health plan changes for medicare-eligible retirees
DESCRIPTION
Health Plan Changes for Medicare-Eligible Retirees. Effective January 1, 2013. What is Changing. Reynolds American Inc. is changing the way it provides health care benefits to retirees who are eligible for Medicare More choices in health coverage through the individual market - PowerPoint PPT PresentationTRANSCRIPT
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Health Plan Changes for Medicare-Eligible Retirees
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Effective January 1, 2013
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What is Changing• Reynolds American Inc. is changing the
way it provides health care benefits to retirees who are eligible for Medicare– More choices in health coverage through the
individual market– In many cases, coverage available in the individual
market costs less than the current group plan through RAI.
– Access to benefit advisors to help with choosing coverage that fits your health-care and financial needs.
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Assistance Provided to You• Assistance in choosing individual health
coverage– RAI has made an arrangement with Extend Health, Inc. an
insurance broker that specializes in individual Medicare supplemental insurance coverage.
• Financial Assistance with purchasing medical coverage– Retirees and their dependents who are eligible for Medicare
and have been receiving a subsidy from RAI towards the cost of medical coverage will continue to receive financial help when they enroll through Extend Health.
– RAI will make an annual contribution into a tax-free account, called the Health Reimbursement Arrangement.
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4 CONFIDENTIAL |
Introducing Extend HealthThe Industry’s Largest Medicare Exchange
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• Independent company
• Partner with 75+ health plan carriers
• Objective and Trusted US based benefit advisors
• Focused on helping each participant make an informed
and confident decision
Who is Extend Health?
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Why Extend Health
• We are experienced in helping people just like you
• Our services are at no cost to you
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7 CONFIDENTIAL |
Market-Leading Private Sector Clients175 Employers – 40 Fortune 500 Companies
95%+ Client Retention Rate
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8 CONFIDENTIAL |
Plans & Partners
All Medicare Plan Types
• Medicare Advantage
• Medigap (supplement)
• Prescription Drug (Part D)
VisionDental
Select Carriers
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Educate
Evaluate/Enroll
Manage
The Process
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• Gather information – (e.g. prescriptions)– Pre-existing conditions will not limit your plan selection*– Give us a call: 855-835-3811– www.ExtendHealth.com/rai
EducationGetting Started Guide
* except end-stage renal disease
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• Prepare you for enrollment discussion• Review Medicare basics• Appointment confirmation letter
EducationEnrollment Guide
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Decision Support Tools
• Help Me Choose
• Prescription Profiler
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Licensed Benefit Advisor• 100% domestic workforce• Objective advocacy• Neutral compensation• Extend University• Licensed, certified, appointed• Average age 43
Hours of OperationMonday – Friday8 a.m. – 9 p.m. Eastern Time
Evaluate and Enroll
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Enrollment Process• Benefit Advisors can discuss
coverage options with anyone – need to speak to the participant to complete the enrollment.
• Once you have made a coverage selection, enrollment is conducted via telephone.
• 100% of calls are recorded.
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Medicare and You
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Your Future Coverage
Primary Coverage Medicare A & B
Additional Coverage (Your Choice) Medicare Advantage with
Prescription Drug (MAPD)
Medigap + Prescription Drug
Optional Coverage (your choice)
Dental and Vision
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17 CONFIDENTIAL |
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Initial Coverage You pay Deductible and co-pays for your plan Coverage for the first $2970 in actual cost of meds
Coverage Gap – Donut HoleYou pay 47.5% of brand drugs and 79% of generics until out of pocket costs reach $4750
Catastrophic CoverageYou pay $2.65 for generics and $6.60 for brand or 5% whichever is greater
Medicare PrescriptionDrug Coverage
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20 CONFIDENTIAL |
Location Specific plans
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Plan TypeNumber of Plans
Offered2012
Monthly Premium Company
Medicare Advantage
15 $0 - $100AARP, Humana,
BCBS of NC,
Medigap/ Medicare
Supplement
32 $58 - $191
AARP, Aetna, Humana, BCBS of NC,
American Continental
Part D 19 $15 - $113
AARP, Aetna, BCBS of NC, Cigna, CVS, Humana, Coventry,
WellCare, Community CCRx
Plan Availability in Winston/Salem
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Plan TypeNumber of
Plans Offered2012
Monthly Premium Company
Vision 1
$14 per person per monthAnnual eye exam: $15
Coverage for eye glasses, lenses and frames
Vision Service Plan (VSP)
Dental 2$19 - $48
$0 - $50 deductible$1,000 - $1,600 annual maximum
Humana, Delta Dental (Renaissance Dental)
Plan Availability in Winston/Salem
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– $0 per month
– $47 per month - network: PPO– Deductible: $0– Doctor co-pay: $15 Specialist co-pay: $40– Hospital: $195 co-pay days 1-6– Emergency Room: $65 co-pay if not admitted– Rx: $7/$40/$80/33%– Mail order: (90 day discount)
Plan Example
Medicare Advantage Plan
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– Medical/Rx $215 ($175 - $40)
– $173 – ($137/plan F + $36/pdp)
– Network: any doctor that accepts Medicare– Deductible: $0– Doctor co-pay: $0 Specialist co-pay: $0– Hospital: $0– Emergency Room: $0 co-pay– Rx: $0 deductible $7/$39/$74/33%– Mail order: (90 day discount)
Plan Example
Medigap Plan F and PDP – 70 year old male
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Auto-Reimbursement How the Process Works
Health Reimbursement Arrangement
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What Is An HRA?
• Tax-advantaged account used to reimburse you for eligible health care expenses
• You must meet Reynolds American Inc.’s eligibility requirements to qualify for HRA
• Your HRA funds will be available January 1, 2013
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Reynolds American Inc.
allocates benefit dollars
to HRA account of
eligible participant
Participant HRA
Account
Administered by Extend Health
Participant enrolls in a medical plan through Extend
Health to enroll in individual coverage
Participant is reimbursed for
healthcare expenses using
HRA benefit dollars
Health Reimbursement Arrangement: How It Works
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How to File a Paper ClaimParticipant pays plan premium or
co-pays
Participant fills out claim form, attaches required information
Extend Health verifies receipt of
payment and eligibility
Extend Health reimburses customer
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Extend HealthHRA Claim Form
Remember,You can be
Reimbursed for Part B by sending in your statement
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How Auto-Reimbursement Works
Participant pays plan premium to
insurance company
Insurance company forwards receipt of payment to Extend
Health
Extend Health verifies receipt of
payment and eligibility
Extend Health reimburses participant
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Next Steps
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Next Steps
Review “Getting Started Guide”
Gather Medicare Prescriptions and Doctor information
Call Extend Health (855) 835 -3811
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Post Enrollment Customer Service
Advocacy and support services• Toll Free number to contact Extend Health
representative• Direct support for claims issues, appeals and
network questions• Renewal process – ability to pick new coverage for
future years – not locked into this year’s choice• Ongoing enrollment services
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Questions