OPEN ENROLLMENT GUIDE

PLAN YEAR 2017 OPEN ENROLLMENT GUIDE FOR RETIRED EMPLOYEES & FAMILY SECURITY PARTICIPANTS OPEN ENROLLMENT IS NOVEMBER 28 TO DECEMBER 9, 2016 Contac...
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PLAN YEAR 2017

OPEN ENROLLMENT GUIDE FOR RETIRED EMPLOYEES & FAMILY SECURITY PARTICIPANTS

OPEN ENROLLMENT IS NOVEMBER 28 TO DECEMBER 9, 2016

Contact SwRI Retiree Benefits: 210.522.2232 | [email protected] | www.swri.org/retirees/#insurance

Employee Benefits Office

“To provide a quality employee benefits program that includes excellent benefit options, accurate and useful communications, and helpful employee assistance.”

Letter from Employee Benefits TABLE OF CONTENTS

Open Enrollment Highlights

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Benefit Programs and Related Premiums

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Medical Care Options for Pre-65 & Medicare-Age Participants

4

Comparison of Prescription Drug Programs

5

Vision Care Summary - Avesis

6

Vision Care Summary - VSP

7

Dental Care Benefits

8

Updates and Required Notices

10

Helpful Reminders

12

Urgent Care Facilities – Texas Premier Choice Plan

14

Know Before You Go – Texas Premier Choice Plan

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Plan Contact Information

16

Service Area for the Secure Horizons Plan

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Welcome to Open Enrollment for Plan Year 2017. This “Open Enrollment Guide” covers the information needed to understand your options for the coming plan year. For the many retirees and dependents in the Medicare-Age plans, you will be pleased to note that we are offering the same medical plans for 2017 without changes in plan benefits. Members who are participating in a pre-65 medical plan will be enrolled in the UnitedHealthcare Texas Premier Choice Plan for 2017. The plan benefits, copayments, co-insurance, annual deductible, and annual out-of-pocket maximum are very attractive and desirable when compared to other plans available for you on the Health Insurance Marketplace. Additionally, for the UnitedHealthcare Texas Premier Choice plan, the Summary of Benefits and Coverage (SBC) has been posted to the retiree website at www.swri.org/retirees/ #insurance. You may change benefit elections from November 28 to December 9, 2016. If your elections remain the same as last year’s, you do not need to do anything. Please read through this booklet which contains important information about changes that may affect your decisions. Feel free to contact SwRI Retiree Benefits for any additional information or assistance in the evaluation/change process. Sincerely,

Buck Brockman Assistant Director, Employee Benefits

Open Enrollment Highlights As usual, this year’s open enrollment presents a great selection of SwRI-sponsored benefits. This section is a brief reminder of changes and important things to know about the benefit providers and benefit changes.

Medical Plan Premium Changes Premiums for the medical care programs and Retiree Dental Plan are based on the insurers’ expected experience for 2017 and include the same premium support from the Institute as in 2016. For its fiscal year ended September 30, 2016, the Institute contributed $2.5 million toward retiree medical care programs.

Flu Shot Coverage – Texas Premier Choice Plan If you, your spouse or a dependent child is covered by the UnitedHealthcare Texas Premier Choice Plan and desire to get a seasonal flu shot, you are advised that HEB, WalMart, Walgreens, Target, and CVS have an arrangement with the plan to administer the shot. The claim will be filed with UHC and the plan will cover the cost at 100%.

Health4Me Mobile APP UnitedHealthcare Health4Me™ provides instant access to your critical health information— anytime/ anywhere. It is designed to make managing your health a lot simpler. You can easily access the information you need, find the care you’re looking for,

personalize the interface with your photos and even talk to someone directly if you have questions. To register for the App go to: https://itunes.apple.com/us/ap p/health4me/id489196274?mt= 8 or go to your smart phone App store and search Health4Me. Deep discounts on hearing aids for VSP members TruHearing is offering all VSP members and their covered dependents free access ($108 value) to the TruHearing MemberPlus® Program, which saves members $1,200 per hearing aid and up to $2,400 on a pair of hearing aids. Members may also add up to four extended family members for a VSP-exclusive rate of $71. VSP members can learn more about this program and sign up at vsp.truhearing.com or by calling (877) 372-4040. Hearing Aid coverage for UHC members Hearing aids are covered as a plan benefit for pre-65 participants enrolled in the Texas Premier Choice Plan. Benefits are provided by the plan after the annual deductible has been met. Benefits are limited to a single purchase (including repair/replacement) per

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hearing impaired ear every three years. Covered benefits for wearable hearing aids include the hearing aid device, fitting charges and testing. Benefits exclude coverage for batteries, accessories, dispensing fees, and frequency modulated systems. Contact UnitedHealthcare for coverage information for Semiimplantable Electromagnetic Hearing Aids (SEHA) and Bone Anchored Hearing Aids (BAHA). Benefits provided in the Secure Horizons Medicare Advantage plan administered by UnitedHealthcare include a $500 allowance for eligible hearing aids available to enrolled members every 36 months. UHC members also can participate in the HealthInnovationsTM program, which provides a discount on a specific selection of hearing aids. Call 1-866-926-6632 or visit https://www.hi healthinnovations.com/united for more information. You must have a hearing exam and order your hearing aid through HealthInnovationsTM to receive the discount available in this program.

