2019 Annual Enrollment Non-Medicare Eligible Retirees Jennifer - - PowerPoint PPT Presentation

Jennifer Gondorchin November 2018

2019 Annual Enrollment

Non-Medicare Eligible Retirees

• Annual Enrollment for Non-Medicare Eligible Retirees
• Medical Plans for Non-Medicare Eligible Retirees
• PPO plan Prescription Drug Changes
• Telehealth – PPO Plan
• The Affordable Care Act
• Medicare – Via Benefits Age-in Process
• Important Points To Remember
• Benefits Department Contacts
• Questions & Answers

Agenda

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2019 Annual Enrollment

• Fermilab’s Annual Enrollment applies only to retirees and dependents who are

not eligible for Medicare.

• Dependents of retirees enrolled in the Via Benefits program may be covered in

Fermilab’s retiree medical plan if the dependent is not Medicare eligible.

• The Annual Enrollment period is November 1 to 16.
• Changes take effect January 1, 2019.
• If you do nothing your medical plan and coverage tier will remain the same in

2019.

• All Medicare eligible retirees will continue to partner with Via Benefits for

medical and prescription drug coverage to supplement Medicare.

• This Annual Enrollment is not applicable to retirees with Medicare.
• Via Benefits communicates directly with Medicare eligible retirees about their

coverage options for 2019.

• This presentation will not address Medicare’s annual open enrollment or

related topics. These questions should be directed to Via Benefits.

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2019 Retiree Medical Change Form

• If you want to make a change to your

medical plan or coverage level for 2019 during this Annual Enrollment, use this form.

• Select the plan and select the

coverage tier.

• Enroll the participants in the plan.
• No new dependents may be added.
• Newly acquired dependents must be

added within 31 days of the event (i.e., marriage, birth or adoption).

• Also use this form to cancel coverage

effective January 1, 2019.

• If you cancel coverage or drop a

dependent you may not re-enroll.

• Return the form to the Benefits Office

by Friday, November 16, 2018.

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What is Annual Enrollment for retirees?

Annual enrollment gives our retirees an opportunity to change medical plans

• r coverage tiers (i.e., who is covered).

What happens if the retiree or spouse is moving to Via Benefits?

The member who is not on Medicare will stay on the current plan while the retiree or spouse moves to Via Benefits. If the remaining participant is not the retiree, the subscriber will now be the trailing dependent. A new ID card will be issued.

Do I have to do anything during Annual Enrollment?

If you do nothing your medical plan and coverage tier will remain the same in 2019.

2019 Retiree Medical Plan Enrollment - FAQ

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2019 Retiree Premiums

• Fermilab continues to subsidize premiums for our retirees

who are not yet eligible for Medicare.

• Effective January 1, 2019 retiree contributions will go up
• verall 14%. Some coverage tiers and plans are less than

14% and some are more than 14%.

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Coverage Tier BCBS PPO BCBS Blue Advantage HMO Single $263.07 $238.13 Retiree & Spouse $575.68 $498.19 Retiree & Child(ren) $480.62 $439.21 Family $822.20 $740.84

Medical Plans – BCBS – PPO

• Co-pays, deductibles and out of pocket maximums will

remain the same.

• No PCP selection or referrals required.
• Physician office visits covered at 100% after copayment.
• Includes x-ray and labs provided in doctor’s office during visit.

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In Network Out of Network Copayments $30 PCP, $40 Specialist Deductible Individual $500 Family Max $1,500 Individual $750 Family Max $2,250 Coinsurance You pay 10% after deductible You pay 20% after deductible Out-of-Pocket Max Individual $2,200 Family Max $6,600 Individual $4,150 Family Max $12,450

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Medical Plans – BCBS – Blue Advantage HMO

• You must select a Medical Group and Primary Care Physician

(PCP).

• All care must be received within your chosen Medical Group.
• All non-PCP provided services require a PCP referral.
• There is no out-of-network coverage except in emergencies.
• Physician and ER copayments will remain the same.

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In Network Out of Network Physician Copayments $20 PCP, $30 Specialist N/A ER Copayment $150 Deductible N/A N/A Coinsurance N/A N/A Out-of-Pocket Max Individual $1,500 Family Max $3,000 N/A

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PPO Plans Prescription Drug Formulary Changes

• Effective January 1, 2019 the Express Scripts formulary will have some minor
• changes. If you or a covered dependent are impacted by the change you will

receive a letter from Express Scripts notifying you of the change and outlining the steps you need to take.

• The chart shows a snapshot of the drug classifications impacted by the changes.

Some of the drugs may require prior authorization before the plan will pay for the drug.

