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GROUP MEDI CARE ADVANTAGE HMO
Tier 1 Rx Copay Reduction
What’s New for 2013
Hearing Discounts
Rx Manager New Name
WellCardEnhancements
Eligibility Requirements
In-Network Benefits
Copayments
Additional Benefits
WEBCAST TOPI CS
$
ELI GI BI LI TY
REQUI REMENTS
Person
State
Eligible
The below are eligible for the Group Medicare Advantage HMO Plan:
• Retiree• LTD Recipient• Qualified Survivor• Domestic Partner• Eligible Dependents
ELI GI BI LI TY REQUI REMENTS
Group Medicare Advantage
To enroll in the Group Medicare Advantage HMO Plan, you must have:
Medicare Parts A & B
ELI GI BI LI TY REQUI REMENTS
Medicare Plan
The Group Medicare Advantage HMO Plan is available:
• Arizona• All Counties
ELI GI BI LI TY REQUI REMENTS
Group Medicare Advantage
Question & Answer 1
ELI GI BI LI TY REQUI REMENTS
Roland is an ASRS retiree with Medicare Parts A&B. He lives full time in Carefree, Arizona. Can he enroll in this plan?
a. Yes
b. No
Question & Answer 2
ELI GI BI LI TY REQUI REMENTS
Nora is an actively contributing member of the ASRS. She has Medicare parts A and B. Can she enroll in the Medicare Advantage HMO? ?
a. Yes
b. No
I N- NETWORK BENEFI TS
I N- NETWORK BENEFI TS
Medicare Part D:• Is included, and is equal to or
better than the standard Medicare Part D Coverage.
Group Medicare Advantage
Prescription
I N- NETWORK BENEFI TS
UnitedHealthcare Formulary:
• Approved outpatient prescription drugs
• Doctor must use• Participating pharmacy
Additional Information
I N- NETWORK BENEFI TS
• No annual benefit limit in coverage
• No annual deductibles
• No prescription coverage gap
Selection
I N- NETWORK BENEFI TS
You must select a Primary Care Physician in the network.
Your doctor will make referrals to specialists within the network
Pre-Existing Condition
I N- NETWORK BENEFI TS
Currently the ASRS does not deny health insurance for any reason in relation to a pre-existing condition
Health Insurance Card
I N- NETWORK BENEFI TS
You will be issued one card that covers your • Medical• Vision• Prescriptions
Question & Answer 1
I N- NETWORK BENEFI TS
Does the Medicare Part D prescription coverage gap apply to the Group Medicare Advantage HMO plan?
a. Yesb. No
Question & Answer 2
I N- NETWORK BENEFI TS
Paula is an ASRS retiree and is enrolled in the Medicare Advantage HMO plan. Does she need to select a primary physician?
a. Yesb. No
COPAYMENTS
Copayments – (examples)
Hearing Exam$0
Routine Physical$0
Ambulance$25
The most common copays…
Copayments – (examples)
The most common copays…
Doctor Visit$15
Lab Tests$0
Specialist$30
Emergency$50
Waived if admitted
Copayments – (examples)
Prescription monthly copays…
Tier I
$10
Tier II
$40
COPAYMENTS
Mail Order Prescriptions
90-day supplies:
• Tier I $20• Tier II $80
COPAYMENTS
Annual Amounts
Your out-of-pocket coinsurance yearly maximum: • $6,700 Per Individual
No lifetime maximum benefit
Question & Answer
COPAYMENTS
Mary isn’t sure what her yearly out-of-pocket coinsurance maximum would be. Is it….
a. $7,600b. $6,700
ADDI TI ONAL BENEFI TS
Passport Program
ADDI TI ONAL BENEFI TS
Allows you to move your HMO coverage:
• Participating areas
• 9 consecutive months during the year• Same copays
Wellness Services
ADDI TI ONAL BENEFI TS
Additional benefits include:
• Silver Sneakers• Solutions for Caregivers• Nurseline
Disease Management
ADDI TI ONAL BENEFI TS
• Disease and Specialty Case Management
• Personal Health Management
• Advanced Illness Care Management
Question & Answer 1
ADDI TI ONAL BENEFI TS
Gina has a chronic condition. She is enrolled in the Group Medicare Advantage HMO with several very large claims in the last 2 years. Will she reach a maximum lifetime benefit?
a. Yesb. No
Question & Answer 2
Jenny’s mother needs more care than she can give her. Which program can provide assistance?
a. Silver Sneakersb. Solutions for Caregiversc. Nurseline
ADDI TI ONAL BENEFI TS
Group Medicare - Full Monthly Premiums
Retiree + Dependent
$380/$520Retiree
$190/$260
Retiree & Dependent(s) Medicare & Non Medicare Eligible
Combination Plans
For more detailed information
please refer to the Guide!
ARI ZONA STATE RETI REMENT SYSTEM
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Have a great day!