Medicare Group Retiree Plans

Highlights of the Group Retiree Medical Plan

No Networks - Proposed plans provide access to all Medicare providers nationwide. Therefore, retirees have the freedom to choose their own doctors. Coverage is not limited to a local area
No Referrals - Retirees can see specialists when they choose
Guaranteed Issue - There are no preexisting condition exclusions
Coverage for Spouses - Spousal coverage is available when the spouse is over 65 and enrolled in Medicare Parts A & B
Portability - Coverage can go with retirees if they move or have multiple residences
Affordable - The proposed program offers competitive, fully-insured rates to limit financial risk
Electronic Claims - Claims are processed through Medicare’s crossover process. There are virtually no retiree claim forms

Features include:

Fill the Donut Hole – Plan designs are available that fill the Medicare Part D Coverage Gap, commonly referred to as the “donut hole”. Plans can cover brand drugs and generics in the coverage gap, or just generics, based on the group’s desired plan design
Enhanced Catastrophic Coverage – Full-coverage plans put a maximum on Catastrophic Coverage copays/coinsurance; once in this coverage phase, member copays will never exceed that of their Initial Coverage Stage
Covered Drugs – Broadest formulary that includes coverage for all drugs eligible under Medicare Part D, and covers Non-Part D drugs with the exception of Part B drugs (typically covered by medical plan), BEERS drugs (which have been identified as high-risk for seniors), and Lifestyle drugs (which can be covered for an additional fee).
Mail Order – Retirees can receive a 90-day supply of most medications through Home Delivery, typically with lower co-pays than they would pay at retail
Flexibility in Plan Design – Matching plan designs as closely as possible minimizes member disruption. Our strategy allows us to minimize disruption while still showing savings
Pharmacy Network – Includes all major pharmacies including CVS, Walgreen's, and Rite Aid. There are over 66,000 pharmacies nationwide
Government Subsidy – The proposed plan premium rates include Medicare Part D subsidy. There is no additional subsidy filing needed. The average subsidy under their EGWP plans is higher than the average subsidy received by their clients who file for the RDS subsidy