City of Peabody Health Plan Educational Information for Medicare Retirees October 2012 Boston Benefit Partners: Lenna Bablouzian, Carol Chandor, Robyn. - презентация

1 City of Peabody Health Plan Educational Information for Medicare Retirees October 2012 Boston Benefit Partners: Lenna Bablouzian, Carol Chandor, Robyn Olson AFT-MA: Andrew Powell

2 2 Agenda Overview What is the GIC? Medicare Highlights Group Insurance Commission (GIC) Plans Health Maintenance Organization (HMO) Plans Indemnity Plans Drug Tiering Peabodys Mitigation Plan Tips for Selecting a GIC Medicare Supplement Plan

3 3 Overview All City employees and retirees will receive their health insurance through the Group Insurance Commission (GIC) starting on January 1, 2013 and continuing through June 30, 2016 Current town plans will be in effect until December 31, 2012 Open enrollment will be held from Tuesday, October 9 th through Wednesday, October 24 th All employees and retirees MUST enroll in order to have coverage as of January 1, 2013 Marriage licenses, Birth Certificates, Adoption and Guardianship records are required to enroll dependents Retired Municipal Teachers (RMTs) will gain access to additional GIC plans but must re-enroll during the Open Enrollment period

4 What Is the GIC? The mission of the GIC is to deliver high quality care at reasonable costs GIC was established by the Legislature in 1955 GIC is a quasi-independent state agency governed by a 15-member Commission appointed by the Governor Commission members include representatives of labor and retirees GIC's FY12 appropriation is $1.3 billion. GIC covers 212,000 subscribers and 375,000 lives 4

5 Medicare Guidelines Retirees age 65 or older and certain disabled people who qualify (40 quarters of paying Medicare taxes) Medicare Part A - Free Inpatient hospital care Some skilled nursing facility care Hospice Medicare Part B – Standard monthly premium = $99.90 (calendar year 2012) Physician care Diagnostic, x-ray and lab services Durable medical equipment GIC Medicare plans coordinate with Medicare to provide you with comprehensive insurance 5

6 Medicare Guidelines (continued) If you (the insured) works beyond age 65, you should NOT enroll in Medicare Part B until you (the insured) retires If retired, you must join Medicare and pay Part B premium to have GIC coverage If your spouse/dependents are under 65, and you are retired, they will stay on an active plan through the GIC See GIC Benefit Decision Guide, page 9 Do NOT enroll in Medicare Part D plans See GIC Benefit Decision Guide for more details and special circumstances 6

7 GIC Medicare Plans 7 Plan NameType of PlanService Area (see map on page 10 of GIC Benefit Decision Guide) Fallon Senior PlanMedicare Advantage (HMO)Broad network in Hampden, & Worcester counties; limited network in Essex, Franklin, Hampshire, Middlesex and Norfolk counties. Harvard Pilgrim Medicare Enhance Supplemental Medicare (Indemnity) Throughout USA Health New England MedPlus Medicare HMOBroad network in Berkshire, Franklin, Hampden & Hampshire counties; limited network in Worcester county. Tufts Medicare ComplementSupplemental Medicare HMOThroughout MA Tufts Medicare PreferredMedicare Advantage (HMO)Barnstable, Essex, Hampden, Hampshire, Middlesex, Norfolk, Suffolk, Worcester UniCare Indemnity/Medicare Extension (OME) with CIC Supplemental Medicare (Indemnity) Throughout USA and outside of USA

8 8 GIC Medicare Plans Two types – HMO and Indemnity HMO Plans Primary Care Physician (PCP) required Referrals required for specialists for most plans No coverage for out of network providers (except emergencies) Medicare Advantage HMO plans have smaller provider networks Indemnity Plans Access to any provider that accepts Medicare