Benefit Programs and Related Premiums BENEFIT PROGRAMS FOR RETIREES & FAMILY SECURITY PARTICIPANTS OPTIONS WHEN ALL PERSONS ARE PRE-65:

RETIREE ONLY

RETIREE & SPOUSE

FAMILY

(AMOUNTS ARE MONTHLY)

UNITEDHEALTHCARE TEXAS PREMIER CHOICE PLAN – FULLY-INSURED PLAN

$549.78

$1,468.26

$2,054.91

Information available from Employee Benefits

TRICARE SUPPLEMENTAL PROGRAM

OPTIONS WHEN ALL PERSONS ARE MEDICARE-AGE: HARTFORD GROUP RETIREE PLAN WITH MEDICARE PART D PRESCRIPTION DRUG PLAN

186.85

373.70

*

SECURE HORIZONS PLAN AND WITH MEDICARE PART D PRESCRIPTION DRUG PLAN

142.31

284.62

*

TRICARE FOR LIFE – INFORMATION AVAILABLE FROM EMPLOYEE BENEFITS

None-Department of Defense pays

OPTIONS WHEN ONE PERSON IS MEDICARE-AGE AND THE OTHER PERSON IS PRE-65: HARTFORD GROUP RETIREE PLAN AND TEXAS PREMIER CHOICE PLAN FOR PRE-65 PARTICIPANTS

N/A

736.63

*

SECURE HORIZONS PLAN AND UHC TEXAS PREMIER CHOICE PLAN

N/A

692.09

*

TRICARE FOR LIFE – INFORMATION AVAILABLE FROM EMPLOYEE BENEFITS

None-Department of Defense pays

VISION CARE OPTIONS: AVESIS PLAN

10.01

17.22

23.05

VISION SERVICE PLAN (VSP)

15.58

26.21

41.83

UNITED CONCORDIA RETIREE DENTAL CARE PLAN – INSURED PLAN (voluntary)

35.70

70.71

110.13

UNITED CONCORDIA DENTAL PPO – SELF-INSURED PLAN AVAILABLE ONLY UNDER COBRA

32.05

53.21

93.96

DENTAL CARE OPTIONS:

LEGAL CARE PROGRAM: 11.70 MONTHLY

HYATT LEGAL PLAN (voluntary)

*Dependent children are $549.78 per month per child.

IMPORTANT REMINDER: To participate in the Hartford Group Retiree Plan or the Secure Horizons Plan, you must be enrolled in Medicare Parts A and B and pay any required premiums to the Medicare Program. See page 12 for additional information on Medicare enrollment. You may obtain additional information about your Medicare premiums at www.medicare.gov. For eligible counties that you must reside in to participate in the Secure Horizons plan, see page 16

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Medical Care Options for Pre-65 & Medicare-Age Participants This chart is a summary. Contact the insurance carrier for specific plan coverages, exclusions, and limitations. PRE-65 PARTICIPANTS UNITEDHEALTHCARE TEXAS PREMIER CHOICE PLAN

BENEFITS/FEATURES

Refer to the Summary of Benefits and Coverage for limitations and exclusions

MEDICARE-AGE PARTICIPANTS SECURE HORIZONS PLAN MEDICARE ADVANTAGE PLAN INCLUDING DRUG CARD

HARTFORD GROUP RETIREE MEDICAL PLAN

PHYSICIAN SELECTION

Services must be provided by providers in the UnitedHealthcare Choice network

Services must be provided by participating plan physicians

Any licensed provider registered with Medicare

SPECIALIST REFERRAL APPROVAL REQUIRED

No

Yes

No

ANNUAL OUT-OF-POCKET

$2,000 individual $4,000 family

$6,700

None

CALENDAR YEAR DEDUCTIBLE

$500 individual $1,000 family

None

None

MAXIMUM LIFETIME BENEFIT

None

None

None

MEMBER PAYS PHYSICIAN OFFICE VISITS (OB/GYN INCLUDED IN UHC $25/visit PLANS ONLY)

