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Understanding Your Retiree Benefits

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Page 1: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Understanding Your Retiree

Benefits

Page 2: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

First Half of Presentation

Eligibility, Service Credit, Health & Dental, and Many Other

Benefits

Second Half of Presentation

Medicare Advantage Plans Offered

Those who are under 65 (Non-Medicare eligible) are not required to stay for the

second half, however if you have a spouse over 65 (Medicare eligible) or nearing 65,

please consider staying

Page 3: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Am I Eligible to Retire?

3R• Full-Time or Part-Time

Faculty and Staff

• On January 1/1/96 you were age 55 or over with 10 or more years of service

• Alternatively, on 6/1/96 you were age 50 with 10or more years of service.

4R• Full-Time or Part-Time

Faculty and Staff

• You were hired or rehired prior to 1/1/96 in a benefits eligible position and you are at least age 55 with 10 or more years of service

5R• Full-Time or Part-Time

Faculty and Staff

• You were hired or re-hired on or after 1/1/96 in a benefits eligible position and you are at least age 60 with 10 or more years of service

You must have 5 consecutive years of service in a benefits eligible position, following up to retirement!

Please Note: If your service included a TAR position or a non-benefit eligible position, this may impact your retiree benefits.

Page 4: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

What if I am not Eligible?

Voluntary Separation from the University, before eligibility is met

You will not be eligible for Retiree Benefits (Health, Dental, Tuition, Life Insurance)

You will not receive a contribution amount

Keep in mind, you have other options outside of the University!

Page 5: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

What if I have Prior Service Credit?

Service Requirement may be met by cumulative

employment at the University of Rochester or

another higher education institution.

(Must have been in a benefits eligible position. Ad Hoc, or per

diem roles are not eligible for consideration)

*Service Credit forms are located on our website

Page 6: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Topics For Today

Health Care Dental Care Life Insurance Tuition Benefits

Page 7: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

What Happens to My Health Care Once I Retire?

• Continue the same plan offered under Active Benefits:

• Your PPO Plan

• Your HSA-Eligible Plan

• Rates will change from your current active premium

Non-Medicare Eligible

• Coverage changes to a special form that supplements or coordinates with Medicare:

• GoldAnywhere PPO (with MVP Part D prescription Drug)

• Preferred Gold HMO-POS with University Major Medical

• Preferred Gold Standard HMO-POS (with MVP Part D Prescription Drug)

• University Complementary Care with Major Medical

• USA Care PPO (with MVP Part D Prescription Drug)

Medicare Eligible

IF you choose

to stay under

University of

Rochester

Health Care

Page 8: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

What You

Need to

Know about

Medicare

Medicare Eligibility

Parts of Medicare

Medicare Enrollment Period

When Enrollment is Necessary

Page 9: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Medicare Eligibility

Who is Currently Eligible?

Individuals age

65 or older, who

paid Medicare

taxes for at least

10 years

Individuals

under age 65

with certain

disabilities

Individuals of all

ages with end-

stage renal

disease

(permanent

kidney failure

requiring dialysis

or a kidney

transplant)

Page 10: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Part A

Hospital Coverage: Inpatient Care in hospitals, including critical access and

long-term care

Part B

Medical Coverage: Doctors services, and outpatient care when medically

necessary

Part C

Medicare Advantage Plans: Includes all of Parts A + B as well as extra

benefits

Part D

Prescription Drug Coverage: Available in standalone plans or as part of Medicare Advantage Plans.

Medicare

Parts A & B are known as Original Medicare

Parts C & D are only available through private Health Plans

Page 11: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Medicare Enrollment Periods: Part A & B

Initial Enrollment Period (IEP)• Occurs if you are retiring at age 65 or already retired and nearing

age 65

• Apply three months prior to turning age 65 on www.ssa.gov

Special Enrollment Period (SEP)• Occurs when retiring after age 65, or already Medicare-eligible due

to disability

• Apply three months prior to 1st of the month following retirement date (paperwork in Benefits Office to complete)

• SEP cannot override IEP. See the benefits office for more details

Page 12: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Initial Enrollment Period (IEP)

When will my Medicare Part B become effective?

