2018 Medicare Advantage PPO

Transcription

1 2018 Medicare Advantage PPO a Medicare Advantage plan from Blue Cross Blue Shield of Michigan Alabama, Florida and Indiana Medicare Plus Blue SM is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal.

2 Joining is EASY as Review this packet. If you have questions, call :30 a.m. to 8 p.m. Eastern time, Monday through Friday. 2 Enroll by calling , 8:30 a.m. to 4:30 p.m. Eastern time, Monday through Friday. TTY users should call Begin enjoying the confidence of being covered by Medicare Plus Blue Group PPO along with our enhanced benefits.

3 Contents Savings with Blue Cross Medicare Advantage PPO reasons Blue Cross Medicare Advantage PPO makes sense...4 ABCs of Medicare...6 Becoming eligible for Medicare...7 Summary of frequently used benefits and cost sharing...8 Understanding important terms...9 Frequently asked questions...14 Ready to join? Here s what happens next...17 Contact information... Back cover 1

4 Look at the money you can keep in your pocket with Medicare Advantage PPO from Blue Cross Deductible, copayments, coinsurance and dollar maximums Physician office services Monthly contribution Deductible Out-of-pocket maximum (including deductible and coinsurance amounts) Office visit (primary care) Office visit (specialist) Your Medicare Advantage PPO option $0 per person $245 in network** $630 in network $20 per visit in network (not subject to Part B deductible) $25 per visit in network (not subject to Part B deductible) Traditional Care Network $17 per month ($204 per year) $400 in network $800 in network You pay 20% of covered charges after your Medicare Part B annual deductible is met You pay 20% of covered charges after your Medicare Part B annual deductible is met Savings $17 per month ($204 per year * ) $155 * $170 * vs. 20% after your Part B $20 copay deductible * $25 copay vs. 20% after your Part B deductible * *Savings may vary based on when you enroll and how much you use your coverage. 2 **In network deductible is limited to $245 for specific in network services that don t require a copay.

5 Emergency medical care Outpatient diagnostic services Hospital and other services Beyond original Medicare Emergency care visit Urgent care visit Laboratory and pathology tests Inpatient hospital services Outpatient surgery Skilled nursing SilverSneakers Fitness membership Physical therapy $50 copay $25 copay 100% covered 10% coinsurance after plan deductible is met Included at no cost with your coverage $125 copay $50 copay 10% coinsurance after plan deductible is met 10% coinsurance after plan deductible is met Not a benefit $75 per visit * $25 per visit * 100% covered vs. 10% coinsurance after your Traditional Care Network deductible is met * Lower deductible * saves you money Fitness membership (at no extra cost) 3

6 6 reasons Blue Cross Medicare Advantage PPO makes sense More than 89,000 of your fellow UAW Trust retirees are currently enrolled in the Medicare Advantage PPO plan from Blue Cross. Here s why: 1 When enrolled in the Blue Cross Medicare Advantage plan, you pay no monthly contribution to the Trust. 4 There are no referrals required You can visit the hospital or doctor of your choice, including specialists. 2 That s a savings of $204 per year. Low in-network deductible Your plan starts paying a share of the cost sooner, so you save money. 5 The SilverSneakers Fitness program Your Medicare Advantage PPO plan includes a free fitness center membership at more than 13,000 locations across the U.S. For more information about SilverSneakers, visit or call TTY users call 711. You must use SilverSneakers facilities to obtain this benefit. 4 3 Low copayments on emergency and urgent care visits Whether you re traveling across the country or around the world, emergency and urgent care coverage travels with you. Tivity Health is an independent corporation retained by Blue Cross Blue Shield of Michigan to provide health and fitness services to its Medicare Plus Blue SM PPO members. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries Tivity Health, Inc. All rights reserved.

