Welcome to Open Enrollment Benefits Choices for 2009. Introduce yourself. Again, Sandia is offering you the option to change your medical plan anytime between October 20 th and November 10 th for effective coverage on 1/1/2009. Remember that if you are in the UHC HDHP or CIGNA Premier PPO, you need to make a new selection. The OE Change Form is on page 61 of your booklet Please hold your questions until the end of the presentation so that we can get all our vendor to come help answer your questions.
If you didn’t receive your packet, we may not have your correct address. Please stop by the Sandia table in the lobby to write down your address so we can update your records. We have extra supplies of these items at the Sandia table in the lobby. If after you leave here today, you realize that you didn’t pick up a copy of this information, you may call Benefits Customer Service at 844-4237. Of course, the Open Enrollment website is also available. Please call us anytime to make an address change when you move.
This is what we will be covering today…
We have eliminated two plan options for non-Medicare retirees: UHC High Deductible Health Plan with 8 subscribers CIGNA Premier PPO with 56 subscribers Read: We made some copay and coinsurance changes as described under each plan in your booklet Catalyst Rx is now the Pharmacy Benefit Manager under both UHC and CIGNA. Waiver of prescription drug coverage is not longer an option Dental Care Plan replaces the Dental Expense Plan Eligibility: We removed the financially dependent requirement for dependent children under age 24 – refer to the OE booklet for Tax Treatment under for “qualifying child” or “qualifying relative” to determine whether your dependents’ coverage is taxable. Contact your Tax Advisor to determine tax treatment and if you determine that you dependent’s benefits are taxable contact Sandia Benefits. New Class 2s will not be eligible for coverage (pg. 37), but current Class 2s will be allowed to continue coverage.
This will be a high-level overview since you can refer to your OE booklet and Chart for details. You can always call the plan’s Members Services if you think of any questions on coverage after you leave here today. The vendor Contact List is on page 49 of your OE booklet.
These are the two plan options available to non-Medicare retirees. Here is an example how the networks are different in NM under those two plans.
Deductible is the amount you need to meet before the plan will begin providing coverage for those services that are co-insurance based. Office visits and Rx drug copays do not go towards the deductible so you don’t need to meet the deductible to get coverage for OV copays. Out-of-pocket means that once you hit this amount the plan will pick up 100% of the eligible expenses for the remainder of the year Coinsurance – the percentage on the screen is the amount the member pays, the plan pays the other percentage. By definition, coinsurance will vary according to the price of the service – it is not a set amount like a copay Copay is a set amount – e.g., $20 for an office visit Other definitions are in the OE booklet on pages 43 through 46.
Here are the copay/coinsurance changes for the UHC plan. All the changes are listed under each plan in your OE booklet.
Here are the copay changes for the CIGNA In-Network Plan. All the changes listed under each plan in your OE booklet.
The following do not apply to the Out-of-Pocket Maximum: Charges for noncovered health services Reduction in benefit for non-compliance with pre-certification requirement Out-of-network behavioral health service Charge that exceed eligibile expenses Prescription Drug Program
This will be a high-level overview since you can refer to your OE booklet and Chart for detailed. The vendor Contact List is on page 49 of the OE booklet.
In-network Rx benefits review. This information is on pages 12 thru 14 of the OE booklet. Go over Rx drug retail copays Preferred brand means that it is listed on the plan’s formulary. Drugs are put on the formulary after being evaluated for cost, therapeutic merit, practice patterns, etc. Non-preferred brand drugs are not on the vendor’s formulary and will cost you more
The Specialty Drug Management Program drugs are listed on pages 57 thru 59 of the OE booklet. The Mandatory Specialty Program provides significant savings: those drugs are usually highly priced and limiting scripts to 30 days will help in reducing waste due to intolerance to a specific drug You will get personalized help by a certified technicians in specialty drug use and counseling
You can begin to register in the Mail Service Program beginning January 1, 2008, after your eligibility data has been loaded. You can register by mail by completing the form included in your Catalyst Welcome packet, or you may call Catalyst to register, or you can register online with Catalyst: The instructions for their website will be included in the “Welcome” packet. You must register first to obtain refills. The following will require new prescriptions from your doctor: Compound medications Controlled substances Expired prescriptions Prescriptions without remaining refills and future fill prescriptions. For those CIGNA members that have mail order prescriptions, you may want to order your refills (TelDrug for CIGNA members) no later than mid-December if you’re going to run out of pills in early January. I believe you can get refills 25 days before your prescription runs out. Check your prescription bottle to make sure.
This table is identical to the OE Change Form. It lists the medical plan combination options (during OE) for families that have members that are Medicare eligible as well as members that are not Medicare eligible. You’ll see that the Presbyterian MediCare PPO has no corresponding plan for non-Medicare eligibles.
Provider networks – Do you use Lovelace or Pres doctors; Do you use facilities outside of NM? Benefit coverage – Does the plan cover a particular service you may need (e.g., acupuncture and behavioral health), Does it have any limitation on coverage? In/out-of-network coverage – Do you want flexibility to go outside the network or does this matter? Copays vs. coinsurance – Are payments for service through a fixed copay or through coinsurance which varies depending on the cost of service Coverage while on travel – How does the plan provide coverage while you are on travel such as for emergency, urgent care, or follow-up care – you might need both internationally and within the US depending on where you travel? Dependent coverage – What plan is my spouse eligible for? Remember, all members of your family must be Medicare-eligible to enroll in the Presbyterian Medicare. Check out the premiums for all the plans in the booklet starting on page26 of the OE booklet.
Screen shot of how it looks on the web.
The plan will automatically include the number of service you will need according to your health requirements. You can change any number you’d like. Screen shot also.
Calculation of your costs for medical care needs according to plans.
The Dental Care Plan is coinsurance based instead of a fixed coverage amount. More information on the Dental Care Plan is on pages 24 and 25 of your OE booklet.
Delta Dental has two networks: a PPO network and a Premier network.
So, how can I get the most from my benefits under the medical plans..
Stay in the network because network providers charge you a discounted rate while the out-of-network can charge you their full rate.
Most likely your provider will do this if in-network...but you want to make sure they do as the onus is on the member
This list changes from time to time…your physician may access the latest list by calling 1-800-244-6224
IMPORTANT TO NOTE: if you waived medical coverage and as a retiree you die, your surviving spouse will not be allowed to enroll in any Sandia medical plan. The surviving spouse must have coverage with Sandia at the time of the retiree death to be eligible for continued coverage through Sandia
ID cards – Make sure that your providers have the new # on your ID card to process claims otherwise you may have claims problems.
Screenshot of OE website. Sandia’s open enrollment website on the external web for retirees…here you can access the retiree booklet, the change form,
Complete the OE change form especially those on the UHC High Deductible Health Plan and the CIGNA Premier PPO.
No changes, no action.
Vendor contacts list is on pages 49 and 50 of the OE booklet.
Other items that are in the OE booklet are: Option to waive coverage if you don’t want Sandia health plans coverage on pages 47 and 48 (when you waive coverage for yourself, you are also waiving for all your dependents. Preventive health reference guide to use when you go for you annual physical (make sure you tell each office you visit for those service that it’s your preventive care service that is covered at 100%. Medicare Part D Creditable Coverage Notice (keep in case you are waiving Sandia’s coverage and are getting coverage somewhere else or with a separate Medicare plan). That way you won’t have to pay a late enrollment fee for the rest of your life.
Non-Medicare Retirees October 20 - November 10, 2008 Benefits Choices 2009 Open Enrollment
Medical Plan Options for 2009 For details, review your 2009 OE Booklet and Medical Plan Comparison Chart UnitedHealthcare Premier PPO Plan CIGNA In-Network Plan Presbyterian Hospital/Doctors UNMH Independent Providers Lovelace Health System ABQ Health Partners UNMH Independent Providers
Summarized Comparison * Does not include prescription drug coverage. Catalyst Rx Catalyst Rx Prescription drug coverage administrator Yes Yes National network coverage Primarily copay Primarily coinsurance Payment via No No Referrals to specialist required In-network only Both In- and out-of-network coverage $1500 per person/ $3000 family $1750 per person/ $3500 family Annual CY out-of-pocket (in-network) * None $250 per person/ $750 family Annual CY deductible (in-network) * CIGNA In-Network Plan UHC Premier PPO Plan
UHC Premier PPO Plan Changes *Subject to deductible 15% * $25 copay Allergy Treatment Not covered $25 copay Hypnotherapy/biofeedback $1000 each maximum/CY $1500 combined maximum/CY ChiropracticAcupuncture (combined with out-of-network) $35 copay $25 copay Specialist Office Visit $20 copay $15 copay PCP Office Visit 2009 2008 In-Network
CIGNA In-Network Plan Changes *Combined maximum of 60 visits per calendar year $30 copay $25 copay Allergy Testing $125 copay $100 copay Emergency Room Visit $75 copay $50 copay Ambulance $125 coopay $100 copay Outpatient Surgery Not covered $25 copay Hypnotherapy/biofeedback $20 copay $15 copay Speech, Physical, and Occupational Therapy * $20 copay $15 copay ChiropracticAcupuncture * $400 copay $200/day up to $500 Inpatient Admit $30 copay $25 copay Specialist Office Visit $20 copay $15 copay PCP Office Visit 2009 2008 In-Network CIGNA In-Network Plan
What is Applied to Deductibles and Out-of-Pocket Maximums
CIGNA In-Network Plan
Copays (e.g., $20/PCP visit, $30/specialist visit) DO apply to the out-of-pocket maximum (except for Rx drug copays)
UHC Premier PPO Plan
Copays for PCP or specialist office visits (including Rx copays/coinsurance) are NOT applied to out-of-pocket maximum or to the deductible
Deductibles and coinsurance amounts ( e.g., 15%, 20%, 30%) DO apply to out-of-pocket maximums (with some exceptions)
Deductibles and out-of-pocket maximums are NOT cross applied between in-network and out-of-network benefits
Summarized Rx Changes Mail Order (up to 90 day maximum supply) 30% with $25 min. and $40 max. $30 copay No change 30% with $25 min. and $40 max. Preferred Brand 40% with $40 min. and $60 max. N/A No change 40% with $40 min. and $60 max. Non-preferred Brand 20% with $12 min. and $24 max $20 copay 20% with $12 min. and $24 max $18 copay Generic 40% with $80 min. and $120 max. N/A 40% with $80 min. and $120 max. $100 copay Non-preferred Brand 30% with $50 min. and $80 max. $60 copay 30% with $50 min. and $80 max. $65 copay Preferred Brand 20% with $6 min. and $12 max. $10 copay No change 20% with $6 min. and $12 max. Generic Retail (up to 30 day maximum supply) 2009 2008 2009 2008 In-Network CIGNA In-Network Plan UHC Premier PPO
Open Enrollment Coverage Options Lovelace Senior Plan CIGNA In-Network Plan Presbyterian MediCare PPO No corresponding plan UHC Senior Premier PPO UHC Premier PPO Medicare-Member Plans Non-Medicare Member Plans
Dental coverage for surviving spouse and eligible dependents is discontinued at the end of the month of retiree’s death
Coverage may be temporarily continued (COBRA process), for up to thirty-six months, by paying the monthly COBRA surviving spouse/dependent group rate (2009 single rate – $38.00/month + 2% administrative fee)