If you sign up for Part A (if you

have to buy it) and/or Part B in

this month:

Your coverage starts:

1 month before you turn 65 The month you turn 65

The month you turn 65 1 month after you sign up

1 month after you turn 65 2 months after you sign up

2 months after you sign up 3 months after you sign up

Page 13: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

When is Medicare Enrollment for Parts A

and B Necessary?

When turning 65 and already retired (IEP)

Working past age 65 and then retire (SEP)

It is NOT Necessary when:

Turning 65 and continuing to work in a benefits-

eligible position (Full-Time or Part-Time).

Do NOT enroll in any part of Medicare if contributing pre-tax

dollars to an HSA account. Stop contributing 6-months prior to

enrolling in any parts of Medicare. For more information, go to

HSA & Medicare.

Page 14: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

What to Know About the Plans:

Billing Cycles

Premiums and Contribution Amounts

Other Benefits, Continued

Page 15: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

All of Our Medicare-Eligible Plans:

Supplement or

Coordinate with

Medicare Parts A & B

Offer prescription drug coverage:

- Medicare Part D

- Credible prescription drug

coverage to Medicare Part D (University Major

Medical)

Require you to enroll in A & B to

obtain full benefit of

plan

Page 16: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

University Health Care Costs

• Retiree and the University share the cost of health care plan coverage

• Billed quarterly by the University

• Cost of Health Care varies based on:

• The Coverage Selected

• Retiree Level (Hire date, birth date, service date, retirement date, prior service

credit)

Jan Feb Mar

Apr May Jun

Jul Aug Sept

Oct Nov Dec

Visit our new retiree website to view premiums based upon your retiree level

Page 17: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Contribution Amounts

• Contributions already built into health care premiums

• Pay a flat rate: what you see is what you pay

3R Level

• Based on a point system

• Age + Years of Service = Total Amount of Points

• Contribution increases once you turn 65

• Locked in at the time you retire

4R Level

• Your contribution amount will depend on your years of service at the University and does not change under any circumstances

• Locked in at the time you retire

5R Level

Money that the

University of Rochester

gives you toward your

health care plan.

Note*o Does not go toward dental,

only health care

o You do not receive a retiree

health care contribution if

you choose coverage outside

University

o You never lose your

contribution, even if you

choose coverage elsewhere

and decide to come back

Page 18: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Points at Retirement

(Age + Service at Retirement)

Monthly University Contribution

For Retirees Age 55 - 64Single Contracts Family Contracts

85 pts. (max.) $83.33 $166.67

84 pts. 81.25 162.50

83 pts. 79.17 158.33

82 pts. 77.08 154.17

81 pts. 75.00 150.00

80 pts. 72.92 145.83

79 pts. 70.83 141.67

78 pts. 68.75 137.50

77 pts. 66.67 133.33

76 pts. 64.58 129.17

75 pts. 62.50 125.00

74 pts. 60.42 120.83

73 pts. 58.33 116.67

72 pts. 56.25 112.50

71 pts. 54.17 108.33

70 pts. 52.08 104.17

69 pts. 50.00 100.00

68 pts. 47.92 95.83

67 pts. 45.83 91.67

66 pts. 43.75 87.50

65 pts. (min.) 41.67 83.33Age Years Of

Service Points

4R: Hired or re-hired before

1/1/1996

Under 65

Note*

Contribution

is halved for

part-time

employees

Page 19: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Points at Retirement

(Age plus Service at Retirement)

