Benefits Choices 2009 Open Enrollment

Non-Medicare Retirees October 20 - November 10, 2008 Benefits Choices 2009 Open Enrollment

What Should I Have Received in the Mail?
Packet including:
Annual Open Enrollment Booklet (2009)
Open Enrollment Change Form
Medical Plans Comparison Chart
Self-addressed envelope

Presentation Topics
What’s New for 2009
2009 Medical Plans Overview
2009 Prescription Drugs Overview
Choosing a Medical Plan
2009 Dental Care Plan Overview
How to Get the Most from Your Benefits
Open Enrollment Information
Questions

Plans eliminated: UHC High Deductible Health Plan, and CIGNA Premier PPO
Plan design changes (e.g., copays and coinsurance as described under each plan)
Prescription drug coverage for CIGNA members change to Catalyst Rx
Waiver of prescription drug coverage no longer an option
New Dental Care Plan replaces Dental Expense Plan
Class I eligibility rules modified (OE Booklet, pg. 36-38)
New Class IIs no longer eligible
What’s New for 2009?

2009 Medical Plans Overview

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

Emergencies, Urgent Care, Follow-up Care
Call 911 if you require immediate medical or surgical care or go to the nearest hospital!
If admitted, call member services within 48 hours or as soon as reasonably possible.
Emergencies are covered at the in-network benefit level worldwide under all plans as determined by the claims administrator.
UHC Premier PPO Plan
Urgent care and follow-up care benefit level (within USA) is according to the provider of service (in-network versus out-of-network provider)
Urgent care and follow-up care (outside USA) will be covered at the out-of-network benefit level
Urgent care is covered worldwide
Follow-up care (within USA) is covered only if received from an in-network providers
Follow up care (outside USA) is NOT covered

Eligibility Changes
Refer to IRS Code Section 152 or Publication 502, or consult your tax advisor for “qualifying child or qualifying relative” for health care coverage.
“ Financially dependent on you” has been eliminated and changed to “unmarried child under age 24”
Although dependent may be eligible for our plans, you are required to report to Sandia any dependents who do not meet the tax requirements as we will need to impute income on the premiums
Imputed income means that the full premium rate for your dependent shall be reported as taxable
Stepchildren of the primary covered member who lives with the primary covered member at least 50% of the calendar year, or if ages 19 through 23, is a full-time student.

Ineligible Dependents
You must disenroll ineligible dependents within 31 calendar day of the event causing ineligibility
Consequence of failing to disenroll ineligible dependents:
Ineligible dependent’s coverage retroactively terminated
You will be held liable to refund to Sandia the health care plan claims or monthly premiums
Your dependent could lose any rights to temporary continued health care coverage (COBRA)
Sandia shall not be required to refund any premiums to the subscriber

2009 Prescription Drug Overview

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

Specialty Drug Program – New!
Specialty drug coverage through Walgreens/MedMark
Limited to 30 day supply at the preferred brand drug rate (30% with a $25 minimum and $40 maximum)
Drugs delivered via mail order through Walgreens/MedMark
Specialty Care Team
Making contact by December 15
Available Monday to Friday (6 a.m. to 5 p.m MST) at 866-823-2712
Specialty Drugs
Treatment for cancer, multiple sclerosis, HIV, hemophilia, etc.
Tend to be very expensive and require special monitoring

Catalyst Rx Coverage – New Members
Catalyst has different preferred drug list so the status of your drug may change (e.g., from preferred to non-preferred)
Mail Service is provided by Walgreens Mail Service
Most prescriptions with open refills will be transferred to Catalyst/Walgreens
Certain prescriptions such as controlled substances cannot be transferred and will require a new prescription from your provider
Register with Walgreens Mail Service first before ordering refills through mail order

Welcome Kit mailed in mid-December
Letter with general info
ID cards (1/single; 2/family)
Preferred brand name listing (condensed version)
Pharmacies (major) listing (include Lovelace pharmacies)
Registration and prescription form
Present your new Catalyst ID card when getting a new prescription beginning January 1, 2009
Pharmacy Help Desk 1-866-854-8851 (available 24/7)
Website www.catalystrx.com – Username: SNL Password: SNL
Sandia external website at www.sandia.gov , Resources for…, Employees and Retirees, Retiree Open Enrollment
Catalyst reps will be available in the lobby
Catalyst Rx Coverage – New Members

Choosing a Medical Plan

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

What to Consider When Choosing a Medical Plan
Provider Networks (e.g., doctors, hospitals)
Benefits coverage
In-network and out-of-network coverage
Copays vs. coinsurance payment for services
Coverage while on travel
Dependent coverage
Premiums, if applicable

How do I know which medical plan is best for me?
Want to choose the plan that gives you the most “bang for your buck”? Use the Medical Plan Estimator Tool!
Estimates your costs for both premiums and out-of-pocket expenses (deductibles, copays)
Located on Sandia external website: www.sandia.gov under Resources for…
Employees and Retirees
Retiree Open Enrollment

Medical Plan Estimator Tool

Medical Plan Estimator Calculation

Dental Care Plan Overview

2009 Dental Care Plan Overview
Delta Dental remains the Administrator
Dental Care Plan (one plan)
Coinsurance coverage based on a percentage of the maximum approved fee:
100% preventive care
80% basic and restorative
50% major and orthodontic
Deductible Maximum $50 individual/$150 family
Annual Maximum $1500 per person
Lifetime Maximum $1800 orthodontia
Premium-sharing if retirement after 12/31/2008
$8.00 for retiree only
$15.00 for retiree + 1
$20.00 for retiree + 2

2009 Dental Overview
The Dental Care Plan includes coverage enhancements:
Sealants covered for all dependent children under age 14
Benefits for specified (Endosteal) implant services
You can see any dentist in the Delta Dental PPO or the Delta Dental Premier or an out-of network dentist.
Your out-of-pocket costs will be lower if you see a Delta Dental PPO network dentist because those dentists have agreed to a lower maximum approved fee thus making your percentage portion lower.
If you see an out-of-network dentist, those dentists can balance bill you for any amount above the maximum approved fee for the Delta Dental Premier network.
Maximum approved fee is contracted fee between Delta Dental and the network providers.