PLAN PAYS

$10 co-pay per visit

100% of the Medicare Balance*

SPECIALIST OFFICE VISITS

$25 or $50/visit

$10 co-pay per visit

100% of the Medicare Balance*

HOSPITAL SERVICES (SEMI-PRIVATE ROOM)

Inpatient: $100/confinement and deductible. Outpatient: $200/visit and deductible

No charge – Inpatient and outpatient services covered in full for unlimited days as medically necessary

100% of Medicare hospital deductible

SURGEON SERVICES

No charge after deductible

No charge for covered services

100% of the Medicare Balance*

ROUTINE ANNUAL PHYSICALS (OB/GYN SEPARATE FROM THIS BENEFIT)

No charge

No charge (one exam per year)

100% of the Medicare Balance*

ROUTINE EYE EXAMINATIONS

$25/visit

$10 co-pay (one exam per year)

Not covered

No charge for covered services

100% of the Medicare Balance*

X-RAY AND LABORATORY

Diagnostic test (x-ray, blood work): No charge Imaging (CT/PET scans, MRIs): No charge after deductible has been met

ROUTINE MAMMOGRAPHY OR ROUTINE PROSTATE TEST

Mammogram – Standard X-ray covered (physician order required): No charge Prostate screening covered for age 40+: No charge

No charge for covered services

100% of the Medicare Balance*

COLONOSCOPY

No charge for preventive colonoscopy No charge for covered services (covered for age 50+)

100% of the Medicare Balance*

EMERGENCY SERVICES

Emergency room services: $300/visit Emergency medical transportation: No Charge after deductible Urgent Care: $75/visit

MENTAL HEALTH

Inpatient: No Charge after deductible Inpatient: no charge – up to 190 days/lifetime Outpatient: $25/visit Outpatient: $10/visit (group or individual therapy)

HEARING AIDS

No Charge after deductible

$50 co-pay for emergency room; waived if admitted to hospital within 24 hours Urgent Care: $10/visit; waived if admitted within 24 hours

$500 allowance available every 36 months

*Medicare Balance means the 20% of allowable charges not paid by Medicare.

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100% of the Medicare Balance*

100% of the Medicare Balance*

Not Covered

Comparison of Prescription Drug Programs This chart is a summary. Contact the insurance carrier for specific plan coverages, exclusions, and limitations. MEDICARE-AGE PARTICIPANTS SECURE HORIZONS – TM OptumRx

HARTFORD GROUP RETIREE PLAN – Express Scripts Medicare™

RETAIL CO-PAY PROGRAM (LIMITED TO A 30-DAY SUPPLY)

RETAIL CO-PAY PROGRAM (LIMITED TO A 30-DAY SUPPLY)

TIER 1

$10 per prescription

$5 per prescription

TIER 2

$20 per prescription

$10 per prescription

TIER 3

$40 per prescription

$25 per prescription

TIER 4

$40 per prescription

$60 per prescription

TIER 5

n/a

33% of plan cost per prescription

MAIL ORDER CO-PAY PROGRAM (LIMITED TO A 90-DAY SUPPLY)

MAIL ORDER CO-PAY PROGRAM (LIMITED TO A 90-DAY SUPPLY)

TIER 1

$20 per prescription

$8 per prescription

TIER 2

$40 per prescription

$15 per prescription

TIER 3

$80 per prescription

$56 per prescription

TIER 4

$80 per prescription

$165 per prescription

TIER 5

n/a

Not Available

OTHER INFORMATION

OTHER INFORMATION

ANNUAL TRUE OUT-OF-POCKET MAXIMUM FOR Rx

$4,950

$4,950

CATASTROPHIC COVERAGE

Maximum of 5% of plan cost or $3.30 for generic or $8.25 for all other drugs, whichever is greater.

Maximum of 5% of plan cost or $3.30 for generic or $8.25 for all other drugs, whichever is greater.

COVERAGE GAP

None

None

OUT-OF-NETWORK COVERAGE

None

Refer to Plan Provider Booklet

PRE-65 PARTICIPANTS TM

TEXAS PREMIER CHOICE PLAN – OptumRx TIER 1 TIER 2 TIER 3

$10/retail prescription, 31-day supply $20/mail prescription, 90-day supply $30/retail prescription, 31-day supply $60/mail prescription, 90-day supply $60/retail prescription, 31-day supply $120/mail prescription, 90-day supply

WHAT ARE PRESCRIPTION DRUG TIERS? Tiers are the different cost (co-payment) options you pay for a medication. Covered medications are placed on a given Tier by OptumRx, the Pharmacy Benefit Manager for the Texas Premier Choice Plan. Each Tier is assigned a cost, which is determined by the Institute. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3, look to see if there is a lower-tier alternative. You are encouraged to discuss your options with your doctor.