Monthly University Contribution

For Retirees Age 65 and Older

SingleCouple – Both Spouses

Medicare Eligible

Couple Split – One Spouse Non-Medicare

Eligible/One Spouse Medicare Eligible

85 pts. (max) $207.52 $415.04 $290.85

84 pts. $202.33 $404.66 $283.58

83 pts. $197.14 $394.29 $276.31

82 pts. $191.96 $383.91 $269.04

81 pts. $186.77 $373.54 $261.77

80 pts. $181.58 $363.16 $254.50

79 pts. $176.39 $352.78 $247.23

78 pts. $171.20 $342.41 $239.95

77 pts. $166.02 $332.03 $232.68

76 pts. $160.83 $321.66 $225.41

75 pts. $155.64 $311.28 $218.14

74 pts. $150.45 $300.90 $210.87

73 pts. $145.26 $290.53 $203.60

72 pts. $140.08 $280.15 $196.33

71 pts. $134.89 $269.78 $189.05

70 pts. $129.70 $259.40 $181.78

69 pts. $124.51 $249.02 $174.51

68 pts. $119.32 $238.65 $167.24

67 pts. $114.14 $228.27 $159.97

66 pts. $108.95 $217.90 $152.70

65 pts. (min.) $103.76 $207.52 $145.43

4R: Hired or re-

hired before

1/1/1996

Once You

Turn 65,

Amount

Increases

Note*

Contribution

is halved for

part-time

employees

Page 20: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

How to Calculate Monthly Cost

Health Care Premium – Contribution Amount = Total Monthly Cost

Example

You are a 4R with 85 Points, 65 years old and would like to be on the Preferred Gold

Standard HMO-POS plan with your spouse who is also 65:

$521.60 (premium) – $415.04 (contribution) = $106.56 per month

Page 21: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Years of UR Service at

Retirement

% of Max UR

Contribution

Monthly University

Contribution* for Retirees Age

65 and older

Monthly University Contribution* for

Retirees Age 60 - 64

25 or more years 100% 231.80 115.90

24 years 95% 220.21 110.10

23 years 90% 208.62 104.31

22 years 85% 197.03 98.51

21 years 80% 185.44 92.72

20 years 75% 173.85 86.92

19 years 70% 162.26 81.13

18 years 65% 150.67 75.33

17 years 60% 139.08 69.54

16 years 55% 127.49 63.74

15 years 50% 115.90 57.95

14 years 45% 104.31 52.15

13 years 40% 92.72 46.36

12 years 35% 81.13 40.56

11 years 30% 69.54 34.77

10 years 25% 57.95 28.97

5R: Hired or

re-hired after

1/1/1996

Note*

Contribution

is halved for

part-time

employees

Does Not

Increase

When

Turning 65,

Always Stays

the Same

Page 22: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Retirees Remain Eligible for Dental Coverage:

Traditional Plan or Medallion Plan

Single or Family Coverage

Billed Quarterly by the University

Cost Varies Based on Retiree Level

Dental Rates can be found on our website based on retiree level

Dental Insurance

Page 23: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Group Life Insurance

University-Paid Basic Life Insurance

• Terminates at the time of retirement

• Eligible Depending On Retiree Level

Employee-Paid Optional Coverage

• May elect to continue coverage

• Pay premium to Securian

• Same rate as active coverage, however, can increase based on higher age bracket or change in University Group rates

For More Information on Life Insurance, visit

our Life Insurance page HERE

Page 24: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

How Do I Change My Beneficiary?

Log in to the HRMS Website (www.Rochester.edu/people) with your Net ID

Click on ‘Securian Life’

OR

Securian Life’s Website: www.lifebenefits.com

User ID: (UR plus your 6-digit employee ID number)Example: UR123456

Password: (Your 8-digit date of birth plus the last four digits of your social security number)

Example: 012319121234

Page 25: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Tuition Benefits

Retirement is a perfect time to ‘Go Back to School’!

Retirees remain eligible for tuition benefits for courses at the UR as a non-

job related benefit:

Dependent children remain eligible for tuition benefits, regardless of whether

they began college before you retired

Full-Time Faculty and Staff Part-Time Staff

70% Tuition waiver for two credit-

bearing courses per semester/quarter

70% tuition waiver for one credit-

bearing course per semester/quarter

Page 26: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Your Benefits Extras

Group Auto & Home InsuranceOffers group rates on a variety of insurance policies

including auto, home, boat, renter’s, etc. You may

compare quotes from Liberty Mutual, MetLife and

Travelers.

