The Maryland-National Capital Park and Planning Commission
Retiree Health & Benefits Supplement
M-NCPPC HAS BEEN AWARDED THE AWE AWARD FOR 2013 IN RECOGNITION OF ITS HEALTH AND WELLNESS PROGRAMS
Benefit Year 2014 Page 1
Benefit Eligibility During open enrollment, you may drop, add or change benefit plans. You may elect any benefits listed for retirees in the Benefit Eligibility chart below, provided you met the 36 month rule for each plan at the time you retired and continued to have coverage since your retirement date. The only exception is the Legal Resources plan. You can enroll in this plan without having been previously enrolled. However, if you drop the medical, dental, prescription, and vision plans, you may not later re-enroll unless you show proof of continued coverage with a similar plan. Here are the plans available to retirees for calendar year 2014.
Page 2
Benefit Plan Eligibility Chart by Employee Type Eligible Plans Medical – UnitedHealthcare Point Of Service (POS)
Retirees Under 65 X
Retirees 65 and Over Not Eligible
Medical – UnitedHealthcare Exclusive Provider Organization (EPO)
X
X
Medical – Cigna EPO
X
X
Not Eligible
X
Prescription – Caremark
X
X
Dental – United Concordia
X
X
Vision – Vision Service Plan
X
X
Prepaid Legal Services – Legal Resources
X
X
Medical – UnitedHealthcare Medicare Complement
Page 3
Medical Plans All four medical plans, Cigna EPO, UnitedHealthcare (UHC) EPO, UnitedHealthcare POS and UHC Medicare Complement, provide adequate coverage for retirees and their dependents by providing coverage that meets or exceeds your medical insurance needs; however there are differences. You can switch to any medical plan for which you are eligible according to the Benefit Plan Eligibility chart.
Retirees and Dependents Under 65 Retirees and their dependents under the age of 65 may remain in their current plan or switch to another plan. You and your dependents must be enrolled in the same plan except for the UHC POS plan. If you are in the UHC POS plan and your spouse becomes Medicare eligible, he or she must be moved to the UHC Medicare Complement plan. Or, if you turn 65 before your spouse, then you must be moved to the Complement plan and your spouse and dependents remain under the UHC POS plan. You, your spouse and dependent children may remain under both the UHC EPO and Cigna EPO regardless of age; however Medicare becomes primary for you and/or your spouse when eligible for Medicare. All retirees and spouses must enroll in both Medicare Parts A and B when first eligible or the health plan will assume you have Medicare and pay only what they would have paid as the secondary carrier.
Retirees and Dependents 65 and Older Retirees and their dependents 65 and older may remain in their current UHC EPO or Cigna EPO plan or switch between the two EPO plans. You may also switch to the UHC Medicare Complement plan, but dependents not yet eligible for Medicare will be placed in the UHC POS plan. If you are currently in the UHC Medicare Complement plan you may switch to the UHC EPO or the Cigna EPO plan. If you are in the UHC POS plan when you turn 65 and your spouse becomes Medicare eligible, he or she must be moved to the UHC Medicare Complement plan. Or, if you turn 65 before your spouse and you are enrolled then you must be moved to the Complement plan and your spouse and dependents remain under the UHC POS plan.
UnitedHealthcare’s Medicare Complement Plan If you are over 65 (Medicare eligible), Medicare becomes your primary medical insurance carrier. This means that Medicare will pay benefits first and the M-NCPPC plan pays second. In order to access your Medicare benefits, you must select a doctor who accepts Medicare. The Medicare complement plan is designed to pay your deductibles, co-pays and coinsurances that are not covered by Medicare. Basically, you pay nothing for covered services. If a service is not covered by Medicare, it is not covered by the Medicare Complement plan. There are very few services that are not covered by Medicare such as acupuncture, services rendered outside of the country, and some vaccinations. Over the last few years Medicare has been enhanced to cover most services as long as they are medically necessary. It is highly recommended that you review the Medicare & You Handbook for a list of covered services. Page 4
Medical Plans The Medicare Complement plan is much less expensive than the United Healthcare EPO and Cigna EPO plans, but it is not an inferior plan. Coverage is 100% of all Medicare Part A and Part B deductibles and all coinsurance. As mentioned before, Medicare provides coverage for most services. The majority of retirees are enrolled in the UHC Medicare Complement plan and they have been satisfied with the coverage provided by Medicare. Medicare denied charges are not covered under the UHC Medicare Complement plan other than those emergency care charges incurred while you are out of the country. These out-of-country claims should be paid based on charges. If you exhaust a Medicare benefit, there is no further benefit in the Medicare Complement plan. If you are Medicare eligible and live outside of the United States, you must return to the United States to seek routine treatment, in order for a benefit to be available. Please call 1-800-MEDICARE (1-800-633-4227) to confirm the coverage or download the Medicare and You booklet from http://www.medicare.gov/pubs/pdf/10050.pdf
UHC and Cigna EPO As mentioned earlier, all three plans provide adequate coverage to meet your needs as a retiree; however the EPO plans are more expensive than the Medicare Complement plan because they provide coverage for services that may not be covered by Medicare. This means that if you need a service that is not covered by Medicare and it is covered under the EPO plan, the EPO plans will pay for the service as long as you use an innetwork EPO provider. Such services may be infertility treatments, acupuncture and the purchase of hearing aids. In many cases retirees are paying more than two times the cost for coverage if you elect (one) of the EPO plans. As mentioned before, Medicare provides coverage for most services. You may want to determine whether or not your needs could be met by switching to the Medicare Complement plan. The following chart highlights some of the more common types of services and how they are covered under all three plans available to retirees who are Medicare eligible.
