2009 retiree luncheon march 23, 2009
DESCRIPTION
2009 RETIREE LUNCHEON MARCH 23, 2009. 2009 Benefit Plan Update. Medical Plan Changes Non-network Option and HDHP Option now have unlimited Preventive Care Benefit physician must file with Medicare first Full Time Student Status no longer required for Dependent Children up to age 25 - PowerPoint PPT PresentationTRANSCRIPT
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2009 Benefit Plan Update
Medical Plan Changes– Non-network Option and HDHP Option now
have unlimited Preventive Care Benefit• physician must file with Medicare first
– Full Time Student Status no longer required for Dependent Children up to age 25–must satisfy eligibility plan provisions for
dependent child
– Added Medicare Crossover service
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2009 Benefit Plan Update (continued)
Dental Plan Changes– Increased benefit coverage for composite
fillings– allows a benefit composite fillings
regardless of tooth location
– Salaried Retirees will now have access to continue Dental coverage as Post-65 Retiree– same coverage offering as Hourly program
– Retirees pay 100% of the contribution
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2009 Benefit Plan Update (continued)
Vision Program– No Plan Design Changes – Full Time Student Status no longer
required for Dependent Children up to age 25–must satisfy eligibility plan provisions
for dependent child
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Medicare Crossover Highlights of Medicare Crossover• Medicare Cross-Over is the process by which
Medicare automatically forwards medical claims to UnitedHealthcare for processing
• Based on agreements with the Medicare Part B and Durable Medical Equipment (DME) claim processors
• UHC will be able to keep out-of-pocket balance current
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• Medicare Cross-Over is available to any Medicare-primary CITGO enrollee.
• It is available to both enrollees and their Medicare-eligible dependents, if they do not have group coverage from another source.
• Medicare pays first, then claims are submitted electronically to UnitedHealthcare.
• Process eliminates provider submission of claim to UHC after Medicare processing
Medicare Crossover (continued)
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Coordination of BenefitsMedicare Part D Prescription Drug Plan(continued)
• If you enroll in Medicare Part D you and your covered dependents will no longer be eligible to participate in the CITGO Medical Plan
• The CITGO Prescription Drug program meets the requirement for creditable coverage
• Must be enrolled in Part A and B to be eligible for Medicare Part D
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Coordination of BenefitsPreventive Care Benefits• Preventive care benefits are now eligible
for a 100% benefit when not covered by Medicare.
• Routine screenings and immunizations are covered under the CITGO plan
• The 2009 Medicare Preventive Care benefits can be found on the Medicare website at http://www.medicare.gov/Publications/Pubs/pdf/10110.pdf
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Coordination of BenefitsPreventive Care Benefits (continued)
• Your physician must still file with Medicare for the CITGO plan to process the benefits as the secondary plan
• Filing with Medicare is required in order for the CITGO plan to process secondary benefits
• Because the CITGO plan is secondary to Medicare, the filing requirement applies even when Medicare is not going to pay a benefit
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Retiree Medical BenefitsEligibility Requirement for Retiree
Medical
10 Years Continuous Plan Participation while in active employment AND
Meet one or more of the following:Age plus service equals 70 pointsOR• Retire under Company retirement planOR• Age 55 or older and eligible to retire from
the Pension Plan
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Retiree Medical BenefitsEligibility (continued)• Can waive and re-enroll at a future date
– Enrollment allowed at Annual Election or when you have a Qualified Change in Status
– No pre-existing condition exclusions– Enroll at Annual Election or Change in
Status• Other coverage primary • Continue to receive important and critical
benefits information you should always review.
