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Presentation to: SHBP Retirees with Medicare
2013 State Health Benefit Plan Retiree Option Change Period
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MissionThe Georgia Department of Community HealthWe will provide access to affordable, quality health care
to Georgians through effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
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2013 Retiree Option Change Period (ROCP)
• How to Make your 2013 Election• Medicare Advantage MA PPO Changes• Traditional Medicare vs. SHBP MA PPO• SHBP Going Green• Benefit Changes for the HRA, HMO and HDHP
Plans
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Making Your 2013 Benefit Election
• Online Election - Members must make their health election at
www.myshbp.ga.gov
• Website Open & Close Dates- Website opens at 4 a.m. on October 9, 2012
- Website closes at 4:30 p.m. on November 9, 2012
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2013 MA PPO Plan Changes
• Humana MA PPO Premium Plan will not be offered. If you are enrolled in this plan and don’t make an election, your coverage will roll to the Humana MA PPO Standard Plan
• Increase in co-insurance from 15% to 20% under the United Healthcare MA PPO Premium Plan
• Increase in premiums
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Traditional Medicare vs. SHBP MA PPOTraditional Medicare ( Part A and B)
Original Medicare w/supplement OR SHBP non- MA Plans
SHBP Medicare Advantage Plan
Premiums $99.90 ( Monthly Part B Premium and is income based)
$99.90 (monthly Part B)$85-$250 Medigap policy OR at least $1100 monthly SHBP non-MA Plan premium
$99.90 ( monthly Part B)$25.38 / $85.14 ( monthly SHBP MA PPO premium)
Deductible $1,156 (Part A)$ 140 (Part B)
Varies depending on supplemental plan or other plan you choose
$0(You must continue to pay your Part B premiums)
Pharmacy/Rx coverage
No coverage; must add a Medicare Part D plan$25-$75 (monthly Part D premium)
Varies depending on supplemental plan or other plan you choose
Included Plus full coverage in the Gap
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Traditional Medicare vs. SHBP MA PPOTraditional Medicare ( Part A and B)
Original Medicare w/supplement OR SHBP non- MA Plans
SHBP Medicare Advantage Plan
Out of PocketMaximum
No Limit-Member continues to pay co-insurance regardless of total out of pocket expenses
Varies depending on supplemental plan or other plan you choose
$2,500 / $3,500Once member’s total out of pocket maximum reaches these limits, benefits are covered at 100% except for Part D co-payments
Value Adds(such as vision, hearing chiropractic, Silver Sneakers, disease management)
None Varies depending on supplemental plan or other plan you choose
Included
Claims Payment Medicare A or B pays first
Supplemental or other plan(including SHBP non MA Plans) pays secondary benefits*
SHBP Medicare Advantage PPO Plan pays ALL claims.
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Going Green-Important Information for 2014
• This means for your 2014 election you will need to make your election online
• We understand some members do not have access to a computer. SHBP will mail a postcard in April of 2013 allowing you to elect to receive a packet in the mail for your 2014 ROCP
• For your 2013 election you will use the PCF form included in your packet only if you want to make a change
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2013 Benefit and Plan Changes
• Elimination of the Spousal Surcharge • Increase in deductibles and co-insurance for the HRA,
HDHP and HMO Standard and Wellness Plans• Increase in co-payments under the HMO Standard Plans-
PCP & Urgent Care- $55; Specialist - $65 • Change in HRA credits in the Standard Plan• Increase in premiums for most plan options and tiers• Elimination of $125.00 HRA credit for annual physical and
health assessment.
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Making Your 2013 ROCP Election
• If you are enrolled in the Humana MA Standard PPO Option or the UnitedHealthcare MA PPO Standard or UnitedHealthcare MA PPO Premium you do not need to do anything if you want to remain in the same MA PPO Option for 2013
• Your coverage will roll over in the same MA PPO Option and vendor
• If you have Humana Premium MA PPO Plan and take no action, coverage will roll over to Humana MA PPO Standard
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Making Your 2013 ROCP Election
Making your Election- Changes Only
• Online at website www.myshbp.ga.gov if possible
• Complete Personalized Change Form (PCF) only if you need to make a change. This form is included in the 2013 Retiree Packet – ONLY do one or the other.
