Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Open Enrollment Medicare Retirees   October  20 - November 10, 2008 Benefits Choices 2009
What Should I Have Received in the Mail? <ul><li>Packet including: </li></ul><ul><li>Annual Open Enrollment Booklet (2009)...
Presentation Topics <ul><li>What’s New for 2009 </li></ul><ul><li>2009 Medical Plans Overview </li></ul><ul><li>2009 Presc...
<ul><li>Plan eliminated: CIGNA Senior Premier PPO </li></ul><ul><li>Plan design changes (e.g., copays and coinsurance as d...
2009 Medical Plans Overview
Medical Plan Options  For details, review your 2009 Open Enrollment Booklet UnitedHealthcare Senior Premier PPO Presbyteri...
UHC Senior Premier Plan Changes No coverage 20% Hypnotherapy, Biofeedback $1000 each max/CY $1500 combined max/CY Chiropra...
Out-of-Pocket Maximums (UHC Senior Premier PPO) <ul><li>Prescription drug payments do  NOT  apply to the out-of-pocket max...
Out-of-Pocket Maximum (UHC  Senior Premier PPO) <ul><li>Example of how the out-of-pocket maximum works for hospital care (...
UHC Senior Premier PPO Rx Plan Changes 40% with $80 min. and $120 max. 30% with $50 min. and $80 max. 20% with $12 min and...
Catalyst Rx for UHC Senior Premier PPO <ul><li>Mandatory Specialty Drug Program through mail order from Walgreens/MedMark ...
Catalyst Rx Info <ul><ul><li>Welcome Kit mailed in mid-December  (for new UHC Senior Premier PPO members) </li></ul></ul><...
Catalyst Mail Order Form
Medicare Advantage Plans Overview
Medicare Advantage Plan Changes $10 copay $5 copay No change $10 copay PCP Office Visit 2009 2008 2009 2008 In-network Lov...
Medicare Advantage Plans Summarized Comparison Pharmacare Direct Walgreens Mail Service Prescription drug mail order Lovel...
Medicare Advantage Plans Rx Comparison $62 $55 Non-preferred Brand $186 $165 Non-preferred Brand $96 $87.50 Preferred Bran...
Medicare Advantage Plans  (Lovelace Senior Plan and Presbyterian MediCare) <ul><ul><li>Must be continuously enrolled in Me...
Presbyterian MediCare Mail Order Form
Choosing a Medical Plan
Open Enrollment Coverage Options Lovelace Senior Plan CIGNA In-Network Plan Presbyterian MediCare PPO No corresponding pla...
What to Consider When Choosing a Medical Plan <ul><ul><li>Provider networks (e.g. doctors, hospitals) </li></ul></ul><ul><...
Emergencies, Urgent Care, Follow-up Care <ul><ul><li>If you are traveling and covered by UHC Senior Premier PPO: </li></ul...
What Do I Do When I Turn 65? Retirees in New Mexico <ul><ul><li>Within a few months before reaching age 65…  </li></ul></u...
What Do I Do When I Turn 65?  Retirees in CA and Other <ul><ul><li>Within a few months before reaching age 65…   </li></ul...
Continuation of Coverage for Surviving Spouse <ul><li>Medical Coverage </li></ul><ul><li>Coverage for surviving spouse and...
Continuation of Coverage for Surviving Spouse <ul><li>Dental Coverage </li></ul><ul><li>Dental coverage for surviving spou...
Medicare and Sandia Employer Group Plans
Medicare Part D <ul><ul><li>Part D is Medicare’s Prescription Drug Plan </li></ul></ul><ul><ul><li>Sandia’s Retiree Medica...
Medicare Part D  <ul><ul><li>UHC members – your Notice of Creditable Coverage for Part D starts on page 54 of the OE Bookl...
Medicare Coordination of Benefits with UHC Senior Premier PPO <ul><ul><li>Medicare is always the primary payer of benefits...
COB: In-Network Example  Specialist Office Visit with UHC coverage   Medicare UHC Senior Premier Benefit $132.00 Medicare ...
COB: In-Network Example Emergency Room Visit with UHC coverage Medicare UHC Senior Premier Benefit $360 Medicare Pays 80% ...
COB: In-Network Example Hospital Care with UHC coverage Medicare UHC Senior Premier Benefit Full Medicare Coverage $1,068 ...
