wps medicare companion · 2018-11-07 · 7. you deserve to live your life health care and health...

WPS MEDICARE COMPANIONYou’re never alone—we’re committed to helping you with your health careRates effective January 1, 2019

]

Choose the right Medicare supplement insurance with complete customer support!Visit mywpsmedicare.com

Plans A, C, F, G, K, L, and N

Neither Wisconsin Physicians Service Insurance Corporation, nor The EPIC Life Insurance Company, nor their products nor agents are connected with or endorsed by the United States government or the federal Medicare program. WPS Health Insurance is underwritten by The EPIC Life Insurance Company. MO_SALES_1712

Underwritten by:

The EPIC Life Insurance CompanyA WPS Company

MO

2 | mywpsmedicare.com | 1-800-236-8809

ContentsMedicare alone is not enough ............................................................. 2

Peace of mind and complete customer support ............................. 2

Top 7 reasons to choose WPS Medicare Companion ................. 3

Valuable programs included with your plan ................................. 4-7

WPS provides convenient payment options .................................... 8

Enrollment timeline..... ............................................................................ 9

Premium rates ..................................................................................10-13

Parts of Medicare .................................................................................14

Limitations and exclusions ..................................................................14

Medicare is a valuable benefit, but it doesn’t pay every-thing. Deductibles and coinsurance can add up. If you have Medicare alone, there’s a chance a serious illness or injury could exhaust your savings. WPS Medicare Companion supplement plan helps protect your health and retirement savings.

Peace of mind and complete customer supportWPS has been providing coverage as a not-for-profit health insurance company in Wisconsin since 1946, and has served people on Medicare since Medicare began. WPS provides our friends and neighbors with excellent coverage and personal service. Now, we’re offering the same great service and coverage in Missouri with Medicare supplement plans that are underwritten by The EPIC Life Insurance Company.

Medicare alone is not enoughWPS Medicare Companion has your back

“I know other people who are frightened by Medicare. But not us—WPS helps us every step of the way.”

—Linda K. member since 2015

Eliminate the worry“ “Local service ensures you get the kind of attention you need when you have questions. We know your concerns and are equipped to help you get the answers you need to your Medicare supplement questions. WPS has your back!

Wayne R. helps seniors get the most from their Medicare supplements.

1-800-236-8809 | WPS Medicare Companion | 3

Top 7 reasons to choose WPS Medicare Companion

1. Freedom to choose your own doctors and hospitals that accept Medicare anywhere in the U.S. Keep your doctor or select a new doctor at any time. You have complete freedom to choose! And if you move, your coverage moves with you—anywhere in the U.S.

2. Less paperwork, fewer worries Automatic claims service means you don’t have to worry about filing claims or dealing with medical bills. Medicare sends WPS your claims electronically, so we handle them while you enjoy almost no paperwork.

3. Save money with our discounts WPS offers a 7% discount when you and a second household member are enrolled in a WPS Medicare supplement plan.1 You also can get a 2% discount when you choose automatic bank withdrawal.

4. You can always keep your plan as long as you pay your premium Your policy will never be canceled because of your health. As long as you pay your premium on time, your plan is guaranteed renewable for life.

5. You get treated like family When you call WPS, you reach caring people right here in our home state of Wisconsin. Your questions are answered promptly and accurately by our highly trained Customer Support team.

6. Strong commitment to ethics In 2018, WPS Health Insurance was named one of the World’s Most Ethical Companies® for the ninth year in a row by the international Ethisphere® Institute.2

7. You deserve to live your life Health care and health insurance are important, but honestly, you’ve got better things to do than worry about all of it. Let WPS help handle your medical bills while you handle all the activities you enjoy.

1Household: Two or more individuals who reside together in the same dwelling. Dwelling is defined as a single home, condominium unit, or apartment unit within an apartment complex. 22010-2018 World’s Most Ethical Companies®, Ethisphere® Institute, worldsmostethicalcompanies.ethisphere.com.

“


Valuable programs included with your planWPS strives to provide the greatest value possible to its members. WPS Medicare Companion includes an impressive collection of added benefits that costs absolutely nothing extra for members.

The Silver&Fit® Exercise and Healthy Aging Program1

When you choose Plans A, C, F, G, or N (not available with cost-sharing Plans K and L), you also get this great perk! At no extra cost, the Silver&Fit program gives you a fitness club or exercise center membership.

The Silver&Fit network in Missouri includes national and regional fitness chain locations as well as many independent local gyms. Participating facilities include:2

Fitness Chains with Locations Across Missouri

Gold’s Gym Curves Planet Fitness

Anytime Fitness Snap Fitness YMCA

St. Louis area

» St. Louis Fitness Club

» Sunset Hills Community Center

» The Workout Company

» Longevity Wellness Center

» City of St. Peters Rec-Plex

» Centennial Commons

Please note that these programs are not insurance. 1The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit, Silver&Fit logo, and the Silver&Fit Signature Series are registered trademarks of ASH. ChooseHealthy is a product of American Specialty Health Administrators, Inc., a subsidiary of American Specialty Health Incorporated. Services that require an additional cost are not included in the Silver&Fit program. You should check any insurance benefits you have before using this discount program, as those benefits may result in lower costs to you than using this discount program. The discount program provides for discount specialty health care services from participating practitioners. You are obligated to pay for all health care services, but will receive a discount from those health care practitioners who have contracted with the discount program. The discount program does not make payments directly to the participating practitioners in the discount program. The discount program has no liability for providing or guaranteeing services and assumes no liability for the quality of services rendered. Fitness discount programs are not part of the insurance policy and are offered at no additional charge. Enrollment in these programs is subject to contract renewal. The Silver&Fit and ChooseHealthy programs are not included with Medicare supplement cost-sharing Plans K and L. 2The facilities listed are participating in the Silver&Fit network as of Sept. 2018. For the most up-to-date listing of participating facilities, please visit silverandfit.com.

