direct bill open enrollment plan year 2020 · 2019-10-22 · our mission: to protect and improve...

Our Mission: To protect and improve the health and environment of all Kansans.

Direct BillOpen Enrollment Plan Year 2020

1


Agenda

• Introductions and Announcements

• Open Enrollment

• Major Changes

• Non-Medicare Plan Coverage Details

• Medicare Plan Coverage Details

• Questions to Ask Yourself

• Open Enrollment Portal Instructions

• Direct Bill Call Center

• Resources

2

Today we are going to look at the plan options for 2020. We will talk about what’s new and what you need to think about during this open enrollment period.

2


Open EnrollmentOctober 16 – November 15, 2019

• All changes take effect January 1, 2020

• Any changes made will be effective for all of 2020

• Your chance to make any change to your current insurance• Adding dependents

• Changing medical coverage

• Waiving medical & keeping dental

3

Open Enrollment for 2020 is from October 16 through November 15. This is when you are able to make changes to your coverage such as adding dependents, changing carriers.

3


Open EnrollmentOctober 16 – November 15, 2019

• Any change made outside of this time period requires a “qualifying event”

• Remember: If you or a dependent are enrolled in Medicare you must have a “Split Enrollment”

• If you want to cancel all of your health insurance you will need to contact our office at 1-866-541-7100, this cannot be done in the MAP system

4

Remember, after November 15th, unless you experience a qualifying event, you cannot change your coverage level until the next Open Enrollment period. The choices you make now will be effective starting January 1, 2020. Also, if you wish to cancel all of your state health insurance you will need to send this request in writing—you can either email or mail—to let us know to cancel all coverage but remember once you have canceled all of your coverage you cannot return to state coverage.

4


Canceling Coverage• A member is able to cancel all coverage during the

year by giving written notice, then coverage will be canceled the last day of the month in which the state is notified. Coverage for spouse and/or dependents will be cancelled as well.

• A member CANNOT cancel mid-year:– Medical & keep dental and/or vision

– Dental & keep medical and/or vision

– Vision & keep medical and/or dental

These changes can ONLY be made during Open Enrollment

Direct Bill members are able to cancel their coverage at anytime during the year by sending written notification. Coverage will be cancelled the last day of the month in which we receive the notification. If the member has a spouse and/or dependents, their coverage will also be cancelled. Once coverage has been cancelled, they cannot come back onto state coverage. Open Enrollment is the only time members can waive medical and keep dental and/or vision, keep dental and waive medical and/or vision, or keep vision and waive medical and/or dental.

5


Center for Medicare & Medicaid Services (CMS) Decision

Starting January 1, 2020 the Supplemental Plan C & C Select will no longer be available to people new to Medicare. BUT if you are already Medicare eligible then the Supplemental Plan C & C Select will always be an option for you to select.

6

The Center for Medicare and Medicaid Services decided that beginning January 1st, 2020, Supplemental Plan C and C Select will no longer be available to people new to Medicare. If you are already Medicare eligible by December 31st 2019, those plans will always be an option for you. This only affects members that will become Medicare eligible in 2020 and beyond.

6


Health Insurer Fee (HIF)

The Affordable Care Act (ACA) imposed a Health Insurer Fee beginning in 2014. This fee was suspended by Congress in 2017 & 2019. This fee will apply for 2020 & beyond.

Due to this fee premium rates will increase for the following plans

• Aetna Medicare Freedom PPO ESA

• Aetna Medicare Liberty PPO ESA

• Aetna Medicare Elite PPO ESA

The Aetna Advantage plan premium rates will be increasing in 2020 due to the Health Insurer Fee (HIF).

7


Health Care Commission (HCC) Decisions

• The HCC voted to be able reduce the premiums for the non-Medicare plans

• The HCC voted to award the contract for the Part D Plans the state offers to EnvisionInsurance

• The HCC voted to add another Part D plan, so the state will be offering 3 Part D plans– ENVISION Premier Part D

– ENVISION Value Part D

– ENVISION Classic Part D NEW

8

The Healthcare Commission voted to reduce the rates of the Non‐Medicare plans andaward the contract for the Part D plans offered by the state to EnvisionInsurance. We willoffer three Part D plans for Plan Year 2020; Premier, Value, and the new Classic part D.

