Town of Hingham Health Plan Educational Information for Medicare Eligible/Enrolled Retirees April 2017

Agenda Overview Group Insurance Commission (GIC) Plans Drug Tiering What is the GIC? Medicare Highlights Group Insurance Commission (GIC) Plans Health Maintenance Organization (HMO) Plan Indemnity Plan Drug Tiering Mitigation Plan Selecting a GIC Plan

Overview Town employees and retirees will receive their health insurance through the plans offered by the Group Insurance Commission (GIC) starting on July 1, 2017 Current Town plans will be in effect until June 30, 2017 Open enrollment will be held from Wednesday, April 5th through Wednesday, May 3rd ALL employees and retirees MUST enroll if you want coverage as of July 1, 2017 Marriage licenses, Birth Certificates, Adoption and Guardianship records are required to enroll dependents Life Insurance & Dental Insurance will be offered by Town with a separate Open Enrollment process

What Is the GIC? The mission of the GIC is to deliver high quality care at reasonable costs GIC was established by the Legislature in 1955 GIC is a quasi-independent state agency governed by a 17-member Commission appointed by the Governor Commission members include representatives of labor, municipalities, and retirees GIC's FY17 appropriation is $2.1 billion. GIC covers 250,000 subscribers and 436,000 lives

Medicare Guidelines Retirees age 65 or older and certain disabled people who qualify (40 quarters) Medicare Part A – “Free” Inpatient hospital care Some skilled nursing facility care Hospice Medicare Part B - $134 “standard” premium/month – most pay less Physician care Diagnostic, x-ray and lab Durable medical equipment GIC Medicare plans coordinate with Medicare to provide you with comprehensive insurance

Medicare Guidelines (continued) Contact Social Security 3 months before you turn 65 If you (the insured) works beyond age 65, you should NOT enroll in Medicare Part B until you (the insured) retires If retired, you must join Medicare and pay Part B premium to have GIC coverage If your spouse/dependents are under 65, and you are retired, they will stay on an active plan through the GIC Must be enrolled in the same carrier’s plans as subscriber Do NOT enroll in Medicare Part D plans See GIC Benefit Decision Guide for more details and special circumstances

GIC Medicare Plans Plan Name Type of Plan Service Area Fallon Senior Plan Medicare Advantage [HMO] Broad network in Hampden, & Worcester counties; limited network in Essex, Franklin, Hampshire, Middlesex and Norfolk counties. Harvard Pilgrim Medicare Enhance Supplemental Medicare [Indemnity] Throughout U.S.A. Health New England MedPlus Medicare HMO Broad network in Berkshire, Franklin, Hampden & Hampshire; limited network in Worcester. Tufts Medicare Complement Supplemental Medicare HMO Throughout Massachusetts Tufts Medicare Preferred Broad network in Barnstable, Essex, Hampden, Hampshire, Middlesex, Norfolk, Suffolk, Worcester limited network in Bristol & Plymouth counties UniCare Indemnity Medicare Extension (OME) with CIC Throughout USA and outside of USA

GIC Medicare Plans Two types – HMO and Indemnity HMO Plans Primary Care Physician (PCP) required Referrals required for specialists for most plans No coverage for out of network providers (except emergencies) Indemnity Plans Access to any provider that accepts Medicare

GIC Medicare Plans Medicare Retiree Plans with the most subscribers UniCare State Indemnity Plan/Medicare Extension [OME] Harvard Pilgrim Medicare Enhance Enrollment restrictions UniCare State Indemnity Plan/ Medicare Extension [OME] available throughout the United States and outside the United States Harvard Pilgrim Medicare Enhance available throughout the United States Other plans limited to Massachusetts and certain border counties by plan

GIC Medicare HMO Plans Members must select a Primary Care Physician (PCP) Referrals are required to see Specialists No coverage for out of network [non contracted] providers Except for emergency care Lower premium cost than other plan types

GIC Medicare Supplemental Indemnity Plans Members not required to select a Primary Care Physician (PCP) No referrals required for specialists Can utilize any provider that accepts Medicare Highest premium cost plan No geographical restrictions on enrollment Member can live anywhere in the United States Members living outside the U.S. should select UniCare State Indemnity Plan/Medicare Extension [OME]

GIC Indemnity/OME Plan Design Plan Feature Amount/Cost Preventive Service Copay No copay Other Physician Office Copay $10 Inpatient Hospitalization Copay $50 per admission copay; maximum one per quarter Outpatient Surgery Copay Emergency Room Copay $50 copay/waived if admitted

Pharmacy Tiering Formularies Vary from Plan to Plan Mail Order Programs Vary from Plan to Plan Pharmacy Tiering (typically) Tier 1 – Generic and Low Cost Brand Drugs Tier 2 – Brand Name and High Cost Generic Drugs Tier 3 – Brand Name Non-Preferred Drugs

Pharmacy Tiering Copayments Retail 30 day supply Tier 1 - $10 Mail Order 90 day supply Tier 1 - $25 Tier 2 - $75 Tier 3 - $165

Mitigation Plan Public Employee Committee [PEC] and Town Negotiated a Mitigation Program Health Reimbursement Arrangement [HRA] will reimburse Inpatient, Outpatient Surgery and Hi-tech Imaging copayments Currently only the UniCare Indemnity plan has a copay covered by the mitigation plan ($50 I/P copay) Claims for reimbursement are filed with the Town Accountant’s office One time premium credit of $75 in November

Hingham Middle School GYM Local GIC Health Fair April 13th THURSDAY  11:00 AM - 4:00 PM Hingham Middle School GYM 1103 Main Street Hingham

TIPS FOR SELECTING A GIC PLAN Carefully review the GIC Benefit Decision Guide. Complete a questionnaire and estimate your utilization of medical services. Doctors Hospitals Prescriptions Discuss the GIC plans with family, friends and your physician(s).

TIPS FOR SELECTING A GIC PLAN Contact the carriers on the telephone or using the internet. Ask the carriers about: The physicians who treat you The hospitals where you get care The prescription drugs that you take Any Durable Medical Equipment or Device that you use Attend a GIC Health Fair Review Rate Sheets for Monthly Contributions

TIPS FOR SELECTING A GIC PLAN Contact Information Group Insurance Commission: www.mass.gov/gic (617) 727-2310 Harvard Pilgrim Health Plan: www.harvardpilgrim.org/gic (800) 542-1499 Tufts Health Plan: www.tuftshealthplan.com/gic (800) 870-9488 Fallon Community Health Plan: www.fallonhealth.org/gic (866) 344-4442 UniCare: www.unicarestateplan.com (800) 442-9300 Caremark Pharmacy www.caremark.com/gic (877) 876-7214 Health New England: www.hne.com/gic (800) 842-4464 Neighborhood Health Plan: www.nhp.org/gic (866)-567-9715

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