contribute to your medical fund. *See Evidence of Coverage for full benefit description. 2

3 More information How do I know if I am enrolled in a Group Health FEHB Medicare Advantage plan? Take a look at your Group Health ID card. If it says Medicare Advantage HMO on it, you re a Group Health FEHB Medicare Advantage plan member. Here are some other ways to know: You would have filled out an election form. Once we received your completed election form, you would have received an acknowledgment letter from us. Once your enrollment was approved, you would have received a confirmation letter from us. You would also have received a welcome packet containing a provider directory and other information to help you make the most of your Group Health Medicare Advantage plan. What happens if I don t enroll in Medicare Part B as soon as I am eligible? If you don t sign up for Medicare Part B when you re first eligible, you may be charged a late enrollment penalty. The penalty amounts to a 10 percent increase in your Part B premium for every 12 months you were eligible but did not enroll. However, if you didn t elect Part B at age 65 because you had equivalent coverage as an active FEHB employee, or because you were covered under your spouse s employer health insurance plan and he/she was an active employee, you may sign up for Part B within eight months from the time you or your spouse stops working, generally without incurring the penalty. If I enroll in a Group Health FEHB Medicare Advantage plan, will I lose my FEHB benefits? No. You ll remain an FEHB member and also be a Group Health Medicare Advantage member. Enrollment in our Medicare Advantage plan enhances your current FEHB or coverage. Group Health Cooperative is an HMO plan with a Medicare contract. Enrollment in Group Health HMO 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, premiums and/or co-payments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Coverage provided by Group Health Cooperative 3

4 FEHB Group Retirees Medicare Advantage Requires Medicare Parts A and B Coverage High Deductible Health Plan Group Health FEHB MA (HMO) Annual deductible $0 $0 $0 Annual out-of-pocket limit $1,000 $1,000 $1,000 Annual medical fund contribution $750 N/A N/A Benefits Office visit (primary/specialty) Covered in full $10 copay Covered in full Preventive care visits Covered in full Covered in full Covered in full Chiropractic 20 visits PCY Naturopathy 3 visits PCY Acupuncture 8 visits PCY Covered in full $10 copay Covered in full Covered in full $10 copay Covered in full Covered in full $10 copay Covered in full Lab/X-ray Covered in full Covered in full Covered in full Durable medical equipment Covered in full Covered in full Covered in full Prosthetic devices Covered in full Covered in full Covered in full Hospital Inpatient care: Covered in full Outpatient surgery: Covered in full Inpatient care: $100 copay per admit Outpatient surgery: $50 copay Inpatient care: Covered in full Outpatient surgery: Covered in full Urgent care Covered in full $10 copay Covered in full Ambulance Covered in full Covered in full Covered in full Emergency care Covered in full $50 copay $50 copay PCY = per calendar year 4

5 This is a summary of benefits. See your Evidence of Coverage for full benefit details. Coverage High Deductible Health Plan Group Health FEHB MA (HMO) Prescription drugs Tier 1: Formulary generic 90-day mail order supply $3 copay $6 copay $3 copay $6 copay $20 copay Tier 2: Formulary brand 90-day mail order supply $30 copay $60 copay $30 copay $60 copay $80 copay Tier 3: Nonformulary 90-day mail order supply $80 copay $80 copay $60 copay $120 copay Tier 4: Formulary specialty 25% up to $200 25% up to $200 25% up to $200 Tier 5: Nonformulary specialty 50% up to $500 50% up to $500 50% up to $500 Optical supplies $100 every 24 months $100 every 24 months $100 every 24 months Hearing supplies $250 every 24 months $250 every 24 months $250 every 24 months Dental benefits included with : Delta Dental Annual deductible: $50 individual / $150 family Annual benefit maximum: $750 PPO Provider Preventive care: Covered in full, after deductible Periodontal care: You pay 50%, after deductible Any Provider Preventive care: Covered in full, after deductible Periodontal care: You pay 70%, after deductible 5

6 Medicare Choice Original Medicare Coordination of Benefits Requires Medicare Parts A and B* Coverage High Deductible Health Plan Group Health FEHB Medicare Choice COB Annual deductible $0 $0 $0 Annual out-of-pocket limit $1,500 $1,500 $3,000 Annual medical fund contribution $750 N/A N/A Benefits Office visit (primary/specialty) $25 copay $25/$35 copay $25 copay Preventive care visits Covered in full Covered in full Covered in full Chiropractic 20 visits PCY Naturopathy 3 visits PCY Acupuncture 8 visits PCY $25 copay $25/$35 copay $25 copay $25 copay $25/$35 copay $25 copay $25 copay $25/$35 copay $25 copay Lab/X-ray Covered in full Covered in full Covered in full Durable medical equipment Covered in full Covered in full 20% coinsurance Prosthetic devices Covered in full Covered in full 20% coinsurance Hospital Inpatient care: $150 copay per admit Outpatient surgery: $50 copay Inpatient care: $150 copay per admit Outpatient surgery: $50 copay Inpatient care: $350 copay per admit Outpatient surgery: $75 copay Urgent care $25 copay $25/$35 copay $25 copay Ambulance Covered in full Covered in full 20% coinsurance Emergency care $50 copay $50 copay $100 copay PCY = per calendar year * Members with Part A only can still have coordinated benefits, but at higher cost shares than shown above for Medicare Choice. 6

