2018
WAUKESHA COUNTY
OPEN ENROLLMENT Retiree Health Insurance
O C T O B E R 2 , 2 0 1 7
T H R O U G H
N O V E M B E R 3 , 2 0 1 7
1
To: All Individuals Covered under the Waukesha County Retiree Health Insurance Program
From: Waukesha County Human Resources Office
Date: September 26, 2017
Re: 2018 Retiree Health Insurance Open Enrollment Period
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.
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.
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.
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.
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.
All required enrollment form(s) must be returned no later than November 3, 2017 to:
Waukesha County Human Resources 515 W Moreland Blvd, Room 160
Waukesha, WI 53188 Phone: (262) 548-7044
2
Table of Contents Medicare Eligible Plan Options .............................................................................. 3
Option 1: UnitedHealthcare Group Medicare Advantage Plan ........................... 3
2018 Group Medicare Advantage Plan Changes ................................................. 3
Medicare Advantage Prescription Drug Coverage ............................................... 4
Enrolling in UnitedHealthcare Group Medicare Advantage Plan ........................ 4
Option 2: Choice Plus Health Plan without Prescription Coverage ..................... 5
Non-Medicare Eligible Plan Option ........................................................................ 7
Option: Choice Plus Health Plan with Prescription Coverage ............................. 7
2018 Retiree Choice Plus Health Plan Changes ................................................... 7
Enrolling in the Waukesha County Retiree Choice Plus Health Plan ................... 7
BENEFIT COVERAGE AND PREMIUMS ................................................................ 8
UnitedHealthcare Group Medicare Advantage Plan Summary – SE Wisconsin .. 9
Waukesha County Retiree Choice Plus Health Plan .......................................... 10
ENROLLMENT AND ELIGIBILITY RULES ............................................................. 11
I. Annual Open Enrollment Period ................................................................... 11
II. Special Enrollment Period – Becoming Medicare Eligible ............................ 11
III. General Enrollment Rules ........................................................................... 11
IV. Eligibility Rules – Death of Retiree .............................................................. 13
FREQUENTLY ASKED QUESTIONS ..................................................................... 14
Prescription Drug Coverage and Medicare .......................................................... 16
3
Medicare Eligible Plan Options
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 UnitedHealthcare’s fee schedule to avoid having to pay any unexpected excess provider fees. See the benefit outline for the plan serving southeastern Wisconsin for details.
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.
2018 Group Medicare Advantage Plan Changes
Below is a high level overview of the changes occurring for 2018.
In-Patient Skilled Nursing Facility co-pay for days 21-100 increasing to $167 from $164
Medicare covered eye exams co-pay decreased from $50 to $15
Emergency Room co-pay increased to $80 from $75
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
$94
Prescriptions will be offered across 5 Tiers increasing from a 4 Tier structure
Pharmacy Initial coverage limit increasing to $3,750 from $3,700
True Out of Pocket Threshold (TrOOP) increasing to $5,000 from $4,950
Virtual Doctor Visits are available at no-cost for participants who use the available in-network providers.
4
Medicare Advantage Prescription Drug Coverage
The for UnitedHealthcare Group Medicare Advantage Plan includes prescription drug coverage. There is no deductible; copayments are listed:
Co-Payments Retail (30 days) Tier 1 = $15 Tier 3 = $47 Tier 5 = $100 Tier 2 = $15 Tier 4 = $100
Mail (90 days) Tier 1 = $30 Tier 3 = $94 Tier 5 = $200 Tier 2 = $30 Tier 4 = $200
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.
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%.
Enrolling in UnitedHealthcare Group Medicare Advantage Plan
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.
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.
When calling to UnitedHealthcare Pre-Enrollment to enroll:
1. Tell the Customer Service Advocate you are calling about a Group-sponsored Medicare Advantage Plan. Have the group # 12688 for Waukesha County available.
