2017 Open Enrollment 2017 PEBTF Open Enrollment for Non-Medicare Eligible Retirees Changes for Plan Year 2018 (effective January 1, 2018)
Agenda • Plan changes 2018 • Medical plan options • Prescription drug benefits • Other benefits • Making the right decision for you and your family • Enrollment • Additional Information 2
Plan Changes for 2018 • PPO annual deductibles increase • PPO copays increase • PPO lab services • Lab copay if you do not use Quest Diagnostics or LabCorp • Plan buy-up for Choice PPO • For retirees hired on or after 8/1/2003 • Prescription drug plan copays increase 3
Medical Plan Options Medical Plan Options PPO Option Custom HMO Narrow Network Choice PPO Basic PPO Regional (Aetna) (Highmark) (Aetna or Geisinger) Annual deductible Annual deductible No annual deductible & low copays In-network and out-of- In-network and out-of- In-network only – network benefit network benefit IMPORTANT to look at the network before making a decision; www.pebtf.org Plan buy-up for retiree No buy-up for retiree No buy-up for retiree who, as an employee, who, as an employee, who, as an employee, was hired on or after was hired on or after was hired on or after 8/1/03 8/1/03 8/1/03 4
Plans by Region Benefit Changes for 2017 5
PPO Options • Choice PPO (Aetna) Offered in all regions o • Basic PPO (Highmark) Offered in all regions o • Flexible In-network and out-of-network benefits o - You receive greater benefits when you use in-network providers A referral is not required to see a specialist or to receive care outside of the o network • Preventive care covered at 100% Refer to the REHP Benefits Handbook for a list of covered services o • Very important that you take a look at the plan’s network of providers and facilities to ensure that your primary care physician and other providers (e.g., hospitals, physical therapists, urgent care) are in- network before enrolling in either plan 6
PPO Options – Copayments • PPO copayments are the same for both plans PPO Options effective January 1, 2018 PCP Copay $20 Specialist Copay $45 (increase for 2018) Outpatient Therapies $20 Urgent Care $50 Emergency Room (waived if $200 admitted) (increase for 2018) 7
Lab Services Under the PPO • If you use Quest Diagnostics or LabCorp, there is no cost to you for covered lab tests. • If you do NOT use Quest Diagnostics or LabCorp, you will have a $30 lab copay. This is a change. In 2017, the cost of o the lab test was applied to your annual deductible. • If you visit your doctor for the blood draw, the office visit copay will still apply. The Open Enrollment Newsletter has o some examples of what you will pay under different scenarios. Check it out for more info! 8
PPO Options – Deductible Changes • Annual deductible amounts both in and out of network Choice PPO Basic PPO (Aetna) (Highmark) In-network $350 single/$700 family* $1,200 single/$2,400 family* (on certain services) (on certain services) Out-of-network $700 single/$1,400 family * $2,400 single/$4,800 family* *Each individual is responsible for his/her single deductible; see limit above for the most a family would have to pay in deductibles 9
What is a Deductible? • The amount a member owes for health care services before the plan begins to pay The PPO plans have an in-network and an o out-of-network deductible The HMO plan has no deductible; if you go o out of network, you pay 100% of costs • Deductible applies to all services except Preventive care o Primary care physician and specialist office o visits and outpatient therapy copays Emergency room and urgent care copays o Covered diagnostic lab services o 10
Understanding the Deductible Yes No Primary Care Physician (Regardless of Diagnosis) Specialist Immunizations Preventive Care Annual Physical/Well Visit Inpatient Facility/Surgical Outpatient Facility/Surgical Diagnostic Imaging (X-Ray, MRI, CAT-Scan, PET) Lab (bloodwork) Lab (bloodwork at Quest or Labcorp) 11
PPO – When You Will Pay the Annual In-Network Deductible Examples include, but are not limited to: • You have outpatient surgery at a PPO in-network hospital You pay the in-network deductible and then the plan pays o 100% - Choice PPO – $350 single/$700 family (increase for 2018) - Basic PPO – $1,200 single/$2,400 family (increase for 2018) • You get an MRI at a network facility You pay the in-network deductible and then the plan pays o 100% 12