8


Open Enrollment Plan Year 2020

This year members enrolled in the plans listed below and want those plans to continue for Plan Year 2020 DO NOT need to do anything and your current coverage will continue for Plan Year 2020

• Aetna and BCBS Non-Medicare plans A, C, J, N or Q

• Aetna Medicare Advantage Freedom, Liberty or Elite PPO ESA with Aetna Standard Part D

• Kansas Senior Plans C, C Select, G, G Select, or N without Part D

9

In the past, we have told members that if they want to continue their current coverage, they do not have to do anything. This year that statement will not apply to everyone. If you are enrolled in the plans listed and want to continue with your current coverage into Plan Year 2020, you will not need to do anything.

9



For members currently enrolled in one of the Aetna Medicare Advantage plans (Freedom, Liberty or Elite) with either Aetna Premier or Aetna Value Part D, you will need to make a change in coverage for Plan Year 2020.

The Aetna Medicare Advantage Freedom, Liberty & Elite PPO ESA plans will only be offered with the Aetna Standard Part D for Plan Year 2020

If a member does not make an election they will be enrolled in their current medical plan with the Aetna Standard Part D for Plan Year 2020

10

If you are on the Freedom, Liberty, or Elite Advantage plan with Premier or Value Part D, you will need to make an election. If you do not make an election, the state will keep you in the same medical Advantage plan but you will be moved to the Aetna Standard Part D, which is the only Part D plan offered with the Advantage plans for Plan Year 2020. This is to ensure that you have both medical and prescription Part D coverage for Plan Year 2020. If you are currently enrolled in a Premier or Value Part D plan, and still want to be able to enroll in one of those Part D plans your only option would be to enroll in one of the Kansas Senior Supplemental plans.

10



For members currently enrolled in one of the Kansas Senior plans (C, C Select, G, G Select or N) with either Aetna Premier or Aetna Value Part D coverage, you will need to make a change in coverage for Plan Year 2020

11

If you are enrolled in a Supplemental plan with the Premier or Value Part D, you will need to make an election.

11



. Listed below are your options:

• Enroll in one of the plans offered by EnvisionInsurance Envision Premier Part D

Envision Value Part D

Envision Classic Part D NEW

• Waive Part D through the state and enroll in a Part D out on the Private Market

12

You have the option to enroll in a Part D offered by EnvisionInsurance, the new Part D vendor for the state, or waive your Part D coverage with the state and choose a plan on the private market. The Part D plans offered by the state include Envision Premier, Value, and the new Envision Classic, which can be added to any of the Kansas Senior Supplemental plans.

12



If a member does NOT make an election they will be enrolled in the same medical coverage they currently have and then they will be enrolled in the same Part D they had with Aetna but with the new Part D vendor EnvisionInsurance. So if member was enrolled in Aetna Premier Part D that coverage ends 12/31/2019 and member will be enrolled in Envision Premier Part D effective 01/01/2020

13

If you do not make an election, your medical coverage will stay the same but you will be enrolled in the same Part D coverage you currently have but with the new Part D vendor, EnvisionInsurance. The coverage with Envision will take effect January 1, 2020.

13


• Pick a plan design (A, C, J, N or Q)• Which plan design is right for you?

• Premiums, Deductibles, Co-insurance

• Review the provider networks

• Review plan claim example online:• http://www.kdheks.gov/hcf/sehp/default.htm

Selecting Your Non-Medicare Health Plan

14

BCBS and Aetna will continue to offer the Non‐Medicare health plans.

14


Plan ANetworkMedical*

Deductible $1,000/$2,000/$3,000

Co‐insurance 20%

PCP Office Visit $40 Co‐pay

Specialist Visit $60 Co‐pay

Pharmacy*

Co‐insurance 20%/40%/65%

Special Case $100 /30 day

Combined Out‐of‐Pocket (OOP) Max*

Medical & Pharmacy $6,250/$12,500

Non-NetworkMedical*

Deductible $1,200/$2,400/

$3,600

Co‐insurance 50%

Out‐of‐Pocket (OOP) Max*


* Non covered services & discount tier drugs do not count toward Deductible, Co-insurance or OOP Max.

15

The deductibles and co‐insurance for Plan A have not changed for Plan Year 2020.

15


NetworkPlan C

Non-NetworkMedical & Pharmacy*

Deductible $2,750/$5,500

Medical Co‐insurance 10%

PharmacyCo‐insurance 20%/40%/65%

Out‐of‐Pocket Max


Medical*


Co‐insurance 50%

Out‐Of‐Pocket Max

Medical & Pharmacy

$5,500/$11,000

*Note: Discount tier and non covered items or services do not count toward Deductible or OOP Max.