Medicare Advantage Plans <ul><li>Lovelace Senior Plan and the Presbyterian MediCare PPO Plan </li></ul><ul><ul><li>Fully i...
Dental Care Plan Overview
2009 Dental Overview <ul><li>Delta Dental remains the claims administrator  </li></ul><ul><li>New Dental Care Plan replace...
2009 Dental Overview <ul><li>The Dental Care Plan includes coverage enhancements: </li></ul><ul><li>Sealants covered for a...
Eligibility Changes <ul><ul><li>Refer to IRS Code Section 152 or Publication 502, or consult your tax advisor for “qualify...
Ineligible Dependents <ul><ul><li>You must disenroll ineligible dependents within 31 calendar day of the event causing ine...
Open Enrollment Information
Open Enrollment Process Tips <ul><li>Review “Medical Plans Comparison Chart” </li></ul><ul><li>Review Open Enrollment Book...
Do I Need to Take Action? <ul><li>To continue Dental Care Plan coverage  </li></ul><ul><li>If you waived coverage previous...
To make a change…   (postmarked by November 10th)
Member Resources
OE website…
Sandia Benefit Contacts <ul><li>Sandia Open Enrollment website  www.sandia.gov </li></ul><ul><ul><li>–  Resources for… </l...
Open Enrollment Period October 20 – November 10th, 2008 No changes to any of your open enrollment elections will be allowe...
Questions ?
Upcoming SlideShare
Loading in …5
×

Open Enrollment Medicare Retirees October 20 - November 10, 2008

570 views

Published on

  • Be the first to comment

  • Be the first to like this

Open Enrollment Medicare Retirees October 20 - November 10, 2008

  1. 1. Open Enrollment Medicare Retirees October 20 - November 10, 2008 Benefits Choices 2009
  2. 2. What Should I Have Received in the Mail? <ul><li>Packet including: </li></ul><ul><li>Annual Open Enrollment Booklet (2009) </li></ul><ul><ul><li>Open Enrollment Change Form </li></ul></ul><ul><li>Medical Plans Comparison Chart </li></ul><ul><li>Self-addressed envelope </li></ul>
  3. 3. Presentation Topics <ul><li>What’s New for 2009 </li></ul><ul><li>2009 Medical Plans Overview </li></ul><ul><li>2009 Prescription Drugs Overview </li></ul><ul><li>Choosing a Medical Plan </li></ul><ul><li>How Medicare Works with Sandia’s Plans </li></ul><ul><li>2009 Dental Care Plan Overview </li></ul><ul><li>Open Enrollment Information </li></ul><ul><li>Questions </li></ul>
  4. 4. <ul><li>Plan eliminated: CIGNA Senior Premier PPO </li></ul><ul><li>Plan design changes (e.g., copays and coinsurance as described under each plan) </li></ul><ul><li>Waiver of prescription drug coverage no longer an option </li></ul><ul><li>New Dental Care Plan replaces Dental Expense Plan </li></ul><ul><li>Class I eligibility rules modified </li></ul><ul><li>New Class IIs no longer eligible </li></ul>What’s New for 2009?
