HomeMy WebLinkAbout1992-05-27 92-279 ORDERDate WV5'27'92V Item No. 92 27
ameE, ueaignatfng b p losvlth mauran^e C� for
Item/Subject: Retirees O Age 65 in tlas City of Barg Arxatnt
Responsible Department: Hwcaati
Commentary:
Chmxies in ysderal lca ruga s[aMardiaattm of agplmental IAeditaxe it vearce
plane fo� xetircpa over age 65. gbe Bx acxa includity sty, lbpeUal
Atrttarity and Llbr retirees o£fece Ca¢union Plan I with Blue Alliaext Major
Medical. effective . y 1, 1992, This cvvsre9s-will not ba available ad a
selst3en must be vele aimng ] options that veet tatexeguixa-
ma¢s. 1ha eptiwls and the essociatal henefit level asd cost ivpa ate detailed
in the ati lad seen label May 19, 1992. A principal issue in this decision is
Mtetlmr retirees we 65 (cuav2ly 131) sfrnald be retaueerl as pvxt of the BaeaJe¢
accwn[, xesultinnI in mod ately hfghct: pxmdtss fox evmry xne, ox ae}x2'atsl fxva
tde amrnmt, rosulting in to a pxa mums for the sewae I greuP participants.
9ts Riranre C tree diacuseei this issue at lemg at ttel. neetimi on May 18th
arcl m ucetei fur discussion at a budge; w Iurlop echetluled for Svesdey, May
26th. Barbara Rice of the Library atd Elsie Coffey of the Horsing AutFnrity axe
eNwxe of this issue and have been invitei to attxexd aM participate.
y 1 - `�, �Depmnrnrxead�ryl�
Manager's Comments: pb tm-U. [LWUAxOf1 B -R ituuAAA.(fi. ✓hUa�'6v
i 11aD9Pew�JoA �^&
City.Nvmgn
Associated IMonnadon: -
lNler, with Aeeociated Inf®atian
Walter: Approval:
Fdunee Diree,d
Legal Approval blk dm
COY SW ckw
Inst--tm{{{duced For
Passage
`First Reading No—of —
❑Referral
5sslr,e1 to Councuor Bragg May 27,1992 92-279 s
_ CITY OF BANGOR
(TITLE.) (JOnNV£-_.__..._...........Y cjnati ..Group. stealth.insucaace. Covemge _.
for Pefiieea Pier Age 65 sn the City of Bangor PcmuR
By W City fbum l of aty Of Ba :'
ORDER®.
TEAT
in acmrdarce With Federal leglsletion ralufr++5 the
atmaia Zation of suppl� medicare t th inaurame covecagez the
Bangor City Cwuvtl hereby salxts the £ollwheg zy health izrei¢m plan
to corer thoee employees over age 65 in the City of Bangor account:
92-279
ORDER
p:
` :.:Title. egna.
IN CITY COUNCIL
May 27, 1992 D ik tin& Group Health Insurance
11�
.
\ p Coverage forRetirees Over Ag 65 in the
..aU" .Afey �o _¢
�E
IM, CITE COUNCIL [v
Assgued
Sud¢ 3, 1992
Inserting I in apace provided
pass
an11ed Co p by the yes ..... ...
orsfollowing
and no Cohen. Councilors voting yes: wlc ilaav
voting
Bragg, Cohen. Soucy and Shona. Councilors
Coding no: BaldacciCouncilor Blanchette, Frankel.
and Sail. Councilor absent: Sawyer. Motion to carve
felled to page by the following yea and n votes.
Coutou colons yes: keland and
Blanchette, FraSoucy
orscouncilors
Seal.
Saul. g no: Bra Saucy end Stone.
no:
voting n
absent: Sawyer. consid rateq
CouAmended
Reconsideration of insertion of Group I Passedvotes..
I
Amended by intention :f Croup I Passed by the
by yes and voter.
Councilors voting yes: Blanchette, Bragg, Cohen, a
oh n, Franke Soucy and Stone.
Councilor voting v Baldache and Sail. Councilor
for Abse
Councilors Order Passed As Amended by the
yea and no votes. Councilors
kel¢fl.
Blanchette. Bragg, Cohen, Frankel. Saucy and Stone.
e, Bragg,
yrs: Baldting
Cozen i^^tv��Cing no: B xl. councilor absent: Sawyer.
Couingncilor no:
y
i
L
92 279 3,I
5b: Finance C ttae Members
-Fri: Fnbart W. Farrar, Dir Yon of ern,:..:mention
Re: Health Insurance Benefit levels arca B3te.5 - Bangor Atv-rmt Fetireea
O ar sge 65
Date: May 14, 1992
intn2duction
Vara has b0ea zecent Federal legislation c=emtng the stamdaxdfzation of
health irauraoe coverage (�are Msdigap) that is goixy to have an
imuedisre aaddreaeUC iapact m the benafdt levels and � costs for
retirees over age 65 under the City of Bangor G; Health Plan. Inchon in
this yrngi are City, Public Librery, ead abusing Autharity retfraes. 'Brae
xetireee in tla M Cpion are excluded fxm: this issue.
Bangor was ratified of this pending change recently vrhen we r Leaved our
proposed health inmueaca rates for PY 1992-93. (:ran rte a Wdficmice of
this issue aW the i Iicatios for the aty, ire earreat aplaFa g a,d
retirees, I will attempt to ratline the major points ttat read w be
considered w the parties immlvad rove toward a necIsla5. Please be advised
that musx this i gislatlmz, health ineurems plans vast erre i cmpli
July 1, 1992 or when t gimp health insurance plan C,eas dua for renewal,
whichever comes first. in Bmgor's case, this le July 1, 1992.
