MICHIGAN PUBLIC SCHOOL EMPLOYEES RETIREMENT SYSTEM 2015 Health Plan Seminar Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal. H9572_S_15MPSERSSem FVNR 1014
AGENDA Introductions Coverage overview Medical plan BCBSM Vision plan VSP Prescription drug plan CatamaranRx Dental plan Delta Dental Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 2
MPSERS Medicare Advantage
What is Medicare Advantage? Medicare Advantage combines Medicare Parts A and B with supplemental health coverage from a private insurer. Supplement Medicare Advantage plans provide more coverage than Original Medicare A (Hospital) Drug B (Medical) MEDICARE ADVANTAGE IMPORTANT: BCBSM works with your drug carrier to coordinate your care. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 4
With your Medicare Advantage plan You Keep the Benefits Of: Original Medicare Original Medicare rights & protections Original Medicare covered services Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 5
The importance of having a family doctor Familiar with you and your health More easily recognizes changes in your health Single point of expertise Helps you connect the dots with other doctors or specialists Research shows that people with a personal doctor stay healthier as they age. - International Journal of Health Services Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 6
How to find a doctor Multiple ways to help you: 1. Visit our website 2. Call our Customer Service team 1-800-422-9146 (also on the back of your ID card) 3. Consult your Provider Directory Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 7
Welcome to Medicare exam and annual wellness visit Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 8
The Health Assessment Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 9 9
The Health Assessment helps you Know where you stand now Find ways to improve your health Identify a personalized list of topics to discuss with your doctor TIP: BCBSM sends you a report after you ve completed your assessment bring the report with you to the doctor at your next scheduled visit. Your answers will be kept private and won't affect your enrollment, benefits or health care costs in any way Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 10
Costs YOU pay for covered services Deductible: The amount you must pay for covered medical services before your plan begins to pay. You pay 100% of your covered medical costs until you meet your $650 deductible. Your deductible resets annually. Counts towards your out-ofpocket maximum. Copayment (Co-pay): The fixed dollar amount you pay to health care providers. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 11
Costs YOU pay for covered services Coinsurance: A percentage of the allowed amount you are responsible for. Counts towards your out-ofpocket maximum. Out-of-pocket Maximum: The most you will pay in deductibles and coinsurance during the year. After you reach your out-of-pocket maximum, your plan pays 100% of eligible medical expenses for the remainder of the year. Your out-of-pocket maximum resets annually. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 12
Deductible Coinsurance Combined maximum out-of-pocket Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 13
Covered preventive services include Bone mass measurement Diagnostic hearing exams Pap smears and pelvic exams Colorectal screening Prostate cancer screening Immunizations Mammogram Eye exams Annual wellness exam Treatment for eye conditions Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 14
Hearing care program First time hearing aid purchasers are required to get a medical clearance exam Audiometric exam Measures hearing ability Hearing aid Includes binaural (both ears) Binaural hearing aids must be purchased at the same time Conformity test Evaluates the performance of a hearing aid Frequency limitation Payable once every 36 consecutive months Approved provider Deductible and coinsurance apply Non-approved provider Member pays all charges Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 15
We ve got you covered, but Following the guidelines in your Evidence of Coverage will help you pay less out-of-pocket Straying from the guidelines in your Evidence of Coverage will cost you more out-of-pocket TIP: When traveling within the U.S., be sure to use a Medicare-approved doctor. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 16
Manage your plan with our member site Coverage & Claims One site. One stop. Power to compare. On the go. Good to go. bcbsm.com Health & Wellness Provider Search Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 17 17
Login or register at bcbsm.com/mpsers Log in for member site Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 18
