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2012 Health Care Open Enrollment - Medicare

2012 Health Care Open Enrollment - Medicare. Health Care Challenges & Opportunities. Baby Boomers’ Retiring Retirees Living Longer Benefits Perception (a.k.a. “Pension Envy”) Economy Proposed pension plan changes (pension reform) Increasing Cost of Health Care

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2012 Health Care Open Enrollment - Medicare

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  1. 2012 Health Care Open Enrollment - Medicare

  2. Health Care Challenges & Opportunities • Baby Boomers’ Retiring • Retirees Living Longer • Benefits Perception (a.k.a. “Pension Envy”) • Economy • Proposed pension plan changes (pension reform) • Increasing Cost of Health Care • Solvency of Medicare and Social Security • National Health Care Reform

  3. Present & Future of OPERS Health Care • Although Ohio law does not mandate health care coverage, OPERS understands the importance of health care coverage to our benefit recipients • As of 12/31/10, HCPP 1.0 & 2.0 have had an impact of $2.6 billion on the health care fund • $12.3 billion in health care fund as of 12/31/10 • OPERS spent $1.6 billion in 2010 on health care claims for our retirees & dependents • OPERS is currently planning for future changes aiming to improve solvency of health care fund

  4. Eligible Dependent Guidelines • Your Legal Spouse - Spouse under age 55 will pay full premium cost - Once covered spouse reaches age 55 OPERS will again subsidize portion of premium cost • Your biological and/or legally adopted children: - Under age 26 with no other qualifications • Grandchildren, if legally adopted or with a court order pursuant to the Ohio Revised Code See page 11 of 2012 Open Enrollment Guide

  5. 2012 OPERS Health Care Update • Humana Medicare Advantage Plan design and provider access will remain same • Health care premiums will remain same for all Enhanced Plan and Humana participants • Deductible, out-of-pocket max, ER copay & inpatient deductible will increase for Non-Medicare participants with Medical Mutual • Brand-name prescription copays will increase for both Non-Medicare & Medicare participants with Express Scripts • Medicare participants in a “split family” enrolled in MMO Enhanced will be transitioned to Humana

  6. Medical Coverage for families with Medicare & Non-Medicare participants • In 2011, MMO is the plan for Medicare & Non-Medicare retirees or dependents in a “split family” • In 2012, Non-Medicare participants will remain in MMO • In 2012, Medicare participants in a split family will follow the rules below: • Medicare participants in MMO Enhanced Plan will be enrolled in Humana • Medicare participants in the MMO Intermediate or Basic may remain in their current coverage or enroll in Humana during open enrollment

  7. Medical Mutual Plan • Non-Medicare participants have lower out of pocket costs by using network providers (PPO) • Medical Mutual (MMO) has largest provider network of any insurer in state of Ohio • Enhanced plan level • Intermediate plan level • Basic plan level See pages 4 - 6 of 2012 Open Enrollment Guide

  8. Non-Medicare Prescription Coverage • Administered by Express Scripts See page 7 of 2012 Open Enrollment Guide • 30-day supply at retail pharmacy • 90-day supply through Express Scripts mail order • Our formulary is a preferred list of medications • Formulary brands & generics have lowest copays • Cost savings through mail order

  9. Humana Medicare Advantage Plan • Retirees or covered dependents with Medicare Part A & B or Medicare Part B only who live in the United States • Claims are sent directly to Humana for processing & are not sent to Medicare • Member must meet annual deductible of $250 before most services are paid at 96% or higher • Provider must accept Medicare & Humana card • Premiums will not increase for 2012 See pages 1 & 2 of 2012 Open Enrollment Guide

  10. 2012 Humana Medicare Advantage Plan Comparison

  11. 2012 Kaiser Permanente Plans OPERS will continue to offer Kaiser Permanente in 2012 to retirees in certain Ohio counties • Kaiser Permanente Plans • Non-Medicare Plan • Medicare Plus Plan • 2012 Kaiser Permanente Plan Changes • Premiums will decrease in 2012 • Vision coverage will include routine exam • Vision coverage will not include hardware • Dental coverage will no longer be offered

  12. OPERS Medicare Part D Prescription Plan • Administered by Express Scripts See page 3 of 2012 Open Enrollment Guide • 90-day supply at Medicare approved pharmacy • 90-day supply through Express Scripts mail order • Zostavax vaccine for Shingles covered • 100% coverage for formulary diabetic medications • Brand medications will be subject to $50 deductible and coinsurance

  13. 2011-12 Medicare D Prescription Plan Comparison

  14. 2011-12 Medicare D Prescription Plan Comparison Express Scripts Medicare D Plan

  15. Aetna Vision & MetLife Dental Coverage • Dental & vision premiums will remain same for 2012 • Dental & vision coverage will remain same • MetLife Dental • High Option • Low Option • Aetna Vision • High Option • Low Option See pages 9 & 10 of 2012 Open Enrollment Guide

  16. OPERS Wellness Programs • $50 deposit in Retiree Medical Account (RMA) for each of the following with a maximum $100 per rolling 12 month period (not calendar year): • Complete a Health Assessment questionnaire • Have an annual physical exam • Complete a Lifestyle Coaching Program • Participate in a Disease Management Program for those with certain chronic conditions See page 13 of 2012 Open Enrollment Guide

  17. Wellness & Retiree Medical Account Step 1 – Complete! • Complete incentive eligible activities through Humana (health risk assessment, physical exam, wellness or disease coaching programs) Step 2 – Receive! • Humana will notify OPERS once you complete the eligible activities and you will receive $50 deposit into your Aetna RMA eight weeks later Step 3 – Redeem! • Obtain reimbursement for eligible expenses (copays, deductibles, premiums) by submitting claim form & required documents to Aetna

  18. Getting Information During Open Enrollment • Open Enrollment packet - Personalized cost statement - Coverage guide • OPERS website - Dedicated open enrollment section - Interactive presentations • OPERS newsletter • Vendor & OPERS customer service centers

  19. 2012 OPERS Health Care Open Enrollment • Open enrollment period ends October 31, 2011 • No action required if no changes necessary • Retirees can call OPERS or complete the Open Enrollment Change Form to: • Change vision & dental levels (High & Low) • Terminate vision or dental coverage • Retirees must complete an Open Enrollment form to: • add new coverage • add a new dependent See page 15 of 2012 Open Enrollment Guide

  20. Important Contact Information • Humana Prudential LTC - 1-877-890-4777 - 1-877-893-3367 humana.com/operswww.prudential.com • Medical Mutual MetLife Dental - 1-877-520-6728 - 1-888-262-4874 medmutual.com metlife.com/dental • Express Scripts Aetna Vision - 1-866-727-5873 - 1-866-591-1913 express-scripts.comaetnavision.com • Aetna RMA OPERS - 1-888-672-9136 - 1-800-222-7377 aetna.comopers.org

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