Background
As a benefit upon ratfrerent, forret eia,Fees may slat to xe"a;" in the
aty's grmp health insurance plan. pergreas under the Bangor account are
PrxsamtlY mvered.urmtler a g Blue Cross-Blua 9 ld plan loam as
coqvLLrn Plan I wiu Blue Alliance Major Medical. nmay are resp risible for
paying the full praairy enumt, either through a de uctlon in t Sr M
State Fe.� rmnthly check or df insufficient funds e r rtumgh a
direct palaent t gh the City Tri pt.m Shield. a gently, sroe
212 retiraes partic4Ate, 81 t= age 65, 3 age 65. 93a change that
must occur m or abort July 1 is frOe t e t o0av ,ar Plan I and. Major
y4dical for retirees war age 65 to one of sever optioe. As our provider,
Blue Cross -Blue Shield has radia wallable these seven optica which Imbat the
new Federal staciardizel .a.,.�...= for health imvnnce mveraga
careening those o x age 65. here aro air raw CMPm Plan gltiorm Al B,
C, E, F, I and One C¢� id� as CaVe-Qat cvxrage. Me Chart below
illustrates arse options and The associated costs.
gff-�,
Cwpaniw Plea I wtth Blue Alliarsa Major Ma ical
Btlivithml 2 -Parson
7/91 - 6/92 $ 70.53 $156.35
7/92 - 6/93* $ 83.28 $185.43
*Estimated o y - c0a a r Plan I with Major Dktlir.r no linger available
A
$ 39.23
$ 78.46
B
$ 53.69
$ 87.30
C
$ 64.35
$128.70
E
$65.58
$131.16
F
$ 78.94
$157.88
I
- $115.92
$231.84
$ 97.05 $212.97
92 279
O the six new C®ianion Plane, pptiq g A, B, C, B, F, I, Q> m I most
closely maeffilea the t,gent hKiget Setel enjoyed by mtdrepa. tvaever, this
oarerage 3s not irisntical ZUNI theme is Sae dcczasse in benefits, if arty of
these six optima axe sedated, the expsrieoe (utilization rate) of the +65
group wind not be factoxel Lrco the Bangor amxnmt. PmsetlY, their
s:,+/i a 1A Lrluded in our xcoimt. As will ba discassel later, this is a
part of the overall decinlam making prxees.
when consia'er all wren optinw, the Caxve-put option'tast olcsay mat
the existing level of benefits. Hoerer, I the Carve- ut option, the
experiece (utflizetion rata) of the +65 gxoup is factored into the overall
City gxoup rating. Tia result is that the wM account, in fact, a,beidiaea
the +65 GXtW. slue Omss-O ua Shield has ralm,late3 tbet tda =c , wind
same some $73,000 in peeenia cost for F792-93 ff the +65 group xexe aepsrate,,
frena the meet of the account. 1 ,.� mases, the dart belw
swnarfres the 1992-93 Proposed rata for laeseot eeployee with eni without
the +65 9rm+P.
IbMhly Health mesa.ee Pmapfuets
1991-92
lPcesaRl whitl1 Lwithout �5 Croup)
hxiividnal C� $147 $144
Fa y Couarage $364 $375 $356
The chart illustrates that inst ad of a 38 ircmase in rates (with L*e +65
group it 'l ) the tenger eCCGmt wind ac y en]oy a 2% dsxaeee in
mtes without the age 65 gawp, ar on Ore diffexerce of 58 ($73,000
est;.,we,v savings)..
pl.$aus
As we begin to analyse the jwpeot of tee cptioee, the axe other variables
that nest la cweitlzretl es is a swsaxy of variables and issues
that need to be revtc ti regarding tte cpcxws.
1. Ceve-0ut Cat¢age Optima. As stated pxeviousiy. the Carve-0ut cm's a
optima Pmovirles the highest ard met level of •bnoeffts w
Copemed to the existing cot¢ags. ibavar, it is significantly wm
axp naive for tla retiree than Ua current Pdan, ar if selected, ths
3 92 279
retixea utilization rate .raid continue be negatively inpsct the
in a of tho gzOup. Btnuld the City select this option, it may at a
later date, switch to one of the follawin2 Cakn Plan options; AB
C, E, F. Cr, the egAcypa may select Cmpntinn Plan option A, B, C, ,
, E,
P or I at a later date, but mould then ba in a non -group plan ani would
be subject to Pnoentieiiy higher' rates. Further, the "I" option could
only be selectai by an rookies during the next ysar.
2. CMDOniPlan . Ibe City ney select any of the new Crngmdon
Plan optfone identified es A, B, C, E, F, I. The °I- option ie only
available now as a City iFnop plan. If "I" is not selected by the City
nO as the group plan, it cannot be selected at any time in the future as
a group pian. An indtvidml rails¢, buena., say elect at a latex date
W upgrade hen a lout plan (A, B, Cr a or F) to tyle •I" covetage, but
only ! a nun -group setting, eM only for the next year.
There is an Opportunity none Per year fox. the City to elect to upgrade or
dmveRteda coverage by One step within the A, B, C, Er F range. Idditionally,
the ® IOYse may elect to upgefe or dvwngnade WVarage ly one step W Ut
the A, Br C, E, F, I ange. Again, if the totixeee, eelection does not
coxxespnd with the city's group selection, then the mr:.,n cold be pieced
in a no nyscvp category.
IYe benefit to salecting any of the Coopanon Plan options, A, Br C, E, Fr I
is that the negative expos due to pour expxiesce by the retirees, is
eliminft d. mor becaase the +65 getup would be ental aepsrat 1yy
Eton the Bangor account. For illustrative pyrEoses, with the +65 group
included in the Bangor account, the lajor Maitcel partion of our health
insurance pre iuume rose 23.58 fxmn 1991-92 to 1992-93. Backing not this
9r , which would lapnun under ell of the six oec Corp kon plan optione,
the Malo. M el pxtime decreased 5.16 or a total awing of 28.66.