7 6 Confidence comes with every card Don t leave your money behind One ID card When a Traditional Care Network member transfers to One comprehensive health care plan Medicare Advantage PPO during the calendar year, you get credit for what you ve already paid toward One explanation of benefits statement your TCN Plan*: One dedicated Customer Service team TCN MA Deductible up to $245 per person Out-of-pocket maximum up to $630 per person Questions? Call , 8:30 a.m. to 8 p.m. Eastern time, Monday through Friday. Or visit us online at * This applies only to members transferring from the TCN plan to Medicare Advantage PPO. 5

8 The ABCs of Medicare Medicare Part A helps cover an inpatient stay at the hospital, skilled nursing facility or rehabilitation facility. Here are just a few of the costs that are covered through Part A: A semi-private hospital room Drugs, medical supplies and medical equipment as an inpatient Lab tests, X-rays and radiation treatment as an inpatient Operating room and recovery room services Some blood transfusions in a hospital or skilled nursing facility Rehabilitation services, such as physical therapy through home health care Original Medicare A Part Part C adds extra benefits 6 Medicare Part B goes hand-in-hand with Part A. It covers the cost of doctor visits including an annual wellness exam and other medical services. You can count on it for expenses, such as: Visits to your doctor and outpatient medical services Emergency services Clinical laboratory services, such as blood and urine tests Some preventive care, including flu shots Some preventive screenings, such as mammograms, colorectal screenings and prostate cancer screenings When enrolled in the Medicare Advantage plan, you ll still need to pay your Part B premium. Original Medicare Part B

9 Becoming eligible for Medicare In most cases, if you already receive Social Security, you ll be automatically enrolled in Medicare Part A and Part B. You may contact the Social Security Administration to verify your enrollment. If you need to enroll in Medicare Parts A and B, follow these three easy steps: Our Medicare Advantage PPO plan includes benefits you won t get from Original Medicare including: 100 percent coverage for an annual routine physical Annual EKG screening Annual Pap smear Online and live fitness coaching Everyday member savings 24/7 nurse line SilverSneakers Fitness program Call the Social Security Administration at between 7 a.m. and 7 p.m. Monday through Friday for an appointment. TTY users call Apply online at the official website: ssa.gov/medicareonly/ Visit in person at your local Social Security office. The easiest time to enroll in the Blue Cross Medicare Advantage PPO plan is when you become eligible for Medicare and have enrolled in Medicare Part B. Then, once your Medicare coverage starts, your Medicare Advantage PPO coverage starts, too. The sooner you sign up, the sooner you can start enjoying lower costs, one ID card, one explanation of benefits statement and extras like SilverSneakers. 7

10 2018 Summary of frequently used benefits, cost sharing and important terms In network Annual deductible per member per year $245* Coinsurance Deductible, copayments, coinsurance and dollar maximums Out of pocket maximum (for deductible and coinsurance amounts for Medicare-covered medical services, per member per year) Out-of-pocket maximum for copay-based services 10% coinsurance *In-network deductible is limited to $245 for specific services that don t require a copay. $630 You pay Out of network $490 In network and out of network combined $1,395 In network and out of network combined This is a safety net to ensure you don t pay more than $1,500 in copays in one year 8 This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.

11 Understanding important terms Insurance pays 100% Out-of-pocket maximum met (coinsurance and deductible) $$$ $630 in network $1,395 out of network Coinsurance (you and insurance share cost) Deductible met $$ $245 in network $490 out of network Deductible (you pay) Medical costs Deductible the amount you pay annually before your plan begins to pay. This doesn t apply to services that require a copay. Coinsurance percentage you pay for covered services after you have met your deductible. Out-of pocket maximum the most you will pay in deductibles and coinsurance during the year. Copay a fixed amount you pay to receive a medical service, usually at the time of service (office visits, emergency room, urgent care). In network a provider contracted to be in Blue Cross Blue Shield s Medicare Advantage PPO network. Out of network a provider who doesn t have a contract to be in Blue Cross Blue Shield s Medicare Advantage PPO network. 9

