Presentations text content in Welcome to the TCU – One Exchange
Slide1
Welcometo theTCU – One Exchange Informational Meeting
Slide2What’s changing?TCU changed the way it provides medical benefits to Medicare-primary retirees and their Medicare-primary dependents.
Retiree’s medical benefits will be managed through a Health Reimbursement Arrangement account (HRA).
2
Slide3What we’ll cover todayWhy this approach?
How this affects
youMedicare 101Introducing OneExchange
Going forward
Questions & answers
3
Slide4Why This Approach?Provides Medicare-eligible retirees with:
Greater flexibility in how to use health care dollars
A broader range of plan optionsThe possibility that new coverage will cost less than current coverage
Enables
TCU to continue supporting retirees during a time of uncertainty surrounding the rising cost of medical insurance and services
Enables TCU to predict and budget for health care costs more accurately
4
Slide5How This Affects Medicare Eligible Retirees
Medical premiums and out-of-pocket costs
will vary depending on the coverage you choose.You will work with OneExchange
to enroll in a plan that meets your medical and Rx needs.
TCU will establish your Health Reimbursement Account. This account will be administered by
OneExchange
OneExchange
Advisors will help you understand the
costs
associated with your coverage – premiums,
co-payments, deductibles
and all other costs.
What you pay
How
to
enroll
Your support
Slide6Medicare 101Everything you wanted to know about Medicare, but were afraid to ask!
Slide7Original Medicare:
A Health insurance program for
People 65 years of age and older
Some people with disabilities
People with End Stage Renal Disease (ESRD)
Administered by CMS
Enrollment handled by Social Security Administration or Railroad Retirement Board
Key
Terms
Medicare Part A = Hospital Coverage – administered by CMS
Medicare Part B = Medical Coverage – administered by CMS
Medicare Part C = Medicare Advantage Plans – private plans – group or individual market
Medicare Part D = Prescription Drug Coverage – private plans – group or individual market
Medicare Supplement (Medigap) – private plans – group or individual market
7
Slide8Original Medicare: Part A (Hospital)
Premiums:
Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Medicare-covered employment.$254.00 for 30-39 quarters of Medicare-covered employment.
$461.00 for people who have less than 30 quarters of Medicare employment.
Foreign citizens and Americans who worked abroad
Coverage:
Medicare Part A covers:
Hospital Stays
Skilled Nursing Facility (SNF)
Home Health Care
Hospice Care
Pints of blood received at a hospital or skilled nursing
facility during a covered stay
8
Slide9Original Medicare: Part B (Medical)
Initial Enrollment Period:
When turning 65. 3 months before, the month of, and three months after 65
th
B-Day.
(7 month window
)
Coverage:
Doctors’ services (physician office and some hospital settings)
Limited Chiropractic Services
Outpatient Services:
Diagnostic
tests- clinical Lab
(x-ray, MRI, CAT, EKT, nutritional therapy, etc…)
Other medical services
Durable medical equipment (DME)- prosthetic, wheelchair etc.
Diabetic Supplies
Ambulance service
9
Slide10A person that is eligible for Medicare but opts out of Part B may be subject to a 10% per year Part B penaltyPenalty is waived if beneficiary has coverage through a group policy based on
active employment
Medicare Part B - Late Enrollment Penalty
Slide11For employers with 20 or more employees, group coverage is primary for Medicare beneficiaries who are still active, and Medicare is secondary. Therefore, active beneficiaries don’t have to enroll in Part B and will not be penalized when they decide to retire. When they decide to retire, beneficiaries should enroll in Part B three months prior. This will insure that they can enroll in a Medicare Supplement plan and have it effective as soon as their group coverage ends
.
Medicare Eligibility & Active Employment
If
active and covered under the group health plan,
employee
does not enroll in Medicare Part B or select a Medicare supplemental plan(s) until they retire or lose coverage.
11
Slide12Post-65 Coverage Options
Added Optional Coverage
Part A Hospital Institutional
Part B
Doctors
Supplies
Outpatient
Professional
Medicare Supplement (Medigap Plans)
Fills in Medicare payment “gaps” in coverage
Medicare Advantage
(MA)
Part D
Drugs
HMO
Part D
Drugs
(Stand
Alone)
PFFS
OR
Original Medicare-
FFS (Fee For Service)
+
+
MA-PD
PPO
12
Slide13Part D: What is Medicare Part D?Medicare Part D is optional prescription drug coverage for everyone with Medicare Part A
or
BPDP’s are run by private insurance companies approved by Medicare (Like MA plans)If beneficiaries decline to enroll in a Medicare drug plan when they are first eligible, they may be penalized. (1% of national average per month)
Beneficiaries sign up when they first become eligible for Medicare, or during the AEP
13
Slide14Helping You Prepare For Your Upcoming Medicare Enrollment
One
Exchange
TOWERS WATSON
Slide15Who We Are
Transitions Can Be A Good Thing!