16

The first family member must reach an out of pocket of $2,800 and then the rest of the family pays $2,700 until they reach $5,500. After you meet your deductible, using network providers, you will pay a 10% co‐insurance and then the plan pays %90, which is a change from 2019.

16


NetworkPlan J


Deductible $500/$1,000





Medical*


Co‐insurance 50%


Medical & Pharmacy

$10,000/$20,000


17

The deductibles and co‐insurance for Plan J have not changed for Plan Year 2020.

17


NetworkPlan N







Medical*


Co‐insurance 50%


Medical & Pharmacy

$6,650/$13,300


18

The deductibles and co‐insurance have not changed for Plan N for Plan Year 2020.

18


NetworkPlan Q







Medical*


Co‐insurance 60%


Medical & Pharmacy

$6,650/$13,300


19

The deductibles and co‐insurance have not changed for plan Q for Plan Year 2020.

19


Plan Year 2020 Retiree/Direct Bill Non-Medicare Medical & Drug Rate Chart

20

Coverage Choice

PLAN A PLAN C PLAN J PLAN N PLAN Q

Aetna/BCBS Aetna/BCBS Aetna/BCBS Aetna/BCBS Aetna/BCBS

Member Only

$978.16 $722.06 $798.52 $695.73 $702.57

Member Spouse

$2,038.46 $1,556.46 $1,651.39 $1,447.16 $1,475.65

Member Children

$1,749.62 $1,316.53 $1,403.96 $1,260.24 $1,273.54

Member Family

$2,905.02 $2,276.16 $2,474.99 $2,071.00 $2,172.15

Please see the premium rates for the 2020 Non‐Medicare plans.

20


Plan Year 2020 Retiree/Direct Bill Dental and Vision Rate Chart

21

Coverage Choice

Delta Dental Surency Vision Basic

Surency Vision Enhanced

Member Only

$37.43 $3.68 $7.24

Member Spouse

$85.21 $7.21 $14.29

Member Children

$94.76 $6.51 $12.89

Member Family

$152.11 $10.05 $19.99

Dental rates went up and vision rates stayed the same for Plan Year 2020.

21


Telehealth

• All plans include the Telehealth benefits – Aetna is offering the Teledoc Service

– BCBS is offering the Amwell Service

• Virtual Office Visits with licensed medical providers via the internet or your smart phone

• Convenient access: Providers available 24/7

• Lower member OOP cost than Urgent Care or ER visits

22

Both BCBS and Aetna are offering convenient virtual doctors office visits with licensedmedical providers via the internet or your smartphone. Convenient access to medicalproviders 24/7. This benefit is available today and is a less expensive alternative to UrgentCare or ER visits. Restrictions on services provided are listed on the SEHP website and Co‐insurance or copays do apply (depending on plan design).

You will need to register an account with the service before you can begin using theservices. Visit your health plan’s webpage for more details. Watch for more informationabout the new telehealth options in the near future.

22

23


• Rx continues to be offered by CVS Caremark

• Uses same Preferred Drug List as Plan A

• Claims subject to deductible for each plan

• After the deductible has been met, Co-insurance tiers apply:• Uses same Co-insurance tiers as Plan A

• 20% Generic

• 40% Preferred Brand Name Drugs

• 65% Non Preferred Brand Name Drugs

Plan C, J, N and Q Prescription Drug Plan

23

• The Preferred Drug List is the same as the one used for Plans A. It is available on Caremark.com.

• On Plan C, prescription drugs are subject to the overall plan Deductible and then Co‐insurance applies.

• Generic drugs have a 20 percent Co‐insurance

• Preferred Brand Name Drugs have a 40 percent Co‐insurance

• Non Preferred Brand Name Drugs have a 65 percent Co‐insurance

10/21/2019


Preferred Lab Benefits

• Available with both medical carriers

• Plan A - 100% coverage for eligible outpatient lab services

• Plans C, J, N, Q - Discounts on eligible outpatient lab services until deductible met, then paid at 100%

BCBS Members: The local BCBS plan of the physician that ordered the lab test will process the lab claim. If your provider is outside of the BCBS of Kansas area, Stormont Vail may not be a network provider and the claim may be subject to non network benefits.

24

• Stormont Vail HealthCare is a regional preferred lab vendor for Plans A and C.

• On Plan A, when you have covered outpatient lab work performed and billed byStormont‐Vail, the plan pays 100 percent of the cost of the services.

•On Plans C, J, N & Q, members receive significant discounts on covered outpatient Labservices by using Stormont Vail HealthCare until the Plan C Deductible is satisfied, and thencovered services are paid at 100 percent.