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
handy, and name and address of your pharmacy. 4. If you’re calling about drug coverage, please have your list of current prescriptions and
dosages ready.
5
What to expect after enrolling in the UnitedHealthcare Group Medicare Advantage Plan:
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
you with easy, convienient access to all your plan information.
4. After your enrollment, UnitedHealthcare will reach out to you to complete a short health survey per Medicare requriements.
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.
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.
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.
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.
6
2017 AARP MedicareRx Preferred Plan Monthly Premium for Wisconsin: $71.00
[2018 rate not available at time of publication] 1. Yearly
Deductible 2. Copayment or coinsurance paid at the
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
3. Coverage gap (donut hole)
4. Catastrophic Coverage
There is no deductible for this plan
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%
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.
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
More detailed information can be found at https://www.aarpmedicareplans.com/
Enrolling in the Waukesha County Retiree Choice Plus Health Plan
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.
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.
7
Non-Medicare Eligible Plan Option
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.
2018 Retiree Choice Plus Health Plan Changes
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 (Sam’s Club is not included), Costco, Meijer, and Kroger. For a complete listing of nationwide network pharmacies please visit www.waukeshacounty.gov/retiree
The health plan could see significant savings by implementing the Standard Pharmacy Network anchored by Walgreen’s. This change will eliminate most independent pharmacies, some mass merchants, and all CVS pharmacies.
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.
Enrolling in the Waukesha County Retiree Choice Plus Health Plan
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.
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.
8
BENEFIT COVERAGE AND PREMIUMS
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:
Waukesha County Choice
Plus Health Plan
UnitedHealthcare Medicare
Advantage Plan
Single, Non-Medicare $759.92 N/A
Two Party, Non-Medicare $1,519.81 N/A
Family, Non-Medicare $2,013.77 N/A
Single, Medicare $243.46 $10.00
Two Party, Medicare $486.95 $10.00 each
One with Medicare, one without $1,003.38 N/A
Family, two with Medicare and dependents
$978.26 N/A
Family, one with Medicare, one without and dependents
$1,494.71 N/A
9
UnitedHealthcare Group Medicare Advantage Plan Summary – SE Wisconsin
BENEFIT IN-NETWORK OUT-OF-NETWORK
Lifetime Maximum Unlimited Unlimited
Annual Deductible -0- -0-
Co-insurance -0- -0-
Maximum Annual Out-of-Pocket Expense $5,900 $10,000 (Combined with In-Network)
Primary Care Physician Office Visits $20 $35
Specialist Office Visits $50 $60
Annual Physical Exam -0- 60%/40%
Chiropractic Visit (Medicare Covered) $20 $25
Inpatient Hospitalization Day 1 – 6 = $275 Day 7 – 999 = $0
60%/40%
Emergency Room $75 (waived if admitted within 24 hrs) $75 (waived if admitted within 24 hrs)
Urgent Care $65 (waived if admitted within 24 hrs) $65 (waived if admitted within 24 hrs)
Skilled Nursing Facility Co-Pay $0 day 1 – 20 $167 day 21 – 100
$175 day 1 – 100
Outpatient Hospitalization 80%/20% 60%/40%
Diagnostic Procedures/Tests 80%/20% 60%/40%
Immunizations (Medicare Covered) -0- -0-
Lab Services $50 $50
Radiology Services and X-Ray Services 80%/20% 60%/40%
Durable Medical Equipment 80%/20% 60%/40%
Preventive Services -0- 60%/40%
Home Health Services -0- 80%/20%
Ambulance Services $250 $250
Physical Therapy $40 60%/40%
Eye Exam Every 12 months (Medicare) $50 $60
Hearing Exam Every 12 months (Medicare) $50 $60
Mental Health and Chemical Dependency Services
Outpatient Hospital $40/individual visit $10/group visit
$60/individual visit $35/group visit
Inpatient Hospital
$175 day 1 – 8 -0- day 9 – 190
60%/40%
Hearing Aid Allowance Every 3 years $500
Cardiac/Pulmonary Rehabilitation 80%/20% 60%/40%
Prescriptions Retail (30-day supply) $ 15 = Tier 1 $15 = Tier 2 $47 = Tier 3 $100 = Tier 4 $100 = Tier 5
Not covered
This outline is intended to provide a brief overview of the coverage available to you. It should not be considered a complete source of information. For a complete description of the benefits, limitations, exclusions, terms and conditions, please refer to the master plan documents which are available from UnitedHealthcare. In a conflict between this outline and the master plan documents, the master plan documents control.