Hyatt Legal PlansProvides retirees with legal representation for many

different legal matters, including estate planning

documents, real estate matters, family law and elder

care issues.

VSP Vision CareHelps with the costs of exams, glasses, contact

lenses, etc. for you and your family.

For more information about these benefits and to

enroll online go to:

www.yourbenefitsextras.comFor additional questions or help, contact Corestream at 1-888-935-9595

Page 27: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Benefits, Continued

Retiree ID Card

University Libraries

University Health

Services

Employee Pharmacy

Athletic Facilities

Meliora Dining

Page 28: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Recap, Recommendations, Things to Know

If you are considering reducing time, it is recommended to retire while full-time before transitioning to a part-time or time-as-reported (TAR) position

If you return to work part-time, retirees and their dependents continue with part-time active benefits, even if you are nearing 65 or passed age 65. Retirees and their dependents do NOT need to sign up for Medicare until the retiree/employee stops working in a benefits eligible position (full-time/part-time)

If returning to work time-as-reported, contact the Benefits Office for benefit eligibility

If you retire with no return to work, and turn 65 later on, you will sign up for Medicare on your own (IEP)

Meetings should be scheduled no earlier than 3 months prior to retirement, for those 65 and older. Employees retiring under 65 or those planning to return to work, should plan to meet with us 1-2 months prior. Each scenario requires different timing.

Page 29: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Where to begin?Contact Retiree

Benefits 3 months

prior

Decide before

meeting what you

want to do

Meeting with Benefits

Representative

Turn in paperwork 3 weeks prior

to retirement date

Start your journey! Stay

connected with UR for

updates

Visit our website for more guidance and information

Follow the Retirement Checklist

Set aside time to do research at home

(Remember, this is YOUR new journey)

Sign up for one of our Retirement Support Groups

E-mail retiree benefits for additional questions:

[email protected]

WHAT WE RECOMMEND TO YOU

Page 30: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Medicare-Eligible Health Care Plans

University Complementary Care with Major Medical

Preferred Gold HMO-POS with University Major Medical

Preferred Gold Standard HMO-POS with MVP Part D Prescription Drug

GoldAnywhere PPO with MVP Part D Prescription Drug

USACare PPO with MVP Part D Prescription Drug

Page 31: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

University Complementary Care

With Major Medical

Page 32: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

University Complementary Care with Major Medical

- Medicare Supplemental Plan

- Provides coverage to retirees residing anywhere in the world

- Not limited to a network of providers

- Preventive Care not covered outside United States

Medical Deductible Medical Out of Pocket Maximum (OOPM)

$123 $300 per person

Page 33: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

University Complementary Care with Major Medical

Covered Services What You PayPrimary Care Office Visits Covered at 80% after major medical deductible

Specialist Office Visits Covered at 80% after major medical deductible

Inpatient Hospital Covered in Full

Outpatient Surgery Covered in Full

Outpatient X-Ray Covered in Full

CAT, PET, MRI Scans Covered in Full

Outpatient Lab Tests Covered in Full

Emergency Room Covered in Full

Urgent Care Covered at 80% after major medical deductible

Ambulance Covered in Full

Page 34: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

University Complementary Care with Major Medical

Covered Services What You PaySkilled Nursing Facility 100% days 1-120, additional days covered at

80% after major medical deductible

Physical, Speech, Occupational Therapy Covered at 80% after major medical deductible

Routine Eye Exams Not Covered

Routine Hearing Exams Not Covered

Prescription Drug Coverage:

• Deductible of $811 per person

• Coinsurance of 20%

• Out of Pocket Maximum of $1,700 per person

Page 35: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not
Page 36: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

How Does a Medicare Advantage Plan Work?

Takes the place of Medicare. Your medical care and prescription

drugs will be covered by MVP Preferred Gold HMO-POS with University Major Medical has prescription drug

coverage through Aetna or Excellus

Referrals are NOT required

Use your MVP ID Card for services. Put your card away in a

safe place!