The Silver&Fit network is continually growing, including the additions of facilities nominated by WPS members. Visit silverandfit.com for a complete list of participating facilities.

Plus, additional facilities in these areas and in many other parts of the state!

Springfield

» Genesis Health Clubs

» 10 Fitness

» Advance Fitness

Kansas City/Independence area

» Eagle Fitness

» Liberty Community Center

» Genesis Health Clubs

» Kingswood Senior Living Fitness Center

» Legacy Park Community Center

» Platte County Community Center South YMCA

» Blue Bicycle Health and Fitness

» Fit For Life

» Raytown Schools Wellness Center

The ChooseHealthy® Affinity Program1The Silver&Fit program also offers: » Fitness clubs with group classes for older

adults, where available, such as:• Signature Series• Senior Dance• Senior Yoga• Aqua• Cardio• Strength• And more

Or, if you would prefer to work out at home, home fitness kits are available which can include:

• DVDs• Pedometer• Quick starts guides• And more

» Fitness challenges and rewards

» And more

All WPS Medicare Companion plan options, except cost-sharing Plans K and L, also include the ChooseHealthy program at no extra cost. You receive valuable discounts on services from nearly 33,000 providers in the ChooseHealthy network, including:

» Chiropractors

» Acupuncturists

» Massage therapists

» Registered dietitians

You also get a broad choice of health and wellness products in the online store:

» Vitamins and minerals

» Food supplements

» Sports nutrition

» Herbs and botanicals

4ChooseHealthy is a product of American Specialty Health Administrators, Inc., an affiliate of ASH Group and a subsidiary of American Specialty Health Incorporated.

1-800-236-1448 | WPS Medicare Companion | 5 1-800-236-8809 | WPS Medicare Companion | 5

EyeMed Vision Care discount program

All WPS Medicare Companion members receive access to the EyeMed Vision Care discount program at no additional cost.1 EyeMed offers substantial savings on eye care and eyewear at thousands of provider locations nationwide.

WPS Medicare Companion members receive a discount simply by showing their WPS ID card at participating EyeMed providers and mentioning EyeMed discount.

EyeMed’s provider network includes many familiar optical retailers, including:

» America’s Best Contacts & Eyeglasses » Clarkson Eyecare » LensCrafters » Pearle Vision » Sears Optical » Target Optical » Vision Source Eyecare » and many more!

Find a vision care provider in your area:

Vision Care Services Member Benefits

Eye exam (with dilation, as necessary)

$5 off routine exam$10 off contact lens exam

Complete Pair Eyeglass Purchase2

Frames

Any available frame at provider location 35% off retail price

Standard Plastic Lenses

Single vision $50

Bifocal $70

Trifocal $105

Lens Options

UV coating $15

Tint (solid and gradient) $15

Standard scratch-resistant coating $15

Standard polycarbonate $40

Standard anti-reflective coating $45

Standard progressive (add-on to bifocal) $65

Other add-ons and services 20% off retail price

Contact Lenses (discount applies to materials only)

Conventional 15% off retail price

Laser Vision Correction

LASIK or PRK from U.S. Laser Network

15% off retail price5% off promotional price

Frequency of use for examination, frames, lenses, or contact lenses unlimited

1Vision discount program is not insurance, nor is it part of the insurance policy, and is offered at no additional charge. Enrollment in this program is subject to contract renewal. 2Frame, lens, and lens option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price. Benefits may not be combined with any discount, promotional offering, or other group benefit plans, except as indicated. Discount plan is effective Oct. 1, 2018 through Sept. 30, 2020.

Call EyeMed toll-free at 1-866-559-5252

EnrollWithEyeMed.com/access


Hear In America programThe Hear In America discount program, available to all WPS Medicare Companion members, makes you eligible to receive:

» Free hearing screenings

» A three-year warranty on new hearing aids

» Free office services (including retests, cleanings, and adjustments) for three years

» A 45-day trial period for your hearing aid

» Discounts from 35 to 70% off of manufacturer’s suggested retail price (MSRP) for hearing aids from all 9 major manufacturers including:

Sample SavingsMSRP or

Average PriceYou Pay* Savings % Saved

FREE annual hearing screening $0 100%

Three-year repair warranty, three-year loss and damage warranty

$500 $0 $500 100%

Three years of hearing aid batteries $315 $0 $315 100%

Three years of office service $600 $0 $600 100%

12 months financing (to those who qualify)$0 service charges

and interestUp to

$1,160

Basic digital hearing aid $1,450 $995 $455 31%

Mid-level hearing aid $3,995 $1,475 $2,520 63%

Premium digital hearing aid $5,996 $2,540 $3,456 58%

Examples of how you can save

• Phonak• Starkey• ReSound• Rexton• Siemens• Sonic Innovations• Oticon• Unitron• Widex

*These are savings examples only. May be used in conjunction with your existing insurance coverage. Hearing discount programs are not part of the insurance policy and are offered at no additional charge. Enrollment in these programs is subject to contract renewal.