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Vision Care Summary - Avesis This chart is a summary. Contact SwRI Retiree Benefits for specific plan coverages, exclusions, and limitations.

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Vision Care Summary - VSP This chart is a summary. Contact SwRI Retiree Benefits for specific plan coverages, exclusions, and limitations.

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Dental Care Benefits This chart is a summary. Refer to the retiree website at www.swri.org/retirees/#insurance for specific plan exclusions and limitations. BENEFITS/ FEATURES Dental network Dentist selection

Specialty care Calendar year deductible Cost of services Orthodontia Annual benefit maximum Predetermination

UNITED CONCORDIA PPO (COBRA ONLY)

UNITED CONCORDIA RETIREE DENTAL CARE PLAN

Advantage Plus Network Any licensed dentist. Use of a network dentist assures savings to the participant. Non-network dental providers’ charges are limited to usual and customary fees. No pre-approval or referral required when services provided by a licensed dentist or physician.

Advantage Plus Network Any licensed dentist. Use of a network dentist assures savings to the participant. Non-network dental providers’ charges are limited to usual and customary fees. No pre-approval or referral required when services provided by a licensed dentist or physician.

$50 per individual $150 per family Covered services require a co-benefit amount from 0 to 50% based on class of service performed. Covered at 50% of eligible charges. Maximum lifetime benefit of $1,500 per participant.

$50 per individual $150 per family Covered services require a co-benefit amount of 0 to 50% based on class of service performed.

$2,000 (excludes orthodontia services)

$1,500

Recommended when the cost of a treatment plan exceeds $350.

Recommended when the cost of a treatment plan exceeds $350.

None

PLAN PAYS

UNITED CONCORDIA RETIREE DENTAL CARE

MEMBER PAYS CLASS I

Exams Cleanings X-rays (bitewing) X-rays (all other) Sealants Fluoride treatments Palliative treatment

100% of Allowed Amount

Basic restorative (fillings) Simple extractions Space maintainers Repairs of crowns, inlays, onlays, bridges and dentures Non-surgical periodontics

80% of Allowed Amount

Surgical periodontics Inlays, onlays, crowns Prosthetics Endodontics Complex oral surgery General anesthesia Implants

50% of Allowed Amount

$0 – and if out of network, any charges in excess of the Allowed Amount*

CLASS II 20% of Allowed Amount and if out of network, any charges in excess of the Allowed Amount*

CLASS III

50% of Allowed Amount and if out of network, any charges in excess of the Allowed Amount*

MAXIMUMS AND DEDUCTIBLES Calendar year maximum Calendar year deductible (Class I exempt)

$1,500 $50 / $150

BENEFIT WAITING PERIOD

Retirees enrolling from the Institute-offered dental care plan

None

Retirees not currently enrolled in the Institute-offered dental care plan

12 months for Class III Benefits

*Note: In-network providers agree to accept United Concordia’s maximum benefit allowance for covered services and also agree to file claims for you. You pay only the co-insurance and any charges for non-covered services. Out-of-network providers may charge you more than the maximum benefit allowance. You are responsible for any amounts over the maximum benefit allowance. This schedule includes a representative listing of services covered under the plan. Standard exclusions and limitations apply.

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Health Insurance Marketplace – Exchanges The Health Insurance Marketplace is intended for the uninsured and those whose employers do not offer jobbased health plans. Under the Affordable Care Act (ACA), persons not eligible for an employer health care plan or Medicare now have additional options to buy health insurance coverage. These options vary from state to state and can be found on the www.healthcare.gov website. Information about health insurance plans offered through the Health Insurance Marketplace found on the above website discloses premiums, deductibles and out-of-pocket costs so that interested persons can make an informed decision about enrolling themselves and/or eligible family members. Persons eligible for a subsidized medical plan through the Institute will lose the premium subsidy provided by the Institute if they elect coverage through the Health Insurance Marketplace. Information about when you may enter a health insurance plan through an election made in the Health Insurance Marketplace is provided by the plan’s enrollers. Options available through the Health Insurance Marketplace may change on an annual basis including the addition of new plans, the cancellation of existing plans and the revision of premiums and plan coverage rules. These changes are communicated on the www.healthcare.gov website. The annual Health Insurance Marketplace open enrollment period for 2017 individual insurance coverage is now open. • • •

December 15, 2016: Last date to enroll in or change health plans by this date for your health plan to start January 1, 2017. January 1, 2017: 2017 insurance starts if you enrolled or changed plans by December 15. January 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period.

