Teachers’ Retirement Insurance Program (TRIP) CMS Bureau of Benefits Lesley Newsome Supervisor Medicare and Coordination of Benefits (COB) Unit

What Coverage is Included under TRIP? Plans TRIP Standard Plans TRIP Medicare Advantage Plans Benefits Choice May 2016 TRAIL October 15, 2016-November 15, 2016 OAP and HMO Plans Teachers’ Choice Health Plan (TCHP) (administered by Cigna) Medicare HMO Plans Medicare PPO (administered by UnitedHealthcare) Prescription and Behavioral Health Coverage

TRIP Standard Plans Standard Plans are for: “New”members coming into the Program Retirees that are not eligible for Medicare (64 years old and under) Retirees that are enrolled in Medicare, but may have a dependent on the plan that is not enrolled in Medicare

TRIP STANDARD Plan Choices HMO Illinois/BlueAdvantage HMO Health Alliance HMO Coventry OAP/Coventry HMO HealthLink OAP Changes can be made during the month of May Plan year is July 1-June 30th Teachers’ Choice Health Plan (CIGNA)

Standard PPO Plan Design Teachers Choice Health Plan (TCHP-CIGNA) Plan Year Deductible---$500 per enrollee Additional Deductibles (in addition to the plan year deductible, do not apply to services covered by Medicare) In-Network services are covered at 80% of the allowable amount Out of Network service are covered at 60% of allowable amount In-Network Out of Pocket MAX for covered services=$1,200.00 Individual Out of Network Out of Pocket MAX for covered services=$4,400 Individual

HMO Plans No annual deductibles Copayments required at the time of service Primary Care Physician (PCP) coordinates care Must stay in network (use PCP referrals) Out-of-network provider services are not covered

How Much Does Standard Coverage Cost? Type of Participant Type of Plan Not Medicare Primary Under Age 26 Age 26 – 64 Age 65 and Above Medicare Primary * All Ages Benefit Recipient Managed Care (includes HMO and OAP plans) $75.65 $235.00 $320.18 $92.87 TCHP Plan When managed care is not available in county $98.17 $277.09 $416.72 $110.11 $196.34 $554.16 $833.43 $220.21 Dependent Beneficiary $302.72 $939.98 $1,280.68 $321.73** When managed care is not available in county $392.68 $1,108.33 $1,666.86 $330.32** $440.42 * Must purchase BOTH Parts A and B to qualify for lower premium. ** These Medicare Primary dependents receive a premium subsidy. The above rates are FY17 Rate changes go into effect July 1st of each year

Prescriptions – Standard Plan Enrollees Maximum medication fill at retail Pharmacy: Coventry HMO= 30 day supply OAP and TCHP= 60 days HMO Illinois, Blue Advantage, Health Alliance HMO= 90 days Mail Order medications: OAP and TCHP =90 days for 2 copays (instead of 3) HMO=90 days at discounted rate (varies) TCHP ONLY-Prescription out of pocket maximum of $1,500.00 per plan year. Once met, plan pays 100% for the rest of the plan year for covered medications.

Medicare A=Yes! Medicare B=No I am eligible for Medicare, am required to enroll in Medicare Part A and B? Medicare A=Yes! Medicare B=No Enrolling in A and B= lower monthly premium eligible for TRAIL Medicare Advantage plan

TRIP Medicare Advantage (MAPD) TRAIL Plans MAPD TRAIL Plans are for: Retirees and all covered dependents are enrolled in Medicare Parts A and B (based on age or disability) Medicare A and B enrollment is prior to 9/30/16 Reside in the United States

TRIP Medicare Advantage (MAPD) TRAIL Plan Choices United HealthCare PPO Humana Benefit Plan HMO/Humana Health Plan HMO Health Alliance MAPD HMO Coventry Advantra HMO Changes can be made during October 15-November 15 Plan year is January 1-December 31

TRAIL PPO Plan Design (United Healthcare) Plan year deductible-$250.00 Out of pocket maximum-$1,000.00 Most services are covered at 80% (for services that Medicare would normally pay) Coinsurance is 20% until out of pocket is met

HMO Plans No annual deductibles Copayments required at the time of service Primary Care Physician (PCP) coordinates care Must stay in network (use PCP referrals) Out-of-network provider services are not covered

How Much Does TRAIL Coverage Cost? FY17 Rates Not Yet Determined Type of Plan Coventry Advantra HMO Health Alliance MAPD HMO Humana HMO UnitedHealthcare PPO Member Rate $38.99 $42.32 $42.31 $52.44 Dependent Rate $116.95 $126.96 $126.93 $157.29 TRAIL enrollees must continue to pay Medicare Part B monthly premiums to maintain enrollment in the TRAIL plan. TRAIL coverage will term if an enrollee stops paying for Medicare Part B The above rates are plan year 2016 (January 1 – December 31, 2016

Prescriptions – ‘TRAIL’ Members Maximum medication fill at retail Pharmacy: 90 days Coventry HMO and UnitedHealthcare 2 x Health Alliance HMO 2.5 x Humana HMO 3 x Mail Order medications: All plans 90 days for 2 copays

Does anyone remember this? Custom Benefit Solution Online Enrollment System Coming this FALL for the TRAIL Enrollment Period

What is the Custom Benefit Solution? Online enrollment tool Decision support tool Easy to access All member elections will be made on the ‘MyBenefits’ website, including: Electing and changing carriers Adding or dropping dependents

Custom Benefit Solution All member elections made on Morneau Shepell website such as: Adding or dropping Dependents Electing and changing Carriers Opt Out/In

Watch for more information Notifications about changes will be coming this fall from Central Management Services in the mail

Websites to access information Access to Program Books Links to Carrier Websites www.benefitschoice.il.gov www.cms.illinois.gov/thetrail