  5. 5. 2009 Medical Plans Overview
  6. 6. Medical Plan Options For details, review your 2009 Open Enrollment Booklet UnitedHealthcare Senior Premier PPO Presbyterian MediCare PPO Lovelace Senior Plan Presbyterian UNMH Independent Providers Presbyterian Lovelace Health System UNMH ABQ Health Partners NM only NM Only
  7. 7. UHC Senior Premier Plan Changes No coverage 20% Hypnotherapy, Biofeedback $1000 each max/CY $1500 combined max/CY Chiropractic/Acupuncture 2009 2008
  8. 8. Out-of-Pocket Maximums (UHC Senior Premier PPO) <ul><li>Prescription drug payments do NOT apply to the out-of-pocket maximums </li></ul><ul><li>Coinsurance (e.g., 20%) does apply to the out-of-pocket maximum (with some exceptions) </li></ul><ul><li>One annual out-of-pocket maximum for both in- and out-of-network services </li></ul>
  9. 9. Out-of-Pocket Maximum (UHC Senior Premier PPO) <ul><li>Example of how the out-of-pocket maximum works for hospital care (2009 costs): </li></ul>$267 per day $68 Sandia Pays You Pay Cost $0 $267 per day Days 61 – 90 $1000 OOP maximum per calendar year Medicare deductible $1068 Days 1 – 60
  10. 10. UHC Senior Premier PPO Rx Plan Changes 40% with $80 min. and $120 max. 30% with $50 min. and $80 max. 20% with $12 min and $24 max. 2009 $100 copay Non-preferred Brand $65 copay Preferred Brand $18 copay Generic Mail Order Rx Drugs (maximum of 90 day supply) 2008
  11. 11. Catalyst Rx for UHC Senior Premier PPO <ul><li>Mandatory Specialty Drug Program through mail order from Walgreens/MedMark (limited to 30 day supply) </li></ul><ul><li>Drugs delivered via mail order through Walgreen/MedMark </li></ul><ul><li>Specialty Team </li></ul><ul><ul><li>Making contact by December 15 </li></ul></ul><ul><ul><li>Available Monday to Friday (6 a.m. to 5 p.m. MST) at 1-866-823-2712 </li></ul></ul><ul><li>Specialty Drugs </li></ul><ul><ul><li>Treatment for cancer, multiple sclerosis, HIV, hemophilia, etc. </li></ul></ul><ul><ul><li>Tend to be very expensive and require special monitoring </li></ul></ul>
  12. 12. Catalyst Rx Info <ul><ul><li>Welcome Kit mailed in mid-December (for new UHC Senior Premier PPO members) </li></ul></ul><ul><ul><ul><li>Letter with general info </li></ul></ul></ul><ul><ul><ul><li>ID cards (1/single; 2/family) </li></ul></ul></ul><ul><ul><ul><li>Preferred drug listing (condensed version) </li></ul></ul></ul><ul><ul><ul><li>Pharmacies (major) listing </li></ul></ul></ul><ul><ul><ul><li>Registration and prescription form </li></ul></ul></ul><ul><ul><li>Present your new Catalyst ID card when getting a new prescription beginning January 1, 2009 </li></ul></ul><ul><ul><li>Pharmacy Help Desk 1-866-854-8851 (available 24/7) </li></ul></ul><ul><ul><li>Website www.catalystrx.com – Username: SNL Password: SNL </li></ul></ul><ul><ul><li>Sandia external website at www.sandia.gov , Resources for…, Employees and Retirees, Summary Plan Descriptions, Catalyst Rx Info </li></ul></ul><ul><ul><li>Catalyst reps available in lobby </li></ul></ul>
  13. 13. Catalyst Mail Order Form
  14. 14. Medicare Advantage Plans Overview
  15. 15. Medicare Advantage Plan Changes $10 copay $5 copay No change $10 copay PCP Office Visit 2009 2008 2009 2008 In-network Lovelace Senior Plan Presbyterian MediCare PPO $50 copay $25 copay Eye glass or contact lenses after cataract surgery $50 copay $25 copay Prosthetics $50 copay $40 copay Durable Medical Supplies $35 copay $30 copay Outpatient Rehabilitation $35 copay $30 copay PCP Office Visit 2009 2008 Out-of-Network Presbyterian MediCare PPO
  16. 16. Medicare Advantage Plans Summarized Comparison Pharmacare Direct Walgreens Mail Service Prescription drug mail order Lovelace Presbyterian Prescription drug coverage administrator Copays Copays (in-network) Payment via No No Referrals to specialist required In-network only Both In- and out-of-network coverage N/A N/A Annual CY out-of-pocket N/A N/A Annual CY deductible Lovelace Senior Plan HMO Presbyterian MediCare PPO Employer Group Plans
