MICHIGAN PUBLIC SCHOOL
EMPLOYEES RETIREMENT SYSTEM
2015 Health Plan Seminar
H9572_S_15MPSERSSem FVNR 1014
Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in
Medicare Plus Blue depends on contract renewal.
2
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
AGENDA
•
Introductions
•
Coverage overview
•
Medical plan – BCBSM
•
Vision plan – VSP
•
Prescription drug plan – CatamaranRx
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
What is Medicare Advantage?
Supplement
A
(Hospital)
Drug
B
(Medical)
MEDICARE ADVANTAGE
IMPORTANT:
BCBSM works with your drug
carrier to coordinate your care.
Medicare Advantage combines Medicare
Parts A and B with supplemental health
coverage from a private insurer.
Medicare Advantage plans provide more
coverage than Original Medicare
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
With your Medicare Advantage plan
•
Original Medicare
•
Original Medicare
rights & protections
•
Original Medicare
covered services
You Keep the
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
- International Journal of Health Services
Research shows that people with a personal doctor
stay healthier as they age.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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)
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Welcome to Medicare exam and annual
wellness visit
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
The Health Assessment
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
Your answers will be kept private and won't affect
your enrollment, benefits or health care costs in any
way
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.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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-of-pocket maximum.
Copayment
(Co-pay):
The fixed dollar amount you pay to health
care providers.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Coinsurance:
A percentage of the allowed amount you are
responsible for. Counts towards your
out-of-pocket 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.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Deductible
Coinsurance
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Bone mass measurement
Pap smears and pelvic exams
Prostate cancer screening
Mammogram
Annual wellness exam
Diagnostic hearing exams
Colorectal screening
Immunizations
Eye exams
Treatment for eye conditions
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Hearing care program
• Measures hearing ability
Audiometric exam
• Includes binaural (both ears)
• Binaural hearing aids must be purchased at the same time
Hearing aid
• Evaluates the performance of a hearing aid
Conformity test
• Payable once every 36 consecutive months
Frequency limitation
• Deductible and coinsurance apply
Approved provider
• Member pays all charges
Non-approved provider
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Manage your plan with our member site
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bcbsm.com
Coverage
& Claims
Provider
Search
Health &
Wellness
One site. One stop.
Power to compare.
On the go. Good to
go.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Login or register at
bcbsm.com/mpsers
Log in for
member site
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
One site. One stop.
Personal Snapshot
Easy-to-understand
graphics help you
quickly see where
you are in your plan.
Prominent
recent claims
activity
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
2015 plan updates
2014
2015
Deductible
$500
$650
Out-of-pocket
maximum
$1,300
$1,450
Durable medical
equipment and
supplies, prosthetics
and orthotics
Participating provider:
Participating provider:
Covered in full
10% coinsurance plus
deductible
Non-participating provider: Non-participating provider:
20% coinsurance plus
deductible
30% coinsurance plus
deductible
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
2015 plan updates
2014
2015
Deductible
$650
$850 or
$650
*
Out-of-pocket
maximum
$800
$800
Durable medical
equipment and
supplies, prosthetics
and orthotics
SUPPORT supplier:
Participating provider:
Covered in full
10% coinsurance plus
deductible
Non-SUPPORT supplier:
Non-participating provider:
20% coinsurance plus
deductible, plus difference in
cost
30% coinsurance plus
deductible, plus difference in
cost
*Members who complete the steps to enroll in LivingWell can lower their deductible to
$650.
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
LivingWell Program Steps
1
• Complete the health assessment
2
• Select a primary care physician
3
• Get an annual routine physical
BONUS
•
Choose a Patient-Centered Medical home
doctor
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Standard vs. Patient-Centered approach
Standard 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.
She can’t get an appointment to visit
her doctor for several weeks. She
ends up being readmitted to the
hospital.
Patient-centered approach
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.
When she’s discharged, the
hospital works with her PCMH to
ensure she is discharged in the
right setting with the right
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
32
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
•
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Plan Design
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Vision Care Services
In-Network
Out-of-Network
Reimbursement
Exam
$10 copay
$40
Lenses
Single
Bifocal
Trifocal
$15 copay
$15 copay
$15 copay
$16
$23
$27
Frames
$0 copay,
$120 allowance
$23
Contact Lens
Conventional
Medically Necessary
$15 copay, $120 allowance
$0 copay
$35
$96
Frequency
Exam
Lenses
Frames
Once every 24 months
Once every 24 months
Once every 24 months
Welcome to
Welcome to Catamaran!
Catamaran manages the
prescription drug plan for the
Michigan Public School
Employee Retirement system
We want to help you
get maximum value from
your pharmacy benefits.
Welcome to Catamaran!
Why do some
medications
cost more than others?
A formulary is a
listing of medications
covered by your plan.
1
Why do some medications
cost more than others?
The formulary is
continually updated,
based on the latest
research and clinical
evidence.
2
Why do some medications
cost more than others?
A formulary
places medications
on different
levels or “tiers.”
3
Why do some medications
cost more than others?
Your cost for a
prescription is
determined by
the tier the
medication is on.
4
Why do some medications
cost more than others?
