2018 WAUKESHA OUNTY OPEN ENROLLMENT ?· 2018 WAUKESHA OUNTY OPEN ENROLLMENT ... Each year Waukesha ounty…

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<ul><li><p>2018 </p><p>WAUKESHA COUNTY </p><p>OPEN ENROLLMENT Retiree Health Insurance </p><p>O C T O B E R 2 , 2 0 1 7 </p><p>T H R O U G H </p><p>N O V E M B E R 3 , 2 0 1 7 </p></li><li><p>1 </p><p>To: All Individuals Covered under the Waukesha County Retiree Health Insurance Program </p><p>From: Waukesha County Human Resources Office </p><p>Date: September 26, 2017 </p><p>Re: 2018 Retiree Health Insurance Open Enrollment Period </p><p> With this letter, we are announcing the 2018 Open Enrollment Period for members of the Waukesha County Retiree Health Insurance Program. The open enrollment period will run from October 2, 2017 through November 3, 2017. </p><p>Waukesha County offers two health insurance plan options for retirees depending on Medicare eligiblity. The two plans offered are the Waukesha County Retiree Choice Plus Health Plan or a UnitedHealthcare Group Medicare Advantage Plan. If you are eligible for Medicare coverage, you may choose either the Waukesha County Retiree Choice Plus Health Plan without prescription drug coverage or the UnitedHealthcare Group Medicare Advantage Plan option. If you are not yet Medicare eligible, you may enroll in the Waukesha County Retiree Choice Plus Health Plan with prescription drug coverage. </p><p>Each year Waukesha County conducts an Open Enrollment for the retiree health insurance. During this time, you may change coverage. If you wish to continue your existing coverage, no action on your part is required. However, if you are eligible for Medicare or soon will be, please consider your choices carefully. </p><p>We will not be holding Retiree Health Insurance Open Enrollment meetings this year. The 2018 premium rates for the Waukesha County Retiree Choice Plus Health Plan remain the same. </p><p>If you have questions on the insurance offerings or wish to make a change, please contact Mary Gutoski at 262-548-7048 for the forms. Forms and resources are also available online at www.waukeshacounty.gov/retiree. </p><p>All required enrollment form(s) must be returned no later than November 3, 2017 to: </p><p>Waukesha County Human Resources 515 W Moreland Blvd, Room 160 </p><p>Waukesha, WI 53188 Phone: (262) 548-7044 </p><p>http://www.waukeshacounty.gov/retiree</p></li><li><p>2 </p><p>Table of Contents Medicare Eligible Plan Options .............................................................................. 3 </p><p>Option 1: UnitedHealthcare Group Medicare Advantage Plan ........................... 3 </p><p>2018 Group Medicare Advantage Plan Changes ................................................. 3 </p><p>Medicare Advantage Prescription Drug Coverage ............................................... 4 </p><p>Enrolling in UnitedHealthcare Group Medicare Advantage Plan ........................ 4 </p><p>Option 2: Choice Plus Health Plan without Prescription Coverage ..................... 5 </p><p>Non-Medicare Eligible Plan Option ........................................................................ 7 </p><p>Option: Choice Plus Health Plan with Prescription Coverage ............................. 7 </p><p>2018 Retiree Choice Plus Health Plan Changes ................................................... 7 </p><p>Enrolling in the Waukesha County Retiree Choice Plus Health Plan ................... 7 </p><p>BENEFIT COVERAGE AND PREMIUMS ................................................................ 8 </p><p>UnitedHealthcare Group Medicare Advantage Plan Summary SE Wisconsin .. 9 </p><p>Waukesha County Retiree Choice Plus Health Plan .......................................... 10 </p><p>ENROLLMENT AND ELIGIBILITY RULES ............................................................. 11 </p><p>I. Annual Open Enrollment Period ................................................................... 11 </p><p>II. Special Enrollment Period Becoming Medicare Eligible ............................ 11 </p><p>III. General Enrollment Rules ........................................................................... 11 </p><p>IV. Eligibility Rules Death of Retiree .............................................................. 13 </p><p>FREQUENTLY ASKED QUESTIONS ..................................................................... 14 </p><p>Prescription Drug Coverage and Medicare .......................................................... 16 </p></li><li><p>3 </p><p>Medicare Eligible Plan Options </p><p>Option 1: UnitedHealthcare Group Medicare Advantage Plan This a group-sponsored Medicare Advantage Plan. You must be entitled to Medicare Part A and enrolled in Medicare Part B to participate in this plan. This plan is a PPO plan with network and non-network health care providers and benefits. If you use network providers, you will receive a higher level of benefit coverage. If you use non-network providers, make sure they accept Medicare and UnitedHealthcares fee schedule to avoid having to pay any unexpected excess provider fees. See the benefit outline for the plan serving southeastern Wisconsin for details. </p><p>Medicare pays UnitedHealthcare a pre-determined monthly fee, and in return, UnitedHealthcare assumes the risk of