2020 insurance benefits - uky.edu
TRANSCRIPT
Health insurance for retirees age 65 and over is a bit differentdue to Medicare. This guide covers:
• Health insurance and prescriptions = UK Medicare Advantage
• Dental insurance = UK Dental or Delta Dental
• Vision insurance = EyeMed
Every year, you have opportunities to make changes during:
• Spring open enrollment = make dental and vision changes
receive mail from us a few months before you turn 65. You can also access forms online: www.uky.edu/hr/forms/benefits
Turning 65 soon?That’s a qualifying event, which allows you to enroll in UK MedicareAdvantage if you’re eligible. At age 65 you become ineligible forUK HMO, PPO, EPO and RHP plans, except in certain cases. You’ll
FOR RETIREES AGE 65+2020 INSURANCE BENEFITS
CONTACTSMedicare 1-800-633-4227 www.medicare.gov
UK Medicare AdvantageUK Benefits (for enrollment and eligibility) 859-257-9519, option [email protected]
Prescription Express Scripts 1-877-242-1864 www.express-scripts.com
Know Your Rx 859-218-5979 or 1-855-218-5979 www.uky.edu/hr/benefits/pharmacy
More coverage UK Dental 859-323-8566
dentistry.uky.edu/patient-care/plan
Home, auto and pet insurance
1-800-438-6388 www.metlife.com/mybenefits
Disability, disease, accident, life, legal and more insurance 1-859-223-4973 or 1-888-388-1676 www.thempmgroupllc.com
Retirement savings TIAA 1-800-842-2776 or 859-224-6900 for appointments www.tiaa.org
Fidelity 1-800-343-0860 or
1800-642-7131 for appointments
www.fidelity.com
Well-being benefits
Health coaching 859-257-9355 www.uky.edu/hr/wellness/be
Mental health therapy 859-257-9433 www.uky.edu/wlc
Nutrition 859-257-9355 www.uky.edu/hr/wellness/eat
Personal finance 859-218-1589 www.uky.edu/hr/financial-well-being
Email us at [email protected]. Reach us by phone at 859-257-9519, select option 3 or toll-free 1-800-999-2183
Fitness 859-257-9355 www.uky.edu/hr/wellness/move
Elder care 859-323-4600 or 1-800-873-8532 www.uky.edu/hr/eldercare
EyeMed Vision Care 1-866-723-0596 www.eyemedvisioncare.com
Delta Dental 1-800-955-2030 www.deltadentalky.com
United Healthcare (for planinformation) 1-844-488-3956www.uhcretiree.com/uky
• Fall open enrollment = enroll or unenroll in Medicare Advantage
If you don’t make changes, your plan selections stay the same.
AGE 65 OR OVER? HEALTH INSURANCE IS DIFFERENTAt age 65, whether you’re working or not, you’re eligible for Medicare from the government. Whenyou retire, if you’re eligible for health insurance from UK as a retiree, you could enroll in UK Medicare Advantage. This includes Original Medicare and so much more, including prescriptions!
Parts of MedicareMedicare is available as part A, B, C and D. The government provides A and B, knownas Original Medicare. UK offers C and D.
If you’re not workingYou’re required by the government to have Medicare parts A and B, whether it’s included in Part C from your retiree benefits or not.
If you’re working and want to keep your current plan
Health insurance timeline by ageBefore your 65th birthday, if you’re eligible for health insurance from UK as a retiree, you’llreceive several plan options (HMO, PPO and more). Your annual open enrollment is in spring.
Three months beforeyou turn 65, you canenroll in Medicarethrough the socialsecurity website or yourlocal office. You’ll also receive mail from us to enroll in Medicare Advantage if you prefer.
At and after age 65, youropen enrollment period to make changes to health insurance happens in thefall instead of spring. You can still make dental and vision changes in spring.
When you turn 65...
A Hospital insurance
Medical insurance
All-in-one alternative
Prescription coverage
We suggest you enroll in Medicare part A only. This will make it easier to enroll in part B when you retire.
