2013 Benefits
Medicare and Emeriti’s Health Insurance and Reimbursement Benefit
This presentation is copyrighted © exclusively by Emeriti
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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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• Tax-advantaged savings and investment vehicle, via VEBA
Trusts, for payment of future medical expenses in retirement
•
Portable group retiree health insurance options building on the foundation of Medicare
• Tax-free reimbursement of other qualified medical expenses not covered by Medicare or Emeriti insurance options
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TIAA-
CREF
Accumulation
Recordkeeping
Trust Services
Investment
Management
Savitz Aetna
Proprietary
Mutual Funds
Non
Proprietary
Mutual Funds
Insurance
Premiums
Disbursement
Recordkeeping
Retiree Health
Plans
Qualifying
Medical
Expenses
HealthPartners
Retiree Health
Plans
Debit Card Manual Claims
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Source: EBRI estimates from the 2009 Medical Expenditure Panel Survey.
*VA, Tricare, other private, Medicaid, other.
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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
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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• Part A deductible
• Part B deductible
• Part B premium
• Part D deductible
• Part D Coverage Gap cost share
• Part D Catastrophic
Threshold cost share
• Premiums
• Deductibles
• Co-pays and coinsurance
• Vision
• Hearing
• Medical equipment
• Long-term care
• In-home health care
Note: Higher-income retirees may pay a higher Part B premium and may also be subject to a Part D premium
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• Guaranteed issue group health insurance coverage
• Portable, nationwide access
• A flexible menu of insurance options
• Annual choice among plans
• Catastrophic protection
• Part D prescription drug coverage
• Foreign urgent or emergency care*
• Preventive care**
*Available in some plans.
** Varies by plan .
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in Medicare Parts A & B
NOTE: Consult your Summary Plan Description for details.
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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 must enroll in same coverage as participant
NOTE: The employer’s plan establishes specific rules for vesting in the Emeriti account balance and retirement eligibility for the Emeriti insurance.
*Domestic partners’ coverage is available only if elected by the institution. Independent 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 Group Medical Plans
One Medicare coordination plan
Two Medicare supplemental plans (availability based on state approval)
One Medicare Advantage PPO (Extended Service Area (ESA) available for geographical areas outside Aetna’s network)
Emeriti 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
Emeriti Dental Plan
One dental plan
PLEASE NOTE: Emeriti will offer Aetna Group Medicare Supplement Insurance (GMS) Plans A and L to retirees living in Florida.
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Choose Rx Low Plan as stand-alone option
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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select a medical plan
select an Rx plan
Consider the optional dental plan
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A tax-free method for you to pay for other qualified out-of-pocket medical expenses not covered by Medicare or Emeriti insurance.
A tax-advantaged way to save and invest for future medical expenses.
Note: ACH savings option will be available in 2013.
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•
•
•
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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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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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
Consult your summary plan description for details
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• Improved Emeriti Service Center: 9am – 5:30pm ET 1-866-EMERITI
• Dedicated Emeriti representatives
• Improved warm transfers
• Enhanced reimbursement benefit options:
• Manual claims can be submitted via direct mail, fax, or uploaded to participant benefits dashboard, starting in January
• New debit card option in development for 2013
• Online participant dashboard:
• At-a-glance summary of Health Account activity, insurance plan information, and reimbursement benefit transactions.
• Quarterly statements:
• Investment statement from TIAA-CREF
• Health insurance and reimbursement benefit statement from Savitz
• Enhanced menu of investment funds and institutional Microsites:
• Proprietary and non-proprietary fund choices
• Microsites in development for 2013
• Improved suite of life-stage communications for participants:
• Retired participants
• Participants nearing retirement
• Younger active participants – in development for 2013
• Improved ACH savings opportunity from personal bank accounts:
• Recurring and periodic lump sum savings option – in development for 2013
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CORE
FUNDS
CORE
PLUS
FUNDS
(Retirement Class)
• Lifecycle funds
• Asset diversification among asset classes
• Automatic rebalancing
(Retirement Class)
• A money market mutual fund
• Seeks to assure the value of your investment at $1 per share
Additional Mutual
Funds – based on institution’s election
• Some TIAA-CREF proprietary funds
• Some non-proprietary funds from other mutual fund families
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10
WAYS TO GET
MORE INFORMATION
Call toll-free:
1-866-EMERITI
(1-866-363-7484)
Monday – Friday
9:00AM to 5:30PM (ET)
Scheduled annually on campus, these workshops provide you with details about your
Emeriti Health Account,
Insurance Plan Options, and the Emeriti
Reimbursement Benefit.
