Transcript Welcome [www.elmiracityschools.com]

Welcome
Presenters:
MVP-Joe Durse
MVP-Amber Wallace
ECSD-Maryjane Carpenter
ECSD-Jake Sheehan
Today’s Presentation
AGENDA:
 Outline of key dates, background and goals
 Overview of MVP Health Care
 Question and answer session with MVP &
ECSD
YOU WILL LEAVE WITH:
 MVP Health Care Medicare Advanatge Plan Guide
 Side-by-side on Website March 12th
Background
• The Elmira City School District’s agreement
with POMCO expires June 30, 2015.
• The District must provide a health care plan
that is Affordable Care Act compliant.
• The District has been working with SMOLA
Consulting to help provide the best options
for health care plans.
• The District’s law firm, Sayles and Evans, has
reviewed the transition .
Our Goals
 To provide our retirees with the best
possible health plan coverage.
 To execute a smooth and seamless transition
for retirees to their new health care plan.
 To support all retirees throughout the
transition and to continue that support after
the transition.
MVP Health Care
 The Elmira City School District would like to
welcome JOE DURSE from MVP Health Care.
 MVP is ranked in the top three Medicare
plans in NYS
Eligibility & Enrollment
• Must be enrolled in Medicare Parts A and B.
• GoldAnywhere PPO members must reside in
the MVP service area for 6 months of the
year. USA Care PPO residency in US or
Puerto Rico.
• A network of more than 19,000 providers,
no specialist referrals required!
2015 GoldAnywhere PPO Service
Clinton
Franklin
Grand Franklin
Isle
Orleans
Lamoille
Chittenden
Caledonia
St. Lawrence
Washington
Essex
Jefferson
Addison
Orange
Lewis
Hamilton
Rutland
Windsor
Warren
Oswego
Niagara
Monroe
Wayne
Herkimer
Onondaga
Genesee
Ontario
Wyoming
Erie
Livingston
Cattaraugus
Allegany
Seneca
Madison
Cayuga
Yates
Steuben
Chautauqua
Wash.
Oneida
Orleans
Cortland
Schuyler
Tompkins
Chemung
Tioga
Otsego
Chenango
Fulton
Saratoga
Benn.
Windham
Montgomery
Schenectady
Schoharie
Rensselaer
Albany
Greene
Delaware
Broome
Columbia
Ulster
Dutchess
Sullivan
Orange
Essex
Putnam
Westchester
Rockland
*Medicare eligible retirees residing outside of the service area will be enrolled in USA Care PPO*
HOW A MEDICARE ADVANTAGE PLAN WORKS:
• Medicare pays MVP a subsidy each month.
• MVP takes the place of Medicare. Medical care and
prescription drugs will be covered by MVP.
• Use MVP ID card for services. Put the Medicare card
away in a safe place.
• Easy to use virtually no claim forms.
• Fulfills Medicare Part D requirement
• Upon enrollment into another Medicare Advantage or
Part D drug plan, Medicare will automatically dis-enroll
you from your Elmira CSD Medicare Advantage plan and
enroll you in your new plan.
ONE CARD FOR EVERYTHING
Use the MVP ID card for all medical services and
purchasing prescriptions. The pharmacy will change
your coverage to MVP.
OUT OF POCKET PROCTECTION
No Annual Deductible –
• from day one members are only responsible for applicable
copays for medical services and prescription drugs, MVP pays
the rest.
$4,000 Annual Out-of-Pocket Protection –
• If met, plan pays 100% for covered benefits. Excludes monthly
• Premium, prescription drug costs, acupuncture, eyewear, and
hearing aid expenses.
No balance billing –
• providers can not bill MVP Medicare Advantage Plan members
for costs above and beyond plan copays.
MVP Travels With You Worldwide
GoldAnywhere PPO (live in MVP service area)
In-Network
Out-ofNetwork
Primary Care Office Visits (PCP)
$10 Copay
$25 Copay
Specialist Doctor Office Visits
$15 Copay
$25 Copay
Covered in full
20%
Ambulance
$35 Copay
$35 Copay
Emergency Visits – Worldwide
(waived if admitted)
$65 Copay
$65 Copay
Urgent Care Visits
$15 Copay
$15 Copay
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
Covered in full
20%
Outpatient X-Ray
$15 Copay
$25 Copay
PT,OT & ST
$15 Copay
$25 Copay
Routine Annual Eye & Hearing Exams
$15 Copay
$25 Copay
Covered Service
Inpatient Hospital
©2014 MVP Health Care, Inc.
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USA Care PPO (live outside MVP service area)
Covered Service
In-Network
Primary Care Office Visits (PCP)
$10 Copay
Specialist Doctor Office Visits
$15 Copay
Inpatient Hospital
Covered in full
Ambulance
$35 Copay
Emergency Visits – Worldwide
(waived if admitted)
$65 Copay
Urgent Care Visits
$15 Copay
Ambulatory Surgery Outpatient
Covered in full
Lab Services
Covered in full
Skilled Nursing Facility – Days 1-100
Covered in full
Home Health Care
Covered in full
Outpatient X-Ray
$15 Copay
PT,OT & ST
$15 Copay
Routine Annual Eye & Hearing Exams
$15 Copay
©2014 MVP Health Care, Inc.
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Preventive Care
Covered Service
In-Network
Out-of-Network
Periodic Health Assessment
(Well Visit)
Covered in full
$25 Copay
Mammography
Pap Test / Pelvic Exams
Colorectal Screening
Bone Mass Measurement
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Prostate Screening
Flu, Pneumonia Vaccines
©2014 MVP Health Care, Inc.
