DePauw University Medicare Benefits Program Overview

This presentation details the DePauw University Medical & Rx Benefits Program for Medicare retirees, presented by Justin Goodwin from Amwins Group Benefits. It covers the agenda for the day, introduction to the program, information about Amwins Group Benefits, DePauw University's role in the Medicare program, available plans including Group Medicare Supplemental Plan and Medicare Part D Plans, benefits such as no provider networks and guaranteed acceptance, and contact details for assistance. The program offers choice, value, and service to retirees with Medicare Parts A and B. Non-Medicare eligible individuals will enroll in a separate plan offered by DePauw University.

• DePauw University
• Medicare Benefits
• Retiree Health Care
• Amwins Group Benefits
• Medicare Program

quin_er Follow

Uploaded on Sep 16, 2024 | 1 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.

Presentation Transcript

1. DePauw University Medical & Rx Benefits Program for Medicare Retirees Presented by: Justin Goodwin Amwins Group Benefits DePauw University Retiree Health Care Program

2. Agenda for Today Introduction About Amwins Group Benefits Your 2024 Post-65 Retiree Medical Plan Your 2024 Post-65 Retiree Rx Plan Options Your Enrollment Form Questions and Answers DePauw University Retiree Health Care Program

3. Introduction This Presentation is for people with Medicare Parts A and B Only. Non-Medicare Eligible Spouses and/or Dependents will enroll in a DePauw University Non-Medicare Plan. This program offers you more choice, value and service! DePauw University is continuing to provide premium support for its retirees DePauw University Retiree Health Care Program

4. About Amwins Founded in 1991 Division of Amwins Group, Inc. Over 7,000 employees Retiree Medical Specialists Serving over 1,000+ Employers State-of-the-art Retiree Customer Care Center Dedicated, trained, licensed agents to help you. DePauw University Retiree Health Care Program

5. Overview: DePauw Medicare Program DePauw University s role: Sponsor the Program Provide Program Management and Oversight Handle VEBA Account deductions for your Premium Payments (if utilized). Amwins role: Provide Advocacy, Daily Service and Administration.

6. Overview: DePauw Medicare Program 1 Group Medicare Supplemental Plan 3 Group Medicare Part D Plans Available Including Rx benefits with and without the Donut hole Optional Dental Plan (with purchase of above plans) Amwins Medicare Advocates to Assist You Toll Free Assistance 8am to 8pm (EST) M-F 888-883-3757

7. Overview: DePauw Medicare Program No Provider Networks Go-Anywhere-Care Any provider that accepts Medicare 97% of all providers accept Medicare No Medical Questions to Join Guaranteed Acceptance No waiting periods for medical benefits to be active (unless you lapsed other coverage before joining the plan).

8. Overview: DePauw Medicare Program Non-Medicare Eligible Spouses and Dependents will remain in the DePauw Non-Medicare Plan or other healthcare coverage as applicable. Plans will renew on January 1st each year and operate on a calendar year basis thereafter.

9. Overview: DePauw Medicare Program Transamerica Premier Life Insurance Company: Insures and administers the Medical claims. Pays claims to any Medicare provider. Express Scripts: Insures and Administers the Prescription Drug plan. Utilizes their pharmacy network (65,000+).

10. Overview: DePauw Medicare Program Delta Dental Plan Insures and administers the Dental plan benefits.

11. Health Insurance Plan Terms What is a Deductible ? The amount you pay before the plan pays any benefits. What is Co-Insurance ? The amount you pay for a service after the plan pays. Usually expressed in a percentage.

12. Health Insurance Plan Terms What is a Maximum Out-of-Pocket The Maximum amount you pay, then the plan pays 100% What is a Plan Maximum ? Total amount plan pays on your behalf.

13. Medicare Preventive Services Annual Wellness Exam Cardiovascular Screening Cancer Screenings Flu Shots Bone Mass Measurements Diabetes Screening Glaucoma Tests For more information go to www.medicare.gov or visit https://www.medicare.gov/coverage/preventive-and-screening-services.html

14. 2024 DePauw Medicare Plan Info 2024 Plan Year Deductible Coinsurance Out-of-Pocket Maximum $240 20% to $400 then 4% to $1,250 $1,250 Annual Plan Maximum Unlimited

15. 2024 DePauw Hospital Benefits Medicare Part A Services - Hospitalization FIRST 60 Days Medicare Pays All but $1,632 Plan Pays $1,632 $0 You Pay DAYS 61-90 Medicare Pays All but $408/day Plan Pays $408/day $0 You Pay

16. 2024 DePauw Hospital Benefits Medicare Part A Services Hospitalization DAYS 91-150: 60 Lifetime Reserve Days Medicare Pays All but $816/day Plan Pays $816/day $0 You Pay Extra 365 DAYS After Reserve Days are used Medicare Pays $0 Plan Pays All Costs $0 You Pay

17. 2024 DePauw Skilled Nursing Benefits Medicare Part A Services Skilled Nursing Facility FIRST 20 Days Medicare Pays All approved amounts Plan Pays $0 $0 You Pay DAYS 21-100 Medicare Pays All but $204/day $204/day Plan Pays $0 You Pay

18. 2024 DePauw Medical Benefits Medicare Part B Services Example Services Physician Services (Primary, Specialist, etc..) Physical and Speech Therapy Inpatient and Outpatient Medical and Surgical Services Laboratory Services (Blood Tests) Diagnostic Tests and X-rays Home Health Care (Skilled care) Durable Medical Equipment

19. 2024 DePauw Medical Benefits Medicare Part B Services Medical Services $240 Part B Deductible (Once per calendar year) Medicare Pays $0 $0 Plan Pays You Pay $240 Remaining Part B Amounts: Medicare pays 80% of all Part B services, your plan pays the difference after YOU PAY: Medicare Pays 80% Plan Pays $0 20% till $400 You Pay *(includes $240 deductible)