One site. One stop. Personal Snapshot Important alerts Easy-to-understand graphics help you quickly see where you are in your plan. Prominent recent claims activity Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 19
2015 plan updates 2014 2015 Deductible $500 $650 Out-of-pocket maximum Durable medical equipment and supplies, prosthetics and orthotics $1,300 $1,450 Participating provider: Covered in full Non-participating provider: 20% coinsurance plus deductible Participating provider: 10% coinsurance plus deductible Non-participating provider: 30% coinsurance plus deductible Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 20
MPSERS Non-Medicare PPO
When you turn 65 You will become eligible for Medicare. Some individuals may become eligible before they turn 65, for example, if they are permanently disabled. You must tell ORS if you or a family member become eligible for Medicare before age 65 Make sure you are enrolled in both Medicare Parts A and Part B. Part B is required to enroll in Medicare Advantage You will receive a red, white, and blue Medicare card in the mail. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 22
When you turn 65 (cont.) Your Retirement System will submit your enrollment application to Blue Cross automatically. We may reach out to you for additional information if we need it to enroll you in Medicare Advantage. NOTE: Services are not payable for Medicare-eligible members until they are enrolled in the Medicare Advantage Plan Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 23
2015 plan updates 2014 2015 Deductible $650 $850 or $650* Out-of-pocket maximum Durable medical equipment and supplies, prosthetics and orthotics $800 $800 SUPPORT supplier: Covered in full Non-SUPPORT supplier: 20% coinsurance plus deductible, plus difference in cost Participating provider: 10% coinsurance plus deductible Non-participating provider: 30% coinsurance plus deductible, plus difference in cost *Members who complete the steps to enroll in LivingWell can lower their deductible to $650. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 24
LivingWell Program Wellness program for MPSERS members Provides tools to help you work towards a healthier lifestyle Non-Medicare members can complete three steps to receive a reduction in their deductible Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 25
LivingWell Program Steps 1 Complete the health assessment 2 Select a primary care physician 3 BONUS Get an annual routine physical Choose a Patient-Centered Medical home doctor Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 26
What is a Patient-Centered Medical Home? A Patient-Centered Medical Home is a team approach to better health care. Your PCMH doctor leads a team of health care professionals who work together to: Improve your health Help you reach your health goals Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 27
What do Patient-Centered Medical Homes offer? 24-hour access to your care team Extended office hours Phone access Online resources for medical information and support Appointment reminders Tailored care plans to help you reach your health goals Manage chronic conditions 28 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 28
Standard vs. Patient-Centered approach Standard approach Patient-centered approach Sarah is a 44 year old type 2 diabetic. She schedules appointments with her primary care physician when she is sick. She feels ill on a Saturday. Her doctor s office is closed, so she visits the ER and is admitted. Sarah is discharged and instructed to follow up with her doctor. Sarah is a 44 year old type 2 diabetic. Her office care team identifies Sarah in their diabetic patient registry. They call her to schedule an appointment. She feels ill on a Saturday. She visits her doctor the same day because they have extended office hours. Her doctor sends her to the hospital to be admitted and treated. She can t get an appointment to visit her doctor for several weeks. She ends up being readmitted to the hospital. When she s discharged, the hospital works with her PCMH to ensure she is discharged in the right setting with the right treatment. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 29
THANK YOU
MPSERS Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 31
Your BlueVision SM Coverage BCBSM has partnered with VSP Vision Care since 1998 BCBSM and VSP Vision Care work together to offer you BlueVision SM coverage To learn more about your vision coverage, visit vsp.com To find a participating provider, visit vsp.com/advantage 32 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 32
New Vision ID Card Members received a new ID card in January 2014. (Members do not need an ID card to receive services) Members have a dedicated toll-free number for vision 33 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 33
