City of Providence Providence Public School District Benefits - - PowerPoint PPT Presentation
City of Providence Providence Public School District Benefits Division 2020 Teacher Retiree Benefits Workshop Benefits Manager Stacy Roberts Senior Benefits Analyst Jennifer Charbonneau Benefits Specialist Claire Girard
Benefits Manager – Stacy Roberts Senior Benefits Analyst – Jennifer Charbonneau Benefits Specialist – Claire Girard Benefits Clerk – Toni Barletta
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child*) * Certification/documentation required
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4 Medical Prescription Drug Coverage Dental BCBSRI
CVS Caremark Delta Dental
calendar year
calendar year
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What’s Covered What You Pay In Network
Primary Care Office Visits $10 per visit Specialist Office Visit $10 per visit Emergency Room Care $100 per visit Urgent Care Center $10 per visit Allergy & Dermatology $15 per visit
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What’s Covered What You Pay In Network Primary Care Office Visits $30 per visit Preventative Care $0 per visit Specialist Office Visit $30 per visit Emergency Room Care $100 per visit Urgent Care Center $50 per visit Diagnostic lab, x-ray, imaging, high end radiology 0% after deductible
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Retail Pharmacy Network Generics $5 Preferred Brand $15 Annual Cap $600
Retail Pharmacy Network Generics $5 Preferred Brand $15 Non Preferred Brand $30
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Procedures Plan pays 100%:
Plan pays 50%:
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Procedures Plan pays 100%:
Plan pays 50%:
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11 Frequently Asked Questions (Pre-65)
Q - How will you know what your rate will be in October? A - You will receive a rate letter in the mail in June with coupons that show the new rate. Q - When is my payment due? A - Payment is due by the 15th of each month. (If at any point, you run into a financial hardship, you may contact the Benefits Office to arrange a payment plan.) Q - How do I pay my monthly payments? A - You will need to send a check or money order to us (made payable to Providence School Department) each month to our confidential PO Box (Attn: PPSD Retiree PO Box 1656, Providence, RI 02901). Q - Can I pay more than one month at a time? A - Yes, you may pay more than one month in advance. On the memo portion of your check please write in which months you are paying and your Account number that is listed on the payment coupon. Q - When do I need to return applications for coverage or the deferral form? A - You should return all applications and/or deferral form to the Benefits Office 30 days prior to the effective date of retiree coverage (August 31st or as soon as you are confident in your decision).
PDP) OR Medicare Part D – Prescription Coverage – BCBSRI Individual Options – Blue Medicare Rx Individual Plans or Open Market
12 Medical Supplement Prescription Drug Coverage Dental Plan 65 or Blue Chip Blue Medicare Rx Delta Dental
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Blue Chip for Medicare Plan 65
Medicare Advantage Plan – Group Plus Option Medicare Supplement Plan Instead of Original Medicare In Addition to Original Medicare Enhanced skilled nursing care benefit Basic Medicare skilled nursing care benefit Includes: Prescription Drug Coverage, Certain Dental Services, Vision Benefit Does NOT Include: Prescription Drug Coverage, Dental Services, Vision Benefit PCP Co-Payment: $0 - $10 PCP Co-Payment: $0 Specialist Co-Payment: $30 Specialist Co-Payment: $0 Hospitalization: $250 per admission Hospitalization: $0 per admission Skilled Nursing Facility: $0 each day for day 1-29; $50 each day for days 30-100 Skilled Nursing Facility: $0 each day for day 1-20; $170.50 each day for days 21-100; 100% of cost for days 101+ Home Healthcare: $0 Home Healthcare: $0 Durable Medical Equipment: $0 Durable Medical Equipment: $0 Diagnostic Lab/X-Ray Services: $0 Diagnostic Lab/X-Ray Services: $0 MRI/CT Scan/PET Scan (w/ Pre-Authorization): $50 MRI/CT Scan/PET Scan: $0 Outpatient Hospital: 20% Outpatient Hospital: $0 Emergency Room: $65 (waived if admitted w/in 1 Day) Emergency Room: $0 Urgent Care: $40 Urgent Care: $0 Out-Of-Pocket Maximum: $3,000 Out-Of-Pocket Maximum: N/A
14 Blue Cross Individual Part D Offerings - Effective January 1, 2020 - December 31, 2020
Drug Tier Blue MedicareRx Value Plus* *Not sponsored by the City of Providence – Individual plan only Blue MedicareRx Premier* *Not sponsored by the City of Providence – Individual plan only Blue MedicareRx Group Plus (PDP)** **Group Plan – sponsored by the City of Providence Monthly Premium $42.50 $128.00 $209.00 Annual Deductible $0 (Tiers 1 & 2) $435 (Tiers 3, 4, & 5) $0 $0 Initial Coverage Level You pay the following until your annual prescription drug costs for covered drugs reach $4,020 Network Retail Pharmacy with Preferred Cost- Sharing 30-day supply Retail Network Retail Pharmacy with Standard Cost-Sharing 30-day supply Retail 90-day supply Mail- Order Network Retail Pharmacy with Preferred Cost- Sharing 30-day supply Retail Network Retail Pharmacy with Standard Cost- Sharing 30-day supply Retail 90-day supply Mail-Order Standard Retail (30 day) Mail-Order (90 day) Tier 1 Generics - $10 Tier 2 Brand - $20 Tier 2 Specialty - $20 Tier 1 Generics - $10 Tier 2 Brand - $40 Tier 2 Specialty – N/A $2 / $8 / $37 40% / 26% $7 / $19 / $47 / 50%/ 26% $2 / $16 / $74 / 40% / N/A $1 / $7 / $30 / 35% / 33% $6 / $12 / $40 / 45% / 33% $1 / $14 / $60 / 35% / N/A $10 / $20 $10 / $40 Coverage Gap Between $4,020 in annual drug costs and $6,350 in annual