paying all claims at the established benefit levels. UnitedHealthcare is the sole claims processor. In addition, many of the network services covered under this plan requires that you pay only a co-pay. If your health care provider collects your co-pay at the time of the service, you will have peace of mind in knowing that the balance of the covered charges will be paid by UnitedHealthcare. You can review the list of participating healthcare providers in this plan by visiting: https://www.uhcretiree.com. </p><p>2018 Group Medicare Advantage Plan Changes </p><p>Below is a high level overview of the changes occurring for 2018. </p><p> In-Patient Skilled Nursing Facility co-pay for days 21-100 increasing to $167 from $164 </p><p> Medicare covered eye exams co-pay decreased from $50 to $15 </p><p> Emergency Room co-pay increased to $80 from $75 </p><p> Pharmacy In-Network Retail and Mail Order Cost-Sharing decreases for Tiers 2 and 3 o Retail: Tier 2 decreasing to $15 from $47 and Tier 3 decreasing to $47 from $100 o Mail Order: Tier 2 decreasing from $94 to $30 and Tier 3 decreasing from $200 to </p><p>$94 </p><p> Prescriptions will be offered across 5 Tiers increasing from a 4 Tier structure </p><p> Pharmacy Initial coverage limit increasing to $3,750 from $3,700 </p><p> True Out of Pocket Threshold (TrOOP) increasing to $5,000 from $4,950 </p><p> Virtual Doctor Visits are available at no-cost for participants who use the available in-network providers. </p><p>https://www.uhcretiree.com/</p></li><li><p>4 </p><p>Medicare Advantage Prescription Drug Coverage </p><p>The for UnitedHealthcare Group Medicare Advantage Plan includes prescription drug coverage. There is no deductible; copayments are listed: </p><p>Co-Payments Retail (30 days) Tier 1 = $15 Tier 3 = $47 Tier 5 = $100 Tier 2 = $15 Tier 4 = $100 </p><p> Mail (90 days) Tier 1 = $30 Tier 3 = $94 Tier 5 = $200 Tier 2 = $30 Tier 4 = $200 </p><p>Coverage Gap (Donut Hole): After your total drug costs reach $3,750, you pay 40% of the cost plus the dispensing fee for brand name drugs and 51% of the cost for generic drugs. </p><p>Catastrophic Coverage: After your total out-of-pocket drug costs reach $5,000, you will pay the greater of $3.35 for generics and brand drugs treated as generics, $8.35 for all other drugs, or 5%. </p><p>Enrolling in UnitedHealthcare Group Medicare Advantage Plan </p><p>If you are currently enrolled in the Medicare Advantage plan and wish to continue this coverage, it will not be necessary for you to fill out a new enrollment form. Your coverage will continue into 2018 through UnitedHealthcare. </p><p>If you are not enrolled in the Medicare Advantage plan, but wish to enroll for 2018, you must complete enrollment telephonically with the UnitedHealthcare Pre-Enrollment Team. Please call 1-877-714-0178 to enroll. We have moved from a paper enrollment process to a telephonic enrollment. In the enrollment process you will be interacting with a live person. The Pre-Enrollment Team will be able to better address questions you have regarding specific coverage benefits, network providers, or prescription drug coverage. Someone is available from 8am 8pm local time, 7 days a week. They can answer questsions prior to enrollment and handle the enrollment. </p><p>When calling to UnitedHealthcare Pre-Enrollment to enroll: </p><p>1. Tell the Customer Service Advocate you are calling about a Group-sponsored Medicare Advantage Plan. Have the group # 12688 for Waukesha County available. </p><p>2. Have your Medicare claim number and Medicare effective date. 3. If you have a question about your doctor or clinic, please have the names and addresses </p><p>handy, and name and address of your pharmacy. 4. If youre calling about drug coverage, please have your list of current prescriptions and </p><p>dosages ready. </p></li><li><p>5 </p><p>What to expect after enrolling in the UnitedHealthcare Group Medicare Advantage Plan: </p><p>1. You will receive your member ID card. 2. You will receive a Welcome Packet in the mail. Please review it. 3. After your effective date, register online at www.uhcretiree.com. This website will provide </p><p>you with easy, convienient access to all your plan information. </p><p>4. After your enrollment, UnitedHealthcare will reach out to you to complete a short health survey per Medicare requriements. </p><p>Option 2: Waukesha County Retiree Choice Plus Health Plan without Prescription Coverage Coverage for prescription drugs in the Waukesha County Retiree Choice Plus Health Plan ends when you become eligible for Medicare. </p><p>If you are eligible for Medicare and choose to be enrolled in the Waukesha County Retiree Choice Plus Health Plan, you are responsible for enrolling in a Medicare Part D Prescription Drug Plan and paying the monthly premium. This deduction will likely be taken from your monthly Social Security check. You will also be responsible for paying the monthly premium cost for medical coverage. Medical coverage costs are outlined on page 8. </p><p>There are different Medicare Part D plans available. For information regarding available Medicare Part D plans, please visit https://www.aarpmedicareplans.com/ or https://www.uhcmedicaresolutions.com. Or call UnitedHealthcare at 1-877-517-5276 to discuss available Medicare