10/05/2012

Anthem Medicare Preferred (PPO) Medicare Advantage PPO and Part D Prescription Drug Coverage Anthem Blue Cross Life and Health Insurance Company (Anthem Blue Cross) Los Angeles City Employees‘ Retrement System Employer Group Retiree January 1, 2013

Y0071_13_15862_I_001 10/04/2012

Agenda

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• What is a Medicare Advantage (MA) plan? • What is a Medicare Advantage PPO plan? • Eligibility Eli ibilit • Finding a doctor • Anthem Medicare Preferred (PPO) • Medical benefits • Prescription drug benefits • Programs for a healthier you • How to enroll • Questions

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10/05/2012

What is a Medicare Advantage (MA) plan?



• Health plan options (like PPOs and HMOs) offered by private insurers that have been approved by Medicare. Also called “Medicare Part C.” • Medicare pays a fixed amount for your care every month to the health insurance companies offering MA plans. These companies must follow rules set by Medicare. • Coverage for basic hospital and medical expenses (replaces Part A and Part B) and often combined with Part D prescription drug coverage. May include additional benefits such as vision, dental and wellness programs. • One plan and one card for your covered medical / hospital and Part D drug b benefits. fit • An MA plan is not a Medicare Supplement, Medigap or Medicare Select plan. • Out-of-pocket limits to protect you from high, unexpected medical costs.

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What is a Medicare Advantage PPO plan?



• A PPO plan uses a network of health care providers, and gives you the freedom to see providers outside of the network when you use providers that accept Medicare. • Freedom to see specialists without getting a referral. • Provides out-of-network services as long as those services are covered by Medicare.

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In-network vs. out-of-network provider



In-network providers • Providers and other health care professionals who participate in our network and agree to accept our payment plus the member’s cost-share amount as payment in full.

Out-of-network provider • Providers and other health care professionals who do not participate in our network and are not required to provide services to Los Angeles City Employees’ Retirement System retirees. –

If the p provider accepts p Medicare and agrees g to treat yyou,, then the p provider will bill the local Blue plan for reimbursement.

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You will pay the in-network cost-share and deductible amounts.

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Eligibility



To enroll in an MA plan, you must: • Be enrolled in Medicare Part A and Medicare Part B B. • Continue to pay your monthly Part B premium (unless otherwise paid for under Medicaid or by another third party, if applicable). • Live in the plan’s service area. Our CMSdefined geographic service area for this plan is: all 50 states, Washington, DC and Puerto Rico. • Not have end-stage renal disease. Some exceptions p may y apply. pp y Contact p plan for details.

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Finding your doctor in our network



Here are a few ways you can check to see if your doctor participates in our network: • Check your Anthem Medicare Preferred (PPO) Provider Directory. • Call our toll-free customer service number listed on your member ID card. • Call 1-800-810-Blue. • Visit the “Doctor & Hospital Finder” at www.anthem.com/ca to find a Blue Medicare Advantage PPO provider provider.

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Anthem Medicare Preferred (PPO) medical benefits summary Medicare-covered services Physician services, including doctor’s office visits ((Medicare-covered services): ) • Physician visits • Specialist visits • Deductible Inpatient hospital care • Prior authorization is required for in-network and requested for out-of-network • Hospital days are unlimited. Covered services include, but are not limited to: semi-private room (or a private room if medically necessary) • Covered services include, but are not limited to: semi-private room (or private room if medically necessary) X-rays necessary), X rays, lab tests tests, drugs and medications



In-network

Out-of-network

$0 copay $0 copay

$0 copay $0 copay $100

$0 copay per day per admission

$0 copay per day per admission

Skilled nursing facility care • Prior authorization is required for in-network and requested for out-of-network • 100 days each benefit period

$0 copay per day per admission

$0 copay per day per admission

Ambulance services

$0 copay

$0 copay

Emergency outpatient care (waived if admitted within 72 hours)

$0 copay

$0 copay 8

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Anthem Medicare Preferred (PPO) medical benefits summary Medicare-covered services Durable medical equipment and related supplies Outpatient mental health care Preventive care and screenings • Bone mass measurement



In-network

Out-of-network

$0 copay

$0 copay

$0 copay

$0 copay

$0 copay

$0 copay

• Abdominal aortic aneurysm screening • Colorectal screening, immunizations, mammography, clinical breast exam, pelvic exam and pap smear, prostate cancer screening, cardiovascular disease testing, HIV and STI screenings, diabetes screening, obesity screening, depression screening, smoking cessation counseling, medical nutrition therapy, screening and counseling to reduce alcohol misuse Physical exams • Annual wellness visit Hearing services