WPS Medicare Companion has seven smart plan options

• Automatic bank withdrawal (includes 2% discount!)• Credit/debit card payment• Direct billing

Please see the WPS Medicare Companion enrollment application for additional instructions for selecting a payment option.

Choose from convenient payment options

Coverage of Plan A Plan C Plan F Plan G Plan K Plan L Plan N

Basic benefits √ √ √ √ √1 √2 √

Part B coinsurance √ √ √ √ √1 √2 √3

Part A deductible √ √ √ 50% 75% √

Skilled nursing facility coinsurance

√ √ √ 50% 75% √

Foreign travel emergency

√ √ √ √

Part B excess charges

√ √

Part B deductible √ √1After deductible, hospitalization and preventive care paid at 100%; other basic benefits paid at 50%. Out-of-pocket limit set by CMS; pays at 100% after limit reached.2After deductible, hospitalization and preventive care paid at 100%; other basic benefits paid at 75%. Out-of-pocket limit set by CMS; pays at 100% after limit reached.3After deductible, requires up to $20 copayment for office visits; up to $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible.


Turn

65!Turn

65!

If you apply during your one-time open enrollment period, you won’t need to answer any health questions; simply submit a policy enrollment application.

One-time open enrollment

period ends

You cansubmit an application

or enroll in Part B

66Months

AfterMonths

After

33Months Before

Months Before

Enrollment timeline when you enroll in Medicare Part B—by turning 65

or due to disability

WPS Medicare Companion monthly premium ratesEffective January 1, 2019Determine your rate area:

Area 1=St. Louis and Kansas City metro areas630_ _: All ZIPs that begin with these 3 numbers631_ _ : All ZIPs that begin with these 3 numbers633_ _: All ZIPs that begin with these 3 numbers640_ _: All ZIPs that begin with these 3 numbers641_ _ : All ZIPs that begin with these 3 numbers

Area 2=All other Missouri ZIP codes

RelocationIf, in the future, you permanently relocate to another state, Area 1 rates will apply. If you relocate to another Missouri ZIP code, you will pay the rates for the area to which you move.

21

Rating Area

Have other coverage that’s terminating or changing?If so, you may be eligible for guaranteed acceptance of this policy. Contact your agent or call a WPS sales representative at 1-800-236-8809 for information.

Enroll anytime after you turn 65Already passed the 65-year milestone?You can switch Medicare supplement plans at any time throughout the year. You don’t have to wait for an annual enrollment period like you do with Medicare Advantage plans. It’s easy to make the switch! Just contact your agent or call a WPS sales representative at 1-800-236-8809.

Coverage begins on the first of the month that you turn 65 and/or enroll in Medicare Part B, or on the effective date you request up to three months in the future.

*Hou

seho

ld: T

wo

or m

ore

indi

vidu

als

who

resi

de to

geth

er in

the

sam

e dw

ellin

g. D

wel

ling

is d

efine

d as

a

sing

le h

ome,

con

dom

iniu

m u

nit,

or a

part

men

t uni

t with

in a

n ap

artm

ent c

ompl

ex.

Are

a 1

Rat

es—

Mal

e7%

Hou

seho

ld D

isco

unt:

Get

the

best

rate

pos

sibl

e w

hen

you

enro

ll w

ith a

se

cond

mem

ber o

f you

r hou

seho

ld.*

You

each

pay

the

“You

with

Dis

coun

t”

rate

sho

wn

belo

w.

Not

e: R

ates

incl

ude

a 2%

dis

coun

t for

mem

bers

who

enr

oll

in a

utom

atic

ban

k w

ithdr

awal

. Tho

se w

ho p

ay b

y cr

edit

card

or

pap

er b

ill w

ill p

ay a

slig

htly

hig

her p

rem

ium

than

thos

e lis

ted

here

. Ple

ase

cont

act u

s w

ith a

ny q

uest

ions

.