•Labs drawn at Cotton‐O’Neil Clinic locations may be included if performed by networkproviders.

•You can access the program by showing the Stormont Vail or Cotton‐O’Neil lab yourmedical ID card.

24


Quest Diagnostics• Regional preferred lab vendor:

Topeka, Emporia, Manhattan,

Carbondale, Wamego• Labs drawn at Cotton O’Neil

locations may be included if by network providers

• Show your medical ID card to access benefit

25

• Statewide preferred lab vendor

• List of collection sites: www.labcard.com

• Your doctor can draw the sample and send to Quest

• Access your results quickly

and easily by going to the

patient portal

and app

Stormont Vail Health

TOLL FREE - 800-637-4716TOPEKA AREA - 785-354-1150

• Quest Diagnostics is the statewide preferred lab vendor for the SEHP.o Any provider may use the Quest lab service by calling Quest to pick up the

sample. You and your provider will decide whether or not to do so.o Visit Quest’s website for a complete list of Quest collection sites.o Create a My Quest account to receive lab results directly on your phone or

desktop

• Stormont Vail Health is a regional preferred lab vendor for the SEHP.o Labs drawn at Cotton O’Neil Clinic locations may be included if performed by

network providers.o You can access the program by showing the Stormont Vail or Cotton O’Neil lab

your medical ID card.

25


Delta Dental

Enhanced

Benefit PPO Premier Non‐Network

Preventive Services Covered in full Covered in full Allowed amount covered in full

Basic Restorative 50% 50% 50%

Major Restorative 60% 70% 70%

Benefit PPO Premier Non‐Network

Preventive Services Covered in full Covered in full Allowed amount covered in full

Basic Restorative 20% 40% 40%

Major Restorative 50% 50% 50%

Basic• Plan pays for 2 exams & cleanings per year

26

• There are no changes to the dental program. The dental plan covers two (2) exams andcleanings per member per year.

• To receive the enhanced benefit level, you must have had a dental exam or cleaning inthe prior 12 months to qualify. On the enhanced benefit, the plan pays a higherpercentage of your costs for restorative care.

• Members of the health plan who have not had a covered exam or cleaning in the prior12 months will be at the basic level of benefits and will pay more of the cost ofrestorative services. There is a change in the basic dental plan coverage. If they needmajor restorative work, they will be responsible for paying a higher Co‐insurance forthese services.

• Over 70 percent of covered dental members are currently on the enhanced benefits andwill see no change in their coverage.

26


Surency Vision Benefits Enhanced Plan ‐ Covers everything in the Basic Plan PLUS…

Frame Allowance $150

High Index Allowance Up to $116

Polycarbonate lenses Covered in Full

Progressive lensesAllowance

Up to $165

Scratch & UV coating Covered in full

Basic Plan

Office Visit Co‐pay $50

Materials Co‐pay $25

Frame Allowance $100

Lenses: single vision, standard bifocal, trifocal or lenticular

100%

Contact lenses Allowance

$150

Contact Fitting Fee Co‐pay

$35

27

• There are no changes to the vision programs through Surency Life and Health InsuranceCompany, a wholly owed subsidiary of Delta Dental of Kansas.

• You may choose between the Basic and Enhanced plans.

• Basic covers a pair of standard eyeglasses or contact lenses.

• The Enhanced Plan includes everything Basic offers plus offers a higher frame allowanceand provides coverage toward lens enhancements like progressive lenses (no linebifocals).

27


Medicare Advantage Plan Options

• Aetna Medicare Freedom, Liberty & Elite PPO ESA (Extended Service Area) with Aetna Standard Part D

• These plans are available for Direct Bill members enrolled in Medicare Part A and Part B

• A copy of your Medicare card is required

28

Medicare Advantage plans are the Part C of Medicare. The state of Kansas offers 3 plans: Aetna Freedom, Liberty, and Elite PPO ESA with Standard Part D. With these plans members are not able to elect one of the other Part D’s the state offers—Aetna Standard Part D is their only option. These plans require members to enroll in both parts A and B of Medicare.

28


Aetna Medicare Freedom, Liberty & Elite PPO ESA Plans

Additional benefits offered with these plans:• Offer more benefits than Medicare

• No referrals needed

• Access to providers nationwide

• Money each year toward hearing aids

• Resources for Living

• SilverSneakers

29

The Aetna Medicare Advantage plans are able to offer additional benefits to Medicare. No referrals are needed, there is nationwide access, and money towards hearing aids. Aetna has a PPO network, but as long as your provider accepts Medicare, claims will be processed as “in‐network.” The plans also offer the SilverSneakers program, which pays for your monthly gym membership.

