0. 2013 State Health Benefit Plan Retiree Option Change Period
Presentation to: SHBP Retirees with Medicare
Welcome to the Retiree Option Change Period

1. Mission The Georgia Department of Community Health
We will provide access to affordable, quality health care to Georgians through effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
Read slide

2. 2013 Retiree Option Change Period (ROCP)
How to Make your 2013 Election
Medicare Advantage MA PPO Changes
Traditional Medicare vs. SHBP MA PPO
SHBP Going Green
Benefit Changes for the HRA, HMO and HDHP Plans
In the presentation we will be covering the following:
How to Make your 2013 Election
Medicare Advantage MA PPO Changes
Traditional Medicare vs. SHBP MA PPO
SHBP Going Green
Benefit Changes for the HRA, HMO and HDHP Plans

3. Making Your 2013 Benefit Election
Online Election
- Members must make their health election at
Website Open & Close Dates
- Website opens at 4 a.m. on October 9, 2012
- Website closes at 4:30 p.m. on
November 9, 2012
Our Retiree Option Change Period this year is October 9, 2012 through November 9, The web site will be up from 4 a.m. on October 9, 2012 and will close at 4:30 p.m. on November 9, Members can make their health election at
The Health Plan Decision Guide contains IMPORTANT INFORMATION about benefit changes for 2012 and outlines the steps members need to take during OE to make their election. This guide will be posted to the Retiree Option Change and State Health Benefit Plan websites by September 28, 2012. 3

4. 2013 MA PPO Plan Changes
Humana MA PPO Premium Plan will not be offered. If you are enrolled in this plan and don’t make an election, your coverage will roll to the Humana MA PPO Standard Plan
Increase in co-insurance from 15% to 20% under the United Healthcare MA PPO Premium Plan
Increase in premiums
The Humana MA PPO Premium Plan will not be offered. If you are enrolled in this plan and don’t make an election, your coverage will roll to the Humana MA PPO Standard Plan
There is an increase in co-insurance from 15% to 20% under the United Healthcare MA PPO Premium Plan
There are also increases in premiums.
There is no change in benefits for the MA PPO Standard Options for both United Healthcare and Humana

5. Traditional Medicare vs. SHBP MA PPO
( Part A and B)
Original Medicare w/supplement OR SHBP non- MA Plans
SHBP Medicare Advantage Plan
Premiums
$99.90 ( Monthly Part B Premium and is income based)
$99.90 (monthly Part B)
$85-$250 Medigap policy OR at least $1100 monthly SHBP non-MA Plan premium
$99.90 ( monthly Part B)
$25.38 / $85.14 ( monthly SHBP MA PPO premium)
Deductible
$1,156 (Part A)
$ (Part B)
Varies depending on supplemental plan or other plan you choose $0
(You must continue to pay your Part B premiums)
Pharmacy/Rx coverage
No coverage; must add a Medicare Part D plan
$25-$75 (monthly Part D premium)
Included Plus full coverage in the Gap
There is a lot of information contained in this charge for you to compare the difference between having Traditional Medicare and one of the State Health Benefit Plan Medicare Advantage Plans. The big things to note are:
With the SHBP MA Plans, each month, the member pays for Medicare Part B and a small premium to SHBP
The SHBP MA Plan pays the Medicare approved benefit plus the enhanced benefits under these plans.
The member is only responsible for the co-payment or co-insurance.
Under the SHBP MA Plans there is also no gap in the prescription drug coverage, unlike most Part D plans and our plans have a maximum out-of-pocket limit.

6. Traditional Medicare vs. SHBP MA PPO
( Part A and B)
Original Medicare w/supplement OR SHBP non- MA Plans
SHBP Medicare Advantage Plan
Out of Pocket
Maximum
No Limit-Member continues to pay co-insurance regardless of total out of pocket expenses
Varies depending on supplemental plan or other plan you choose
$2,500 / $3,500
Once member’s total out of pocket maximum reaches these limits, benefits are covered at 100% except for Part D co-payments
Value Adds
(such as vision, hearing chiropractic, Silver Sneakers, disease management)
None
Included
Claims Payment
Medicare A or B pays first
Supplemental or other plan
(including SHBP non MA Plans) pays secondary benefits*
SHBP Medicare Advantage PPO Plan pays ALL claims.
Once the member meets the out of pocket limits, benefits would be covered at 100%.
SHBP MA Plans also cover many things that Traditional Medicare does not. Including hearing aids, vision care, chiropractic and Silver Sneakers program