9 9 GIC Medicare Plans Medicare Retiree Plans with the most subscribers UniCare State Indemnity Plan/Medicare Extension [OME] Harvard Pilgrim Medicare Enhance 88% of GIC Medicare retirees in these 2 plans, which most closely resemble Peabodys current Medex plan Enrollment restrictions UniCare State Indemnity Plan/ Medicare Extension [OME] available throughout the United States and outside the United States Harvard Pilgrim Medicare Enhance available throughout the United States Other plans limited to Massachusetts and certain border counties by plan

10 10 GIC Medicare HMO Plans Members must select a Primary Care Physician (PCP) Referrals are required to see Specialists No coverage for out-of-network providers Except for emergency care Lower premium cost than other plan types

11 11 GIC Medicare Supplemental Indemnity Plans Members not required to select a Primary Care Physician (PCP) No referrals required for specialists Can utilize any provider that accepts Medicare Highest premium cost plan No geographical restrictions on enrollment Member can live anywhere in the United States Members living outside the U.S. should select UniCare State Indemnity Plan/Medicare Extension [OME]

12 GIC Indemnity/OME Plan Design Plan FeatureAmount/Cost Preventive Service CopayNo copay Other Physician Office CopayNo copay after $35/year deductible Inpatient Hospitalization Copay$50 per admission copay; maximum one per quarter Outpatient Surgery CopayNo copay Emergency Room Copay$25 copay 12

13 13 Prescription Drug Tiering Drug formularies vary by plan Pharmacy tiering Tier 1 – Generic and low cost brand drugs Tier 2 – Brand name and high cost generic drugs Tier 3 – Brand name non-preferred drugs Copayments Retail 30-day supply Tier 1 - $10 Tier 2 - $25 Tier 3 - $50 Mail Order 90-day supply Tier 1 - $20 Tier 2 - $50 Tier 3 - $110

14 Mitigation Plan Public Employee Committee (PEC) and City Negotiated a Mitigation Program: PEC Agreement creates 3½ -Year, City-funded Employee Health Mitigation Fund [EHMF] Medicare eligible retirees will pay 1% of premium costs and those retired before 7/1/09 will receive a subsidy of their supplemental plan premium for 3 ½ years A separate rate sheet for Medicare eligible RMTS is available Medicare retirees have access to two separate health reimbursement account (HRA) programs: 1. HRA Part 1 – Reimbursement of new GIC copays 2. HRA Part 2 – Reimbursement of high out-of-pocket costs 14

15 Peabody Mitigation Program HRA Part 1 – Reimbursement of new GIC copays Outpatient surgery copays Inpatient hospital admission copays High Tech Imaging copays (such as MRI, CT, and PET scans) HRA Part 2 – Reimbursement of high out-of-pocket costs HRA Part 2 covers out-of-pocket expenses greater than: $2,000/member or $4,000/family to maximum of $5,000/member or $10,000/family Additional information about the mitigation plans will be distributed to all participants 15

16 GIC Health Fair 16 October 18 th Thursday 11:00 AM - 4:00 PM Kiley School Administration Building 21 Johnson Street

17 17 Tips for Selecting a GIC Plan Carefully review the GIC Benefit Decision Guide Complete a questionnaire and estimate your utilization of medical services Discuss the GIC plans with family, friends and your physician(s)

18 Tips for Selecting a GIC Plan Contact the carriers on the telephone or using the Internet. Ask the carriers about: The physicians who treat you The hospitals where you get care The prescription drugs that you take Any Durable Medical Equipment or Device that you use Attend a GIC Health Fair 18

19 Tips for Selecting a GIC Plan Contact Information Group Insurance Commission: (617) www.mass.gov/gic Harvard Pilgrim Health Plan: (800) www.harvardpilgrim.org/gic Tufts Health Plan: (888) www.tuftshealthplan.com/gic Fallon Community Health Plan: (866) www.fchp.org UniCare: (800) www.unicarestateplan.com Caremark Pharmacy (877) www.caremark.com/gic Health New England: (800) www.hne.com ADDITIONAL RESOUR ES: or 19

20 20 Questions and Answers