Health Plan Changes for
Medicare-Eligible Retirees
Effective January 1, 2013
1
What is Changing
• Reynolds American Inc. is changing the way it
provides health care benefits to retirees who are
eligible for Medicare
– More choices in health coverage through the individual
market
– In many cases, coverage available in the individual
market costs less than the current group plan through
RAI.
– Access to benefit advisors to help with choosing coverage
that fits your health-care and financial needs.
2
Assistance Provided to You
• Assistance in choosing individual health coverage
– RAI has made an arrangement with Extend Health, Inc. an insurance
broker that specializes in individual Medicare supplemental insurance
coverage.
• Financial Assistance with purchasing medical
coverage
3
– Retirees and their dependents who are eligible for Medicare and have
been receiving a subsidy from RAI towards the cost of medical
coverage will continue to receive financial help when they enroll
through Extend Health.
– RAI will make an annual contribution into a tax-free account, called
the Health Reimbursement Arrangement.
Introducing Extend Health
The Industry’s Largest Medicare Exchange
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Who is Extend Health?
•
Independent company
•
Partner with 75+ health plan carriers
•
Objective and Trusted US based benefit advisors
•
Focused on helping each participant make an informed
and confident decision
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Why Extend Health
• We are experienced in helping people just
like you
• Our services are at no cost to you
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Market-Leading Private Sector Clients
175 Employers – 40 Fortune 500 Companies
95%+ Client Retention Rate
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Plans & Partners
All Medicare Plan Types
•
Medicare Advantage
•
Medigap (supplement)
•
Prescription Drug (Part D)
Vision
Dental
Select Carriers
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The Process
Educate
Evaluate/Enroll
Manage
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Education
Getting Started Guide
•
Gather information
– (e.g. prescriptions)
– Pre-existing conditions will
not limit your plan selection*
– Give us a call:
855-835-3811
– www.ExtendHealth.com/rai
* except end-stage renal disease
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Education
Enrollment Guide
•
•
•
Prepare you for
enrollment discussion
Review Medicare basics
Appointment confirmation
letter
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Decision Support Tools
• Help Me
Choose
• Prescription
Profiler
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Evaluate and Enroll
Licensed Benefit Advisor
•
•
Hours of Operation •
Monday – Friday •
8 a.m. – 9 p.m.
•
Eastern Time
•
100% domestic workforce
Objective advocacy
Neutral compensation
Extend University
Licensed, certified, appointed
Average age 43
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Enrollment Process
•
Benefit Advisors can discuss
coverage options with anyone
– need to speak to the
participant to complete the
enrollment.
•
Once you have made a
coverage selection,
enrollment is conducted via
telephone.
•
100% of calls are recorded.
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Medicare and You
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Your Future Coverage
Primary Coverage
Medicare A & B
Additional Coverage (Your Choice)
Medicare Advantage with
Prescription Drug (MAPD)
Medigap + Prescription Drug
Optional Coverage (your choice)
Dental and Vision
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Medicare Prescription
Drug Coverage
Initial Coverage
You pay
Deductible and co-pays for your plan
Coverage for the first $2970 in actual cost of meds
Coverage Gap – Donut Hole
You pay
47.5% of brand drugs and 79% of generics
until out of pocket costs reach $4750
Catastrophic Coverage
You pay
$2.65 for generics and $6.60 for brand
or 5% whichever is greater
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Location Specific plans
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Plan Availability in Winston/Salem
Plan Type
Medicare
Advantage
Medigap/
Medicare
Supplement
Part D
Number of Plans
Offered
2012
Monthly Premium
15
$0 - $100
32
19
$58 - $191
$15 - $113
Company
AARP, Humana,
BCBS of NC,
AARP, Aetna, Humana, BCBS
of NC,
American Continental
AARP, Aetna, BCBS of NC,
Cigna, CVS, Humana, Coventry,
WellCare, Community CCRx
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Plan Availability in Winston/Salem
Plan Type
Vision
Dental
Number of
Plans Offered
2012
Monthly Premium
1
$14 per person per month
Annual eye exam: $15
Coverage for eye glasses, lenses and
frames
2
$19 - $48
$0 - $50 deductible
$1,000 - $1,600 annual maximum
Company
Vision Service Plan (VSP)
Humana, Delta Dental
(Renaissance Dental)
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Plan Example
Medicare Advantage Plan
–
$0 per month
–
$47 per month - network: PPO
Deductible: $0
Doctor co-pay: $15 Specialist co-pay: $40
Hospital: $195 co-pay days 1-6
Emergency Room: $65 co-pay if not admitted
Rx: $7/$40/$80/33%
Mail order: (90 day discount)
–
–
–
–
–
–
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Plan Example
–
–
–
–
–
–
–
–
–
Medical/Rx
$215 ($175 - $40)
Medigap Plan F and PDP – 70 year old male
$173 – ($137/plan F + $36/pdp)
Network: any doctor that accepts Medicare
Deductible: $0
Doctor co-pay: $0 Specialist co-pay: $0
Hospital: $0
Emergency Room: $0 co-pay
Rx: $0 deductible $7/$39/$74/33%
Mail order: (90 day discount)
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Health Reimbursement
Arrangement

Auto-Reimbursement

How the Process Works
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What Is An HRA?
• Tax-advantaged account used to reimburse you
for eligible health care expenses
• You must meet Reynolds American Inc.’s
eligibility requirements to qualify for HRA
• Your HRA funds will be available January 1, 2013
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Health Reimbursement
Arrangement: How It Works
Reynolds
American Inc.
allocates
benefit dollars
to HRA
account of
eligible
participant
Participant enrolls
in a medical plan
through Extend
Health to enroll in
individual coverage
Participant
HRA
Account
Administered by
Extend Health
Participant is
reimbursed for
healthcare
expenses using
HRA benefit
dollars
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How to File a Paper Claim
Participant pays
plan premium or
co-pays
Extend Health
reimburses
customer
Participant fills out
claim form, attaches
required information
Extend Health
verifies receipt of
payment and
eligibility
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Extend Health
HRA Claim Form
Remember,
You can be
Reimbursed for
Part B by sending
in your statement
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How Auto-Reimbursement
Works
Participant pays
plan premium to
insurance company
Extend Health
reimburses
participant
Insurance company
forwards receipt of
payment to Extend
Health
Extend Health
verifies receipt of
payment and
eligibility
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Next Steps
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Next Steps
Review “Getting Started Guide”
Gather Medicare Prescriptions
and Doctor information
Call Extend Health
(855) 835 -3811
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Post Enrollment
Customer Service
Advocacy and support services
•
•
•
•
Toll Free number to contact Extend Health
representative
Direct support for claims issues, appeals and
network questions
Renewal process – ability to pick new coverage for
future years – not locked into this year’s choice
Ongoing enrollment services
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Questions
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