20. 2024 DePauw Medical Benefits Medicare Part B Services Medical Services Medicare Pays 80% Plan Pays 16% 4% till $1,250 You Pay *(includes $240 deductible)

21. The Golden Rule If Medicare covers a benefit or service, then the DePauw Medicare plan will also cover the benefit or service. If Medicare does not cover a benefit or service, then the DePauw Medicare plan will not cover the benefit or service. Medicare covers anything that is medically necessary . Note: The Shingles Vaccine is covered by the Prescription Drug Plan

22. 2024 DePauw Foreign Travel Benefit Medicare Pays $0 outside the USA or US Territories! (Medicare covers US Territories: Puerto Rico, Guam, US Virgin Islands, Northern Mariana Islands, and American Samoa)

23. 2024 DePauw Foreign Travel Benefit Foreign Travel Medical Coverage FOREIGN TRAVEL $250 DEDUCTIBLE Medicare Pays $0 Plan Pays You Pay $0 $250 REMAINDER OF CHARGES (after $250 deductible) Medicare Pays $0 Plan Pays 80% You Pay 20% Plan Maximum: PLAN PAYS UP TO $50,000

24. 2024 DePauw Low Rx Option Express Scripts Medicare Part D Plan Deductible: $545 Copay: Retail (31 Days) Mail Order (90 Days) Tier 1: Preferred Generic 15% 10% Tier 2: Generic 15% 10% Tier 3: Preferred Brand 30% 25% Tier 4: Non-Preferred Brand 30% 30% Tier 5: Specialty 25% 25% Coverage in Gap : You pay: 25% for Generics / 25% for Brands

25. 2024 DePauw Rx Mid Option Express Scripts Medicare Part D Plan Deductible: $100 Copay: Retail (31 Days) Mail Order (90 Days) Tier 1: Preferred Generic 15% 10% Tier 2: Generic 15% 10% Tier 3: Preferred Brand 30% 25% Tier 4: Non-Preferred Brand 50% 50% Tier 5: Specialty 25% 25% Coverage in Gap : Covered the Same for Generic Drugs Only. You pay 25% for Brands

26. 2024 DePauw Rx High Option Express Scripts Medicare Part D Plan Deductible: $100 Copay: Retail (31 Days) Mail Order (90 Days) Tier 1: Preferred Generic 15% 10% Tier 2: Generic 15% 10% Tier 3: Preferred Brand 30% 25% Tier 4: Non- Preferred Brand 40% 35% Tier 5: Specialty 25% 25% Coverage in Gap : Full coverage, all tiers capped at 25%

27. 2024 DePauw Prescription Plan Rx Maximum Out-of-Pocketand Catastrophic Coverage Once you have paid a total of $8,000 in 2024 toward the cost of your prescriptions, the plan then provides you with catastrophic coverage. After $8,000, you will then pay: For all 3 Plans: $0

28. 2024 DePauw Prescription Plan Formulary List (list of covered drugs) Prior-Authorization Provider can override Formulary if medically necessary . Some special drugs must be authorized even though they are on the formulary. Transition Policy Enables retiree to continue on old Rx for up to 60 days until they can get a new prescription. Pharmacy Network 65,000+ pharmacies

29. 2024 DePauw Dental Plan Voluntary Dental Plan Provided by Delta Dental $1,500 annual maximum benefit (after a $100 plan deductible). 100% Preventive, 50% Basic, 50% Major

30. 2024 DePauw Vision Plan Voluntary Vision Plan Provided by Anthem Blue View Vision Eye Exam, $10 In-Network One pair of frames, $130 allowance with 20% off remaining balance Eyeglass Lenses, $10 co-pay Lens Upgrades available at various co-pays Non-disposable Contact Lenses, $130 allowance, then 15% off remaining balance Medically Necessary, covered in full

31. 2024 DePauw Monthly Plan Cost Check with Brooke

32. 2024 Monthly Payment Options ACH Bank Account Automatic Deduction Secure, easy to establish, automatic payment VEBA Account Deduction Secure, automatic through DePauw University Monthly Invoice Pay by check

33. Frequently Asked Questions When do I need to turn in my application? 21 days prior to your coverage effective date Will I be able to keep my current doctors? YES As long as they accept Medicare 97% of all providers accept Medicare

34. Frequently Asked Questions Will my insurance still work when I travel to other states? YES, providers all over the country accept Medicare

35. Frequently Asked Questions Will I have to use generic prescription drugs? You may use any drug prescribed by your doctor that is covered by the formulary list. Am I limited to certain pharmacies? There is a pharmacy network, and you must use one of the 65,000+ pharmacies in the network.

36. Frequently Asked Questions When do my plan benefits renew? Benefits renew every January 1st. Medicare Part B deductible of $240 is based on a calendar year. What networks are involved? This is an indemnity plan, which allows you to access any provider who accepts Medicare.

37. DePauw Documents you may receive Shortly after enrollment: Welcome kit and insurance ID cards (medical and Rx ID cards will be sent separately) Insurance Certificate of Coverage (policy) Privacy Notice During renewal season (4th quarter each year) Plan renewal letter with rates and changes (if applicable) Medicare and You guide (sent from Medicare) Rx plan Annual Notice of Change (Part D requirement) Medicare This is not a bill notice of service Transamerica Explanation of Benefits or EOB

38. HAVE QUESTIONS? Please call our Customer Care Center at: 888-883-3757

39. Thank you for joining us. Please note: In the event of errors, the DePauw University Medicare Plan documents govern the plans.