City of Peabody презентация

Partners: Lenna Bablouzian, Carol Chandor, Robyn Olson
AFT-MA: Andrew Powell

(HMO) Plans
Indemnity Plans
Drug Tiering
Peabody’s Mitigation Plan
Tips for Selecting a GIC Medicare Supplement Plan

the Group Insurance Commission (GIC) starting on January 1, 2013 and continuing through June 30, 2016
Current town plans will be in effect until December 31, 2012
Open enrollment will be held from Tuesday, October 9th through Wednesday, October 24th
All employees and retirees MUST enroll in order to have coverage as of January 1, 2013
Marriage licenses, Birth Certificates, Adoption and Guardianship records are required to enroll dependents

Retired Municipal Teachers (RMT’s) will gain access to additional GIC plans but must re-enroll during the Open Enrollment period

high quality care at reasonable costs
GIC was established by the Legislature in 1955
GIC is a quasi-independent state agency governed by a 15-member Commission appointed by the Governor
Commission members include representatives of labor and retirees
GIC's FY12 appropriation is $1.3 billion.
GIC covers 212,000 subscribers and 375,000 lives

qualify (40 quarters of paying Medicare taxes)
Medicare Part A - Free
Inpatient hospital care
Some skilled nursing facility care
Hospice
Medicare Part B – Standard monthly premium = $99.90 (calendar year 2012)
Physician care
Diagnostic, x-ray and lab services
Durable medical equipment
GIC Medicare plans coordinate with Medicare to provide you with comprehensive insurance

should NOT enroll in Medicare Part B until you (the insured) retires
If retired, you must join Medicare and pay Part B premium to have GIC coverage
If your spouse/dependents are under 65, and you are retired, they will stay on an active plan through the GIC
See GIC Benefit Decision Guide, page 9
Do NOT enroll in Medicare Part D plans
See GIC Benefit Decision Guide for more details and special circumstances

(PCP) required
Referrals required for specialists for most plans
No coverage for out of network providers (except emergencies)
Medicare Advantage HMO plans have smaller provider networks
Indemnity Plans
Access to any provider that accepts Medicare

Indemnity Plan/Medicare Extension [OME]
Harvard Pilgrim Medicare Enhance
88% of GIC Medicare retirees in these 2 plans, which most closely resemble Peabody’s current Medex plan

Enrollment restrictions
UniCare State Indemnity Plan/ Medicare Extension [OME] available throughout the United States and outside the United States
Harvard Pilgrim Medicare Enhance available throughout the United States
Other plans limited to Massachusetts and certain border counties by plan

are required to see Specialists
No coverage for out-of-network providers
Except for emergency care
Lower premium cost than other plan types

Care Physician (PCP)
No referrals required for specialists
Can utilize any provider that accepts Medicare
Highest premium cost plan
No geographical restrictions on enrollment
Member can live anywhere in the United States
Members living outside the U.S. should select UniCare State Indemnity Plan/Medicare Extension [OME]

Generic and low cost brand drugs
Tier 2 – Brand name and high cost generic drugs
Tier 3 – Brand name non-preferred drugs

Copayments
Retail 30-day supply
Tier 1 - $10
Tier 2 - $25
Tier 3 - $50
Mail Order 90-day supply
Tier 1 - $20
Tier 2 - $50
Tier 3 - $110

Agreement creates 3½ -Year, City-funded Employee Health Mitigation Fund [EHMF]
Medicare eligible retirees will pay 1% of premium costs and those retired before 7/1/09 will receive a subsidy of their supplemental plan premium for 3 ½ years
A separate rate sheet for Medicare eligible RMTS is available
Medicare retirees have access to two separate health reimbursement account (HRA) programs:
HRA Part 1 – Reimbursement of new GIC copays
HRA Part 2 – Reimbursement of high out-of-pocket costs

surgery copays
Inpatient hospital admission copays
High Tech Imaging copays (such as MRI, CT, and PET scans)
HRA Part 2 – Reimbursement of high out-of-pocket costs
HRA Part 2 covers out-of-pocket expenses greater than: $2,000/member or $4,000/family
to maximum of
$5,000/member or $10,000/family
Additional information about the mitigation plans will be distributed to all participants

Building

21 Johnson Street

Guide

Complete a questionnaire and estimate your utilization of medical services

Discuss the GIC plans with family, friends and your physician(s)

or using the Internet. Ask the carriers about:
The physicians who treat you
The hospitals where you get care
The prescription drugs that you take
Any Durable Medical Equipment or Device that you use

Attend a GIC Health Fair

(617) 727-2310
Harvard Pilgrim Health Plan: www.harvardpilgrim.org/gic (800) 542-1499
Tufts Health Plan: www.tuftshealthplan.com/gic (888) 333-0880
Fallon Community Health Plan: www.fchp.org (866) 344-4442
UniCare: www.unicarestateplan.com (800) 442-9300
Caremark Pharmacy www.caremark.com/gic (877) 876-7214
Health New England: www.hne.com (800) 842-4464

ADDITIONAL RESOUR ES: WWW.PPEC.USWWW.PPEC.US or WWW.PEABODY-MA.US