Transcript THE EMERITI PROGRAM for those planning for retirement

2014 Benefits
THE EMERITI PROGRAM for those planning for retirement
Medicare and Emeriti’s Health Insurance and Reimbursement Benefit
This presentation is copyrighted © exclusively by Emeriti
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Your Institution’s Commitment
Your Institution is:
• Giving you a tax-free way to pay for your health care expenses in retirement
• Providing access to group health insurance when you retire
• Keeping you informed about retiree health care issues along the way
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Emeriti’s Core Benefit Features
Emeriti Health
Accounts
• Tax-advantaged savings and investment vehicle for
payment of future medical expenses in retirement
Emeriti Health
Insurance
• Portable group retiree health insurance options building
on the foundation of Medicare
Emeriti
Reimbursement
Benefits
• Tax-free reimbursement of qualified medical expenses
not covered by Medicare or Emeriti insurance options
Participant
Education &
Decision Support
Services
•
•
•
•
Online
In print
On the phone
In person
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Emeriti’s Service Providers
Emeriti
TIAACREF
Accumulation
Recordkeeping
Trust Services
Investment
Management
Proprietary
Mutual Funds
Non
Proprietary
Mutual Funds
Savitz
Aetna
HealthPartners
Disbursement
Recordkeeping
Retiree Health
Plans
Retiree Health
Plans
Qualifying
Medical
Expenses
Insurance
Premiums
Debit Card
Manual Claims
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It’s Not Too Late To Save
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Health Expenses in Retirement Can Add Up
Medicare
Supplemental Insurance
Other Medical
Expenses
Parts A, B & D
deductibles
Premiums for all
insurance
Vision
Parts B & D*
premiums
Out-of-pocket
medical costs
Hearing
Part D Coverage
Gap cost share
Co-pays and
co-insurance
Part D (True Outof-Pocket) TrOOP
Out-of-Pocket Expenses
Medical
equipment
Long-term care
Nursing Home
*Part D premium is indexed to income.
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Medicare is Not Enough
Other
14%*
Out-ofPocket
13%
Medicare
59%
Private
Insurance
14%
Source: EBRI estimates from the 2009 Medical Expenditure Panel Survey.
*VA, Tricare, other private, Medicaid, other.
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Keep This In Mind
•
Building up tax-free assets for retiree healthcare protects
your pension retirement income.
•
Medicare cost shares are increasingly indexed to income.
•
Investment and tax diversity are key.
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How Medicare Works
Part A (Hospital) and Part B (Medical)
Original Medicare
• Medicare provides these coverages
• You have your choice of doctors & providers
Part C
Medicare Advantage, PPO Plan
• Private insurers approved by Medicare provide
Parts A & B coverage
• You may get extra benefits
Part D
Prescription Drug
• Private insurers approved by Medicare provide coverage
• Different plans cover different drugs at different levels
• You can choose from a range of plan designs
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Emeriti Retiree Health Insurance Platform
• Guaranteed issue group health insurance for lifetime of the participant
• Portable, nationwide access*
• Choice of insurance options (medical, Part D Rx, dental)
• Annual choice among plans
• Catastrophic protection
• Foreign urgent or emergency care*
• Ongoing information and decision support services
*Available in some plans.
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When You Can Access Emeriti Health Insurance
After age 65
When you retire
After enrollment in
Medicare Parts A & B
Must meet all three requirements in addition to satisfying your
Plan’s retirement eligibility rules (age and service criteria).
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Who Can Use Emeriti Health Insurance
Available for Eligible Participant & Dependents
Participant’s dependents include:
Spouse (pre- or post-65)
Domestic partner (pre- or post-65) depending on your plan*
Dependent children (before majority, to age 26)
Permanently disabled children**
Post-65 dependents can enroll in separate coverage from participant.
*Domestic partners’ coverage is available only if elected by the institution. Nondependent domestic
partners pay for insurance outside of the Health Account.