Age

W

hen

Pla

n Ta

kes

Eff

ect

Pla

n A

Pla

n C

Pla

n F

Pla

n G

Pla

n K

Pla

n L

Pla

n N

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

6515

6.28

14

5.34

23

6.47

21

9.92

23

6.97

22

0.39

21

0.19

19

5.48

11

3.83

10

5.86

15

9.71

14

8.5

3 19

0.37

17

7.04

6615

9.40

14

8.2

4 24

1.19

22

4.30

24

1.70

22

4.78

21

4.38

19

9.38

11

6.09

10

7.96

16

2.9

0 15

1.49

19

4.17

18

0.58

6716

2.5

1 15

1.14

24

5.91

22

8.7

0 24

6.43

22

9.18

21

8.5

7 20

3.2

7 11

8.36

11

0.08

16

6.08

15

4.45

19

7.97

18

4.11

6816

7.29

15

5.58

25

3.1

2 23

5.41

25

3.6

6 23

5.91

22

4.99

20

9.24

12

1.84

11

3.3

1 17

0.95

15

8.9

8 20

3.7

8 18

9.52

6917

2.0

6 16

0.01

26

0.35

24

2.1

2 26

0.90

24

2.6

3 23

1.41

21

5.21

12

5.31

11

6.54

17

5.83

16

3.5

2 20

9.58

19

4.91

7017

6.83

16

4.45

26

7.56

24

8.8

3 26

8.1

3 24

9.36

23

7.83

22

1.18

12

8.79

11

9.78

18

0.70

16

8.0

5 21

5.39

20

0.32

7118

1.59

16

8.8

8 27

4.78

25

5.55

27

5.36

25

6.09

24

4.24

22

7.14

13

2.2

6 12

3.0

0 18

5.58

17

2.5

9 22

1.21

20

5.72

7218

6.37

17

3.3

2 28

2.0

0 26

2.2

6 28

2.5

9 26

2.8

1 25

0.65

23

3.1

1 13

5.74

12

6.24

19

0.45

17

7.12

22

7.02

21

1.13

7319

1.05

17

7.68

28

9.08

26

8.8

4 28

9.70

26

9.42

25

6.95

23

8.9

6 13

9.15

12

9.41

19

5.24

18

1.57

23

2.7

2 21

6.43

7419

5.74

18

2.0

3 29

6.17

27

5.43

29

6.79

27

6.02

26

3.2

5 24

4.82

14

2.5

6 13

2.5

8 20

0.02

18

6.02

23

8.4

2 22

1.73

7520

0.41

18

6.38

30

3.2

5 28

2.0

2 30

3.9

0 28

2.6

3 26

9.54

25

0.67

14

5.97

13

5.75

20

4.81

19

0.47

24

4.13

22

7.04

7620

5.09

19

0.74

31

0.34

28

8.6

1 31

0.99

28

9.22

27

5.84

25

6.53

14

9.38

13

8.9

2 20

9.59

19

4.92

24

9.83

23

2.3

4

7720

9.78

19

5.09

31

7.42

29

5.20

31

8.0

9 29

5.82

28

2.1

4 26

2.3

9 15

2.7

9 14

2.1

0 21

4.38

19

9.37

25

5.54

23

7.65

7821

4.08

19

9.10

32

3.9

3 30

1.25

32

4.62

30

1.89

28

7.92

26

7.77

15

5.92

14

5.0

0 21

8.7

7 20

3.4

5 26

0.78

24

2.5

2

7921

8.3

7 20

3.0

9 33

0.43

30

7.30

33

1.13

30

7.95

29

3.7

1 27

3.1

5 15

9.05

14

7.92

22

3.1

7 20

7.54

26

6.01

24

7.39

8022

2.6

8 20

7.09

33

6.93

31

3.3

5 33

7.65

31

4.01

29

9.49

27

8.5

2 16

2.1

8 15

0.83

22

7.56

21

1.63

27

1.24

25

2.2

6

8122

6.98

21

1.09

34

3.4

4 31

9.40

34

4.17

32

0.07

30

5.27

28

3.9

0 16

5.32

15

3.7

4 23

1.95

21

5.71

27

6.49

25

7.13

8223

1.27

21

5.08

34

9.95

32

5.45

35

0.69

32

6.14

31

1.05

28

9.28

16

8.4

4 15

6.65

23

6.35

21

9.80

28

1.72

26

2.0

0

8323

7.82

22

1.17

35

9.85

33

4.66

36

0.60

33

5.36

31

9.84

29

7.45

17

3.2

1 16

1.08

24

3.0

3 22

6.02

28

9.69

26

9.41

8424

4.37

22

7.27

36

9.77

34

3.8

9 37

0.55

34

4.61

32

8.6

7 30

5.67

17

7.99

16

5.53

24

9.73

23

2.2

5 29

7.68

27

6.84

85+

250.

91

233

.35

379.

66

353

.09

380.

47

353

.83

337.

46

313

.84

182

.75

169.

96

256.

42

238

.47

305.

64

284.

25

unde

r 65

176.

11

163

.78

266.

46

247.

81

267.

03

248

.34

236.

85

220.

27

128

.26

119.

28

179.

97

167.

37

214.

51

199.

50

Are

a 1

Rat

es—

Fem

ale

Age

W

hen

Pla

n Ta

kes

Eff

ect

Pla

n A

Pla

n C

Pla

n F

Pla

n G

Pla

n K

Pla

n L

Pla

n N

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

6514

2.0

7 13

2.1

3 21

4.97

19

9.92

21

5.43

20

0.35

19

1.08

17

7.70

10

3.48

96

.23

145.

19

135.

02

173

.07

160.

95

6614

4.90

13

4.76

21

9.27

20

3.9

2 21

9.73

20

4.34

19

4.89

18

1.25

10

5.54

98

.15

148.

09

137.

72

176.

52

164.

