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Benefits Choices 2009
Open Enrollment
Non-Medicare Retirees
October 20 - November 10, 2008
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?
2009Medical 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/DoctorsUNMH
Independent Providers
Lovelace Health SystemABQ Health Partners
UNMHIndependent Providers
Summarized Comparison
UHC Premier PPO PlanCIGNA In-Network
Plan
Annual CY deductible (in-
network)*$250 per person/
$750 familyNone
Annual CY out-of-pocket
(in-network)*$1750 per person/
$3500 family$1500 per person/
$3000 family
National network coverage
Yes Yes
In- and out-of-network coverage
Both In-network only
Referrals to specialist required
No No
Payment via Primarily coinsurance Primarily copay
Prescription drug coverage administrator
Catalyst Rx Catalyst Rx
*Does not include prescription drug coverage.
UHC Premier PPO Plan Changes
In-Network 2008 2009
PCP Office Visit $15 copay $20 copay
Specialist Office Visit $25 copay $35 copay
Allergy Treatment $25 copay 15%*
Chiropractic\Acupuncture (combined with out-of-network)
$1500 combined
maximum/CY
$1000 each maximum/CY
Hypnotherapy/biofeedback $25 copay Not covered
*Subject to deductible
CIGNA In-Network Plan Changes
CIGNA In-Network Plan
In-Network 2008 2009
PCP Office Visit $15 copay $20 copay
Specialist Office Visit $25 copay $30 copay
Allergy Testing $25 copay $30 copay
Ambulance $50 copay $75 copay
Emergency Room Visit $100 copay $125 copay
Outpatient Surgery $100 copay $125 coopay
Inpatient Admit $200/day up to $500 $400 copay
Chiropractic\Acupuncture* $15 copay $20 copay
Speech, Physical, and Occupational Therapy*
$15 copay $20 copay
Hypnotherapy/biofeedback $25 copay Not covered
*Combined maximum of 60 visits per calendar year
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 PlanUrgent 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
CIGNA In-Network PlanUrgent care is covered worldwideFollow-up care (within USA) is covered only if received from an in-network providersFollow 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 terminatedYou will be held liable to refund to Sandia the health care plan claims or monthly premiumsYour dependent could lose any rights to temporary continued health care coverage (COBRA)Sandia shall not be required to refund any premiums to the subscriber
2009Prescription
Drug Overview
Summarized Rx Changes
UHC Premier PPO CIGNA In-Network Plan
In-Network 2008 2009 2008 2009
Retail (up to 30 day maximum supply)
Generic 20% with $6 min. and $12 max.
No change$10 copay
20% with $6 min. and $12 max.
Preferred Brand 30% with $25 min. and $40 max.
No change$30 copay
30% with $25 min. and $40 max.
Non-preferred Brand 40% with $40 min. and $60 max.
No changeN/A
40% with $40 min. and $60 max.
Mail Order (up to 90 day maximum supply)
Generic$18 copay
20% with $12 min. and $24 max $20 copay
20% with $12 min. and $24 max
Preferred Brand$65 copay
30% with $50 min. and $80 max. $60 copay
30% with $50 min. and $80 max.
Non-preferred Brand$100 copay
40% with $80 min. and $120 max. N/A
40% with $80 min. and $120 max.
Specialty Drug Program – New!
Specialty drug coverage through Walgreens/MedMarkLimited 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/MedMarkSpecialty Care Team
Making contact by December 15Available Monday to Friday (6 a.m. to 5 p.m MST) at 866-823-2712
Specialty DrugsTreatment 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
Non-Medicare Member Plans Medicare-Member Plans
UHC Premier PPO UHC Senior Premier PPO
No corresponding plan Presbyterian MediCare PPO
CIGNA In-Network Plan Lovelace Senior Plan
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 PlanOverview
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 14Benefits 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 planAnnual Physical including CBC, urinalysis, metabolic profile, diabetes screening, thyroid screeningPap Test, PSA Test, Mammography, Colonoscopy, Bone Density Testing at certain intervalsImmunizations, including flu shots
Prescription DrugsUse Generics – much lower copays and costs for therapeutically equivalent medicinesMail 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 servicesDental services stemming from an accident/injury/sicknessDurable medical equipment (DME) with a purchase/cumulative rental value of $1,000 or more (includes oxygen)Home health careHospice careHospital inpatient staysReconstructive proceduresAir ambulance servicesSkilled nursing facility/inpatient rehabTransplant servicesCertain behavioral health benefits
Failure to pre-notify will result in reduction of benefits by $300.
CIGNA Pre-certification Requirements
CIGNA In-Network PlanAsk your provider to handle this for in-network careServices that need pre-certification include:
Hospital staySurgical procedures (inpatient or outpatient)AcupunctureBiofeedbackDental service stemming from an accident or illnessDurable medical equipment (DME) including oxygenExternal prosthetic appliancesHome health careHospice careMRI, CT and PET scansVaricose 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 BApproximately 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. 10th
Confirmations will be sent to only those who make changes
OE website…
To make a change…
Follow the instructions below to make changes to your 2009 medical coverage.
STEP 1: Are you making any changes to your medical coverage for next year?
No No action is necessary. DO NOT RETURN THIS FORM. Yes Continue to Step 2
STEP 2: Do you need or want to change your medical plan for next year? Note: CIGNA Premier/Senior Premier and High Deductible Health Plan are no longer medical plan options. All members enrolled in these plans MUST select another medical plan option.
No Yes
NON-MEDICARE Member Plans MEDICARE Member Plans
UHC Premier PPO UHC Senior Premier PPO
Presbyterian MediCare PPO (No corresponding non-Medicare Plan is available)
Must be Medicare Part A & B eligible in January 2009 to enroll in this plan.
CIGNA In-Network
Lovelace Senior Plan Must be Medicare Part A & B eligible in January
2009 to enroll in this plan.
Kaiser Permanente Traditional HMO
Kaiser Permanente Senior Advantage
Must be Medicare Part A & B eligible in January 2009 to enroll in this plan.
STEP 3: Do you want to add or drop dependents for medical or dental for next year?
No Continue to Step 4. Yes Use the table below to add or drop your dependents.
Add/Drop Name Relat ionship Bir th Date/Age Medica l Denta l
A d d J o h n S m i th S o n 7 /1 6 /8 5 /6 5 y e a rs Y e s Y e s
STEP 4: Please print your name and phone number below:
Name (print) Age: Phone Number Social Security Number:
STEP 5: Sign and mail this form to the address below postmarked by November 10, 2008.
Signature
Date:e
Mail to: Sandia National Laboratories, Attn: Open Enrollment, MS1463 P. O. Box 5800 Albuquerque, NM 87185-1463
O P E N E N R O L L M E N T C H A N G E F O R M 2 0 0 9
Do I Need to Take Action?
Action No Action
MedicalCoverage
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
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
DentalCoverage
To enroll if not currently enrolled
To add or disenroll a dependent
To continue under the Dental Care Plan
If you waived dental coverage previously and wish to remain in this status
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 protected] 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 allowedafter November 10th
Questions ?
