Helping you achieve healthcare security in retirement
2014 Benefits
What’s new in Medicare for 2014?
What’s new in Health Care Reform for 2014?
What are your 2014 Emeriti insurance options?
What are your next steps towards annual enrollment?
What are Emeriti’s ongoing participant services?
Savitz
• Insurance Enrollment
• Premium Billing
Emeriti’s Service Providers For Annual Enrollment
Aetna
• Insurance Underwriter
• Premium Rates
Call Emeriti Service Center to speak with Savitz
representative to enroll or change coverage
Call Emeriti Service Center to ask Aetna
representative specific questions about Emeriti
medical, Rx and dental insurance plans
*Higher income beneficiaries will pay an additional amount for the Part B and D premiums,
Medicare Changes for 2014
Based on current information from the Centers for Medicare and Medicaid Services (CMS)
Medicare Component
2013 Rate
2014 Rate
Part A deductible
$1,184
Waiting for CMS
Monthly Part B
new entrant premium
$104
Waiting for CMS
Part B annual deductible
$147
Waiting for CMS
Part D Coverage Gap threshold
$2,970
$2,850
Part D True Out-of-Pocket
Health Care Reform Updates for 2014
Implications for Part D Benefit
Part D - 50% discount remains on brand-name drugs in Part D Coverage Gap at
point-of-purchase (all Rx Plans).
A 50% discount on the negotiated price of preferred and non-preferred brand drugs (excluding the dispensing fee) continues to be available from manufacturers that have agreed to provide the discount. The discount is applied first.
Part D - 72% participant cost sharing limit change on generic drugs in Coverage Gap
(Rx Low Plan)
Since the Rx Mid and Rx High Plans already include generic drug benefits during the Coverage Gap, this cost share does not apply to those plans. Only the Rx Low Plan will continue to be revised to reflect this required change by Medicare (CMS).
Part D – 97.5% cost sharing limit on brand drugs in the Coverage Gap
(Rx Mid Plan and Rx Low Plan)
Insurance Highlights in 2014
•
Plan designs will generally remain the same
•
Retirees and their post-65 spouse/domestic partner will be able to
enroll in different plans
•
A new Medicare Advantage Low Plan will be available
•
A new fitness program will be available through both the Medicare
Advantage High and Low Plans
Emeriti Insurance Choices for 2014
One Medicare coordination plan
Two Medicare supplemental plans (availability based on state approval)
Two Medicare Advantage PPO (Extended Service Area (ESA) available for
geographical areas outside Aetna’s network)
Rx High Plan – continuing coverage in coverage gap
Rx Mid Plan – generic coverage only in coverage gap
Rx Low Plan – no coverage in coverage gap
One dental plan
Five Group Medical Plans*
Three Rx Plans**
One Dental Plan*
* Availability based on state approval.
** The Rx Mid-High Plan is a grandfathered plan and is closed to new entrants.
Understanding Emeriti’s National
Group Medical Plan Options
Aetna Traditional Choice
Coordinates with original Medicare
• Has a plan deductible
• Parts A & B deductibles covered by plan deductible
• Most claims for Medicare allowable charges will be paid in full after plan deductible
• Preventive services and annual physical covered 100% by Medicare
Aetna Supplemental Retiree Medical Plans K and L
Supplements original Medicare
• Have no plan deductible
• Have coinsurance on some services
• You pay a portion of Part A deductible
• You pay all of the Part B deductible
Understanding Emeriti’s National
Group Medical Plan Options
Aetna Medicare Advantage High and Low PPO (or PPO ESA)
Replaces Original Medicare
• Have no plan deductible
• You pay no Parts A & B deductibles
• High plan has coinsurance, low plan has copayments
• Preventive services and annual physical covered 100% by the Plan
• Silver & Fit
©Exercise & Healthy Aging Program available with both plans
• Access to over 10,000 fitness clubs and exercise centers
You May Have Heard…
Health Care Reform is eliminating
Medicare Advantage plans.
Medicare Advantage is just another supplemental
plan like the one you already have
If you enroll in Medicare Advantage,
you lose your Medicare coverage.
You can’t get more coverage for less money.
It’s too good to be true.
TRUE
FALSE
TRUE
FALSE
TRUE
FALSE
Medicare Advantage Benefits
Go Beyond Original Medicare
Annual eye and hearing exams at no extra cost
Eyewear and hearing aid allowances
Coverage for unlimited inpatient hospital days
Emergency medical coverage worldwide
Low plan premiums, depending on where you live
Advocacy for health and wellness.
If you have a serious
medical condition, a highly skilled Aetna nurse case manager can
help you and your family:
• Understand your doctor’s instructions
Aetna Fitness
℠
Discount Program
Available with Aetna Medicare Advantage Plans
• Work out
• Stay healthy
• Get discounts on gym
memberships, home
Retiree Cost Share for Typical Doctor’s Visit Bill of $100
Traditional
Choice
SRMP L
SRMP K
High MA
PPO/ESA
Charge
Medicare
Pays
Aetna Pays
You Pay
$100
$80
$20
$0
$100
$80
$15
$5
$100
$80
$10
$10
$100
$0
$85
$15
NOTE: Illustration assumes any annual plan deductibles have already been satisfied for the plan year.
