New Coverage &
New Choices for
•
What is changing.
•
How this affects Medicare eligible retirees.
•
Extend Health and the services and health plans
available to EBRPSS Medicare eligible retirees.
•
A look at the Medicare marketplace.
•
Going forward...what to expect.
•
Questions and answers.
What’s Changing?
• Eligible retirees and dependents will have new choices for health care that may more closely match individual needs.
• Extend Health will help Medicare-eligible retirees select and enroll in the coverage that works best for them.
• Existing health care coverage under EBRPSS self-insured medical plan for Medicare eligible retirees and dependents will end on December 31, 2012 and be replaced with a Health Reimbursement Account to reimburse Medicare-eligible retirees for their purchases through the Medicare exchange offered through Extend.
EBRPSS is proposing to change the way it provides health care
benefits
Benefits Of This Approach
•
Leverages the expertise and market presence of
Extend Health - the largest independent Medicare
Market Coordinator and carrier exchange in the
U.S.
•
Provides retirees with better benefit choices,
guidance and value.
•
Personal, expert support for every retiree from
licensed benefit advisors.
•
Lower costs for EBRPSS to be shared with active
employees and non-Medicare eligible retirees
How This Affects You
• It may change – depending on what coverage the Medicare eligible retiree chooses
• Medicare eligible retirees will work with Extend Health to enroll in a plan that meets your medical and prescription needs.
• Extend Health advisors will help Medicare eligible retirees
understand the costs associated with your coverage – premiums, copayments, deductibles and all other costs.
What you
pay
How you
enroll
Your
support
• EBRPSS sponsored coverage will end for Medicare eligible retirees and dependents on December 31, 2012.
• Medicare eligible retirees will select and enroll in plans available through Extend Health.
Introducing Extend Health
7
Who is Extend Health?
•
Independent company, dedicated to serving Medicare-
eligible retirees.
•
Partner with 70+ health plan carriers to provide you
coverage to fit your individual needs and budget.
•
Objective and Trusted U. S. –based licensed benefit
advisors.
8
Why Extend Health?
• Extend is experienced in helping Medicare
participants and their families
• Enrolled over hundreds of thousands of participants
• Extend’s services are provided at no cost to EBRPSS
Plans & Partners
All Medicare Plan Types
Medicare Advantage
Medigap
Prescription Drug (Part D)
Vision
Dental
11
Currently Medicare & EBRPSS Medical and Rx
12
Future Coverage Plus HRA
Primary Coverage
Medicare Parts A & B
Additional Coverage (
Your Choice)Medigap + Prescription Drug (PDP)
or
Medicare Advantage with Prescription Drug (MAPD)
Optional Coverage
(Your Choice)13
You will need to pay your first premium when you enroll…
PART D
PLAN
MEDIGAP
PLAN
OPTION 1:
Medigap Plan + Part D Plan
MEDIGAP (Medicare Supplement)
A Medigap plan fills the “gaps” in original Medicare Part A and Part B coverage (i.e., helps pay the difference between your costs
and the amount original Medicare pays). These plans provide
additional coverage for your doctor visits and hospital stays as well as other expenses not covered by original Medicare.
PART D PLAN
A Part D plan supplements Medigap to provide prescription drug coverage. These plans help pay for your prescription drug
14
Medicare
ADVANTAGE
OPTION 2:
Medicare Advantage Plan with
Prescription Drug Coverage (MAPD)*
MAPD PLAN
An MAPD plan provides an all-in-one plan which bundles your Part A, Part B and prescription drug coverage together with additional benefits. These plans provide coverage for your doctor visits, hospital stays, and prescription drug expenses.
Health Reimbursement Account
Medicare eligible retirees would
receive a defined dollar
contribution of $3,281 annually into
a health reimbursement account
If they had retiree and spouse
Medicare coverage this would mean
$3,281 for the retiree and $3,281 for
the spouse for a total account
funding of $6,562.