29



• Medicare Advantage Plans

– Takes the place of Medicare Part A and Part B

– You are still responsible for Part B premium

– Still have deductibles and co-payments

– Enrollment in private Part D prescription plan = loss of ALL State of Kansas Health benefits

30

The Aetna Medicare Advantage plans take the place of Medicare part A and B. You are still responsible to pay the Part B premium. These plans do have deductibles and copays. If you enroll in a private market Part D prescription plan, you will be dis‐enrolled from all State of Kansas Health benefits. CMS does not allow for participants in the Aetna Medicare Advantage plans to enroll in a private market Part D plan. Enrollment in the Aetna Medicare Advantage Freedom, Liberty, or Elite plans requires enrollment in the Aetna Standard Part D.

30


Freedom Liberty Elite

Deductible $0 $0$150

(ER, UC, ambulance & preventive excluded)

Out-of-pocket maximum $1,000 $500 $150

Preventive care $0 $0 $0

Primary care office visit $10 copay $15 copay $0

Specialty care office visit $25 copay $15 copay $0

Inpatient hospital $150 copay per day, days 1-5 $0 $0

Outpatient surgery $150 copay $0 $0

Emergency room $80 copay $50 copay $0

Hearing Aids $500 every 12 months $500 every 12 months $500 every 12 months

Fitness Benefit Silver Sneakers Silver Sneakers Silver Sneakers31

This is a summary of the comparison of the three Aetna Medicare Advantage Plans. More information is in our Direct Bill Open Enrollment Book. Please note the difference in the Out of Pocket for Maximum for each plan.

31


Aetna Medicare Freedom, Liberty & Elite with Standard Part D

• Coverage Gap or the “Donut Hole”– Begins when you and your plan have paid $4,020

toward your medications.

– Once you reach the coverage gap, you are responsible for the cost of the brand name and some generic medications.

• Catastrophic Coverage– Begins when your Out-of-Pocket cost reaches

$6,350

32

Just a reminder that Aetna Standard Part D is the only Part D a member can have with one of the Advantage plans—Aetna Medicare Freedom, Liberty or Elite. The Coverage Gap or “Donut Hole” begins when you and your plan have paid $4,020 toward your medications. Once you reach the coverage gap, you are responsible for the cost of the brand name and some generic medications.

32


Medicare Supplemental Plan Options

• Kansas Senior Plan C

• Kansas Senior Plan C Select

• Kansas Senior Plan G

• Kansas Senior Plan G Select

• Kansas Senior Plan N

– With or without Envision Part D—Premier, Value & Classic-new options

• These plans are available for Direct Bill members enrolled in Medicare Part A and Part B

• A copy of your Medicare card is required

33

Medicare Supplemental plans include Kansas Senior Plan C, Senior Plan C Select, Senior Plan G, Senior Plan G Select, and Senior Plan N. You can elect Envision Premier, Value, or Classic to the Supplemental plans. Remember Envision Classic is the new Part D that is being offered for Plan Year 2020. Enrollment in Medicare part A and B is required. Remember: Kansas Senior Plan C and Kansas Senior Plan C Select will not available to those becoming Medicare eligible in 2020.

33


Kansas Senior Plan C Select and Kansas Senior Plan G Select

To be eligible to enroll in one of these new plans you must live in a Select county.

Here are those counties:

Atchison, Brown, Butler, Chase, Chautauqua, Clay, Cowley, Doniphan, Douglas, Elk, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Marion, Marshall, Osage, Pottawatomie, Pratt, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee or Washington.

You would also need to use a network hospital for any planned inpatient services.

34

To be eligible for a SELECT plans, you must live in one of the counties listed below. The SELECT plans require that you choose a network hospital for any planned overnight hospital stays.

34


Kansas Senior Plan CMedicare Supplement Plan

Kansas Sr. Plan C Pays You Pay

Part A Inpatient Hospital Care:All deductible and co‐insurance for Medicare covered services

$0

Skilled Nursing:All co‐insurance for Medicare covered services $0

Part B Deductible $0

Out Patient Services $0

Durable Medical Equipment$0

35

Kansas Senior plan C requires you to use hospitals and doctor’s that accept Medicare assignment and you will have no out of pocket expense.

Remember: Kansas Senior Plan C will not available to those becoming Medicare eligible in 2020.