16

6714

7.74

13

7.40

22

3.5

5 20

7.90

22

4.03

20

8.3

5 19

8.7

0 18

4.80

10

7.60

10

0.07

15

0.98

14

0.41

17

9.97

16

7.37

6815

2.0

8 14

1.43

23

0.11

21

4.01

23

0.60

21

4.46

20

4.54

19

0.22

11

0.76

10

3.0

1 15

5.41

14

4.53

18

5.25

17

2.2

8

6915

6.42

14

5.47

23

6.68

22

0.11

23

7.18

22

0.58

21

0.37

19

5.64

11

3.93

10

5.95

15

9.85

14

8.6

6 19

0.53

17

7.19

7016

0.75

14

9.50

24

3.2

4 22

6.21

24

3.7

6 22

6.69

21

6.20

20

1.06

11

7.08

10

8.8

8 16

4.28

15

2.7

8 19

5.81

18

2.1

1

7116

5.09

15

3.5

3 24

9.80

23

2.3

2 25

0.33

23

2.8

1 22

2.0

4 20

6.50

12

0.24

11

1.82

16

8.7

1 15

6.90

20

1.10

18

7.02

7216

9.42

15

7.56

25

6.36

23

8.4

1 25

6.91

23

8.9

2 22

7.87

21

1.92

12

3.4

0 11

4.76

17

3.1

4 16

1.02

20

6.38

19

1.93

7317

3.6

9 16

1.53

26

2.8

1 24

4.41

26

3.3

6 24

4.92

23

3.5

9 21

7.24

12

6.50

11

7.64

17

7.49

16

5.06

21

1.56

19

6.75

7417

7.94

16

5.48

26

9.25

25

0.40

26

9.81

25

0.93

23

9.32

22

2.5

6 12

9.60

12

0.52

18

1.84

16

9.11

21

6.75

20

1.57

7518

2.1

9 16

9.44

27

5.68

25

6.39

27

6.26

25

6.92

24

5.04

22

7.89

13

2.7

0 12

3.4

1 18

6.19

17

3.1

6 22

1.94

20

6.40

7618

6.45

17

3.4

0 28

2.1

2 26

2.3

7 28

2.7

2 26

2.9

3 25

0.76

23

3.2

1 13

5.80

12

6.29

19

0.54

17

7.20

22

7.12

21

1.23

7719

0.71

17

7.36

28

8.5

6 26

8.3

6 28

9.18

26

8.9

4 25

6.49

23

8.5

3 13

8.9

0 12

9.17

19

4.88

18

1.24

23

2.3

1 21

6.05

7819

4.62

18

0.99

29

4.48

27

3.8

7 29

5.10

27

4.44

26

1.75

24

3.4

3 14

1.75

13

1.82

19

8.8

8 18

4.96

23

7.06

22

0.47

7919

8.5

2 18

4.62

30

0.39

27

9.36

30

1.03

27

9.95

26

7.0

0 24

8.3

1 14

4.59

13

4.47

20

2.8

8 18

8.6

8 24

1.82

22

4.90

8020

2.4

3 18

8.2

6 30

6.31

28

4.87

30

6.96

28

5.47

27

2.2

6 25

3.2

1 14

7.44

13

7.12

20

6.87

19

2.3

9 24

6.59

22

9.33

8120

6.34

19

1.90

31

2.2

2 29

0.36

31

2.8

8 29

0.98

27

7.52

25

8.0

9 15

0.28

13

9.76

21

0.87

19

6.11

25

1.35

23

3.7

6

8221

0.25

19

5.53

31

8.1

4 29

5.87

31

8.8

0 29

6.49

28

2.7

7 26

2.9

8 15

3.1

3 14

2.4

2 21

4.86

19

9.82

25

6.11

23

8.1

9

8321

6.20

20

1.06

32

7.13

30

4.23

32

7.82

30

4.87

29

0.77

27

0.41

15

7.46

14

6.43

22

0.93

20

5.47

26

3.3

6 24

4.92

8422

2.1

6 20

6.61

33

6.15

31

2.6

2 33

6.87

31

3.2

8 29

8.7

9 27

7.88

16

1.81

15

0.48

22

7.03

21

1.13

27

0.62

25

1.67

85+

228

.10

212

.14

345.

15

320.

99

345.

88

321.

67

306.

79

285.

31

166.

14

154.

51

233

.10

216.

79

277.

86

258

.41

unde

r 65

160.

09

148

.89

242

.25

225.

29

242

.76

225.

76

215.

32

200.

24

116.

60

108

.44

163

.60

152

.15

195.

01

181.

36

*Hou

seho

ld: T

wo

or m

ore

indi

vidu

als

who

resi

de to

geth

er in

the

sam

e dw

ellin

g. D

wel

ling

is d

efine

d as

a

sing

le h

ome,

con

dom

iniu

m u

nit,

or a

part

men

t uni

t with

in a

n ap

artm

ent c

ompl

ex.

7% H

ouse

hold

Dis

coun

t: G

et th

e be

st ra

te p

ossi

ble

whe

n yo

u en

roll

with

a

seco

nd m

embe

r of y

our h

ouse

hold

.* Yo

u ea

ch p

ay th

e “Y

ou w

ith D

isco

unt”

ra

te s

how

n be

low

.

Not

e: R

ates

incl

ude

a 2%

dis

coun

t for

mem

bers

who

enr

oll

in a

utom

atic

ban

k w

ithdr

awal

. Tho

se w

ho p

ay b

y cr

edit

card

or

pap

er b

ill w

ill p

ay a

slig

htly

hig

her p

rem

ium

than

thos

e lis

ted

here

. Ple

ase

cont

act u

s w

ith a

ny q

uest

ions

.

Are

a 2

Rat

es—

Mal

e

Age

W

hen

Pla

n Ta

kes

Eff

ect

Pla

n A

Pla

n C

Pla

n F

Pla

n G

Pla

n K

Pla

n L

Pla

n N

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

6514

5.34

13

5.17

21

9.92

20

4.53

22

0.38

20

4.96

19

5.48

18

1.80

10

5.86

98

.45

148.

