Welcome State of Minnesota Retirees

HEALTHPARTNERS® FREEDOM GROUP (COST)

Your plan at your fingertipsMedical benefits 4

Dental benefits 8

Dear State of Minnesota Retiree,HealthPartners is pleased to offer you Medicare medical, dental and prescription drug coverage plan options for 2018. Before you look through this booklet, you might be interested in some of the great features you can expect from HealthPartners Freedom:

• virtuwell® — You’ll get unlimited visits to virtuwell, the 24/7 online clinic that provides treatment through a nurse practitioner for everyday medical conditions.

• Silver&Fit® Exercise and Healthy Aging Program — You can get a membership at a participating fitness center at no cost to you.

• Travel coverage — With up to nine months of travel coverage within the U.S., you can take your health plan with you wherever you go.

• Personal support — Your Medicare Member Services team is just a phone call away.

You can also easily manage your health care through your personal account at healthpartners.com/segipmedicare. Log on to get your medical, dental and prescription drug information 24/7, whenever and wherever it works for you.

Most of all, we look forward to helping you live your best life. Because a reliable partner in your health makes all the difference.

Wishing you the best health,

Andrea Walsh

President and CEO

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A plan centered on youHealthPartners Freedom gives you the care and coverage you need to stay healthy for what matters most. As a member, you'll have online tools, personal support, added perks, a large provider network and more.

Your Freedom network• Choose from more than 51,000 doctors

and other care providers in Minnesota and western Wisconsin.

• See any specialist in the network — no referrals needed.

• Search the Freedom network by visiting healthpartners.com/segipmedicare.» Search for doctors by name, clinic name,

specialty, language, gender, hours of business, parking and more.

» See cost and quality ratings for doctors.

TRAVEL BENEFITS

Get care anywhereYou have in-network coverage nine months out of the year when you travel in the U.S. Plus, you get worldwide emergency and urgently needed care.To use your Extended Absence Benefit, just let Member Services know before you leave.How it works: You can get Medicare-covered health care from any provider in the U.S. that participates in and accepts Medicare. You have the option to use a non-Medicare provider, but you may be required to pay for some or all services up front. If that happens, HealthPartners will reimburse you once your claim has been submitted and processed. To learn more about this benefit, visit healthpartners.com/segipmedicare.

New for 2018!If something unexpected happens while you're more than 100 miles from home or in a foreign country, you'll have Assist America®* on your side – at no cost to you. Call 24/7 nationwide and worldwide to:

• Talk to experienced clinicians who can help you assess your need for medical care

• Coordinate post-stabilization transportation to the nearest facility or your home

Learn more at assistamerica.com.

* Assist America services are only available during the first 90 consecutive days that you're away from your home and all arrangements must be made through Assist America.

Tools to help you plan your tripGet travel ready with the help of these tools:

• HealthPartners Mail Order Pharmacy: Get up to a 90-day supply of your prescription and over-the-counter medicines so you’ll have plenty with you.

• Travel medicine specialists: Get help with trip-specific health questions or concerns, especially if you’re traveling internationally.

• Health Information Library: Go to healthpartners.com/healthlibrary for tips on immunizations, health concerns and injury prevention before or during your travels.

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Sick. Click. Cured.virtuwell® is convenient online care that treats everyday medical conditions - such as colds, coughs, ear pain or flu. All from the comfort of your home. Get 24/7 access to nurse practitioners who will give you personalized care and a treatment plan. And, if needed, a prescription sent right to your pharmacy. You'll get unlimited access at no cost. Visit virtuwell.com to learn more.

Your plan benefitsThe HealthPartners Freedom Group plan, offered by the State of Minnesota, is outlined here.

BENEFIT STATE OF MINNESOTA PLAN Office visits You pay $10Inpatient hospital You pay $100Ambulance You pay $0Emergency room in U.S. You pay $50Urgent care in U.S. You pay $10DME You pay 10% of the total costMental health You pay $10 for individual sessions and $5 for group sessionsOccupational/physical therapy You pay $0Speech therapy You pay $10Preventive care You pay $0

Prescription drug coverageYou pay $10 for preferred generic and generic, $30 for preferred brand, $50 for non-preferred brand and $50 for specialty drugs

Monthly premium $286.50

See plan Summary of Benefits or Evidence of Coverage for more details. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/ coinsurance may change on January 1 of each year.

Manage your health on the go with an online account

Top 5 ways to use your online account and mobile app1. See recent claims and how much you owe.2. Search for doctors or dentists in your network or near you.3. Get cost estimates for treatments and procedures specific to your plan.4. Check your balances, including how much you owe before your plan starts paying

(deductible) and the most you’ll have to pay (out-of-pocket maximum).5. View your HealthPartners member ID card and fax it to your doctor’s or dentist’s office.There’s so much more you can do. Signing up is easy!Learn more at healthpartners.com/signupnow.