35


Kansas Senior Plan C SelectMedicare Supplement Plan

Kansas Sr. Plan C Select Pays You Pay

Part A Inpatient Hospital Care:To receive full Select benefits, you must obtain your planned Hospitalization services from one of the network hospitals

$0





36

Kansas Senior C Select provides the same benefit as Senior C except all planned overnight stays must be done in network hospitals.

Remember: Kansas Senior Plan C Select will not available to those becoming Medicare eligible in 2020.

36


Kansas Senior Plan GMedicare Supplement Plan

Kansas Sr. Plan G Pays You Pay


$0




Durable Medical Equipment $0

38

Kansas Senior Plan G requires that you pay the Medicare B deductible and then Medicare and the plan pay at 100%.

NOTE: The deductible amount of $185 is the rate for Plan Year 2019, Medicare has not given the new rates as yet for next year.

37


Kansas Senior Plan G SelectMedicare Supplement Plan

Kansas Sr. Plan G Select Pays You Pay

Part A Inpatient Hospital Care:To receive full Select benefits, you must obtain your planned Hospitalization services from one of the network hospitals

$0





39

Kansas Senior G Select provides the same benefit as Senior G except all planned overnight stays must be done in network hospitals.


38


Kansas Senior Plan NMedicare Supplement Plan

Kansas Sr. Plan N Pays You Pay


$0



Balance, other co‐pays Up to $20 office visit Up to $50 ER visit


39

With Kansas Senior Plan N, you will be responsible for the Medicare B deductible and you will have office visit and ER visit co‐pays.


39

The rates for all Medicare options including Part D, dental, and vision plans are listed above.

40


EnvisionInsurance Part D

One of the EnvisionInsurance Part D plans can be added to the Kansas Senior Supplemental plans

– Envision Premier Part D

– Envision Value Part D

– Envision Classic Part D NEW

41

Envision Part D plans—Premier, Value & and the new plan being offered Classic can only be elected if a member is enrolled in one of the Kansas Senior Supplemental plans. If a member elects to enroll in one of these plans Envision will bill them for their premium. They will receive information in the mail to get everything started.

41

Our Mission: To protect and improve the health and environment of all Kansans.42

EnvisionInsurance is a national Medicare Part D provider, serving over 650,000 members through our product, EnvisionRxPlus.

• Approved to offer Medicare plans across the country

• Serving over 650k members across the country (Individual Part D since 2006; Group Part D since 2009)

• Over 60k pharmacies nationwide, including mail order

We have over a decade of experience providing Medicare Part D to members

across the country.

• EnvisionInsurance is a fully‐insured prescription drug plan. Confirm they know what Part D is & explain if needed.

• We provide coverage for Medicare‐eligible beneficiaries & are a Medicare‐approved Part D plan.

• Our plan is EnvisionRxPlus.

• We have a broad pharmacy network of over 60,000 pharmacies across the country, including mail order pharmacies. Note that this is an approximation at the time this slide was developed and that the number of network pharmacies changes throughout the year.

42



• Plans have same pharmacy network and formularies (Preferred Drug List).

• Be sure to review the formulary and verify which plan will be best for you based on the medications you take regularly.

• Remember to take advantage of copays savings by getting 90-day supplies when possible!

• Both Envision Premier and Classic pay through the coverage gap or “donut hole.”

• Specialty medication: 30-day fill only.

43

With this insurance there is some cost share for both Premier & Value plans where getting either a 60 or a 90 day supply would cost the same. So it would be better to get the 90 supply but you need to be sure that your doctor has written your prescription to be filled for a 90 supply.

Both Premier and the New Classic plan pay through the coverage gap and remember that your special case medications can only be filled for 30 days.

43



• All State of Kansas drug coverage is considered creditable coverage.– Coverage that is as good as or better than Medicare

prescription drug coverage.

– You MUST have creditable drug coverage to avoid the Late Enrollment Penalty through Medicare.

• VA and Tricare are considered creditable coverage.

44

The state of Kansas just sent a letter out to all members telling them that state drug coverage is ‘creditable’ what that means is that it is as good or better than Medicare Prescription drug coverage. You do have to have coverage to avoid the ‘Late Enrollment Penalty’ through Medicare. If you are eligible for VA or TriCare they are considered Creditable coverage.