7 This is a summary of benefits. See your Evidence of Coverage for full benefit details. Coverage High Deductible Health Plan Group Health FEHB Medicare Choice COB Prescription drugs Tier 1: Formulary generic 90-day mail order supply $10 copay $20 copay $20 copay $20 copay Tier 2: Formulary brand 90-day mail order supply 20% up to $100 20% up to $200 $80 copay $80 copay Tier 3: Nonformulary 90-day mail order supply 40% up to $250 20% up to $500 $60 copay $120 copay $60 copay $120 copay Tier 4: Formulary specialty Tier 5: Nonformulary specialty 25% up to $200 25% up to $200 25% up to $200 50% up to $500 50% up to $500 50% up to $500 Optical supplies Not covered Not covered Not covered Hearing supplies Not covered Not covered Not covered Dental benefits included with : Delta Dental Annual deductible: $50 individual / $150 family Annual benefit maximum: $750 PPO Provider Preventive care: Covered in full, after deductible Periodontal care: You pay 50%, after deductible Any Provider Preventive care: Covered in full, after deductible Periodontal care: You pay 70%, after deductible 7

8 Monthly plan premiums Rates listed for each plan apply to Medicare Advantage and Medicare Choice options. Plan Type of Enrollment Annuitant Premium (Your monthly share) High Deductible Health Plan Self Only Self Plus One Self and Family Code PT1 Code PT3 Code PT2 $ $ $ Self Only Code 544 Self Plus One Code 546 Self and Family Code 545 $ $ $ Self Only Code 541 Self Plus One Code 543 Self and Family Code 542 $ $ $

9 Group Health Medicare Advantage plan service area To join one of our Medicare Advantage plans, you must live in one of the following counties (note ZIP codes for partial counties): Western Washington Grays Harbor (98541, 98557, 98559, 98568), Island, King, Kitsap, Lewis, Mason (98524, 98528, 98546, 98548, 98555, 98584, 98588, 98592), Pierce, San Juan, Skagit, Snohomish, Thurston, Whatcom Eastern Washington Spokane Medicare Choice Original Medicare Coordination of Benefits service area (same service area as non-medicare Group Health FEHB plans) To select Medicare Choice or other Original Medicare Coordination of Benefits with a Group Health plan, you must live or work in one of the following counties (note ZIP codes for partial counties): Western Washington Grays Harbor (98541, 98557, 98559, 98568), Island, Jefferson (98320, 98325, 98334, 98339, 98358, 98365, 98368, 98376), King, Kitsap, Lewis, Mason, Pierce, San Juan, Skagit, Snohomish, Thurston, Whatcom Central and Eastern Washington Benton, Columbia, Franklin, Kittitas, Spokane, Walla Walla, Whitman, Yakima Idaho Kootenai, Latah 9

10 Multi-Language Insert Multi-language Interpreter Services English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al Alguien que hable español le podrá ayudar. Este es un servicio gratuito. Chinese Mandarin: 我 们 提 供 免 费 的 翻 译 服 务, 帮 助 您 解 答 关 于 健 康 或 药 物 保 险 的 任 何 疑 问 如 果 您 需 要 此 翻 译 服 务, 请 致 电 我 们 的 中 文 工 作 人 员 很 乐 意 帮 助 您 这 是 一 项 免 费 服 务 Chinese Cantonese: 您 對 我 們 的 健 康 或 藥 物 保 險 可 能 存 有 疑 問, 為 此 我 們 提 供 免 費 的 翻 譯 服 務 如 需 翻 譯 服 務, 請 致 電 我 們 講 中 文 的 人 員 將 樂 意 為 您 提 供 幫 助 這 是 一 項 免 費 服 務 Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurancemédicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit. Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí. German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos. Y0033_H5050_15-MED Accepted

11 Korean: 당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화 번으로 문의해주십 시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다. Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. Arabic: إننا نقدم خدمات المترجم الفوري المجانیة للا جابة عن أي أسي لة تتعلق بالصحة أو جدول الا دویة لدینا. للحصول. سیقوم شخص ما یتحدث على مترجم فوري لیس علیك سوى الاتصال بنا على.بمساعدتك. ھذه خدمة مجانیة العربیة Hindi: हम र व य य दव क य जन क ब र म आपक कस भ न क जव ब द न क लए हम र प स म त द भ षय स व ए उपल ध ह. एक द भ षय त करन क लए, बस हम पर फ न कर. क ई य त ज ह द ब लत ह आपक मदद कर सकत ह. यह एक म त स व ह. Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito. French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis. Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer Ta usługa jest bezpłatna. Japanese: 当 社 の 健 康 健 康 保 険 と 薬 品 処 方 薬 プランに 関 するご 質 問 にお 答 えするため に 無 料 の 通 訳 サービスがありますございます 通 訳 をご 用 命 になるには にお 電 話 ください 日 本 語 を 話 す 人 者 が 支 援 いたします これは 無 料 の サー ビスです 11

12 CONTACT US TTY WA Relay: or 711 Monday Friday, 8 a.m. 8 p.m. Extended hours October 1 February 14, 7 days a week, 8 a.m. 8 p.m. medicare.ghc.org 15-MED