7. Going Green-Important Information for 2014
This means for your 2014 election you will need to make your election online
We understand some members do not have access to a computer. SHBP will mail a postcard in April of 2013 allowing you to elect to receive a packet in the mail for your 2014 ROCP
For your 2013 election you will use the PCF form included in your packet only if you want to make a change
All retiree packets for the 2013 ROCP will be mailed by October 3, However, due to the continued increase in the cost of Open Enrollment/ROCP printing and postage costs, the decision has been made that beginning with the 2014 ROCP the SHBP will no longer mail large retiree packets . Retirees that choose to “Go Green” will receive a reminder postcard in October of 2013 that will include the website where you can view any plan, benefit, rate or eligibility changes. This paper/postage reduction will result in a considerable cost savings to SHBP.

8. 2013 Benefit and Plan Changes
Elimination of the Spousal Surcharge
Increase in deductibles and co-insurance for the HRA, HDHP and HMO Standard and Wellness Plans
Increase in co-payments under the HMO Standard Plans- PCP & Urgent Care- $55; Specialist - $65
Change in HRA credits in the Standard Plan
Increase in premiums for most plan options and tiers
Elimination of $ HRA credit for annual physical and health assessment.
The spousal surcharge is being eliminated.
These are the benefit changes –
Increase in deductibles and co-insurance for the HRA, HDHP and HMO Standard and Wellness Plans
Increase in co-payments under the HMO Standard Plans- PCP & Urgent Care- $55; Specialist - $65
Change in HRA credits in the Standard Plan
Increase in premiums for most plan options and tiers
Elimination of $ HRA credit for annual physical and health assessment.
Please refer to your Decision Guide for more information.

9. Making Your 2013 ROCP Election
If you are enrolled in the Humana MA Standard PPO Option or the UnitedHealthcare MA PPO Standard or UnitedHealthcare MA PPO Premium you do not need to do anything if you want to remain in the same MA PPO Option for 2013
Your coverage will roll over in the same MA PPO Option and vendor
If you have Humana Premium MA PPO Plan and take no action, coverage will roll over to Humana MA PPO Standard
If you are enrolled in the Humana MA PPO Standard Plan, the UHC MA PPO Standard or UHC MA PPO Premium Plan and wish to stay in your current plan, it is not necessary to make an election for Your coverage will rollover for 2013.
You only need to make an election if you are in the Humana Premium Plan and do not want to be enrolled in the Human Standard MA PPO or if you want to change to another plan or vendor.

10. Making Your 2013 ROCP Election
Making your Election- Changes Only
Online at website if possible
Complete Personalized Change Form (PCF) only if you need to make a change. This form is included in the 2013 Retiree Packet – ONLY do one or the other.
If you need to make a change for 2013, you will either make your election online at or by completing the PCF included in your 2013 Packet. You only need to do this if you want to change your coverage.
This concludes the SHBP Portion of the 2013 Retiree Option Change Period Presentation.
YOU WILL NOW SEE A SHORT PRESENTATION FROM EACH VENDOR. AFTER THAT, WE WILL DISPLAY SOME FREQUENTLY ASKED QUESTIONS AND REPRESENTATIVES FROM HUMANA AND UHC WILL BE AVAILABLE AT THE TABLES TO ANSWER ANY ADDITIONAL QUESTIONS YOU MAY HAVE.

11. Questions or Additional Information
Cigna - HMO, HRA, HDHP
UnitedHealthcare – HRA, HMO& HDHP or
Refer to or for additional information
TDD – Cigna
TDD UnitedHealthcare – / TTY 711
If you have Questions or Need Additional Information you can call the numbers listed above or go to the websites. <<Read the websites>> 11

12. Important Notice
The information provided in this presentation is a summary of changes for the 2013 Plan Year. It is intended only to highlight principle benefits
Please refer to the Retiree Decision Guide for more details
Rates, decision guides and other information will be available at and by October 1, 2012
The information provided in this presentation is a summary of changes for the 2013 Plan Year. It is intended only to highlight principal benefits.
Please refer to the Active members Decision Guide for more details.
You will new see a short presentation from each vendor after which representatives from United healthcare and Cigna will be available to answer questions you may have. 12