Ibe dxadacl¢ to this appx is that, in all nilaal .w, the pxeoiwrs wlll
be higher for the matinees and the benefit levels offenal in all option A -I
axe lo,.ar than what is being cusantyy prrnid .
Ca%mala these. issues is the fact that a &cisio n met be ride in a
y short timefmmma. Although July 1 is the effective coon ion
date, B W met hove a decision by aiproxientely Tore 1 es the mmrUdy
deductions Eon health insurance pre em must be proressed by w:.,e Stat
�^^ during the smovtl v�k in Ture Eon the vmrth of July. Further, _
samoeenx gh ea have a master i t of tine 131 xecixeover 65, vs love id ei
e to oa�edcata with ttm
he ei.e group, otherr than through im3i+dAna1
letters.
Cur intent is to provide this infomation to yon in order that F.inante
Fmmi eenoers etl the City Cmacil can begin to sigh the benefits and
limitetias of the available optima wtlin ed above. ore of the key VAicy
Is involved is wdethm or not the city aril anent employees stmuid, in
fact, subsidize retired MVnYe6S wen age 65 who now utilize b alth
ins 000ne benefits at a higter rate seri MMe create a greater cost to the
entire ace nt.
-4
92
,'.
179
If the ansos:r to that question is ys, thm oansi ation shwltl be gtven to
the IE the to that question is than'
consideration stnihi W sei
should be given to seedas^; eigocu CPl{iniow Pian "£" or •I°"
nn
agha
xcnallixrg that if "I•• is mt selected as the g plan it cannot to
Plan ata later date. xaarrendatinn an
t by
W//B is that the City lon --I-.ai
tY give sttorg ooruidnvation to Crnganion Plan "I".
City staff a . p�tives f an, Cmss/Blve Shield mill he available
to fully tlfsc s this issue on today night. Also, I Lave invited M.
Partes nice, Bangor nuhiic Librarian, ani Ma. Elsie Coffey, Bangor Noosing
Authority oitsmr, to att l tMd P�ipate as they a in Uu
_++ct
City of Bogor eccmmt. M t msantme, Please feel fcee to m tact ma 1E
l have arty gamtl=-
W/jar
cc: City ManarAr
Finance Director
EGYNIt FesOiuce9
Manager
[4s. Edam Bice
Ms. Elsie Coffey
1.
v i ULBIueShx:
Y)ATED
GROUPS ONLY (EXCLUDES RETENTION)
.r %
92
279
Your Aaitner Ftir
Life
li
,ENDING;
BLUE CROSS/BLUE SHIELD
Ito e,ee s:rcei.Yumana:mund
YEAR
- INCOME INCURRED CLAIMS
LOSS RATIO
7/31/90
-
'$-..862,035 $693,797
80.55
7/31/91.t {,IL
GROUP NAME:
CITY OF BANGOR
ACCOUNT NUMBER:
9472-00
•
RENEWAL DATE:
JULY 10 1992
p'BLUE
PREPARED BY:
MIKE GILES
,.
_____,-------------
-___------- --------- -------------_-_-_-----
------
' CURRENT
PROPOSED
COMPARISON
YEAR 1991
YEAR 1993
7/31/91 -
OF MONTHLY
TOTALS
BC/BS ` ' MM TOTAL
Be/B$ MM
TOTAL
EXP 3991
1992
IND 121.34 :25.30 146.64
119.63 31.25
150.88
166 24,342.24
25,046.08
FAM 297.78 .65.89 363.67
293.55 81.37
374.92
234 85,098.98
870731.29
-:P-9 202.17 44.80 246.97
'P-8
199.33 5543
254.66
37 9,137.89
9,422.42
4
84.9 17.72 102.66
21.88
105.63
1 102.66
105.63
---83_75
-------------------- ..____ ________---__-_____--
TOTALB 338 118,681.57
122,305.41
TOTAL MONTHLY INC(D£C
3,623.84
k OF CHANCE
ypg
----------- _------------- _--------------------
_---------- ______________________
ANNUAL COST $Se424e179
$1,467,665
TOTAL ANNUAL INC/DEC
0431486
k OF CHANGE
3.05
LavvcSvaCHANGEasss_Tss=vse-= _s��__-_ __v_=essvaevsssss_syssssss
CHANGE IN RATES
MM
$ AND k OF CHANGE
PER CATEGOR
$ +EC/85 k
$ + k
IND -1.71 -1.45
5.95 23.55
I
IND $4.24
2.9
FAM -4.2] 1.4E
15.48 23.5$
PAM $11.25
I
3.1
P-9 -1,84 1.4$
10.53 23.51
P-9 $7.69
'" 3.1
P-8 i -1.19 1.45
4.16 23.51
P-8 $2.97
2.9
tAFER1ENCE
Y)ATED
GROUPS ONLY (EXCLUDES RETENTION)
li
,ENDING;
BLUE CROSS/BLUE SHIELD
YEAR
- INCOME INCURRED CLAIMS
LOSS RATIO
7/31/90
-
'$-..862,035 $693,797
80.55
7/31/91.t {,IL
,$Xe0731819 ...$688,403
64.15
p'BLUE
-
,.
ALLIANCE
7/31/90 `.
$ 300,053 $116,336
58.11
7/31/91 -
'.