You pay first
$310 as
deductible
You pay 25% of
drug costs
You pay 97.5%
of brand drugs
You pay 72%
of generic
drugs
You pay 5%
• Greater of $2.55 or 5% for covered generic. • Greater of $6.35 or 5% forall other drugs.
Deductible
Initial Coverage
Period
Coverage Gap
Catastrophic
Coverage
You reach Catastrophic Coverage at $4,550 in true out-of-pocket costs.
You reach the Coverage Gap at $2,850 in total Part D covered drug expenditures
(includes plan deductible, your costs and plan costs in the Initial Coverage Period).
Standard Formulary
$310 deductible
Initial Cov Limit Retail:
15% - 25%
Coverage Gap: no coverage*
Catastrophic Cov: 95% coverage
Step therapy required for some drugs
Open Formulary
$100 deductible
Initial Cov Limit and Coverage Gap Retail
15% - 25% - 40%
Coverage Gap: full coverage
Catastrophic Cov: 100% coverage
No Step therapy required
Open Formulary
$100 deductible
Initial Cov Limit Retail
15% - 25% - 50%
Coverage Gap: generic coverage only*
Catastrophic Cov: 95% coverage
Step therapy required for some drugs
Rx Mid Plan
Rx Low Plan
Emeriti Rx Coverage in 2014
Underwritten by Aetna
Members who use Aetna’s Rx Home delivery Mail Order Drug (MOD) program will pay 5% less than
the negotiated cost of the drug as compared to retail.
Aetna Online Formulary
Aetna will provide an Emeriti-specific formulary guide,
representing the three tiers of coverage specific to Emeriti’s Rx plans:
1. Generic 2. Preferred brand 3. Non-preferred brand
CMS 28% Mandate in the Coverage Gap
For
generic drugs
in the Gap (one month supply obtained at in-network retail pharmacy):
Sample Generic - $30
Rx Low Plan
Rx Mid Plan
Rx-High Plan
Your Cost Share
72%
15%
15%
You Pay
$21.60
$4.50
$4.50
All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low income cost sharing subsidies .
Preventive Service Coverage
100%
Annual Deductible (basic and major services)
$100
Basic Services Coverage
(e.g. fillings, standard crowns, extractions)
50%
Major Services Coverage
(e.g. root canal therapy, surgical removals, dentures)
50%
Annual Benefit Maximum
$1,500
NOTES:
1.Twelve month waiting period applies, but may be waived with evidence of continuing coverage. 2.One-time only opt-in opportunity.
3.Dental is only available when you enroll in a combination Medical/Rx coverage, or elect the stand-alone Rx Low Plan
4. Please note: in the states of CA, OR, WA*, the stand-alone Dental plan may be elected if the participant is enrolled in a Kaiser Permanente MAPD Plan, and with evidence of existing coverage.
Aetna Dental Coverage in 2014
Aetna Insurance ID Cards
Participants may have up to 3 cards:
• Medical
• Rx
• Dental
When You Can Access Emeriti Health Insurance
After age 65
When you retire
After enrollment
In Medicare Parts A & B
Permanently disabled children**
Dependent children (before majority, up to age 26)
Domestic partner (pre- or post-65) depending on your plan*
Available for Eligible Participant & Dependents
Participant’s dependents include:
Who Can Use Emeriti Health Insurance
Spouse (pre- or post-65)
NOTE: The employer’s plan establishes specific rules for vesting in the Emeriti account balance and retirement eligibility for the Emeriti insurance.
*Domestic partners’ coverage is available only if elected by the institution. Independent domestic partners pay for insurance outside of the Health Account.
**Determination of permanent disability also confers access to post-65 insurance for these individuals. Disability must occur before majority.
Lower Out-of-pocket Limit Lower Coinsurance
Lower Deductibles
Higher
Premium
Higher Out-of-pocket LimitsHigher Coinsurance
Higher Deductibles
Lower
Premium
Weighing Your Options
Medical and Rx Expenses
STEP 1
Create Your Own Plan
STEP 2
STEP 3
Or Preserve Your Options
Choose Rx Low Plan as stand-alone option
Select Rx Low Plan
Add dental to the Rx Low Plan if you wish
Consider Dental
How are Insurance Premiums Paid?
•
Seamless transfer from your Health Account
•
Seamless transfer from your personal bank account*
Don’t Forget…
ACH Banking Information Form
Please call Emeriti Service Center to request a ACH Banking Information Form,
complete, and return to Savitz if you have not already done so.
WHY?
To facilitate your timely payment of premiums from your personal bank
account when insufficient funds remain in your Emeriti Health Account.
WHAT YOU WILL NEED:
•
Provide bank name, branch name and address, and routing number
Call Emeriti Service Center to enroll
Have your Medicare Parts A and B numbers
Have your Social Security number
Have dates of birth of any eligible dependents
Have social security numbers for eligible dependents
Return ACH Banking Form to Savitz
Enrolling for the first time?
Already Enrolled?
Do nothing, if satisfied with current
coverage.*
Call Emeriti Service Center to make
changes to your coverage.
