2015 Post 65 OE Guide.pub

 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.