A
B
C
D
Part C: UK Medicare AdvantageProvides Original Medicare (hospital coverage through part A and medical coverage through part B) and much more!
2 U N I V E R S I T Y O F K E N T U C K Y
OriginalMedicare
You must change plans before you can enroll in Medicare part A. Contact us for assistance!
If you have UK Saver insurance
Provides prescription coverage throughKnow Your Rx. You’ll get an updatedExpress Scripts card specific to the UK Medicare Rx plan.
Part D: UK Medicare Rx
From UKUK offers an insurance benefit to eligible retirees who are age 65 and over inclduing:
MEDICARE ADVANTAGE: UK BENEFIT FOR AGE 65+UK offers the Medicare Advantage plan for eligible retirees age 65 and over. Medicare Advantage is administered by United Healthcare and it’s a PPO plan, which means you have some flexibilty inwhere you receive care.
2020 ratesThese rates are for January 1 to December 31, 2020. What you pay monthly is called a premium.
More than Original MedicareWhile Original Medicare covers 80% of your total medical bills, UK offers Medicare Advantage, which gives you closer to 100% coverage — that means even lower medical bills for you. Plus, you’ll get access to these additional programs:
• Many preventive services at $0 co-pay, including your annual Wellness Visit• Enjoy preventive care visits in the privacy of your home with HouseCalls• Get answers to your health questions with NurseLine• See a doctor or a mental health specialist • Special programs for people with chronic or complex health needs• Make caring for a loved one easier with Solutions for Caregiver• Custom-programmed hearing aids• Fitness opportunities through Silver Sneakers• More health and wellness opportunities
If you’re a UK retiree with 5-14 years of service (or if you were hired after January 1, 2006)
Coverage Monthly rate What you pay
Retiree only $186 - $186
Retiree + spouse $372 - $372
Surviving spouse
$186 - $186
What UK pays
Plan year: January 1 to December 31This health insurance plan has a different plan year and open enrollment period than the other UK insurance plans. You’ll be mailed any plan changes and information before the fall open enrollment begins. Fall open enrollment: October 15 to December 7.
If you’re a UK retiree with 15+ years of service and you were hired before January 1, 2006
Coverage Monthly rate What you pay
Retiree only $186 $167 $19
-Retiree + spouse $372 $167 $205
Surviving spouse
$186 $84 $102
What UK pays
32 0 2 0 B E N E F I T S
These rates are for January 1 to December 31, 2020. What you pay monthly is called a premium.
MEDICARE ADVANTAGE PLAN SUMMARY
UK Medicare Advantage plan benefits Benefits for covered services provided at participating providers
Out-of-pocket amount
Annual deductible $185/member
Medical out-of-pocket maximum $3,000/member; $6,000/family
Prescription out-of-pocket maximum N/A
Preventive care
*Coverage underpreventive care category dependson age, symptomsand diagnosis
Routine mammogram and Pap smears, PSA, screening colonoscopy and sigmoidoscopy* Routine child care and immunizations (through age 18) Routine adult physical exam (19 years and above, one per plan year)
100%
Physician services
Routine outpatient laboratory tests and X-rays Office visits (excludes certain diagnostic lab tests and X-ray) Lab tests and X-rays Allergy injections Inpatient services Outpatient surgery and diagnostic tests
96% after deductible
Hospital services
Inpatient care (semi-private room and board, nursing care, ICU) Physician visits to emergency room Outpatient surgery, outpatient nonsurgical care Outpatient tests, lab and X-ray Ancillary services Organ transplants
96% after deductible
Other medical services
Emergency room
Urgent care
Home health careHospice services
$100 co-pay (waived if admitted within 24 hours for same condition)
$65 co-pay (waived if admitted within 24 hours for same condition)
100%
Skilled nursing facility (up to 100 days per plan year) Ambulance services Durable medical equipment Physical, speech, hydrotherapy, occupational and acupuncture
96% after deductible
Mental health &substance abuse
Inpatient mental health or substance abuse Outpatient mental health or substance abuse
96% after deductible
therapy (limited to 45 visits per plan year, combined)
2020 planThis plan design is set for January 1 to December 31, 2020.