The account can reimburse the
retiree for:
Premium selected Medicare advantage,
Medigap and Medicare Part D plans and Dental and Vision Plans
Copays, deductible and co-insurance if
applicable for medical, dental and vision expenses EBRPSS allocates benefit dollars to each retiree’s HRA Retirees are reimbursed for healthcare expenses
Claims are paid daily
Auto reimbursement
Extend Health Medicare Exchange
Medicare Advantage MediGap Plans Male Age 75 Part D (Rx) 10 plan options $0 - $67 15 plan options $82 - $245 15 plan options $15 - $108
Arcadian Community Care, Humana, Wellcare
AARP, Blue Cross Blue Shield of
Louisiana, Humana, United Healthcare
AARP, Aetna, Cigna, Community CCRx,
Coventry, CVS Caremark, Humana, WellCare
Baton Rouge, LA Options
17
Benefits Advantage Plan Medicare Medicare Advantage Fee for Service Medigap Plan F + PDP (Male Age 75) Incumbent Plan (Retiree Only) Premium (monthly) $0 $45 $249 ($205 + $44) $409 Deductible $0 $0 $0 $600
Office Visits PCP: $5 co-pay Specialist: $20 co-pay PCP: $15 co-pay Specialist: $15 - $40 co-pay 100% covered PCP: $30 co-pay Specialist: $60 co-pay
Hospital $50 copay per day, days 1 – 8; after 8
days: $0
$195 copay per day, days 1 – 8; after 8
days: $0
100% covered $600 per admission
Prescription $3/$35/$/$60/33% $7/$41/$82/33% $6/$36/$78/33% $10/$25/$45 after $50 deductible
Other
$4,000 OOP Max for in- and out-of-network services
No Lifetime Max
$5,000 OOP Max for in- and out-of-network services No Lifetime Max Foreign Travel No medical plan copays/coinsurance No Lifetime Max $3,500 OOP Max, exclusive of deductible No Lifetime Max
Sample Plan Comparison for EBRPSS
19
Medicare Prescription Drug Coverage
For 2012
(Part D Plan)
Initial Coverage
You pay
* Deductible and Co-payments for your plan
* Coverage for the first $2,930 in Actual Cost of medications
Coverage Gap – Donut Hole
You pay
* 50% of Brand Drugs and 86% of Generics Until out of pocket costs reach $4,700
Catastrophic Coverage
You pay
Plan Type
Number of Plans Offered
2012
Monthly Premium Company
Vision 1
$14 per person per month
Annual eye exam: $15
Vision Service Plan (VSP) Dental 2 $16 - $43 $0 - $50 deductible $1,000 - $1,600 annual maximum
Varied (i.e., Delta Dental, Humana
Dental)
20
22
Educate
Evaluate/Enroll
Manage
Extend Retiree
®
Communications
23
Marketplace Personalized End to End Individuals
Group Reminders: Postcards and certified letter Outbound/Inbound calls in pre-announced waves and appointments With benefit advisors
Extend Health - Benefit selection confirmation
Getting Started Guide Enrollment Guide Client announcement
letter of program change
Client communication educational piece
HRA Guide
Pre-Season-
45-Days prior to enrollment
Retiree Experience:
1. Client Announcement Letter alerts retiree to the change
2. Extend Health delivers the ‘Getting Started Guide’ which includes:
• Welcome letter
• Frequently Asked Questions
• Workbook to complete before call 3. Retiree calls into Extend Health to:
• Verify profile information
• Provide Prescription drug information
• Schedule personalized enrollment appointment • Ask questions
4. Retiree meetings at EBRPSS facilities
Enrollment-
90-Days prior to eligibility date
Retiree Experience:
1. Extend Health delivers the ‘Enrollment Guide’ which includes:
• Cover letter with appointment confirmation • Medicare basics- plan education
• Frequently asked questions
• What to prepare for and expect on the call 2. Specially trained Benefit Advisors and the retiree
partner to:
• Understand the unique medical and prescription need of the retiree
• Study the plans available that fit the retiree’s needs
• Complete telephonic enrollment
3. Extend Health delivers reminder post-cards and certified mail to those retirees that have not
responded
Post-Enrollment-
Enrollment date and beyondRetiree Experience:
1. Extend Health delivers the ‘Selection Confirmation’ which outlines the details of the plan selection
2. Insurance carrier(s) send out ‘Welcome Guides’ which includes detailed plan information and new insurance cards
3. Extend Health delivers the ‘Health Reimbursement Account ‘ packet
4. Extend Health remains an advocate free of charge, for the lifetime of the retiree to:
• Assist with carrier questions/challenges • Help with future changes to medical and
prescription drug changes
• Support HRA reimbursements and questions
27
Decision Support Tools
• Help Me Choose
• Prescription
28
Licensed Benefit Advisor
•
100% domestic workforce
•
Objective advocacy
•
Neutral compensation
•
Extend University
•
Licensed, certified, appointed
•
Average age 43
Hours of Operation
Monday – Friday
7 a.m. – 8 p.m.
Central Standard Time
Call Extend Health Toll-Free
29
Enrollment Process
Benefit Advisors can
discuss coverage options
with anyone – need to
speak to the participant to
complete the enrollment.
Once Medicare eligible
retiree have made a
coverage selection,
enrollment is conducted via
telephone.
Post-Enrollment-
Enrollment date and beyondRetiree Experience:
1. Extend Health delivers the ‘Selection Confirmation’ which outlines the details of the plan selection
2. Insurance carrier(s) send out ‘Welcome Guides’ which includes detailed plan information and new insurance cards
3. Extend Health delivers the ‘Health Reimbursement Account ‘ packet
4. Extend Health remains an advocate free of charge, for the lifetime of the retiree to:
• Assist with carrier questions/challenges • Help with future changes to medical and
prescription drug changes
• Support HRA reimbursements and questions