13. Humana Medicare Advantage
No talking points here.
SHBP RETIREES 2013

14. Why Should You Choose Humana?
Coverage Backed by over 50 Years of Experience & Financial Security
Extra Benefits & Services
Flexible and Comprehensive Rx Program
Worldwide Coverage for Emergencies
No Referrals Required
Support Services Dedicated to Group Members
Why should you choose Humana? There are many reasons and I will go further into detail for each of these plan features as we continue with this presentation.
Humana is a Fortune 100 company which speaks to our financial security.
We’ve been in business for more than 50 years……..and are planning to be around for a long time.
This plan includes lots of extras, a flexible and comprehensive prescription program, and worldwide coverage for emergencies.
There are no referrals required, and coverage is immediate with no exclusions for any pre-existing conditions.

15. Why Should You Choose Humana?
Humana is dedicated to providing quality customer service to our members!
Humana is dedicated to providing quality customer service to our members! Satisfaction surveys showed Humana’s plan had a 98% service satisfaction score in Our customer service representatives have access to the most up-to-date SHBP benefit information in order to offer unsurpassed guidance. Humana’s Group Medicare customer service department is available from Monday to Friday, 8:00 a.m. to 9:00 p.m.

16. Health Care is not “One Size Fits All”
Your Plan
Choosing your health plan is an important decision and you should consider both the benefits and monthly premium cost.
Step 1: Estimate your annual medical and prescription costs.
Step 2: Compare estimated costs including monthly premium and your
cost share.
Health Care is not “One Size Fits All”
Choosing your health plan is an important decision…….one of the most important that you will make this year. You should consider not only the plan benefits but also how much you will pay for the plan each month.
You should estimate your total medical and prescription costs for next year, which will most likely be similar to the costs this year. Then, determine whether you want to pay a little more when you use your plan with slightly higher costs, or if you want to pay a higher premium each month whether you use your health care benefits or not.
Humana will not offer a Medicare Advantage PPO Premium Plan in This was a tough decision. The Humana Premium Plan had higher medical costs due to increased health care service utilization and as a result this drove a higher cost to Humana. We were not able to adjust the cost of our Premium Plan rates to remain competitive. As a result, we chose to eliminate the plan option rather than to offer it and pass the cost difference on to retirees.
We think our 2012 premium plan enrollees should strongly consider moving to Humana’s Standard Plan in 2013 and use the monies they will save in premiums each month to pay for the slightly increased costs created by the benefit differences.
Your choice is unique to you and one plan is not the best choice for everyone.

17. Your Medicare Advantage Plan
Your SHBP Medicare Advantage Plan is… The Humana Group Medicare PPO
Humana will offer SHBP’s Standard Medicare Advantage Plan through the Humana Group Medicare PPO
If you are enrolled in the Humana Premium Plan, and do not make a n election your coverage will default to the Humana Standard MA Plan
PPO plans traditionally include a network of physicians and hospitals, however --
Your in-network and out-of-network benefits are the same. If you select an out-of-network physician or hospital who accepts both Medicare and Humana’s payment terms your benefits are the same as if you were in-network.
This plan combines maximum flexibility in choosing your healthcare providers with valuable benefits. Each time you need healthcare, you can choose to receive care from a Humana Medicare PPO network physician or hospital, or you may choose an out-of-network physician or hospital who accepts Medicare and Humana’s term and conditions.
Your in-network and out-of-network benefits are the same, as long as the out-of-network physician or hospital accepts both Medicare and Humana’s payment terms.
This Humana Group Medicare Advantage PPO offers you access to Humana’s network of preferred providers – doctors, clinics and hospitals with contracted agreements to treat Humana patients.
However, you are not required to use network providers – you may receive care from any licensed provider who accepts both Medicare and Humana’s payment terms. Humana will pay claims to out of network providers based on the Medicare allowable charges and the benefit structure of your plan.

