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This presentation is copyrighted © exclusively by Emeriti 2013 Benefits THE EMERITI PROGRAM for those planning for retirement 1 Medicare and Emeriti’s Health Insurance and Reimbursement Benefit
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Your Institution’s Commitment Giving you a tax-free way to pay for your health care expenses in retirement Providing access to group health insurance when you retire Keeping you informed about retiree health care issues along the way Your Institution is: 2
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Emeriti’s Core Benefit Components 3 Tax-advantaged savings and investment vehicle, via VEBA Trusts, for payment of future medical expenses in retirement Emeriti Health Accounts Portable group retiree health insurance options building on the foundation of Medicare Emeriti Health Insurance Tax-free reimbursement of other qualified medical expenses not covered by Medicare or Emeriti insurance options Emeriti Reimbursement Benefits
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Emeriti TIAA- CREF Accumulation Recordkeeping Trust Services Investment Management Proprietary Mutual Funds Non Proprietary Mutual Funds Savitz Disbursement Recordkeeping Insurance Premiums Qualifying Medical Expenses Debit CardManual Claims Aetna Retiree Health Plans HealthPartners Retiree Health Plans 4 Emeriti’s Service Providers
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Source: EBRI estimates from the 2009 Medical Expenditure Panel Survey. 11 Out-of- Pocket 13% Private Insurance 14% Medicare 59% Other 14%* *VA, Tricare, other private, Medicaid, other. Medicare is Not Enough 5
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Medicare provides these coverages You have your choice of doctors & providers Part A (Hospital) and Part B (Medical) Original Medicare Private insurers approved by Medicare provide Parts A & B coverage You may get extra benefits Part C Medicare Advantage, PPO Plan Private insurers approved by Medicare provide coverage Different plans cover different drugs at different levels You can choose from a range of plan designs Part D Prescription Drug How Medicare Works 6
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What Are You Saving For? 7 Medicare Part A deductible Part B deductible Part B premium Part D deductible Part D Coverage Gap cost share Part D Catastrophic Threshold cost share Supplemental Insurance Premiums Deductibles Co-pays and co- insurance Out-of-Pocket Expenses Vision Hearing Medical equipment Long-term care In-home health care Note: Higher-income retirees may pay a higher Part B premium and may also be subject to a Part D premium
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Guaranteed issue group health insurance coverage Portable, nationwide access A flexible menu of insurance options Annual choice among plans Catastrophic protection Part D prescription drug coverage Foreign urgent or emergency care* Preventive care** Advantages of Emeriti Post-65 Insurance *Available in some plans. ** Varies by plan. 8 Emeriti’s group plans build on the foundation of Medicare.
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How Do You Access Medicare and Emeriti Health Insurance NOTE: Consult your Summary Plan Description for details. After age 65When you retire After enrollment in Medicare Parts A & B 9
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Permanently disabled children** Dependent children (before majority, to age 26) Domestic partner (pre- or post-65) depending on your plan* Available for Participant & Dependents Participant’s dependents include: Who Can Use Emeriti Health Insurance Spouse (pre- or post-65) 10 NOTE: The employer’s plan establishes specific rules for vesting in the Emeriti account balance and retirement eligibility for the Emeriti insurance. *Domestic partners’ coverage is available only if elected by the institution. Independent domestic partners pay for insurance outside of the Health Account. **Determination of permanent disability also confers access to post-65 insurance for these individuals. Disability must occur before majority. Post-65 dependents must enroll in same coverage as participant
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Emeriti Insurance Choices for 2013 11 One Medicare coordination plan Two Medicare supplemental plans (availability based on state approval) One Medicare Advantage PPO (Extended Service Area (ESA) available for geographical areas outside Aetna’s network) Rx High Plan – continuing coverage in coverage gap Rx Mid Plan – generic coverage only in coverage gap Rx Low Plan – no coverage in coverage gap One dental plan Emeriti Group Medical Plans Emeriti Rx Plans* Emeriti Dental Plan PLEASE NOTE: Emeriti will offer Aetna Group Medicare Supplement Insurance (GMS) Plans A and L to retirees living in Florida.