4 U N I V E R S I T Y O F K E N T U C K Y
www.uky.edu/hr/benefits/retiree-medical-plans/health#medicare-rates
See plan information online:
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PRESCRIPTION COVERAGEYou’re automatically enrolled in prescription coverage along with your health insurance. Express Scripts manages your prescription coverage.
Bulk prescription costs Mail delivery from UK Retail Pharmacies or Express Scripts
30-day supply 90-day supply
Generic 20% or 10% or Minimum of $8 Minimum of $24 Maximum of $50 Maximum of $100
Specialty generic 20% or Minimum of $8 — Maximum of $50
Formulary brand 40% or 30% or Minimum of $20 Minimum of $60 Maximum of $60 Maximum of $120
Non-formulary brand 50% or 40% or Minimum of $40 Minimum of $120 No maximum No maximum
Specialty brand $200 —
Interested in cost-savings? Call our pharmacist teamKnow Your Rx could help you save money and learn more about your prescriptions. Call between 8 a.m. to 6 p.m. at 859-218-5979, 1-855-218-5979 (toll free) or email [email protected].
Learn more: www.uky.edu/hr/rx
O P E N E N R O L L M E N T - R E T I R E E S
52 0 2 0 B E N E F I T S
Preferred brand(formulary)
Generic
Non-preferred(includes some generics)
Non-formulary
MEDICARE RX PRESCRIPTION COVERAGEWhen you enroll in UK Medicare Advantage, you’re automatically enrolled in prescription coverage called UK Medicare Rx through Know Your Rx.
You’ll receive a card from Express Scripts, like you did as an employee, but your card will bespecific to the UK Medicare Rx plan.
Prescription fulfillment options and costs
You can choose to order your prescriptions in different quantities, up to a 30-day supply, or up to a 90-day supply. Prescriptions can be filled by Express Scripts’ home delivery service or by a retail pharmacy. Your retail pharmacy options include UK Retail Pharmacies and Walgreens, which may also offer home delivery.
Up to a 30-day supply 31 to 90-day supplyExpress Scripts and Retail
10% coinsurance orNo min
40% coinsurance orMin = $120No max
30% coinsurance orMin = $60Max = $120
Not covered
20% coinsurance orNo minMax = $100 (31 to 60-day supply)
50% coinsurance orMin = $80 (31 to 60-day supply)Min = $120 (61 to 90-day supply)
Not covered
40% coinsurance orMin = $40 (31 to 60-day supply)
Max = $120 (31 to 60-day supply)
20% coinsurance or No out-of-pocket minimumOut-of-pocket maximum = $50
40% coinsurance orOut-of-pocket minimum = $20Out-of-pocket maximum = $60
50% coinsurance orOut-of-pocket minimum = $40No out-of-pocket maximum
Not covered
Express Scripts Retail
Max = $100
Max = $150 (61 to 90-day supply)
Min = $60 (61 to 90-day supply)
Max = $180 (61 to 90-day supply)
No max
6 U N I V E R S I T Y O F K E N T U C K Y
DENTAL INSURANCEUK Dental: If you prefer UK dentists and lower monthly premium costs.
Delta Dental: If you prefer dentists outside of UK.