12 2018 Summary of frequently used benefits and cost sharing Preventive services In network You pay Out of network Abdominal aortic aneurysm screening (one per lifetime) Annual wellness visit Cardiovascular disease testing (once every five years) Annual EKG screening Immunizations (flu, pneumonia vaccines) Kidney disease education services Annual prostate cancer screening Annual mammography Annual Pap smear and pelvic exams Annual routine physical exam Screening and counseling for alcohol misuse and obesity Annual screening for depression, diabetes (twice per year if prediabetic) and glaucoma Annual screening for HIV and sexually transmitted infections for those at risk Bone mass measurement (every two years) Diabetes self management Nutrition therapy (for end-stage renal disease or diabetes) Annual screening for colorectal cancer Covered at 100% Covered at 100% Covered at 100% Physician office services In network You pay Out of network Office visits: primary care doctor and chiropractic $20 copay 50% coinsurance after deductible Office visits: specialists No referrals required $25 copay 50% coinsurance after deductible 10

13 Ambulance services medically necessary Urgent care Emergency medical care Emergency care copay waived if admitted Inpatient hospital benefits apply, if admitted Worldwide emergency coverage outside of the U.S. and its territories In network You pay 10% coinsurance $25 copay $50 copay Out of network 20% coinsurance up to $25,000 or 60 consecutive days, whichever is reached first Outpatient diagnostic services In network You pay Out of network Laboratory and pathology tests Covered at 100% Covered at 100% Diagnostic procedures and tests, including X rays in office Diagnostic procedures and tests, including X rays in hospital Radiation therapy in office Primary care: $20 copay Specialist: $25 copay 10% coinsurance Primary care: $20 copay Specialist: $25 copay Hospital care In network You pay Out of network Inpatient hospital care 10% coinsurance Outpatient hospital services 10% coinsurance Questions? Call , 8:30 a.m. to 8 p.m. Eastern time, Monday through Friday. Or visit us online at 11

14 2018 Summary of frequently used benefits and cost sharing Alternatives to hospital care You pay In network Out of network Skilled nursing facility (in a Medicare-certified skilled nursing facility) 10% coinsurance up to 100 days, renewable after 60 days without inpatient care; 100% coinsurance after 100 days up to 100 days, renewable after 60 days without patient care; 100% coinsurance after 100 days Hospice care Hospice services through a Medicare-certified hospice program are paid by Original Medicare Home health care Covered at 100% Surgical services Inpatient and outpatient surgery Human organ transplants (Medicare covered) In network 10% coinsurance You pay Out of network 12 Mental health and substance abuse treatment You pay In network Out of network Covered at 100%; Inpatient mental health care ; 190 day lifetime limit 190 day lifetime limit Inpatient substance abuse care Covered at 100% Covered at 100% up to Outpatient mental health care and substance abuse care, in hospital 20 visits; $25 copay for additional visits Outpatient mental health care and substance abuse care, in office Covered at 100% up to 20 visits; $20 copay (primary doctor) or $25 copay (specialist) for additional visits 50% coinsurance

15 Allergy injections Other services Chiropractic spinal manipulations Outpatient audiology, cardiac, physical, respiratory, speech, and occupational therapy Durable medical equipment, prosthetics, orthotic appliances, diabetic monitoring supplies In network Primary care: $20 copay Specialist: $25 copay $20 copay 10% coinsurance You pay Covered at 100% Medical supplies from a supplier or pharmacy Covered at 100% Fitness club membership through SilverSneakers Covered at 100% Out of network 50% coinsurance You must use a SilverSneakers location to use this benefit. Prescription drugs Your UAW Trust prescription drug benefit is provided separately through Express Scripts. For more information on your drug coverage, contact Express Scripts at Express Scripts Inc. is an independent company. It is solely responsible for providing prescription drug coverage to UAW Retiree Medical Benefits Trust members. It does not provide Blue Cross Blue Shield of Michigan products or services to Trust members. Hearing Care Services Your UAW Trust hearing care services and hearing aids are provided though AudioNet. For more information on your hearing care coverage, contact AudioNet. GM and Chrysler Retirees, call ; Ford Retirees, call AudioNet America, Inc. is an independent company. It is solely responsible for providing hearing care services to UAW Retiree Medical Benefits Trust members. It does not provide Blue Cross Blue Shield of Michigan products or services to Trust members. 13

