Welcome and thank you for taking the time today to learn more about united healthcare's group medicare advantage ppo plans designed specifically for pebs medicare retirees and cobra members for those of you already enrolled in one of these plans you will be happy to know that there are no changes for the 2022 plan year.
During our time together i will review original medicare basics your plan benefits programs and features how to enroll and what you can expect next at united healthcare we want you to know we are here for you we are here to help you make the most of your plan by connecting you to the care you need and making sure you understand your benefits.
We're able to provide programs resources and tools to assist you in leading a long healthy life the united healthcare group medicare advantage ppo plans include a large network of medicare providers across the u.s as well as comprehensive drug coverage now we will review original medicare.
To be eligible for medicare a person needs to be 65 years old or under age 65 and qualify on the basis of a disability or special condition and be a u.s citizen or legal resident who has lived in the united states for at least five consecutive years if you or your spouse have contributed to payroll taxes you are eligible for.
Medicare when you reach 65 regardless of your income or health status upon becoming eligible for medicare you can enroll in traditional medicare sometimes called original medicare which is sponsored by the federal government it provides coverage for hospital stays and inpatient care as well as some coverage to help you pay for doctor's.
Visits and outpatient care with original medicare the coverage has deductibles and coinsurance amounts that are the members responsibilities some retirees may choose to enroll in a medicare supplement plan that will help cover the remaining balances from original medicare as well as a part d plan to cover prescriptions.
Another option is to choose a medicare advantage plan also known as a part c plan some of the original medicare rules that we want to make you aware of are you must be entitled to medicare part a and enrolled in medicare part b and continue to pay your medicare part b premium.
You can only be in one medicare advantage plan at a time if you enroll in another plan it will automatically disenroll you from any other medicare advantage or prescription drug plan you may have had previously if you do not enroll in a medicare part d prescription drug plan or a medicare advantage plan that includes.
Prescription drug coverage or you do not have other credible prescription drug coverage you may have to pay what's known as medicare's late enrollment penalty you must inform us of any current prescription drug coverage or future enrollment that includes prescription drug coverage.
And when you are a member you are encouraged to read the plan's evidence of coverage or eoc which can be found at www.uhcretiree.com forward slash w-a-p-e-d-b the eoc also covers specific plan benefits co-pays exclusions limitations and other terms also please review the full text of.
Statement of understanding in the 2022 plan guide now we will review the plan benefits programs and features that are part of the united healthcare ted balance and united healthcare pebb complete healthcare pet balance and united healthcare pep complete will cover all.
Of the benefits of part a including inpatient hospital skilled nursing and home health and all the benefits of part b doctor's office visits outpatient care and labs the part d prescription drug coverage as well as offer additional benefits and programs you are still considered to be covered.
By medicare but all of your benefits and claims will be administered by united healthcare your medicare advantage plans are national ppo plans what this means to you is that you will be able to see doctors clinics and hospitals all across the united states and the u.s territories.
Under the plans there will be coverage for naturopathic medicine vision hearing massage therapy chiropractic care and acupuncture as well as prescription drug coverage there are no referrals needed to see a specialist the national ppo plans let you see providers in or out of the united.
Healthcare network for the same cost to you as long as the out-of-network provider participates in medicare and accepts the plan the provider you are currently seeing may already be in the united healthcare network under your plan to confirm if your provider is in our network you can check online at.
Www.uhcretiree.com forward slash w-a-p-e-b-b or by calling united healthcare customer service at 855-873-3268 if your provider is not in the united healthcare network our customer service team may be able to assist by confirming.
If the provider participates in medicare and accepts the plan there is no deductible for medical services for either the united health care pep balance or united healthcare pet complete plans the annual maximum out of pocket for medical for the pebb balance is two thousand dollars and the annual maximum.
Out of pocket for medical for pebb complete is 500 what this means to you is that once you pay your co-pays for the plan and you reach these amounts then your medical costs for medicare covered services will be covered at a hundred.
Percent for the remainder of the year this chart shows what you will pay for certain types of care the united health pep balance plan is shown on the left and the united healthcare pebb complete plan is on the right as you can see you pay the same amount whether you use a network provider or one that is outside of the network.
First we will look at the united health care pep balance plan you will pay a fifteen dollar copay for a primary care office visit or a thirty dollar copay to see a specialist if you go to an urgent care facility you will pay a 15 copay for an emergency room visit you will pay a 65 copay.
Inpatient hospitalization will be covered with a 500 co-payment per hospital stay and outpatient surgery will have a two hundred and fifty dollar co-payment now i will move to the united health care pep complete plan you will pay nothing for a primary care office visit or to see a specialist.