  17. 17. Medicare Advantage Plans Rx Comparison $62 $55 Non-preferred Brand $186 $165 Non-preferred Brand $96 $87.50 Preferred Brand $15 $10 Generic Mail Order Rx Drugs (maximum of 90 day supply) $32 $35 Preferred Brand $5 $5 Generic Retail Rx Drugs (maximum of 30 day supply) Lovelace Senior Plan Presbyterian MediCare PPO Plan Features
  18. 18. Medicare Advantage Plans (Lovelace Senior Plan and Presbyterian MediCare) <ul><ul><li>Must be continuously enrolled in Medicare Part A and B </li></ul></ul><ul><ul><li>Required to assign your Medicare benefits to the plan </li></ul></ul><ul><ul><ul><li>Cannot be enrolled in one of these plans and another Medicare Advantage plan or another Medicare Part D plan at same time </li></ul></ul></ul><ul><ul><ul><li>Release of Medicare assignment if switching out of these plans (e.g., moving out of state) requires notification to Sandia Benefits at least six weeks prior or as soon as reasonably possible to avoid delays in release of your Medicare Assignment </li></ul></ul></ul><ul><ul><li>Must select PCP although referrals to specialists are not required </li></ul></ul><ul><ul><li>Must inform health plan before moving or leaving the state for more than six months </li></ul></ul><ul><ul><li>Important: if you enroll in one of these plans you must complete the application form sent by Lovelace or Presbyterian and return it to them prior to December 31, 2008 </li></ul></ul><ul><ul><li>Your plan benefits are described by the “Evidence of Coverage” document which is mailed to members in January ( Lovelace or Presbyterian) </li></ul></ul>
  19. 19. Presbyterian MediCare Mail Order Form
  20. 20. Choosing a Medical Plan
  21. 21. 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
  22. 22. What to Consider When Choosing a Medical Plan <ul><ul><li>Provider networks (e.g. doctors, hospitals) </li></ul></ul><ul><ul><li>Benefits coverage </li></ul></ul><ul><ul><li>In-network and out-of-network coverage </li></ul></ul><ul><ul><li>Copay vs. coinsurance payment for services </li></ul></ul><ul><ul><li>Filing claims or not </li></ul></ul><ul><ul><li>Prescription drug formulary under the plan </li></ul></ul><ul><ul><li>Coverage while on travel </li></ul></ul><ul><ul><li>Dependent coverage </li></ul></ul><ul><ul><li>Premiums, if applicable </li></ul></ul><ul><ul><li>Deductible </li></ul></ul><ul><ul><li>Out-of-pocket maximum </li></ul></ul>
  23. 23. Emergencies, Urgent Care, Follow-up Care <ul><ul><li>If you are traveling and covered by UHC Senior Premier PPO: </li></ul></ul><ul><ul><ul><li>Emergencies, urgent care, and follow-up care are covered worldwide </li></ul></ul></ul><ul><ul><li>If you are traveling and covered by the Presbyterian MediCare or Lovelace Senior Plan </li></ul></ul><ul><ul><ul><li>Emergencies and urgent care are covered worldwide </li></ul></ul></ul><ul><ul><ul><li>Follow-up care under Lovelace Senior Plan is not covered (need to return to NM) </li></ul></ul></ul><ul><ul><ul><li>Follow-up care under Presbyterian MediCare PPO Plan </li></ul></ul></ul><ul><ul><ul><ul><li>Follow up care (outside USA) is covered out-of-network </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Follow-up care (within USA) is covered out-of-network </li></ul></ul></ul></ul><ul><li>Medicare does not cover services outside of the USA </li></ul><ul><li>Call 911 if your require immediate medical or surgical care </li></ul><ul><li>Call member services within 48 hours or as soon as reasonable possible if admitted </li></ul>
  24. 24. What Do I Do When I Turn 65? Retirees in New Mexico <ul><ul><li>Within a few months before reaching age 65… </li></ul></ul><ul><ul><ul><li>Enroll in Medicare Parts A and B </li></ul></ul></ul><ul><ul><ul><li>Approximately 2-3 months before age 65, you should receive information from Sandia Benefits and Medicare </li></ul></ul></ul><ul><ul><ul><li>Retiree Medical Plan Options: </li></ul></ul></ul><ul><ul><ul><ul><li>UHC Senior Premier PPO (complete Medicare crossover form) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lovelace Senior Plan (Sandia employer group) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Presbyterian MediCare PPO (enollment only during Open Enrollment and/or if other family members are already in the Plan) </li></ul></ul></ul></ul><ul><ul><ul><li>Coverage takes effect the first day of the month in which you reach age 65 </li></ul></ul></ul><ul><ul><ul><li>Contact Medicare or your local Social Security office for Medicare Parts A and B information </li></ul></ul></ul>