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Or Preserve Your Options Choose Rx Low Plan as stand-alone option Select Rx Low Plan Add dental to the Rx Low Plan if you wish Consider Dental Selecting an RX Low Plan allows you to remain in the Emeriti Program and permits you to change coverage in future years. 12
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STEP 1 Create Your Own Plan STEP 2STEP 3 select a medical planselect an Rx planConsider the optional dental plan 13
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Emeriti’s Other Program Components Emeriti Health Accounts A tax-advantaged way to save and invest for future medical expenses. Note: ACH savings option will be available in 2013. Emeriti Reimbursement Benefits A tax-free method for you to pay for other qualified out-of-pocket medical expenses not covered by Medicare or Emeriti insurance. 14
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Reimbursement Benefits at Work 15 Manually submit claims to Savitz: Mail Fax Upload through Participant Benefits Dashboard (MyEmeritiBenefits.org) Debit card option in development for 2013 Reimbursement Benefits will be paid from participant’s balance in the Money Market Fund. Participants may transfer lump-sum amounts or set-up monthly systematic transfers in amounts of $100 or more. For expenses incurred after termination
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NOTE: A wide range of health care expenses are eligible for tax-free reimbursement as long as they satisfy the requirements of Section 213 (d) of the IRS Code. How You Can Use Your Reimbursement Benefit Emeriti Reimbursement Form available on MyEmeritiBenefits.org 16 Partial List of Uses Medicare premiums and cost shares Supplemental insurance deductibles, co-insurance, co-pays Vision, dental, hearing care Over-the-counter and non-formulary drugs (with Rx prescription from doctor) Medical equipment Long-term care insurance Medical expenses associated with nursing or in-home health care services Other post-65 and pre-65 insurance premiums (if Emeriti coverage is not elected)
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Dependent relatives depending on your plan Permanently disabled children Dependent children (before majority, to age 26) Domestic partner (pre- or post-65) depending on your plan Available for You & Your Dependents Participant’s dependents include: Who Can Use Your Reimbursement Benefits Spouse (pre- or post-65) Consult your summary plan description for details 17
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Status of Services Commitments: 2012 to 2013 18 Improved Emeriti Service Center: 9am – 5:30pm ET 1-866-EMERITI Dedicated Emeriti representatives Improved warm transfers Enhanced reimbursement benefit options: Manual claims can be submitted via direct mail, fax, or uploaded to participant benefits dashboard, starting in January New debit card option in development for 2013 Online participant dashboard: At-a-glance summary of Health Account activity, insurance plan information, and reimbursement benefit transactions. Enhanced menu of investment funds and institutional Microsites: Proprietary and non-proprietary fund choices Microsites in development for 2013 Quarterly statements: Investment statement from TIAA-CREF Health insurance and reimbursement benefit statement from Savitz Improved suite of life-stage communications for participants: Retired participants Participants nearing retirement Younger active participants – in development for 2013 Improved ACH savings opportunity from personal bank accounts: Recurring and periodic lump sum savings option – in development for 2013
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Lifecycle funds Asset diversification among asset classes Automatic rebalancing TIAA-CREF Lifecycle Funds (Retirement Class) A money market mutual fund Seeks to assure the value of your investment at $1 per share TIAA-CREF Money Market Fund (Retirement Class) Some TIAA-CREF proprietary funds Some non-proprietary funds from other mutual fund families Additional Mutual Funds – based on institution’s election Investment Options in 2013 19 CORE FUNDS CORE PLUS FUNDS
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20 10 WAYS TO GET MORE INFORMATION Call toll-free: 1-866-EMERITI (1-866-363-7484) Monday – Friday 9:00AM to 5:30PM (ET) Scheduled annually on campus, these workshops provide you with details about your Emeriti Health Account, Insurance Plan Options, and the Emeriti Reimbursement Benefit. Two different print and electronic statements that detail your Health Account investments, as well as your Health Insurance and Reimbursement Benefit transactions. An at-a-glance benefits website with access to information about your Emeriti Health Account balances, Health Insurance Plan Options, and Reimbursement Benefit transactions. MyEmeritiBenefits.org. Using TIAA-CREFs secure website, you can check your Emeriti Health Account balance any time. Visit tiaa-cref.org to log in. The Emeriti website contains information about each component of the Program, as well as Medicare update, the QME form, a premium rate guide, and other important information. Visit EmeritiHealth.org. An easy-to-use online resource for benefits and health information. Check your insurance claims, find a doctor, order prescriptions online, and access information about eligible health expenses. Visit EmeritiHealth.org and click on the Online Participant Services button. As you near age 65, Emeriti mails insurance age-in retirement kit to your home. You may also request a kit at any time. Once you are enrolled, retiree annual insurance enrollment kits are also mailed to your residence. Various materials to inform and educate you about the Emeriti Program throughout your working years and into retirement. A Plan-level microsite for you to access investment information, including prospectuses, fund fact sheets, and performance reports. This Program feature is currently in development. Details forthcoming.
