Group medicare advantage hmo recording 2 (solo)
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Group medicare advantage hmo recording 2 (solo)
- 1. G O P M I C E A VA TA E H O R U ED AR D N G M
- 2. What’s New for 2013 Tier 1 Rx Copay Rx Manager Hearing WellCard Reduction New Name Discounts Enhancements
- 3. W AST TO C EBC PI S Eligibility Requirements In-Network Benefits $ Copayments Additional Benefits
- 4. Person ELI G B LI TY I I State R U R EN EQ I EM TS Eligible
- 5. ELI G BI LI TY R U R EN I EQ I EM TS Group Medicare Advantage The below are eligible for the Group Medicare Advantage HMO Plan: • Retiree • LTD Recipient • Qualified Survivor • Domestic Partner • Eligible Dependents
- 6. ELI G BI LI TY R U R EN I EQ I EM TS Medicare Plan To enroll in the Group Medicare Advantage HMO Plan, you must have: Medicare Parts A & B
- 7. ELI G BI LI TY R U R EN I EQ I EM TS Group Medicare Advantage The Group Medicare Advantage HMO Plan is available: • Arizona • All Counties
- 8. ELI G BI LI TY R U R EN I EQ I EM TS Question & Answer 1 Roland is an ASRS retiree with Medicare Parts A&B. He lives full time in Carefree, Arizona. Can he enroll in this plan? a. Yes b. No
- 9. ELI G BI LI TY R U R EN I EQ I EM TS Question & Answer 2 Nora is an actively contributing member of the ASRS. She has Medicare parts A and B. Can she enroll in the Medicare Advantage HMO? ? a. Yes b. No
- 10. I N NETW RK BENEFI TS - O
- 11. I N N O K BEN TS - ETW R EFI Group Medicare Advantage Medicare Part D: • Is included, and is equal to or better than the standard Medicare Part D Coverage.
- 12. I N N O K BEN TS - ETW R EFI Prescription UnitedHealthcare Formulary: • Approved outpatient prescription drugs • Doctor must use • Participating pharmacy
- 13. I N N O K BEN TS - ETW R EFI Additional Information • No annual benefit limit in coverage • No annual deductibles • No prescription coverage gap
- 14. I N N O K BEN TS - ETW R EFI Selection You must select a Primary Care Physician in the network. Your doctor will make referrals to specialists within the network
- 15. I N N O K BEN TS - ETW R EFI Pre-Existing Condition Currently the ASRS does not deny health insurance for any reason in relation to a pre-existing condition
- 16. I N N O K BEN TS - ETW R EFI Health Insurance Card You will be issued one card that covers your • Medical • Vision • Prescriptions
- 17. I N N O K BEN TS - ETW R EFI Question & Answer 1 Does the Medicare Part D prescription coverage gap apply to the Group Medicare Advantage HMO plan? a. Yes b. No
- 18. I N N O K BEN TS - ETW R EFI Question & Answer 2 Paula is an ASRS retiree and is enrolled in the Medicare Advantage HMO plan. Does she need to select a primary physician? a. Yes b. No
- 19. C PA EN O YM TS
- 20. Copayments – (examples) The most common copays… Routine Physical Hearing Exam Ambulance $0 $0 $25
- 21. Copayments – (examples) The most common copays… Lab Tests Specialist Emergency Doctor Visit $0 $30 $50 $15 Waived if admitted
- 22. Copayments – (examples) Prescription monthly copays… Tier I Tier II $10 $40
- 23. C PAYM TS O EN Mail Order Prescriptions 90-day supplies: • Tier I $20 • Tier II $80
- 24. C PAYM TS O EN Annual Amounts Your out-of-pocket coinsurance yearly maximum: • $6,700 Per Individual No lifetime maximum benefit
- 25. C PAYM TS O EN Question & Answer Mary isn’t sure what her yearly out- of-pocket coinsurance maximum would be. Is it…. a. $7,600 b. $6,700
- 26. A D TI O A DI NL BEN TS EFI
- 27. AD I TI O AL BEN TS D N EFI Passport Program Allows you to move your HMO coverage: • Participating areas • 9 consecutive months during the year • Same copays
- 28. AD I TI O AL BEN TS D N EFI Wellness Services Additional benefits include: • Silver Sneakers • Solutions for Caregivers • Nurseline
- 29. AD I TI O AL BEN TS D N EFI Disease Management • Disease and Specialty Case Management • Personal Health Management • Advanced Illness Care Management
- 30. AD I TI O AL BEN TS D N EFI Question & Answer 1 Gina has a chronic condition. She is enrolled in the Group Medicare Advantage HMO with several very large claims in the last 2 years. Will she reach a maximum lifetime benefit? a. Yes b. No
- 31. AD I TI O AL BEN TS D N EFI Question & Answer 2 Jenny’s mother needs more care than she can give her. Which program can provide assistance? a. Silver Sneakers b. Solutions for Caregivers c. Nurseline
- 32. Group Medicare - Full Monthly Premiums Retiree Retiree & Dependent(s) Retiree + Dependent Medicare & Non Medicare Eligible $190/$260 $380/$520 Combination Plans
- 33. AR ZO A STATE R R EN SYSTEM I N ETI EM T For moreyou for Thank detailed information watching. please refer to the Guide! Have a great day!
Notes de l'éditeur
- Welcome to the Arizona State Retirement System’s webcast about our contracted Medical provider UnitedHealthcare’s Group Medicare Advantage HMO Plan.
- What’s NEW for 2013? The Tier I Prescription copay is going DOWN!Prescription Solutions has changed their name to OptumRxAll the medical plans will include hearing exam and hearing aid discounts. AND…WellCard has expanded their discounts! Please see the 2013 Retiree Group Insurance Guide for details.
