Who is Extend Health?

Report
Retiree Choices
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What we’ll cover today
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What is changing and why?
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How this affects you
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Introducing Extend Health
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Medicare marketplace
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Going forward
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Questions & answers
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What’s changing?
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Retiree health care coverage options are changing
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Retirees & spouses age 65 and older are eligible
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Why This Approach?
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•
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Allows retirees to have more choice and the ability to
customize their health care coverage.
More than 75 leading insurance companies in the
Medicare supplement market, including national carriers
such as UnitedHealthcare®, AARP®, Aetna and Humana.
Extend Health specializes in helping retirees across the
U.S. choose the individual Medicare plan that meets their
needs and budget.
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How This Affects You
What you
pay
How you
enroll
Your
support
• May change – depending on what coverage you choose.
• You will work with Extend Health to enroll in a plan that
meets your medical and prescription needs. We will also
help you establish your Health Reimbursement Account.
• Extend Health Advisors will help you understand the costs
associated with your coverage – premiums, co-payments,
deductibles and all other costs.
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Introducing Extend Health
The Industry’s Largest Medicare Exchange
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Who is Extend Health?
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Independent company
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Partner with 75+ health plan carriers
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Objective and Trusted US based benefit
advisors
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Focused on helping each participant make an
informed and confident decision
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Why Extend Health
• We are experienced in helping people just
like you
• Our services are at no cost to you
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Plans & Partners
All Medicare Plan Types
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Medicare Advantage
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Medigap (supplement)
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Prescription Drug (Part D)
Select Carriers
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The Process
Educate
Evaluate/Enroll
Manage
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Education
Getting Started Guide
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Gather information
– (e.g. prescriptions)
– Pre-existing conditions will
not limit your plan selection*
– Give us a call
855-663-4225
– www.ExtendHealth.com/transamerica
* except end-stage renal disease
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Education
Enrollment Guide
•
•
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Prepare you for
enrollment discussion
Review Medicare basics
Appointment confirmation
letter
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Decision Support Tools
• Help Me
Choose
• Prescription
Profiler
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Evaluate and Enroll
Licensed Benefit Advisor
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Hours of Operation •
Monday – Friday •
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8 a.m. – 9 p.m.
Eastern Time
100% domestic workforce
Objective advocacy
Neutral compensation
Extend University
Licensed, certified, appointed
Average age 43
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Enrollment Process
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Benefit Advisors can
discuss coverage options
with anyone – need to
speak to the participant to
complete the enrollment.
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Once you have made a
coverage selection,
enrollment is conducted via
telephone.
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100% of calls are recorded.
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Medicare and You
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Your Future Coverage
Primary Coverage
Medicare A & B
Additional Coverage (Your Choice)
Medicare Advantage with
Prescription Drug (MAPD)
Medigap + Prescription Drug
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Medicare Prescription
Drug Coverage
Initial Coverage
You pay
Deductible and co-pays for your plan
Coverage for the first $2,970 in actual cost of meds
Coverage Gap – Donut Hole
You pay
47.5% of brand drugs and 79% of generics
until out of pocket costs reach $4,750
Catastrophic Coverage
You pay
$2.65 for generics and $6.60 for brand
or 5% whichever is greater
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Plan Example
Medicare Advantage Plan
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$0 per month
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Network: PPO
Deductible: $0
Doctor co-pay: $15 Specialist co-pay: $25
Hospital: $850 co-pay per hospital stay
Emergency Room: $65 co-pay if not admitted
Rx: $7/$43/$85/33%
Mail order: (90 day)
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Plan Example
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Medigap Plan F and PDP – 75 year old male
Medical/Rx
$215 ($175 - $40)
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Network: Any doctor that accepts Medicare
Deductible: $0
Doctor co-pay: $0 Specialist co-pay: $0
Hospital: $0
Emergency Room: $0 co-pay
Rx: $0 deductible $7/$43/$85/33%
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Mail order: (90 day)
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What are Popular Coverage Options
and What Do They Cost
Benefits
(costs assume a male, 75-year-old retiree)
Current Medicare
Medigap Plan F plus
Supplement Plan
Prescription Drug Plan
Deductible
Office Visits
Hospital
Out of Pocket Maximum
Lifetime Maximum
Prescription (retail)
$250
20% coinsurance
20% coinsurance
$1,250 per person
$3,000,000
No deductible
$0
$0 co-pay
$0 co-pay
N/A
None
Tier 1: $10 copay
Tier 2: 20% ($30 min/$75 max)
Tier 3: 40% ($50 min/$125 max)
Coverage gap does not apply
No deductible
$7/$38/$74/33%
No gap coverage
Your Medigap Plan F Costs (illustrative)
$183 ($140 medical + $43 Rx)* less any subsidy (if
Your Monthly Plan F Premium
applicable) equals your net monthly Plan F cost
*2012 rate (2013 rates not available yet)
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HRA Information
• You may meet the eligibility requirements to
qualify for a Company subsidy
• The following information pertains to those who
qualify for the subsidy amount
• Please call Extend Health at 855-633-4225 to find
out if you quality for a Health Reimbursement
Account subsidy
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Health Reimbursement
Arrangement