Learn more: www.uky.edu/hr/retirees/dental
UK Dental Delta Dental Classic Ultra Basic Enhanced
Monthly premium
Retiree or spouse only $17.98 $40.03 $24.40 $33.00
Retiree + children $37.82 $82.36 $46.30 $69.80
Retiree + spouse $37.82 $82.36 $51.90 $72.80
Retiree + family $59.87 $127.24 $76.30 $113.50
Services
Routine office visit 100% 100% 100% 100%
Two cleanings per year 100% 100% 100% 100%
Restorative fillings 50% 100% 80% 80%
Simple extractions 50% 100% 80% 80%
Crown, bridge and dental implants Not covered 20% / 30% Not covered 50%
Endodontics (root canal) Not covered 30% 80% 80%
Oral surgery Not covered 30% 80% 80%
Dentures
Complete and partial dentures 50% 50% Not covered 50%
Fixed and removable dentures 50% 50% 50%
Periodontics
Two maintenance visits per year 100% 100%
Scaling, root planning and perio evaluation 50% 50% 80% 80%
Surgical Not covered 30% 80% 80%
Orthodontics
Age limit Not covered Up to age 19 Not covered No age limit
Coverage Not covered 20% up to $1,000 Not covered 50% up to a $1000 lifetime maximum lifetime maximum
Emergency treatment 50% 100%
.
No age limit Up to age 19
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VISION INSURANCE WITH EYEMEDEssential: If you prefer lower monthly premium costs, but higher co-pays.
Enhanced: If you prefer lower co-pays but, higher monthly premium costs.
See all health plans: www.uky.edu/hr/retirees/vision
Essential Enhanced
Monthly premium
Retiree or spouse only $8.50 $21.40
Retiree + children $15.20 $38.00
Retiree + spouse $16.00 $40.00
Retiree + family $21.40 $53.60
Services
Laser vision correction 15% off retail price of 15% off retail price of 5% 5% off promo price off promo code
Examination frequency Once every 12 months Once every 12 months
Exams (member cost / out-of-network cost)
Exam with dilation as necessary $10 co-pay / Up to $40
Standard contact lens $55 / Not covered $0 co-pay, pain-in-full, fit and two follow-up visits / Up to $40
Premium contact lens $10% of retail price / Not covered $0 co-pay, 10% off retail prices, then $55 allowance / Up to $40
Frames
Purchase frames Once every 24 months Once every 12 months
Lens
Purchase lenses or contacts Once every 12 months Once every 12 months
Single vision standard plastic $10 co-pay / Up to $40 $10 co-pay / Up to $40
Bifocal standard plastic $10 co-pay / Up to $60 $10 co-pay / Up to $60
Trifocal standard plastic $10 co-pay / Up to $80 $10 co-pay / Up to $80
Standard progressive $75 co-pay / up to $60 $10 co-pay / Up to $83
Premium progressive (tier 1-3) $95-$120 co-pay / Up to $60 $30-$55 co-pay / Up to $83
Premium progressive (tier 4) $75 co-pay, 80% of charge less $10 co-pay, 80% of charge less $120 allowance / Up to $60 $120 allowance
UV treatment $15 / Not covered $0 co-pay / Up to $12
Tint (solid and gradient) $15 / Not covered $0 co-pay / Up to $12
Standard scratch resistance $15 / Not covered $0 co-pay / Up to $12
Standard polycarbonate for adult $40 / Not covered $0 co-pay / Up to $30
Standard polycarbonate for kids under 19 $0 co-pay, paid-in-full / Up to $30 $0 co-pay / Up to $30
Standard anti-reflective coating $45 / Not covered $0 co-pay / Up to $34
Premium anti-reflective coating (tier 1 & 2) $57-$68 / Not covered $12-$23 co-pay / Not covered
Premium anti-reflective coating (tier 3) 20% off retail price / Not covered $45 allowance, then 20% off / Not covered
Polarization, other add-ons and services 20% off retail price / Not covered 20% off retail price / Not covered
Conventional contact lens $0 co-pay, $130 annual allowance, $0 co-pay, $160 annual allowance / 15% off balance / Up to $100 Up to $128
Medically necessary contact lenses $0 co-pay, paid in full / Up to $200 $0 co-pay, paid in full / Up to $200
(member cost / out-of-network cost)
90% of retail price minus a $40 allowance