  25. 25. What Do I Do When I Turn 65? Retirees in CA and Other <ul><ul><li>Within a few months before reaching age 65… </li></ul></ul><ul><ul><ul><li>Must enroll in Medicare Parts A and B (even if you are not taking your Social Security) </li></ul></ul></ul><ul><ul><ul><ul><li>Approximately 2-3 months before you turn 65, you should receive information from Sandia Benefits and Medicare </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Kaiser HMO members will receive a solicitation for Kaiser Senior Advantage Plan </li></ul></ul></ul></ul><ul><ul><ul><li>Once you reach age 65, the Retiree Medical Plan Option is available for transition as follows: </li></ul></ul></ul><ul><ul><ul><ul><li>UHC Senior Premier PPO for aging-in UHC Premier PPO members </li></ul></ul></ul></ul><ul><ul><ul><ul><li>CIGNA In-Network members must move to the UHC Senior Premier PPO Plan (non-Medicare members must also move to UHC Premier PPO Plan) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Kaiser Senior Advantage Plan (must complete Kaiser enrollment paperwork to assign Medicare) </li></ul></ul></ul></ul><ul><ul><ul><li>Coverage takes effect the first day of the month in which you reach age 65 </li></ul></ul></ul><ul><ul><ul><li>Contact Medicare or your local Social Security office for Medicare Parts A and B information </li></ul></ul></ul>
  26. 26. Continuation of Coverage for Surviving Spouse <ul><li>Medical Coverage </li></ul><ul><li>Coverage for surviving spouse and/or eligible dependents is provided for six months, after retiree’s death, at the same premium-share rate that retiree paid </li></ul><ul><li>To continue coverage after six months, surviving spouse and/or dependents must elect continuation prior to the end of this six-months period </li></ul><ul><li>Continued coverage (7th month and beyond) cost is 50% of the full medical premium (see pg 34 of OE booklet). </li></ul><ul><li>Continued coverage is available until surviving spouse remarries, dependent children become ineligible and/or coverage is terminated with Sandia </li></ul>
  27. 27. Continuation of Coverage for Surviving Spouse <ul><li>Dental Coverage </li></ul><ul><li>Dental coverage for surviving spouse and/or eligible dependents is discontinued at the end of the month of retiree’s death </li></ul><ul><li>Coverage may be temporarily continued (COBRA process), for up to thirty-six months, by paying the monthly, COBRA surviving spouse group rate (2009 single rate - $38.00/month + 2% administrative fee) </li></ul>
  28. 28. Medicare and Sandia Employer Group Plans
  29. 29. Medicare Part D <ul><ul><li>Part D is Medicare’s Prescription Drug Plan </li></ul></ul><ul><ul><li>Sandia’s Retiree Medical Plan Option includes prescription drug coverage – NO NEED to enroll in an individual Part D plan </li></ul></ul><ul><ul><li>Individual Part D Plan </li></ul></ul><ul><ul><ul><li>Use your Part D plan first for prescription drug coverage </li></ul></ul></ul><ul><ul><ul><li>Submit your claim to Catalyst Rx (for UHC Senior Premier PPO members) for consideration of secondary coverage </li></ul></ul></ul><ul><ul><ul><ul><li>Ex: If you pay $10 for a drug through your Part D plan, you would submit a paper claim to either Catalyst Rx (UHC Senior Premier PPO members) and if an eligible drug, you would be reimbursed 50% of the copay so you would receive $5 payment </li></ul></ul></ul></ul><ul><li>Individual Part D members must disenroll from their individual plan to be eligible for the Employer Group Medicare Advantage plans (Lovelace Senior Plan or Presbyterian MediCare) by December 31, 2008. </li></ul>
