As outlined within the Funds announcement letter of September 4th, effective, January 1, 2021, the Lake County Indiana NECA–I.B.E.W. Health and Benefit Plan is converting its medical and prescription drug plans for Medicare-eligible participants into the following:
- An insured Medicare Advantage plan through UnitedHealthcare® for medical benefits; AND
- An insured Medicare prescription drug (Part D) plan through UnitedHealthcare® with supplemental coverage through Sav-Rx.
As explained within that same correspondence, the Plan must have your government issued MBI (Medicare Beneficiary Identifier) number in order to register you into this program. Consequently, if you have not previously done so, make certain that you complete in its entirety the MBI form that accompanied the Fund’s September 4, 2020 letter to you. Upon completion, mail that document back to the Fund Office.
You are reminded that the implementation of these programs neither decreases the Plan sponsored benefits you currently receive and enjoy, nor will it increase the amount of your monthly self-payment. Equally important to understand is the fact that the Plan is not abandoning you. The Plan remains:
- The source of record for all eligibility matters,
- The provider of your dental and vision benefits, and,
- The funding agent for the benefits you receive.
Additionally, the Board of Trustees will be monitoring these programs to make certain that you are receiving the benefits in which the Plan is paying for.
Lastly, and putting aside the increase in benefits previously explained in the September 4th announcement letter, this change will significantly simplify your medical recordkeeping as you will no longer be required to submit the Medicare EOB into the Plan for it to pay the provider the twenty percent (20%) coinsurance amount.
Frequently Asked Questions & Answers
Yes, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B. You must continue paying your Medicare Part B premium to Social Security in order to be eligible for coverage under the plan.
Yes, this plan offers nationwide coverage.
What doctors can I use? What do I need to know about the UnitedHealthcare provider network? What is the difference between in-network and out-of-network providers?
UnitedHealthcare® Group Medicare Advantage (PPO) plan is a unique Preferred Provider Organization (PPO) plan that allows you to see any provider (in-network or out-of-network) at the same cost share, as long as they accept the plan and have not opted out of or been excluded from Medicare. Network providers have a contract with UnitedHealthcare. When you go out-of-network for care, the PPO plan pays providers just as much as Medicare would have paid. You pay the same out-of-pocket cost share as if you had stayed in the network.
What happens if my doctor does not accept Medicare Advantage plans or participates in Medicare but does not accept this plan?
The UnitedHealthcare® Group Medicare Advantage (PPO) plan does not require a doctor to have a contract with UnitedHealthcare. Under this plan, the doctor will be paid the same as Medicare.
If your doctor has opted out of the Medicare program in its entirety, you would only have coverage in an emergency situation. Less than 1% of doctors nationally have opted out of the Medicare program.
Whether your provider is in-network or out-of-network, your provider can submit claims to UnitedHealthcare online. If needed, the UnitedHealthcare claim address information is provided on your UnitedHealthcare Member ID card and in your Welcome Packet. UnitedHealthcare processes claims payments for out-of-network providers in compliance with all federal regulations.
Under this plan, you are protected from any balance billing. When you go out-of-network for care, this plan pays providers just as much as Medicare would have paid (up to the Medicare Limiting Charge), and you pay the same copayment or coinsurance as if you had stayed in-network. If your doctor tries to balance bill you, please contact UnitedHealthcare.
Will I need to organize and coordinate my Medicare explanation of benefits (EOB’s) with those of this Plan?
No. You will be only receiving one explanation of benefits (EOB). One consolidated statement means that your medical record keeping becomes easier.
Your primary plan will be the Part D plan through UnitedHealthcare and your supplemental plan will be through Sav-Rx for your prescriptions. If the primary coverage does not pay because of the design of that plan, but it is currently a covered benefit on your plan today, the secondary plan will continue to pay. There is no deductible and no coverage gap (donut hole). You will pay your usual co-pays for the entire year, unless you reach the catastrophic level.
The secondary plan through Sav-Rx will retain the same rules and exclusions that are currently in place. To avoid out-of-pocket costs, be sure your doctor prescribes generics or authorizes generic substitution whenever generics are available.
If you currently obtain your maintenance and long-term drugs through the Sav-Rx mail-order pharmacy, you will continue to enjoy Sav-Rx’s excellent mail-order services. You are not required to make any changes to your mail order program unless you want to. Should that be the case, you may switch to OptumRx®. OptumRx® handles UnitedHealthcare’s mail-service pharmacy. If that is of interest to you, please carefully read the information that will be included within UnitedHealthcare’s packet that will be sent to you in the near future. Nevertheless, if you are happy with the Sav-Rx mail in pharmacy services you may continue to obtain your mail-order drugs through Sav-Rx. No action needs to be taken to keep your Sav-Rx mail-in pharmacy services.
Because they believe that coupons create a disincentive for patients to utilize pharmaceutical solutions that are more cost effective for both the insurer as well as for the patient, Medicare prohibits the use of coupons or co-pay cards to be used in conjunction with Part D pharmaceutical programs. Consequently, if you are already in the habit of using coupons or co-pay cards, you can continue to do so up until midnight on December 31, 2020. After that, you will no longer be permitted to utilize them.
FLU AND SHINGLES SHOTS
Flu shots can be obtained at any retail pharmacy that participates in the Sav-Rx Retail Pharmacy Network. Shingles vaccinations are limited to only Walgreens and CVS.