OneExchange
– For Your Benefit
A Deeper Dive – Benefit Advisors, Private Exchange, Optimize Savings, Health Reimbursement for You
Next Steps
Questions & Answers
15
Slide16Your Transition OneExchange has been chosen after an extensive evaluation of choices
OneExchange
will help you with total care in transitioning over to more-effective individual Medicare health insuranceThe private exchange offers greater choice and flexibility; many affordable choices exist and in many cases provide more value at a lower cost than an employer group plan
Ongoing support – at no cost to you
16
Transitioning
the
way access is provided to retiree
health benefits for Medicare-eligible retirees
and
their Medicare-eligible
dependents
Slide17About OneExchange
Towers Watson
over
100
y
ears experience
First
and
Largest
private Medicare Exchange
Personalized options
with
plans
from
a nationwide network of carriers
Licensed advisor
provides
guidance
and
lifetime advocacy
Hundreds of thousands
of retirees served across
300+
employers
In the middle of our
9
th annual
enrollment season
Founded in
2004
No added fees for our services
Slide18Why OneExchange?
White-Glove Service
Consultative Process
Simplified Selection
Lifetime
Advocacy
Effortless
Enrollment
Selection Process:
Your Benefit
A
dvisor will provide the guidance you need to easily understand your Medicare options
Enrollment Process
:
100% paperless, telephonic enrollment
Secure and efficient
Consultative Process:
Your Benefit
A
dvisor will determine coverage needs and thoroughly research your options
Advocacy:
Specialized and focused; trained in insurance, Medicare and issue resolution
towerswatson.com
18
Slide19Our Service Centers
Salt Lake City, UT
Dallas, TX
Operating
hours:
Monday-Friday 7am-8pm CT
100% Domestic Workforce
- NO Outsourcing!
Slide20All Medicare Plan Types
Plans and Partners
Multiple plans available to you from national/regional carriers
Prescription Drug
(Part D)
Medicare Advantage
Medicare Supplement
(
Medigap
)
A few examples of the carriers on our Medicare exchange:
towerswatson.com
20
Slide21Your Experience
Slide22Education
Enrollment Guide
Prepare for your enrollment consultation
Review
Medicare
basics
TOLL FREE
1-888-429-8490
medicare.oneExchange.com/TCU
22
Slide23Decision Support ToolsHelp Me Choose
Prescription Profiler
medicare.oneExchange.com/TCU
24/7
access to your information
23
Slide24Benefit AdvisorsLicensed / Certified / Appointed
OneExchange University
™Average age 43Objective & unbiased100% domestic workforce
Hours
of
Operation
Monday
–
Friday
7 am
–
8 pm
C
T
Slide25
Enrollment ProcessBenefit Advisors can discuss coverage options with anyoneTelephonic enrollment – 2 part process100% of calls are recorded
Slide26Application
Data
Processors(ADPs)LicensedBenefit
Advisors
(BAs)
Tag-Team Enrollment Expertise
Allows BAs to Have More Time for Consultations
Ensures Accuracy of Application Submissions
26
Trained in carrier
e
nrollment
a
pplications; the experts in accurately filling out the paperless applications to optimize first-time acceptance by the carriers
Licensed / Certified / Appointed by Departments of Insurance; the experts in probing health plan needs and helping to recommend the right plan
Slide27Enrollment Confirmation Notice
Features: Sent
once a participant has enrolled into a planConfirms all plan selections and enrollmentsCarrier Name
Plan Name
Confirmation Number
Premium
Coverage Effective Date
Whether or not they have selected Automatic Reimbursement
What Happens Next
Expectations on Carrier correspondence, including ID Cards
Subsidy Packet
Automatic Reimbursement
Direct Deposit
Slide28MEDICARE
ADVANTAGE
OPTION 1:
Medicare Advantage Plan with Prescription
Drug Coverage
(MAPD)*
* Note that Medicare Advantage plans are generally network based plans
28
+ PD
Slide29Note: You
may
need to pay your first premium when you enroll in coverage
PART D
PLAN
MEDIGAP
PLAN
OPTION 2:
Medigap
Plan + Part D Plan
29
Slide30Medicare Prescription Drug Coverage 2015