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How to Use the Emeriti Service Center 21 1-866-Emeriti Thank you for calling Emeriti Please listen carefully, as our menu has changed. YOU WILL HAVE 3 CHOICES For information about Annual Enrollment and questions about Emeriti Health Insurance, press 1 For assistance with Annual Enrollment, press 1 Aetna Rep Savitz Rep To speak with an Aetna or HealthPartners representative about your benefits or an existing insurance claim, press 2 TIAA-CREF Rep For questions about Emeriti Health Account balances and investments, press 3 HP Rep Press 1 for an Aetna representative, press 2 for a HealthPartners representative For questions about the Emeriti Reimbursement Benefit, press 2 Savitz Rep
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22 TIAA-CREF Quarterly Statement Savitz Quarterly Statement – when you terminate
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23 TIAA-CREF.org Online Account Details
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24 Register View Health Account, Health Insurance, and Reimbursement Benefit Information
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25 Emeriti Program Fees FeesActivesRetirees* Emeriti$5.00 TIAA-CREF$.67 Savitz$1.00$6.00 Investment management fees are variable by selected mutual funds (see prospectuses) Monthly Participant Fees *Also applies to vested terminated employees Your employer may cover all or some portion of the service fees. Check with your institution’s benefit administrator if you are uncertain.
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Emeriti Retirement Health Solutions is not an insurance company, insurance broker or insurance provider. Summary Plan Description (SPD) This presentation is intended to provide you with a brief summary of some of the details of your Employer’s Emeriti Plan and the Emeriti Program. For a full summary of the terms of your Employer’s Emeriti Plan you must consult the SPD, which will be provided to you upon enrollment or upon request. 26 Emeriti Retirement Health Solutions provided this information and is responsible for its content. Emeriti, TIAA-CREF, Savitz, Aetna Life Insurance Company, and HealthPartners are independent corporations and are not legally affiliated. The retirement healthcare program is offered by the employer. Teachers Insurance and Annuity Association (TIAA) will provide services to the plan and make available investment options. TIAA-CREF Trust Company, FSB provides investment management and trust services.
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Investment Adviser Status Emeriti Retirement Health Solutions is a registered investment adviser for purposes of selecting the range of investment options for the Emeriti Program, selecting the investment manager for employer and voluntary employee contributions, and providing these and other impersonal educational materials to plan participants. Emeriti does not provide advice to participants about their individual investment selections. The participation interests in the voluntary employee contribution VEBA trusts associated with the Emeriti plans (the “Interests”) may be treated as securities under various state securities laws. The offering of these Interests is subject to compliance with any applicable state law. For residents of Georgia, the Interests are being offered in reliance on paragraph 13 of Code Section 10-5-9 of the Georgia Securities Act of 1973, as amended (the “Georgia Act”). The Interests may not be sold or transferred except in a transaction which is exempt under the Georgia Act or pursuant to an effective registration under the Georgia Act. 27
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Addendum 28
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You pay first $325 as deductible You pay 25% of drug costs You pay 97.5% of brand drugs You pay 79% of generic drugs You pay 5% Greater of $2.65 or 5% for covered generic. Greater of $6.60 or 5% for all other drugs. Deductible Initial Coverage Period Coverage Gap Catastrophic Coverage You reach Catastrophic Coverage at $4,750 in true out-of-pocket costs. You reach the Coverage Gap at $2,970 in total Part D covered drug expenditures (includes plan deductible, your costs and plan costs in the Initial Coverage Period). Four Components of Part D Benefit 29
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$200 Deductible 20% coinsurance $1,250 out-of-pocket limit $0 Deductible 25% coinsurance $2,330 out-of-pocket limit (subject to change based on 2013 CMS guidelines ) $0 Deductible 50% coinsurance $4,660 out-of-pocket limit (subject to change based on 2013 CMS guidelines) $300 Deductible in-network $500 Deductible out-of-network 15% coinsurance (in-network) 25% coinsurance (out-of-network) $2,750 out-of-pocket limit (in-network) $5,500 out-of-pocket (out-of-network) *For 2013, the SRM Plans are not available in VT, MN, and America Samoa. After plan deductible is satisfied, plan payment in full on Medicare eligible costs. Emeriti Group Medical Plan Options in 2013 Underwritten by Aetna Payment based on the balance after Medicare’s payment. Payment based on total Aetna allowable cost. Aetna Supplemental Retiree Medical Plan L* Aetna Supplemental Retiree Medical Plan K* Aetna Medicare Advantage - PPO/ESA-PPO Aetna Traditional Choice 100% preventive care covered by Medicare 100% preventive care covered by the Plan 30 NOTES: The ESA-PPO Plan has the same benefits as the In-Network PPO Plan. Aetna’s GMS Plans A and L will be offered in Florida in place of SRM Plans K and L. Age banded Age banded Age banded Community rated