18. How this PPO Plan Works Use only your Humana ID card
Use any provider in or out of network as long as they accept original Medicare and will bill Humana
No referrals required for specialty care
All claims processed by Humana
Under the Humana Group Medicare Advantage Plan, when you go to the doctor or hospital, show only your Humana ID card and tell the doctor that Humana PPO is your Medicare health plan.
You do not need to show your red, white and blue Medicare card.
The Healthcare providers will bill the PPO plan.

19. Extra Benefits Silver Sneakers SmartSummary Humana Active Outlook
Program
My Humana
HumanaFirst
Quit Net
The SilverSneakers® Fitness Program is included with the Humana plan. For no additional charge, Medicare members can use fitness centers with locations carefully selected for their warm, friendly, and safe environments. Steam and sauna rooms, heated pools, body conditioning classes, and strengthening tools are just a few of the benefits offered by SilverSneakers.
The Humana SmartSummary is an industry leading healthcare tool that is a personalized statement that’s mailed monthly to your home, if you have any claims. It helps you keep track of your claims, prescription drug usage and find out how you might be able to reduce your costs. It also can be used when talking to your doctor about your health care needs.
Humana Active Outlook Magazine is a quarterly magazine delivered to your home. It has interesting articles on health and wellness, as well as recipes and fun ways to stay fit and active. Humana Active Outlook has won more than 60 prestigious national publishing awards since Through Humana Active Outlook mailings, seminars, and classes, members receive information for healthy living, and Medicare news and updates.
MyHumana is a personal, secure Web page on Humana.com where members can access benefits information, health tools, claims history and more
HumanaFirst is a 24-hour nurse information line Humana makes available for you for medical questions that may help you avoid an unnecessary doctor’s visit.
You don’t have to quit alone. QuitNet is an online smoking cessation web-site with personal programs, tips, and advice. This is a tobacco cessation program with nicotine replacement therapy.

20. Extra Services Hearing Discount NutriSystem Roadside Assistance
Vision Discount
Mail Order Health & Wellness
Pharmacy and OTC Discounts
Humana Group Medicare members enjoy savings on hearing aids and weight loss programs. You can call Humana’s Customer Service for information on providers in your area! These programs offer discounts on hearing aids, screenings and visits. The hearing aids also include a warranty and coverage for damaged or lost hearing aids. The TruHearing discount program is in addition to the SHBP hearing benefits.
If you are looking to enhance your physical health and wellbeing, Humana offers discounts for NutriSystem Silver! You can contact a NutriSystem representative over the phone or by using their Web site.
Humana also offers discounts on Roadside Assistance, which provides peace of mind when traveling. This includes assistance on flat tires, fuel, batteries, lock-outs, towing and more at a low cost of $49.90 per year.
Humana’ also includes a vision discount program from Eye-Med, which has over 35,000 providers nationwide. With this program, you may receive discounts on eyewear, contact lenses, laser vision correction, and eye exams. You will receive an Eye-Med discount card in your member guide that you can cut out and keep in your wallet. The EyeMed Vision discount program is in addition to the SHBP vision benefits.
You can save money on over the counter medicines like vitamins & minerals and pain relievers. Through RightSource, there’s no charge for Shipping and Handling.
Certain types of prescription drugs often are not covered by prescription drug plans. These include drugs for weight loss, hair loss, and other conditions. But if your doctor prescribes any of these drugs to you, the pharmacy discount service can make them more affordable. This discount program can save you an average of 20% or more for prescription medicines. To see if a drug qualifies for the discount program, go to Humana.com and use the “prescription tools” section of MyHumana, or check your evidence of coverage booklet. All major pharmacy chains participate in this discount program, as well as many independent pharmacies, so it’s easy to find a participating pharmacy.

21. Humana Pharmacy Program
All Medicare approved medications included
All generics in Tier 1
90 day supply available
The drug list includes benzodiapezenes, barbiturates, and erectile dysfunction medication
Mail order available (not required)
Mail order reminders by phone, , or text message (your choice)
Nearly 65,000 pharmacy locations
RightSource® (Humana owned mail order)
The Humana drug list includes ALL medications approved by Medicare and all generic medications are in Tier 1, which has the lowest copayment. The drug list also includes benzodiapezenes, barbiturates, and erectile dysfunction medications.
You can also choose to obtain your prescriptions from Humana’s mail order pharmacy, RightSource. In addition to RightSource there are approximately 65,000 pharmacy locations nationwide in the Humana pharmacy network.
Convenient mail order refill reminders can be sent to you by or text message to your phone, or you can choose to receive a phone call. It is your choice on how you receive these reminders.