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Questions or Additional Information
• Cigna - HMO, HRA, HDHP - 800-633-8519www.mycigna.com/shbp
• UnitedHealthcare – HRA, HMO& HDHP 877-246-4189 or 800-396-6515
www.welcometouhc.com/shbp• Refer to www.myshbp.ga.gov or
www.dch.georgia.gov/shbp for additional information • TDD – Cigna 800-576-1314 • TDD UnitedHealthcare – 800-255-0056 / TTY 711
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Important Notice
• The information provided in this presentation is a summary of changes for the 2013 Plan Year. It is intended only to highlight principle benefits
• Please refer to the Retiree Decision Guide for more details
• Rates, decision guides and other information will be available at www.dch.georgia.gov/shbp and www.myshbp.ga.gov by October 1, 2012
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SHBP RETIREES 2013
Humana Medicare Advantage
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Why Should You Choose Humana?
• Coverage Backed by over 50 Years of Experience & Financial Security
• Extra Benefits & Services• Flexible and Comprehensive Rx Program• Worldwide Coverage for Emergencies• No Referrals Required• Support Services Dedicated to Group Members
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Why Should You Choose Humana?
Humana is dedicated to providing quality customer service to our members!
94%
95%
95%
98%
80% 85% 90% 95% 100%
Humana Overall ServiceSatisfaction
Humana Rx Claims ProcessCorrectly
Humana Medical Claims ProcessedCorrectly
Humana Customer ServiceSatisfaction
2012
2011
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Your Plan
Choosing your health plan is an important decision and you should consider both the benefits and
monthly premium cost.
Step 1: Estimate your annual medical and prescription costs.Step 2: Compare estimated costs including monthly premium and your cost share.
Health Care is not “One Size Fits All”
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Your Medicare Advantage Plan
Your SHBP Medicare Advantage Plan is… The Humana Group Medicare PPO
• Humana will offer SHBP’s Standard Medicare Advantage Plan through the Humana Group Medicare PPO
• If you are enrolled in the Humana Premium Plan, and do not make a n election your coverage will default to the Humana Standard MA Plan
PPO plans traditionally include a network of physicians and hospitals, however --
Your in-network and out-of-network benefits are the same. If you select an out-of-network physician or hospital who accepts both Medicare and Humana’s payment terms your benefits are the same as if you were in-network.
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How this PPO Plan Works
• Use only your Humana ID card• Use any provider in or out of network as long as
they accept original Medicare and will bill Humana• No referrals required for specialty care• All claims processed by Humana
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Extra Benefits
• Silver Sneakers• SmartSummary• Humana Active Outlook • Program• My Humana• HumanaFirst• Quit Net
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Extra Services
• Hearing Discount• NutriSystem• Roadside Assistance• Vision Discount• Mail Order Health & Wellness• Pharmacy and OTC Discounts
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Humana Pharmacy Program
• All Medicare approved medications included• All generics in Tier 1• 90 day supply available• The drug list includes benzodiapezenes, barbiturates, and
erectile dysfunction medication• Mail order available (not required)• Mail order reminders by phone, email, or text message (your
choice)• Nearly 65,000 pharmacy locations• RightSource® (Humana owned mail order)
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Member Services & Additional Information
• Pre-Enrollment Hotline & Member Services 800-942-6724
• www.humana.com
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Presentation to: SHBP Retirees
Presented by: UnitedHealthcare
Date: Fall 2012
UnitedHealthcare Group MedicareAdvantage Plan
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A company you know and trust!
Trusted Partnership - We’ve been serving SHBP actives and retirees for 11 years1!
Health plan of choice – More than 81,000 SHBP retirees1 and their spouses chose an UnitedHealthcare Medicare Advantage plan in 2012.
Experience – We have over 28 years of experience in the Medicare market and serve over 9 million members – that’s one in five people eligible for Medicare2.
National Recognition – UnitedHealth Group was ranked # 1 in its class in the ‘Most Admired Health Care Companies’ by Fortune Magazine annual survey3.
12012 Internal Company Data22012 UnitedHealth Group Annual Report3Fortune Magazine, March 19, 2012
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Dedicated service you can count on!
We work hard to provide you the high quality customer service you deserve.
And according to you, your dedicated customer service team keeps getting better!!
Telephone survey conducted between Feb 23 – Mar 6, 2011 for 600 members. Percent satisfied were those members scoring UnitedHealthcare 3, 4, or 5 out of 5.
Satisfaction with 2011 Medicare Advantage 2010 Medicare Advantage
UnitedHealthcare overall 98.70% 97.80%
Overall performance of a Customer Service representative
98.40% 98.40%
Ability to process medical / behavioral claims correctly
98.0% 96.40%
Availability of specialist in network 97.80% 97.80%
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Access & Convenience
Access•Over 2100 retail pharmacies including more than 900 independent pharmacies in Georgia and 65,000 pharmacies nationwide.
•Georgia preferred extended day network - For those of you who prefer to stay ‘local’ we have more than 927 retail pharmacies that offer a 90 day supply for 2.5 copays (same as mail order).*
Our Medicare Advantage plans include your Part D prescription drug coverage and we know how important convenience and access is for you.
*Pharmacy must be contracted for the GA preferred extended day network, otherwise standard copays will apply.
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Value & Savings
Convenient mail order •Can save you money and have some of your prescriptions delivered right to your door!
Pharmacy Saver Program•Offers some generic medications for as low as $2 at participating pharmacies.•To learn more go to www.UnitedPharmacySaver.com or call Customer Service
Our Medicare Advantage plans help you save on your health care expenses.
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Health & wellness programs
SilverSneakers Fitness program
• More than 240 locations throughout Georgia.
NurseLine program
• Get answers to your health-related questions, 24 hours a day, 7 days a week.
House Calls program
• Personalized health assessment delivered by a nurse practitioner in the comfort of you own home.
These programs are available at no additional cost. They include:
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Customized clinical programs to keep you healthy!
• Welcome Home – helps ensure that your transition from hospital to home goes smoothly!
• Disease Management – helps SHBP retirees with certain medical conditions manage their disease.
• Complex Care Management – lets you take advantage of our recognized centers of excellence including our Cancer Resource Services, Kidney Resource Services and Transplant Resource Services.
• High Risk Case Management – for SHBP members with complex medical conditions, provides face-to-face access to a personal care manager.
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Why Choose UnitedHealthcare?
A company you know and trust Experience National Recognition Dedicated Customer Service Specialists Customized clinical programs such as House Calls give you
personalized care Access to a extensive network of providers and pharmacies. In-Network? Out-of-Network? No difference Innovative programs to save on healthcare expenses including
Pharmacy Saver and a our hearing aid provider
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Enrollment made easy!
Staying with UnitedHealthcare couldn’t be easier!
•If you are already enrolled with us and want to remain in the same plan option, you don’t need to do anything! SHBP will automatically roll your coverage into the same plan option for 2013.
•If you’re currently not a UnitedHealthcare member, we’d love to have you as part of our family.
•Just complete the Personalized Change Form during the upcoming Retiree Option Change Period found in you 2013 Retiree Decision Guide or complete your election online at www.myshbp.ga.gov.
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We’d like to THANK YOU for allowing us to be your health care coverage provider
and would be honored to continue to serve you in 2013.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Drugs and prices may vary between pharmacies and are subject to change during the plan year.UnitedHealthcare® Medicare Advantage plans are insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract.
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FAQsFrequently Asked Questions & Answers
QUESTION #1• I (or my spouse) is not yet 65, but will be turning 65 later this year. How do we get
enrolled in the Medicare Advantage (MA) PPO plan?
ANSWER• Approximately 3 months prior to your 65th birthday, you will receive a kit from
your current vendor and a letter from SHBP explaining the process. • A few important notes:
– You must send SHBP a copy of your Medicare Part B card or a copy of the letter from Social Security approving your Medicare as soon as you receive it.
– Once we have a copy of your Medicare Part B card, you will automatically be enrolled in the Standard plan option with your current carrier (unless you choose otherwise), effective the first day of your birthday month.
– If you do not provide a copy of your Medicare card, you will remain in the Standard option of your current plan and health care vendor. However, you will be charged 100% of the premium.
– A current mailing address is a must! All communications are mailed to the last known address. MA PPO enrollment requires a street address.
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FAQsFrequently Asked Questions & Answers
QUESTION #2 • Can we (my spouse and I) pick different plan options or do we both have to
elect the same plan option?
ANSWER • No.
– Spouses and/or dependents must follow the election of the retiree. You cannot mix and match unless…
• You and your spouse are BOTH retirees of the State and each have your own single coverage, or
• You are a “split-age” family (meaning one is under 65, the other is over 65 and enrolled in one of the MA PPO options).
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FAQsFrequently Asked Questions & Answers
QUESTION #4• What if my doctor is not in the network? How much will I pay?
ANSWER• As long as your provider accepts Medicare, you may continue to see this provider
as an out-of-network provider in 2013. • Your cost is the same as if the doctor was contracted and in-network.• Please be sure your provider understands that you have a PPO plan with out-of-
network coverage.
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FAQsFrequently Asked Questions & Answers
QUESTION #5• I have an RX plan under my spouse’s coverage. Do I need to cancel that?
ANSWER• As long as your spouse’s plan is not considered a MA or Part D plan, you can
maintain both. • However, if your other coverage is a MA or Part D plan, once enrolled in the SHBP
MA PPO plan, you will automatically be dis-enrolled from the other MA or Part D Plan as MA plans can not have coverage under two MA or Part D plans.
• Since the MA PPO plan includes full-prescription drug coverage, you don’t need two separate plans.