If you go to an urgent care facility you will pay 15 co-pay for an emergency room visit you will pay a 65 copay both for inpatient hospitalization stays and outpatient surgery are covered at a hundred percent and you will pay nothing preventive services such as annual physicals immunizations breast cancer.
Screening and colon cancer screenings are covered in full under both united health care pet balance and united health care pet complete the next two slides show some additional benefits included with the peb balance and peb complete plans you are covered for routine podiatry for.
Up to six visits per year under the united health care pep balance plan your cost is a 30 copay per visit or the visits are covered in full under the united healthcare pebb complete plan you have up to 20 combined visits for chiropractic care and acupuncture services under the united healthcare pet balance.
Plan you will pay a 15 co-pay per visit and you will pay nothing under the united healthcare peb complete plan the routine vision services are the same for both united healthcare pep balance and the united healthcare ped complete plans you are covered at a hundred percent for one eye exam every 12 months and you have a 300.
Allowance towards eyewear every 24 months both of these plans include coverage while traveling outside of the u.s you will need to pay for services out of your own pocket and when you return you submit the receipts to unitedhealthcare you will be reimbursed minus your member responsibility.
The routine hearing services are also the same for both the united health care ped balance and united healthcare pebb complete plans you're covered at a hundred percent for one hearing exam per year and you have a thousand five hundred dollar allowance towards hearing aids every five years massage therapy is covered for up to.
Thirty visits per year under the united healthcare pep balance plan your cost is a fifteen dollar copay per visit or the visits are covered in full under the united healthcare pebb complete plan both plans offer unlimited visits for naturopathic medicine with a 30 co-pay one of the programs we are able to offer with both the united healthcare pep.
Balance and the united healthcare pebb complete plant is coverage for diabetic testing and monitoring supplies at no cost to you under the program there are a variety of one-touch and accu-check products available the meters corresponding test strips lancets lansing devices glucose control.
Solution and replacement batteries are all covered at no cost to you if you're not currently using a one-touch or accu-check device you will want to check with your doctor to see if one of the systems will work for you to help you save money both of these plans are ppo plans meaning you can choose a network.
Provider or one that is outside of the network the vision coverage is under the medical benefits and the vision providers are part of our united healthcare medical network if you choose to go out of the network your provider may not bill uhc you may need to pay out of pocket and.
Submit those charges to us for reimbursement forms are available online at uhc.com forward slash w-a-p-e-b-b both the united health care ped balance and the united health care ped complete plans include prescription drug coverage or part d this coverage is the same for both plans.
You have the option of using over thousands of united healthcare in-network pharmacies the pharmacies include national regional local chains and independent neighborhood pharmacies there are thousands of covered brand name and generic prescription drugs as well as a bonus drug list you can also check the plans covered.
Prescription drugs by going to www.uhc retiree.com forward slash w-a-p-e-v-b or by calling customer service to review your prescriptions under your prescription drug part d plan in the initial coverage stage you have a one hundred dollar deductible that.
Applies to drugs in tiers two three and four after that you pay a copay or coinsurance and the plan pays the rest for the 2022 plan year once your total drug costs have reached 4430 you move into the coverage gap also known as the donut hole.
Total drug costs include the amounts you pay or others pay on your behalf as well as what the plan pays for prescription drugs it does not include your premiums the plan provides additional coverage through the gap specifically negotiated for the washington peb retirees while you are in the coverage gap you.
Will continue to pay the same coinsurance that you did previously and there's no change in the benefit for you once your out of pocket costs reach seven thousand fifty dollars you will move to the catastrophic coverage stage out of pocket costs include the amount you pay as well as others pay on your behalf for prescription drugs including.
Coverage gap discount program payments this does not include premiums or the amount the group health plan or former employer or plan sponsors pays for prescription drugs in the catastrophic coverage stage you will continue to pay the same coinsurance for your prescription drugs your prescription drug plan has an.
Annual out of pocket maximum of two thousand dollars when your total out of pocket costs the amounts you pay reach two thousand dollars you will not pay any copay or coinsurance for the remainder of the year you have an annual deductible of a hundred dollars that applies to tiers.
Two three and four only the plan includes a list of preventive drugs covered at no cost to you you will pay a five percent coinsurance up to a maximum of ten dollars for a 30-day supply or a 5 coinsurance up to a 30 copay for a 90-day supply of preferred insulin.
This is a separate list and does not include all insulin if you see i have listed out the specific preferred insulins in the chart if you use insulin please review the plan guide for more details if you purchase prescription drugs while traveling outside of the country you.