Easy to use, virtually no claim forms

Page 37: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Medicare Advantage Plan Eligibility & Enrollment

You must be signed up for

Medicare Parts A and B

You will continue to

pay your Part B premium separately

Residency Requirements

Enrollment is individual, no

family or two-person contracts

Page 38: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

MVP Coverage Travels With You!

Emergency Care – Around the clock, around the world. You pay only your in-network copay. Covered in full if hospitalized.

Urgently Needed Care – You are covered worldwide. You pay only your in-network copay.

Page 39: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Out of Pocket Maximum

All MVP Plans:

• Have zero annual deductibles

• $4,000 Annual Out-Of-Pocket Protection

If $4,000 Annual OOPM is Met:

• Plan pays 100% for covered benefits

for the rest of the calendar year

Excludes

• Monthly Premium

• Part D Prescription

Drug Costs

• Acupuncture

• Eyewear Expenses

• Hearing Aid Expenses

• Major Medical

Expenses, on Preferred

Gold HMO-POS with

Major Medical

Page 40: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold HMO-POS with University

Major Medical

Page 41: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold HMO-POS With University

Major Medical

Health Maintenance Organization (HMO)

Medicare Advantage Plan where doctors, hospitals, other health care

professionals provide services for a set amount of money. Usually members must get care from the providers in the plan, except for emergency care.

Point of Service(POS)

Members can choose to get services from non-contracted providers.

There is a dollar limit, some services require prior approval

• You pay 30% coinsurance, MVP pays $5,000 maximum

Page 42: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold HMO-POS with

University Major Medical Residence Area

Franklin Orleans

ChittendenLamoille

Caledonia

Essex

Washington

Addison Orange

WindsorRutland

Benn.

Windham

Rockland

Niagara Orleans

Erie

Onondaga

Jefferson

ChautauquaSteuben

Cayuga

Orange

Monroe Wayne

Genesee

St. Lawrence

Allegany

Wyoming

Cattaraugus

OntarioSeneca

Livingston

Schuyler

Chemung

Cortland

Oswego

Lewis

Madison

Chenango

Delaware

Franklin

Sullivan

Essex

Clinton

AlbanySchoharie

Greene

Wash.

Rensselaer

Saratoga

Warren

Schenectady

Columbia

Ulster

Dutchess

Putnam

Fulton

Montgomery

Herkimer

Hamilton

Oneida

TiogaBroome

Tompkins

Yates Otsego

Grand

Isle

Hello!

Page 43: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold HMO-POS with Major Medical

Covered Services What You PayPrimary Care Office Visits $10

Specialist Office Visits $15

Inpatient Hospital Covered in Full

Outpatient Surgery Covered in Full

Outpatient X-Ray $15

CAT, PET, MRI Scans $15

Outpatient Lab Tests Covered in Full

Emergency Room (worldwide) $65

Urgent Care (worldwide) $15

Ambulance $50

Skilled Nursing Facility 100% days 1-20, $135/day 21-100

Physical, Speech, Occupational Therapy $15

Routine Annual Eye Exams $15

Page 44: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold HMO-POS with Major Medical

Prescription Coverage Major Medical Coverage

• $811 Deductible per person

• 20% Coinsurance

• $1,700 out-of-pocket maximum

• $123 Deductible per person

• $300 out-of-pocket maximum

Major Medical Items

• Durable medical equipment

• Acupuncture

• Skilled Nursing Facility

• Diabetic equipment & supplies, etc.

Page 45: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold Standard HMO-POS with MVP

Part D Prescription Drug

Page 46: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold Standard HMO-POS with MVP

Part D Prescription Drug

Health Maintenance Organization (HMO)

Medicare Advantage Plan where doctors, hospitals, other health care

professionals provide services for a set amount of money. Usually members must get care from the providers in the plan, except for emergency care.

Point of Service(POS)

Members can choose to get services from non-contracted providers.

