mvp medicare advantage ppo plan and elmira city schools · ©2016 mvp health care, inc. the...
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©2016 MVP Health Care, Inc.©2016 MVP Health Care, Inc.©2017 MVP Health Care, Inc.
MVP Medicare Advantage PPO Plan andElmira City SchoolsMVP Medicare Advantage PPO Plan Benefits Overview
Effective 1/1/20
Presentation Overview
How Medicare Advantage Plans Work
2020 MVP Medicare Plan Options
Next Steps
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MVP Health Care
Same network of Physicians and Hospitals Elmira City School employees know and utilize
• 100% of local and regional hospitals
• 99% of local and regional physicians
• 500,000+additional providers with MVP’s national network partner, Cigna
©2016 MVP Health Care, Inc.©2016 MVP Health Care, Inc.
The Advantages of Medicare Advantage Plans MVP’s PPO plans are proud to be rated 4.5 out of 5 Stars overall by Medicare, which reflects our commitment to quality and service for our members!
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. View Star Ratings at www.medicare.gov.
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How A Medicare Advantage Plan Works
• Medicare pays MVP a subsidy each month.
• Your medical care and prescription drugs will be covered by MVP.
• Specialist referrals are not required.
• Use your MVP ID card for all medical and Rx services. Keep your Medicare card in a safe place.
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Eligibility & Enrollment
• You must be enrolled in Medicare Parts A and B
• Must have legal residence within plan service area
• Special CMS enrollment rules apply to End Stage Renal Disease
©2016 MVP Health Care, Inc.©2016 MVP Health Care, Inc. 7
Plan Highlights
•No Specialist Referrals!
•No Annual Deductible – 1st Day/Dollar Coverage
•Annual Out-of-Pocket Member Protection – once the maximum is met, the plan pays 100% for covered medical benefits each year.
•No balance billing – providers can not bill MVP Medicare Advantage plan members for medical costs above and beyond plan copays and coinsurance.
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©2016 MVP Health Care, Inc.©2016 MVP Health Care, Inc. 8
MVP Travels With You Worldwide
• Worldwide Emergency Room Care – anywhere in the world. Member pays applicable copay only. Copay waived if admitted to hospital.
• Worldwide Urgently Needed Care – Member pays a specialist copay.
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©2016 MVP Health Care, Inc.
GoldAnyWhere PPO Plan Options
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2020 GoldAnywhere PPO
Covered Service In-Network
Out-of-Network
Annual Out of Pocket Maximum $4,000Primary Care Office Visits (PCP) $10 Copay $25 CopaySpecialist Doctor Office Visits $15 Copay $25 CopayRoutine Annual Eye & Hearing Exams $15 Copay $25 CopayChemotherapy $15 Copay $25 CopayRadiation Therapy Covered in Full 20%
Dialysis Covered in Full Covered in Full
Inpatient Hospitalization Covered in Full 20%
Surgery Center & Outpatient Surgery Covered in Full 20%Ambulance $35Worldwide Emergency Room Care $65Worldwide Urgent Care Visits $15
2020 USACare
Covered Service In-Network
Annual Out of Pocket Maximum $4,000Primary Care Office Visits (PCP) $10 CopaySpecialist Doctor Office Visits $15 CopayRoutine Annual Eye & Hearing Exams $15 CopayChemotherapy $15 CopayRadiation Therapy Covered in Full
Dialysis Covered in Full
Inpatient Hospitalization Covered in FullSurgery Center & Outpatient Surgery Covered in FullAmbulance $35Worldwide Emergency Room Care $65Worldwide Urgent Care Visits $15
**ALL PLANS**Covered Service
Telemedicine/My Visit Now $0 copay for medical and mental health services
Diabetic Glucose Test Strips Free: Precision, OneTouch & Freestyle Other Brands: 10%
Hearing Aid Allowance $600 Every 3 yearsTruHearing Discount 30-60% discount on over 100 models of hearing aidsEye Wear Allowance $100 Every 2 yearsDental Allowance $300 per calendar year for any dental serviceAcupuncture 50% up to 10 visits per year
Preventive CareAnnual Physical/Wellness Exam Covered in FullMammogram, Prostate, Pap tests Covered in FullBone Mass Measurements Covered in FullFlu & Pneumonia Immunizations Covered in Full
©2016 MVP Health Care, Inc.