22. Member Services & Additional Information
Pre-Enrollment Hotline & Member Services
If you have questions or need additional information, please contact Humana at the number listed in this presentation or your enrollment materials. Provider and drug list information can also be accessed by going to
We look forward to serving you as a Humana Medicare Advantage member in the upcoming year.

23. UnitedHealthcare Group Medicare
Advantage Plan
Presentation to: SHBP Retirees
Presented by: UnitedHealthcare
Hello, my name is Gayle Adams, president of Group Retiree Services for UnitedHealthcare. We’re excited to again be part of the 2013 plan offerings customized just for SHBP retirees.
Date: Fall 2012

24. A company you know and trust!
Trusted Partnership - We’ve been serving SHBP actives and retirees for 11 years1!
Health plan of choice – More than 81,000 SHBP retirees1 and their spouses chose an UnitedHealthcare Medicare Advantage plan in 2012.
Experience – We have over 28 years of experience in the Medicare market and serve over 9 million members – that’s one in five people eligible for Medicare2.
National Recognition – UnitedHealth Group was ranked # 1 in its class in the ‘Most Admired Health Care Companies’ by Fortune Magazine annual survey3.
A company you know and trust - For many of you, UnitedHealthcare is not just a name but is part of your family. We have been serving SHBP active employees and retirees consistently for 11 years. And we are honored that over 81,000 SHBP retirees and spouses have made us your health plan of choice. We are also honored to continue to receive recognition in Fortune Magazine’s annual survey as one of the world’s “Most Admired Health Care Companies – capturing the number 1 spot in our class for the second year in row.
12012 Internal Company Data
22012 UnitedHealth Group Annual Report
3Fortune Magazine, March 19, 2012

25. Dedicated service you can count on!
We work hard to provide you the high quality customer service you deserve.
And according to you, your dedicated customer service team keeps getting better!!
Satisfaction with
2011 Medicare Advantage
2010 Medicare Advantage
UnitedHealthcare overall
98.70%
97.80%
Overall performance of a Customer Service representative
98.40%
Ability to process medical / behavioral claims correctly
98.0%
96.40%
Availability of specialist in network
We’re excited to report that your dedicated customer service team has earned top ratings from our most important clients – you! With an overall satisfaction rating of 98.7% in 2011, they are ready to meet your high expectations for quality and service. And while we appreciate your high ratings, we don’t take if for granted. We will continue to work hard to keep our ratings by you at the top!
Telephone survey conducted between Feb 23 – Mar 6, 2011 for 600 members. Percent satisfied were those members scoring UnitedHealthcare 3, 4, or 5 out of 5.

26. Access & Convenience
Our Medicare Advantage plans include your Part D prescription drug coverage
and we know how important convenience and access is for you.
Access
Over 2100 retail pharmacies including more than 900 independent pharmacies in Georgia and 65,000 pharmacies nationwide.
Georgia preferred extended day network - For those of you who prefer to stay ‘local’ we have more than 927 retail pharmacies that offer a 90 day supply for 2.5 copays (same as mail order).*
Getting the health care you need should be easy, affordable and convenient. With the UnitedHealthcare Medicare Advantage plan, prescription drug coverage is included in your Medicare Advantage plan.
You have convenient access to over 2,100 retail pharmacies including 900 independent pharmacies in Georgia. But that’s not all. If you are travelling or live outside of Georgia, you have access to 65,000 pharmacies nationwide.
We have also created a special Georgia Preferred extended day pharmacy network with more than 927 retail pharmacies in the state of Georgia, where you can get a 90 day supply at the same discount as mail order.
*Pharmacy must be contracted for the GA preferred extended day network, otherwise standard copays will apply.

27. Value & Savings
Our Medicare Advantage plans help you save on your health care expenses.
Convenient mail order
Can save you money and have some of your prescriptions delivered right to your door!
Pharmacy Saver Program
Offers some generic medications for as low as $2 at participating pharmacies.
To learn more go to or call Customer Service
Our Medicare Advantage plans offer you several ways to save money on your health care.
Our convenient mail order pharmacy allows you to receive a 90 day supply of your maintenance medications delivered right to your door at a discounted rate.
In addition, you have access to our UnitedHealthcare Pharmacy Saver program where you can get generic medications for as low as $2 at participating pharmacies such as Publix, Kroger, Target and more. To look up qualifying drugs, participating pharmacies and prices go to or just call customer service.