44


EnvisionInsurance Part D – PREMIER Available to those enrolled in one of the BCBSKS Senior Plans

Part D Plan Benefits – PREMIER Option—Only available to BCBSKS Senior Plans

PrescriptionNetwork Retail30 Day Supply

Network Retail60 Day Supply

Network Retail/Mail Order90‐Day Supply

Tier 1 – Preferred Generic Drugs

25% Co‐insurance up to a $30 maximum



Tier 2 ‐ Generic Drugs 25% Co‐insurance up to a $30 maximum



Tier 3 – Preferred Brand Name drugs




Tier 4 – Non PreferredGeneric and Brand Name drugs




Tier 5 – Specialty30 day supply ONLY

25% Co‐insurance No maximum

N/A N/A

If out‐of‐pocket expenses exceed $6,350

Generics: the greater of 5% Co‐insurance or $3.60

Brands: the greater of 5% Co‐insurance or $8.95





45

This chart shows the benefits for Envision Premier Part D plan

45


EnvisionInsurance Part D – PREMIER Available to those enrolled in one of the BCBSKS Senior Plans

90 Day Supply Mail Order provided by EnvisionPharmacies Mail Service Pharmacy

Prescription Member Pays



Tier 2 ‐ Generic Drugs 25% Co‐insurance up to a $45 maximum





46

This chart continues for the benefits for Envision Premier Part D plan for the Mail Order drugs

46


EnvisionInsurance Part D – Value

Part D Plan Benefits – VALUE Option‐‐Only available to BCBSKS Senior Plans

PrescriptionNetwork Retail 30 Day Supply

Network Retail 60 Day Supply

Network Retail/Mail Order 90 Day Supply

Deductible ‐ $100 deductible for initial out of pocket prior to tier coverage.

All Co‐payments would be cost of drug or Co‐payment listed below. Whichever is less.

Network / Preferred Pharmacy


$12 Co‐payment $24 Co‐payment $24 Co‐payment

Tier 2 –Generic Drugs $16 Co‐payment $32 Co‐payment $32 Co‐payment



Tier 4 – Non Preferred Generic and Brand Name drugs



25% Co‐insurance No Maximum

N/A N/A

47

This chart shows the benefits for Envision Value Part D plan

47


EnvisionInsurance Part D – Value Available to those enrolled in one of the BCBSKS Senior Plans




$24 Co‐payment

Tier 2 ‐ Generic Drugs$32 Co‐payment

Tier 3 – Preferred Brand Name drugs $84 Co‐payment


$172 Co‐payment


Generics: the greater of 5% Co‐insurance or $3.60Brands: the greater of 5% Co‐insurance or $8.95

48

This chart continues for the benefits for Envision Value Part D plan for the Mail Order drugs

48


EnvisionInsurance Part D – Classic-NEW

Part D Plan Benefits – Classic Option—Only available to BCBSKS Senior Plans

PrescriptionNetwork Retail 30 Day Supply

Network Retail 60 Day Supply

Network Retail/Mail Order 90 Day Supply

Deductible ‐ $435 deductible for initial out of pocket prior to tier coverage.

All Co‐payments would be cost of drug or Co‐payment listed below. Whichever is less.

Network / Preferred Pharmacy



Tier 2 –Generic Drugs $13 Co‐payment $26 Co‐payment $30 Co‐payment



Tier 4 – Non Preferred Generic and Brand Name drugs



25% Co‐insurance No Maximum

N/A N/A

49

This chart shows the benefits for Envision Classic Part D plan

49


EnvisionInsurance Part D – Classic-NEWAvailable to those enrolled in one of the BCBSKS Senior Plans



Tier 1 – Preferred Generic Drugs $9 Co‐payment

Tier 2 ‐ Generic Drugs$15 Co‐payment

Tier 3 – Preferred Brand Name drugs $120 Co‐payment


$240 Co‐payment

After you have a total drug spend over $4,020 coverage in Coverage Gap

Coverage through the Coverage Gap for all Tiers


Generics: the greater of 5% Co‐insurance or $3.60Brands: the greater of 5% Co‐insurance or $8.95

50

This chart continues for the benefits for Envision Classic Part D plan for the Mail Order drugs

50


Questions to Ask Yourself

• Which health plan is best for me?– How often do I visit the doctor?

– How many medications do I take?

– Compare premiums, deductibles and co-insurance

• Which health plan carrier is the best for me?– Ask my doctor’s office which insurance plans they

accept

• What is the total cost to me?– Add it all up

51

Here is a list of questions to ask yourself when making your decision on which coverage would be the best for you.

51

52


Identification Cards• Aetna Medicare PPO ESA plans--only members

that make changes or new members will receive new cards

• BCBS and Caremark will be sending new cards to all members

• Aetna, Delta, Surency and Quest are only sending cards to new members or members who make changes in coverage

• Envision Part D-Classic, Value & Premier members will receive new cards

52

• BCBS, Caremark & EnvisionInsurance are sending new id cards to all members. Aetna Medicare PPO ESA will send ID cards to members that make changes and to any new members.