$' 292,537 $160,679
54.95
4 li
9z 279
GROUP NAMEt CITY OR BANGOR
i ACCOUNT NUMBER: 9472-00
RENEWAL DATE: JULY 1, 1992 -
PREPARED BY: MIRE GILES
YEAR 1991
BC/BS- 194 TOTAL
IND 121..34 ¢5.30 146.64
FAM 297.78 65.89 363.67
P-9 202.17 44.80 246.92
P-8 84.94 17.72 102.66
PROPOSED
YEAR 1992
BC/BS IRS TOTAL
119.63 24.01 143.64
293.55 62.53 356,08
199.33 42.52 243.85
83.25 16.82 100.57
----------------
TOTALS
COMPARISON
-3.36
OF MONTHLY
TOTALS
EXP
1991
1952
166
24,042.24
23,844.24
234
85,098.28
83,322.72
37
9,132.89
81946.45
1
-------------------------
102.66
-----------------
100.52
TOTALS 438 118,681.52 116,215.90
TOTAL MONTHLY INC/DEC (2,465.59)
% OF CHANGE -2.093
ANNUAL COST $1,424,179 $1,394,592
TOTAL ANNUAL INC/DEC ($294587)
2 OF CHANGE -2.08%
CHANGE IN RATES
---------------------------------------------------------------•----------------
8C/BS MN S AND $ OF CHANGE PER CATEGORY
S +71.
IND rl.]Y -1.43 -1.29 -$.IS IND ($3 00) -2 08
FAM
P-9
P-8
EXPERIENCE
-4.23
-1.4%
-3.36
-S.1$
$ 862,035 $693,797
80.5%
FAM
($7.59)
-2.1%
-2.84
-1.4%
-2.28
-S.Ii
P-9
($5.12)
-2.1%
-1.19
-1.4%
-0.90
-5.1i
RATES MRPLECT
REMOVAL OF MAJOR MEDICAL COVERAGE
P-8
($2.09)
-2.0%
--------------
---
--------------------------------------------
------
GROUPS ONLY (EXCLUDES RETENTION)
BLUE CROSS/BLUE SHIELD
YEAR ENDING-
INCOME INCURRED CLAIMS
LOSS RATIO
-_7/31/90
$ 862,035 $693,797
80.5%
7/31/91
$1,023,819 $688,403
64.1%
-
-BLUE ALLIANCE
7/31/90
':
$ 200,353 $116,336
58.1$ e
7/31/91
$ 292,537 $160,679
54.9%
RATES MRPLECT
REMOVAL OF MAJOR MEDICAL COVERAGE
POM X65 RETIREES
3�
92 279
0BT
The Carve -Out product supplements Medicare and provides the
group -enrolled member With the same level of coverage held by
payor, andrthe nregular (Under 65)ugroupecoverage dicare sh
is secondary.
vi. Member Enrollment
A. Eiimibility. To be eligible for enrollment in
Carve -out:
1. An applicant must be enrolled in both Part A
and Part B of Medicare at all times; .
2. An through asnt group of 2rorlCarve-Out
more; and,
3. An applicant must meet the applicable criteria
for groups not-TEFPA qualified, TEFPA qualified,
not -OBRA qualified, or OBRA qualified as .
previously described under section III.
B,
Termination. When a Carve -Out member fails to maintain
Medicare Part B coverage:
1. we will terminate his/her Carve -Out coverage on
the first of the month after subscriber _
notification.
2. Ali coverage will stop unless, within 30 days of
the ueonthe group's regular la
ber elects to
continue r coverage.
Procedure Letter
Underwriting RegUlations/Ccmvanion and Carve -Out
ageNine ofEleven
woon
MeSheld
Blue Crass and Blue Shield of Maine
1992 Outline of Medicare Supplemental Coverage
Companion Plan A. Plan B. Plan C. Plan E. Plan F, and Plan I*
Medicare supplemeral insurance can be sold in only An standard plans. This chant shows the benefits included in each plan. Every company most
make available Plan "A" Some plans may not be available in your enure.
Basic Benefits: Included in all Plans.
Hospitalization: Pan A coinsurance plus coverage for 365 adt itiond days after Medicare benefits end.
Medical Fipentes: Pmt B reassurance (20% of Medicare-appamol expenses).❑ Plans D, G, H, and I are not offered by
Blood: Fire[ tinea piens of blood each year. Blue Cross and Blue Shield of Maine
A
B
C
D
E
F
G
H
I*FPDeducfible
Basic Benefits
Basic HeneSts
Basic Benefas
Heaic Benefits
Basic Benefits
Basic Benefits
Basic Benefits
Basic Benefits
Basic Benefitsenefits
Skilled
Skilled
Skilled
Skilled
Sk0led
Skilled
Sued
Nursing
Nursing
Nursing
Nursing
Nursing
Nursing
Nursing
Coirvsurance
Coinsurance
Coinsumvce
Coinsurance
Cainsumnce
Coinsurance
Coinmmnce
Coinsurance
NAA
Pat
PartA
PdnA
FenA
Pat
Part
PenA
Deductible
Deducible
Deductible
Deductible
Deductible
Deductible
Deductible
Deductible
iblePan
B
Tart B
Deducible
Deductible
ibleNAB
NAB
Partes
Excess 00%
Excess 80%
Excess 100%
100%Foreign
Foreign
Foreign
Foreign
Foreign
Foreign
Fomign
Travel
Travel
Travel
Travel
Travel
Travel
Travel
Travel
Eme
emenev
Ememenev
I haterseraw
I Ememencv,
I Ememencv
Emementv
At -Honor
At Home
At -Home
At -Home
Recovery
Recovery
Recomery
Basic
Basic
Extended
Drugs
Drags
Drug
$1,250Eimit
9,250Umit)($3,0001,mai
Preventive
Preventive
Care
Care I
*BnroUmeM in Cmtpa ims Man lisreshieted. PkaemauaN aafarmore information. N
$$39.23 $53.69 $64.35 $65.58 $78.94 $115.92 N
� 1
m
Premium Information
Companion Plan A: $36.47*
Companion Plan B: $50.57*
Companion Plan C: $60.75*
Companion Plan E: $62.22*
Companion Plan F. $76.24*
Companion Plan I: $110.16*
• Discoume: 1) Your premium will be discounted $0.50 per month if you participate in our CmssCheck payment Panama; 2) your premium will be
discounted R33% (Nath) each month for the first twelve months of your enrollment if you submit your application to us during the seven month
period which includes the three months before, the month of, and three months after your 65th biMday; and/or 3) your premium will be discounted
8.33% ('/,2dd each month for the fust twelve months of your enrollment if you transfer coverage from a TEFRA group within the three month period
following your termination of group coverage.
Surchmges: For applications submitted on or after October 1, 1992 the following applies: if your application is submitted later than the 91h month
following the mouth of your 65th birthday or later than the 9th month following the month of your transfer of coverage from a TEFRA group,
your premium will be pemuneutly surcharged 5% for each year 41 am enrollment up to a maximum of 50%. This does not apply to applications
submitted within 90 days of print Companion Plan or other Blue Cross and Blue Shield coverage.
We Blue Cass and Blue Shield of Maine) can only rain your premium if we raise the premium for all policies like yours in this state
Disclo6nre5
Use this outline to compare heralds and premiums among policies.
Read Your Policy Very Carefully
This is My an outline describing your policy's mast important features. The policy is your insurance contract. You mug read the policy itself to
understand all of the rights and duties of both you and your insurance company.
Right To Return Policy
If you fired that you are not satisfied with your policy, you may return it to 2 Gannett Drive, South Portland, Maine 04106-6911. If you send the policy
back m us within 30 days after you receive it, we will treat the policy as if it had never been issued and mtum a0 of your payments.
Policy Replacement
If you are replacing number health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it.
Notice
This policy, may not fully cover all of your medical casts.
Neither Blue Cross and Blue Shield of Maine nor its agents am connected with Medicare.
This outline 9 coverage does nor give all the details of Medicare coverage. Contact your local Social Security Office or consult "The Medicare
Handbook" for more details. - iv
Complete Answers Are Very important IND
Review, the application carefully before you sign it. Be certain that all information has been property retarded.
Plan A
Medicare (Part A) — Hospital Services — Per Benefit Period
* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not
received skilled care in any other facility for 60 days in a row.
SERVICES
MEDICARE PAYS
PLAN PAYS
YOU PAY
lWaVlfa's
$nmiprnawivaM mom and board, general nursing, and miscellaneous services
andsupplies
First
AO but M52
$0
$652 (Pon AdMuctible)
61st throughhrough son day
All but $10 163eday
$163aChia,
so
91st day and after:
•while using 0
All but $326aday
$326 allay
so
reserve
• Once lifetime reserve days are used:
used
—Additional 363 days
$0
$100%oftaedicam
$0
eligible expeuses
—Beymd the additional 365 days
EO
$0
All mats
.Skilled Nursing Adhfy Care*
Y must meat Medicarc'a requirements, including having been in a hospital
for at least 3 days and entered a MMirareapproved facility within 30 days
after leaving the hospital
Fiat 20 days
All approved amounts
$0
$0
21st through tooth due
All but $81.50 a day
$0
Up to $81.50 a day
101st day and atter
$0
All costs
Blood
First 3 Fina
3 Pints
$0
Additiondamauna
100%
$0
$o
Hosake Care
Available as long as your doctor certifies you am terminally ill and you elect
All but very limited
so
Balance
to receive these servicesce
for outpatient
usna
drugainpabrnt rtapite
care
Plan A
Medicare (Part B) — Medical Services — Per Calendar Year
* Once you have been billed $Iq) of Medicare -approved amounts for covered services (which are noted with an asterisk), your part Bdeductible will
have been met for the calendar year.
$FdtVICaS
MEDICARE PAYS
PLAN R$YS
NDC PAY
McA'ml fiepmvw
-
In or enl of the hospital atm outpatieat hospital treatment, such as pbysl-
100%
$0
$0
chim's services, Inpatient and Outpatient medical and surgical services and
supplies, physical and ;peach therapy, diannomic tare, durable medical
_
$0
$100 (Pan B deductible)
m.
eqP r $I00 of Medicare-appvm'ed] amounn*
$0
$0 -
$100 (Pan B dedugible)
Remainder of Medicareapproved amounts
80%
20%
$0
Part B Excess Charges (above Medinnreappmsysd amounts)
$0
$0 -
All casts
Blood
First 3 pass
$0
All emits
SIP
Nmt$I00 of Medicare-approred amwna*
$0
$0
she (hit B deductible)
Remainder ofMedicnre-approved amoums
80%
20%
$0
Ctinudtn$mmoo' Sorsa—Blood Tats
For diagnatic services
100%
$0
$0
Parts A & B
Home Health Car¢
Medicare-apprmed services -
-
Medically necessary skilled cure services and medical supplies
100%
$0
$0
Durable medical equipment
• Firat $100 of Medicare -approved amounts*
$0
$0
$100 (Pan B deductible)
• Remainder ofMedicam-approved amount;
80%
20%
$0
Plan B
Medicare (Part A) — Hospital Services — Per Benefit Period
' A benefit period begins on the first day, you receive service as an inpatient in a hospital and ends after you here been out of the hospital and have not
received skilled care in any other facility for 60 days in a row.
SMVICFS
h1EOICAItE PAYS
MANPAYS
YOU PAY
SpvWim'
Semiprrivate room and bnaN, general nursing, and miscellaneous services
emi
and supplies
-
Pirst60days
All but $652
$652
50 -
PanAdeductible)
h day
61st through 90th$
All but $163 achy
$163 atlay
$0
•tetchy add
• usingafter:
dyssam
All but $326adry
$326 edgy
$0
• used:
lifetime reserve days are used:
Onceuerals reserve
—Ad
—Additional 365 drys
$0
1100% of Medicare
M
eligible expenses
—Beyon0 the additional M5 days
SD
SO
All mars
Skiifed Nursing NraBiry Card
We must nrcd Medicare's rets iremenrs, including baring been in a hospial
far at least 3 days and entered a Medicare-appmrei facility within 30 days
after leaving the hospital
First 20 days
All approved amounts
$0 -
$0
21stthmugh 100th day
Allbut$81.50aday
$0
Up to $81.50 a day
101st day and after
$0
$0
All costs
Bland
First 3 pints
$0
Spines
$0
Additional amounts
100%
$0
$0
Avableas ong as your doctor certifies you me terminally ill and you elect
All but very limited
$0
Balance
to receive these services
minsureece kr outpatient
drugs and inpatient respite
Plan B
Medicare (Part B) — Medical Services — Per Calendar Year
* Once you have been billed $100 of Medicaweppmrcd amounts for covered services (which are noted with an aweriels), your Parc B deductible will
have been met for the calendar year.
sEltvfCES
MEDICARE PAYS
PLAN PAYS
Home Heald Care
s physi-
oat of thenpatie
t and outpatie t meth ailand puri cial se is
andinpatient and outpatient nodical and surgcal aemedic endsupplies,
100%
$0
7�UPAYUcb�)OtofthIvor
pM1ysical and speech [M1erapy, diegwstic testi. durable medicalequipment.
• First VW of Medicare -approved emwats*
$0
W
$100(Part B deductible)
Firs[$100r amour•
$0
$0
$0
of Maicaroappmove
Mance; o-appmvedamaunts
g0%
20%
For Bexcess
Pan Bexcese cM1argu (above MedicareapprwMammmb)
$0
$0
Blood
First J pints
$0
All costs
$0
Next $I00 of Medicare-approva�amounta* -
$0
$0
$100 (Ran B deductible)
Remainderof Medic approelamaans
M%
20% -
$0
Cb oe6—Blood'RIIS
adiagnostic
For services
100%
$0
$0
Parts A & B
Home Heald Care
Mediusc-appswedservices
Medically necessary skilled cart services aid medical supplies
100%
$0
$0
Durable medial equipment
• First VW of Medicare -approved emwats*
$0
W
$100(Part B deductible)
Remainder of Medicae-approved amounts
$0%
20%
$0
Plan C
Medicare (Part A) — Hospital Services — Per Benefit Period
A benefit period begins on the riot day you receive service Man inpatient in a hospital and ends after you have been out oithe hospilal am have not
received skilled care in my other facility for 60 days in a row.
SERVICES
MEDICARE PAYS
TIAhl PAYS
YUUPAY
Xospiadliate
roam and board, general noming, and miscellaneous services
no•
and supplies
and
First
Pirsl M days
W d
All bw 5652
$652
$0
A deductible)
after day
61sl day
All but E163 edgy
$Pan
$163 qday
$0
am
91st dale using
• 60
omsdyssam
All but E326adry
532fiaday
FO
used
• Once li4time reserve drys are used:
Once fiedune moms
—Additional 365 days
$0
ellbo%af Medicare
$D
eligible expenses
—Beyond the additione1365 days
EO
$0
All cost
Skilled Naming fbcik Care*
You most meet Medicare's reauiremms, including having been in a hospital
-
foraleast 3 days and entered a Medicare approved facility within M days
after Icaving the hospital
Pirst20days
All approved summers
$0
$0
21at through High day
All but $81.50 a day
Up to SBI.50 a day
$ft
Won day and after
EO
$0
All cons
Elrod
first 3 pints
$0
Spins
$o
Additional amounts
100%
$0
So
Hospice Cam
Available as long as your doctor cerifies yon are womanly ill and you elect
All but very limited
$0
balance
to receive these services
coinsurance for outpatient
-
drugs and impudent respite
Plan C
Medicare (Part B) — Medical Services — Per Calendar Year
* Once you have been billed $100 of Medicare -approved amount¢ for covered services (which are noted with an asterisk), your Part B deductible will
have been met for the calendar year.
SERVICES
MEDICARE PAYS
PLAN PAYS
YOUPAY
Mmieal serving
In or net of due hospital and outpe teal hospital treatment, such as phyai-
100%
$0
n, inpatient and outpatient medical and sugieal services and
—
supplies, physical and speech in=". diagmatic tuts, durable medical
$0
$100
$0
equipment.
(Part B deductible)
First $100 of Medicare -approved anmumA
$0
$100
$0
(Parr B deductible)
Remainder of Medicare -approved amounts
80%
20%
Part Beeess charges(above Medicarwappri ed amOmts)
SO
$0
All sous
&sad
First 3 pints
$0
All costs
$0
Next $100 of Mediesmappiu ed amounts*
SO
$100
$0
(Pert B deductible)
Remainder of Medirerreppmved amounts
80%
20%
$0
animal faAomrory Services —Bbol few
Fordiagmslicservices
100%
$0
$0
Parts A & B
Hone HeaRA Care
Medicare -approved service
Medically necessary skilled care services and medical supplies
100%
$0
Durable medical equipment
—
• First $100 of Medicare-approeed amouors*
$0
$100
$0
(Part B deductible)
• Remainder of Medicare-epprmed amounts
s0%
20%
$0
T
Plan C
Other Be fits - Not Covered By Medicare
SERVICES
M I. REPA"
PLANPAYS
YOU PAY
Poreign ]Y me—NN fmremdBy
am serve
Medically each emergency care services beginning during the lira[
60 Jaya trip the
each trip outside the USA
First 2 each year
59
EO
of
RemeiiMer of chargee
mete
SA
g0%to amura
20%And amounsover
20%
beime
am neaeR[
Nesfaeme
Of $SQOgO
maximumimam
Plan E
Medicare (Part A) — Hospital Services — Per Benefit Period
A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have riot
received skilled care in any other facility for 60 days in a mw.
SERVICES
MEDICARE PAVS
PLAN PAYS
YOU PAY
H pna4'wtion•
Semiprivate room am bound, general nursing, and miscellaneous services
am supplies
First 60days
All but $652
$652
$0
(Pan A deductible)
61st through 90th day
All but $163 a day
$163 a day
$o
91st day and after:
• While using 050 lifetime reserve days
All but $326 a day
$326 a day
$0
• once lifetime reserve days are used:
—Additional 365 days
ad
$100%dismisses
$o
eligible expenses
—Beyond the additional 365 days
$0
$0
All mats
Cary
requirements, including having been in
mustedicar red
You must men Mand
30 days kr at least 3 days and en¢red a MMicere-eppmvcd facility within 30 days
entered a
after the hospital
0 d
First 2 20 days
All approved amounts
EO
$0
lgkh Mry
All $gL50aday
Up $81.50lo50 eday
lost by allies
sday am
�
EO
All msrc
Must
First 3 pine -
$0
Spins
$0
Additional amounts
100%
$0
$0
Hospice Care
Available as long as your doctor certifies you are terminally ill and you elect
All but very limited
$0
Balance
to receive these services
coinsurance for outpatient
drugs and mpmimt respite
-
cam
Plan E
Medicare (Part B) — Medical Services — Per Calendar Year
' Once you have been billed $100 of Medicare -approved amounts for covered services (which are nded with an asterisk), your Part B deductible will
have been met for the calendar year.
SERVICES
MEDICARE PAW
PLAN PAYS
YOU PAY
MdICN Exporter
In or out of the hospital and outpatient hosphal treatment, such as pbysi-
100%
$0
$0
outpatient
Inpatlent and outpatient medical and sugical urvims; and
suppear
l and speech therapy, diagnostic testa, durable medical
$0
$0
$IOD that B deductible)
equipment.
W%
20%
$0
First $100 of Madicsreappareed amounest
$0
$0
$100(Pam B deductible)
Remainder of MedicarrapprOved amounts -
SO%
20%
$0
Part B excess chames(above Mdicato-approved amounts)
W
ED
All costs
Blood
First 3 pints
$0
All coma -
$0
Next $100 of Medicare-approvdl amOuwA
W
$0
1100 Wart B deductible)
Remainder of Medicareapprovedamounts
W%
20%
$0
QFordrinbomforyvices r—BbM ]Erb
-
Pordiagnosticservicer
IW%
10 -
$0
Home HeaBh Care
Mdicare-apprmed services
Medically necessary skilled care services sed medical supplies
100%
$0
$0
Durable medical equipment
• Fo t $100 of Merficam-appraved amount*
$0
$0
$IOD that B deductible)
• Remainder ofMedicarc-approved amounts
W%
20%
$0
U
Plan E
Other Benefits — Not Covered By Medicare
SERVICES
MEDICARE PAYS
PI RAYS
YOU PAY
rmmtm—Abt Cmeredy
cam seine
Medicallycare services beginning daring the first
Medically necessary unide
fio days each trip outside they USA
year
2 each year
$0
8250
Remainder ares
Remainder of chargee
$0
maximum fetime
20% add over
maximum benefit
e$5000mounis
turce
the$500001iktime
01700,000
Prevendre MedhW Gam Benefit— Not Covesed By Medicare
Annual physical and preventive rcss and services such es: kcal occult blood
test, chiral rectal exam, mvomognm, hearing screening, dipstick urinalysis,
diabetes ideating, thyroid function teat. influenv shot, tetanus and diphtheria
-
booster, and education, administered or ordered by your doctor when not
covered by Medicare
First $120 each calendar year
so
$120
So
Additional charges -
$0
$o
All tests
Plan F
Medicare (Part A) — Hospital Services — Per Benefit Period
A befit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have and
received skilled care in any other facility for of days in a row. -
SERVICES
MEDICARE PAYS
PLAN PAYS
YOU PAY
n+
Semiprivate
Semiprivate room and based, general mining, and miscellaneous services
-
a
ant esd
W
Flrat 60 days
First
All but $652
$632
EO
-
(Part Aaedunible)
61st through 90th day
All but $163 alley
$163 silty
SD
91st day and after:
•
All but $326aday
E326adry
EO
Once lising601ifefimereservedrys
reserve Jaya are a. is
—Additional
—Additiats1365 days
EO
$lila%of Mes
$0
eligible expenses
s
—Beyond the additional drys
$0
EO -
All caste
Skilled Nursing Facility C
lbn must meet Medicare's refinements, including having been in a hospital
fur at least 3 days and entered a Medicare -approved facility within 30 days
after leaving the hospital
First 20 days
All approved amounts
$0
all
2 though 100th day
All but$81.50 a day
Up to $81.50 a day
SO
What day and after
SO
$0
All ones
RINKI
First 3 pins
SO _
3iies
SD
Additional amounts
100%
$0
SO
ykassum Can
Available as long as your donor cedifies you are terminally ill and you elan
All but very limited
$O
Balance
to receive these services
mainsuranceforcumatient
drugs and inpatient respite
Plan F
Medicare (Part B) — Medical Services — Per Calendar Year
* Once you have been billed SIM of Medirareappsoved amounts for cweret services (which are rested wide an asterisk), your Part B deductible will
have brain and for the calendar year.
SERVIC
MEDICARE PAYS.
PLAN PAYS
YOU PAY
Med cad Expenses
In or out oath¢ hospital and outpatient hi epital treatment, such as physi-
100%
0
50
inpatient and outpatient medical and surgical services and
supplies' physical and speech therapy, diagnostic posts, durable medical
w
SI00
SO
equipment.
(Pad B deductible)
First SIM of Medicam-approva]amounu*
$0
SIM
$0
yantlidedudlble)
Remainder of Medicaro-appaved amounts
80%
M% -
SO
Part a excess chzrges(above Medicare -approved amours)
$0
100% -
$0
Bland
First 3 pines
$0
All coats
SO
Next SIM of Medicate -approver ameune+
$0
SIM
(PartBdeduRble)
Remainder of Flodicaro approvadi amounts
80%
20%
CBnhwiagnomroryvicem a—Bbod TSID
Por diagnas�ic services -
100%
$0
$0
Home Health Can
Mediraro-npProved services
Medically mxeasary, skilled care services and medical supplies
100%
0
50
Durable motion] equipment
• First SIM of Meticam-approved amounts*
w
SI00
SO
(Pad B deductible)
•Remainder of Medicaroapproved amounts
80%
N%
SO
Plan F
Other Benefits — Not Covered By Medicare
SP.a [M
MEDICABEPAYS
PLANPAYS
YOU PAY
I Wgn]favi!—M Covered By Ma&&M
Medically hemssmy euumpnty care services Insuring during the firs)
W days oreach nip mxmde the USA
Fust $250 each calendar year
a0
$250
Renminderofchmgea
$0
SO%malifafime
20%and amouns over
um beneft
the$SOp001iftime
ofs$501"
max
Plan I
Medicare (Part A) — Hospital Services — Per Benefit Period
* A benefit period begins on the first day you receive service as an inpatient in a hospital add ends after you have been out of the hospital and base not
received skilled care in any other Willy far 60 days in a row.
SERVICES
MEDICARE PAYS
PLAN PAYS
YOU PAY
ifn..,privamm�•
mom and board, geroral nursing, and miscellaneous services
and supplies
and
First 60 day
Fim W days
All but 5552
5652
A deducible)
61st 9Oh day
All but $163 allay
$163aday
$163
$o
daythrough
91st day and
nd
using 61)
• Whileelifetime
All but $326aday
$326 edgy
d0
• Once lifetime reserve days ea used:
reservmeresam used
—Additional 30 days
SO
$103% of Medicare
$0
eligible expenses
—Beyord the additional 365 days
50
SO
All costs
Skilled Narsiug Ruairy Gave*
You must raw Medeares requirements, including having been in a hospital
for at least 3 days and entered a Medicars-approved factify within 30 days
after leaving the lroapiml
FirstMdays
All applrrvN amounts
$0
SO
21st through 100th day
All but $81.50 a they
Up to $81.50 a day
$0
1019 day add after
$0
All were
Blood
First 3 pinta
$0
3 Pima
$0
Additional amounts
100%
$0
$0
Abadics Care _
Available as long as your elector certifies. you am terminally ill and you elect
All but very limited
$0
Balance
to receive there services
coinsurance for outpatient
drugs and inpatient respite
cars
Plan I
Medicare (Part B) — Medical Services — Per Calendar Year
Once you have been billed $M() of Mer icam-appowed amounts for reacted services (which are armed with au asterisk), your Part B deductible will
have been me[ for the calendar year.
SERVICES
MEDICARE PAYS
PLAN PAYS
YOU PAY
Me dimlt
of thew
In or out of hospital and outpatient hospital such as plrysi-
100%
30SO
sugic l s
inpatientand ohem", medicaland s,
services, in
:,m)
durAbservicesand
supplies, physical and speech rM1empy, diagnostic was, durable medical
$0
$0
(pan B deductible)
equipment.
80%
20%
$0
00 d aamountts
$0
20
$100 (Pari D deductible)
der of Medicre-app
Remainder Madicare-mmMedamoono
Ron
80%
20%
$0
Bmcess
Peng escess char3es (above Medicare -approved accounts)
$0 -
100%
$0
Blood
First 3 pints
$0
All cars
$0
Next A00 of Medicare, approved amonnl5*
$0
$0
$100(part B deductible)
Remainder ofMWicareopproveE amounts
80%
20%
1$0
awnat lalwvrmy SvriunJ—Bond nm
For diagnostic services
100%
$0
$0
Paris A & B
Home Healm Core
Medicare-approvedaervires
Medically necessary skilled care services and medical supplies
100%
30SO
Durable medical equipment
:,m)
• Ftrst saw of Malicaroapproved amounts*
$0
$0
(pan B deductible)
• Remainder of Medicare -approved amounts -
80%
20%
$0
Continued on nut page
S
Plan I
Medicare (Parts A & B) — (continued)
SERVICES
MEBICAREPAVS
PI. ftw
VOUM
Dome Health Care monfd)
Abbome recovery service— na covered by Medisre
Home cert anified by your doctor, for permnel can during recovery from an
$0
$0
Balance
injury or sicloams bar which Medicare approved a Home Care Oleatmerd Plan
$0
80%m a lifrdme
M%and amomts over
Bandit for each visit
$0
Actual chvges
the$50,000 B4dme
m UO a visit
neadneurn
Number of visits covered(mast be received within 8 weeks of las[
w
Uptodwnumberof
Medicaroappmved visit)
EO
Medicare -approved
$250
Next $2,500 each calerMaz year
$0
visits, not to exceed
50%
7 each k
Caleadar year maximum
$0
$1,fi110
Other Benefits
amend 2Yawl— NM Covered By Medicare
Medically necessary emetgnry care services beginning during the first E0
days aench trip outside the USA
Ficu$250eachcahrmaryear
$0
$0
$250
Remainder of charges,
$0
80%m a lifrdme
M%and amomts over
ma imm benWt
the$50,000 B4dme
of$50000
neadneurn
Basic Or"ama AeeerWon Drags — Not G ned By Medieare
Firm $250 each calendar year
EO
$0
$250
Next $2,500 each calerMaz year
$0
50%—$1,250
50%
canaries year
mounnuca benefit
Over$2,500 eacb calendar year
N
All cwts