16 Frequently asked questions What is Medicare Plus Blue Group PPO? Medicare Plus Blue Group PPO is the name of the Blue Cross Blue Shield of Michigan Medicare Advantage PPO plan. It combines your Medicare Part A and Part B along with additional benefits into a convenient and comprehensive health care package. Our plan features a network of doctors, hospitals and other health care providers who provide health care to Medicare beneficiaries and follow the requirements of the PPO plan. You may choose your own doctors, including specialists. If you choose a provider who isn t part of the network, you re still covered by the plan, but you may pay more for some services. Medicare Plus Blue Group PPO is an all-in-one Medicare Advantage plan. You will not be giving up your Medicare benefits when enrolling in the Medicare Advantage plan. Blue Cross Blue Shield of Michigan is contracted with Medicare to administer all of your health care benefits. Is Medicare Plus Blue Group PPO funded through the UAW Retiree Medical Benefits Trust? Yes. Does that make it a better choice for me than Original Medicare? The UAW Retiree Medical Benefits Trust offers you coverage with comprehensive health care benefits that go beyond Original Medicare. Medicare Advantage plans are regulated by the federal government and administered by Medicare-approved private insurance companies, such as Blue Cross Blue Shield of Michigan. The Trust continues to offer the Medicare Advantage PPO plan from Blue Cross as a Medicare Advantage plan of choice for its Medicare-eligible members and their Medicare-elibible dependents. With a Medicare Advantage plan, you get the same hospital and medical benefits you d get from Original Medicare Parts A and B. You also get many wellness benefits, such as SilverSneakers and access to the Blue Cross 24/7 nurse line and care management programs. 14

17 Am I eligible? You re eligible for the Blue Cross Blue Shield of Michigan Medicare Advantage PPO plan if the following conditions are met: You re enrolled in Medicare Part A and Part B. Your permanent residence is in any of the six states where the Blue Cross Medicare Advantage PPO plan is offered through the Trust: Alabama, Florida, Indiana, Michigan, Missouri or Tennessee. Although your permanent address must be in one of the 6 states, you re covered for services in all 50 states. You can still enroll in our Medicare Plus Blue Group PPO plan even if you have family members on your contract who aren t Medicare eligible. All non-medicare eligible family members will remain in their current plan. Note: You can only be enrolled in one Medicare Advantage plan at a time. What s the difference between the Blue Cross Blue Shield of Michigan s Medicare Advantage PPO plan and the Traditional Care Network plan? Both plans are backed by the recognition and reputation of Blue Cross Blue Shield of Michigan. Each plan uses a different provider network. Both plans offer comprehensive medical coverage and help cover more than what Original Medicare pays for. TCN supplements your Original Medicare coverage while the Medicare Advantage PPO plan packages all of your Original Medicare and extra benefits into one plan. Our Medicare Advantage plan operates under a contract with Medicare, and includes a fitness benefit and other extras. You ll also find it simpler: You use only your Medicare Plus Blue member ID card when you have medical services, instead of using both a Medicare and a Blue Cross card. Medicare Advantage plans focus on health, not just health care, and can help you attain and maintain better health through coverage for preventive services, as well as care and disease management programs. 15

18 Frequently asked questions Do I still pay the premium for Medicare Part B? Yes. You must continue to pay your Medicare Part B premium. What should I do with my Medicare card? Keep it in a safe place and do not destroy it. You won t need the Medicare card for as long as you re enrolled in the Medicare Advantage PPO plan. Your Blue Cross Blue Shield of Michigan Medicare Plus Blue Group PPO member ID card is the only card you ll need when you get medical care. Will I have to switch doctors? No. We encourage our members to seek services from doctors who are in our provider network. If your doctor isn t part of the network, and accepts Medicare and your Medicare Plus Blue Group PPO card, you may pay a higher cost for covered services. Do I give up my Medicare benefits once enrolled in a Medicare Advantage PPO plan? No. Medicare Advantage PPO plans provide the same benefits as Original Medicare. You get all your Original Medicare benefits plus many that Medicare doesn t offer, such as a SilverSneakers fitness membership and the Blue Cross 24/7 nurse line and care management programs. Am I locked into a plan? No, You can try the plan. If it doesn t work for you, you can switch back to the Traditional Care Network plan at any time. How does my coverage work when I travel in the U.S.? Your benefits travel with you. You should get services from health care providers in the local Blue Cross Blue Shield plan s Medicare Advantage PPO network (where available). If there isn t a Medicare Advantage network where you re traveling, you pay the same cost sharing for covered services as if you received them from a network provider. Be sure to show your new ID card when you visit a doctor s office or hospital. The card contains important information about your coverage and how to file claims. Does the Medicare Advantage PPO plan cover services outside the U.S.? Yes. Your plan covers urgent and emergency care outside the U.S. 16