**Determination of permanent disability also confers access to post-65 insurance for these
individuals. Disability must occur before majority.
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Emeriti Insurance Choices for 2014
Five Group Medical Plans*
One Medicare coordination plan
Two Medicare supplemental plans (availability based on state approval)
Two Medicare Advantage PPO (Extended Service Area (ESA) available for geographical
areas outside Aetna’s network)
Three Rx Plans**
Rx High Plan – continuing coverage in coverage gap
Rx Mid Plan – generic coverage only in coverage gap
Rx Low Plan – no coverage in coverage gap
One Dental Plan*
One dental plan
* Availability based on state approval.
** The Rx Mid-High Plan is a grandfathered plan and is closed to new entrants.
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Create Your Own Plan
STEP 1
select a medical plan
STEP 2
select an Rx plan
STEP 3
Consider the optional dental plan
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Or Preserve Your Options
Select Rx Low Plan
Choose Rx Low Plan as stand-alone option
Consider Dental
Add dental to the Rx Low Plan if you wish
Selecting an RX Low Plan allows you to remain in the Emeriti Program and permits you to change coverage in future years.
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Emeriti’s Other Program Components
Emeriti Reimbursement Benefits
A tax-free method for you to pay for other qualified out-of-pocket medical expenses not
covered by Medicare or Emeriti insurance.
Emeriti Health Accounts
A tax-advantaged way to save and invest for future medical expenses.
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Reimbursement Benefit Options
Manually submit claims to Savitz:
• Mail
• Fax
• Upload through Participant Benefits Dashboard
(MyEmeritiBenefits.org)
Reimbursement Benefits will be paid from participant’s balance in the Money Market Fund.
Participants may transfer lump-sum amounts or set-up monthly systematic transfers in
amounts of $100 or more.
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How You Can Use Your Reimbursement Benefit
Partial List of Uses
Medicare premiums and cost shares
Supplemental insurance deductibles, co-insurance, co-pays
Vision, dental, hearing care
Over-the-counter and non-formulary drugs (with Rx prescription from doctor)
Medical equipment
Long-term care insurance
Medical expenses associated with nursing or in-home health care services
Other post-65 and pre-65 insurance premiums (if Emeriti coverage is not elected)
NOTE: A wide range of health care expenses are eligible for tax-free reimbursement as long as they satisfy
the requirements of Section 213 (d) of the IRS Code.
Emeriti Reimbursement Form available on MyEmeritiBenefits.org
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Who Can Use Your Reimbursement Benefits
Available for You & Your Dependents
Participant’s dependents include:
Spouse (pre- or post-65)
Domestic partner (pre- or post-65) depending on your plan
Dependent children (before majority, to age 26)
Permanently disabled children
Dependent relatives depending on your plan
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Investment Options in 2014
CORE
FUNDS
TIAA-CREF
Lifecycle Funds
(Retirement Class)
TIAA-CREF
Money Market Fund
(Retirement Class)
• Lifecycle funds
• Asset diversification among asset classes
• Automatic rebalancing
• A money market mutual fund
• Seeks to assure the value of your investment at $1
per share
Core Plus Funds subject to Plan Sponsor election.
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Emeriti Program Fees
Your employer may cover all or some portion of the service fees. Check with
your institution’s benefit administrator if you are uncertain.
Monthly Participant Fees
Fees
Active Service
Terminated/Retiree
Emeriti
$5.00
$5.00
TIAA-CREF
$ .67
$ .67
Savitz
$1.00
$6.00
Investment management fees are variable by selected mutual funds (see prospectuses)
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Participant
Education and Decision Support Tools
Online
In Print
On the Phone
In Person
Coming Soon
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Emeriti Retiree Teleconferences
Want more information about Emeriti’s Insurance Plan Options for 2014?
Attend a teleconference
Wednesday, November 20 at 3pm (ET)
Wednesday, December 4, at 3pm (ET).
For both calls, please call 1-866-692-3580,
and enter Conference ID: 6163967.