• Aetna, Delta, Surency and Quest are only sending new ID cards to members that make changes.

10/21/2019


Open Enrollment Website

• SEHP Membership Administrative Portal (MAP):

https://sehp.member.hrissuite.com/

• You will need to upload electronic copies of birth certificates & marriage licenses if you are adding dependents during OE in MAP

– Scans

– Photos

• You will be able to update your information & mailing address

– Address changes are for the health plan information can be made at any time during the year

MAP Questions: [email protected]

53

• The website listed is the Member Portal where you sign into so you can make any changes to your coverage.

• Open Enrollment is your opportunity to decide what changes, if any, you want to make for next year. Open Enrollment is from October 16th through November 15th and enrollment will again be done online in the Membership Administration Portal (MAP). If you need help making changes in MAP you can call the Direct Bill Call Center @ 1‐866‐541‐7100 and someone will be available to help make these changes.

• If you are adding a spouse/dependent to your coverage you will need to upload copies of the appropriate documentation, again if you are needing help please call the Call Center.

53


Membership Administrative PortalMAP

• Enroll online with any computer that has internet access

– Do not have a computer at home? Visit your local public library or Senior Center!

• You will log in using

– Your Kansas Employee ID

– Your Social Security Number

– Your Date of Birth

– Email Address

54

The Member Portal can be access from any computer that has internet access. Be sure you have your Kansas Employee ID—if you don’t know this number you will need to call the DB Call Center and they can give it to you‐‐,your Social Security #, date of birth and an email address.

54


Open Enrollment Website

• Remember to review all contact information that is currently on file and make any necessary changes. All SEHP Benefit information will be sent to the contact information currently in MAP

– Address, phone number, email address & ACH—bank information

• Complete the enrollment online

– Follow the instructions on the screen and make election changes

• “Save and Submit” your changes

– Print off the summary of changes for your records

– An email confirmation statement will be sent to the email address provided

55

When you are in the Member Portal be sure to review and update your contact information. You will then complete your elections by following the screens and then you MUST click the Save and Submit button for your changes to be made. Once you do that you will then receive an email with a ‘Pending Election” statement showing your elections for Plan Year 2020.

55


Direct Bill Call Center

• Direct Bill Call Center Available

– October 11, 2019 – December 6, 2019

• Hours of Operation

– 8:30 am – 4:30 pm Monday - Friday

• Call Center Phone Numbers

– 1-866-541-7100 (Toll Free)

– 1-785-296-1715 (Topeka)

• Closed for the following holidays

– Monday, November 11 (Veteran's Day)

– Thursday, November 28 & Friday, November 29 (Thanksgiving)

56

We have a Direct Bill Call Center for our retirees to call and listed above is the information as to hours of operation, phone number and days the call center will be closed.

56


Resources

• Open Enrollment Information

– 2020 Direct Bill Open Enrollment Booklet Online (charts included)

• Direct Bill Newsletter

– Includes important reminders and announcements

• Medicare and You handbook for all Medicare participants

• Email [email protected]

• SEHP Website www.kdheks.gov/hcf/sehp

• Medicare Website www.medicare.gov

– Membership Portal https://sehp.member.hrissuite.com/

57

Resources available to you are the Direct Bill Open Enrollment book for Plan Year 2020. Some members requested a copy of this book be mailed to them, others can view this book online at our website listed below—SEHP Website. Also, a Direct Bill newsletter has been sent to all Direct Bill members with information about changes for next year.

Medicare will be sending a Medicare and You handbook to all Medicare participants and then we have listed some websites for your convenience

57


Resources• Direct Bill Call Center Phone Numbers

– 1-866-541-7100 (Toll Free)

– 1-785-296-1715 (Topeka)

• Health Insurance Counseling (SHICK)– 1-800-860-5260

– Kansas Dept for Aging & Disability Services

– County Extension Office

• Medicare– 1-800-633-4227

• Social Security Administration– 1-800-772-1213

– 1-800-325-0778 (TTY)58

The Direct Bill phone # listed is staffed to help with any questions you might have about your coverage or if you are needing help making changes to your coverage.

Other phones listed for your convenience

58


www.kdheks.gov/hcf/sehp/default.htm

End the PowerPoint with KDHE logo and website

59

direct bill open enrollment plan year 2020 · 2019-10-22 · our mission: to protect and improve...

Documents