53

138

.13

177.

04

164.

64

6614

8.2

3 13

7.86

22

4.30

20

8.6

0 22

4.78

20

9.05

19

9.38

18

5.42

10

7.97

10

0.41

15

1.49

14

0.88

18

0.57

16

7.93

6715

1.14

14

0.56

22

8.6

9 21

2.6

8 22

9.18

21

3.1

4 20

3.2

7 18

9.04

11

0.08

10

2.3

8 15

4.46

14

3.6

5 18

4.11

17

1.22

6815

5.58

14

4.68

23

5.41

21

8.9

3 23

5.91

21

9.39

20

9.24

19

4.59

11

3.32

10

5.39

15

8.99

14

7.86

18

9.51

17

6.25

6916

0.01

14

8.8

1 24

2.1

2 22

5.17

24

2.6

3 22

5.64

21

5.21

20

0.14

11

6.54

10

8.3

8 16

3.52

15

2.0

8 19

4.91

18

1.27

7016

4.45

15

2.9

4 24

8.8

3 23

1.41

24

9.36

23

1.91

22

1.18

20

5.69

11

9.78

11

1.39

16

8.05

15

6.29

20

0.31

18

6.29

7116

8.8

8 15

7.06

25

5.54

23

7.66

25

6.08

23

8.1

6 22

7.13

21

1.24

12

3.0

0 11

4.39

17

2.5

9 16

0.51

20

5.72

19

1.32

7217

3.3

2 16

1.19

26

2.2

6 24

3.9

0 26

2.8

1 24

4.41

23

3.1

1 21

6.79

12

6.23

11

7.40

17

7.13

16

4.73

21

1.12

19

6.34

7317

7.67

16

5.24

26

8.8

4 25

0.02

26

9.42

25

0.56

23

8.9

6 22

2.2

4 12

9.41

12

0.35

18

1.56

16

8.8

6 21

6.43

20

1.28

7418

2.0

4 16

9.29

27

5.44

25

6.16

27

6.02

25

6.70

24

4.82

22

7.69

13

2.5

8 12

3.3

0 18

6.01

17

2.9

9 22

1.73

20

6.21

7518

6.39

17

3.3

4 28

2.0

2 26

2.2

8 28

2.6

2 26

2.8

4 25

0.67

23

3.1

3 13

5.75

12

6.25

19

0.47

17

7.14

22

7.04

21

1.14

7619

0.74

17

7.39

28

8.6

1 26

8.4

1 28

9.23

26

8.9

8 25

6.53

23

8.5

8 13

8.9

2 12

9.20

19

4.92

18

1.28

23

2.3

4 21

6.07

7719

5.10

18

1.44

29

5.21

27

4.54

29

5.82

27

5.12

26

2.4

0 24

4.03

14

2.1

0 13

2.1

5 19

9.37

18

5.42

23

7.65

22

1.01

7819

9.10

18

5.16

30

1.25

28

0.16

30

1.89

28

0.76

26

7.77

24

9.02

14

5.0

0 13

4.85

20

3.4

5 18

9.21

24

2.5

2 22

5.54

7920

3.0

9 18

8.8

7 30

7.30

28

5.79

30

7.96

28

6.40

27

3.1

5 25

4.03

14

7.92

13

7.57

20

7.54

19

3.0

2 24

7.39

23

0.07

8020

7.08

19

2.5

9 31

3.3

5 29

1.41

31

4.01

29

2.0

3 27

8.5

3 25

9.03

15

0.83

14

0.27

21

1.63

19

6.82

25

2.2

6 23

4.60

8121

1.09

19

6.32

31

9.40

29

7.04

32

0.08

29

7.67

28

3.9

1 26

4.03

15

3.7

4 14

2.9

8 21

5.71

20

0.61

25

7.13

23

9.13

8221

5.08

20

0.02

32

5.45

30

2.6

7 32

6.14

30

3.3

1 28

9.28

26

9.03

15

6.65

14

5.69

21

9.80

20

4.42

26

2.0

0 24

3.6

6

8322

1.17

20

5.68

33

4.66

31

1.23

33

5.36

31

1.88

29

7.45

27

6.63

16

1.08

14

9.81

22

6.02

21

0.20

26

9.41

25

0.55

8422

7.26

21

1.35

34

3.8

9 31

9.82

34

4.61

32

0.48

30

5.66

28

4.27

16

5.53

15

3.9

4 23

2.2

5 21

5.99

27

6.84

25

7.46

85+

233

.35

217.

01

353

.08

328

.37

353

.83

329.

06

313

.85

291.

88

169.

96

158

.06

238

.46

221.

77

284.

25

264.

35

unde

r 65

163

.78

152

.31

247.

81

230.

47

248

.34

230.

96

220.

26

204.

85

119.

29

110.

94

167.

37

155.

66

199.

50

185.

53

*Hou

seho

ld: T

wo

or m

ore

indi

vidu

als

who

resi

de to

geth

er in

the

sam

e dw

ellin

g. D

wel

ling

is d

efine

d as

a

sing

le h

ome,

con

dom

iniu

m u

nit,

or a

part

men

t uni

t with

in a

n ap

artm

ent c

ompl

ex.