10
Waukesha County Retiree Choice Plus Health Plan (Administered by UnitedHealthcare)
BENEFIT IN-NETWORK OUT-OF-NETWORK
1. Lifetime Maximum Unlimited $1 million/individual
2. Annual Deductible $750 person $2,250 family
$1,500 person $4,500 family
3. Co-insurance 70% of eligible expenses after deductible 50% of eligible expenses after deductible
4. Maximum Annual Co-insurance Out-of-Pocket Expense
$2,000 person $4,000 two party or family
$4,000 person $8,000 two party or family
5. Hospitalization 70%/30%* 50%/50%*
6. Surgical-Medical Care 70%/30%* 50%/50%*
7. Physician Visits in Hospital 70%/30%* 50%/50%*
8. Maternity 70%/30%* 50%/50%*
9. X-Ray & Lab Tests 70%/30%* 50%/50%*
10. Radiation Therapy 70%/30%* 50%/50%*
11. Emergency Care 70%/30%* 50%/50%*
12. Physician Office 70%/30%* 50%/50%*
13. Outpatient Therapy 70%/30%* 50%/50%*
14. Immunizations & Injections 70%/30%* 50%/50%*
15. Durable Medical Equipment 70%/30%* 50%/50%*
16. Prescription Drugs Non-Medicare Retirees
Retail: (31-day supply) $20 co-pay – tier 1 $40 co-pay – tier 2 $60 co-pay – tier 3 $100 co-pay – tier 4 Mail (90-day supply) 2.5 x Retail copay
No coverage
17. Prescription Drugs Medicare Eligible Retirees
No Coverage. Must have separate Medicare Plan D coverage
No coverage
18. Allergy Care 70%/30%* 50%/50%*
19. Mental Health and Substance Abuse
A. Outpatient Hospital
B. Inpatient Hospital
C. Transitional Treatment
70% / 30%* 70% / 30%* 70% / 30%*
50% / 50%* 50% / 50%* 50% / 50%*
20. Ambulance 70%/30%* 50%/50%*
21. Private Duty Nursing 70%/30%* 50%/50%*
22. Oral Surgery 70%/30%* 50%/50%*
23. Skilled Nursing Facility 70%/30%* 50%/50%*
24. Medical Eye Care 70%/30%* 50%/50%*
25. Physicians Charges for Routine Physical Exams
70%/30%* 50%/50%*
26. Hearing Screening 70%/30%* Not Covered
27. Well Baby Care 70%/30%* 50%/50%*
28. TMJ Syndrome 70%/30%* (Certain limitations apply.) 50%/50%* (Certain limitations apply.)
29. Chiropractic 70%/30% * 50%/50% *
*Coinsurance applies after the deductible has been met. This summary is intended to provide a brief overview of the health insurance options available to you. It should not be considered a complete source of information. For a complete description of the benefits, limitations, exclusions, terms and conditions of each plan, please refer to the master plan documents which are available for review in the Department of Administration, Human Resources. In a conflict between this outline and the master plan documents, the master plan documents will apply.
11
ENROLLMENT AND ELIGIBILITY RULES
I. Annual Open Enrollment Period
Each year, Waukesha County will conduct an annual open enrollment period. During this time, you will be allowed to switch coverage to another plan option. For example, a Medicare-eligible retiree who is enrolled in the Waukesha County Retiree Choice Plus health plan can switch to the UnitedHealthcare Medicare Advantage plan. The open enrollment period will be held in fall each year and coverage changes will take effect on January 1st of the next year.