  30. 30. Medicare Part D <ul><ul><li>UHC members – your Notice of Creditable Coverage for Part D starts on page 54 of the OE Booklet </li></ul></ul><ul><ul><ul><li>This Notice ensures that you can enroll, without penalty, in an individual Part D plan if you lose coverage with Sandia (the Medicare Advantage plans may require this notice) </li></ul></ul></ul><ul><ul><li>Medicare does not allow double coverage by Medicare plans; therefore, your coverage through Presbyterian MediCare or the Lovelace Senior Plan will be dropped altogether if you enroll in an individual plan </li></ul></ul><ul><ul><li>Note: The vast majority of Sandia retirees elected to participate in a Sandia Retiree Medical Plan Option with prescription drug coverage and chose not to purchase an individual Medicare Part D prescription drug plan. </li></ul></ul>
  31. 31. Medicare Coordination of Benefits with UHC Senior Premier PPO <ul><ul><li>Medicare is always the primary payer of benefits </li></ul></ul><ul><ul><li>The UHC Senior Premier PPO Plan is secondary coverage </li></ul></ul><ul><ul><li>After Medicare pays, then UHC Senior Premier PPO Plan calculates what it would have paid if not for Medicare, and then subtracts what Medicare has paid and pays the difference </li></ul></ul><ul><ul><li>Once a retiree has met the out-of-pocket maximum for the calendar year, your UHC plan will pay the remaining balance of Medicare-eligible expenses that are not paid by Medicare and are eligible for benefits under this Plan (up to $150,000 lifetime maximum) </li></ul></ul>
  32. 32. COB: In-Network Example Specialist Office Visit with UHC coverage Medicare UHC Senior Premier Benefit $132.00 Medicare Pays 80% After Deductible $168.00 $165.00 $135.00 $300.00 $325.00 Balance Due Balance After Deductible Medicare Deductible (Part B in 2009) Medicare Allowable Total Charge $60.00 Member Pays $60.00 $108.00 $168.00 $300.00 $325.00 Accumulated Annual Maximum UHC Pays Balance After Medicare Medicare Allowable Total Charge $300.00 x .8 = $240 - $132 $300.00-$240.00
  33. 33. COB: In-Network Example Emergency Room Visit with UHC coverage Medicare UHC Senior Premier Benefit $360 Medicare Pays 80% After Deductible $90 $450 Satisfied $450 $600 Balance Due Balance After Deductible Medicare Deductible Medicare Allowable Total Charge $90 Member Pays $150 $0 $90 $450 $600 Accumulated Annual Maximum UHC Pays Balance After Medicare Medicare Allowable Total Charge $60 (from last claim) + $90.
  34. 34. COB: In-Network Example Hospital Care with UHC coverage Medicare UHC Senior Premier Benefit Full Medicare Coverage $1,068 $0 $1,068 Days 1-60 $0 Balance Due Balance After Deductible Medicare Deductible (Part A in 2008) Medicare Allowable Total Charge Met $0 $8,010 $8,010 Days 61-90 $267 per day $1,000 $850 $218 $1,068 Days 1-60 $0 Accumulated Annual Maximum Member Pays UHC Pays Balance After Medicare Medicare Allowable Total Charge
  35. 35. Medicare Advantage Plans <ul><li>Lovelace Senior Plan and the Presbyterian MediCare PPO Plan </li></ul><ul><ul><li>Fully insured employer group plans </li></ul></ul><ul><ul><li>Assign your Medicare to them </li></ul></ul><ul><ul><li>Provide all your medical and prescription drug coverage </li></ul></ul><ul><ul><li>No coordination of benefits with Medicare </li></ul></ul>
  36. 36. Dental Care Plan Overview
  37. 37. 2009 Dental Overview <ul><li>Delta Dental remains the claims administrator </li></ul><ul><li>New Dental Care Plan replaces Dental Expense Plan </li></ul><ul><ul><li>Coinsurance coverage based on a percentage of the maximum approved fee: </li></ul></ul><ul><ul><ul><li>100% for preventive </li></ul></ul></ul><ul><ul><ul><li>80% for basic and restorative services </li></ul></ul></ul><ul><ul><ul><li>50% for major and orthodontic </li></ul></ul></ul><ul><ul><li>Annual deductible $50 per person/$150 family </li></ul></ul><ul><ul><li>Annual maximum benefit $1500 (non-orthodontic) </li></ul></ul><ul><ul><li>Lifetime maximum benefit $1800 for orthodontic </li></ul></ul><ul><li>Monthly Premium-sharing for retirement after 12/31/2008 </li></ul><ul><ul><li>$8.00 for retiree </li></ul></ul><ul><ul><li>$15.00 for retiree + 1 </li></ul></ul><ul><ul><li>$20.00 for retiree + 2 </li></ul></ul>