Two different print and electronic statements that detail your Health
Account investments, as well as your Health
Insurance and
Reimbursement Benefit transactions.
An at-a-glance benefits website with access to information about your
Emeriti Health Account balances, Health Insurance
Plan Options, and
Reimbursement Benefit transactions.
MyEmeritiBenefits.org.
Using TIAA-CREFs secure website, you can check your
Emeriti Health Account balance any time.
Visit tiaa-cref.org to log in.
The Emeriti website contains information about each component of the Program, as well as Medicare update, the
QME form, a premium rate guide, and other important information.
Visit EmeritiHealth.org.
An easy-to-use online resource for benefits and health information.
Check your insurance claims, find a doctor, order prescriptions online, and access information about eligible health expenses.
Visit EmeritiHealth.org and click on the Online
Participant Services button.
As you near age 65, Emeriti mails insurance age-in retirement kit to your home. You may also request a kit at any time.
Once you are enrolled, retiree annual insurance enrollment kits are also mailed to your residence.
Various materials to inform and educate you about the Emeriti
Program throughout your working years and into retirement.
A Plan-level microsite for you to access investment information, including prospectuses, fund fact sheets, and performance reports.
This Program feature is currently in development.
Details forthcoming.
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1-866-Emeriti
Thank you for calling Emeriti
Please listen carefully, as our menu has changed.
YOU WILL HAVE 3 CHOICES
For questions about the Emeriti
Reimbursement
Benefit, press 2
For assistance with Annual
Enrollment, press 1
Savitz
Rep
For information about
Annual Enrollment and questions about Emeriti
Health Insurance, press 1
To speak with an Aetna or
HealthPartners representative about your benefits or an existing insurance claim, press 2
Press 1 for an Aetna representative, press 2 for a
HealthPartners representative
Aetna Rep HP Rep
Savitz Rep
For questions about
Emeriti Health Account balances and investments, press 3
TIAA-CREF Rep
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TIAA-CREF Quarterly Statement
Savitz Quarterly Statement – when you terminate
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TIAA-CREF.org
Online Account Details
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Register
View Health Account, Health Insurance, and Reimbursement
Benefit Information
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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
Emeriti
TIAA-CREF
Savitz
Actives
$5.00
$ .67
$1.00
Retirees*
$5.00
$ .67
$6.00
Investment management fees are variable by selected mutual funds (see prospectuses)
*Also applies to vested terminated employees
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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 for the Emeriti Program, selecting the investment manager for employer and voluntary employee contributions, and providing these and other impersonal educational materials to plan participants. Emeriti does not provide advice to participants about their individual investment selections.
The participation interests in the voluntary employee contribution VEBA trusts associated with the Emeriti plans (the “Interests”) may be treated as securities under various state securities laws. The offering of these Interests is subject to compliance with any applicable 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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Deductible
You pay first
$325 as deductible
Initial Coverage
Period
You pay 25% of drug costs
Coverage Gap
You pay 97.5% of brand drugs
You pay 79% of generic drugs
Catastrophic
Coverage
You pay 5%
•
Greater of $2.65 or 5% for covered generic.
• Greater of $6.60 or 5% for all other drugs.
You reach the Coverage Gap at $2,970 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 $4,750 in true out-of-pocket costs.
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Aetna Traditional Choice
$200 Deductible
Aetna Supplemental
Retiree Medical Plan L*
$0 Deductible
Aetna Supplemental
Retiree Medical Plan K*
$0 Deductible
20% coinsurance
25% coinsurance 50% coinsurance
$1,250 out-of-pocket limit
$2,330 out-of-pocket limit
(subject to change based on 2013
CMS guidelines )
$4,660 out-of-pocket limit
(subject to change based on 2013
CMS guidelines)
100% preventive care covered by Medicare
After plan deductible is satisfied, plan payment in full on
Medicare eligible costs.
Age banded
100% preventive care covered by Medicare
Payment based on the balance after
Medicare’s payment.
Age banded
100% preventive care covered by Medicare
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 2013, the SRM Plans are not available in VT, MN, and America Samoa.