7% H

ouse

hold

Dis

coun

t: G

et th

e be

st ra

te p

ossi

ble

whe

n yo

u en

roll

with

a

seco

nd m

embe

r of y

our h

ouse

hold

.* Yo

u ea

ch p

ay th

e “Y

ou w

ith D

isco

unt”

ra

te s

how

n be

low

.

Not

e: R

ates

incl

ude

a 2%

dis

coun

t for

mem

bers

who

enr

oll

in a

utom

atic

ban

k w

ithdr

awal

. Tho

se w

ho p

ay b

y cr

edit

card

or

pap

er b

ill w

ill p

ay a

slig

htly

hig

her p

rem

ium

than

thos

e lis

ted

here

. Ple

ase

cont

act u

s w

ith a

ny q

uest

ions

.

Are

a 2

Rat

es—

Fem

ale

*Hou

seho

ld: T

wo

or m

ore

indi

vidu

als

who

resi

de to

geth

er in

the

sam

e dw

ellin

g. D

wel

ling

is d

efine

d as

a

sing

le h

ome,

con

dom

iniu

m u

nit,

or a

part

men

t uni

t with

in a

n ap

artm

ent c

ompl

ex.

Age

W

hen

Pla

n Ta

kes

Eff

ect

Pla

n A

Pla

n C

Pla

n F

Pla

n G

Pla

n K

Pla

n L

Pla

n N

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

You

You

with

D

isco

unt

6513

2.1

2 12

2.8

7 19

9.92

18

5.93

20

0.35

18

6.33

17

7.70

16

5.26

96

.24

89.5

0 13

5.02

12

5.57

16

0.96

14

9.69

6613

4.76

12

5.33

20

3.9

2 18

9.64

20

4.35

19

0.05

18

1.25

16

8.5

6 98

.15

91.2

8 13

7.72

12

8.0

8 16

4.16

15

2.6

7

6713

7.41

12

7.79

20

7.90

19

3.3

4 20

8.3

5 19

3.7

6 18

4.80

17

1.86

10

0.07

93

.06

140.

41

130.

59

167.

37

155.

66

6814

1.43

13

1.53

21

4.0

0 19

9.02

21

4.46

19

9.45

19

0.22

17

6.90

10

3.01

95

.80

144.

53

134.

41

172

.28

160.

22

6914

5.47

13

5.29

22

0.11

20

4.70

22

0.58

20

5.14

19

5.64

18

1.94

10

5.95

98

.53

148.

66

138

.25

177.

19

164.

79

7014

9.50

13

9.03

22

6.21

21

0.38

22

6.69

21

0.83

20

1.07

18

6.99

10

8.89

10

1.27

15

2.7

8 14

2.0

9 18

2.1

0 16

9.36

7115

3.5

4 14

2.7

9 23

2.3

2 21

6.06

23

2.8

1 21

6.51

20

6.50

19

2.0

4 11

1.82

10

3.9

9 15

6.90

14

5.92

18

7.02

17

3.9

3

7215

7.56

14

6.53

23

8.4

1 22

1.73

23

8.9

2 22

2.2

0 21

1.92

19

7.08

11

4.77

10

6.73

16

1.01

14

9.74

19

1.93

17

8.5

0

7316

1.52

15

0.22

24

4.41

22

7.30

24

4.92

22

7.78

21

7.24

20

2.0

3 11

7.64

10

9.40

16

5.06

15

3.5

1 19

6.75

18

2.9

8

7416

5.48

15

3.9

0 25

0.40

23

2.8

7 25

0.93

23

3.3

6 22

2.5

7 20

6.99

12

0.52

11

2.0

8 16

9.11

15

7.27

20

1.58

18

7.47

7516

9.44

15

7.58

25

6.39

23

8.4

4 25

6.93

23

8.9

4 22

7.89

21

1.94

12

3.4

1 11

4.77

17

3.1

6 16

1.04

20

6.41

19

1.96

7617

3.4

0 16

1.26

26

2.3

8 24

4.01

26

2.9

3 24

4.53

23

3.2

1 21

6.89

12

6.29

11

7.45

17

7.20

16

4.80

21

1.23

19

6.44

7717

7.36

16

4.95

26

8.3

6 24

9.58

26

8.9

3 25

0.11

23

8.5

3 22

1.83

12

9.17

12

0.13

18

1.24

16

8.5

5 21

6.05

20

0.93

7818

1.0

0 16

8.3

3 27

3.8

7 25

4.70

27

4.44

25

5.23

24

3.4

2 22

6.38

13

1.83

12

2.6

0 18

4.96

17

2.0

1 22

0.47

20

5.04

7918

4.62

17

1.70

27

9.36

25

9.80

27

9.96

26

0.36

24

8.3

1 23

0.93

13

4.47

12

5.05

18

8.6

8 17

5.47

22

4.90

20

9.16

8018

8.2

6 17

5.08

28

4.87

26

4.93

28

5.46

26

5.48

25

3.2

0 23

5.48

13

7.12

12

7.52

19

2.3

8 17

8.9

2 22

9.33

21

3.2

8

8119

1.89

17

8.4

6 29

0.36

27

0.04

29

0.98

27

0.61

25

8.0

9 24

0.03

13

9.77

12

9.98

19

6.11

18

2.3

8 23

3.7

6 21

7.40

8219

5.53

18

1.84

29

5.87

27

5.16

29

6.49

27

5.73

26

2.9

7 24

4.57

14

2.4

1 13

2.4

4 19

9.81

18

5.83

23

8.1

9 22

1.52

8320

1.07

18

6.99

30

4.23

28

2.9

4 30

4.87

28

3.5

3 27

0.41

25

1.48

14

6.43

13

6.18

20

5.47

19

1.08

24

4.92

22

7.78

8420

6.60

19

2.1

4 31

2.6

2 29

0.74

31

3.2

9 29

1.36

27

7.88

25

8.4

3 15

0.48

13

9.95

21

1.13

19

6.35

25

1.67

23

4.06

85+

212

.14

197.