19 Ready to join? Here s what happens next Enroll by calling Retiree Health Care Connect at , from 8:30 a.m. to 4:30 p.m. Eastern time, Monday through Friday, TTY users should call 711, between August 1, 2017 and November 30, 2017 for a January 1, 2018 effective date. Once you ve signed up, here s what you can expect: 1 We ll confirm your eligibility. Two to three weeks before your effective date, we ll make sure you re eligible for the plan before you re enrolled. 2 3 Look for your member ID card and welcome packet. You ll receive your new Blue Cross Blue Shield of Michigan member card and a welcome kit one to two weeks before your coverage date. The welcome kit will help you get the most out of your plan. It includes Evidence of Coverage, a booklet that describes your benefits and how to use the plan, plus other materials you ll need to get started. Begin enjoying the confidence of being covered by Medicare Plus Blue Group PPO along with our enhanced benefits. Begin using your new Blue Cross member ID card on the date your coverage starts. Your SilverSneakers card will arrive separately four to six weeks after your coverage starts. Until it arrives, you may use your Blue Cross member ID card at the SilverSneakers location of your choice. For more information about SilverSneakers, or to get your membership number, visit or call TTY users call

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22 Multi-language interpreter services Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). Arabic: ملحوظة : إذا كنت تتحدث العربیة فا ن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم (رقم ھاتف الصم والبكم: 711). Chinese: 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY: 711) Syriac: ܢܘܗܪܐ : ܡܓܢܡܥܕܪܝܢܢܘܡܓܢܡܫܡܫܝܢܢܐܢܡܠܠܝܬܘܢ ܣ ܘܪܝ ܝ ܐ ܥܒܕܛܝܒܐ ܡܠܠܥܡܢܥܠܡܢܝ ܢܐ: (711 TTY: ) 20 Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). Albanian: KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në (TTY: 711). Korean: 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. Bengali: ম ন র খ বন: য দ আপন র ভ ষ ব ল হয়, ভ ষ সহ য়ত প র ষব, আপ ন বন ম লয প ত প রন কল করন (TTY: 711) Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (TTY: 711). German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: 711). Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: 711). Japanese: 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY: 711) まで お電話にてご連絡ください Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). Serbo-Croatian: OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite (TTY: Telefon za osobe sa oštećenim govorom ili sluhom: 711). Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: 711).

23 Discrimination is Against the Law Blue Cross Blue Shield of Michigan and Blue Care Network comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross Blue Shield of Michigan and Blue Care Network do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Blue Cross Blue Shield of Michigan and Blue Care Network: Provide free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats) Provide free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact the Office of Civil Rights Coordinator. If you believe that Blue Cross Blue Shield of Michigan or Blue Care Network have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Office of Civil Rights Coordinator 600 E. Lafayette Blvd. MC 1302 Detroit, MI , TTY: 711 Fax: civilrights@bcbsm.com You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, the Office of Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at 21

24 Contact information Retiree Health Care Connect :30 a.m. to 4:30 p.m. Eastern time, Monday through Friday. TTY users call 711. Enrollment questions :30 a.m. to 8 p.m. Eastern time, Monday through Friday. TTY users call Prescription drug questions (Express Scripts) Open 24 hours a day, seven days a week (except Thanksgiving and Christmas). TTY users call 711. SilverSneakers questions TTY users call AudioNet America GM and Chrysler Retirees: Ford Retirees: TTY users call The provider network may change at any time. You will receive notice when necessary. Out-of-network/non-contracted providers are under no obligation to treat Medicare Plus Blue Group PPO members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. DB SEP17 H9572_S_UAW18prekitALFLIN FVNR 0517 Blue Cross Blue Shield of Michigan is proudly represented by the UAW R068590