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Access 2014 Annual Enrollment Materials
Click on
ALREADY A PARTICIPANT tab
EmeritiHealth.org
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Emeriti Retirement Health Solutions provided this information and is responsible for its content.
Emeriti, TIAA-CREF, Savitz, Aetna Life Insurance Company, and HealthPartners are independent corporations
and are not legally affiliated.
The retirement healthcare program is offered by the employer. Teachers Insurance and Annuity Association (TIAA) will provide services
to the plan and make available investment options. TIAA-CREF Trust Company, FSB provides investment management and trust services.
Emeriti Retirement Health Solutions is not an insurance company, insurance broker or insurance provider.
Summary Plan Description (SPD)
This presentation is intended to provide you with a brief summary of some of the details of your Employer’s Emeriti Plan and the Emeriti
Program. For a full summary of the terms of your Employer’s Emeriti Plan you must consult the SPD, which will be provided to you upon
enrollment or upon request.
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Investment Adviser Status
Emeriti Retirement Health Solutions is a registered investment adviser for purposes of selecting the range of investment options available under the Emeriti Program.
Emeriti may provide non-personalized educational materials to plan participants relating to their and their employer’s contribution to their Emeriti Plan and the
allocation of their Emeriti Health Account balances among available investment options. Emeriti does not provide personalized investment advice to participants.
The participation interests in the voluntary employee contribution VEBA trusts associated with the Emeriti plans (the “Interests”) may be treated as securities under
federal or various state securities laws. The offering of these Interests is subject to compliance with any applicable federal or state law. For residents of Georgia, the
Interests are being offered in reliance on paragraph 13 of Code Section 10-5-9 of the Georgia Securities Act of 1973, as amended (the “Georgia Act”). The Interests may
not be sold or transferred except in a transaction which is exempt under the Georgia Act or pursuant to an effective registration under the Georgia Act.
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Addendum
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Understanding Emeriti’s National
Group Medical Plan Options
Aetna Traditional Choice
Coordinates with original Medicare
• Has a plan deductible
• Parts A & B deductibles covered by plan deductible
• Most claims for Medicare allowable charges will be paid in full after plan deductible
• Preventive services and annual physical covered 100% by Medicare
Aetna Supplemental Retiree Medical Plans K and L
Supplements original Medicare
• Have no plan deductible
• Have coinsurance on some services
• You pay a portion of Part A deductible
• You pay all of the Part B deductible
• Preventive services and annual physical covered 100% by Medicare
NOTE: Participants always pay the Medicare Part B premium.
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Understanding Emeriti’s National
Group Medical Plan Options
Aetna Medicare Advantage High and Low PPO (or PPO ESA)
Replaces original Medicare
• Have no plan deductible
• You pay no Parts A & B deductibles
• High plan has coinsurance, low plan has coinsurance and copayments
• Preventive services and annual physical covered 100% by the Plan
• Silver & Fit© Exercise & Healthy Aging Program available with high and low plans
• Access to over 10,000 fitness clubs and exercise centers
• Engage online and through educational materials
NOTE: Participants always pay the Medicare Part B premium.
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Emeriti Group Medical Plan Options in 2014
Underwritten by Aetna
Aetna
Traditional
Choice*
Aetna
Medicare Advantage
High PPO/ESA-PPO
Aetna
Medicare Advantage
Low PPO/ESA-PPO
Aetna
SRM Plan L**
Aetna
SRM Plan K**
$200 deductible
$0 plan deductible
$0 plan deductible
$0 plan deductible
in- and out-of-network
$0 plan deductible
in- and out-of-network
20% coinsurance
25% coinsurance
50% coinsurance
15% coinsurance in-network
25% coinsurance out-of-network
Primary care visit at $15
Specialist visit at $40 (in-network)
30% coinsurance (out-of-network)
$1,250
out-of-pocket limit
$2,400 out-of-pocket
limit (2013 calculation)
$4,800 out-of-pocket
limit (2013 calculation)
$2,750 out-of-pocket limit
in-network
$5,500 out-of-pocket limit
out-of-network
$6,700 out-of-pocket limit
in-network
$10,000 out-of-pocket limit
out-of-network
100% preventive care
covered by Medicare
100% preventive care
covered by Medicare
100% preventive care
covered by Medicare
100% preventive care covered by the
plan
100% preventive care covered by
the plan
After plan deductible is
satisfied, plan payment in
full on Medicare eligible
costs.