Will need to pay out of pocket and request reimbursement from your plan when you return home you will be reimbursed minus your share of the cost which is thirty percent up to a maximum of forty seven dollars after your deductible is met tier one includes all covered generic drugs.
You will pay ten percent up to a maximum of twenty five dollars for a thirty day supply you can also receive a ninety day supply at retail or mail order for ten percent up to a maximum of seventy five dollars you do not pay a deductible for drugs that fall in tier one.
Tier two includes many common brand name drugs called preferred brands after your deductible is met you will pay a 30 co insurance up to a maximum of 47 for a 30 day supply or you can also receive a 90 day supply through retail or mail order for 30 up to a maximum of 141.
Tier 3 includes non-preferred brand name drugs and eligible compound medications after your deductible is met you will pay 50 coinsurance for a 30-day supply or a 90-day supply through retail or mail order tier 4 include specialty medications which are unique and are very high cost brand drugs.
For tier 4 only you are limited to a 30-day supply and you will pay 50 up to a hundred dollars after the deductible is met at either retail or mail order if you do not see your medication listed in the formulary please call customer service and discuss your medications we will be.
Happy to help you with the transition supply until you are able to work with your doctor to find alternatives there are more ways that you can save under the plan first we recommend that you review your medications with your doctor at least annually maybe there is a generic or less costly.
Drug that has been developed and now on the market that will help you stay healthy while reducing your costs make sure that you present your united health care id card when you go to the pharmacy it's always best to use participating pharmacies to help lower your costs and for added convenience you can choose.
To use optum rx mail order we want to make sure that you feel safe and comfortable using the mail order process your prescription drugs through the mail order will be filled by optumrx now i will explain the process and how it goes through getting to you.
Optim rx receives the retiree's prescription this can be done through a phone call or an online request from you or your doctor the optum rx pharmacist reviews the information to make sure there is no issues with allergies dosage or interactions with other drugs you may be taking.
After that the medication is dispensed and reviewed by another optima rx pharmacist for accuracy if all is well the medication is sealed in a tamper evident package and sent to your home you will receive a notification by email or phone call letting you know the order.
Has been shipped you can also go online at optimrx.com to track your order at any time you heard mention of an annual physical and annual wellness visit during this presentation and you might be wondering what the difference is your annual physical is your opportunity to have labs and tests done to measure.
Your current level of health your annual wellness visit is your opportunity to set aside time to have a conversation with your primary care physician to discuss options for preventive care and to discuss screenings or exams you may have heard about and need to know if they're.
Right for you while your annual wellness visit can be scheduled at any time throughout the year many people do choose to combine the annual wellness and physical into one visit to allow you to have longer time with your doctor you can request this at the time you.
Schedule your appointments there is no charge to you for either visit and we encourage you to schedule yours vaccines work with your body's natural defenses to protect you against infection and help reduce the risk of disease they do this by imitating an infection.
Without actually causing the disease and getting your immune system to respond in the same way it would as if you had the real infection this prepares your body to recognize and fight the disease when it comes across it in the future check with your doctor to see if the vaccines listed on this slide are right.
For you here you see the shingles vaccine is covered at a hundred percent this is an enhanced benefit specifically negotiated for these pebb plans united healthcare house calls is a wonderful optional program that allows you to have an in-home conversation and.
Preventive care visit with a licensed professional at no cost to you this is in addition to your annual wellness visit and routine physical that are also covered at no cost to you under these plans during the visit they will review your health history and current medications they will perform a basic health.
Screening and help you identify any health risks in your environment they can even connect you with resources to help reduce those risks it's a great opportunity to ask questions you may not have had a chance to address with your doctor once the visit is complete the house calls team will send a summary of your.
Visit to both you and your primary care provider you may even get a reward for participating renew by unitedhealthcare is our member-only health and wellness experience that includes inspiring lifestyle tips coloring pages recipe libraries streaming music interactive.
Quizzes and tools learning courses health news articles and videos and a health topics library as a united health care member you can explore all that renew has to offer by logging into your member website under the renew rewards program you may be eligible to receive a visa gift card by completing certain health care.
Activities like having a house calls visit or by completing your annual physical or wellness visit we want to reward you by for taking your health care into your own hands renew active is your chance to stay both physically and mentally fit with a free gym membership and gives you access to thousands of gym.
Locations including your local ymca also you have access to a personalized fitness plan an online brain health program exclusively from aarp and connections with others at local health and wellness events through the fitbit community if you prefer to work out at home or you can't get to the gym for whatever reason.
