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Offered Exclusively Through
Seniors Choice is the premier group retiree medical plan for employees and retirees age 65+ which originates where Medicare ends.
The Basics Employer Options Underwritten by Guarantee Trust Life in
Glenview, IL Administered by MBA MBA, Inc. owner/distributor
SC Benefit Design Optional Benefits “How Deductibles Work” SC Part D Eligibility TEFRA Prospects Enrollment
Today’s Discussion
The Seniors Choice Plan Design
Basic Plan F Design Base Plan Benefits
• No Lifetime Maximum• Part A & B Deductible Coverage• Coverage for Excess Charges
Included• Skilled Nursing up to 100 Days• Foreign Travel included
The Seniors Choice Plan Design Cont.
$10 – Office Visit, Lab and X-ray Co-pay $10- Durable Medical Equipment $20 – All other outpatient services $100 – Emergency Room Co-pay
(waived if admitted) Excess charges are covered (up to 15%
above MAC) No Co-pay plan is also available
Deductible Options
Multiple Deductible Options◦From $0 to $4,000 All deductible options include the Medicare Part B deductible ($147)
Sponsor can choose one or as many deductibles as desired
Non-traditional Deductible
Example Deductible• Enrolled in SC $500 deductible plan option• Member incurs $1,000 in physician services
Member Out of Pocket Calculation
Physicians Services $1,000
Subtract Medicare Part B Deductible ($147)
Balance after Part B Deductible $853
Subtract 80% of Claim Paid by Medicare ($682.40)
Remainder Owed (Member pays this amount) $170.60
Part B Deductible (Member pays this amount) $147
Member Total Out-of-Pocket $317.60Remaining Annual Deductible Calculation
Seniors Choice Annual Plan Deductible $500
Subtract Out-of-Pocket amount paid by member which includes the Medicare Part B Deductible
($317.60)
Remaining Annual Plan Deductible $182.40
Optional Benefits
Comprehensive Wellness Benefit◦ Up to $250 per calendar year
Private Duty Nursing Benefit◦ $100 per 8 hour shift; 30 shifts per calendar year.
At Home Recovery Benefit◦ Certified by a doctor◦ Approved by Medicare
Additional Skilled Nursing Coverage ◦ From 101 days to 365 days
Enhanced Benefits EPIC Hearing Service Plan
Included with all plans National network of local ear physicians
and audiologists Testing, evaluations and hearing aid
fittings by licensed audiologists Savings of 35% to 65% on brand name
hearing aids Toll free telephone support No Administrative forms or paperwork
Enhanced BenefitsOutlook Vision Services
Outlook Vision Services◦Included with all plans◦Discounts on eye exams at approved locations
◦Up to 50% off eyewear◦Up to 50% discount on mail order contact lens replacement
◦Providers within a 15 minute drive for 85% of the U.S. population
Part D Late Enrollment PenaltyA Penalty will be assessed to anyone
who:1. Did not join a Medicare drug plan
when they were first eligible for Part A and/or
Part BOR
2. Went without creditable prescription drug coverage for 63 days or more
Penalty will be for ALL fully uncovered months
Calculate number of fully uncovered months:
Example: Uncovered from 5/16/06 - 12/31/08 =
31 months
Penalty is 1% for each number of fully uncovered
months: Example: 31 months x 1%
= 31%
Multiply penalty percent by current national base beneficiary premium*
Example: (2012): $31.00 x 31% = $9.61
Cost of Standard Part D plan premium + $9.61
(late enrollment penalty) = Part D total monthly premium
The penalty will be added to the standard premium of any Part D
plan for which the member enrolls. The member will have to pay the penalty each month as
long as he/she has the Medicare prescription drug
coverage.
*The current national base beneficiary premium is set by CMMS (Medicare) and is subject to change each calendar year.
Previous Years: [2011: $32.34] [2010: $31.94] [2009: $30.36] [2008: $27.93] [2007: $27.35] [2006: $32.20]
Plan Highlights
Always Guaranteed Acceptance Full takeover of pre-existing conditions Enhanced Benefits Optional Benefits Part D Coverage Gap coverage
Eligibility for Seniors Choice Group Retiree Medical Plans
Enrollee Qualification◦Currently Age 65 or over◦Enrolled in Medicare Parts A & B◦SC grandfathers any individual who has been employed by the sponsoring entity
Group Sponsorship Requirement
A group of 1 life may sponsor SC – Sole proprietors such as :• Lawyers• Dentists• Doctors• Insurance Agents• Real Estate Agents
Tax Equity and Fiscal Responsibility Act (TEFRA)
Employers with 20 or more FT/PT employees
20 or more weeks in the current or preceding year
The 20 weeks do not have to be consecutive
The requirements are based on the number of employees, not the number of individuals covered under the medical plan.
Seniors Choice Prospects
Groups of Under 20 employees◦Age 65 and over FT Employees TEFRA does not apply thus Medicare is primary
Premiums are generally higher for employees age 65 and over
Can raise the average age of group
Seniors Choice Prospects Continued
Groups with 20 or More Employees
◦Must comply with TEFRA regulations
◦Employees eligible for the employer sponsored group plan are ineligible for SC
◦Employees not eligible for the employer sponsored group plan are eligible for SC
Why Choose SC over a Traditional Medicare Supplement or MA Plan?
Tax benefits for premium contribution SC is always guaranteed issue Section 125 POP eligible Portable Extensive Part D Plan Open Enrollment Every December Enhanced Benefits Included
Example
Number EES 1010
Number of EES 65+ 1
Group Premium w/65 $5,500
Group Premium w/o/65
$4,000
Seniors Choice Premium w/Rx for 65 yr. old
$4,000 + $450 = $4,450
Monthly Savings = $1,050
How To Enroll In Seniors Choice
• Sponsoring Employers Must:– Complete Employer Trust
Participation Agreement– Employer may sponsor one or as
many deductibles as they desire• If voluntary, the Optional Prescription
Drug Benefit is elected by the enrollee
• Enrollee and/or Spouse Must:– Complete Enrollment Form– Make check or money order
payable to “Seniors Choice”– Make copy of Medicare I.D. card
and Medical I.D. card, if applicable
Remember . . . This is Group Retiree Medical Insurance All Agents and Brokers must be
appropriately licensed where the employer is domiciled
Any and all Marketing Materials utilized in connection with SC must first be approved in writing by Merchants Benefit Administration, Inc. prior to use