Important Reminder – If you are under the age of 65 and eligible for subsidized SwRI-sponsored retiree medical coverage, you may delay or opt out of coverage in the SwRI-sponsored Texas Premier Choice plan by enrolling in a plan available through the Health Insurance Marketplace or through your spouse’s employer. For more information on this option, please contact SwRI Retiree Benefits.

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Updates and Required Notices Express Scripts Medicare™ Prescription Drug Plan The prescription drug plan available to Medicare-Age participants who are enrolled in the Hartford Medigap plan is the Express Scripts Medicare™ Prescription Drug Plan (PDP) for Southwest Research Institute (sponsor) through the Express Scripts Insurance Company. The Plan is a Medicare approved Part D Plan and is regulated by the Centers for Medicare and Medicaid Services (CMS). Co-pays remain consistent in the Initial Coverage Stage and the Coverage Gap. The participant’s co-pays will remain the same until the True-Out-ofPocket costs reach $4,950. At this point, the retiree will pay the following co-pay values for prescriptions purchased during the remainder of the calendar year: the greater of $3.30 for a generic drug (including brand drugs treated as generics) and $8.25 for all other drugs OR 5% of the total cost, with a maximum not to exceed the standard copayment in the Initial Coverage Stage. More information about the Plan is available on Express Script’s website www.express-scripts.com. Secure Horizons Prescription Drug Coverage Notice Please note the following with regard to the drug coverage on this Medicare Advantage Part D (MAPD) plan: • There is a specific Part D drug formulary that applies. Drugs not on the formulary list are not covered.

• Part D formulary for calendar year 2017 is pending approval by CMS. The 2017 formulary will include certain changes in specific drugs covered, and drug coverage tiers. These changes will be communicated to members in our annual notification of change materials. • Secure Horizons reserves the right to change its pharmacy benefit manager and/or its pharmacy network for calendar year 2017. • Part D plan designs include standard catastrophic coverage per CMS regulations. Specifically, once a member reaches $4,950 in True-Out-ofPocket prescription medication costs in the 2017 calendar year, the member will pay the greater of a $3.30 co-pay or 5% coinsurance for generic drugs, and the greater of a $8.25 co-pay or 5% coinsurance for brand name drugs, regardless of whether these drugs are received at a retail pharmacy or through the Secure Horizons mail order program. Optum Health Services All members will continue to receive the full expanded suite of wellness and health advisory services through OptumHealth including OptumHealth Allies (health discount programs), Nurseline, which includes Treatment Decision Support and Access Support, along with access to focused disease management programs. In addition, your plan offers a senior fitness benefit and a caregiver benefit.

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Secure Horizons – Medicare Advantage Changes Required under Affordable Care Act Health Care Reform (Patient Protection and Affordable Care Act) had some impacts on Medicare Advantage (MA) plans. Listed below are the changes that impact benefit plan design. 1) Medicare Advantage plans must have Maximum Out-ofPocket (MOOP) limits and those limits cannot exceed $6,700. 2) IMPORTANT CHANGE – Member cost sharing (deductibles, co-insurance and co-payments) for Medicarecovered Part A and Part B services (including office visits) will go toward the Maximum Out-of-Pocket (MOOP) limit. 3) Medicare-covered Chiropractic Services – per CMS, member cost share may not exceed 50% of the actuarial equivalent value of the cost of the service and cannot be discriminatory. Member cost share may not exceed $10 co-payment in and out-of-network. If current cost share is more than $10 or a coinsurance, benefit will be updated to no greater than 50% co-insurance. 4) Medicare-covered Preventive Services – no co-payment for 18 CMS-identified services, applies to all MA plans. Services received out-of-network may have cost sharing. 5) Medicare-covered Annual Wellness Visit – CMS has added a requirement to add an Annual Routine Physical Exam to all Group benefit plans (no co-pay

in network, cost share allowed out-of-network). Your benefit plan has been updated to include these changes if they were not already included in your plan. Annual Notices Included in Past Open Enrollment Booklets NOTICE ABOUT THE GENETIC INFORMATION NONDISCRIMINATION ACT (GINA) GINA is a federal law that basically prohibits health plans and insurers from requiring genetic tests for plan participation, from collecting genetic testing information and from adjusting plan premiums based on genetic information. Family history of disease information collected in connection with any health risk assessment is genetic information that is protected health information under HIPAA and GINA. This information, accordingly, is not shared with employees who administer the health plan except in the form of aggregate, desensitized data NOTICE REQUIRED BY THE DEPARTMENT OF LABOR Group health plans, including those described in this guide, and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96 hours following a cesarean section, or require that a provider obtain authorization from the plan or insurance issuers for prescribing a length of stay not in excess of the above periods.

