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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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Presentation Transcript
health care challenges opportunities
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
present future of opers health care
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
eligible dependent guidelines
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

2012 opers health care update
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
medical coverage for families with medicare non medicare participants
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
medical mutual plan
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

non medicare prescription coverage
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
humana medicare advantage plan
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

2012 kaiser permanente plans
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
opers medicare part d prescription plan
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

2011-12 Medicare D Prescription Plan Comparison

Express Scripts Medicare D Plan

aetna vision metlife dental coverage
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

opers wellness programs
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

wellness retiree medical account
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
getting information during open enrollment
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
2012 opers health care open enrollment
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

important contact information
Important Contact Information
  • Humana Prudential LTC - 1-877-890-4777 - 1-877-893-3367
  • Medical Mutual MetLife Dental - 1-877-520-6728 - 1-888-262-4874
  • Express Scripts Aetna Vision - 1-866-727-5873 - 1-866-591-1913
  • Aetna RMA OPERS - 1-888-672-9136 - 1-800-222-7377