confidential property of unitedhealthcare. do not distribute or reproduce without the express...

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.

Welcome to Public Safety Retirement System

Open Enrollment 2008


Agenda

Updates for 2008Plan OptionsBenefits

Medicare Non-Medicare

Enrollment and Contact Information

Questions


Updates for 2008 No rate increase on all plans Senior Supplement -

Medicare Part D Changes TDE $2,510 TrOOP $4,050

PPO RX copays $20/$40

New ID cards for all Medicare and PPO members

SecureHorizons Brand (no change for PSPRS)



Plan Options



Medicare Eligible Medical Plans

MedicareComplete HMO (Secure Horizons)Medicare eligible retirees/dependents

living in Cochise, Coconino, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yavapai and Yuma Counties

Senior SupplementMedicare eligible retirees/dependents

living nationwide



Non-Medicare Medical Plans

Health Maintenance Organization (HMO)Non-Medicare eligible retirees/dependents

using providers in Maricopa, Pima and Pinal Networks

Preferred Provider Organization (PPO)Non-Medicare eligible retirees/dependents

living in the state of Arizona

Indemnity Non-Medicare eligible retirees/dependents

living outside the state of Arizona



Additional Programs



SilverSneakers

Offered to all medical plansMembership at participating fitness centers

at no additional costGroup exercise classes designed to

increase strength, flexibility and energySenior Advisor at each fitness centerSocial eventsSteps Program for the Rural Areas



Caregivers

Offered to all medical plansUnlimited telephonic access to geriatric

experts

Personalized research into and screening of community programs

Assistance in making and coordinating care arrangements

Six hours of geriatric care management services annually



Benefit Overview



MedicareComplete HMO (SecureHorizons)

Must have Medicare Parts A & BAutomatically enrolled with Medicare

Part DSign Statement of UnderstandingSelect a Primary Care Physician (PCP)Select a Hospital NetworkPCP Referral to Specialists




Outpatient Services

Primary Care Physician $15 copaymentSpecialist $30 copaymentLab You pay nothingStandard X-Rays You pay

nothingSpecialized Scans $50 copayment



Outpatient Services

Urgent Care $15 copaymentEmergency Room $50 copayment

(waived if admitted)

Ambulance $25 copayment



HospitalizationInpatient $100 copay per admitMental Health $100 copay per admit;

190 days lifetime maximum

Skilled Nursing No copay; limit ofFacility 100 days per benefit

period




Prescription Drug BenefitFormulary AppliesUnlimited Annual MaximumRetail 30 day supply

Tier 1 $20 copaymentTiers 2, 3 & 4 $40 copayment

Mail Order 90 day supplyTier 1 $40 copaymentTiers 2, 3 & 4 $80 copayment



MedicareComplete HMO (SecureHorizons)Optical Benefits

Routine Care - Spectera ProvidersEye Exam $20 copaymentFrames $130 allowance/yrLens Covered 100%

OrContact Lenses $105 allowance/yr

Medically Necessary – Contracted Medical ProvidersEye Exam $15 copayment



Hearing BenefitsMedically Necessary

Hearing Exam $30 copayment

Routine hearing exams Not covered

Hearing Aids Not Covered

See page 13 of ASRS/PSPRS brochure for discounts on routine hearing exam and hearing aids – Please note this is not an insurance benefit


Senior Supplement

Must have Medicare Parts A & B

Automatically enrolled in Medicare Part D

ID cards -Medical (including vision)Prescription Drugs – UnitedHealth Rx


Senior Supplement

Freedom to use any provider who accepts Medicare

Medicare is primary insuranceSenior Supplement helps pay for

deductibles and coinsurance not covered by Medicare (based on schedule of benefits up to policy limit)

Calendar Year Deductible - $100


Senior Supplement

Medical Services - Physician services, inpatient and outpatient

medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipmentAfter Satisfying the Calendar Year

Deductible, Plan pays the Part B deductible Plan pays 20% of Medicare approved amounts

Plan pays 50% of outpatient Mental Health services


Senior Supplement

Hospitalization After Satisfying the Calendar Year

Deductible, Plan pays the Part A Deductible and the daily coinsurance rates after the 61st day

After you have exhausted the Medicare covered days, Plan pays 100% of Medicare eligible expenses for 365 additional lifetime days


Senior Supplement

LimitationsInpatient Mental Health – 190 days lifetime

maximumSkilled Nursing Facility – 100 days per

benefit period


UnitedHealth RX for Group PDP

Prescription Drug BenefitOpen FormularyRetail 30 day supply

Tier 1 $10 copaymentTiers 2, 3 & 4 $35 copayment

Mail Order 90 day supplyTier 1 $20 copaymentTiers 2, 3 & 4 $70 copayment




Prescription Drug Benefit continued

Copays applies to the first $2,510 of prescription drug cost per person.