Decision Time
Emeriti’s Other Program Components
Emeriti Health Accounts
A tax-advantaged way to save and invest for future medical expenses.
Emeriti Reimbursement Benefits
NOTE: A wide range of health care expenses are eligible for tax-free reimbursement as long as they satisfy the requirements of Section 213 (d) of the IRS Code.
How You Can Use Your Reimbursement Benefit
Emeriti Reimbursement Form available on MyEmeritiBenefits.org
Partial List of Uses
Medicare premiums and cost shares
Supplemental insurance deductibles, co-insurance, co-pays
Vision, dental, hearing care
Over-the-counter and non-formulary drugs (with Rx prescription from doctor)
Medical equipment
Long-term care insurance
Medical expenses associated with nursing or in-home health care services
Dependent relatives depending on your plan
Permanently disabled children
Dependent children (before majority, up to age 26)
Domestic partner (pre- or post-65) depending on your plan
Available for You & Your Dependents
Participant’s dependents include:
Who Can Use Your Reimbursement Benefits
Reimbursement Benefits at Work
Manually submit claims to Savitz:
•
•
Fax
•
Upload through Participant Benefits Dashboard
(MyEmeritiBenefits.org)
Debit card option in development for 2014
• Lifecycle funds
• Asset diversification among asset classes
• Automatic rebalancing
TIAA-CREF
Lifecycle Funds
(Retirement Class)
• A money market mutual fund
• Seeks to assure the value of your investment
at $1 per share
TIAA-CREF
Money Market
Fund
(Retirement Class)
• Some TIAA-CREF proprietary funds
Participant
Education and Decision Support Tools
Online
In Print
On the Phone
In Person
Register
It’s easy!
Emeriti Program Fees
Fees
Active Service
Terminated/Retiree
Emeriti
$5.00
$5.00
TIAA-CREF
$ .67
$ .67
Savitz
$1.00
$6.00
Investment management fees are variable by selected mutual funds (see prospectuses)
Monthly Participant Fees
Your employer may cover all or some portion of the service fees.
Check with your institution’s benefit administrator if you are uncertain.
Emeriti Retiree Teleconferences
Want another review of Emeriti’s Insurance Plans for 2014?
Attend a teleconference
Wednesday, November 20 at 3pm (ET)
Wednesday, December 4, at 3pm (ET).
Access 2014 Annual Enrollment Materials
Click on
ALREADY A PARTICIPANT
tab
Emeriti Retirement Health Solutions is not an insurance company, insurance broker or insurance provider.
Summary Plan Description (SPD)
This presentation is intended to provide you with a brief summary of some of the details of your Employer’s Emeriti Plan and the
Emeriti Program. For a full summary of the terms of your Employer’s Emeriti Plan you must consult the SPD, which will be provided
to you upon enrollment or upon request.
Emeriti Retirement Health Solutions provided this information and is responsible for its content.
Emeriti, TIAA-CREF, Savitz, Aetna Life Insurance Company, and HealthPartners are independent corporations
and are not legally affiliated.
Investment Adviser Status
Emeriti Retirement Health Solutions is a registered investment adviser for purposes of selecting the range of investment options available under the Emeriti Program. Emeriti may provide non-personalized educational materials to plan participants relating to their and their employer’s contribution to their Emeriti Plan and the allocation of their Emeriti Health Account balances among available investment options. Emeriti does not provide personalized investment advice to participants.
*For 2014 the Traditional Choice plan is not available in MD.
**For 2014, the SRM Plans are not available in VT, MD, MN, and U.S. Territories.
Emeriti Group Medical Plan Options in 2014
Underwritten by Aetna
Aetna
SRM Plan L**
Aetna
SRM Plan K**
Aetna
Medicare Advantage
High PPO/ESA-PPO
Aetna
Traditional
Choice*
NOTES: The ESA-PPO Plan has the same benefits as the In-Network PPO Plan. Aetna’s GMS Plans A and L will be offered in Florida in place of SRM Plans K and L.
$200 deductible $0 plan deductible $0 plan deductible $0 plan deductible
in- and out-of-network
$0 plan deductible in- and out-of-network
20% coinsurance 25% coinsurance 50% coinsurance 15% coinsurance in-network 25% coinsurance out-of-network
Primary care visit at $15 in- and out-of-network Specialist visit at $40 in- and out-of-network $1,250 out-of-pocket limit $2,400 out-of-pocket limit (2013 calculation) $4,800 out-of-pocket limit (2013 calculation) $2,750 out-of-pocket limit in-network $5,500 out-of-pocket limit out-of-network $6,700 out-of-pocket limit in-network $10,000 out-of-pocket limit out-of-network 100% preventive care covered by Medicare 100% preventive care covered by Medicare 100% preventive care covered by Medicare
100% preventive care covered by the plan
100% preventive care covered by the plan
After plan deductible is satisfied, plan payment in full on Medicare eligible costs.
Payment based on the balance after Medicare’s payment.
Payment based on the balance after Medicare’s payment.
Payment based on total Aetna allowable cost.
Payment based on total Aetna allowable cost.