NOTICE REQUIRED UNDER THE WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 Group health plans, including those described in this guide, in the past have provided coverage for mastectomies. This coverage generally includes procedures necessary to effect reconstruction of the breast on which the mastectomy was performed as well as the cost of prostheses (implants, special bras, etc.) and physical complications of all stages of a mastectomy, including lymphedemas, as recommended by the patient’s physician. Additionally, plans described in this guide provide coverage for any necessary surgery and reconstruction of the breast on which a mastectomy was not performed to produce a symmetrical appearance for any participant currently receiving plan benefits. This coverage is subject to the same coinsurance, deductibles, co-payments, and other limitations that apply to mastectomies under the plans’ current terms. HIPAA PRIVACY RULE REMINDER A federal law known as HIPAA (the Health Insurance Portability and Accountability Act) requires that Institute employees as well as those who administer health care plans take reasonable steps to ensure the privacy of personally identifiable health information (PHI). The term PHI includes all individually identifiable health information that is communicated orally, in writing, or in electronic form between a plan participant and those who provide health care services and who administer health care plans. PHI includes any combination of a member’s name, address, date of birth, social 11

security number, marital status, and sex when disclosed with the person’s health history, medical records, or information about present or future health care. PHI should be disclosed only to health care providers for treatment, to third party administrators who make coverage determinations and payments, and to the people who administer the health care plan on behalf of the plan administrator. The Privacy Notice for the SwRI Medical Benefits Office can be obtained by calling 210-522-2227. TEXAS HIPAA ALERT Texas Statute H.B. 300 makes all individuals responsible for safeguarding protected health information (PHI) in the same manner that covered entities (doctors, hospitals, pharmacies, health plans, medical clinics, etc.) are required to do under the federal HIPAA privacy rules. You should not disclose information about your personal health to anyone who does not need that information for a business reason. If you do so, the individual health information you disclosed is no longer protected. If you become aware of health information pertaining to someone that was not voluntarily provided to you by that person, you should not share that information without permission to do so. H.B.300 provides for both civil and criminal penalties when PHI is improperly disclosed. The privacy protection under Texas law exceeds the privacy protection extended under the federal HIPAA privacy rules and extends to information about your name, address, gender, social security number and banking information.

Helpful Reminders UnitedHealth Premium Designation Program UnitedHealthcare recognizes that variations in care contribute to health care cost increases and inconsistent quality of the care that people receive. The UnitedHealth Premium Designation Program evaluates and identifies network physicians and cardiac facilities that adhere to nationally recognized evidencebased criteria for quality and efficiency of care for 19 physician specialties, and then shares this information with its members. Physicians who meet this highly credentialed status will be indicated by a Tier 1 symbol and listed at the top of your physician search when visiting www.myuhc.com. Help with Prescription Drug Costs There are programs to help people with limited resources pay for their prescription drugs. You might qualify to get help in paying for your drugs. There are two basic kinds of help: “Extra Help” from Medicare. This program is also called the “lowincome subsidy” or LIS. People whose yearly income and resources are below certain limits can qualify for this help. See the new Medicare & You 2017 Handbook or call 1-800-MEDICARE (1-800-633-4227). Telephone Typewriter (TTY) users should call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week.

Help from your state’s pharmaceutical assistance program. Many states have State Pharmaceutical Assistance Programs (SPAPs) that help some people pay for prescription drugs based on financial need, age, or medical condition. Each state has different rules. Check with your State Health Insurance Assistance Program. Help and Information from Medicare Here are three ways to get information directly from Medicare: • Call 1-800-MEDICARE (1-800633-4227), 24 hours a day, 7 days a week. Telephone Typewriter (TTY) users should call 1-877486-2048. • Visit the Medicare website (http://www.medicare.gov). • Read the Medicare & You 2017 Handbook. Every year in October, this booklet is mailed to people with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. If you don’t have a copy of this booklet, you can get it at the Medicare website (http://www.medicare.gov) or by calling 1-800-MEDI- CARE (1800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

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Help and Information from Your State Health Insurance Assistance Program The State Health Insurance Assistance Program (SHIP) is a government program with trained counselors in every state. State Health Insurance Assistance Programs are independent (not connected with any insurance company or health plan). They are state programs that get money from the federal government to give free local health insurance counseling to people with Medicare. SHIP counselors can help you with your Medicare questions or problems. They can help you understand your Medicare plan choices and answer questions about switching plans. You can call the SHIP in your state using the contact information found at www.shiptalk.org. Medicare Enrollment Information REMINDER: To participate in the Hartford Group Retiree Plan and the Secure Horizons Plan you must enroll in Medicare Parts A and B, and you cannot enroll in any other Medicare Part D plan. The Employee Benefits Office receives frequent questions about when a person should sign up for Medicare. This summary covers the enrollment requirements for Medicare Parts A, B and D including the consequences of late enrollment.

