Welcome to the TCU – One Exchange PowerPoint Presentation, PPT - DocSlides

Welcometo theTCU – One Exchange Informational Meeting

What’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

What we’ll cover todayWhy this approach?

How this affects

youMedicare 101Introducing OneExchange

Going forward

Questions & answers

3

Why 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

How 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

Medicare 101Everything you wanted to know about Medicare, but were afraid to ask!

Original 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

Original 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

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Original 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

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A 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

For 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. 

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Post-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

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Part 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

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Helping You Prepare For Your Upcoming Medicare Enrollment

One

Exchange

TOWERS WATSON

Who 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

Your 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

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Transitioning

the

way access is provided to retiree

health benefits for Medicare-eligible retirees

and

their Medicare-eligible

dependents

About 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

Why 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

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Our Service Centers

Salt Lake City, UT

Dallas, TX

Operating

hours:

Monday-Friday 7am-8pm CT

100% Domestic Workforce

- NO Outsourcing!

All 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

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Your Experience

Education

Enrollment Guide

Prepare for your enrollment consultation

Review

Medicare

basics

TOLL FREE

1-888-429-8490

medicare.oneExchange.com/TCU

22

Decision Support ToolsHelp Me Choose

Prescription Profiler

medicare.oneExchange.com/TCU

24/7

access to your information

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Benefit AdvisorsLicensed / Certified / Appointed

OneExchange University

™Average age 43Objective & unbiased100% domestic workforce

Hours

of

Operation

Monday

–

Friday

7 am

–

8 pm

C

T

Enrollment ProcessBenefit Advisors can discuss coverage options with anyoneTelephonic enrollment – 2 part process100% of calls are recorded

Application

Data

Processors(ADPs)LicensedBenefit

Advisors

(BAs)

Tag-Team Enrollment Expertise

Allows BAs to Have More Time for Consultations

Ensures Accuracy of Application Submissions

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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

Enrollment 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

MEDICARE

ADVANTAGE

OPTION 1:

Medicare Advantage Plan with Prescription

Drug Coverage

(MAPD)*

* Note that Medicare Advantage plans are generally network based plans

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+ PD

Note: 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

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Medicare 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

How 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

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Local Plan Slides

Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame

Plans 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

Also 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

Medicare 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

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2014

Medigap 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

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2014

Health Reimbursement Arrangement (HRA)

What 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.

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Health Reimbursement Arrangement

If you are eligible, reimbursements are made up to the amount available in your HRA

Health 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

Service 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)

Next Steps

What 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

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Your First Contact Call – We’re Ready!

44

Personal G

uidance: For a Lifetime

A

lifetime advocate

:

Navigation

Enrollment

Claim issues

Denied policies

Affordability concerns

Prescription

Late

enrollment

HRA

Annual plan review

Why 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

Frequently 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

Q: 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

Q: 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

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We Are Ready For Your Call

1-888-429-8490