2 MEDICARE ELIGIBLE Open RETIREE GUIDE CITY OF CHESAPEAKE OPEN Enrollment Meetings ENROLLMENT O C TO B E R 1 4 , 2 0 1 4 — N OV E M B E R 4 , 2 0 1 4 OCTOBER 14, 2014—NOVEMBER 4, 2014 If you have any questions or need assistance enrolling, please attend one of the sessions below or contact the Human Resources Department at 757-382-6492 or [email protected] 2014 WHAT IS NEW FOR 2015? Monday The City is entering year three of wellness incentives and will be making changes to update the incentive. In 2015, employees will earn $100 for completing a Personal Health Assessment (PHA) that has been available for the past two years; the new components are $50 for completing a Nutrition Digital Health Assistant (DHA); and $50 for completing a Exercise DHA. Please refer to page 5 for more information. Due to increased utilization, healthcare reform, and nationwide medical costs, the health insurance plan designs will be changing from copays to primarily coinsurance. For more information about the new plan designs, please refer to page 3 and for information about medical terms, refer to pages 9 and 10. Tuesday October 13 14 Open Enrollment begins 20 21 S Norfolk Library 801 Poindexter St 10:30 a.m.12:30 p.m. 27 CIBH 224 Great Bridge Blvd. 9:30am11:30am 28 4 Open Enrollment ends Thursday Friday 15 Sheriff 401 Albemarle Dr. 2:00-4:00 p.m. 16 HR Training Room 306 Cedar Rd 4th flr 3:00-5:00 p.m. 17 22 Management 925 Executive Blvd 7:00 – 9:00 a.m. 23 Human Services 100 Outlaw St. 10:00 a.m.-noon 24 Central Library 298 Cedar Rd. 10:30 a.m.-12:30 p.m. 29 Online Enrollment Assistance HR Training Room 306 Cedar Rd. 4th flr 9:00am - 3:00pm 30 HR Training Room 306 Cedar Rd. 4th flr 1:00 – 3:00 p.m. 31 Waste This is not an Open Enrollment meeting— Computer Assistance Only November 3 Wednesday Plan Designs The City will be offering one option for the Medicare Carve Out Retiree Medical Plan through Optima Health. This plan does not include dental coverage. Find out more information below on the new plan designs, deductibles, and copays for this medical plan option. 2015 Medicare Carve Out Plan 2015 Plan Design Type Current Plan Plan Effective 2015 Annual Deductible (Individual/Family) $400/800 $750/$1,500 Medical Out of Pocket Maximum $3000/$6000 $4000/$8000 Pharmacy Out of Pocket $6,350/$12,700 Maximum Pharmacy Inpatient Hospitalization Outpatient Surgery Emergency Room 3 4 $2,600/$5,200 $10/$30/ $10/$30/$50/ $50/20% ($250 $75 or 20% max. per Rx per month) Want to Know The Cost of a Medical Procedure or Prescriptions? $500 (copay after Caption describing picture or graphic. deductible) $250 (copay after Treatment Cost Calculator deductible) $200 (copay after deductible) Accessible AnyƟme, Anywhere “To catch the reader's attention, place an interesting sentence or quote from the story X-rays Advanced Imaging Lab Work 10% (coinsurance after deductible) 10% (coinsurance after deductible) 20% (coinsurance after deductible) 10% (coinsurance after deductible) Provides highly accurate geographic based cost estimates for over 300 procedures and services including x-rays, advanced imaging, outpatient surgeries, office visits, labs, immunizations Rehabilitation (Vascular, 10% (coinsurance after deductible) Cardiac, etc.) 2015 Monthly Rates Coverage Levels Retiree 2015 Optima Medicare Carve Out Plan Physical Speech, Occupational Therapy Spouse $616.32 Once logged in, the Treatment Cost Calculator will be a link under the member’s MyOpƟma menu. 10% (coinsurance Caption describing picture or graphic. after deductible) Prescrip on Search outpatient facility Hospice Care Home Health Care Maternity Care 10% (coinsurance 20% (coinsurance after after deductible) deductible) 10% (coinsurance 20% (coinsurance after deductible) after deductible) $200 (global copay for Obstetrician after deductible) Helps members make more informed decisions, plan for future expenses, compare providers and save money. Available to all covered health plan members only via secure login through www.opƟmahealth.com. $25 (copay if service Chemotherapy, Radiation performed by PCP Therapy, IV Therapy. $50 (copay if perInhalation Therapy formed by a specialist/ $431.44 Cost sharing amounts are calculated for each member based on their specific benefit information, such as remaining deductible, out-ofpocket limits, coinsurance and copayment amounts. 