MEDICARE PART A Medicare Part A covers hospital services. No premium is charged for Part A coverage for eligible persons. You should sign up for Part A coverage 60 days prior to the month you reach age 65. When you sign up could make a difference in when your coverage is effective. This is especially important if you are in the pre-65 retiree medical care plan offered by SwRI. Your Part A coverage will start at the beginning of your birthday month when you sign up prior to reaching age 65. If you sign up during your birthday month, coverage starts on the first day of the following month. If you sign up any later than your birthday month, you will face a delay in the start of your coverage. If you are already on Social Security, Medicare will send you a reminder three months before your birthday and automatically sign you up. If you are not on Social Security, you can enroll online or by going to the nearest Social Security Administration Office. Since Medicare Part A is free to anyone who has paid the Medicare tax for at least 10 years (40 quarters), you should file before you reach age 65. MEDICARE PART B Medicare Part B covers physician and most other medical services except prescription drugs. Noncompliance with the enrollment rules for Medicare Part B has consequences. Generally, you must file when you

turn age 65 or when you stop working, whichever comes later. There is a monthly premium for Medicare Part B coverage. If you enroll late, there is a 10% surcharge (or penalty) added to your premium for every year that you could have signed up but did not. This penalty will not apply if you sign up soon after the health care coverage provided by your employer’s medical care plan (or your spouse’s plan if you are a dependent) ends. Sign up for Medicare Part B before you or your spouse stop active employment (you should begin the Plan B enrollment process at least 60 days before your active employment ends). If you are enrolled in the SwRI-sponsored pre-65 retiree medical care plan, enroll 60 days prior to the month in which you turn 65. CAUTION: Some new participants in the Part B program may be subject to higher Part B premiums because their earnings from the previous three calendar years (or tax years if different) are considered in the calculation of Medicare Part B premiums. Visit www.medicare. gov for more information on Part B premiums. MEDICARE PART D Medicare Part D covers prescription drugs. Currently benefits are provided exclusively through private plans that are supervised by the Centers for Medicare and Medicaid Services (CMS). You are penalized for late

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enrollment (signing up for it after the month that you could have first enrolled). You are not late if you sign up immediately after you or your spouse are no longer actively employed. If the penalty applies, it is 1% extra for every month that you could have enrolled but did not. Enrollment in one of the two Medicare-Age plans allows you to also be in a Part D Prescription Drug Plan (Express Scripts Medicare™ Prescription Drug Plan or OptumRx™ Prescription Drug Plan). The premium for these prescription drug programs is combined with your medical care program premium. You cannot enroll in any other Medicare Part D private plan that is approved by CMS. REMINDER: In the year a person will turn age 64 and every year thereafter while still actively employed (or the spouse of an actively employed person), a Creditable Coverage Letter is required by CMS to be sent to that person in October. When you or your spouse stop active employment OR are no longer eligible for the pre-65 retiree medical plan because you are 65, you must provide this letter to Social Security if you enroll in an outside Medicare Part D plan so you will not be assessed a penalty for not enrolling at an earlier date.

Urgent Care Facilities – Texas Premier Choice Plan If you experience a significant health event, you may need to visit an emergency room to receive appropriate care. However, you and your medical plan save when you select an Urgent Care Center instead of the emergency room for care in non-life-threatening situations. As a continuing reminder, the red circle below includes a partial list of the San Antonio area Urgent Care Centers providers that participate in the UnitedHealthcare Choice network as of October 2016. The network of doctors and facilities is always evolving. Before you see the doctor, always check that the urgent care facility participates in the UnitedHealthcare Choice network. To find out, you can ask your doctor or facility, call Member Services at the toll free number on your ID card, or log-in to review the provider’s network status at www.myuhc.com or on the Health4Me mobile phone app. Caution: Stand-alone emergency facilities are not Urgent Care Centers. If you receive care at a stand-alone emergency facility, the emergency room co-payment will apply.

San Antonio Urgent Care Centers in the Choice network include: Always check that the Urgent Care Center still participates in the UnitedHealthcare Choice network.

Concentra Urgent Care Fastmed Urgent Care Good Night Pediatrics Impact Urgent Care Little Spurs Pediatric Urgent Care Medpost Urgent Care Nextcare Urgent Care Promptu Immediate Care Quality Urgent Care

Ask before lab work is ordered to ensure that lab work is not sent to a lab that does not participate in the UnitedHealthcare Choice network.