  38. 38. 2009 Dental Overview <ul><li>The Dental Care Plan includes coverage enhancements: </li></ul><ul><li>Sealants covered for all dependent children under age 14 </li></ul><ul><li>Benefits for specified (Endosteal) implant services </li></ul><ul><li>You can see any dentist in the Delta Dental PPO or the Delta Dental Premier or an out-of network dentist. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Maximum approved fee is contracted fee between Delta Dental and the network providers. </li></ul>
  39. 39. Eligibility Changes <ul><ul><li>Refer to IRS Code Section 152 or Publication 502, or consult your tax advisor for “qualifying child or qualifying relative” for health care coverage. </li></ul></ul><ul><ul><ul><li>“ Financially dependent on you” has been eliminated and changed to “unmarried child under age 24” </li></ul></ul></ul><ul><ul><ul><li>Although dependent may be eligible for our plans, your 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 </li></ul></ul></ul><ul><ul><ul><ul><li>Imputed income means that the full premium rate for your dependent shall be reported as taxable </li></ul></ul></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
  40. 40. Ineligible Dependents <ul><ul><li>You must disenroll ineligible dependents within 31 calendar day of the event causing ineligibility </li></ul></ul><ul><ul><ul><li>Consequence of failing to disenroll ineligible dependents: </li></ul></ul></ul><ul><ul><ul><ul><li>Ineligible dependent’s coverage retroactively terminated </li></ul></ul></ul></ul><ul><ul><ul><ul><li>You will be held liable to refund to Sandia the health care plan claims or monthly premiums </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Your dependent could lose any rights to temporary continued health care coverage (COBRA) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sandia shall not be required to refund any premiums to the subscriber </li></ul></ul></ul></ul>
  41. 41. Open Enrollment Information
  42. 42. Open Enrollment Process Tips <ul><li>Review “Medical Plans Comparison Chart” </li></ul><ul><li>Review Open Enrollment Booklet for more information </li></ul><ul><li>Complete “Open Enrollment Change Form 2009” (especially important for CIGNA Senior Premier PPO members) </li></ul><ul><ul><li>Must be postmarked by Nov. 10 th </li></ul></ul><ul><li>Complete Presbyterian MediCare or Lovelace Senior Plan form (if applicable) </li></ul><ul><li>Confirmations will be sent to only those who make changes </li></ul>
  43. 43. Do I Need to Take Action? <ul><li>To continue Dental Care Plan coverage </li></ul><ul><li>If you waived coverage previously and wish to remain in this status </li></ul><ul><li>To enroll if not currently enrolled </li></ul><ul><li>To add or disenroll a dependent </li></ul>Dental Coverage <ul><li>To continue current medical plan coverage (except CIGNA Senior Premier PPO members) </li></ul><ul><li>If you waived coverage previously and wish to remain in this status </li></ul><ul><li>If currently enrolled in the CIGNA Senior Premier PPO </li></ul><ul><li>To enroll if not currently enrolled </li></ul><ul><li>To change your current medical plan </li></ul><ul><li>To add or disenroll a dependent </li></ul>Medical Coverage No Action Action  
  44. 44. To make a change… (postmarked by November 10th)
  45. 45. Member Resources
  46. 46. OE website…
  47. 47. Sandia Benefit Contacts <ul><li>Sandia Open Enrollment website www.sandia.gov </li></ul><ul><ul><li>– Resources for… </li></ul></ul><ul><ul><ul><li>– Employees and Retirees </li></ul></ul></ul><ul><ul><ul><ul><li>Retiree Open Enrollment </li></ul></ul></ul></ul><ul><li>Benefits Customer Service Center </li></ul><ul><li>(505) 844-HBES (4237) or </li></ul><ul><li>(800) 417-2634, ext. 844-HBES (4237) </li></ul><ul><li>Fax #: (505) 844-7535 </li></ul><ul><li>If you have questions you can… </li></ul><ul><li>Send an email to [email_address] OR </li></ul><ul><li>Go to www.sandia.gov </li></ul><ul><ul><li>click on Employees & Retirees </li></ul></ul><ul><ul><li>click on HBE Weekly Update </li></ul></ul><ul><ul><li>click on ? Get answers </li></ul></ul>
  48. 48. Open Enrollment Period October 20 – November 10th, 2008 No changes to any of your open enrollment elections will be allowed after November 10th
  49. 49. Questions ?

×