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Options to stay activeWhen you join the Silver&Fit® Exercise & Healthy Aging Program, you can get a membership at a participating fitness club at no cost to you. Visit silverandfit.com to find a club. Prefer to work out at home? Choose the

Home Fitness Program and get up to two Home Fitness kits each year.You’ll also get:

• The Silver Slate®, a quarterly newsletter.• Healthy Aging materials (online or DVD).• Silver&Fit Connected!™*, to track your exercise at a facility, or through a wearable fitness device

or app and earn rewards. (These rewards may change, and the purchase of the device or app is not included.)

• A toll-free customer service hotline to answer questions about the program.Signing up for Silver&Fit is easy. Visit silverandfit.com or call Silver&Fit customer service at 888-797-8092 (TTY: 711), Monday through Friday, 7 a.m. to 8 p.m., CT for more information.

* Your use of Silver&Fit Connected! serves as your consent for American Specialty Health Fitness, Inc. (ASH) Fitness to receive information about your tracked activity and to use that data to process and administer available rewards to you under the program.

The Silver&Fit program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit, Silver&Fit Connected!, the Silver&Fit logo, and The Silver Slate are federally registered trademarks of ASH and used with permission herein.

Once you’re a HealthPartners member, you’ll learn more about other great discounts available to you.

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Coverage for your medicinesHERE ARE ANSWERS TO THREE COMMON QUESTIONS

1. Is my prescription covered?You can see if your prescriptions are covered by searching the 2018 Medicare Formulary. This is the list of medicines covered by your plan. Go to healthpartners.com/medicarerx and search by:

• The name of your medicine (ex. simvastatin)• The type of medicine (drug category) you're taking (ex. cholesterol)• The first letter of the medicine you're taking (ex. ‘S’)

2. How much do I have to pay for my medicines?You pay $10 for preferred generic and generic, $30 for preferred brand, $50 for non-preferred brand and $50 for specialty drugs.You can find more benefit details by looking at your Summary of Benefits.

3. What if my medicine isn't on the list?If your medicine isn't on the list, it's not covered by your plan. In that case, we may suggest alternative medicines listed on the formulary.If you want to switch to a covered medicine, we can help you see your options. Go to healthpartners.com/medicarerx and choose "Search the Medicare drug list." Then, search for the type of medicine you're taking. A list of covered medicines will come up. Print it out and bring it to your doctor to see if one of those will work for you.

Save time and moneyGet your medicines your way with HealthPartners mail-order. Your prescriptions are delivered right to your door. There's no additional cost and shipping is free. Typically, you can expect to get your medicines within five to eight business days of when the mail order pharmacy receives your order.Log on to healthpartners.com/mymailrx to sign up. Or, call 612-623-4002 or 800-591-0011. Monday - Friday, 7:30 a.m. to 7 p.m. CT and Saturdays, 8 a.m. to 4 p.m. CT.

For help understanding your medicines and saving money on your presctiptions, use "Ask a pharmacist" at healthpartners.com/pharmacy.

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Your plan pays for some great thingsWith the HealthPartners® Dental Open Access plan you get:

• Preventive dental services covered 100 percent

• Extra exams and cleanings covered 100 percent if you have diabetes and are at risk for gum disease

• Help covering the cost of other dental care at the amounts shown in your Summary of Benefits (SOB)

It works like thisPreventive care is covered at no cost to you when you see a network dentist. Extra work, like getting a cavity filled, might cost a deductible (an amount you have to pay before your plan helps with the cost) or coinsurance (a percent of the bill). Check your SOB for your specific amounts.And remember that your dental plan has an annual maximum. It’s a bit different than your medical plan. Your dental plan max is the most your plan will pay for dental care each year. You’re in charge of the rest.

You pick your dentistWith the largest network of dentists and clinics, you’ve got lots of choices. Go to healthpartners.com/dentalopenaccess to find one.

SAVINGS TIP! You’ll pay less if you see a dentist in the Open Access network. Out-of-network dentists cost more.

There’s a connectionPeople who are diabetic are at greater risk of gum disease. And gum disease can make it harder to manage your diabetes.

You have free helpIf you’re living with diabetes and are at risk of gum disease, your dental plan covers 100 percent of services to help control or prevent gum disease. That includes root planing and scaling. Think of those services as a deep cleaning for your teeth. All other dental services, like a cavity and root canal, are covered according to your Summary of Benefits (SOB).