There is a dollar limit, some services require prior approval

• You pay 30% coinsurance, MVP pays $5,000 maximum

Page 47: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold Standard HMO-POS with MVP Part D

Prescription Drug

Covered Services What You PayPrimary Care Office Visits $15

Specialist Office Visits $30

Inpatient Hospitalization $250 copay 3 times max, then 100%

Outpatient Surgery $30 Surgical Center; $60 Hospital

Outpatient X-Ray $30

CAT, PET, MRI Scans $60

Outpatient Lab Tests $10

Page 48: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold Standard HMO-POS with MVP Part D

Prescription Drug

Covered Services What You PayEmergency Room Care (worldwide) $75

Urgent Care (worldwide) $30

Ambulance $100

Skilled Nursing Facility Covered in full days 1-20, $160/day 21-100

Home Health Care Covered in full

Physical, Speech, Occupational Therapy Covered in full

Page 49: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Preferred Gold Standard HMO-POS with

MVP Part D Prescription Drug

* This Plan Has the Coverage Gap or ‘Donut Hole’

Retail (30-Day Supply) Mail Order (90-Day Supply)

$0 Tier 1: Preferred Generics 2 times retail copay

$10 Tier 2: Generic Drugs

$35 Tier 3: Preferred Brand Drugs

50% Tier 4: Non Preferred Drugs

33% Tier 5: Specialty Drugs Not Available Via Mail

Part D Prescription Drug Coverage

Page 50: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

The Coverage Gap or ‘Donut Hole’

Page 51: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

GoldAnywhere PPO With MVP Part D

Prescription Drug

Page 52: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

What Does PPO Stand For?

Preferred Provider Organization

Provides flexibility to choose doctors, hospitals, health care

professionals that have a contract with MVP OR providers not contracted with MVP for an

additional cost.

Page 53: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

GoldAnywhere PPO With MVP Part D

Prescription Drug

Franklin Orleans

ChittendenLamoille

Caledonia

Essex

Washington

Addison Orange

WindsorRutland

Benn.

Windham

Rockland

Westch

ester

Niagara Orleans

Erie

Onondaga

Jefferson

ChautauquaSteuben

Cayuga

Orange

Monroe Wayne

Genesee

St. Lawrence

Allegany

Wyoming

Cattaraugus

OntarioSeneca

Livingston

Schuyler

Chemung

Cortland

Oswego

Lewis

Madison

Chenango

Delaware

Franklin

Sullivan

Essex

Clinton

AlbanySchoharie

Greene

Wash.

Rensselaer

Saratoga

Warren

Schenectady

Columbia

Ulster

Dutchess

Putnam

Fulton

Montgomery

Herkimer

Hamilton

Oneida

TiogaBroome

Tompkins

Yates Otsego

Grand

Isle

Can reside anywhere in NYS

and Vermont, excluding NY

Counties: Nassau, Suffolk &

Westchester

Page 54: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

GoldAnywhere PPO with MVP Part D Prescription Drug

Covered Service In-Network Out-Of-Network

Primary Care Office Visits (PCP) $10 copay $25 copay

Specialist Doctor Office Visits $15 copay $25 copay

Inpatient Hospital (Urgent or Emergent) Covered in full Covered in full

Inpatient Hospital (Non-Emergent) Covered in full 20%

Ambulance $35 copay $35 copay

Emergency Visits (worldwide) $65 copay $65 copay

Urgent Care Visits (worldwide) $15 copay $15 copay

Page 55: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

GoldAnywhere PPO with MVP Part D Prescription Drug

Covered Service In-Network Out-Of-Network

Ambulatory Surgery Outpatient Covered in full 20%

Lab Services Covered in full 20%

Skilled nursing facility (days 1-100) Covered in full 20%

Home Health Care (unlimited days) Covered in full 20%

Outpatient X-Rays $15 copay $25 copay

Physical, Speech, Occupational Therapy $15 copay $25 copay

Routine Annual Eye Exams $15 $25

Page 56: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

GoldAnywhere PPO with MVP Part D Prescription Drug

$0 Tier 1: Preferred Generics 2 times retail copay

$10 Tier 2: Generic Drugs

$30 Tier 3: Preferred Brand Drugs

$60 Tier 4: Non Preferred Drugs

$60 Tier 5: Specialty Drugs Not Available Via Mail

Retail (30-Day Supply) Mail Order (90-Day Supply)

2018 When total costs reach $3,750, you

will continue to pay the copays above

Part D Prescription Drug Coverage

Page 57: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

USACare PPO With MVP Part D

Prescription Drug

Page 58: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

USACare PPO With MVP Part D Prescription Drug

Provides coverage to retirees residing anywhere in the United States or Puerto Rico. Members can choose to see doctors, hospitals and other health care professionals that have a contract with Medicare. There is not a limited network.

