Welcome to Public Safety Retirement System Open Enrollment 2008
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Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Welcome to Public Safety Retirement System
Open Enrollment 2008
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Agenda
Updates for 2008Plan OptionsBenefits
Medicare Non-Medicare
Enrollment and Contact Information
Questions
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Updates for 2008 No rate increase on all plans Senior Supplement -
Medicare Part D Changes TDE $2,510 TrOOP $4,050
PPO RX copays $20/$40
New ID cards for all Medicare and PPO members
SecureHorizons Brand (no change for PSPRS)
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Plan Options
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Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Medicare Eligible Medical Plans
MedicareComplete HMO (Secure Horizons)Medicare eligible retirees/dependents
living in Cochise, Coconino, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, Yavapai and Yuma Counties
Senior SupplementMedicare eligible retirees/dependents
living nationwide
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare Medical Plans
Health Maintenance Organization (HMO)Non-Medicare eligible retirees/dependents
using providers in Maricopa, Pima and Pinal Networks
Preferred Provider Organization (PPO)Non-Medicare eligible retirees/dependents
living in the state of Arizona
Indemnity Non-Medicare eligible retirees/dependents
living outside the state of Arizona
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Additional Programs
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Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
SilverSneakers
Offered to all medical plansMembership at participating fitness centers
at no additional costGroup exercise classes designed to
increase strength, flexibility and energySenior Advisor at each fitness centerSocial eventsSteps Program for the Rural Areas
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Caregivers
Offered to all medical plansUnlimited telephonic access to geriatric
experts
Personalized research into and screening of community programs
Assistance in making and coordinating care arrangements
Six hours of geriatric care management services annually
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Benefit Overview
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Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)
Must have Medicare Parts A & BAutomatically enrolled with Medicare
Part DSign Statement of UnderstandingSelect a Primary Care Physician (PCP)Select a Hospital NetworkPCP Referral to Specialists
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)
Outpatient Services
Primary Care Physician $15 copaymentSpecialist $30 copaymentLab You pay nothingStandard X-Rays You pay
nothingSpecialized Scans $50 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)
Outpatient Services
Urgent Care $15 copaymentEmergency Room $50 copayment
(waived if admitted)
Ambulance $25 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)
HospitalizationInpatient $100 copay per admitMental Health $100 copay per admit;
190 days lifetime maximum
Skilled Nursing No copay; limit ofFacility 100 days per benefit
period
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)
Prescription Drug BenefitFormulary AppliesUnlimited Annual MaximumRetail 30 day supply
Tier 1 $20 copaymentTiers 2, 3 & 4 $40 copayment
Mail Order 90 day supplyTier 1 $40 copaymentTiers 2, 3 & 4 $80 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)Optical Benefits
Routine Care - Spectera ProvidersEye Exam $20 copaymentFrames $130 allowance/yrLens Covered 100%
OrContact Lenses $105 allowance/yr
Medically Necessary – Contracted Medical ProvidersEye Exam $15 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
MedicareComplete HMO (SecureHorizons)
Hearing BenefitsMedically Necessary
Hearing Exam $30 copayment
Routine hearing exams Not covered
Hearing Aids Not Covered
See page 13 of ASRS/PSPRS brochure for discounts on routine hearing exam and hearing aids – Please note this is not an insurance benefit
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
Must have Medicare Parts A & B
Automatically enrolled in Medicare Part D
ID cards -Medical (including vision)Prescription Drugs – UnitedHealth Rx
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
Freedom to use any provider who accepts Medicare
Medicare is primary insuranceSenior Supplement helps pay for
deductibles and coinsurance not covered by Medicare (based on schedule of benefits up to policy limit)
Calendar Year Deductible - $100
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
Medical Services - Physician services, inpatient and outpatient
medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipmentAfter Satisfying the Calendar Year
Deductible, Plan pays the Part B deductible Plan pays 20% of Medicare approved amounts
Plan pays 50% of outpatient Mental Health services
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
Hospitalization After Satisfying the Calendar Year
Deductible, Plan pays the Part A Deductible and the daily coinsurance rates after the 61st day
After you have exhausted the Medicare covered days, Plan pays 100% of Medicare eligible expenses for 365 additional lifetime days
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Senior Supplement
LimitationsInpatient Mental Health – 190 days lifetime
maximumSkilled Nursing Facility – 100 days per
benefit period
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UnitedHealth RX for Group PDP
Prescription Drug BenefitOpen FormularyRetail 30 day supply
Tier 1 $10 copaymentTiers 2, 3 & 4 $35 copayment
Mail Order 90 day supplyTier 1 $20 copaymentTiers 2, 3 & 4 $70 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
UnitedHealth RX for Group PDP
Prescription Drug Benefit continued
Copays applies to the first $2,510 of prescription drug cost per person.
