welcome 2010 univera healthcare fall member meeting univera healthcare contracts with the federal...

Welcome2010

Univera HealthcareFall Member Meeting

Univera Healthcare contracts with the Federal Government and is a Medicare Advantage Organization with a Medicare contract.

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Our Vision

“…to be a best in class Medicare Program, providing Medicare beneficiaries with a

range of products and services that meet their needs for health coverage at

an affordable price.”

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2010 Highlights

• As the health care landscape evolves, Univera Healthcare continues to provide low cost, benefit-rich Medicare health plans

• No Change To Most Benefits

• Valuable Extras

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Why Univera Healthcare?

• More than 3,000 participating providers

• In business for over 30 years

• Commitment to serving our local communities

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Agenda

• Plan Changes

• What’s New?

• Valuable Extras

• What Do You Need to Do?

• Questions

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HMO vs. PPO

HMOHealth Maintenance Organization

PPOPreferred Provider Organization

Primary Care Physician (PCP) is required. Primary Care Physician (PCP) not required

Referrals required to see specialists No referrals required to see specialists

Must use In-Network providers

(You must receive all routine care from plan providers)

Can use In-Network & Out-of-Network providers*

(Out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as emergency care, urgently

needed care, or out-of-area renal dialysis)

*Univera Healthcare provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary.

You are eligible to join a Medicare Advantage Plan if you have MedicarePart A and B, live in our service area, and don’t have end stage renal disease.

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Medicare Advantage Plan Options

• HMO Plans

▪ SeniorChoice® Value (HMO)

▪ SeniorChoice® Value Plus (HMO)

▪ SeniorChoice® Secure (HMO)

▪ SeniorChoice® Select (HMO)

• PPO Plan

▪ Univera Medicare PPOSM 102 (PPO)

For full information on SeniorChoice and/or Univera Medicare PPO benefits, call our Customer Service Department at 1-800-558-4320 for SeniorChoice or 1-800-509-6350 for Univera Medicare PPO and TTY/TDD 1-800-421-1220 Monday-Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are available weekends from 8:00 a.m. – 8:00 p.m.

Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2011. Please contact Univera Healthcare for details.

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Senior ChoiceSenior Choice®® Value (HMO) Value (HMO)

No changes to the following benefits or cost-sharing in 2010:

PCP Office VisitSpecialist Office VisitAmbulance ServicesEmergency RoomInpatient HospitalOutpatient Hospital

Physical TherapySkilled Nursing Facility (SNF)Chiropractic $650 Active Anytime® Fitness Benefit

…and more!

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Monthly Premium

2009 2010

$0* $16*

*You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Benefit 2009 2010Outpatient Mental Health Care (per visit)

50% coinsurance 45% coinsurance

Radiology Services (per visit) 10% coinsurance 20% coinsurance

Durable Medical Equipment 30% coinsurance 20% coinsurance

Prosthetic Devices 30% coinsurance 20% coinsurance

Diabetic Supplies 30% coinsurance 20% coinsurance

Part D Deductible $175 $150

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Senior ChoiceSenior Choice®® Value Plus (HMO) Value Plus (HMO)




…and more!

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Senior ChoiceSenior Choice®® Value Plus (HMO)Value Plus (HMO)

Monthly Premium

2009 2010

$30* $46*

* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Senior ChoiceSenior Choice®® Value Plus (HMO) Value Plus (HMO)

Benefit 2009 2010

Outpatient Mental Health Care

(per visit)50% coinsurance 45% coinsurance





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Senior ChoiceSenior Choice®® Secure (HMO) Secure (HMO)




…and more!

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Monthly Premium

2009 2010

$70* $86*


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Benefit 2009 2010




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Senior ChoiceSenior Choice®® Select (HMO) Select (HMO)



Physical TherapySkilled Nursing Facility (SNF)Durable Medical Equipment (DME)Chiropractic

$650 Active Anytime® Fitness Benefit

…and more!

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Monthly Premium

2009 2010

$40* $55*


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Benefit 2009 2010


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Univera Medicare PPOUnivera Medicare PPOSMSM 102 (PPO) 102 (PPO)



Physical TherapySkilled Nursing Facility (SNF)Chiropractic $650 Active AnytimeSM Fitness Benefit

…and more!

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Univera Medicare PPOUnivera Medicare PPOSMSM 102 (PPO) 102 (PPO)

Monthly Premium

2009 2010

$20* $36*


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Univera Medicare PPOUnivera Medicare PPOSMSM 102 (PPO) 102 (PPO)Benefit 2009 2010

Radiology Services (Per visit)10% coinsurance

In-Network

20% coinsurance

In-Network

Outpatient Mental Health Care

(per visit)

50% coinsurance

In-Network

45% coinsurance

In-Network

Durable Medical Equipment

30% In-Network

40% Out-Of-Network

coinsurance

20% In-Network

30% Out-Of-Network

coinsurance

Prosthetic Devices

30% In-Network

40% Out-Of-Network

coinsurance

20% In-Network

30% Out-Of-Network

coinsurance

Seasonal flu/pneumonia vaccines 30% Out-of-NetworkCovered in full

Out-of-Network

Diabetic Supplies30% coinsurance

In-Network

20% coinsurance

In-Network


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Medicare Prescription Drug Plan (Part D)Medicare Prescription Drug Plan (Part D)

You pay $2.50 for generics and $6.30 for brand name drugs, or

5% of the price (whichever is greater)

Catastrophic CoverageUnivera Healthcare pays

the balance

Coverage GapAll costs are out-of-pocket

You PayYour

copays/coinsurance

Initial Coverage PeriodUnivera Healthcare pays

the balance

Deductible is out-of-pocket$0 or $1502

4 Coverage Phases

Catastrophic Coverage Begins when you or others on your behalf have spent $4,5501.