You can access fitbit premium with thousands of workout videos available virtual visits allow you to have a live video chat with a doctor or behavioral health specialist from your smartphone tablet or computer anything with a camera built in and a strong internet connection virtual visits are available 24 hours a.
Day virtual doctors visits are covered at no cost to you under the peb complete plan under the peb balance plan you will pay the applicable copay for the provider that you visit with you can speak with a provider ask questions receive a diagnosis and the doctor can even prescribe medication and.
Have it sent to your pharmacy the virtual visit doesn't require a co-pay potentially however you would pay your normal copay for any medication that is prescribed to you you can call our telephonic nurse support line 24 hours a day seven days a.
Week to get answers to help you make health decisions or by answering your health related questions registered nurses are available to help you choose where to go for care find a doctor or hospital or understand the diagnosis or treatment option united healthcare hearing allows you to receive a hearing exam every year at no.
Cost to you and provides you with a wide selection of brand name and private label custom program hearing aids at a significant savings you can choose from many major manufacturers and receive your hearing aids in person or via home delivery you will receive personalized care and.
Follow-up support to help you hear better and live life to the fullest with united healthcare's first-line essentials you can conveniently order over-the-counter health products you will receive a forty dollar program credit to spend each quarter on essential health supplies from the health products catalogs first line.
Essentials website or first line benefits app there are over 200 products available to order like vitamins supplements first aid item and more the health products catalog will be sent to you each quarter with instructions on how to order or you can choose to go through the website or first line.
Benefits app the products are delivered right to your door at no charge no shipping handling or tax you must order at least 35 dollars worth of product per order and at the end of the quarter any unspent dollars will expire you will receive a program statement with your account balance and a new.
Catalog each quarter this is a great program to help you save money and trips to the store the post discharge meal delivery program helps members focus on their recovery without worrying about having a healthy meal after an inpatient hospital stay here's how it works during an inpatient hospital stay united.
Healthcare assigns a case manager to help coordinate your care the case manager can then refer you for the post-discharge meal delivery program upon discharge eligible members can receive up to 84 home delivered meals usually within 72 hours after being discharged all meals are ordered in succession of.
One another and cannot be spread out through the year meals are delivered to the members door in a climate controlled cooler in fresh lock packaging in shipments of 14 meals or greater meals can be refrigerated for up to 14 days or frozen for up to three months the benefit can be used one time per.
Plan year and is provided by mom's meal now i will provide instructions on how to enroll if you are already enrolled in one of the united healthcare peb plans and are happy with your plan you do not need to do anything if you are interested in enrolling or switching plans.
And would like to obtain more information you can call united healthcare customer service at 855-873-3268 and request a 2022 plan guide you can also download a copy of the plan guide by going online to www.uhcretiree.com forward slash w-a-p-e-b-b.
United healthcare customer service is available to answer all of your questions from 8 am to 8 pm 7 days a week if you are ready to enroll please follow the instructions on which forms to complete on your washington state health care authority website which is hca.wa.gov.
Forward slash p e b b retirees you must do this during pebbs program annual open enrollment period from november 1 to november 30th your new coverage with united healthcare will begin january 1 of 2022 now for more information on what happens.
After enrollment all current and new enrollees will receive a new id card for the 2022 plan year in addition to your id card you will receive a quick start guide in the mail prior to january 1st if you do not receive your united healthcare.
Member id card by the end of december please call our customer service if you have your member id card you can register online at uhc retiree.com forward slash wapeb to get access to your plan information for new enrollees soon after your effective date we will contact you to complete a short survey.
To make sure you have everything you need to make the most out of your plan if you still want to learn more about the united healthcare peb plans please visit our virtual education center it's an online resource that allows you to learn more about the benefits programs and services available to you as part of the united healthcare group medicare.
Advantage ppo plan you can view flyers brochures videos and more by visiting www.uhc virtual retiree dot com forward slash w-a-p-e-b-b beginning january 1 2022 you can begin using your united health care id card you can place your red white and blue.
Medicare id card away for safe keeping when you go to your health care provider or a pharmacy all you need to do is show them the united healthcare member id card on the back of the member id card are important phone numbers for you and your providers to call if there are any questions.
Once you receive your member id card you can go to www.uhc retiree.com forward slash wap ebb to register when you have registered you will be able to access additional information you can review your plan benefits and materials you can look up claim.
Information after we have received and processed the claim you can also print a temporary member id card or request a new one if necessary you can search for drugs to find out how much they may cost under your plan find providers and explore all that renew has to offer on behalf of united healthcare we want to thank you for your time today and we.
Look forward to welcoming you to our medicare family if you're currently enrolled with united healthcare we thank you for your continued support and we appreciate being able to help you in the future you