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Retiree Medical BenefitsSpouse Eligibility • CITGO Retiree becomes Medicare eligible
before eligible spouse– Not eligible for network options– Coverage Non-Network Medical Option
• Eligible Spouse becomes Medicare eligible before CITGO retiree– Coverage for retiree remains the same– Medicare becomes primary payer for the
spouse– Medicare coordination of benefits is
applied
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Retiree Medical BenefitsSpouse Eligibility (continued)• CITGO Retiree dies before eligible spouse
– Coverage continues– Medical options depend on spouse’s
eligibility for Medicare• Eligible children
– Eligible for coverage up to age 25 – Full Time Student Status no longer
required for Dependent Children up to age 25• must satisfy eligibility plan provisions
for dependent child
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Retiree Medical Benefits when Retiree is NOT
Medicare Eligible• Same medical plan options as active
employees• CITGO is the primary plan• CITGO secondary for dependents age 65
and over• Includes same Prescription Drug Program
available to Active Employees
Retiree Medical Benefits
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Retiree Medical BenefitsRetiree Medical Benefits when Retiree is
Medicare Eligible• Medicare becomes the primary payor
– Medicare Part A – Hospital – Medicare Part B – Medical Expenses
• CITGO becomes secondary not a supplement
• CITGO Plan provides a “carve-out” benefit and does not “supplement”
• CITGO primary for < age 65 dependents• Includes full Prescription Drug Program
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Prescription Drug ProgramRetiree Coverage is Same as Active
Coverage• CITGO is the primary plan for both Pre-65
and Post-65 Retirees except when– You enroll in Medicare Part D– You are enrolled as an Active Employee
under another employer plan• Prescription drug program benefits
– not subject to deductible – not subject to annual or lifetime limits
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Prescription Drug Plan Snapshot
For Short-Term and ImmediatePrescriptions
Retail Pharmacy Program*
Up to a 31 day supply.
You pay 30% with $10 minimum a $200 maximum per prescription for Tier 1 and Tier 2.
You pay 40% with $10 minimum and a $200 maximum per prescription for Tier 3.
You pay 40% with $10 minimum and a $200 maximum per prescription for Tier 3.
For Long-Term and MaintenanceMedications
Mail-Order Program*
Up to a 90 day supply:
$25 for Tier 1
$50 for Tier 2
$75 for Tier 3
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Retiree Dental BenefitsPre-65 and Post-65 Retiree Dental• Applies to Hourly and Salaried Retirees• Same as active employees
• CIGNA Preferred Provider Program (PPO)
• Retiree is responsible for 100% of the contribution for Retiree
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Dental Benefits SnapshotBenefits Covered Services Coverage - You Pay
Preventive and Diagnostic
Two oral examinations per year, routine cleaning and scaling, and X-rays.
You pay 0%
BasicFillings, extractions, oral
surgery, periodontics and endodontics
You pay 20% after calendar year deductible
Major RestorativeCrowns, bridges and
dentures You Pay 50% after calendar
year deductible
OrthodonticBraces and other
appliance therapy You Pay 50%
Deductible $50 per person per year
Dental Maximum $1,500 per person per lifetime for orthodontia
Orthodontic Maximum $1,500 per person per lifetime for orthodontia
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Retiree Vision BenefitsUnited Healthcare Vision - SPECTERA)• Same coverage as Active Employees• Provides coverage for routine eye exam,
corrective lenses, eyeglass frames, contact lenses
• Discount available on progressive lenses• In-network benefits available after
applicable copay• Out of Network benefits available• Coverage available for your dependents
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Vision Benefits Snapshot
Benefits In-Network Covered Services You Pay
Comprehensive Vision Exam Once Every 12 months by a network optometrist or ophthalmologist
You pay $10
Materials You pay$25Materials copay applies to the
entire purchase of eyeglasses(lenses and frames), or contactsin lieu of eyeglasses
Pair of lenses (for eyeglasses) once every 12 months for standard single, lined bifocal, lined trifocal, standard lenticular:
Frames Once every 24 months
Elective Contact Lenses (in lieu of eyeglasses)
Once every 12 months
Deductible None
Refractive Eye Surgery Discounts available from Spectera providers
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Long Term Care InsuranceAetna insures the Long Term Care • Personal care, health care and social
services– Assistance with normal activities of daily
living– Assistance if you have a serious Cognitive
disorder such as Alzheimer’s Disease• For more information:
– Call Aetna at 1-800-537-8521 or– Learn more at the website: www.aetna.com/group/citgo
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For More Information • Log on to www.hr.citgo.com to view your benefit information using your Retiree PRNR
For personal questions contact the Benefits HelpLine toll free at 1-888-443- 5707
You can also email: [email protected] this MaterialThis material provides an overview of CITGO’s Retiree benefits. The benefits described are governed by legal plan documents, contracts, and insurance policies. If a conflict should occur, the legal plan documents, acts, and insurance policies will prevail.