Changes for Plan Year 2018 (effective January 1, 2018) Agenda - - PowerPoint PPT Presentation

Changes for Plan Year 2018

(effective January 1, 2018)

2017 PEBTF Open Enrollment for Non-Medicare Eligible Retirees

2017 Open Enrollment

• Plan changes 2018
• Medical plan options
• Prescription drug benefits
• Other benefits
• Making the right decision

for you and your family

• Enrollment
• Additional Information

Agenda

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• PPO annual deductibles increase
• PPO copays increase
• PPO lab services
• Lab copay if you do not use Quest Diagnostics
• r LabCorp
• Plan buy-up for Choice PPO
• For retirees hired on or after 8/1/2003
• Prescription drug plan copays increase

Plan Changes for 2018

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Medical Plan Options PPO Option Custom HMO Narrow Network Choice PPO (Aetna) Basic PPO (Highmark) Regional (Aetna or Geisinger)

 Annual deductible  Annual deductible  No annual deductible & low copays  In-network and out-of- network benefit  In-network and out-of- network benefit  In-network only – IMPORTANT to look at the network before making a decision; www.pebtf.org  Plan buy-up for retiree who, as an employee, was hired on or after 8/1/03  No buy-up for retiree who, as an employee, was hired on or after 8/1/03  No buy-up for retiree who, as an employee, was hired on or after 8/1/03

Medical Plan Options

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Benefit Changes for 2017

Plans by Region

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• Choice PPO (Aetna)
• Offered in all regions
• Basic PPO (Highmark)
• Offered in all regions
• Flexible
• In-network and out-of-network benefits
• You receive greater benefits when you use in-network providers
• A referral is not required to see a specialist or to receive care outside of the

network

• Preventive care covered at 100%
• Refer to the REHP Benefits Handbook for a list of covered services
• Very important that you take a look at the plan’s network of providers

and facilities to ensure that your primary care physician and other providers (e.g., hospitals, physical therapists, urgent care) are in- network before enrolling in either plan

PPO Options

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• PPO copayments are the same for both

plans

PPO Options effective January 1, 2018

PCP Copay $20 Specialist Copay $45 (increase for 2018) Outpatient Therapies $20 Urgent Care $50 Emergency Room (waived if admitted) $200 (increase for 2018)

PPO Options – Copayments

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• If you use Quest Diagnostics or LabCorp,

there is no cost to you for covered lab tests.

• If you do NOT use Quest Diagnostics or

LabCorp, you will have a $30 lab copay.

• This is a change. In 2017, the cost of

the lab test was applied to your annual deductible.

• If you visit your doctor for the blood draw,

the office visit copay will still apply.

• The Open Enrollment Newsletter has

some examples of what you will pay under different scenarios. Check it out for more info!

Lab Services Under the PPO

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• Annual deductible amounts both in and
• ut of network

Choice PPO (Aetna) Basic PPO (Highmark)

In-network $350 single/$700 family* (on certain services) $1,200 single/$2,400 family* (on certain services) Out-of-network $700 single/$1,400 family * $2,400 single/$4,800 family*

*Each individual is responsible for his/her single deductible; see limit above for the most a family would have to pay in deductibles

PPO Options – Deductible Changes

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• The amount a member owes for health

care services before the plan begins to pay

• The PPO plans have an in-network and an
• ut-of-network deductible
• The HMO plan has no deductible; if you go
• ut of network, you pay 100% of costs
• Deductible applies to all services except
• Preventive care
• Primary care physician and specialist office

visits and outpatient therapy copays

• Emergency room and urgent care copays
• Covered diagnostic lab services

What is a Deductible?

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Yes No

Primary Care Physician (Regardless of Diagnosis)  Specialist  Immunizations  Preventive Care  Annual Physical/Well Visit  Inpatient Facility/Surgical  Outpatient Facility/Surgical  Diagnostic Imaging (X-Ray, MRI, CAT-Scan, PET)  Lab (bloodwork)  Lab (bloodwork at Quest or Labcorp) 

Understanding the Deductible

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Examples include, but are not limited to:

• You have outpatient surgery at a PPO in-network hospital
• You pay the in-network deductible and then the plan pays

100%

• Choice PPO – $350 single/$700 family (increase for 2018)
• Basic PPO – $1,200 single/$2,400 family (increase for 2018)
• You get an MRI at a network facility
• You pay the in-network deductible and then the plan pays

100% PPO – When You Will Pay the Annual In-Network Deductible

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Examples include, but are not limited to:

• You visit your primary care physician (PCP; your family doctor) for

a sore throat

• No deductible – pay PCP office visit copay of $20
• You visit an orthopedic surgeon
• No deductible – pay the specialist office copay of $45 (increase for

2018)

• Blood test at Quest Diagnostics
• Covered 100% – you pay no copay or deductible
• Blood test at an in-network hospital
• You pay a $30 lab copay (change for 2018)

PPO – When You Will Pay the Annual In-Network Deductible

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• Regional HMO networks:
• REHP Custom HMO Southeast –

Aetna

• REHP Custom HMO Central –

Aetna

• REHP Custom HMO West – Aetna
• REHP Custom HMO Northeast –

Geisinger

• Smaller network of providers
• Low copayments and no annual

deductible (no changes for 2018)

• Only in-network benefits
• Preventive care covered at 100%

(Refer to the REHP Benefits Handbook)

REHP Custom HMO Effective January 1, 2018

PCP Copay $5 Specialist Copay $10 Outpatient Therapies $5 Urgent Care Copay $50 Emergency Room (waived if admitted) $150 Annual deductible $0

IMPORTANT You must check the Custom HMO network to verify your doctor participates. Visit www.pebtf.org. If you’re selecting a new doctor, you should verify they are accepting new patients.