Payment based on the balance after
Medicare’s payment.
Age banded
Aetna Medicare Advantage -
PPO/ESA-PPO
$300 Deductible in-network
$500 Deductible out-of-network
15% coinsurance (in-network)
25% coinsurance (out-of-network)
$2,750 out-of-pocket limit (in-network)
$5,500 out-of-pocket (out-of-network)
100% preventive care covered by the Plan
Payment based on total
Aetna allowable cost.
Community rated
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Trad. Choice SRMP L SRMP K MA-PPO/ESA
Charge
Medicare Pays
Aetna Pays
You Pay
$100
$80
$20
$0
$100
$80
$15
$5
$100
$80
$10
$10
NOTE: Illustration assumes any annual plan deductibles have already been satisfied for the plan year.
$100
$0
$85
$15
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Deductible
YOU PAY FIRST
$325 AS
DEDUCTIBLE
Initial Coverage
Period
PLAN PAYS 75%
OF DRUG COSTS
($1983.75)
Coverage Gap
YOU PAY 97.5%
OF BRAND
DRUGS AND 79%
OF GENERIC
DRUGS
($3763.75)
Catastrophic
Coverage
PLAN PAYS 95%
YOU PAY 25% OF
DRUG COSTS
($661.25)
You reach the Coverage Gap at $2,970 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 $4,750 in true out-of-pocket costs. This threshold includes plan deductible, your 25% cost share during Initial Coverage Period, and your
97.5% cost share for brand drugs and 79% cost share for generic drugs in the Coverage Gap.
YOU PAY 5%
* Greater of $2.65 or 5% for covered generic (including brand drugs treated as generic) drugs.
Greater of $6.60 or 5% for all other drugs.
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Standard Formulary
$325 deductible
Initial Cov Limit Retail:
15% - 30%
Coverage Gap: no coverage*
Catastrophic Cov: 95% coverage
Step therapy required for some drugs
Geographically rated
Open Formulary
$100 deductible
Initial Cov Limit Retail
15% - 30% - 50%
Coverage Gap: generic coverage only*
Catastrophic Cov: 95% coverage
Step therapy required for some drugs
Geographically rated
Open Formulary
$100 deductible
Initial Cov Limit and Coverage Gap Retail
15% - 30% - 40%
Coverage Gap: full coverage
Catastrophic Cov: 100% coverage
No Step therapy required
Geographically rated
*Participant has 79% cost sharing limit on generic drugs in Coverage Gap (Rx Low Plan), and 2.5% plan cost sharing on brand drugs in the Coverage Gap (Rx Mid Plan and Rx Low Plan).
NOTES: Members who use Aetna’s Rx Home delivery Mail Order Drug (MOD) program will pay a reduced percentage of the negotiated cost of the drug as compared to retail.
The Medicare Coverage Gap Discount Program provides a 50% manufacturer discount on brand drugs in the Coverage Gap for all Rx plans for participants not already receiving “Extra Help.”
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For generic drugs in the Gap (one month supply obtained at in-network retail pharmacy):
Sample Generic - $30
Your Cost Share
You Pay
Rx Low Plan
79%
$23.70
Rx Mid Plan
15%
$4.50
Rx-High Plan
15%
$4.50
All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low income cost sharing subsidies .
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For eligible brand drugs in the Gap (one month supply obtained at in-network retail pharmacy):
Sample Brand - $100
(Preferred Brand)
Rx Low Plan Rx Mid Plan Rx High Plan
Pharma Cost Share 50% Manufacturer
Discount on total cost of drug
50% Manufacturer
Discount on total cost of drug
50% Manufacturer
Discount on total cost of drug
Plan Cost Share
Your Cost Share
You Pay
2.5% of $100 total drug cost
47.5%
$47.50
2.5% of $100 total drug cost
47.5%
$47.50
Plan pays balance, after your
30% cost share
30% of total drug cost
$30
All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low-income cost sharing subsidies. There is also a dispensing fee.
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Preventive Service Coverage
Annual Deductible (basic and major services)
Basic Services Coverage
(e.g. fillings, standard crowns, extractions)
Major Services Coverage
(e.g. root canal therapy, surgical removals, dentures)
Annual Benefit Maximum
100%
$100
50%
50%
$1,500
Rate Structure Community rated
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.
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