20% (coinsurance after deductible) Go to www.optimahealth.com Select ‘Members’ at the upper left Select ‘Find Doctors, Drugs and Facilities’ at the top of the screen Select ‘Drugs’ You may either sign in using Optima Health Username and Password or select ‘Four Tier Commercial’ and click Continue Type in the name of the prescription to determine the tier and alternate options Health Incentive 5 6 Options for Care Knowing where to go when you are sick or injured can keep money in your pocket and save you valuable time. In an emergency situation, you should always go to your nearest provider. Be sure your health situation is an emergency before seeking care at a hospital. Conditions such as ear/throat pain, cold/flu, and rashes are often best treated by calling your doctor. For non-emergency illness or injuries consider the following: Want to earn $200? Call your doctor’s office. For a complete list of doctors in the Optima Health network, visit www.optimahealth.com. Caption describing picture or graphic. Personal Health Assessment (PHA) “To catch the reader's attention, place an Employees can earn $100 on a debit card by completing a PHA between 1/1/15 and 3/31/15. interesting sentence or quote from the story here.” The health assessment is an advanced health profiling/risk assessment tool that scores the individual’s health status, calculates risk levels, and provides recommendations for health improvement and behavior change. The health assessment analyzes different health risk factors that affect an individual’s health and well-being. These factors fall into personal health status and lifestyle choices and habits. At the end of the assessment the member will view a results summary screen – with participant’s score, personalized steps to improve health, and risk and condition reports. The objective of the results summary is to guide you to the appropriate program and resource to improve health. Digital Health Assistant Exercise and Nutrition If your primary care physician is not available, consider Sentara MDLIVE prior to the Urgent Care Center or the Emergency Department for non-emergent matters. When you need to connect with a physician, call 1-866-648-3638. From there, you can choose to connect to a physician via phone right away, or you can request a video visit online. Employees can earn $50 for completing the Exercise Assistant and $50 for the Nutrition Assistant for a total of $100. This incentive would also be applied to a debit card and earned anytime through 10/31/15. The Digital Health Assistant (DHA) is a research-based, comprehensive, engaging behavior-change application. The DHA provides an online experience designed to emulate what happens in a 1:1 telephonic or face-to-face coaching session. Users interacting with the DHA select long-term goals that are suggested for them based on clinical guidelines. Users then create a weekly plan comprised of short-term goals or activities. Tracking against short- and long-term goals is a critical component of the DHA, and users are encouraged and reminded to come back to the DHA on a weekly basis to update their plan. The focus of the DHA is on helping the user to take action. Individuals are also presented with content to promote learning about risks and conditions. If your doctor’s office is closed, call the Care Coordination Program/ After Hours Nurse Advice Line at 1-877-817-3037. This free call is your link to a licensed nurse who can assist you in determining your immediate next steps for care. If this call recommends seeking care other than your doctor’s office when it re-opens, then consider steps 3 and 4. Caption describing picture or graphic. Urgent Care Centers may meet your needs and are usually a less expensive and faster option for treatment than a hospital Emergency Department. These facilities are usually open on evenings, weekends, and holidays when your doctor’s office may be closed. Hospital Emergency Departments are the most expensive option and often take longer than other treatment options in non-life threatening situations. If you choose to go to an Emergency Department, knowing which hospitals participate with Optima Health can save you money. Online Video Phone Call See your doctor using a computer over the Internet No webcam? No problem! Talk to a doctor over the phone! Secure Email Advice 97 Ask questions and get advice privately using secure e-mail 8 A Few Tidbits Packages from Optima Health will not be mailed to you. The 2015 Optima Medicare Carve-Out Plan can be found online at: www.optimahealth.com/ches The new rates for 2015 will be deducted in December with plan coverage effective January 1, 2015. To cancel the Medicare Carve-Out Plan, visit www.optimahealth.com/ches. If you have any questions, please contact the Human