PPO – When You Will Pay the Annual In-Network Deductible Examples include, but are not limited to: • You visit your primary care physician (PCP; your family doctor) for a sore throat No deductible – pay PCP office visit copay of $20 o • You visit an orthopedic surgeon No deductible – pay the specialist office copay of $45 (increase for o 2018) • Blood test at Quest Diagnostics Covered 100% – you pay no copay or deductible o • Blood test at an in-network hospital You pay a $30 lab copay (change for 2018) o 13
REHP Custom HMO IMPORTANT • Regional HMO networks: You must check the Custom HMO REHP Custom HMO Southeast – o Aetna network to verify your doctor REHP Custom HMO Central – participates. o Aetna Visit www.pebtf.org. If you’re REHP Custom HMO West – Aetna o selecting a new doctor, you REHP Custom HMO Northeast – o should verify they are accepting Geisinger new patients. • Smaller network of providers • Low copayments and no annual REHP Custom HMO deductible (no changes for 2018) Effective January 1, 2018 • Only in-network benefits PCP Copay $5 Specialist Copay $10 • Preventive care covered at 100% Outpatient Therapies $5 (Refer to the REHP Benefits Handbook) Urgent Care Copay $50 Emergency Room (waived if admitted) $150 Annual deductible $0 14
REHP Custom HMO • In-Network benefit only • You must choose an in-network Primary Care Physician (PCP) at time of enrollment Your PCP must refer you for all in-network services o • Networks are limited to help keep costs low • Very important that you take a look at the plan’s network of providers and facilities to ensure that your primary care physician and other providers (e.g., hospitals, physical therapists, urgent care) are in-network before enrolling in the plan. • A customized network for REHP members is used for this plan – visit www.pebtf.org > 2017 Open Enrollment 15
Choice PPO Plan Buy-Up • Retirees who, as an employee, were hired on or after 8/1/2003 pay a plan buy-up for the Choice PPO o Deducted from monthly pension Monthly Buy-Up Amounts for Choice PPO For Retirees Hired on or After 8/1/03 ff In 2017, In 2018, Retirees Hired on or after 8/1/03 pay Retirees Hired on or after 8/1/03 pay $56.66 per month – single coverage $58.74 per month – single coverage $113.32 per month – family coverage $117.48 per month – family coverage 16
What Will You Pay Under Each Option • For PPOs and REHP Custom HMO You visit your network o PCP for your annual physical - You pay $0 You get your annual o preventive mammogram - You pay $0 Your child has a well- o child visit and gets a covered immunization - You pay $0 17
What Will You Pay Under Each Plan • For PPOs and REHP Custom HMO You visit your in-network PCP for o an earache - $20 copay (PPOs) - $5 copay (HMO) You visit an in-network specialist o - $45 copay (PPOs) - $10 copay (HMO) – referral required You get outpatient physical o therapy (in-network provider) - $20 copay (PPOs) - $5 copay (HMO) You sprain your ankle, are o treated and released - At urgent care, $50 copay (PPOs & HMO) - At the emergency room • $200 copay (PPOs) • $150 copay (HMO) 18
What Will You Pay Under Each Option • For PPOs and REHP Custom HMO MRI o - PPO – covered 100% after you meet the annual deductible - HMO – covered 100% in-network (referral required, no deductible) Inpatient surgery – in-network facility o - PPO – covered 100% after you meet the annual deductible - HMO – covered 100% (referral required, no deductible) 19
Prescription Drug Plan • Continues to be administered by CVS Caremark • Continues to have a formulary, which is a list of the preferred drugs 30 day supplies – network pharmacy o 90 day supplies o - Mail order - CVS pharmacy - Rite Aid pharmacy 20
Prescription Drug Copay Changes Your Copay Your Copay Today Effective January 1, 2018 Prescriptions at a Network Pharmacy Up to a 30 Day Supply Tier 1: Generic drug $10 $12 Tier 2: Preferred brand-name drug $20* $30* Tier 3: Non-Preferred brand-name drug $40* $60* CVS - Retail Maintenance & Mail Order Up to a 90 Day Supply Tier 1: Generic drug $15 $18 Tier 2: Preferred brand-name drug $30* $45* Tier 3: Non-Preferred brand-name drug $60* $90* Retail Maintenance at a Rite Aid Pharmacy Up to 90 Day Supply Tier 1: Generic drug $20 Rite Aid $24 Rite Aid Tier 2: Preferred brand-name drug $40 Rite Aid* $60 Rite Aid* Tier 3: Non-Preferred brand-name drug $80 Rite Aid* $120 Rite Aid* *plus the cost difference between the brand and the generic, if one exists 21
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