Auto-Reimbursement

How the Process Works
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What Is An HRA?
• Tax-advantaged account used to reimburse you
for eligible health care expenses
• You must meet the Plan’s eligibility requirements
to qualify for HRA
• Your HRA funds will be available January 1, 2013
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Health Reimbursement
Arrangement: How It Works
Eligible
participants
receive annual
HRA subsidy
Participant
HRA
Account
Administered by
Extend Health
Participant is
reimbursed for
healthcare
expenses using
HRA benefit
dollars
Participant works
through Extend
Health to enroll in
individual coverage
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How to File a Paper Claim
Participant pays plan
premium (Medical or
Rx) or Medical copays
Extend Health
reimburses customer
Participant fills out
claim form, attaches
required information
Extend Health
verifies receipt of
payment and
eligibility
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Extend Health
HRA Claim Form
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How Auto-Reimbursement
Works
Participant pays
plan premium to
insurance company
Extend Health
reimburses
participant
Insurance company
forwards receipt of
payment to Extend
Health
Extend Health
verifies receipt of
payment and
eligibility
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What is Auto-Reimbursement?
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Auto-Reimbursement (AR) is a service offered by Extend
Health
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Auto-reimbursement applies only to premiums paid, not
expenses
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Auto-reimbursement is NOT available on all plans
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Due to the timing of Auto-Reimbursement, it is usually not
the fastest way to be reimbursed
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Forms and instructions provided in the HRA Welcome Kit
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Next Steps
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Next Steps
Review “Getting Started
Guide”
Gather Medicare Prescriptions
and Doctor information
Call Extend Health (855) 6634225
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Post Enrollment
Customer Service
Advocacy and support services
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Toll-free number to contact Extend Health
representative
Direct support for claims issues, appeals and
network questions
Renewal process – ability to pick new coverage for
future years – not locked into this year’s choice
Ongoing enrollment services
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Questions
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Frequently Asked Questions
Q: Do you offer plans that cover me in multiple states-I am a snowbird?
A: Medigap plans are accepted by every Medicare-participating provider in the U.S., with some
emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these
plans may be right for you. Part D plans provide nationwide coverage from participating
pharmacies. Medicare Advantage plans cover urgent and emergency services nationwide, but
some may not provide nationwide coverage for non-emergency services. If you live part of the
year out-of-state, these plans may not be right for you.
Q: How often will I be billed? By whom? Can I pay by check?
A: When you enroll in a new plan, you will need to begin making premium payments to the
insurance company in order to maintain your coverage. Some insurance companies may require
the first month’s premium payment during the application process. In this case, you should expect
to make a payment within a few days of your enrollment. Please have your billing information
ready when you make your enrollment call to Extend Health.
Most insurance companies give you several billing options for ongoing payments: direct billing,
paid by check each month, Electronic Funds Transfer from your checking account, or automatic
deduction from your social security check. You can choose to pay monthly, quarterly, or yearly.
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Frequently Asked Questions
Q: If I don’t like the plan that I enrolled in, when can I change?
A: Every year you will have an Annual Medicare Enrollment Period during which you can
investigate other medical and drug plans and potentially enroll in a different plan. However,
during future Medicare Annual Enrollment Period your current medical conditions may limit the
plans available to you. You will receive notification from Extend Health of the Annual Medicare
Enrollment Period (October 15-December 7), we encourage you to contact us should you have
any questions.
Q: Will I be refused coverage due to a pre-existing condition? Will I pay more?
Can my policy be cancelled once I am enrolled because of my condition? Can
my rate be raised for that reason?
A: If you enroll in a Medigap plan when you first transition from group coverage, and you wish
to change to another Medigap in the future, you will go through Medical underwriting. You will
not necessarily be denied, but your monthly premiums could be higher. Your policy cannot be
cancelled once you are enrolled unless you do not pay your premiums and your rate will not be
raised for medical reasons. If you wish to enroll in a Medicare Advantage plan, they are always
guaranteed issue.
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Frequently Asked Questions
Q: What if I have the option for other coverage (spouse, military) – if I don’t enroll
with Extend for 2013 can I enroll later?
A: No. You must enroll through Extend Health. You will need to enroll into Medical and
Prescription coverage to be eligible for the HRA funding if applicable.
Q: Will my premium rates increase every year? If so, by how much?
A: In general, insurance premiums do increase every year. The increase in plan cost year-toyear can vary widely. We advise our enrollees to contact us and compare other plans if you
experience rate increases in the 10-15% range. The national average is 3-4%.
Q: Are there plans that will cover me when I travel domestically or internationally?
A: Medigap plans are accepted by every Medicare-participating provider in the U.S., with some
emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these
plans may be right for you. A few Medicare Advantage plans also have world wide emergency
coverage.
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Frequently Asked Questions
Q: How does Extend Health make its money? Will our services be free next year?
A: On a high level, Extend Health, Inc. is paid just as any agent would be, by the carrier, not your
company. Our services are always free to you.
Q: Can I obtain Medical and Rx from one carrier or will I need separate plans for
each?
A: Some Medicare Advantage plans have limited provisions for all of these needs. If you enroll in a
Medigap plan, you will need to enroll in each option separately. Your Benefit Advisor can help you
find the best combination for you.
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