2018 WAUKESHA OUNTY OPEN ENROLLMENT .2018 WAUKESHA OUNTY OPEN ENROLLMENT ... Each year Waukesha ounty

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  • 2018

    WAUKESHA COUNTY

    OPEN ENROLLMENT Retiree Health Insurance

    O C T O B E R 2 , 2 0 1 7

    T H R O U G H

    N O V E M B E R 3 , 2 0 1 7

  • 1

    To: All Individuals Covered under the Waukesha County Retiree Health Insurance Program

    From: Waukesha County Human Resources Office

    Date: September 26, 2017

    Re: 2018 Retiree Health Insurance Open Enrollment Period

    With this letter, we are announcing the 2018 Open Enrollment Period for members of the Waukesha County Retiree Health Insurance Program. The open enrollment period will run from October 2, 2017 through November 3, 2017.

    Waukesha County offers two health insurance plan options for retirees depending on Medicare eligiblity. The two plans offered are the Waukesha County Retiree Choice Plus Health Plan or a UnitedHealthcare Group Medicare Advantage Plan. If you are eligible for Medicare coverage, you may choose either the Waukesha County Retiree Choice Plus Health Plan without prescription drug coverage or the UnitedHealthcare Group Medicare Advantage Plan option. If you are not yet Medicare eligible, you may enroll in the Waukesha County Retiree Choice Plus Health Plan with prescription drug coverage.

    Each year Waukesha County conducts an Open Enrollment for the retiree health insurance. During this time, you may change coverage. If you wish to continue your existing coverage, no action on your part is required. However, if you are eligible for Medicare or soon will be, please consider your choices carefully.

    We will not be holding Retiree Health Insurance Open Enrollment meetings this year. The 2018 premium rates for the Waukesha County Retiree Choice Plus Health Plan remain the same.

    If you have questions on the insurance offerings or wish to make a change, please contact Mary Gutoski at 262-548-7048 for the forms. Forms and resources are also available online at www.waukeshacounty.gov/retiree.

    All required enrollment form(s) must be returned no later than November 3, 2017 to:

    Waukesha County Human Resources 515 W Moreland Blvd, Room 160

    Waukesha, WI 53188 Phone: (262) 548-7044

    http://www.waukeshacounty.gov/retiree

  • 2

    Table of Contents Medicare Eligible Plan Options .............................................................................. 3

    Option 1: UnitedHealthcare Group Medicare Advantage Plan ........................... 3

    2018 Group Medicare Advantage Plan Changes ................................................. 3

    Medicare Advantage Prescription Drug Coverage ............................................... 4

    Enrolling in UnitedHealthcare Group Medicare Advantage Plan ........................ 4

    Option 2: Choice Plus Health Plan without Prescription Coverage ..................... 5

    Non-Medicare Eligible Plan Option ........................................................................ 7

    Option: Choice Plus Health Plan with Prescription Coverage ............................. 7

    2018 Retiree Choice Plus Health Plan Changes ................................................... 7

    Enrolling in the Waukesha County Retiree Choice Plus Health Plan ................... 7

    BENEFIT COVERAGE AND PREMIUMS ................................................................ 8

    UnitedHealthcare Group Medicare Advantage Plan Summary SE Wisconsin .. 9

    Waukesha County Retiree Choice Plus Health Plan .......................................... 10

    ENROLLMENT AND ELIGIBILITY RULES ............................................................. 11

    I. Annual Open Enrollment Period ................................................................... 11

    II. Special Enrollment Period Becoming Medicare Eligible ............................ 11

    III. General Enrollment Rules ........................................................................... 11

    IV. Eligibility Rules Death of Retiree .............................................................. 13

    FREQUENTLY ASKED QUESTIONS ..................................................................... 14

    Prescription Drug Coverage and Medicare .......................................................... 16

  • 3

    Medicare Eligible Plan Options

    Option 1: UnitedHealthcare Group Medicare Advantage Plan This a group-sponsored Medicare Advantage Plan. You must be entitled to Medicare Part A and enrolled in Medicare Part B to participate in this plan. This plan is a PPO plan with network and non-network health care providers and benefits. If you use network providers, you will receive a higher level of benefit coverage. If you use non-network providers, make sure they accept Medicare and UnitedHealthcares fee schedule to avoid having to pay any unexpected excess provider fees. See the benefit outline for the plan serving southeastern Wisconsin for details.

