Welcome Gwinnett County Board of Commissioners Retirees The Humana Medicare Employer PPO Plan GHHHWTDEN_15 Let’s talk about Medicare Advantage Humana Medicare employer plans Your employer-sponsored plan The plan’s extra benefits How to enroll 2 About Humana: Experience behind the coverage Humana offers a wide range of products and services that use a holistic approach to lifelong well-being Dedication to the community More than 50 years of helping people of all ages Financial stability Fortune 100 company National coverage We offer Medicare plans in 50 states, including Puerto Rico and the District of Columbia 3 Overview of Humana’s Medicare Advantage Plan Medicare Advantage health plans are private insurance companies’ health plans approved by Medicare. Medicare Advantage plans include: All the benefits of Original Medicare plus extra coverage Maximum out-of-pocket protections Worldwide emergency coverage Original Medicare Secondary/ Supplement Plan Or Medicare Advantage plan Part C and Prescription Drug (Part D) Plan Medicare Part D Medicare Part C is available only to those enrolled in Parts A and B of Medicare through age or disability. Your Humana member identification ID card When you go to the doctor or hospital Show your Humana member ID card and tell the provider that Humana Medicare Employer PPO is your Medicare health plan Do not show your red, white, and blue Medicare card You will pay plan deductibles or copayments at your appointment or the provider may bill you later The doctor or hospital will bill Humana for the rest Your Humana Medicare Employer PPO Plan The Humana Medicare Employer Preferred Provider Organization (PPO) plan Gwinnett County Board of Commissioners and Humana teamed up to design a Medicare health plan just for you In this plan, you must have both Medicare Part A and B and continue to pay your Medicare Part B premium Your Humana Medicare Employer PPO plan Plan highlights Choose any doctor or hospital that accepts Medicare – who accepts Assignment and agrees to bill Humana In all plans, there’s a limit to how much maximum out-of-pocket costs you pay One member ID card No copayments for all preventive services/health screenings Extra benefits Affordable copayments for doctor visits Worldwide coverage for emergencies No referral needed to see any provider Your Humana Medicare Employer PPO Plan Benefit In Network Annual Deductible Combined in and Out-of Network $150 Combined in and Out-of Network $150 Annual Maximum Out of Pocket* $3,400 $3,400 Inpatient Hospital 100% after combined annual deductible and $500 copayment per admission 100% after combined annual deductible and $500 copayment per admission 100% per visit after $50 copayment 100% per visit after $50 copayment Outpatient Ambulatory Surgical Center Out of Network *If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year. Your Humana Medicare Employer PPO Plan Benefit In Network Out of Network 100% per visit after $0-$75 copayment or 20% of the cost (based on services received) 100% per visit after $0-$75 copayment or 20% of the cost (based on services received) Emergency Room Care 100% per visit after $50 copayment (waived if admitted within 72 hours) 100% per visit after $50 copayment (waived if admitted within 72 hours) Primary Care Physician 100% per visit after $15 copayment 100% per visit after $15 copayment Specialist 100% per visit after $30 copayment 100% per visit after $30 copayment 10% 10% Outpatient Hospital Visits Durable Medical Equipment Your Part D Coverage Network Retail Pharmacies A 30-day supply (A 90-day supply at three times your 30-day cost*) Mail-order Benefit* A 90-day supply Tier 1 Generic or Preferred Generic $10 copayment $15 copayment Tier 2 Preferred Brand $30 copayment $75 copayment Tier 3 Non-Preferred Brand $60 copayment $150 copayment 30%* coinsurance ($100 maximum per prescription) N/A* Tier 4 Specialty *Specialty drugs are not available in a 90-day supply. Regardless of tier placement, Specialty drugs are limited to a 30-day supply. Your Part D Coverage How coverage works with Prescription Drug Schedule Rx Rider 77 $0 - $4,700 – you pay a cost share Once your true out-of-pocket costs reach $4,700, you pay the greater of $2.65 for generics (including brand-name drugs treated as generic) and $6.60 for all other drugs, or 5 percent coinsurance Prescription drug formulary Group Plus formulary • Open formulary – includes all prescription drugs approved by CMS • Most* generics are in Tier 1 • *Certain high-cost generics can fall out of Tier 1 Four-tier design • • • • Tier 1: Preferred generic Tier 2: Preferred brand Tier 3: Non-preferred brand Tier 4: Specialty Mail Order Pharmacy You will have access to mail order pharmacies, including Humana’s owned, RightSource. With RightSource, you will have: Easy ordering Refill reminders Discounts and potential savings Visit RightSourceRx.com/Medicare After you become a Humana member, you can sign in with your MyHumana username and password or register to get started. You can also sign up by calling 1-855-297-7117 (TTY: 711) Monday – Friday, 8 a.m. – 8 p.m., and Saturday, 9 a.m. – 6 p.m., Eastern time. New prescriptions typically take 7-10 business days to receive. Call RightSource if you have questions. Other mail-order pharmacies are also available in our network. SmartSummary® mailed to your home Statements that explain your health, benefits, claims and health care spending; issued each month you incur claims Statements list your past prescription drug purchases and medical claims and help you plan for the future SmartSummaryRx shows how much your plan and you personally