Here’s how it worksIt’s easy to get the care you need to stay healthy:

• Visit a network dentist• Pay nothing, not even a deductible or

coinsurance for certain services• Relax, your plan will pay even if you’ve

reached your annual maximum for the year

Dental Open Access planDid you know the average person spends hundreds of dollars on dental care each year? There’s good news though. Your dental plan can help keep a lid on costs and help you stay healthy from teeth to toes.”DORIS, MEMBER SERVICES

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Dental Schedule of Benefits for 2018Annual Maximum per person (does not apply to Orthodontia) $1500.

Covered Services In-network Benefits Out-of-network Benefits

Diagnostic and preventive carePreventive care; examinations, x-rays, oral hygiene & teeth cleaning

100% coverage(deductible does not apply)

50% coverage of the allowed amount (deductible does not apply)

Fluoride treatment (to age 19) 100% coverage(deductible does not apply)

50% coverage of the allowed amount (deductible does not apply)

Space maintainers 100% coverage(deductible does not apply)

50% coverage of the allowed amount (deductible does not apply)

Annual Deductible $50 per person$150 per family

$125 per person

Restorative care and prostheticsFillings (customary restorative materials)

80% coverage after deductible 50% coverage of the allowed amount after deductible

Sealants 80% coverage after deductible 50% coverage of the allowed amount after deductible

Oral surgery (simple extractions and root canals)

80% coverage after deductible 50% coverage of the allowed amount after deductible

Periodontics (gum disease therapy)

80% coverage after deductible 50% coverage of the allowed amount after deductible

Endodontics (root canal therapy)

80% coverage after deductible 50% coverage of the allowed amount after deductible

Inlays and overlays 80% coverage after deductible 50% coverage of the allowed amount after deductible

Restorative crowns 80% coverage after deductible 50% coverage of the allowed amount after deductible

Fixed or removable bridgework 50% coverage after deductible 50% coverage of the allowed amount after deductible

Full or partial dentures 50% coverage after deductible 50% coverage of the allowed amount after deductible

Dental relines or rebases 50% coverage after deductible 50% coverage of the allowed amount after deductible

Orthodontics - $2400 Lifetime Maximum (does not start over if you change dental plans)

50% coverage (deductible does not apply). Coverage is limited to dependents under age 19.

50% coverage of the allowed amount (deductible does not apply). Coverage is limited to dependents under age 19.

Emergency services are covered at the same benefit level as non-emergency services.

See Certificate of Coverage for specific plan limitations

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Personal supportGive us a call when you have questions about your coverage or health – we’re here for you.

IF YOU HAVE QUESTIONS ABOUT… CONTACT

Finding a doctor, drug or benefit details before enrolling in this planHow to enroll

Medicare SalesMonday - Friday, 8 a.m. - 8 p.m. CT (Feb. 15 - Sept. 30) and seven days a week, 8 a.m. - 8 p.m. CT (Oct. 1 - Feb. 14).952-883-7428, 866-993-7428 or 711 (TTY)Interpreters are available if you need one.healthpartners.com/segipmedicare

Your coverage, claims or account balancesFinding a doctor, dentist or specialistHealth plan services

Member ServicesMonday - Friday, 8 a.m. - 8 p.m. CT (Feb. 15 - Sept. 30) and seven days a week, 8 a.m. - 8 p.m. CT (Oct. 1 - Feb. 14).Call the number on the back of your member ID card or 952-883-7979, 800-233-9645 or 711 (TTY).Interpreters are available if you need one.healthpartners.com/medicare

Whether you should see a doctorHome treatment optionsA medicine you're taking

CareLineSM Service nurse line24/7, 365 days a year612-339-3663, 800-551-0859 or 711 (TTY)healthpartners.com/medicare

Understanding your health care and benefits How to choose a treatment option

HealthPartners® Nurse Navigators programMonday - Friday, 7:30 a.m. - 5 p.m. CT.Call the Member Services number on the back of your member ID card.healthpartners.com/medicare

Finding a mental or chemical health care professional in your networkYour behavioral health benefits

Behavioral Health NavigatorsMonday - Friday, 8 a.m. - 5 p.m. CT.952-883-5811 or 888-638-8787healthpartners.com/medicare

8170 33rd Ave S Bloomington MN, 55425

15777 (10/17) © 2017 HealthPartners H2462_106968 IR Approved 10/2017

Questions?

Call us at 952-883-7428 or 866-993-7428. TTY users should call 711.Or, go to healthpartners.com/segipmedicare for everything you need to know about enrolling!

HealthPartners is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal.