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Welcome to the TCU – One Exchange Informational Meeting

Welcome to the TCU – One Exchange Informational Meeting. What’s changing?. TCU changed the way it provides medical benefits to Medicare-primary retirees and their Medicare-primary dependents.

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Welcome to the TCU – One Exchange Informational Meeting

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  1. Welcometo theTCU – One Exchange Informational Meeting

  2. What’s changing? • TCU changed the way it provides medical benefits to Medicare-primary retirees and their Medicare-primary dependents. • Retiree’s medical benefits will be managed through a Health Reimbursement Arrangement account (HRA).

  3. What we’ll cover today • Why this approach? • How this affects you • Medicare 101 • Introducing OneExchange • Going forward • Questions & answers

  4. Why This Approach? • Provides Medicare-eligible retirees with: • Greater flexibility in how to use health care dollars • A broader range of plan options • The possibility that new coverage will cost less than current coverage • Enables TCU to continue supporting retirees during a time of uncertainty surrounding the rising cost of medical insurance and services • Enables TCU to predict and budget for health care costs more accurately

  5. How This Affects Medicare Eligible Retirees • Medical premiums and out-of-pocket costs will vary depending on the coverage you choose. • You will work with OneExchange to enroll in a plan that meets your medical and Rx needs. • TCU will establish your Health Reimbursement Account. This account will be administered by OneExchange • OneExchangeAdvisors will help you understand the costs associated with your coverage – premiums, co-payments, deductibles and all other costs. What you pay How toenroll Your support

  6. Medicare 101 • Everything you wanted to know about Medicare, but were afraid to ask!

  7. Original Medicare: • A Health insurance program for • People 65 years of age and older • Some people with disabilities • People with End Stage Renal Disease (ESRD) • Administered by CMS • Enrollment handled by Social Security Administration or Railroad Retirement Board Key Terms Medicare Part A = Hospital Coverage – administered by CMS Medicare Part B = Medical Coverage – administered by CMS Medicare Part C = Medicare Advantage Plans – private plans – group or individual market Medicare Part D = Prescription Drug Coverage – private plans – group or individual market Medicare Supplement (Medigap) – private plans – group or individual market 7

  8. Original Medicare: Part A (Hospital) 8 Premiums: • Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Medicare-covered employment. • $254.00 for 30-39 quarters of Medicare-covered employment. • $461.00 for people who have less than 30 quarters of Medicare employment. • Foreign citizens and Americans who worked abroad Coverage: • Medicare Part A covers: • Hospital Stays • Skilled Nursing Facility (SNF) • Home Health Care • Hospice Care • Pints of blood received at a hospital or skilled nursing facility during a covered stay

  9. Original Medicare: Part B (Medical) • Coverage: • Doctors’ services (physician office and some hospital settings) • Limited Chiropractic Services • Outpatient Services: • Diagnostic tests- clinical Lab • (x-ray, MRI, CAT, EKT, nutritional therapy, etc…) • Other medical services • Durable medical equipment (DME)- prosthetic, wheelchair etc. • Diabetic Supplies • Ambulance service 9 Initial Enrollment Period: • When turning 65. • 3 months before, the month of, and three months after 65th B-Day. (7 month window)

  10. Medicare Part B - Late Enrollment Penalty A person that is eligible for Medicare but opts out of Part B may be subject to a 10% per year Part B penalty • Penalty is waived if beneficiary has coverage through a group policy based on active employment

  11. Medicare Eligibility & Active Employment • If active and covered under the group health plan, employee does not enroll in Medicare Part B or select a Medicare supplemental plan(s) until they retire or lose coverage.  11 For employers with 20 or more employees, group coverage is primary for Medicare beneficiaries who are still active, and Medicare is secondary.  Therefore, activebeneficiaries don’t have to enroll in Part B and will not be penalized when they decide to retire.  When they decide to retire, beneficiaries should enroll in Part B three months prior. This will insure that they can enroll in a Medicare Supplement plan and have it effective as soon as their group coverage ends.

  12. Post-65 Coverage Options Original Medicare- FFS (Fee For Service) MA-PD OR • Part A • Hospital • Institutional Part D Drugs • Part B • Doctors • Supplies • Outpatient • Professional Medicare Advantage (MA) + PFFS PPO HMO Added Optional Coverage + Part D Drugs (Stand Alone) Medicare Supplement (Medigap Plans) Fills in Medicare payment “gaps” in coverage 12

  13. Part D: What is Medicare Part D? 13 • Medicare Part D is optional prescription drug coverage for everyone with Medicare Part A or B • PDP’s are run by private insurance companies approved by Medicare (Like MAplans) • If beneficiaries decline to enroll in a Medicare drug plan when they are first eligible, they may be penalized. (1% of national average per month) • Beneficiaries sign up when they first become eligible for Medicare, or during the AEP

  14. Helping You Prepare For Your Upcoming Medicare Enrollment OneExchange TOWERS WATSON

  15. Who We Are • Transitions Can Be A Good Thing! • OneExchange – For Your Benefit • A Deeper Dive – Benefit Advisors, Private Exchange, Optimize Savings, Health Reimbursement for You • Next Steps • Questions & Answers 15

  16. Your Transition • Transitioning the way access is provided to retiree health benefits for Medicare-eligible retirees and their Medicare-eligible dependents • OneExchange has been chosen after an extensive evaluation of choices • OneExchange will help you with total care in transitioning over to more-effective individual Medicare health insurance • The private exchange offers greater choice and flexibility; many affordable choices exist and in many cases provide more value at a lower cost than an employer group plan • Ongoing support – at no cost to you

  17. Towers Watson over 100 years experience About OneExchange In the middle of our 9th annualenrollment season Hundreds of thousands of retirees served across300+employers Licensed advisor providesguidanceandlifetime advocacy Founded in 2004 Personalized options withplans from a nationwide network of carriers No added fees for our services FirstandLargest private Medicare Exchange

  18. Why OneExchange? White-Glove Service Consultative Process Simplified Selection EffortlessEnrollment Lifetime Advocacy Selection Process: • Your Benefit Advisor will provide the guidance you need to easily understand your Medicare options • Advocacy: • Specialized and focused; trained in insurance, Medicare and issue resolution • Consultative Process: • Your Benefit Advisor will determine coverage needs and thoroughly research your options • Enrollment Process: • 100% paperless, telephonic enrollment • Secure and efficient towerswatson.com

  19. Our Service Centers 100% Domestic Workforce - NO Outsourcing! Salt Lake City, UT Dallas, TX Operating hours: Monday-Friday 7am-8pm CT

  20. Plans and Partners • All Medicare Plan Types Medicare Supplement(Medigap) Medicare Advantage Prescription Drug(Part D) • A few examples of the carriers on our Medicare exchange: Multiple plans available to you from national/regional carriers towerswatson.com

  21. Your Experience

  22. EducationEnrollment Guide Prepare for your enrollment consultation • Review Medicare basics TOLL FREE 1-888-429-8490 medicare.oneExchange.com/TCU

  23. Decision Support Tools • Help Me Choose • Prescription Profiler • medicare.oneExchange.com/TCU • 24/7 access to your information

  24. Benefit Advisors • Licensed / Certified / Appointed • OneExchangeUniversity™ • Average age 43 • Objective & unbiased • 100% domestic workforce Hours of Operation Monday – Friday 7 am – 8 pm CT

  25. Enrollment Process • Benefit Advisors can discuss coverage options with anyone • Telephonic enrollment – 2 part process • 100% of calls are recorded

  26. Tag-Team Enrollment Expertise • Allows BAs to Have More Time for Consultations • Ensures Accuracy of Application Submissions Licensed Benefit Advisors (BAs) Application Data Processors (ADPs) Licensed / Certified / Appointed by Departments of Insurance; the experts in probing health plan needs and helping to recommend the right plan Trained in carrier enrollment applications; the experts in accurately filling out the paperless applications to optimize first-time acceptance by the carriers

  27. Enrollment Confirmation Notice • Features: Sent once a participant has enrolled into a plan • Confirms all plan selections and enrollments • Carrier Name • Plan Name • Confirmation Number • Premium • Coverage Effective Date • Whether or not they have selected Automatic Reimbursement • What Happens Next • Expectations on Carrier correspondence, including ID Cards • Subsidy Packet • Automatic Reimbursement • Direct Deposit

  28. OPTION 1:Medicare Advantage Plan with Prescription Drug Coverage (MAPD)* MEDICARE ADVANTAGE + PD * Note that Medicare Advantage plans are generally network based plans

  29. OPTION 2:Medigap Plan + Part D Plan MEDIGAP PLAN PART D PLAN Note: You may need to pay your first premium when you enroll in coverage

  30. Medicare Prescription Drug Coverage 2015 You pay 45% of Brand Name and 65% of Generics until your out of pocket costs reach $4700; Pharmaceutical contributions will count towards the $4700 True Out Of Pocket costs You Pay Full Retail Until Deductible is Met 2015 - $320 Initial Coverage Coverage Gap Catastrophic Coverage Deductible Only 25% reach Donut Hole Only 4% reach Catastrophic You pay copays for your plan coverage for the first $2960 in actual costs of Medications You Pay $2.65 for Generics and $6.60 for Brand Name or 5% - whichever is greater

  31. How This Affects You • Depends on the plan you choose • Choose the right level of coverage for you and your spouse individually What you pay How you enroll • You enroll directly through OneExchange • You and your Medicare-eligible spouse enroll in separate plans Your support • OneExchangewill be your partner as you make this decision and enroll in plans • OneExchangewill provide ongoing support - at no cost to you

  32. Local Plan Slides Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame

  33. Plans Available in Dallas and Tarrant Counties Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame

  34. Also Available in Dallas & Tarrant Counties Vision plans and Dental plans are not Medicare plans Note: 2014 rate examples; 2015 rates will be available in the October 2014 time frame

  35. Medicare Advantage Plan 2014

  36. Medigap Plan F + PDP (75 year old male) 2014

  37. Health Reimbursement Arrangement (HRA)

  38. What Is An HRA? • Tax-free account used to reimburse you for eligible health care expenses – you pay first and then get reimbursed • If you are eligible, your former employer will make an annual contribution to a Health Reimbursement Account (HRA) • You may use HRA funds to reimburse yourself for eligible medical expenses which include premiums that you pay coverage for (including Medicare Part B) and certain out-of-pocket expenses • Your HRA funds will be available on the first of the month of your retirement, prorated for the year. On Jan 1st of the next year, you receive the full annual amount.

  39. Health Reimbursement Arrangement If you are eligible, reimbursements are made up to the amount available in your HRA

  40. 2. Manual Reimbursement Health Reimbursement Arrangement Reimbursement Options 1. Automatic Reimbursement [including recurring claims] If you are eligible, reimbursements are made up to the amount available in your HRA

  41. Auto-Reimbursement (AR) • Service offered by OneExchange • Available on most plans • Works for premium reimbursement only • No claim form is required • Can take 2-3 billing cycles to initiate • If you need your reimbursement sooner, simply file a paper claim. The form and instructions will be provided in your Funding and Reimbursement Guide

  42. Next Steps

  43. What You Need To Do: Action Required! • You MUST enroll in Medicare Part B if not already enrolled – contact the SSA • Contact OneExchangeat your toll free # • Make a first contact call now and schedule an enrollment appointment • Enroll in your new coverage • Call us during your scheduled appointment time • You are guaranteed coverage

  44. Your First Contact Call – We’re Ready!

  45. Personal Guidance: For a Lifetime • A lifetime advocate: • Navigation • Enrollment • Claim issues • Denied policies • Affordability concerns • Prescription • Late enrollment • HRA • Annual plan review

  46. Why OneExchange Retiree Experience First and largest Medicare Exchange; private Satisfaction 99% client retention rate Average retiree satisfaction 9.2/10.0 Relationship As life happens, we are here for you Technology Most automated connections, across 90 carrier partners Size and Strength 300 employers and 500,000 retirees being served People Objective and personal touch through stringent training processes and CMS compliance criteria

  47. We Are Ready For Your Call 1-888-429-8490

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