• Some drugs may require you to try utilizing a different drug before the plan will pay

for the higher cost drug. This approach, which is intended to control the costs posed by prescription drugs, is also known as step therapy.

• Drug quantity limits are in place for some drug categories.

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PPO Plans Prescription Drug Formulary Changes

Prior Authorization Step Therapy Drug Quantity Limits

Allergies Blood Cell Deficiency Anti-infective Specialty Asthma Specialty Bone Conditions Asthma – Specialty Bone Conditions BPH Blood Cell Deficiency Diabetes Fertility Bone Conditions High Blood Cholesterol Growth Hormone Diabetes Inflammatory Conditions Hepatitis C Endocrine Disorder Narcolepsy High Blood Cholesterol Fertility Pain High Blood Pressure Hepatitis C Sexual Disorders Inflammatory Conditions High Blood Cholesterol Skin Conditions Mental Health/Behavioral Health High Blood Pressure Sleep Disorder Metabolic, Immune disorders or Inherited Rare Disease Inflammatory Conditions– Specialty Multiple Sclerosis Multiple Sclerosis Multiple Sclerosis Osteoarthritis Oncology Pain Neurological Disorders Pulmonary Arterial Hypertension Pulmonary Hypertension Hormone Supplementation Migraine Headaches Impotence 11/2/2018 Jennifer Gondorchin | 2019 Annual Enrollment - Non-Medicare Eligible Retirees 10

Telehealth – MDLIVE – PPO plans only

• MDLIVE is an integrated BCBSIL partner
• $15 co-pay for a virtual visit; 50% reduction from traditional
• ffice visit
• MDLIVE treats over 50 non-emergency medical conditions:

– Common cold, Allergies, Constipation, Cough, Diarrhea, Ear Problems, Pink eye, Rash, Respiratory Problems, Sore throat, UTI (Females, 18+), Fever, Flu, Headache, Insect Bites, Nausea, Vomiting

• Behavioral health – Counselor and Psychiatrist
• Dermatologist

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When to Use Virtual Visits

Non-Emergency Medical Conditions

• Allergies
• Cold and flu
• Diarrhea
• Earache
• Fever
• Headache
• Insect bites
• Nausea
• Pinkeye
• Sore throat

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Schedule a Visit

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Note: Service availability and communication mode dependent upon member’s location at time of service.

MDLIVE, an independent company, that provides virtual visit services for Blue Cross and Blue Shield of Illinois. MDLIVE operates and administers the virtual visit program and is solely responsible for its operations and that of its contracted providers.

BY ONLINE VIDEO

MDLIVE.com/BCBSIL Visit MDLIVE’s website and log in with username and password Automatically connect with an available doctor via

• nline portal or schedule a

future appointment

888-676-4204

Call toll-free hotline 24/7/365 Speak with a care coordinator to confirm a virtual visit is appropriate and be directed to a list of eligible doctors to select from Automatically connect with an available doctor

• r schedule a future

appointment

BY TELEPHONE BY MOBILE APP

Log in to mobile app with username and password Automatically connect with an available doctor via smartphone or schedule a future appointment Receive system assistance to confirm a virtual visit is appropriate, and view a list of doctors using specialty, language, gender, location or next available doctor criteria Receive system assistance to confirm a virtual visit is appropriate, and view a list of doctors using specialty, language, gender, location or next available doctor criteria

Log in via Blue Access for Members

SM or

mdlive.com/bcbsil, choose location* and doctor for visit Choose first available provider or schedule an appointment Provide a brief medical history, pharmacy information and method

• f payment

Receive confirmation and visit the doctor

• r therapist!

Requesting a Virtual Visit

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*Each state has different regulations for virtual visits. The state the member is in when requesting a virtual visit will determine whether the consultation is by phone or by video.

Jane Doe Jane Doe

Using Your Preventive Care Benefits

• Receiving preventive care services and

establishing a relationship with a primary care physician is important at all ages.

• Both medical plans cover preventive care services

when utilizing an in-network provider.

• Patients who maintain a relationship with a

primary care physician and receive regular preventive care treatment have fewer emergency rooms visits, fewer hospital stays, and are more likely to lead an active lifestyle as they age.

• Consider using the following resources to locate a

primary care physician: – Search www.bcbsil.com. – Ask fellow retirees, family and friends for a referral and read the physician’s online reviews.

• Review the adult wellness guidelines from the

American Academy of Family Physicians provided by BCBS of IL.

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Go Mobile! Access benefits information via mobile device

• Are you always on the go?
• Mobile apps allow you to access the information you need when you

need it.