Resources Department at 382-6492 or email [email protected] Get 24/7/365 Care Access to Board Certified-doctors anytime, anywhere. Sentara MDLIVE Treats: Sentara Virtual Appointments Acne Joint Aches Allergies Nausea Asthma Pink Eye Bronchitis Poison Ivy Cellulitis Rashes Cold & Flu Constipation Respiratory Infections Diarrhea Sinus Infections Ear Infection Skin Inflammation Fever Gout Headache Infections Insect Bites Nausea & Vomiting Your primary care doctor is not available Request prescriptions or get refills Prescriptions are issued only when clinically appropriate. No controlled substances may be prescribed, the availability may be restricted by law. CHECKList And More... If you are considering the emergency department or urgent center for a non-emergency medical issue Sports Injuries When to use Sentara MDLIVE Open Enrollment To get started, go to www.mdlive.com/op ma or call 1‐866‐648‐3638 Find participating providers by visiting www.phcs.com. Retirees enrolled in the PPO plan have access to Optima’s out of area network, PHCS. If you cancel coverage, complete an Authorization to Deduct Health Insurance Premiums (VRS-78) and return to Finance Dept., 5th floor, City Hall, 306 Cedar Rd. Chesapeake, VA 23322 by November 4, 2014. Beginning on October 14, 2014 at 8:00a.m., visit www.optimahealth.com/ches to change benefit elections. The Customer/Employer Access Number is C952727058. Changes must be processed by November 4, 2014 at 5:00p.m. Traveling and in need of medical care During or after normal business hours, nights, weekends, and even holidays Task Health 9 10 Health Insurance Terms Insurance Terms Ever wonder what a word meant related to your health insurance, but never thought to ask? The listing below provides definitions for some commonly used terms regarding health insurance. This listing includes many commonly used health coverage terms, but is not a full list. A full list can be found at In-Network Provider (Participating Provider): Any physician, hospital, pharmacy, laboratory or other diagnostic center under contract with the health plan to provide services to members at a specified cost. http://www.optimahealth.com/healthinsurance101/Pages/Glossary.aspx Allowed Amount: The maximum amount on which payment is based for covered healthcare services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." Out-of-Pocket Maximum (OOP max or MOOP): The maximum amount that an insured person will have to pay for covered expenses during the plan year. Plan Year: January 1st through December 31st Benefit Period: Period for application of deductibles, after which time a deductible must again be satisfied. Coinsurance: Form of cost sharing between the member and the insurance company. An insured individual pays a percentage of the cost of covered medical services, and the insurance company pays a percentage. For example, if your plan has a 20 percent coinsurance and the service costs $1000, you would pay $200. If the service was $200, you would pay $40. Pre-Authorization: The authorization required by an insurance company before the member is eligible to receive services. Preventive Care: Care received to help prevent or detect illness before it occurs, such as routine physicals, well child, annual gynecological exams, etc. Copayment: Set dollar amount a member pays for a service while the insurance company pays the remaining costs. For example, the general practitioner copayment for non-preventive services is $25 per visit. Deductible: A set dollar amount that a person must pay before the insurance company begins paying. Emergency Services: Services provided in connection with an unforeseen acute illness or injury requiring immediate medical attention. Family Deductible: A deductible which is satisfied by the combined expenses of all covered family members. For example, a program with a $200 individual deductible may limit a maximum of three deductibles ($600) for the family, regardless of the number of family members. Urgent Care: Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care. Virtual Consult: The delivery of health-related services and information via telecommunications technologies, including telephones and personal computers. For example, MDLIVE is a service which provides a virtual appointment with a medical doctor, from the comfort of your home on your computer. The doctor may prescribe medication(s) if needed to treat a condition. Examples of appropriate concerns for a visit include fever, headaches, cold, flu, etc.
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