28. Health & wellness programs
These programs are available at no additional cost. They include:
SilverSneakers Fitness program
More than 240 locations throughout Georgia.
NurseLine program
Get answers to your health-related questions, 24 hours a day, 7 days a week.
House Calls program
Personalized health assessment delivered by a nurse practitioner in the comfort of you own home.
Helping you to maintain or improve your health is our mission. That’s why UnitedHealthcare’s plans continue to provide a number of programs, like SilverSneakers – at no additional cost – that are designed to help you maintain your health and make better healthcare decisions. We also offer 24/7 access to registered nurses to answer your health care questions.
In addition, we’ve added an innovative program in 2012 called House Calls – a program exclusive to UnitedHealthcare. With our House Calls program, you can receive a full health assessment by a nurse practitioner in the comfort of your own home to track your conditions and ensure you are getting the care you deserve.

29. Customized clinical programs to keep you healthy!
Welcome Home – helps ensure that your transition from hospital to home goes smoothly!
Disease Management – helps SHBP retirees with certain medical conditions manage their disease.
Complex Care Management – lets you take advantage of our recognized centers of excellence including our Cancer Resource Services, Kidney Resource Services and Transplant Resource Services.
High Risk Case Management – for SHBP members with complex medical conditions, provides face-to-face access to a personal care manager.
While many of our programs are focused on maintaining good health, we also know that as we age, maintaining our health can become more complicated. So, whether it’s welcoming you home from the hospital to make sure all your needs are met, or programs that can help you manage more challenging, on-going health problems, we will be there when you need us.

30. Why Choose UnitedHealthcare?
A company you know and trust
Experience
National Recognition
Dedicated Customer Service Specialists
Customized clinical programs such as House Calls give you personalized care
Access to a extensive network of providers and pharmacies.
In-Network? Out-of-Network? No difference
Innovative programs to save on healthcare expenses including Pharmacy Saver and a our hearing aid provider
We know how important choosing the right health plan can be and we want to make sure you make the right choice for you. Here are a few reasons why we believe you should choose UnitedHealthcare:
We are a known and trusted source with over 10 years of consistent experience serving you and nearly 30 years of experience working with Medicare. We continually receive national recognition for our company and our programs, and we put that experience to work for you.
We provide innovative health care services, like our House Calls programs, that can be customized to meet your needs. And finally, we believe health care should be convenient and affordable to match your lifestyle. That’s why we designed your Medicare Advantage plan to allow you as much flexibility as possible to see the doctors, hospitals and pharmacies you want. And we’ve added programs like the Pharmacy Saver program and our hearing aid program that that can help you save significantly on the cost of your health care.

31. Enrollment made easy!
Staying with UnitedHealthcare couldn’t be easier!
If you are already enrolled with us and want to remain in the same plan option, you don’t need to do anything! SHBP will automatically roll your coverage into the same plan option for 2013.
If you’re currently not a UnitedHealthcare member, we’d love to have you as part of our family.
Just complete the Personalized Change Form during the upcoming Retiree Option Change Period found in you 2013 Retiree Decision Guide or complete your election online at
So now that you know about your new plan options, how do you enroll? It’s easy! If you are already a UnitedHealthcare member, you don’t have to do anything! SHBP will automatically enroll you into the UnitedHealthcare Group Medicare Advantage (PPO) plan that corresponds to your current coverage (Standard or Premium), unless you make another choice.
If you are not currently with UnitedHealthcare, but want to join our plan or if you want to make a change, you can complete your election on line or complete the Personalized Retiree Option Change Form included in your 2013 Retiree Packet. Make sure it’s postmarked by November 10th, 2012.

32. We’d like to THANK YOU for allowing us to be your health care coverage provider and would be honored to continue to serve you in 2013.
We hope you’ve enjoyed this presentation and we’ve answered most of your questions. However, if you do have additional questions, please give us a call. We’ll be very happy to assist you.
Thank you for your time today and we look forward to serving you as a member.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Drugs and prices may vary between pharmacies and are subject to change during the plan year.
UnitedHealthcare® Medicare Advantage plans are insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract.