Michigan Public Employee
Retirement System
Prescription Plan
Tiers 1 and 2
20%
coinsurance
$10 Minimum / $40 Maximum
Generic, Formulary brand, & Formulary
specialty medications
MPSERS Prescription Plan
30 Day Supply
Tier 3 and 4
40%
coinsurance
$10 Minimum / No Max
Non-Formulary Brand & Non-Formulary
Specialty Medications
Tier 1, 2, and some 4
20%
coinsurance
$25 Minimum / $100 Maximum
Generic, Formulary brand, & Formulary
specialty medications
MPSERS Prescription Plan
90 Day Supply
Tier 3 and most Tier 4
40%
coinsurance
$25 Minimum / No Max
Non-Formulary Brand & Non-Formulary
Specialty Medications
money
save
How to
the most
when choosing
Go generic!
Generics are safe, effective and
have the same active ingredients
as a brand name medication,
but
cost an average of 85% less.
How to save the most money
when choosing medications
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?”
How to save the most money
when choosing medications
Stay preferred.
If a generic medication is
not available,
choose a
preferred
brand.
49
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
medication.
50
website
is loaded with pharmacy plan
Your personal, secure
information
Compare drug
costs before you
fill a prescription.
1
Your personal, secure website is loaded
with pharmacy plan information
On the website you can:
View your
medication history.
2
Your personal, secure website is loaded
with pharmacy plan information
On the website you can:
Learn more about
your medications.
3
Your personal, secure website is loaded
with pharmacy plan information
On the website you can:
Review the
formulary.
4
Your personal, secure website is loaded
with pharmacy plan information
On the website you can:
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
Good health is in the palm of your hand
with the Catamaran Mobile App
When you are on-the-go:
Easily share your
prescription list
with your doctor.
1
Good health is in the palm of your hand
with the Catamaran Mobile App
When you are on-the-go:
Find a nearby
pharmacy.
2
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.
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
you take every day
Beginning 1/1/15
Catamaran Home
Delivery will
become your Mail
Order pharmacy
Never run out of the medications
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.
Never run out of the medications
you take every day
Catamaran Home Delivery
Save money and time
when you use Catamaran
Home Delivery.
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.
By Mail:
−
Use a blank paper form
−
Please fill out all data requested
−
Mail to
PO Box 145,
Avon Lake, OH 44012-
0145
1
Pre-Register with Catamaran Home
Delivery
By Fax:
−
Use a blank paper form
−
Please fill out all data requested
Fax to 800-893-2299
(fax number located
on the form)
2
Pre-Register with Catamaran Home
Delivery
Log on to
www.mycatamaranrx.com
3
Pre-Register with Catamaran Home
Delivery
By Web:
Pre-Register with Catamaran Home
Delivery
Pre-Register with Catamaran Home
Delivery
Pre-Register with Catamaran Home
Delivery
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.
Never run out of the medications
you take every day
Catamaran Retail 90
Save money and time
when you choose
Retail 90.
Never run out of the medications
you take every day
Catamaran Retail 90
Fill a 90-day supply of
medication at your
local pharmacy.
Specialty Pharmacy
BriovaRx Specialty Pharmacy
Multiple Sclerosis, Crohn’s
Disease and Rheumatoid
Arthritis are examples of
specialty conditions.
BriovaRx Specialty Pharmacy
Patients with specialty
conditions get
extra care
and
high-touch
support
from
BriovaRx, the Catamaran
specialty pharmacy.
BriovaRx Specialty Pharmacy
BriovaRx Specialty Pharmacy
Learn more:
www.BriovaRx.com
BriovaRx Specialty Pharmacy
Your Catamaran
Welcome Kit
has everything you need!
Look for your
Welcome Kit in the
mail approximately
Mid-December
berServ maranRx www.mycata
Your Catamaran Welcome Kit
has everything you need
Your Catamaran Welcome Kit
has everything you need
Your Welcome Kit includes:
Pharmacy ID cards
Your Catamaran Welcome Kit
has everything you need
Your Welcome Kit
includes:
Tips for Using Your
Benefits
Your Catamaran Welcome Kit
has everything you need
Your Welcome Kit includes:
Home Delivery
Materials:
•
Order Form
•B
rochure
•
Return Envelope
Catamaran is
here to help!
Get help and answers to
your questions with just a
few clicks or a phone call.
Catamaran is here to help!
Catamaran is here to help!
Find answers to questions, forms
and your plan details on our
website and mobile app
Contact our
Call Center
24/7 for assistance
Catamaran Member Services:
Non-Medicare Members- 1-866-288-5209
Medicare Members- 1-855-577-6517
Catamaran is here to help!
91
Lisa Eggert
Senior Account Manager
MPSERS
Michigan Public School Employees Retirement System
Fall Seminars 2014
92
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
93
Network Comparison
Nonparticipating
Delta Dental Premier
®
315,100+ locations
148,400+ unique dentists
•
Significant discounts
•
No balance billing above the
Maximum Allowed Fee
•
Acceptance of processing policies
•
No discounts
•
Balance billing
Delta Dental PPO
SM
234,500+ locations
95,000+ unique dentists
•
Most significant discounts
•
No balance billing above the Delta
Dental PPO Schedule
94
MPSERS Dental Plan
Delta Dental PPO
dentist
nonparticipating dentist
Delta Dental Premier or
Diagnostic and Preventive Services
Two cleanings, exams and fluoride (to
age 21) per calendar year
95%
90%
Basic Services
Restorative services
X-rays—95%
Fillings—80%
All other—75%
75%
Major Services
Prosthodontic services
50%
50%
Orthodontics
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MPSERS Dental Plan
(continued)
Annual Maximum (per calendar year)
Applies to Diagnostic & Preventive, Basic Services, and
Major Services benefits
$1,100
Orthodontic Maximum (lifetime maximum)
Applies to Orthodontic benefits
$1,200
96
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
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•
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
Thank you!
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