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Retiree Cost Share for Typical Doctor’s Visit Bill of $100 Trad. ChoiceSRMP LSRMP KMA-PPO/ESA Charge Medicare Pays Aetna Pays You Pay $100 $80 $20 $0 $100 $80 $15 $5 $100 $80 $10 $100 $0 $85 $15 NOTE: Illustration assumes any annual plan deductibles have already been satisfied for the plan year. 31
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YOU PAY FIRST $325 AS DEDUCTIBLE PLAN PAYS 75% OF DRUG COSTS ($1983.75) YOU PAY 25% OF DRUG COSTS ($661.25) YOU PAY 97.5% OF BRAND DRUGS AND 79% OF GENERIC DRUGS ($3763.75) PLAN PAYS 95% YOU PAY 5% * Greater of $2.65 or 5% for covered generic (including brand drugs treated as generic) drugs. Greater of $6.60 or 5% for all other drugs. Deductible Initial Coverage PeriodCoverage Gap Catastrophic Coverage You reach Catastrophic Coverage at $4,750 in true out-of-pocket costs. This threshold includes plan deductible, your 25% cost share during Initial Coverage Period, and your 97.5% cost share for brand drugs and 79% cost share for generic drugs in the Coverage Gap. You reach the Coverage Gap at $2,970 in total Part D covered drug expenditures (includes plan deductible, your costs and plan costs in the Initial Coverage Period). Standard Medicare Part D in 2013 32
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Standard Formulary $325 deductible Initial Cov Limit Retail: 15% - 30% Coverage Gap: no coverage* Catastrophic Cov: 95% coverage Step therapy required for some drugs Open Formulary $100 deductible Initial Cov Limit and Coverage Gap Retail 15% - 30% - 40% Coverage Gap: full coverage Catastrophic Cov: 100% coverage No Step therapy required Open Formulary $100 deductible Initial Cov Limit Retail 15% - 30% - 50% Coverage Gap: generic coverage only* Catastrophic Cov: 95% coverage Step therapy required for some drugs The Medicare Coverage Gap Discount Program provides a 50% manufacturer discount on brand drugs in the Coverage Gap for all Rx plans for participants not already receiving “Extra Help.” Rx Mid PlanRx Low Plan Rx Coverage Remains Unchanged in 2013 Underwritten by Aetna NOTES: Members who use Aetna’s Rx Home delivery Mail Order Drug (MOD) program will pay a reduced percentage of the negotiated cost of the drug as compared to retail. 33 *Participant has 79% cost sharing limit on generic drugs in Coverage Gap (Rx Low Plan), and 2.5% plan cost sharing on brand drugs in the Coverage Gap (Rx Mid Plan and Rx Low Plan). Rx High Plan Geographically rated Geographically rated Geographically rated
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CMS 21% Mandate in the Coverage Gap 34 For generic drugs in the Gap (one month supply obtained at in-network retail pharmacy): Sample Generic - $30Rx Low PlanRx Mid PlanRx-High Plan Your Cost Share79%15% You Pay$23.70$4.50 All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low income cost sharing subsidies.
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CMS 2.5% Mandate in the Coverage Gap 35 For eligible brand drugs in the Gap (one month supply obtained at in-network retail pharmacy): Sample Brand - $100 (Preferred Brand) Rx Low PlanRx Mid PlanRx High Plan Pharma Cost Share 50% Manufacturer Discount on total cost of drug Plan Cost Share 2.5% of $100 total drug cost Plan pays balance, after your 30% cost share Your Cost Share 47.5% 30% of total drug cost You Pay$47.50 $30 All costs above are illustrative. Table reflects cost sharing between plan Initial Coverage Limit and TrOOP threshold for members not eligible for low-income cost sharing subsidies. There is also a dispensing fee.
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Preventive Service Coverage100% Annual Deductible (basic and major services)$100 Basic Services Coverage (e.g. fillings, standard crowns, extractions) 50% Major Services Coverage (e.g. root canal therapy, surgical removals, dentures) 50% Annual Benefit Maximum$1,500 Rate StructureCommunity rated NOTES: 1.Twelve month waiting period applies, but may be waived with evidence of continuing coverage. 2.One-time only opt-in opportunity. 3.Dental is only available when you enroll in a combination Medical/Rx coverage, or elect the stand-alone Rx Low Plan 4. Please note: in the states of CA, OR, WA*, the stand-alone Dental plan may be elected if the participant is enrolled in a Kaiser Permanente MAPD Plan, and with evidence of existing coverage. Aetna Dental Coverage in 2013 Dental Design 36
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