have spent on health care, and how much is left before you reach the coverage gap Get these statements by mail or on the web at Humana.com Extra benefits Humana Active Outlook® A lifestyle enrichment program for Humana Medicare Members Humana Active Outlook helps you live a full, active, and productive life Enjoy health and wellness information through mailings, online content, individual health coaching, classes, and our member assistance program (MAP) Humana’s award-winning* Humana Active Outlook Magazine comes to you four times a year Get practical tips for living with chronic health conditions from Humana Active Outlook Digest *Humana Active Outlook has won more than 100 major national publishing awards, including the APEX Awards for Publication Excellence and the MarCom Awards. These awards were not given by Medicare. Get fit your way™ with SilverSneakers® Fitness Reach you goals with access to more than 11,000 fitness locations where you can: • Use fitness equipment, pools and saunas* • Take SilverSneakers classes* • Get help from a SilverSneakers Program AdvisorTM • Enjoy fun social activities *Classes and amenities vary by location. SilverSneakers® Steps SilverSneakers Steps® is a personalized fitness program for members who don’t have convenient access to a SilverSneakers location Sign up for SilverSneakers Steps® if you can’t get to a fitness location. Select a fitness kit that you can use at home or on the go. • General fitness • Walking • Strength • Yoga HumanaVitality® Now there’s an easy way to stay in control of your health. Introducing HumanaVitality®, a wellness program just for Humana members. It’s included with your Humana Medicare plan at no extra cost. HumanaVitality was designed to help you get, and stay, on a healthier path – one small step at a time. HumanaVitality is a fun and engaging program that helps you find out more about your health. This makes it easier to find healthy options that work for you! HumanaVitality is based on a comprehensive lifestyle approach to wellness. It gives you personalized goals and activities to help improve your health. HumanaVitality not only rewards you with a healthier lifestyle, but also with great items like gift cards, movie tickets, and fitness apparel when you earn Vitality Bucks® for completing eligible activities. 19 Smoking cessation program A service to help you quit smoking Features include: Tips and advice from our experts, online or by phone A plan to quit tobacco, created just for you Two treatments to replace nicotine An online support group you can reach 24 hours a day, seven days a week Health management programs Humana at Home® Humana at Home can help you manage the challenges specifically associated with chronic conditions like: Diabetes Congestive heart failure Coronary artery disease COPD Rheumatoid arthritis Multiple sclerosis Parkinson’s disease Case management Nobody wants to face a health crisis or major medical procedure. But if this happens, Humana’s case managers are here to help. Our nurses can help you follow your treatment plan on your return home. We also can connect you to other resources for more support. Members may receive a call to enroll in one of these programs if eligible or may self-refer through Humana by calling 1-800-662-9508; TTY: 711. We’re available 8 a.m. – 5:30 p.m., Eastern time. MyHumana MyHumana is your online resource for personalized health benefits information. Review your plan benefits, use health and pharmacy tools, or look up medical and prescription claims. MyHumana Mobile app and website helps you access your information while on the go, sign in to your secure, mobile account or download our iPhone or Android app for details about your plan benefits, find a doctor in network, find a lower-cost drug alternative, review your claims and more. HumanaFirst® HumanaFirst® Nurse Advice Line is a toll-free, 24 hour-a-day health information line. A registered nurse can answer your general health questions and provide guidance on your medical needs. Find out about a medical condition. Discuss a sudden health concern. Learn how Humana can help you live a healthier life. Next steps: enrollment How you’ll enroll Enroll by employer Gwinnett County Board of Commissioners will get your information and enroll you in the Humana plan. Humana may ask for more information from you by mail or phone. What happens after I enroll? Humana processes your enrollment and confirms that you are eligible Medicare confirms your enrollment Your ID card arrives in your mailbox Member Benefit Package arrives in your mailbox Health Assessment We’ll contact you about filling out a health questionnaire 25 Where to find more information Humana.com Group Medicare Customer Care – Group Medicare Customer Care at 1-866-396-8810 (TTY: 711) Monday – Friday from 8:00 a.m. - 9:00 p.m., Eastern time. – Our phone system may answer your call on Saturdays, Sundays, and holidays. Leave a message and we’ll call back by the end of the next business day. Humana Group Medicare Questions? Humana is a Medicare Advantage organization with a Medicare contract. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change from year to year. Enrollment in this Humana plan depends on contract renewal. This information is available for free in other languages. Please call our customer care number at 1-866-396-8810 (TTY: 711). You can call Monday - Friday, from 8 a.m. - 9 p.m., Eastern time. Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de Atención al Cliente al 1-866-396-8810 (TTY: 711). Los representantes están disponibles de lunes a viernes de 8 a.m. a 9 p.m., hora del Este.