- The topics we will be covering are the Eligibility Requirements, the In-Network Benefits, what the copays are and the variety of additional benefits.
- Let’s start with the Eligibility Requirements for this Plan so you can see who can enroll.
- You may enroll if you are… a retiree of the Arizona State Retirement System, Public Safety Personnel Retirement System, Corrections Officer Retirement Plan, Elected Officials’ Retirement Plan or one of the three State University’s Optional Retirement Plans - You may enroll if you are on the ASRS Long Term Disability AND Not enrolled in your former employer’s insurance.For survivor qualifications, your survivor should contact the ASRS as soon as possible.Not only can you enroll for yourself, you may cover a domestic partner and eligible dependents
- You must have Medicare Parts A & B
- Arizona residency is required
- Roland is an ASRS retiree with Medicare Parts A&B. He lives full time in Carefree, Arizona. Can he enroll in this plan? Yes or No – what do you think? <PAUSE>. There is coverage for all counties in Arizona, so, YES – he may enroll.
- Nora is an actively contributing member of the ASRS. She has Medicare parts A and B. Can she enroll in this plan? Yes or No? <PAUSE> This plan is for eligible retirees and their dependents so the answer is B: No. Once she does retire, she could enroll!
- This is an in-network only plan.
- You do not need to enroll in a separate Part D Plan. The Medicare prescription drug plan included offers more than what is available under Medicare Part D.
- Your medication costs are kept down by use of a Formulary. That is a list of Medicare Part D approved prescription drugs. Your doctor must prescribe medication for you from this formulary and the prescription must be filled at a participating pharmacy.
- There is no annual benefit limit, annual deductibles and no prescription coverage gap.
- The Group Medicare Advantage HMO is an IN-NETWORK plan. By enrolling, you have made a decision to receive all your routine health care from contracted providers. You will need to select a Primary Care Physician and network. Your doctor will make referrals to specialists within the network
- A pre-existing condition is generally considered to be an illness a person has prior to applying for health insurance. Currently the ASRS does not deny health insurance for any reason in relation to a pre-existing condition
- You will be issued 1 card that covers your medical, vision and prescription drug plan.
- Here’s a question for you. Does the Medicare Part D prescription coverage gap apply to the Group Medicare Advantage HMO plan? Yes or No? <PAUSE> No. There is no coverage gap or annual limit.
- What about Paula? She is an ASRS retiree and enrolled in the plan. Does she need to select a primary physician? Yes or No? <PAUSE> Yes. She will need to select a Primary Care Physician and network. To find the current online directory, please see the inside back page of the GUIDE
- This Plan has standardized Copayments. Let’s look at some of the most common - but be sure to check the GUIDE for more information
- For example, there is no copay for your routine physical or hearing exam. For ambulance service - whether its ground or air – there is a $25 copay
- Your Doctor’s visit is $15. There is no charge for Outpatient Lab Tests, and to see a Specialist, the copay is $30. The $50 Emergency room copay is waived if you are admitted to the hospital.
- UnitedHealthcare classifies its prescription drugs as Tier 1 and 2. Tier 1 are preferred generics with a $10 copay for a 1-month prescription. THIS HAS GONE DOWN FROM LAST YEARS COPAY OF $20!!! Tier 2 are preferred brand names with a monthly copay of $40.
- You may also take advantage of the convenience in having your prescriptions mailed directly to you. The copays cover a 90-day supply and are $20 for Tier 1, and $80 FOR Tier 2.
- The out of pocket Coinsurance maximums are $6,700 per person and there is NO lifetime maximum benefit
- Mary isn’t sure what her yearly out-of-pocket coinsurance limit would be. Is it….A: $7,600 or B: $6,700? <PAUSE> Her individual annual out of pocket maximum would be $6,700
- There are included benefits for you at no additional cost through the Plan
- The Passport Program allows you to move your HMO coverage to participating areas for up to 9 consecutive months of the year - and pay your same copays. Please see the GUIDE for more information.
- Wellness Services include: the Silver Sneakers Fitness Program which provides complementary membership with access to participating locations throughout the country to you and your covered dependents. If you find yourself in a caregiver situation for a relative or friend in need, Solutions for Caregivers is a comprehensive eldercare management program who can counsel you on your loved one’s individual, medical, financial, safety, emotional and social needs. The Nurseline is a direct “hotline” provided after enrollment.
- The Disease and Specialty Management Services include: The Disease and Specialty Case Management program that targets chronic conditions, provides interventions to help manage those conditions and bridges the gap between you and your care teams. The Personal Health Management program serves retirees with moderate and high risk factors including transitioning from hospital care to home. The Advanced Illness Care Management program provides services for retirees with advanced illness and who are facing end of life issues. Please see the Guide for more information about all these programs
- Meet Gina. She has a chronic condition and is enrolled in the Plan with several very large claims in the last 2 years. Will she reach a maximum lifetime benefit? Yes or No? <PAUSE> No – there is no maximum lifetime benefit with the Group Medicare Advantage HMO!
- Which program do you think would help Jenny? Her mother needs more care than she can give her. Would it be… A) Silver Sneakers, B) Solutions for Caregivers or C) Nurseline. <PAUSE> b) Solutions for caregivers can counsel you on your loved one’s individual, medical, financial, safety, emotional and social needs.
- The monthly premiums are determined by where you live –either in Maricopa, Pima and Pinal County or all other Counties. Single coverage is $190, and $260 for all other counties. If you cover one dependent the monthly premium is $380 or $520 in all other counties. There are combination rates for those of you whom one is Medicare Eligible and one is not.
- For detailed information please refer to the GUIDE available on our website under the Retiree Tab.We hope you now have a better understanding of the Group Medicare Advantage HMO. Thank you for taking the time to view this webcast. Be sure to check our other on-demand webcasts.