Catastrophic Coverage
Coverage Gap
Initial Coverage
Deductible
You Pay Full Retail Until Deductible is Met 2015 - $320
You
pay copays
for your plan coverage for the first $2960 in actual costs of Medications
You pay 45% of Brand Name and 65% of Generics until your out of pocket costs reach $4700; Pharmaceutical contributions will count towards the $4700
True Out Of Pocket costs
You Pay $2.65 for Generics and $6.60 for Brand
Name or
5% - whichever is greater
Only 25% reach Donut Hole
Only 4% reach Catastrophic
Slide31How This Affects You
Depends on the plan you choose
Choose the right level of coverage for you and your spouse individually
What you pay
How you enroll
Your support
You enroll directly through
OneExchange
You and your Medicare-eligible spouse enroll in separate plans
OneExchange
will be your partner as you make this decision and enroll in plans
OneExchange
will provide ongoing support
- at no cost to you
31
Slide32Local Plan Slides
Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame
Slide33Plans Available in Dallas and Tarrant Counties
Plan Type
Number of
Plans Offered
2014
Monthly Premium
Carriers
Medicare Advantage
19
$0 - $89
Coventry, Humana, AARP, Aetna, Scott & White, CIGNA Health Spring
Medigap
/ Medicare Supplement
16
$66 - $306
AARP, Humana, BC BS TX
Prescription Drug
(Part D)
17
$13 - $127
AARP, Aetna, CIGNA, Express Scripts, Humana, Silver Script,
WellCare
Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame
Slide34Also Available in Dallas & Tarrant Counties
Plan Type
Number of
Plans Offered
2014
Monthly Premium
Company
Vision
1
$14 per person per month
Annual eye exam: $5
Coverage for eye glasses, lenses and frames
Vision Service Plan (VSP)
Dental
4
$16 - $46
$50 - $75 deductible
$750 - $1500 annual maximum
Delta Dental, Humana, MetLife Dental
Vision plans and Dental plans are not Medicare plans
Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame
Slide35Medicare Advantage Plan
Benefit
Cost
Premium
$34
Network
PPO
Deductible
$0
Doctor Copay
$10
Specialist Copay
$40
Hospital
$300
copay per days: 1-7
Emergency Room
$65 unless
admitted to the hospital
Deductible
$0
Rx
$0/ $2/ $39/ $85/ 33%
30-day supply
Mail Order
$13/ $18/ $110/ $238
90-day supply
35
2014
Slide36Medigap Plan F + PDP (75 year old male)
Benefit
Cost
Premium
$220
($202 Medical + $18 PDP)
Network
Any
doctor who accepts Medicare
Deductible
$0
Doctor Copay
$0
Specialist Copay
$0
Hospital
$0
Emergency Room
$0
Deductible
$0
Rx
$0/ $15/ $40/ $90/ 33%
30 day supply
Mail Order
$0/ $30/ $80/ $180
90 day supply
36
2014
Slide37Health Reimbursement Arrangement (HRA)
Slide38What Is An HRA?
Tax-free
account used to reimburse you for eligible health care
expenses – you
pay first and then get reimbursed
If you are eligible,
your former employer will
make an annual contribution to a Health Reimbursement Account (
HRA)
You may
use HRA funds to reimburse yourself for eligible medical expenses which include premiums that you pay coverage for (including Medicare Part B) and certain out-of-pocket
expenses
Your
HRA funds will be
available on the first of the month of your retirement, prorated for the year. On Jan 1
st
of the next year, you receive the full annual amount.
38
Slide39Health Reimbursement Arrangement
If you are eligible, reimbursements are made up to the amount available in your HRA
Slide40Health Reimbursement Arrangement
Reimbursement Options
1.
Automatic
Reimbursement
[including recurring claims]
2.
Manual Reimbursement
If you are eligible, reimbursements are made up to the amount available in your HRA
Slide41Service offered by OneExchange
Available on most plans
Works for premium reimbursement onlyNo claim form is requiredCan take 2-3 billing cycles to initiateIf you need your reimbursement sooner, simply file a paper claim. The form and instructions will be provided in your Funding and Reimbursement Guide
Auto-Reimbursement (AR)
Slide42Next Steps
Slide43What You Need To Do: Action Required!