After $2,510 in Total Drug Expenditures (TDE), you are responsible for 100% of drug cost until $4,050 in True Out of Pocket (TrOOP) is met;

Then you pay $2.25 generic, $5.60 brand name or 5% of the cost; whichever is greater



How Medicare Part D Prescriptions works: Applied to Your Applied to

Cost of RX TDE Copay TrOOP$100 → $100 $35 → $35$ 50 → $150 $10 → $45

↓ ↓$2,510 100% ↓

↓when TrOOP adds up to $4,050generic $2.25 or 5%brand $5.60 or 5%


Senior Supplement

Optical Benefits - Routine & Medical

Eye Exam $20 deductible

In-Network – 100% after Spectera Vision deductible

Providers

Out-of-Network $80 allowance

after

deductible


Senior SupplementOptical Benefits

Frames & Lenses OR Contact LensesIn-Network

Frames $130 allowance/yrLenses Covered 100% OrContact Lenses $105 Allowance/yr

Out-of-NetworkFrames & Lenses Or Contacts $100 Allowance/yr


Senior Supplement

Hearing BenefitsHearing Exam Medically NecessaryHearing Aids Not Covered

See page 13 of ASRS/PSPRS brochure for discounts on routine hearing exam and hearing aids – Please note this is not an insurance benefit


Enrollment and Contact Information



Forms to Submit

PSPRS enrollment form

Statement of Understanding – if enrolling in the MedicareComplete HMO (SecureHorizons) plan



How to Reach PacifiCare

Customer ServicePhone Numbers Listed on Back of ID cards

and on the inside cover of the ASRS/PSPRS Open Enrollment Guide

www.pacificare.com

www.securehorizons.com


Non-Medicare HMO

Select a Primary Care Physician (PCP)

Select a Network

PCP Referral to Specialists

Self Referral for Mental Health, GYN, Optical and Hearing


Non-Medicare HMO

Outpatient Services

Primary Care Physician $20 copaymentSpecialist $40 copaymentLab You pay nothingStandard X-Rays $20

copaymentSpecialized Scans $150 copayment


Non-Medicare HMO

Outpatient Services

Urgent Care $40 copayment

Emergency Room $75 copayment

(waived if admitted)

Ambulance You pay nothing


Non-Medicare HMO

HospitalizationInpatient You pay 30%Outpatient Surgery You pay 30%Mental Health You pay 30%

Out of Pocket Maximum (Inpatient or Outpatient Hospital coinsurance applies)

$3,000 Individual$9,000 Family


Non-Medicare HMO

Prescription Drug BenefitFormulary AppliesUnlimited Annual Maximum Retail 30 day supply

Generic $20 copaymentBrand Name $40 copayment

Mail Order 90 day supplyGeneric $40 copaymentBrand Name $80 copayment


Non-Medicare HMO

Optical BenefitsEye Exam $40 copaymentFrames $50 allowanceLens $50 allowance

OrContact Lens $100 allowance

Hearing BenefitsHearing Exam $40 copaymentHearing Aids $200 allowance

per calendar year


Non-Medicare PPO

In Area PPO rates are for retirees and dependents living in Maricopa, Pima and Pinal counties

Out of Area PPO rates are for retirees and dependents living in all other counties in Arizona


Non-Medicare PPO

Freedom to use any licensed provider In-Network Providers paid at

contracted rateOut-of-Network Providers paid at

Usual, Customary and Reasonable (UCR)


Non-Medicare PPO

Calendar Year Deductible $500 per person$1,000 per family

$75 Emergency Room Deductible

$250 Out-of-Network Hospital

deductible per admission


Non-Medicare PPO

In-Network Out of Pocket

$2,000 per person$4,000 per family

Out-of-Network Out of Pocket

$6,000 per person$12,000 per family

Lifetime maximum benefit

$2,000,000


Non-Medicare PPO

In Network Out of

Network Office Visit $15 copay* 60%

including preventative

Coinsurance 80% 60%

Emergency Room 80% 60%

Ambulance 70% 70%

*lab and x-ray subject to deductible and coinsurance


Non-Medicare PPO

Prescription Drug BenefitFormulary AppliesUnlimited Annual Maximum Retail 30 day supply

Generic $20 copaymentBrand Name $40 copayment

Mail Order 90 day supplyGeneric $40 copaymentBrand Name $80 copayment


Questions?

confidential property of unitedhealthcare. do not distribute or reproduce without the express...

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medicare parts

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ppo rx copays

energy senior advisor

care arrangements

agenda updates

rate increase

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