• Blue Access mobile allows secure access to healthcare coverage

information, claims status, provider search and ID cards from your mobile device.

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ACA Mandated 1095 Reporting

• The Affordable Care Act (ACA) requires employers to provide a statement to employees and retirees that

includes information about the type of healthcare coverage offered to the employees, if any, during the prior year.

• This statement is to be filed with the employee’s Federal tax return. Think of the Form 1095 as a type of W-

2 for the health insurance offered to you during the year. The 1095 forms must be provided to retirees by January 31, 2019.

• The 1095 form is your proof that you had the required coverage. Retirees that were covered either in the

active employee plan or retiree non-Medicare eligible plan for any portion of 2018 will receive a form.

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Medicare

• Medicare is a health insurance program mainly for people age 65 or older, or who are

determined to be disabled by Social Security.

• The retiree becomes eligible for the Via Benefits program on the first day of the month after

the first full month that the retiree is eligible for Medicare (age 65). – Example: a retiree turns 65 on 3/28/19. The retiree is eligible for Via Benefits on 5/1/19. The group coverage through Fermilab ends on 4/30/19. – You must be enrolled in Medicare to participate in this program.

• Retirees and their dependents who are eligible for Medicare must enroll in Medicare Part

A and Part B timely or they risk gaps in coverage, or denial of coverage.

• If you are becoming Medicare eligible because you are turning 65, your enrollment period

is the three months before and after your birthday. The enrollment period for those eligible for Medicare due to disability is different.

• There will be a late-enrollment penalty imposed by Medicare if you do not enroll in Part B

during your designated enrollment period. This penalty is permanent, and is added to all future monthly Part B premiums.

• For more information about Medicare, visit their website at:

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http://www.medicare.gov

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2019 Retiree Medical – Via Benefits

• All Medicare-eligible retirees and dependents will select an individual medical

plan to supplement Medicare with help from a licensed benefit advisor at Via Benefits.

• If a retiree enrolls in a Medigap plan he/she also enrolls in a prescription drug

(Part D) plan that fits the retiree’s individual needs at this time.

• Medicare Advantage plans include prescription drug coverage.
• Dental and vision insurance policies are also available.
• Fermilab provides a subsidy of $175/month, per person, funded to a Health

Reimbursement Account (HRA) to pay for the chosen plans.

• The account may be used to pay insurance premiums, Medicare Part B

premiums and other health care expenses not covered by insurance.

• If a retiree is Medicare-eligible and his/her spouse is not, the spouse remains

in the current Fermilab PPO or HMO until Medicare-eligible.

• If the spouse is Medicare eligible, and the retiree is not, the spouse joins

OneExchange.

• These changes also apply to former employees who are receiving benefits in

Fermilab’s Long Term Disability Plan who are eligible for Medicare.

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Via Benefits – Age-in Process

• Current and future retirees who are not Medicare eligible now will

“age into” the plan.

• Via Benefits sends a letter to the retiree (or spouse) 6 months prior

to the retiree’s (spouse’s) 65th birthday encouraging the retiree to make a telephone appointment with a Benefit Advisor.

• Via Benefits will send an enrollment guide 3 months prior to 65th

birthday.

• The retiree is eligible for the Via Benefits program the first day of

the month following a full month after he/she turn 65.

• This allows enough time to enroll in Medicare and select a plan

through Via Benefits.

• Example: Mr. Retiree turns 65 on 2/14/19. He is eligible for the

Via Benefits plan effective 4/1/19. The group coverage through Fermilab ends on 3/31/19.

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Important Points to Remember

• 2019 retiree medical plan changes can be made from November 1-16.
• Changes effective January 1, 2019.
• If you do nothing your medical plan and coverage tier will remain the

same in 2019.

• ID cards will be mailed in mid-December.
• New BCBS ID cards will be issued for the PPO plan.
• The ID card for the PPO plan will show only the retiree’s name.
• You can order extra cards by calling Blue Cross Blue Shield or Express

Scripts.

• Fermilab’s retiree medical plan in 2019 covers only retirees and/or

dependents who are not Medicare eligible.

• All Medicare eligible retirees or dependents move to Via Benefits after

they become Medicare eligible

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Benefits Vendor Contacts

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Benefits Team

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• We are committed to providing excellent service and

look forward to assisting you.

• The Benefits office hours are M-F 8:30 a.m. – 5 p.m.

Jennifer Gondorchin Laboratory Benefits Manager 630.840.4361 jgondo@fnal.gov Ann Marie Matthei Benefits Administrator 630.840.3395 amatthei@fnal.gov Maria Lifka Benefits Specialist 630.840.8569 mlifka@fnal.gov

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Questions & Answers

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