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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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]

12. 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

13. 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

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

15. 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

16. 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

17. 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).

18. 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

19. TIPS FOR SELECTING A GIC PLAN
Contact Information
Group Insurance Commission: (617)
Harvard Pilgrim Health Plan: (800)
Tufts Health Plan: (800)
Fallon Community Health Plan: (866)
UniCare: (800)
Caremark Pharmacy (877)
Health New England: (800)
Neighborhood Health Plan: (866)

20. Questions and Answers