You MUST enroll in Medicare Part B if not already enrolled – contact the SSA
Contact
OneExchange
at your
toll free #
Make a first
c
ontact call now and schedule an enrollment appointment
Enroll in your new coverage
Call us during your scheduled appointment time
Y
ou are guaranteed coverage
43
Slide44Your First Contact Call – We’re Ready!
44
Slide45Personal G
uidance: For a Lifetime
A
lifetime advocate
:
Navigation
Enrollment
Claim issues
Denied policies
Affordability concerns
Prescription
Late
enrollment
HRA
Annual plan review
Slide46Why OneExchange Retiree
People
Objective and personal touch through stringent
training
processes and
CMS compliance criteria
Size and
Strength
300 employers and 500,000 retirees being served
Technology
Most automated
connections
,
across 90
carrier partners
Satisfaction
99% client retention rate
Average retiree satisfaction 9.2/10.0
Experience
First and largest Medicare
Exchange; private
Relationship
As life happens, we are here for you
Slide47Frequently Asked QuestionsQ:
Do you offer plans that cover me in multiple states-I am a snowbird?
A: Medigap plans are accepted by every Medicare-participating provider in the U.S., with some emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these plans may be right for you. Part D plans provide nationwide coverage from participating pharmacies. Medicare Advantage plans cover urgent and emergency services nationwide, but some may not provide nationwide coverage for non-emergency services. If you live part of the year out-of-state, these plans may not be right for you.
Q: How often will I be billed? By whom? Can I pay by check?
A: When you enroll in a new plan, you will need to begin making premium payments to the insurance company in order to maintain your coverage. Some insurance companies may require the first month’s premium payment during the application process. In this case, you should expect to make a payment within a few days of your enrollment. Please have your billing information ready when you make your enrollment call to
OneExchange
.
Most insurance companies give you several billing options for ongoing payments: direct billing, paid by check each month, Electronic Funds Transfer from your checking account, or automatic deduction from your social security check. You can choose to pay monthly, quarterly, or yearly.
47
Slide48Q: If I don’t like the plan that I enrolled in, when can I change?A: Every year you will have a Medicare Annual Enrollment
Period during which you may
investigate other medical and drug plans and potentially enroll in a different plan. However, during future Medicare Annual Enrollment Periods your medical conditions at that time may limit the plans available to you. You will receive notification from
OneExchange
of the
Medicare Annual
Enrollment Period (October 15-December 7
);
we encourage you to contact us should you have any questions
.
Q
:
Will I
be refused coverage due to a pre-existing condition? Will I pay more? Can my policy be cancelled once I am enrolled because of my condition? Can my rate be raised for that reason?
A: If you enroll in a
Medigap plan when you first transition from group coverage you have guaranteed issue rights – no questions about pre-existing medical conditions may be asked. If you later change Medigap plans in the future, you MAY go through Medical underwriting. You will not necessarily be denied, but your monthly premiums could be higher. Your policy is always ‘guaranteed renewable’ – meaning you cannot be cancelled once you are enrolled unless you do not pay your premiums and your rate will not be raised for medical reasons. If you enroll in a Medicare Advantage plan, they are always guaranteed issue with no questions of pre-existing medical conditions.
Frequently Asked Questions
48
Slide49Q: What if I have the option for other coverage (spouse, military) – if I don’t enroll with OneExchange can I enroll later?
A:
Yes, during annual enrollment each fall. You will need to enroll into Medical or prescription drug plan coverage to be eligible for the HRA funding. Q: I re-married after I retired—is my spouse eligible for OneExchange’s
services?
A:
Yes.
OneExchange
can
assist you with individual plan
coverage consultation but you will not be eligible for the program subsidy.
Q
: Will my premium rates increase every year? If so, by how much?
A: In general, insurance premiums do increase every year. The increase in plan cost year-to-year can vary widely. We advise our enrollees to contact us and compare other plans if you experience rate increases in the 10-15% range. The national average is 3-4%.
Q
: Are there plans that will cover me when I travel domestically or internationally?
A: Medigap plans are accepted by every Medicare-participating provider in the U.S., with some emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these plans may be right for you.
A few Medicare Advantage plans also have world wide emergency coverage
.
Frequently Asked Questions
49
Slide5050
We Are Ready For Your Call
1-888-429-8490
Slide51
Welcome to the TCU – One Exchange
Download Presentation - The PPT/PDF document "Welcome to the TCU – One Exchange" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.