II. Special Enrollment Period – Becoming Medicare Eligible
A. Retirees and spouses should enroll in Medicare Parts A and B during the three (3) month period prior to their 65th birthday or when they otherwise become eligible for Medicare.
B. A retiree or a covered spouse will be eligible to enroll in the UnitedHealthcare Medicare Advantage plan at the time they first become eligible for Medicare coverage.
C. A retiree or covered spouse should enroll in a Medicare D prescription plan if they want to enroll or remain enrolled on the Waukesha County Retiree Choice Plus Plan.
D. Members electing the UnitedHealthcare Medicare Advantage Plan must enroll telephonically.
E. Members electing the Waukesha County Retiree Choice Plus Health Plan must complete the enrollment form.
III. General Enrollment Rules
A. In the event that an alternative Medicare Advantage health plan ceases to be available, the covered member(s) will be permitted to re-enroll in the County’s Retiree Choice Plus health plan without any benefit limitations or coverage waiting periods. Contact Human Resources at that time for assistance.
B. Ineligible for Medicare – Retiree, Spouse, or Dependents
1. A single retiree may enroll in the County’s Retiree Choice Plus health plan.
2. A retiree with a covered spouse and/or dependent children may enroll in the County’s Retiree Choice Plus health plan.
3. A retiree and spouse are not permitted to have two separate single policies under the County’s Retiree Choice Plus health plan, unless both were previously County employees and were eligible to participate in the County’s retiree health insurance program at the time of retirement.
12
C. Eligible for Medicare – Retiree, Spouse, or Dependents
1. A single retiree will have the choice of enrolling in either the UnitedHealthcare
Medicare Advantage plan or the Waukesha County Retiree Choice Plus health plan
without prescription drug coverage. The retiree would need to enroll in a Medicare
Part D prescription plan in conjunction with the Retiree Choice Plus health plan.
2. A retiree with a covered spouse and/or dependent children may enroll in family
coverage under the Waukesha County Retiree Choice Plus health plan. The
individual(s) entitled to Medicare will not have prescription drug coverage through
the Waukesha County Retiree Choice Plus health plan and will need to enroll a
Medicare Part D prescription drug plan.
3. A retiree with a covered spouse only, may enroll in two separate single policies under
the UnitedHealthcare Medicare Advantage plan or as a two-party family in the
Waukesha County Retiree Choice Plus health plan. The individual(s) entitled to
Medicare will not have prescription drug coverage through the Waukesha County
Retiree Choice Plus health plan and will need to enroll a Medicare Part D prescription
drug plan.
4. It is not permissible for a spouse to enroll in the Waukesha County Retiree Choice
Plus health plan and the other spouse to enroll in the UnitedHealthcare Medicare
Advantage plan, unless both were previously County employees and were eligible to
individually participate in the retiree health insurance program at the time of
retirement.
5. Dependent children are not eligible to enroll in the UnitedHealthcare Medicare
Advantage plan through Waukesha County.
D. Retiree and Spouse Become Eligible for Medicare at Different Times - Whomever (retiree
or spouse) becomes eligible for Medicare first will be given the option to enroll in the
UnitedHealthcare Medicare Advantage plan or remain enrolled in the Waukesha County
Retiree Choice Plus health plan but without prescription drug coverage. The non-Medicare
member will be permitted to remain enrolled in the Waukesha County Retiree Choice Plus
health plan with prescription coverage.
1. If the Medicare eligible member chooses to remain covered under the Waukesha
County Retiree Choice Plus health plan, that individual must enroll in a Medicare Part
D prescription drug plan and the non-Medicare spouse will remain enrolled in the
Waukesha County Retiree Choice Plus health plan but with prescription drug
coverage. They will be billed the premium for one with Medicare and one without
Medicare.
