group medicare advantage hmo recording 2 (solo)

GROUP MEDI CARE ADVANTAGE HMO

Tier 1 Rx Copay Reduction

What’s New for 2013

Hearing Discounts

Rx Manager New Name

WellCardEnhancements

Eligibility Requirements

In-Network Benefits

Copayments

Additional Benefits

WEBCAST TOPI CS

$

ELI GI BI LI TY

REQUI REMENTS

Person

State

Eligible

The below are eligible for the Group Medicare Advantage HMO Plan:

• Retiree• LTD Recipient• Qualified Survivor• Domestic Partner• Eligible Dependents

ELI GI BI LI TY REQUI REMENTS

Group Medicare Advantage

To enroll in the Group Medicare Advantage HMO Plan, you must have:

Medicare Parts A & B

ELI GI BI LI TY REQUI REMENTS

Medicare Plan

The Group Medicare Advantage HMO Plan is available:

• Arizona• All Counties

ELI GI BI LI TY REQUI REMENTS

Group Medicare Advantage

Question & Answer 1

ELI GI BI LI TY REQUI REMENTS

Roland is an ASRS retiree with Medicare Parts A&B. He lives full time in Carefree, Arizona. Can he enroll in this plan?

a. Yes

b. No

Question & Answer 2

ELI GI BI LI TY REQUI REMENTS

Nora is an actively contributing member of the ASRS. She has Medicare parts A and B. Can she enroll in the Medicare Advantage HMO? ?

a. Yes

b. No

I N- NETWORK BENEFI TS

I N- NETWORK BENEFI TS

Medicare Part D:• Is included, and is equal to or

better than the standard Medicare Part D Coverage.

Group Medicare Advantage

Prescription

I N- NETWORK BENEFI TS

UnitedHealthcare Formulary:

• Approved outpatient prescription drugs

• Doctor must use• Participating pharmacy

Additional Information

I N- NETWORK BENEFI TS

• No annual benefit limit in coverage

• No annual deductibles

• No prescription coverage gap

Selection

I N- NETWORK BENEFI TS

You must select a Primary Care Physician in the network.

Your doctor will make referrals to specialists within the network

Pre-Existing Condition

I N- NETWORK BENEFI TS

Currently the ASRS does not deny health insurance for any reason in relation to a pre-existing condition

Health Insurance Card

I N- NETWORK BENEFI TS

You will be issued one card that covers your • Medical• Vision• Prescriptions

Question & Answer 1

I N- NETWORK BENEFI TS

Does the Medicare Part D prescription coverage gap apply to the Group Medicare Advantage HMO plan?

a. Yesb. No

Question & Answer 2

I N- NETWORK BENEFI TS

Paula is an ASRS retiree and is enrolled in the Medicare Advantage HMO plan. Does she need to select a primary physician?

a. Yesb. No

COPAYMENTS

Copayments – (examples)

Hearing Exam$0

Routine Physical$0

Ambulance$25

The most common copays…

Copayments – (examples)

The most common copays…

Doctor Visit$15

Lab Tests$0

Specialist$30

Emergency$50

Waived if admitted

Copayments – (examples)

Prescription monthly copays…

Tier I

$10

Tier II

$40

COPAYMENTS

Mail Order Prescriptions

90-day supplies:

• Tier I $20• Tier II $80

COPAYMENTS

Annual Amounts

Your out-of-pocket coinsurance yearly maximum: • $6,700 Per Individual

No lifetime maximum benefit

Question & Answer

COPAYMENTS

Mary isn’t sure what her yearly out-of-pocket coinsurance maximum would be. Is it….

a. $7,600b. $6,700

ADDI TI ONAL BENEFI TS

Passport Program

ADDI TI ONAL BENEFI TS

Allows you to move your HMO coverage:

• Participating areas

• 9 consecutive months during the year• Same copays

Wellness Services

ADDI TI ONAL BENEFI TS

Additional benefits include:

• Silver Sneakers• Solutions for Caregivers• Nurseline

Disease Management

ADDI TI ONAL BENEFI TS

• Disease and Specialty Case Management

• Personal Health Management

• Advanced Illness Care Management

Question & Answer 1

ADDI TI ONAL BENEFI TS

Gina has a chronic condition. She is enrolled in the Group Medicare Advantage HMO with several very large claims in the last 2 years. Will she reach a maximum lifetime benefit?

a. Yesb. No

Question & Answer 2

Jenny’s mother needs more care than she can give her. Which program can provide assistance?

a. Silver Sneakersb. Solutions for Caregiversc. Nurseline

ADDI TI ONAL BENEFI TS

Group Medicare - Full Monthly Premiums

Retiree + Dependent

$380/$520Retiree

$190/$260

Retiree & Dependent(s) Medicare & Non Medicare Eligible

Combination Plans

For more detailed information

please refer to the Guide!

ARI ZONA STATE RETI REMENT SYSTEM

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