REHP Custom HMO

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• In-Network benefit only
• You must choose an in-network Primary Care Physician

(PCP) at time of enrollment

• Your PCP must refer you for all in-network services
• Networks are limited to help keep costs low
• Very important that you take a look at the plan’s network of

providers and facilities to ensure that your primary care physician and other providers (e.g., hospitals, physical therapists, urgent care) are in-network before enrolling in the plan.

• A customized network for REHP members is used for this plan

– visit www.pebtf.org > 2017 Open Enrollment

REHP Custom HMO

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Monthly Buy-Up Amounts for Choice PPO For Retirees Hired on or After 8/1/03ff In 2017, Retirees Hired on or after 8/1/03 pay In 2018, Retirees Hired on or after 8/1/03 pay $56.66 per month – single coverage $113.32 per month – family coverage $58.74 per month – single coverage $117.48 per month – family coverage

Choice PPO Plan Buy-Up

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• Retirees who, as an employee, were hired on or after 8/1/2003

pay a plan buy-up for the Choice PPO

• Deducted from monthly pension

• For PPOs and REHP

Custom HMO

• You visit your network

PCP for your annual physical

• You pay $0
• You get your annual

preventive mammogram

• You pay $0
• Your child has a well-

child visit and gets a covered immunization

• You pay $0

What Will You Pay Under Each Option

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• For PPOs and REHP Custom

HMO

• You visit your in-network PCP for

an earache

• $20 copay (PPOs)
• $5 copay (HMO)
• You visit an in-network specialist
• $45 copay (PPOs)
• $10 copay (HMO) – referral

required

• You get outpatient physical

therapy (in-network provider)

• $20 copay (PPOs)
• $5 copay (HMO)
• You sprain your ankle, are

treated and released

• At urgent care, $50 copay (PPOs

& HMO)

• At the emergency room
• $200 copay (PPOs)
• $150 copay (HMO)

What Will You Pay Under Each Plan

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• For PPOs and REHP Custom HMO
• MRI
• PPO – covered 100% after you meet the annual deductible
• HMO – covered 100% in-network (referral required, no

deductible)

• Inpatient surgery – in-network facility
• PPO – covered 100% after you meet the annual deductible
• HMO – covered 100% (referral required, no deductible)

What Will You Pay Under Each Option

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• Continues to be administered by CVS Caremark
• Continues to have a formulary, which is a list of the

preferred drugs

• 30 day supplies – network pharmacy
• 90 day supplies
• Mail order
• CVS pharmacy
• Rite Aid pharmacy

Prescription Drug Plan

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Your Copay Today Your Copay Effective January 1, 2018 Prescriptions at a Network Pharmacy Up to a 30 Day Supply Tier 1: Generic drug $10 $12 Tier 2: Preferred brand-name drug $20* $30* Tier 3: Non-Preferred brand-name drug $40* $60* CVS - Retail Maintenance & Mail Order Up to a 90 Day Supply Tier 1: Generic drug $15 $18 Tier 2: Preferred brand-name drug $30* $45* Tier 3: Non-Preferred brand-name drug $60* $90* Retail Maintenance at a Rite Aid Pharmacy Up to 90 Day Supply Tier 1: Generic drug $20 Rite Aid $24 Rite Aid Tier 2: Preferred brand-name drug $40 Rite Aid* $60 Rite Aid* Tier 3: Non-Preferred brand-name drug $80 Rite Aid* $120 Rite Aid*

*plus the cost difference between the brand and the generic, if one exists

Prescription Drug Copay Changes

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• Optum continues to administer the

mental health and substance abuse benefits

• Benefits mirror the medical plan
• ption you choose
• Outpatient mental health office visit

copay

• $20 – if enrolled in the PPO
• $5 – if enrolled in the REHP Custom

HMO

• DMEnsion continues to administer

the durable medical equipment (DME) prosthetics, orthotics, medical and diabetic supply benefit

Other Benefits

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• 1. Take a look at the plans available in your region
• 2. Check the plan’s network of doctors, providers and facilities to see if

they participate in the network

• Important if you are considering the REHP Custom HMO because it has

a limited network

• REHP Custom HMO offers lowest copayments, no annual deductible

and you need a referral for specialist care

• 3. Determine if you would like an out-of-network benefit – both PPOs
• ffer that
• 4. Both PPOs have annual deductibles on certain services
• 5. Consider the buy-up for the Choice PPO – retirees who were hired

hired on/after 8/1/2003 only Making the Right Decision for You and Your Family

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• During Open Enrollment – October 16 –

November 3

• If you want to change plans for 2018
• Follow the instructions in the Open Enrollment

newsletter mailed to your home in early October or view online at www.pebtf.org

• You may complete an online form or you may

download a paper form from the website.

• All enrollments must be done by November 3

Enrollment Instructions

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• Review the Open Enrollment

Newsletter

• Visit www.pebtf.org
• FAQs
• Links to medical plans online

directories

• Contact the PEBTF with

questions

• 717-561-4750
• 800-522-7279
• Email:
• penenrollment@pebtf.org

For More Information

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Questions

• Visit www.pebtf.org
• Contact the PEBTF with questions

717-561-4750 800-522-7279 Email: openenrollment@pebtf.org

• Medical Plans:

Choice PPO - Aetna 1-800-991-9222 www.aetna.com/dse/custom/pebtf Basic PPO – Highmark 1-888-301-9273 https://provdir.highmarkblueshield.com/; Select PPOBlue PEBTF Custom HMO: West – Aetna 1-800-991-9222 Central – Aetna 1-800-991-9222 Southeast – Aetna 1-800-991-9222 www.aetna.com/dse/custom/pebtf Northeast – Geisinger 1-800-504-0443 https://www.geisiner.org/pebtf 26