13
2. At the time that the non-Medicare member becomes eligible for Medicare, the
individual may enroll in the UnitedHealthcare Medicare Advantage plan during the
initial eligibility period or remain enrolled in the Waukesha County Retiree Choice
Plus health plan and enroll in a Medicare Part D prescription drug plan. The member
who was previously eligible to enroll Medicare, but did not, will not be able to enroll
the UnitedHealthcare Medicare Advantage plan at that time. This individual must
time enrolment into the UnitedHealthcare Medicare Advantage plan with the
Medicare Open Enrollment period. Medicare Open Enrollment occurs from October
15 to December 7 of every year. Ultimately, both retiree and spouse will need to be
enrolled in the same option.
IV. Eligibility Rules – Death of Retiree
In the event of the death of a retiree, the surviving spouse will be permitted to remain covered under the County’s Retiree Health Insurance Program for as long as the County offers a health plan to retirees. The following coverage options will be made available to the surviving spouse and/or dependent children who are covered under the retiree’s health plan.
a. Surviving Spouse Not Eligible for Medicare – The spouse may enroll in the County’s Retiree Choice Plus health plan as a subscriber. Dependent children may also be covered under the surviving spouse’s policy until such time as they would normally cease to be eligible under the plan. At the time the surviving spouse becomes eligible for Medicare, he or she will be required to enroll and remain in the Medicare Advantage plan as a subscriber. Exception: The spouse may remain in the County’s Retiree Choice Plus health plan if dependent children are still covered under the policy.
b. Surviving Spouse Eligible for Medicare – The spouse will be eligible for all health plan options for the first 36 months following the death of the retiree. However, at the end of the 36-month continuation period, the spouse must enroll and remain in the Medicare Advantage plan. Exception: The spouse may remain in the County’s Retiree Choice Plus health plan if dependent children are still covered under the policy.
c. In the event that an alternative Medicare Advantage health plan is not offered, the surviving spouse may enroll and remain in the County’s Retiree Choice Plus health plan.
d. The spouse of a deceased retiree will not be permitted to cover a new spouse under the
County’s Retiree Health Insurance program.
14
FREQUENTLY ASKED QUESTIONS Q. If I do not turn in an enrollment form, will my health insurance coverage be cancelled?
A. No. Your current health insurance coverage and prescription drug coverage will automatically continue.
Q. Can I be denied coverage during the Open Enrollment period if I have a pre-existing medical condition?
A. No. Under our program, there are no exclusions for pre-existing medical conditions during the Open Enrollment period.
Q. Who administers the Waukesha County Retiree Choice Plus health plan?
A. UnitedHealthcare is the plan administrator. Q. If I cancel my retiree health insurance coverage, can I re-enroll at a later date?
A. No. If a retiree dis-enrolls, they are not permitted to re-enroll at a later date. Q. Will I receive a new ID card if I switch to another health plan?
A. If you newly enroll in the Waukesha County Retiree Choice Plus health plan with prescription coverage, you will receive one ID card from UnitedHealthcare. If you newly enroll in the Waukesha County Retiree Choice Plus health plan without prescription coverage, you will receive an ID card from UnitedHEalthcare for medical coverage only. You will receive a separate prescription ID card from whichever vendor you elect for Medicare Part D coverage.
If you newly enroll in the UnitedHealthcare Group Medicare Advantage plan, you will receive a new
insurance I.D. card from UnitedHealthcare. With the Medicare Advantage plan one card covers both your medical and prescription drug claims.
Q. When can I expect to receive my new ID card?
A. Your new card should be mailed to your home prior to January 1, 2018. Q. When should I begin using my new ID card?
A. Start using your new card beginning January 1, 2018. Be sure to inform your providers (doctors, clinics, pharmacies) that you have a new insurance ID card.