After $2,510 in Total Drug Expenditures (TDE), you are responsible for 100% of drug cost until $4,050 in True Out of Pocket (TrOOP) is met;
Then you pay $2.25 generic, $5.60 brand name or 5% of the cost; whichever is greater
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
UnitedHealth RX for Group PDP
How Medicare Part D Prescriptions works: Applied to Your Applied to
Cost of RX TDE Copay TrOOP$100 → $100 $35 → $35$ 50 → $150 $10 → $45
↓ ↓$2,510 100% ↓
↓when TrOOP adds up to $4,050generic $2.25 or 5%brand $5.60 or 5%
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
Optical Benefits - Routine & Medical
Eye Exam $20 deductible
In-Network – 100% after Spectera Vision deductible
Providers
Out-of-Network $80 allowance
after
deductible
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior SupplementOptical Benefits
Frames & Lenses OR Contact LensesIn-Network
Frames $130 allowance/yrLenses Covered 100% OrContact Lenses $105 Allowance/yr
Out-of-NetworkFrames & Lenses Or Contacts $100 Allowance/yr
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Senior Supplement
Hearing BenefitsHearing Exam Medically NecessaryHearing Aids Not Covered
See page 13 of ASRS/PSPRS brochure for discounts on routine hearing exam and hearing aids – Please note this is not an insurance benefit
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Enrollment and Contact Information
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Forms to Submit
PSPRS enrollment form
Statement of Understanding – if enrolling in the MedicareComplete HMO (SecureHorizons) plan
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
How to Reach PacifiCare
Customer ServicePhone Numbers Listed on Back of ID cards
and on the inside cover of the ASRS/PSPRS Open Enrollment Guide
www.pacificare.com
www.securehorizons.com
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
Select a Primary Care Physician (PCP)
Select a Network
PCP Referral to Specialists
Self Referral for Mental Health, GYN, Optical and Hearing
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
Outpatient Services
Primary Care Physician $20 copaymentSpecialist $40 copaymentLab You pay nothingStandard X-Rays $20
copaymentSpecialized Scans $150 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
Outpatient Services
Urgent Care $40 copayment
Emergency Room $75 copayment
(waived if admitted)
Ambulance You pay nothing
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
HospitalizationInpatient You pay 30%Outpatient Surgery You pay 30%Mental Health You pay 30%
Out of Pocket Maximum (Inpatient or Outpatient Hospital coinsurance applies)
$3,000 Individual$9,000 Family
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
Prescription Drug BenefitFormulary AppliesUnlimited Annual Maximum Retail 30 day supply
Generic $20 copaymentBrand Name $40 copayment
Mail Order 90 day supplyGeneric $40 copaymentBrand Name $80 copayment
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare HMO
Optical BenefitsEye Exam $40 copaymentFrames $50 allowanceLens $50 allowance
OrContact Lens $100 allowance
Hearing BenefitsHearing Exam $40 copaymentHearing Aids $200 allowance
per calendar year
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
In Area PPO rates are for retirees and dependents living in Maricopa, Pima and Pinal counties
Out of Area PPO rates are for retirees and dependents living in all other counties in Arizona
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
Freedom to use any licensed provider In-Network Providers paid at
contracted rateOut-of-Network Providers paid at
Usual, Customary and Reasonable (UCR)
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
Calendar Year Deductible $500 per person$1,000 per family
$75 Emergency Room Deductible
$250 Out-of-Network Hospital
deductible per admission
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
In-Network Out of Pocket
$2,000 per person$4,000 per family
Out-of-Network Out of Pocket
$6,000 per person$12,000 per family
Lifetime maximum benefit
$2,000,000
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
In Network Out of
Network Office Visit $15 copay* 60%
including preventative
Coinsurance 80% 60%
Emergency Room 80% 60%
Ambulance 70% 70%
*lab and x-ray subject to deductible and coinsurance
Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare.
Non-Medicare PPO
Prescription Drug BenefitFormulary AppliesUnlimited Annual Maximum Retail 30 day supply
Generic $20 copaymentBrand Name $40 copayment
Mail Order 90 day supplyGeneric $40 copaymentBrand Name $80 copayment
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