Payment based on the
balance after
Medicare’s payment.
Payment based on the
balance after
Medicare’s payment.
Payment based on total Aetna
allowable cost.
Payment based on total Aetna
allowable cost.
NOTES: The ESA-PPO Plan has the same benefits as the In-Network PPO Plan.
Aetna’s GMS Plans A and L will be offered in Florida in place of SRM Plans K and L.
*For 2014 the Traditional Choice plan is not available in MD.
**For 2014, the SRM Plans are not available in VT, MD, MN, and U.S. Territories.
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Retiree Cost Share for Typical Doctor’s Visit Bill of $100
Traditional
Choice
SRMP L
SRMP K
High MA
PPO/ESA
Low MA
PPO/ESA
$100
$100
$100
$100
$100
Medicare
Pays
$80
$80
$80
$0
$0
Aetna Pays
$20
$15
$10
$85
$85
You Pay
$0
$5
$10
$15
$15
Charge
NOTE: Illustration assumes any annual plan deductibles have already been satisfied for the plan year.
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Four Components of Standard Part D Benefit in 2014
Coverage Gap
Deductible
You pay first
$310 as
deductible
Initial Coverage
Period
You pay 25% of
drug costs
You pay 97.5% of
brand drugs
You pay 72% of
generic drugs
Catastrophic
Coverage
You pay 5%
•
Greater of $2.55 or 5% for
covered generic.
•
Greater of $6.35 or 5% for all
other drugs.
You reach the Coverage Gap at $2,850 in total Part D covered drug expenditures
(includes plan deductible, your costs and plan costs in the Initial Coverage Period).
You reach Catastrophic Coverage at $4,550 in true out-of-pocket costs.
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Emeriti Rx Coverage in 2014
Underwritten by Aetna
Rx Low Plan
Rx Mid Plan
Rx High Plan
Standard Formulary
Open Formulary
Open Formulary
$310 deductible
$100 deductible
$100 deductible
Initial Cov Limit Retail:
Initial Cov Limit Retail
Initial Cov Limit and Coverage Gap Retail
15% - 25%
15% - 25% - 50%
15% - 25% - 40%
Coverage Gap: no coverage*
Coverage Gap: generic coverage only*
Coverage Gap: full coverage
Catastrophic Cov: 95% coverage
Catastrophic Cov: 95% coverage
Catastrophic Cov: 100% coverage
Step therapy required for some drugs
Step therapy required for some drugs
No Step therapy required
Members who use Aetna’s Rx Home delivery Mail Order Drug (MOD) program will pay 5% less than the
negotiated cost of the drug as compared to retail.
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Aetna Dental Coverage in 2014
Dental Design
Preventive Service Coverage
100%
Annual Deductible (basic and major services)
$100
Basic Services Coverage
(e.g. fillings, standard crowns, extractions)
50%
Major Services Coverage
(e.g. root canal therapy, surgical removals, dentures)
50%
Annual Benefit Maximum
$1,500
NOTES:
1.Twelve month waiting period applies, but may be waived with evidence of continuing coverage.
2.One-time only opt-in opportunity.
3.Dental is only available when you enroll in a combination Medical/Rx coverage, or elect the stand-alone Rx Low Plan
4. Please note: in the states of CA, OR, WA*, the stand-alone Dental plan may be elected if the participant is enrolled in a Kaiser
Permanente MAPD Plan, and with evidence of existing coverage.
5. Dental not available in MD.
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