Q. I have Medicare. If I enroll in the Medicare Advantage plan, will my doctor still need to send my claims
to Medicare first and then to UnitedHealthcare? A. No. Your doctor will send the bill directly to UnitedHealthcare. Medicare will not be involved in the
claims processing. You will receive just one Explanation of Benefits form. Many of the plan’s covered services require you to pay a flat dollar co-pay, not a coinsurance. This means you will know upfront what you owe when you receive many of your services.
Q. Will the way I pay my monthly insurance premiums to Waukesha County change?
A. If you enroll in the UnitedHealthcare Medicare Advantage plan, UnitedHealthcare will bill you directly for your monthly premiums. If you enroll in the Waukesha County Retiree Choice Plus health plan, you will continue to pay Waukesha County via automated payment from your bank account.
15
To: Waukesha County Retiree Participants
Subject: Compliance Notifications
Date: September 28, 2017
Waukesha County is providing you with the following memo to ensure you are aware of federal notice regulations as they relate to your group health plan. We have included a copy of the Medicare Part D notice, which shows that the current prescription drug plan is creditable. We have also included a listing of additional notices relevant to the Waukesha County group health plan. If you would like a copy, contact Human Resources.
Please share this information with your dependents and/or plan beneficiaries. Included below is a listing of the notices with a brief description of each:
An overview of the notices is below:
• CHIP/CHIPRA – two required notices. Notice that outlines when eligible employees or dependents that are eligible but not enrolled, will be permitted to enroll if they lose eligibility for Medicaid or CHIP coverage or become eligible for a premium assistance subsidy under Medicaid or CHIP. Second notice outlines the contact information where employees may inquire about CHIP.
• General Notice of COBRA Continuation Coverage Rights – Notice to covered employees, covered spouses, and covered dependents of the right to purchase temporary extension of group health coverage when coverage is lost due to a qualifying event.
• Health Insurance Marketplace Coverage Options – Notice explaining the availability of insurance coverage through the Health Insurance Marketplace (Exchange).
• HIPAA Privacy Notice – Notice of Privacy Practices and an explanation of your privacy rights.
• HIPAA Portability Rights and Special Enrollment Rights – The Notice of Special Enrollment Rights outlines your right to join the plan at a future date if you should lose coverage due to a qualifying event.
• Medicare Part D Notice (Individual Creditable Coverage Disclosure Notice Language) – by October15th each year. Provided to active and retired employees and to Medicare Part D eligible individuals. This creditable coverage notice alerts you as to whether or not your prescription drug coverage is comparable to the Medicare Part D coverage.
• Newborns’ and Mothers’ Health Protection Act – Notice regarding hospital stays in conjunction with maternity.
• USERRA – Notice of rights, benefits and obligations of persons entitled to USERRA.
• Women’s Health and Cancer Rights Act – Notice of the availability of benefits for the required coverage and information on how to obtain a detailed description.
If you would like to receive a paper copy of the notices, please contact Human Resources at 262-548-7044 and the notices will be provided to you free of charge.
16
Important Notice from Waukesha County About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Waukesha County and about your options under Medicare’s prescription drug coverage. Waukesha County has determined that the prescription drug coverage offered by UnitedHealthcare in the Waukesha County Retiree Choice Plus Plan is creditable coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Waukesha County has determined that the prescription drug coverage offered by the Waukesha County Group Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
________________________________________________________________________
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Waukesha County coverage will be affected. See plan administrator for details. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D.
If you do decide to join a Medicare drug plan and drop your current Waukesha County coverage, be aware that you and your dependents will not be able to get this coverage back. See your plan administrator for details.
17
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Waukesha County and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information or call Human Resources at 262-548-7044. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Waukesha County changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the
“Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: September 28, 2017 Name of Entity/Sender: Waukesha County Contact--Position/Office: Human Resources Address: 515 W. Moreland Boulevard Waukesha, WI 53188
Phone Number: (262) 548-7044
18
Waukesha County Human Resources 515 W Moreland Blvd, Room A160
Waukesha, WI 53188
Recommended
