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Welcome 2010 Univera Healthcare Fall Member Meeting Univera Healthcare contracts with the Federal Government and is a Medicare Advantage Organization with.

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Presentation on theme: "Welcome 2010 Univera Healthcare Fall Member Meeting Univera Healthcare contracts with the Federal Government and is a Medicare Advantage Organization with."— Presentation transcript:

1 Welcome 2010 Univera Healthcare Fall Member Meeting Univera Healthcare contracts with the Federal Government and is a Medicare Advantage Organization with a Medicare contract.

2 2 Our Vision “…to be a best in class Medicare Program, providing Medicare beneficiaries with a range of products and services that meet their needs for health coverage at an affordable price.”

3 Highlights As the health care landscape evolves, Univera Healthcare continues to provide low cost, benefit-rich Medicare health plans No Change To Most Benefits Valuable Extras

4 4 Why Univera Healthcare? More than 3,000 participating providers In business for over 30 years Commitment to serving our local communities

5 5 Agenda Plan Changes What’s New? Valuable Extras What Do You Need to Do? Questions

6 6 HMO vs. PPO HMO Health Maintenance Organization PPO Preferred Provider Organization Primary Care Physician (PCP) is required.Primary Care Physician (PCP) not required Referrals required to see specialistsNo referrals required to see specialists Must use In-Network providers (You must receive all routine care from plan providers) Can use In-Network & Out-of-Network providers* (Out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis) *Univera Healthcare provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary. You are eligible to join a Medicare Advantage Plan if you have Medicare Part A and B, live in our service area, and don’t have end stage renal disease.

7 7 Medicare Advantage Plan Options HMO Plans ▪ SeniorChoice ® Value (HMO) ▪ SeniorChoice ® Value Plus (HMO) ▪ SeniorChoice ® Secure (HMO) ▪ SeniorChoice ® Select (HMO) PPO Plan ▪ Univera Medicare PPO SM 102 (PPO) For full information on SeniorChoice and/or Univera Medicare PPO benefits, call our Customer Service Department at for SeniorChoice or for Univera Medicare PPO and TTY/TDD Monday-Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are available weekends from 8:00 a.m. – 8:00 p.m. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, Please contact Univera Healthcare for details.

8 8 Senior Choice ® Value (HMO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 Active Anytime ® Fitness Benefit …and more!

9 9 Senior Choice ® Value (HMO) Monthly Premium $0*$16* *You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

10 10 Senior Choice ® Value (HMO) Benefit Outpatient Mental Health Care (per visit) 50% coinsurance45% coinsurance Radiology Services (per visit) 10% coinsurance20% coinsurance Durable Medical Equipment 30% coinsurance20% coinsurance Prosthetic Devices 30% coinsurance20% coinsurance Diabetic Supplies 30% coinsurance20% coinsurance Part D Deductible $175$150

11 11 Senior Choice ® Value Plus (HMO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 Active Anytime ® Fitness Benefit …and more!

12 12 Senior Choice ® Value Plus (HMO) Monthly Premium $30*$46* * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

13 13 Senior Choice ® Value Plus (HMO) Benefit Outpatient Mental Health Care (per visit) 50% coinsurance45% coinsurance Durable Medical Equipment 30% coinsurance20% coinsurance Prosthetic Devices 30% coinsurance20% coinsurance Diabetic Supplies 30% coinsurance20% coinsurance Part D Deductible $175$150

14 14 Senior Choice ® Secure (HMO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 Active Anytime ® Fitness Benefit …and more!

15 15 Senior Choice ® Secure (HMO) Monthly Premium $70*$86* * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

16 16 Senior Choice ® Secure (HMO) Benefit Durable Medical Equipment 25% coinsurance20% coinsurance Prosthetic Devices 25% coinsurance20% coinsurance Diabetic Supplies 30% coinsurance20% coinsurance

17 17 Senior Choice ® Select (HMO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Durable Medical Equipment (DME) Chiropractic $650 Active Anytime ® Fitness Benefit …and more!

18 18 Senior Choice ® Select (HMO) Monthly Premium $40*$55* * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

19 19 Senior Choice ® Select (HMO) Benefit Diabetic Supplies 30% coinsurance20% coinsurance

20 20 Univera Medicare PPO SM 102 (PPO) No changes to the following benefits or cost-sharing in 2010: PCP Office Visit Specialist Office Visit Ambulance Services Emergency Room Inpatient Hospital Outpatient Hospital Physical Therapy Skilled Nursing Facility (SNF) Chiropractic $650 Active Anytime SM Fitness Benefit …and more!

21 21 Univera Medicare PPO SM 102 (PPO) Monthly Premium $20*$36* * You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

22 22 Univera Medicare PPO SM 102 (PPO) Benefit Radiology Services (Per visit) 10% coinsurance In-Network 20% coinsurance In-Network Outpatient Mental Health Care (per visit) 50% coinsurance In-Network 45% coinsurance In-Network Durable Medical Equipment 30% In-Network 40% Out-Of-Network coinsurance 20% In-Network 30% Out-Of-Network coinsurance Prosthetic Devices 30% In-Network 40% Out-Of-Network coinsurance 20% In-Network 30% Out-Of-Network coinsurance Seasonal flu/pneumonia vaccines30% Out-of-Network Covered in full Out-of-Network Diabetic Supplies 30% coinsurance In-Network 20% coinsurance In-Network Part D Deductible$175$150