No coverage when total drug spend exceeds $2,8301 until your true out of pocket spending reaches $4,5501.

Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2,830.1

You must pay your deductible, if applicable before you start getting your prescription coverage.

1 Coverage limits for all phases of the Part D benefit change annually.

2 Benefits, formulary, pharmacy network, premium, copayment/coinsurance may change on January 1, 2011. Contact Univera Healthcare for details.

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Formulary Changes• Review the drugs you are taking• Consult with your doctor if your drug will no longer be covered.

Network• About 60,000 pharmacies nationwide• Retail, mail order, long-term care, home infusion, Indian/Tribal/Urban

pharmacies included• For additional information regarding our pharmacy network, quantity

limits, and mail order prescription drug services, call:

1-800-558-4320 TTY/TDD 1-800-421-1220

Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1 representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

• You may write us at: Univera Healthcare, PO Box 546, Buffalo, NY 14201

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies.

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You may be able to get Extra Help to pay for your prescription drug premiums and costs.

• To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;

• The Social Security Administration at 1-800-772-1213 between 7:00 a.m. – 7:00 p.m., Monday through Friday, TTY/TDD users should call 1-800-325-0778; or

• Your State Medicaid office.

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People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for:

seventy-five percent of drug costs including monthly prescription drug premiums,

annual deductibles, and coinsurance.

Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local

Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.


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Summary of 2010 Benefit Changes

• No Change To Most Benefits

• Valuable Extras

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Health and Wellness

• Active Anytime® Fitness Benefit• Up to $650 per calendar year* • Qualified fitness facility membership fees • Qualified weight management program

membership fees

* This benefit does not cover any ancillary services or items that are not part of a membership fee.

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What’s New

Enhanced Web Tools

• Side by side comparisons of:

• Your plan options &

• Estimated out-of-pocket costs.

• 2010 plan changes

• Learn more about cost-cutting options

• Research health topics

• Change your doctor

• Request ID cards

• Access health coaching information

www.univerahealthcare.com/medicarewww.univerahealthcare.com/medicare

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Valuable Extras

• Medicare Dedicated Customer Service Unit• Knowledgeable and friendly staff dedicated to

answering any questions you may have timely, accurately, and professionally.

• 24-hour Personal Health Coaching Line• Provides education and programs on nutrition, weight

management and much more.

• Disease & Case Management• Clinical staff work with you to make informed choices

on your health care and prescriptions

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What To Expect

• Whether changing your coverage or not, you will receive new:• ID cards

• ActiveAnytime® card (if you already have a card that you’re using for this benefit)

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What Do You Need To Do?

• If you want to stay in your current plan, there is nothing you need to do.

• If the plan you are in no longer suits your needs, we have many other plan options.

• Complete an option transfer form if switching from an HMO plan to another HMO plan within our organization.

• Complete an application if switching between HMO, PPO or Medicare Supplemental Plans.

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Medicare Advantage Plan Enrollment PeriodsThere are only certain times during the year when you may change or voluntarily end your membership in a Medicare Advantage Plan.

Annual Enrollment Period (AEP)– Runs from November 15 – December 31, each year– Can change Medicare Advantage plans or stand-alone

Prescription Drug Plan– Can add or drop prescription drug coverage– Can return to Original Medicare– Enrollment changes take effect on January 1

Open Enrollment Period (OEP)– Runs from January 1 – March 31, each year– Can change Medicare Advantage plans– Cannot add or drop prescription drug coverage– One opportunity to change to a similar plan (No-drug plan to no-drug plan –OR– drug plan to drug plan)– Enrollment or disenrollment becomes effective the month

after the application is received

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Special Enrollment Period (SEP)• Change of residence into or out of the service area• Loss of employer coverage• Qualify for Low Income Subsidy

Medicare Advantage Plan Enrollment Periods

To obtain more information regarding Medicare Advantage Plan enrollment you can call our Customer Service Department at 1-800-558-4320 for SeniorChoice or 1-800-509-6350 for Univera Medicare PPO TTY/TDD 1-800-421-1220 Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends 8:00 a.m. – 8:00 p.m.

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How to Contact UsFor full information on Univera Healthcare benefits:

• Call us: SeniorChoice® (HMO)

1-800-558-4320

Univera Medicare PPOSM 1-800-509-6350

TTY/TDD 1-800-421-1220

Monday-Friday, 8:00 a.m. -8:00 p.m. From November 15 - March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

• Write us:Univera Healthcare, PO Box 546, Buffalo, NY 14201

• Visit us on the Web at www.univerahealthcare.com/medicare

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Interested in Receiving Emails?

Fill out our simple form provided by your sales representative or call us to receive some information such as health and wellness from Univera Healthcare in your Email!

Call: 1-800-659-1986 (TTY/TDD 1-800-421-1220), Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

Interested in Becoming an Ambassador?

Ask your Medicare representative about our exciting Ambassador program.

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We Value Your Opinion

Tell us how we are doing!

Call our Confidential Voice Message System

1-800-230-7092

24 hours a day, 7 days a week

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Questions?

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Thank You!

H3351, H3335 1777_0 (10/2009)

welcome 2010 univera healthcare fall member meeting univera healthcare contracts with the federal...

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