Page 5
Medical Plan Comparison Chart Procedures Acupuncture Allergy Shots Ambulance Services Annual Physical Exams Bereavement Counseling Chiropractic Care Durable Medical Equipment (DME) Flu Shots Hearing Aids Hearing Tests Home Health care In-patient Hospital Care IVF Lifetime Maximum Mammography Mental Health (InPatent) Mental Health (Outpatient) Occupational Therapy Physical Therapy Speech Therapy
UnitedHealthcare Cigna EPO EPO Yes, covered* Yes, covered* Yes, covered Yes, covered Yes, covered Yes, covered
UHC Medicare Complement Not covered Unknown Yes, covered
Yes, covered
Yes, covered
Yes, covered
Yes, covered* Yes, covered*
Not covered Yes, covered*
Yes, covered* Yes, covered*
Yes, covered* Yes, covered Not covered Yes, covered* Yes, covered*
Yes, covered* Yes, covered Not covered Not covered Yes, covered
Yes, covered* Yes, covered Not covered Not covered Yes, covered*
Yes, covered Yes, covered* Unlimited Yes, covered
Yes, covered Yes, covered* Unlimited Yes, covered
Yes, covered Not covered Unlimited Yes, covered
Yes, covered
Yes, covered
Yes, covered
Yes, covered Yes, covered* Yes, covered* Yes, covered*
Yes, covered Yes, covered* Yes, covered* Yes, covered*
Yes, covered* Yes, covered* Yes, covered* Yes, covered*
*Many benefits may be covered with limits, such as the following: prior authorization required, limit on the number of visits and a co-insurance portion paid by you and the health plan. Please note that the above list is not exhaustive of the covered services, so you should compare the charts in the Health & Benefits Enrollment Instruction Booklet to the Medicare & You booklet for specific procedures you may need.
Page 6
Prescription Coverage There is no prescription coverage in the medical plans. In order to obtain prescription coverage, you will need to enroll in the Commission’s prescription plan or the federal Medicare Part D plan if you are Medicare eligible. Each year during open enrollment, a Medicare-eligible prescription drug plan participant will be required to choose between enrolling in the federal government’s Medicare Part D prescription plan and the Commission’s Caremark plan. Medicare eligible participants cannot be enrolled in both plans. If a Medicare eligible retiree or dependent enrolls in both, the enrollment in the federal government’s plan is binding and the participant will be required to dis-enroll from the Commission’s prescription plan. It is very important if you are a Medicare eligible retiree, spouse, or survivor that you carefully compare the Commission’s prescription drug plan and the Medicare Part D prescription drug plan. You will be able to make a new election every year during open enrollment for one of the two plans. Creditable Coverage Notice The federal government wants to make sure that anyone with a choice between an employer plan and the Medicare Part D plan has information regarding the employer’s plan design. Therefore an employer plan must have an in-depth evaluation performed on the plan design and the claims paid performed by actuaries from an outside firm. The Commission will provide the outcome of this evaluation in a written notice to certain employees, retirees or their spouses who are covered by one of the Commission’s health plans and Medicare. This notice will help Medicare Part D eligible individuals decide whether or not to enroll in Medicare Part D, based on whether or not the Commission’s prescription plan will pay out as much as the Medicare Part D program and the coverage on average is at least as good as Part D. If you are eligible for Medicare Part D and you have questions regarding the Commission’s prescription plan, you may contact the Health & Benefits Office at 301454-1683, 1684 or 1685 or via email at
[email protected] . If you have questions about Medicare Part D, please contact the Centers for Medicare and Medicaid (CMS) at their Internet Site: www.medicare.gov
Page 7