Part D Prescription Drug Coverage
Both Medicare Plans Prescription Drug Coverage
Retail (30-day supply)
Tier 1 Preferred GenericsTier 2 GenericsTier 3 Preferred BrandsTier 4 Non-Preferred DrugsTier 5 Specialty Rx
$0 copay $5 copay $5 copay $5 copay $5 copay
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Optional Mail Order (up to 90-day supply)Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
$0 copay $10 copay $10 copay $10 copay not available
*No Deductible *No Donut Hole
CVS/Caremark –Pharmacy Benefit Manager
• Pharmacies are not limited to CVS pharmacies.
• You can fill prescriptions at over 69,000 participating pharmacies locally and nationwide.
• Fast Start Mail Order Program – CVS Caremark will reach out to provider to set up mail order process
• MVP members will receive a MVP-CVS ExtraCare Card providing a 20% discount on items not covered through the basic CVS loyalty card. More than 2200 items purchased in the store or online.
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MVP Health Care Pharmacy Benefits – FormularyMVP Prescription Formulary
Located on the MVP website: 2020 MVP Medicare Part D Employer-Based Plan Formulary
Check the MVP Formulary to see:• What tier your medications are in• If they require prior authorization, have step therapy or have
quantity limits• If they are excluded from coverage• If they are available through mail order, CVS Caremark Mail
Service Pharmacy• If they need to be obtained though MVP’s specialty
pharmacy, CVS Specialty–MVP has it’s own Pharmacy & Therapeutics (P&T) Committee that creates and reviews the Formulary–The Formulary is subject to change
©2016 MVP Health Care, Inc.
Health & Wellness Benefits
©2016 MVP Health Care, Inc.
Living Well Programs
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24/7 Nurse Advice LineCall anytime day or night for answers to your health questions.
New for 2020! $100 WellBeing RewardsReceive a $100 prepaid gift card for completing screenings, financial education courses, community classes and mind & spirit well-being activities.
Annual Physical/Wellness Exam Hearing & Vision Exams Fall Prevention Activities Attending Community Classes Mind & Spirit Well Being Activities
SilverSneakers® Fitness ProgramStay fit at 14,000 locations nationwide, at no extra cost to you!
©2017 MVP Health Care, Inc.©2017 MVP Health Care, Inc.
New for 2020! Meal Delivery Benefit
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MVP is partnering with Mom’s Meals for post-hospitalization meal delivery
14 meals delivered post-discharge
Inpatient admissions only – not observation or SNF
Lunch and Dinner for 7 days
No cost share
Administered by case management
©2016 MVP Health Care, Inc.©2016 MVP Health Care, Inc. 2020
TruHearing Hearing Aid Discounts
©2016 MVP Health Care, Inc.
• WellBeing Rewards to $100 annually (from $75, formerly called Wellness rewards)
• WellBeing Rewards to $100 annually (from $75, formerly called Wellness rewards)
©2016 MVP Health Care, Inc.
$0 Copay for 24/7 Online Doctor Visits
• $0 copay for physical and mental health services
• “Face-to-face” visits on your computer, tablet, or smartphone
• Expert diagnosis, and prescriptions, if needed
• Convenient – available 24 hours a day, 365 days a year
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MVP at Your Service - 1-800-665-7924Dedicated Medicare Customer Care Center
• Monday-Friday 8am to 8pm Extended Enrollment Hours: Oct 1st – March 31st 8am-8pm, seven days a week
• Specialized & dedicated Medicare Member Service Team, representatives work only with our Medicare Advantage Plan members.
• No automated systems and calls are never sent outside of the United States!
• Live USA based service team
What Happens Next
• Contact MaryJane Carpenter, Employee Benefit Coordinator, at 607-735-3005 to enroll
• You will need only your red, white and blue Medicare card to complete the application
• You will receive a Welcome Letter from MVP verifying your enrollment before your receive your MVP member ID card. The Welcome Letter will act as proof of insurance until your ID cards arrive.