    Medicare pays UnitedHealthcare a pre-determined monthly fee, and in return, UnitedHealthcare assumes the risk of paying all claims at the established benefit levels. UnitedHealthcare is the sole claims processor. In addition, many of the network services covered under this plan requires that you pay only a co-pay. If your health care provider collects your co-pay at the time of the service, you will have peace of mind in knowing that the balance of the covered charges will be paid by UnitedHealthcare. You can review the list of participating healthcare providers in this plan by visiting: https://www.uhcretiree.com.

    2018 Group Medicare Advantage Plan Changes

    Below is a high level overview of the changes occurring for 2018.

    In-Patient Skilled Nursing Facility co-pay for days 21-100 increasing to $167 from $164

    Medicare covered eye exams co-pay decreased from $50 to $15

    Emergency Room co-pay increased to $80 from $75

    Pharmacy In-Network Retail and Mail Order Cost-Sharing decreases for Tiers 2 and 3 o Retail: Tier 2 decreasing to $15 from $47 and Tier 3 decreasing to $47 from $100 o Mail Order: Tier 2 decreasing from $94 to $30 and Tier 3 decreasing from $200 to

    $94

    Prescriptions will be offered across 5 Tiers increasing from a 4 Tier structure

    Pharmacy Initial coverage limit increasing to $3,750 from $3,700

    True Out of Pocket Threshold (TrOOP) increasing to $5,000 from $4,950

    Virtual Doctor Visits are available at no-cost for participants who use the available in-network providers.

    https://www.uhcretiree.com/

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    Medicare Advantage Prescription Drug Coverage

    The for UnitedHealthcare Group Medicare Advantage Plan includes prescription drug coverage. There is no deductible; copayments are listed:

    Co-Payments Retail (30 days) Tier 1 = $15 Tier 3 = $47 Tier 5 = $100 Tier 2 = $15 Tier 4 = $100

    Mail (90 days) Tier 1 = $30 Tier 3 = $94 Tier 5 = $200 Tier 2 = $30 Tier 4 = $200

    Coverage Gap (Donut Hole): After your total drug costs reach $3,750, you pay 40% of the cost plus the dispensing fee for brand name drugs and 51% of the cost for generic drugs.

    Catastrophic Coverage: After your total out-of-pocket drug costs reach $5,000, you will pay the greater of $3.35 for generics and brand drugs treated as generics, $8.35 for all other drugs, or 5%.

    Enrolling in UnitedHealthcare Group Medicare Advantage Plan

    If you are currently enrolled in the Medicare Advantage plan and wish to continue this coverage, it will not be necessary for you to fill out a new enrollment form. Your coverage will continue into 2018 through UnitedHealthcare.

    If you are not enrolled in the Medicare Advantage plan, but wish to enroll for 2018, you must complete enrollment telephonically with the UnitedHealthcare Pre-Enrollment Team. Please call 1-877-714-0178 to enroll. We have moved from a paper enrollment process to a telephonic enrollment. In the enrollment process you will be interacting with a live person. The Pre-Enrollment Team will be able to better address questions you have regarding specific coverage benefits, network providers, or prescription drug coverage. Someone is available from 8am 8pm local time, 7 days a week. They can answer questsions prior to enrollment and handle the enrollment.

    When calling to UnitedHealthcare Pre-Enrollment to enroll:

    1. Tell the Customer Service Advocate you are calling about a Group-sponsored Medicare Advantage Plan. Have the group # 12688 for Waukesha County available.

    2. Have your Medicare claim number and Medicare effective date. 3. If you have a question about your doctor or clinic, please have the names and addresses

    handy, and name and address of your pharmacy. 4. If youre calling about drug coverage, please have your list of current prescriptions and

    dosages ready.

  • 5

    What to expect after enrolling in the UnitedHealthcare Group Medicare Advantage Plan:

    1. You will receive your member ID card. 2. You will receive a Welcome Packet in the mail. Please review it. 3. After your effective date, register online at www.uhcretiree.com. This website will provide

    you with easy, convienient access to all your plan information.

    4. After your enrollment, UnitedHealthcare will reach out to you to complete a short health survey per Medicare requriements.

    Option 2: Waukesha County Retiree Choice Plus Health Plan without Prescription Coverage Coverage for prescription drugs in the Waukesha County Retiree Choice Plus Health Plan ends when you become eligible for Medicare.

    If you are eligible for Medicare and choose to be enrolled in the Waukesha County Retiree Choice Plus Health Plan, you are responsible for enrolling in a Medicare Part D Prescription Drug Plan an