$ copay $0

$0 copay

$0 copay

• Routine exams

$0 copay

$0 copay

• Maximum benefit per year Vision care

$50

$50

• Routine exams

$0 copay

$0 copay

• Maximum benefit per year

$50

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Anthem Medicare Preferred PPO medical benefits summary Medicare-covered services



In-network

Out-of-network

• Emergency outpatient

$0 copay

$0 copay

• Urgent care

$0 copay

$0 copay

• Inpatient care (60 days lifetime)

$0 copay per emergency admission

$0 copayper emergency admission

Foreign travel emergency

Out-of-pocket maximum 2013

$3,400

The benefit information provided is a brief summary, not a complete description of benefits. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network and co-payments/co-insurance may change upon renewal. See your Benefit Chart for a complete description of your plan including a list of services that require prior authorization and services that apply to your out-of-pocket maximum. All coinsurance, copays are accrued toward the out-of-pocket maximum with the exception of routine vision, routine hearing, the foreign travel deductible and emergency and urgently needed care coinsurance specific to foreign travel. Part D prescription drug deductibles and copays do not apply to the medical plan out-of-pocket maximum. 10 10

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Medicare Part D – how it works



• MA prescription drug coverage helps pay for many brand-name and generic prescribed drugs. • Y You'll 'll h have access tto a pharmacy h network t k with retail pharmacies across the U.S. as well as mail-order options. • Helps you better predict and control your costs at the pharmacy. • What you pay for your prescription depends, in part, on what tier your drug is in. • A formulary is a list of all the drugs your plan covers covers.

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Part D prescription drug benefit summary Initial Coverage copays/coinsurance Retail services (30-day supply)



What you pay in 2013

• Select Generics

• $0 copay

• Generics, including g Specialty p y Drugs g

• $5 copay p y

• Preferred Brands, including Specialty Drugs and

• $25 copay

Vaccines • $50 copay • Non-Preferred Brands and Non-Formulary Drugs

• $5 copay • Diabetes Supplies – insulin syringes and alcohol

swabs

Mail-order services (90-day supply , specialty drugs limited to a 30-day supply)

What you pay in 2013

• Select Generics

•$ $0 copay p y

• Generics, including Specialty Drugs

• $10 copay

• Preferred Brands, including Specialty Drugs and

• $50 copay

Vaccines • $100 copay • Non-Preferred Brands and Non-Formulary Drugs

• $10 copay • Diabetes Supplies – insulin syringes and alcohol

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Your Group Part D plan phases Full Gap coverage



Initial Coverage and Coverage Gap phases • You pay a copay or coinsurance, and your employer-sponsored plan pays p y the rest of the cost of yyour covered drugs g until the total cost of your covered drugs reaches $2,970. • Once you are in the Part D Coverage Gap phase, you continue to pay a copay or coinsurance and your employer-sponsored plan plus the Coverage Gap Discount program pay the rest of the cost of your covered drugs. • Once the amount you and the Coverage Gap Discount program have paid totals $3,600 you move to the Part D Catastrophic phase. You will then pay the catastrophic drug coverage level copay amounts.

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Your Group Part D plan phases Full Gap coverage with Senior Rx Plus



Initial Coverage •

You pay your copay/coinsurance and your plan pays the rest of the cost of your covered drugs until the total cost of your covered drug reaches $2,970.

Coverage Gap •

Generic drugs covered in Tier 1: You pay your copay/coinsurance after your group Medicare plan and Senior Rx Plus have paid benefits.

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Brand drugs: You pay your copay/coinsurance / i after ft your group Medicare M di plan, the Coverage Gap Discount, and Senior Rx Plus have paid benefits.

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One card is all you need: bring your ID card to the pharmacy and your plan will process the claim – all you’ll need to do is pay your copay/coinsurance. 14 14

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Catastrophic drug coverage level



Once your Part D true out-of-pocket drug cost (including the coverage gap discount) reaches $3,600, yyou will then p pay: y • Generic drugs: 5% with a minimum copay of $2.00 and maximum copay of $5 • Brand drugs: 5% with a minimum copay of $5.00 and maximum copay of $25

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Select generics



Select generic medications (are no cost to you): • A small number of commonly prescribed drugs are available. p drugs g that have a p proven track record of effectiveness and • These are specific value in treating many medical conditions. • The list of select generic drugs is included in your enrollment package. Examples include Autonomic and CNS Medications Bupropion hcl Citalopram hbr Fluoxetine hcl Mirtazapine

Cardiovascular Medications Atenolol Captopril Chlorthalidone Enalapril maleate Hydrochlorothiazide y Lisinopril Lisinopril-hctz Lovastatin Metoprolol Simvastatin

Gastrointestinal Medications Omeprazole Ranitidine Musculoskeletal Medications Ibuprofen Indomethacin Piroxicam

These are examples of some of the drug categories and drugs covered under your Select Generic benefit. Please see your formulary for a full list of Select Generic drugs. Not all generic drugs within a drug category are included in your $0 copay Select Generic benefit.