How to Get the Most from your Benefits

Maximizing Your Benefits
Preventive Care – covered 100% by your plan
Annual Physical including CBC, urinalysis, metabolic profile, diabetes screening, thyroid screening
Pap Test, PSA Test, Mammography, Colonoscopy, Bone Density Testing at certain intervals
Immunizations, including flu shots
Prescription Drugs
Use Generics – much lower copays and costs for therapeutically equivalent medicines
Mail Order for maintenance medications – can save up to the cost of one 30 day prescription at retail and convenient delivery
Stay in the network!
Get any necessary pre-authorizations from the claims administrator) ahead of time

UnitedHealthcare Pre-certification Requirements
UHC Plans – must call prior to certain services
Congenital heart disease services
Dental services stemming from an accident/injury/sickness
Durable medical equipment (DME) with a purchase/cumulative rental value of $1,000 or more (includes oxygen)
Home health care
Hospice care
Hospital inpatient stays
Reconstructive procedures
Air ambulance services
Skilled nursing facility/inpatient rehab
Transplant services
Certain behavioral health benefits
Failure to pre-notify will result in reduction of benefits by $300.

CIGNA Pre-certification Requirements
Ask your provider to handle this for in-network care
Services that need pre-certification include:
Hospital stay
Surgical procedures (inpatient or outpatient)
Acupuncture
Biofeedback
Dental service stemming from an accident or illness
Durable medical equipment (DME) including oxygen
External prosthetic appliances
Home health care
Hospice care
MRI, CT and PET scans
Varicose veins treatment, etc.
Failure to pre-certify will result in reduction of benefits by $300.

Continuation of Coverage for Surviving Spouse
Medical Coverage
Coverage for surviving spouse and enrolled dependents is provided for six months, after retiree’s death, at the same premium-share rate that retiree paid
To continue coverage after six months, surviving spouse/dependents must elect continuation of coverage prior to the end of this six-months period
Continued coverage (7th month and beyond) cost is 50% of the full medical premium for the applicable medical plan (see pg 34 of OE booklet).
Continued coverage is available until surviving spouse remarries, dependent children become ineligible and/or coverage is terminated with Sandia
Premiums for 2009 can be located in the Open Enrollment Booklet

Continuation of Coverage for Surviving Spouse
Dental Coverage
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)

What Do I Do When I Turn 65?
Within a few months before reaching age 65…
Enroll in Medicare Parts A and B
Approximately 2-3 months before you turn 65, you should receive information from Sandia Benefits and Medicare
Once you reach age 65, the Retiree Medical Plan Option is available for transition as follows:
UHC Senior Premier PPO for aging-in UHC Premier PPO members
Lovelace Senior Plan for aging in CIGNA In-Network members, (must complete Lovelace enrollment paperwork to assign Medicare)
Lovelace Senior Plan for retirees whose spouse is already in this Plan (must complete Lovelace enrollment paperwork to assign Medicare)
Presbyterian MediCare PPO Plan for retirees whose spouse is already in this Plan (must complete Presbyterian enrollment paperwork to assign Medicare)
Coverage takes effect the first day of the month in which you reach age 65
Contact Medicare or your local Social Security office for Medicare Parts A and B information

Open Enrollment Information

Open Enrollment Process Tips
Review “Medical Plans Comparison Chart”
Review “Annual Open Enrollment” booklet for more information
Use the “Medical Plan Estimator Tool”
Complete “Open Enrollment Change Form 2009” (especially important for current members in the UnitedHealthcare High Deductible Health Plan or the CIGNA Premier PPO Plan)
Submit to Benefits by deadline of Nov. 10 th
Confirmations will be sent to only those who make changes

OE website…

To make a change…

Do I Need to Take Action?
To continue under the Dental Care Plan
If you waived dental coverage previously and wish to remain in this status
To enroll if not currently enrolled
To add or disenroll a dependent
Dental Coverage
To continue current medical plan coverage ( except UHC High Deductible Health Plan or CIGNA Premier PPO Plan )
If you waived medical coverage previously and wish to remain in this status
To elect new coverage if currently under the UHC High Deductible Health Plan or CIGNA Premier PPO Plan
To enroll if not currently enrolled
To change your current medical plan
To add or disenroll a dependent
Medical Coverage No Action Action

Sandia Benefits Contacts
Sandia Open Enrollment website at www.sandia.gov Resources for…
Employees and Retirees
Retiree Open Enrollment
Benefits Customer Service Center
(505) 844-HBES (4237) or
(800) 417-2634, ext. 844-HBES (4237)
Fax # (505) 844-7535
If you have questions you can…
Send an email to [email_address] OR
Go to http://www.sandia.gov
click on Employees & Retirees
click on HBE Weekly Update
click on ? Get answers

Open Enrollment Period October 20 – November 10, 2008 No changes to any of your open enrollment elections will be allowed after November 10th

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Benefits Choices 2009 Open Enrollment

by Maxisurgeon on Dec 08, 2010

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Benefits Choices 2009 Open Enrollment Presentation Transcript