Page 59: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

USACare PPO With MVP Part D Prescription Drug

Covered Service What You PayPrimary Care Office Visits $15

Specialist Office Visits $20

Inpatient Hospital $100 copay max, 3 per year

Outpatient Surgery Covered in full

Outpatient X-Ray $20

CAT, PET, MRI Scans $20

Outpatient Lab Tests Covered in full

Emergency Room (worldwide) $75

Urgent Care (worldwide) $20

Ambulance $35

Skilled Nursing Facility 100% days 1-20, $160/day 21-100

Physical, Speech, Occupational Therapy $20

Routine Eye Exams $20

Page 60: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Part D Prescription Drug Coverage

Retail (30-Day Supply) Mail Order (90-Day Supply)

$0 Tier 1: Preferred Generics 2 times retail copay

$10 Tier 2: Generic Drugs

$30 Tier 3: Preferred Brand Drugs

$60 Tier 4: Non Preferred Drugs

$60 Tier 5: Specialty Drugs Not Available Via Mail

USACare PPO With MVP Part D Prescription Drug

2018 When total costs reach $3,750, you

will continue to pay the copays above

Page 61: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

All MVP Plans Provide:

• $100 every 2 yearsEyewear Allowance

• $600 every 3 yearsHearing Aid Allowance

TruHearing Discount

• Covered in fullAnnual Physical

• Covered in fullMammogram Pap tests

• Covered in fullBone Mass Measurements

• Covered in fullFlu & Pneumonia

Immunizations

• Covered in fullProstate Screening

$600 every 3 years

Preventative

Services

*MVP Plans include Preferred Gold HMO-POS, GoldAnywhere PPO, Preferred

Gold Standard HMO-POS and USA Care PPO.

• 30-60% discount on over 100 models

Page 62: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

CVS/Caremark Pharmacy Benefit Manager

for MVP Plans

• Pharmacies are not limited to CVS pharmacies. You can fill prescriptions at hundreds

of participating pharmacies locally and nationwide.

• MVP members will receive a MVP-CVS ExtraCare Card providing a 20% discount on

items not covered through the basic CVS loyalty card. More than 2200 items purchased in

the store or online.

Page 63: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

Electronic Office Visits Through American Well

Now you can use a smartphone, tablet, or computer in the comfort of your home!

General non-emergent situations such as colds, flu, infections, & allergies when you cannot see your regular doctor.

24 hours a day, visits are confidential, visit summary provided

Primary Care Physician copay applies

Mental Health specialty copay applies

Page 64: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

MVP Invests In Your Well-Being

SilverSneakers ® Fitness Program

Join thousands of MVP Medicare Members with a no-cost fitness center membership at

any SilverSneakers location nationwide

Wellness Rewards

• $75 Master Gift Card!For completing your annual wellness visit,

blood pressure check, height, weight & BMI measurement and flu shots. Your doctor will complete the form, you then submit to MVP

Page 65: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

The Office of Total Rewards is

Moving to a New Location!

When? July 2018

Where? Corporate Woods

No meetings or sessions will be held in July. If you plan to retire in July,

please contact Retiree Benefits at [email protected].

Otherwise, contact Retiree Benefits 3 months prior to your set retirement

date.

Page 66: Understanding Your Retiree Benefits: Retiree Benefits Overview · Second Half of Presentation Medicare Advantage Plans Offered Those who are under 65 (Non-Medicare eligible) are not

The University reserves the right to

modify, amend, or terminate the plans at

any time, including actions that may

affect coverage, cost-sharing, or covered

benefits, as well as benefits that are

provided to current and future retirees.