29

320.

99

298

.52

321.

67

299.

15

285.

32

265.

34

154.

51

143

.69

216.

79

201.

61

258

.41

240.

32

unde

r 65

148

.88

138

.46

225.

29

209.

52

225.

76

209.

96

200.

24

186.

23

108

.44

100.

85

152

.15

141.

49

181.

36

168

.66

7% H

ouse

hold

Dis

coun

t: G

et th

e be

st ra

te p

ossi

ble

whe

n yo

u en

roll

with

a

seco

nd m

embe

r of y

our h

ouse

hold

.* Yo

u ea

ch p

ay th

e “Y

ou w

ith D

isco

unt”

ra

te s

how

n be

low

.

Not

e: R

ates

incl

ude

a 2%

dis

coun

t for

mem

bers

who

enr

oll

in a

utom

atic

ban

k w

ithdr

awal

. Tho

se w

ho p

ay b

y cr

edit

card

or

pap

er b

ill w

ill p

ay a

slig

htly

hig

her p

rem

ium

than

thos

e lis

ted

here

. Ple

ase

cont

act u

s w

ith a

ny q

uest

ions

.


Parts of Medicare

The Medicare program has several different parts, which can be confusing if you’re unfamiliar with them. A Medicare supplement works with your Medicare Part A and Part B coverage.

Part A Part B Part D

• Hospital care• Skilled nursing

facility care• Nursing home care• Hospice• Home health services

• Medically necessary outpatient services to diagnose or treat your medical condition

• Most preventive outpatient services, including an annual wellness exam

• Stand-alone prescription drug plans (PDP) help pay for medications

• Mail order options and access to retail pharmacies nationwide

Limitations and exclusionsNo insurance policy covers everything. Here’s a list of things this Medicare supplement doesn’t cover:

• Personal comfort items• Routine physical exams and any related diagnostic, X-ray,

and laboratory tests except those covered by Medicare• Eye exams or hearing exams, except for those services

covered by Medicare• Orthopedic shoes or other supporting devices for

the feet• Routine foot care not covered by Medicare• Custodial care, including maintenance care or

supportive care• Cosmetic surgery, except as stated in the policy• Outpatient prescription drugs• Professional services not provided by a physician, except

as required by law• Routine immunizations, except if eligible under Medicare

and except as stated in the policy• Preparation, fitting, or purchase of eyeglasses or hearing

aids, unless covered by Medicare• Care, treatment, filling, removal, or replacement of teeth;

dental X-rays, root canals, surgery for impacted teeth, or other surgical procedures to the teeth or supporting structures

• Nursing home care costs beyond what is covered by Medicare

• If you terminate your Medicare coverage, expenses which would have been covered by Medicare

• Your Medicare Part A deductible, unless you purchase full or partial coverage of the Medicare Part A deductible

• Your Medicare Part B deductible, unless you purchase Plan C or F

• Physician charges above Medicare’s approved charge, unless you purchase Plan F or G

• Home health care beyond what is covered by Medicare• Any health care treatments, services, or supplies received

outside the United States, unless you purchase Plan C, F, G, or N

• Any health care treatments, services, or supplies:- Not covered by Medicare, unless specifically stated in

the policy- You, or anyone on your behalf, aren’t legally obligated

to pay for- Paid for by Medicare or another government entity or

program- For any injury, occurring on or after your effective date,

caused by an act of war- Provided by immediate family members or by anyone

else who lives with you- To the extent covered by worker’s compensation or

similar laws- Provided before the effective date of coverage or

after coverage ends- Determined by Medicare to be unreasonable or

unnecessary- For a military service-related condition treated at

any military or veterans hospital, or at any hospital contracted by any national government or agency


Notes__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

This is an advertisement for insurance. Neither Wisconsin Physicians Service Insurance Corporation, nor The EPIC Life Insurance Company, nor their products nor agents are connected with or endorsed by the United States government or the federal Medicare program. WPS Health Insurance is underwritten by The EPIC Life Insurance Company. This plan summary provides only a general description of benefits and limitations. A detailed description of coverage is in the applicable policy. If there is ever a discrepancy between the policy and this document, the policy has final authority.

Medicare supplement insurance helps give you peace of mindOriginal Medicare covers a lot—about 80% of your approved health care costs. But covering even just the 20% that Medicare leaves behind can be a real burden and hassle. WPS Medicare supplement insurance plans help reduce these out-of-pocket costs when you need medical care.

Join our WPS Medicare supplement family today and get worry-free peace of mind you’ll enjoy for years to come!

Ready to take the next step?Contact your local agent or call WPS today at 1-800-236-8809.

MO_SALES_1712 ©2018 All rights reserved. JO9627

The EPIC Life Insurance CompanyA WPS Company

31313-100-1809

wps medicare companion · 2018-11-07 · 7. you deserve to live your life health care and health...

Documents