For covered generics, you pay: 37% of costs For covered brands, you pay: 25% of negotiated price (excluding the dispensing fee) For covered generics in Tiers 1 & 2 you pay: There is no coverage gap for this plan After your total yearly drug costs reach $4,020 or the coverage gap, your copayments, and monthly premium will remain the same as outline above. Your copayments will not change until you qualify for catastrophic coverage $1 / $7 30-Day Supply Retail with Preferred Cost-Sharing $6 / $12 30-Day Supply Retail with Standard Cost- Sharing $1 / $14 90-Day Supply Mail-Order For covered generics in other tiers you pay 37% of costs For covered brands, you pay 25% of negotiated price Catastrophic Coverage Level After yearly out-of- pocket drug costs reach $6,350 You pay greater of:
generics
You pay greater of:
generics
You pay greater of:
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If you have Blue Chip for Medicare Group Plus:
BlueCHiP for Medicare Group Plus
JOHN Q PCP Jane A Doe MD SAMPLE
PCP Phone: (000) 000-0000
X99999999999
RXBIN: 0000000 PCP Visit $10 Issuer: 000000 Specialist Visit $20 RXPLN: MEDADV Emergency Room $50 RXGRP: XXXXXXX Inpatient Adm $100 CMS: H4152 817
Issued XX/XX/XX
MEDICARE ADVANTAGE
DENTAL
If you have Group Plan 65 and Blue Medicare Rx (optional):
JOHN Q SAMPLE X99999999999
Group Plan 65
Blue MedicareRx (PDP)
Prescription Drug Plan
NAME: John Q Sample ID: G99999999999 RXBIN: 0000000 RXPLN: MEDADV RXGRP: XXXXXXX ISSUER (0000): X000-000
Key Points to remember – Prescription Drug Coverage
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17 Frequently Asked Questions
Q – I am about to turn 65, what do I need to do? A – You must sign up for Medicare Part A and Part B. You have three (3) months before you turn 65, the month in which you turn 65, and 3 months after you turn 65 to apply. This is your initial enrollment period (IEP). Q - I am already 65 and just retired. What do I need to do? A- According to Medicare guidelines, since you have been covered under a group health plan based on current employment, you have a Special Enrollment Period (SEP) to sign up for Part A and/or Part B. This means you can sign up for Parts A & B once you retire and you will not be subject to a penalty. Q – What do I do after I sign up for Medicare Parts A & B? A – You will need to enroll in a Part C or Medicare Advantage plan. The 2 options offered by the City are Plan 65 (Medicare Supplement Plan) or Blue Chip for Medicare (Medicare Advantage Plan). Q – When is the School Retiree Annual Open Enrollment? A – Open Enrollment occurs annually from December 1 – 31 with an effective date of January 1.
Q – How do I enroll in prescription coverage? A – You may choose a Part D (prescription coverage) plan in one of the following ways:
Q – Where do I go to sign up for Medicare? A – You can sign up for Medicare in several ways:
Providence – Warwick – Newport – Woonsocket - Pawtucket
Q – How do I submit my first payment? How will I know if my rate changes? A - You should return your completed enrollment form/healthcare applications along with a check for the first month’s payment via mail during the month of September to our confidential PO Box. You will be notified of any change in rates via letter by June of each year.
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Medicare Website – http://www.socialsecurity.gov/medicare/apply.html
20 The Rhode Island Senior Health Insurance Program (SHIP)
The Point
Tri-Town Community Action 50 Valley Street 160 Cranston Street 1126 Hartford Avenue Providence, RI 02909 Providence, RI 02907 Johnston, RI 02919 401-462-4444 401-274-6783 401-709-2635 For a complete listing of 2020 SHIP Agencies, please contact 401-462-0510
Medicare /Social Security Administration: 1-877-402-0808 to speak with SSA or in person at 1 Empire Plaza, 6th Floor, Providence, RI 02903
Group Blue Chip for Medicare members may call: 1-800-267-0439 to speak with a Blue Cross representative Group Plan 65 members may call: 1-800-639-2227 to speak with a Blue Cross representative Group Blue Medicare Rx members may call: 1-888-620-1748 to speak with a CVS Caremark representative Individual Blue Medicare Rx members may call: 1-888-543-4917 to speak with a CVS Caremark representative 21
BCBS Customer Service Information
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Stacy Roberts Benefits Manager 401-680-5749 sroberts@providenceri.gov Jennifer Charbonneau Senior Benefits Analyst 401-680-5280 jcharbonneau@providenceri.gov Claire Girard Benefits Specialist 401-680-5535 cgirard@providenceri.gov Toni Barletta School Department Benefits Clerk (Focus: RETIREES) 401-680-5285 tbarletta@providenceri.gov Jesse Lee School Department Benefits Clerk (Focus: Actives) 401-680-5281 jlee@providenceri.gov
Benefits Department Fax 401-680-5457 Confidential Post Office Box Attn: PPSD Retiree P.O. Box 1656 Providence, RI 02901
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