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How do I get my covered prescriptions?



Using in-network pharmacies: 1. Go to your network retail pharmacy, show your ID card, pay your required amount and receive your medication. di ti 2. Have your medications delivered to you by using a network mail-order pharmacy. You may receive medications by simply calling or ordering online. Using out-of-network pharmacies: •

In certain circumstances, you may be reimbursed for drug costs when you must get a covered prescription filled at an out-of-network pharmacy. You will have to pay the cost of the drug and submit a claim to us. You will be responsible for all amounts over our negotiated cost, plus any deductible, copay or coinsurance listed in this benefit chart.

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How do I get started with the mail-order pharmacy?



You will receive a patient order form in your post-enrollment materials. You also may contact customer service to receive an order form. • Complete the form, including your prescription information. • Return the form and prescriptions to the address listed on the form. • Once you are registered, you may order medications online or by calling the customer service toll-free number.

Your doctor can fax new prescriptions to the mail-order pharmacy. It usually takes 1014 days to process and ship orders. You will get the most from your prescription drug benefits when you use the mail-order pharmacy. Your cost share will be lower.

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Programs for a healthier you



Condition Management

MyHealth

• You’ll receive a Health Risk Assessment call or form to complete that has been designed specifically for you.

• Access to a WebMD-powered health center with resources such as:

• Condition management is available to help you manage ongoing chronic conditions and increase quality of life. • An integrated care management program is available to assist with multiple conditions by developing an integrated care plan that addresses your physical, social and emotional well-being.

- Men’s health - Women’s health - Life after 50 - Fitness and nutrition

Our WebMD Symptom Checker uses a 3-D graphic of the human body to help members understand their symptoms. 19 19

Value-Added programs: Health and Fitness memberships (no cost to you)



24/7 nurse help line and audio library • Talk in private with a registered nurse about your health any time day or night • Listen to health topics by calling the 24/7 nurse help line audio library SilverSneakers® Fitness Program • A health, exercise and wellness program to help you live healthier and active lifestyles, while having fun and meeting new friends • A variety of participating locations throughout the country. Many sites offer: – Exercise equipment (treadmills and free weights) – Conditioning classes, pool and sauna – Health education seminars and other events that promote the benefits of a healthy lifestyle – Member-only access to online support that can help you lose weight, quit smoking or reduce your stress The SilverSneakers Fitness Program provided by Healthways, Inc., an independent company. SilverSneakers® is a registered mark of Healthways, Inc.

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More programs: SpecialOffersSM



For alternative health and wellness programs outside the gym – try these discounted or free health maintenance programs/products: • Diet/nutrition and fitness: Jenny Craig®, WeightWatchers®, Lindora®, Living Lean® • Vitamins and personal care: Puritan's Pride, drugstore.comTM • Vision and hearing: TruVisionTM, Premier LASIK, HearPO, Beltone • Healthy habits: Living FreeTM, Living SmartTM • And, lots more! Note: Vendors and offers are subject to change without prior notice. Anthem Blue Cross does not endorse and is not responsible for the products, services or information provided by the vendors. Services and supplies accessed through this program are NOT a part of your health coverage. Please refer to your schedule of benefits for coverage details. Information is being provided for educational purposes only and should not be considered medical advice or treatment. Please consult your doctor for advice about changes that could affect your health or lifestyle.

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Enrolling in Anthem Medicare Preferred (PPO)



• Complete the enrollment form that was mailed to you or that you received at this meeting and return it to Los Angeles City Employees’ Retirement System. • The form is due November 15, 2012. • The proposed effective date of your Anthem Medicare Preferred (PPO) is January 1, 2013.

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Using Your Anthem Medicare Preferred (PPO) Plan



First Impressions Welcome Line (Use this number to get answers prior to enrollment) 877-411-1647; (TTY/TDD: 711) Monday - Friday 8 a.m. to 9 p.m. ET, except holidays.

Your new Anthem Medicare Preferred (PPO) ID card • An ID card is issued to all new enrollees. • You need only one ID card, your Anthem Medicare Preferred (PPO) ID card. You can put your red, white and blue Medicare ID card in a safe place. • Make sure to carry your ID card with you at all times.

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About Anthem Blue Cross



• One in three Americans carry a Blue Cross Blue Shield Association card to access health care* • Full complement of health care products • Offers innovative wellness and preventive care programs at no cost to you

*www.bcbsa.com

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Questions? 25 25

Thank you for joining us.



Anthem Blue Cross Life and Health Insurance Company is a health plan with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network and co-payments/co-insurance may change upon renewal. Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

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