Part D plans in your area. </p><p>Below is a brief description of an available Medicare Part D option. This is an example; you may find other Medicare Part D option to meet your needs. </p><p>http://www.uhcretiree.com/https://www.aarpmedicareplans.com/https://www.uhcmedicaresolutions.com/</p></li><li><p>6 </p><p>2017 AARP MedicareRx Preferred Plan Monthly Premium for Wisconsin: $71.00 </p><p>[2018 rate not available at time of publication] 1. Yearly </p><p>Deductible 2. Copayment or coinsurance paid at the </p><p>pharmacy. Cost Sharing depends on where you purchase the prescription: Preferred Retail Pharmacy 30 days/Standard Network Pharmacy 30 days/Preferred Mail Order 90 days </p><p>3. Coverage gap (donut hole) </p><p>4. Catastrophic Coverage </p><p>There is no deductible for this plan </p><p>Each covered member pays the following cost sharing for each prescription purchased: Tier 1 Preferred Generics: $5/$8/$0 Tier 2 Non-Preferred Generics: $10/$15/$0 Tier 3 Preferred Brands: $35/$45/$90 Tier 4 Non-Preferred Brands: 40%/50%/40% Tier 5 Specialty: 33%/33%/33% </p><p>Once the member and the plan have spent $3,750 for covered drugs, the member is in the coverage gap and pays 40% for covered brand-name drugs and 51% for covered generics. What the member pays + the discount paid by the drug companies accumulates towards the maximum out-of-pocket costs. If this reaches $5,000, the member becomes covered by Catastrophic Coverage. </p><p>The member pays the following for covered drugs: Generics: the greater of 5% or $3.30 All Other Drugs: the greater of 5% or $8.25 </p><p>More detailed information can be found at https://www.aarpmedicareplans.com/ </p><p>Enrolling in the Waukesha County Retiree Choice Plus Health Plan </p><p>If you are currently enrolled in the Waukesha County Retiree Choice Plus Health Plan and wish to continue that coverage in 2018, it will not be necessary for you to fill out any forms. Your medical coverage will automatically continue into 2018. Continue to use your existing ID card for medical coverage. You will use your Medicare Part D card for prescription coverage. </p><p>If you are not enrolled in the Waukesha County Retiree Choice Plus health plan, but wish to enroll for 2018, you must complete an enrollment form and return it to Waukesha County Human Resources by November 3, 2017. Forms can be downloaded from www.waukeshacounty.gov/retiree or obtained by calling Human Resources at 262-548-7044 to have them mailed to you. </p></li><li><p>7 </p><p>Non-Medicare Eligible Plan Option </p><p>Option: Waukesha County Retiree Choice Plus Health Plan with Prescription Coverage If you are not eligible for Medicare, you may enroll in the Waukesha County Retiree Choice Plus Health Plan with Prescription drug coverage. </p><p>2018 Retiree Choice Plus Health Plan Changes </p><p>In 2018, the pharmacy network will be changing from the Broad Network to the Standard Walgreens Pharmacy Network. Leading pharmacy chains included in the network are Walgreens, Walmart (Sams Club is not included), Costco, Meijer, and Kroger. For a complete listing of nationwide network pharmacies please visit www.waukeshacounty.gov/retiree </p><p>The health plan could see significant savings by implementing the Standard Pharmacy Network anchored by Walgreens. This change will eliminate most independent pharmacies, some mass merchants, and all CVS pharmacies. </p><p>The standard network provides better discounts and control on medication pricing to ensure the most cost effective option is available. Walgreens as the pharmacy anchor was selected because it was the most utilized pharmacy chain, provided the least member disruption, and provided the greatest cost savings. </p><p>Enrolling in the Waukesha County Retiree Choice Plus Health Plan </p><p>If you are currently enrolled in the Waukesha County Retiree Choice Plus Health Plan and wish to continue that coverage in 2018, it will not be necessary for you to fill out any forms. Your coverage will automatically continue into 2018. Continue to use your existing ID card for medical and prescription drug coverage. </p><p>If you are not enrolled in the Waukesha County Retiree Choice Plus health plan, but wish to enroll for 2018, you must complete an enrollment form and return it to Waukesha County Human Resources by November 3, 2017. Forms can be downloaded from www.waukeshacounty.gov/retiree or obtained by calling Human Resources at 262-548-7044 to have them mailed to you. </p><p>http://www.waukeshacounty.gov/retiree</p></li><li><p>8 </p><p>BENEFIT COVERAGE AND PREMIUMS </p><p>The outlines of benefit coverage for the Waukesha County Retiree Choice Plus health plan and UnitedHealthcare Medicare Advantage plan are provided on the following pages. The 2018 monthly premiums are listed in the chart below: </p><p> Waukesha County Choice </p><p>Plus Health Plan </p><p> UnitedHealthcare Medicare </p><p>Advantage Plan </p><p>Single, Non-Medicare $759.92 N/A </p><p>Two Party, Non-Medicare $1,519.81 N/A </p><p>Family, Non-Medicare $2,013.77 N/A </p><p>Single, Medicare $243.46 $10.00 </p><p>Two Party, Medicare $486.95 $10.00 each </p><p>One with Medicare, one without $1,003.38 N/A </p><p>Family, two with Medicare and...</p></li></ul>

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