Plan Design Vision Care Services In-Network Out-of-Network Reimbursement Exam $10 copay $40 Lenses Single Bifocal Trifocal Frames Contact Lens Conventional Medically Necessary $15 copay $15 copay $15 copay $0 copay, $120 allowance $15 copay, $120 allowance $0 copay $16 $23 $27 $23 $35 $96 Frequency Exam Lenses Frames Once every 24 months Once every 24 months Once every 24 months 34 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 34
Welcome to 35
Welcome to Catamaran! Catamaran manages the prescription drug plan for the Michigan Public School Employee Retirement system 36
Welcome to Catamaran! We want to help you get maximum value from your pharmacy benefits. 37
Why do some medications cost more than others? 38
Why do some medications cost more than others? 1 A formulary is a listing of medications covered by your plan. 39
Why do some medications cost more than others? The formulary is 2 continually updated, based on the latest research and clinical evidence. 40
Why do some medications cost more than others? A formulary 3 places medications on different levels or tiers. 41
Why do some medications cost more than others? Your cost for a 4 prescription is determined by the tier the medication is on. 42
Michigan Public Employee Retirement System Prescription Plan 43
MPSERS Prescription Plan 30 Day Supply Tiers 1 and 2 20% coinsurance Tier 3 and 4 40% coinsurance $10 Minimum / $40 Maximum $10 Minimum / No Max Generic, Formulary brand, & Formulary specialty medications Non-Formulary Brand & Non-Formulary Specialty Medications 44
MPSERS Prescription Plan 90 Day Supply Tier 1, 2, and some 4 20% coinsurance Tier 3 and most Tier 4 40% coinsurance $25 Minimum / $100 Maximum $25 Minimum / No Max Generic, Formulary brand, & Formulary specialty medications Non-Formulary Brand & Non-Formulary Specialty Medications 45
save How to the most money when choosing medications 46
How to save the most money when choosing medications Go generic! Generics are safe, effective and have the same active ingredients as a brand name medication, but cost an average of 85% less. 47
How to save the most money when choosing medications Go generic! Ask your doctor or pharmacist, Is there a generic that is right for me? 48
How to save the most money when choosing medications Stay preferred. If a generic medication is not available, choose a preferred brand. 49
medication. 50 How to save the most money when choosing medications Stay preferred. A preferred medication is lower cost and/or more clinically effective than a non-preferred
Your personal, secure website is loaded with pharmacy plan information 51
Your personal, secure website is loaded with pharmacy plan information On the website you can: 1 Compare drug costs before you fill a prescription. 52
Your personal, secure website is loaded with pharmacy plan information On the website you can: 2 View your medication history. 53
Your personal, secure website is loaded with pharmacy plan information On the website you can: 3 Learn more about your medications. 54
Your personal, secure website is loaded with pharmacy plan information On the website you can: 4 Review the formulary. 55
Your personal, secure website is loaded with pharmacy plan information Visit the website: mycatamaranrx.com 56
Good health is in the palm of your hand with the Catamaran Mobile App 57
Good health is in the palm of your hand with the Catamaran Mobile App When you are on-the-go: 1 Easily share your prescription list with your doctor. 58
Good health is in the palm of your hand with the Catamaran Mobile App When you are on-the-go: 2 Find a nearby pharmacy. 59
Good health is in the palm of your hand with the Catamaran Mobile App When you are on-the-go: 3 Order a prescription refill from Home Delivery. 60
Good health is in the palm of your hand with the Catamaran Mobile App Available for Android and iphone: Search: CatamaranRx 61
Never run out of the medications you take every day 62
Never run out of the medications you take every day Beginning 1/1/15 Catamaran Home Delivery will become your Mail Order pharmacy 63
Never run out of the medications you take every day Catamaran Home Delivery Drugs to control blood pressure and cholesterol are examples of maintenance medications you may take on a regular basis. 64
Never run out of the medications you take every day Catamaran Home Delivery Save money and time when you use Catamaran Home Delivery. 65
Never run out of the medications you take every day Catamaran Home Delivery A 90-day supply of medication is delivered right to your door. 66
Pre-Register with Catamaran Home By Mail: Delivery 1 Use a blank paper form Please fill out all data requested Mail to PO Box 145, Avon Lake, OH 44012-0145 67
Pre-Register with Catamaran Home By Fax: Delivery 2 Use a blank paper form Please fill out all data requested Fax to 800-893-2299 (fax number located on the form) 68