Texas MedClinic

Virtual (online) visits are now available from UnitedHealthcare. Log-in to your account at myuhc.com and select Virtual Visits for more information.

If you require an emergency room visit following your visit to an Urgent Care Center, the ER copayment will also apply.

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Know Before You Go – Texas Premier Choice Plan IN-NETWORK VS. OUT-OF-NETWORK For participants in the Pre-65 Texas Premier Choice plan, the following are examples of potential circumstances where checking to see if an out-of-network provider is being recommended could help you avoid higher costs:







Your physician orders lab work and the order is for an out-of-network lab service, such as Quest Diagnostics. Request your doctor to send the lab work to an in-network provider, such as Laboratory Corporation of America (LabCorp). You are scheduled for surgery at an in-network hospital using an in-network surgeon. However, the anesthesiologist, assistant surgeon, nueromonitoring service or other provider assisting in the surgery may not participate in the Choice network. Prior to your surgery, ask the hospital or your surgeon about other providers that will be participating in your surgery and if they are in the Choice network. You visit an urgent care center and lab work is needed. The urgent care center may send the lab work to an outside laboratory. Before the lab work is ordered, ask where the lab work is being sent to ensure that an in-network provider, such as LabCorp, is used.

Check with your provider when you schedule a visit or before you receive services. It is your responsibility to ensure a network provider is used. It is important for you to to remember that, except for emergency services, if you receive care or services in 2017 from a provider outside of the UnitedHealthcare Choice network, you will pay all of the costs for your care and services. Because the Texas Premier Choice plan only covers services received from a network provider, out-of-network costs can add up quickly, even for routine care. STAND-ALONE EMERGENCY ROOMS ARE NOT URGENT CARE CENTERS When you or your covered family members are hurt or ill, you want quality and convenient care. Only you can make the decision where to receive care. Before you have to make that decision, you should know there are additional costs for care at a stand-alone emergency room or a hospital-based emergency room. If you or your covered family members experience a significant health event, you may need to visit a stand-alone emergency room to receive appropriate care. A partial list of stand-alone emergency rooms in the San Antonio area includes: • • • • • •

Alamo Heights Complete Care First Choice Emergency Room Complete Emergency Care Elite Care Emergency Room Choice ER Five Star ER

These and other stand-alone emergency rooms are not Urgent Care Centers. Your cost for a visit to a standalone emergency room will be at least $300 in the Texas Premier Choice plan. Alternatively, a co-payment of only $75 applies in the Texas Premier Choice Plan for a visit to an in-network Urgent Care facility. A partial list of Urgent Care facilities in the network is listed on the previous page. Always check that the doctor or facility participates in your network by calling the toll free number on your ID card. If you are not sure where to go for care, call NurseLine on the back of your ID card to speak with a registered nurse 24 hours a day, 7 days a week.

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Plan Contact Information BENEFIT PLAN

CUSTOMER SERVICE NUMBER

WEBSITE

HARTFORD GROUP RETIREE PLAN - ELIGIBILITY

800-368-3653

www.umr.com

HARTFORD GROUP RETIRE PLAN – MEDICAL CLAIMS

844-380-4556

http:www.webtpa.com

HARTFORD GROUP RETIREE PLAN – PHARMACY (PROVIDED THROUGH EXPRESS SCRIPTS)

800-236-4782

www.express-scripts.com

UNITEDHEALTHCARE TEXAS PREMIER CHOICE AND SECURE HORIZONS PLAN

866-633-2446

TRICARE SUPPLEMENTAL PROGRAM

800-638-2610, ext. 255

www.myuhc.com www.selmantricareresource.com

UNITED CONCORDIA DENTAL PPO

888-828-6432

www.ucci.com

VISION SERVICE PLAN (VSP)

800-877-7195

www.vsp.com

AVESIS

800-828-9341

www.avesis.com

HYATT LEGAL PLAN

800-821-6400

www.legalplans.com

Service Area for the Secure Horizons Plan Participation in the Secure Horizons Plan requires that either or both the retiree or his/her spouse be age 65 or older and enrolled in Medicare Parts A and B. Furthermore, the service area for this plan is limited to retirees whose residence is located in the official Medicare service area. The list of Texas counties in which you must reside follows:

Atascosa

Dallas

Johnson

Rockwall

Bee

Denton

Kaufman

San Patricio

Bexar

Ellis

Kendall

Tarrant

Collin

Guadalupe

Kleberg

Wilson

Comal

Jim Wells

Nueces

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SOUTHWEST RESEARCH INSTITUTE® EMPLOYEE BENEFITS OFFICE P.O. Drawer 28510 6220 Culebra Road San Antonio, TX 78228-0510 (210) 522-2227