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Additional Benefits
• Hearing Aid Allowance - $600 every 36 months
• Eye Wear Allowance - $100 every two calendar
years
• Dental Allowance - $300 allowance for any dental
service
• Acupuncture – 50% of the cost and receive up to
10 visits per calendar year
• CVS ExtraCare Health Card - provides a 20%
discount on more than 2,200 CVS branded health
related products
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PRESCRIPTIONS
©2012 MVP Health Care, Inc.
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MVP Offers You Select Generic Drugs
and Vaccines At NO COST !
$0
Includes coverage for the
shingles vaccine and other select
vaccines at no cost!
©2014 MVP Health Care, Inc.
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Part D Prescription Drug Coverage
Retail (30 day Supply)
$0 Copay - Tier 1 - Preferred Generic
$5 Copay - Tier 2 - Non-Preferred Generic
$5 Copay - Tier 3 - Preferred Brands
$5 Copay - Tier 4 - Non-Preferred Brands
$5 Copay - Tier 5 - Specialty > $600
$0 Copay - Tier 6 - Vaccines
* No Deductible
CVS Caremark
Mail Order-2x Copay
(90 day Supply)
$0 Copay - Tier 1 - Preferred Generic
$10 Copay - Tier 2 - Non-Preferred Generic
$10 Copay - Tier 3 - Preferred Brands
$10 Copay - Tier 4 - Non-Preferred Brands
$10 Copay - Tier 5 - Specialty > $600
$0 Copay - Tier 6 - Vaccines
* No Donut Hole
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WELLNESS
©2012 MVP Health Care, Inc.
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MVP INVESTS IN WELLNESS
SilverSneakers® Fitness Program
• Join more than 25,000 MVP Medicare
members with a No Cost fitness center
membership at any SilverSneakers
location nationwide. Includes Curves.
HealthDollarsSM
• $100 annual allowance for: Wellness or
fitness classes, massage, yoga, dance.
• Safe driving courses
• Personal emergency response system
• Even medical ID tags!
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MVP INVESTS IN YOUR WELLBEING
24 Hour Nurse Advice Line for:
• Health questions in the middle of the night
• Answers to “what do I do if” health questions
• Finding information and resources about
prevention, wellness, treatments, chronic
conditions.
• Free Confidential Programs When You Need
Extra Support
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MVP at Your Service www.mvphealthcare.com
• Personal member content available via secure online member portal
• View plan information
• Claims status & history
• Change mailing address
• Download member forms
• Request and print new ID cards
• Comprehensive provider search
• View Rx formulary and compare drug costs
• Complete a personal health assessment, utilize interactive health and
wellness tools
• View provider and hospital quality ratings and reports
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MVP AT YOUR SERVICE
• MVP at Your Service - 1-800-665-7924
Dedicated Medicare Customer Care Center
• Call with questions on MVP plans prior to January
1, 2015
• Provide assistance with Medicare Advantage plan
and benefit questions
• Look up your providers and prescriptions
• No automated systems, phone trees or numbers
to push!
• Located in Rochester, NY
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Enrolling
Question: How and when can I enroll?
Answer: Enrollment starts March 23
All forms will be mail to you. These forms
can be mailed or dropped off to the
District office.
 April 17 Enrollment Clinic (9am-12pm)
 April 22 Enrollment Clinic (1pm-4 pm)
 May 6 Enrollment Clinic (1pm-4 pm)
Rates
Question: Is my rate going to change?
Answer: If you pay a percentage, you will
continue to pay a percentage of the
current premium. Your premium costs
will change based on your plan of choice.
If you currently do not contribute to your
premium costs, this will not change.
Rates
Question: Is my rate going to change?
PLAN
POMCO
-Current
NY 44
-Current
MVP
-2015
$7,221
$5,991
Not eligible
Retiree and Spouse
$21,649*
$15,666
Not eligible
Family
$21,649
$16,578
Not eligible
Single
$6,066
$5,991
$5,061
Retiree and Spouse
$14,371*
$15,666
$10,123
Family
$14,371
$16,578
$15,183
65 and Over
Pre 65
Single
Medicare Part B Reimbursement
Question: Will I continue to receive
my Medicare Part B reimbursement?
Answer: Those who retired under a
collective bargaining agreement that
provided the Medicare Part B
reimbursement as a benefit, will
continue to receive it.
Current Doctors
Question: Will I be able to keep my
current Doctors?
You Live
Your Plan
Your Network
NY State
Gold Anywhere
Is the MVP Health Care
network.
Outside of NY State
USA Care
Any Medicare participating
provider. No out of
network costs.
Coordination of Benefits
Question: Will MVP Health Care
coordinate benefits?
Answer: No, MVP does not offer the
coordination of benefits within the
plan.
Specific Questions
Question: How do I get a specific
question answered?
Answer: There are few ways to do this.
 The first, is to contact MVP Health Care.
 The second, is to set up an appointment,
signup sheets are in the back of the
auditorium.
Upcoming Key Dates
DATE
EVENT
March 3
MVP Health Care Plan Meeting
March 5
NY 44 Health Care Plan Meeting
March 11
District Question and Answer
March 23
Open Enrollment Begins
April 17
Enrollment Clinic (9am-12pm)
April 22
Enrollment Clinic (1pm-4 pm)
May 6
Enrollment Clinic (1pm-4 pm)
May 15
Open Enrollment Ends
July 1
New Plan Starts
Questions?
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