Pre-Register with Catamaran Home By Web: Delivery 3 Log on to www.mycatamaranrx.com 69
Pre-Register with Catamaran Home Delivery 70
Pre-Register with Catamaran Home Delivery 71
Pre-Register with Catamaran Home Delivery 72
Never run out of the medications you take every day Catamaran Retail 90 Drugs to control blood pressure and cholesterol are examples of maintenance medications you may take on a regular basis. 73
Never run out of the medications you take every day Catamaran Retail 90 Save money and time when you choose Retail 90. 74
Never run out of the medications you take every day Catamaran Retail 90 Fill a 90-day supply of medication at your local pharmacy. 75
Specialty Pharmacy 76
BriovaRx Specialty Pharmacy 77
BriovaRx Specialty Pharmacy Multiple Sclerosis, Crohn s Disease and Rheumatoid Arthritis are examples of specialty conditions. 78
BriovaRx Specialty Pharmacy Patients with specialty conditions get extra care and high-touch support from BriovaRx, the Catamaran specialty pharmacy. 79
BriovaRx Specialty Pharmacy 80
BriovaRx Specialty Pharmacy Learn more: www.briovarx.com 81
Your Catamaran Welcome Kit has everything you need! 82
Your Catamaran Welcome Kit has everything you need Look for your Welcome Kit in the mail approximately Mid-December berserv maranrx www.mycata 83
Your Catamaran Welcome Kit has everything you need Your Welcome Kit includes: Pharmacy ID cards 84
Your Catamaran Welcome Kit has everything you need Your Welcome Kit includes: Tips for Using Your Benefits 85
Your Catamaran Welcome Kit has everything you need Your Welcome Kit includes: Home Delivery Materials: Order Form Brochure Return Envelope 86
Catamaran is here to help! 87
Catamaran is here to help! Get help and answers to your questions with just a few clicks or a phone call. 88
Catamaran is here to help! Find answers to questions, forms and your plan details on our website and mobile app 89
Catamaran is here to help! Contact our Call Center 24/7 for assistance Catamaran Member Services: Non-Medicare Members- 1-866-288-5209 Medicare Members- 1-855-577-6517 90
MPSERS Michigan Public School Employees Retirement System Fall Seminars 2014 Lisa Eggert Senior Account Manager 91
Delta Dental PPO Standard Access to two Delta Dental networks Delta Dental PPO SM Delta Dental Premier Freedom to choose any dentist All claims are reimbursed at the PPO dentist schedule amount Additional charges may be incurred when utilizing a Delta Dental Premier or nonparticipating provider 92
Network Comparison Delta Dental PPO SM 234,500+ locations 95,000+ unique dentists Delta Dental Premier 315,100+ locations 148,400+ unique dentists Nonparticipating Most significant discounts No balance billing above the Delta Dental PPO Schedule Acceptance of processing policies Significant discounts No balance billing above the Maximum Allowed Fee Acceptance of processing policies No discounts Balance billing 93
MPSERS Dental Plan Diagnostic and Preventive Services Two cleanings, exams and fluoride (to age 21) per calendar year Basic Services Restorative services Major Services Prosthodontic services Orthodontics Orthodontic services (to age 19) Delta Dental PPO dentist Delta Dental Premier or nonparticipating dentist 95% 90% X-rays 95% Fillings 80% All other 75% 75% 50% 50% 50% 50% 94
MPSERS Dental Plan (continued) Annual Maximum (per calendar year) Applies to Diagnostic & Preventive, Basic Services, and Major Services benefits Orthodontic Maximum (lifetime maximum) Applies to Orthodontic benefits $1,100 $1,200 Deductible $0 95
Adult Cleaning Payment Example Delta Dental PPO dentist Delta Dental Premier dentist Nonparticipating dentist Submitted Fee $90 $90 $90 Maximum Allowed Fee $54 $77 $90 Delta Dental PPO Schedule $54 $54 $54 Coverage level 95% 90% 90% Amount Delta Dental pays $51.30 $48.60 $48.60 Amount you pay $2.70 $28.40 $41.40 96
Contacting Delta Dental Toll free: (800) 345-8756 Advisors Available 8:30 a.m. 8:00 p.m. (EST), Monday Friday DASI (automated system) Available 24 hours a day, seven days a week Provides benefit, claims, eligibility information, Delta Dental s mailing address and the names of Delta Dental PPO and Delta Dental Premier dentists near you. www.deltadentalmi.com 97
Thank you! 10/2014
How to reach us Blue Cross Blue Shield of Michigan Call: 1-800-422-9146 (TTY users call 711) Weekdays, 8:30 a.m. to 5 p.m. EST bcbsm.com/mpsers CatamaranRx Call: 1-855-577-6517 (Medicare) 1-866-288-5209 (Non-Medicare) 24 hours a day, seven days a week mycatamaranrx.com BlueVision Call: 1-877-478-7558 (TTY users call 711) Weekdays, 8 a.m. to 11 p.m. EST Saturday, 10 a.m. to 11 p.m. EST Sunday, 10 a.m. to 10 p.m. EST Delta Dental Plan of Michigan Call: 1-800-345-8756 Weekdays, 8:30 a.m. to 8 p.m. EST (Automated service available 24 hours a day, seven days a week) deltadentalmi.com vsp.com Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 99