33. FAQs Frequently Asked Questions & Answers
I (or my spouse) is not yet 65, but will be turning 65 later this year. How do we get enrolled in the Medicare Advantage (MA) PPO plan?
ANSWER
Approximately 3 months prior to your 65th birthday, you will receive a kit from your current vendor and a letter from SHBP explaining the process.
A few important notes:
You must send SHBP a copy of your Medicare Part B card or a copy of the letter from Social Security approving your Medicare as soon as you receive it.
Once we have a copy of your Medicare Part B card, you will automatically be enrolled in the Standard plan option with your current carrier (unless you choose otherwise), effective the first day of your birthday month.
If you do not provide a copy of your Medicare card, you will remain in the Standard option of your current plan and health care vendor. However, you will be charged 100% of the premium.
A current mailing address is a must! All communications are mailed to the last known address. MA PPO enrollment requires a street address.
What if I or my spouse will be turning 65 in March. How do we get enrolled in one of the Medicare Advantage PPO Plans?
SHBP will send you letters 4 and 2 months before you turn 65. The letters will explain what action you need to take. Also you will receive a kit from your current vendor explaining the process.
SHBP must have a copy of your Medicare Part B card or a copy of the letter from Social Security approving your Medicare as soon as you receive it
Once this information is received, SHBP will automatically roll your coverage to the Standard MA PPO Option with your current carrier (unless you choose another option) effective the first day of your birth month
If we not receive Medicare Part B information, you will remain in the Standard option of your current plan and health care vendor BUT you will pay 100% of the premium
DON’T FORGET – SHBP must have a current mailing address in order for us to mail communications to you. ALSO CMS requires you have a street address for enrollment in a MA PPO Plan.

34. FAQs Frequently Asked Questions & Answers
Can we (my spouse and I) pick different plan options or do we both have to elect the same plan option?
ANSWER
No.
Spouses and/or dependents must follow the election of the retiree. You cannot mix and match unless…
You and your spouse are BOTH retirees of the State and each have your own single coverage, or
You are a “split-age” family (meaning one is under 65, the other is over 65 and enrolled in one of the MA PPO options).
Can (my spouse and I) pick different plan options or do we have to elect the same plan option?
No. Spouses and/or dependents must follow the election of the retiree. The only way you can mix and match is if
You and your spouse are BOTH retirees of the State and each have your own single coverage OR
You are a “split age” family meaning one is under 65, the other is over 65 and is enrolled in one of the MA PPO options

35. FAQs Frequently Asked Questions & Answers
What if my doctor is not in the network? How much will I pay?
ANSWER
As long as your provider accepts Medicare, you may continue to see this provider as an out-of-network provider in 2013.
Your cost is the same as if the doctor was contracted and in-network.
Please be sure your provider understands that you have a PPO plan with out-of-network coverage.
Again this year, you may see your provider even if they are not in the network as long as your provider accepts Medicare AND Your cost will be the same as if your doctor was in-network.
You may want to remind your provider that you have a MA PPO plan with in-network and out-of-network coverage.

36. FAQs Frequently Asked Questions & Answers
I have an RX plan under my spouse’s coverage. Do I need to cancel that?
ANSWER
As long as your spouse’s plan is not considered a MA or Part D plan, you can maintain both.
However, if your other coverage is a MA or Part D plan, once enrolled in the SHBP MA PPO plan, you will automatically be dis-enrolled from the other MA or Part D Plan as MA plans can not have coverage under two MA or Part D plans.
Since the MA PPO plan includes full-prescription drug coverage, you don’t need two separate plans.
What if I have prescription drug cover under my spouse’s plan? Do I need to cancel that coverage?
As long as your spouse’s plan is not considered a MA or Medicare Part D plan, you can maintain both.
However, if your other coverage is MA or Part D prescription drug plan, once you are enrolled in the SHP MA PPO Plan, you will automatically be dis-enrolled from the other MA or Part D Plan as CMS does not allow you to have coverage under two MA or Part D Plans.
Also, since your SHBP MA PPO plan includes prescription drug coverage (even if you are in the gap) you don’t need two separate plans.