23 23 Medicare Prescription Drug Plan (Part D) You pay $2.50 for generics and $6.30 for brand name drugs, or 5% of the price (whichever is greater) Catastrophic Coverage Univera Healthcare pays the balance Coverage Gap All costs are out-of-pocket You Pay Your copays/coinsurance Initial Coverage Period Univera Healthcare pays the balance Deductible is out-of-pocket $0 or $ Coverage Phases Catastrophic Coverage Begins when you or others on your behalf have spent $4, No coverage when total drug spend exceeds $2,830 1 until your true out of pocket spending reaches $4, Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2, You must pay your deductible, if applicable before you start getting your prescription coverage. 1 Coverage limits for all phases of the Part D benefit change annually. 2 Benefits, formulary, pharmacy network, premium, copayment/coinsurance may change on January 1, Contact Univera Healthcare for details.

24 24 Medicare Prescription Drug Plan (Part D) Formulary Changes Review the drugs you are taking Consult with your doctor if your drug will no longer be covered. Network About 60,000 pharmacies nationwide Retail, mail order, long-term care, home infusion, Indian/Tribal/Urban pharmacies included For additional information regarding our pharmacy network, quantity limits, and mail order prescription drug services, call: TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1 representatives are also available weekends from 8:00 a.m. – 8:00 p.m. You may write us at: Univera Healthcare, PO Box 546, Buffalo, NY You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies.

25 25 Medicare Prescription Drug Plan (Part D) You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call: MEDICARE ( ), TTY/TDD users should call , 24 hours a day/7 days a week; The Social Security Administration at between 7:00 a.m. – 7:00 p.m., Monday through Friday, TTY/TDD users should call ; or Your State Medicaid office.

26 26 People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for:  seventy-five percent of drug costs including monthly prescription drug premiums,  annual deductibles, and  coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.  Many people are eligible for these savings and don’t even know it.  For more information about this Extra Help, contact your local Social Security office or call MEDICARE ( ), 24 hours per day, 7 days per week. TTY users should call Medicare Prescription Drug Plan (Part D)

27 27 Summary of 2010 Benefit Changes No Change To Most Benefits Valuable Extras

28 28 Health and Wellness Active Anytime ® Fitness Benefit Up to $650 per calendar year* Qualified fitness facility membership fees Qualified weight management program membership fees * This benefit does not cover any ancillary services or items that are not part of a membership fee.

29 29 What’s New Enhanced Web Tools Side by side comparisons of: Your plan options & Estimated out-of-pocket costs plan changes Learn more about cost-cutting options Research health topics Change your doctor Request ID cards Access health coaching information

30 30 Valuable Extras Medicare Dedicated Customer Service Unit Knowledgeable and friendly staff dedicated to answering any questions you may have timely, accurately, and professionally. 24-hour Personal Health Coaching Line Provides education and programs on nutrition, weight management and much more. Disease & Case Management Clinical staff work with you to make informed choices on your health care and prescriptions

31 31 What To Expect Whether changing your coverage or not, you will receive new: ID cards ActiveAnytime ® card (if you already have a card that you’re using for this benefit)

32 32 What Do You Need To Do? If you want to stay in your current plan, there is nothing you need to do. If the plan you are in no longer suits your needs, we have many other plan options. Complete an option transfer form if switching from an HMO plan to another HMO plan within our organization. Complete an application if switching between HMO, PPO or Medicare Supplemental Plans.

33 33 Medicare Advantage Plan Enrollment Periods There are only certain times during the year when you may change or voluntarily end your membership in a Medicare Advantage Plan. Annual Enrollment Period (AEP) –Runs from November 15 – December 31, each year –Can change Medicare Advantage plans or stand-alone Prescription Drug Plan –Can add or drop prescription drug coverage –Can return to Original Medicare –Enrollment changes take effect on January 1 Open Enrollment Period (OEP) –Runs from January 1 – March 31, each year –Can change Medicare Advantage plans –Cannot add or drop prescription drug coverage –One opportunity to change to a similar plan (No-drug plan to no-drug plan –OR– drug plan to drug plan) –Enrollment or disenrollment becomes effective the month after the application is received

34 34 Special Enrollment Period (SEP) Change of residence into or out of the service area Loss of employer coverage Qualify for Low Income Subsidy Medicare Advantage Plan Enrollment Periods To obtain more information regarding Medicare Advantage Plan enrollment you can call our Customer Service Department at for SeniorChoice or for Univera Medicare PPO TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends 8:00 a.m. – 8:00 p.m.

35 35 How to Contact Us For full information on Univera Healthcare benefits: Call us: SeniorChoice ® (HMO) Univera Medicare PPO SM TTY/TDD Monday-Friday, 8:00 a.m. -8:00 p.m. From November 15 - March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. Write us: Univera Healthcare, PO Box 546, Buffalo, NY Visit us on the Web at

36 36 Interested in Receiving s? Fill out our simple form provided by your sales representative or call us to receive some information such as health and wellness from Univera Healthcare in your ! Call: (TTY/TDD ), Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. Interested in Becoming an Ambassador? Ask your Medicare representative about our exciting Ambassador program.

37 37 We Value Your Opinion Tell us how we are doing! Call our Confidential Voice Message System hours a day, 7 days a week

38 38 Questions?

39 39 Thank You! H3351, H _0 (10/2009)


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